Estimates of Paid
Community Health Workers
The Standard Occupational Classification
(SOC) System used by occupational data
collection entities, including the Census
Bureau and the Bureau of Labor Statistics,
does not contain a code that clearly identifies
the occupation of community health worker
(CHW). Until now, CHWs have been counted
in official reports under existing occupation
codes with job descriptions that are similar,
but not equivalent to, the activities
performed by CHWs. The method used in
this study to estimate the number of paid
CHWs is described in the following section.
Despite best efforts, the estimates of
the number of paid CHWs are tentative
since assumptions had to be made about
which occupational codes had been used
by individuals and human resource managers
to report CHW activities. The assumptions
employed were reviewed by scientists knowledgeable
about the methods and designs of the Census
and BLS surveys, as well as by researchers
and specialists who had experience in
studying and working with CHWs. All technical
advisors expressed the opinion that the
estimates, while not ideal, were useful
indicators and the best effort possible
within the budget constraints of the study.
Data Sources
Two sources of data were available to
provide information about employed CHWs:
(1) The 2000 Census data collected by
the Census Bureau and released to the
public in de-identified format as the
Public Use Microdata Sample (PUMS) and
(2) The Staffing Patterns data, used to
calculate occupational estimates, collected
by the Bureau of Labor Statistics (BLS).
Both of these data sets contain information
about workers by occupational title code
(from the SOC System) and industry codes
(from the North American Industry Classification
System - NAICS). The codes used for the
estimates were selected through a multistage
process that began with a review of the
available literature on CHWs.
Even though the coding system is the
same, the Bureau of Labor Statistics collects
more detailed occupation and industry
data than the Census Bureau. This results
in some discrepancy in the information
available from each of the sources. For
example, individuals responding to the
Census "long form" may incorrectly
identify either the industry in which
they are employed or the occupational
title used by their employer. Also, the
PUMS industry and occupational categories
are broader than the BLS categories and
may overestimate the number of workers.
Table B.1 shows a comparison of the two
data sources.
Table B.1 Brief
Comparison of Data Used for Computing
Estimates of Paid CHWs
Characteristic
|
PUMS
|
Staffing
Patterns |
Federal
Agency |
Census
Bureau |
Bureau
of Labor Statistics |
Collected
from |
Individuals
|
Employers
|
Reflects
|
Place
of residence |
Place
of employment |
Collection
schedule |
Every
10 years* |
Every
3 years** |
Occupation
codes |
Broader
categories |
Detailed
categories |
Industry
codes |
Broader
categories |
Detailed
categories |
Unit
reported |
Persons
|
Full-time
employees |
Employee
demographics |
Available
|
Not
available |
* PUMS data from the American Community
Survey will be available on a yearly basis,
as it will replace the "long form"
of the decennial Census.
** Each employer is surveyed every 3 years.
Census Bureau's
Decennial PUMS Data
The U.S. Census Bureau makes data collected
from the "long form" questionnaires
completed by individuals during the decennial
Census available to researchers. Sampled
persons are identified in PUMS areas of
100,000 or more to protect confidentiality.
The PUMS files contain records representing
5 percent of the occupied and vacant housing
units in the United States and the people
in the occupied units. People living in
group quarters are also included in the
sample. The records include a large amount
of data about persons and the housing
units in which they live. The file contains
individual weights for each person and
housing unit, which, when applied to the
individual records, expand the sample
to the relevant total.
The person records provide a number of
items useful for identifying CHWs, and
codes for occupations and the industries
in which persons work. A crosswalk between
Census codes for industry/NAICS and occupation/SOC,
where NAICS is based on the 2002 North
American Industry Classification System
and SOC is based upon the 2000 Standard
Occupational Classification System, is
available and described later in this
appendix.
While there is no specific occupation
code for CHWs, there were a limited number
of occupations in which CHWs may be classified.
By selecting these and the industries
in which CHWs were most likely to be employed,
it was reasonable to expect that this
set of workers could be identified.
Bureau of Labor
Statistics "Staffing Patterns"
Data
The U.S. Department of Labor, Bureau
of Labor Statistics (BLS), has rigorous
guidelines in each State to survey firms
in order to collect detailed SOC occupational
content in each type of NAICS-based industry
category. The resulting statistics are
called the "staffing patterns"
for each industry. Every year, each State
surveys one-third of all of its industries
under strict sampling guidelines set forth
by the statistical sampling techniques
based on employment concentrations. After
3 years, an entire round of all industries
has been updated. Considerable effort
is made by each State to deliver survey
results that meet these specified criteria,
and follow-up activity is utilized to
overcome any shortfalls in sampling.
The percentages from these patterns are
used to calculate occupational estimates
for State and sub-State areas. Since each
State must cooperate in these efforts
set forth by BLS, the staffing patterns
represent a common methodologically collected
series of statistical base ranges upon
which to calculate estimates and - even
more importantly - projections.
Selection of Data
Sources for the Estimates
Prior to calculating any estimates of
paid CHWs from existing data sources,
the Institute for Demographic and Socioeconomic
Research (IDSER) at the University of
Texas at San Antonio, collaborating with
the research team for this component of
the study, reviewed possible sources of
data to determine which would be used
to produce the estimates. This list included
the 2000 Census, 2000 Public Use Microdata
Sample (5 percent sample), and the 2004
American Community Survey.
Given the NAICS codes identified in the
CHW report for inclusion in the estimates,
the data sources were reviewed to determine
the industry coding or NAICS equivalencies
as used by each of the data sources. This
process helped identify which data set
included the most detailed information
for the NAICS categories of interest.
Prior to finalizing this decision, IDSER
reviewed the unweighted numbers for the
NAICS codes of interest using the 2000
PUMS data. The results were evaluated
to ensure sufficient numbers of cases
within each industry code to proceed with
the CHW estimates. After review, it was
determined that the numbers were sufficient
to proceed as planned. The PUMS data were
then weighted.
Based on the review of the data, it was
determined that the 2000 PUMS (5 percent
sample) from the decennial Census would
be the most appropriate data source for
the CHW estimates. Because earlier discussions
had also suggested the use of estimates
based on BLS data, it was decided that
such estimates would be prepared and compared
to the PUMS-based estimates.
Standard Occupation
Classification (SOC)
According to the Bureau of Labor Statistics,
the 2000 SOC System is used by Federal
statistical agencies to classify workers
into occupational categories for the purpose
of collecting, calculating, or disseminating
data.[1]
Workers are classified into one of more
than 820 occupations according to their
occupational definition. These occupations
are then combined to form 23 major groups,
96 minor groups, and 449 broad occupations.
The broader occupation includes detailed
occupation(s) requiring similar job duties,
skills, education, or experience. As per
the American Community Survey,[2]
another survey conducted by the Census
Bureau, Census occupation codes are classified
into 23 major occupational groups based
on the Standard Occupational Classification
(SOC) Manual: 2000, published by the
Executive Office of the President, Office
of Management and Budget.
While the Census Bureau uses its own
classification system for occupations,
that is, Census Occupational Categories,
the Census makes available a crosswalk[3]
to show how occupation codes used by the
Census correspond to the SOC. The following
is an example from a previous Census Bureau
crosswalk:
2000
Code |
Category
Title |
SOC
Equivalent |
200
|
Counselors
|
21-1010
|
201
|
Social
Workers |
21-1020
|
202
|
Misc
Community and Social Service Specialists
|
21-1090
|
In addition, the Census Bureau makes
available descriptions for each SOC code[4]
when it is linked to occupation codes
used by the Census. For instance, Social
and Human Service Assistants (SOC 21-1093)
corresponds to code 2020[5]
where the following SOC description is
provided:
Assist professionals from a wide variety
of fields, such as psychology, rehabilitation,
or social work, to provide client services,
as well as support for families. May assist
clients in identifying available benefits
and social and community services and
help clients obtain them. May assist social
workers with developing, organizing, and
conducting programs to prevent and resolve
problems relevant to substance abuse,
human relationships, rehabilitation, or
adult day care. Exclude "Rehabilitation
Counselors" (21-1015), "Personal
and Home Care Aides" (39-9021), "Eligibility
Interviewers, Government Programs"
(43-4061), and "Psychiatric Technicians"
(29-2053).
A useful tool for viewing occupational
descriptions was available from the Occupational
Information Network (O-Net).[6]
O-Net, available online, allows users
to select specific SOC codes containing
descriptions and classifications of job
requirements and worker competencies.
In addition, O-Net makes available crosswalks,
enabling users to "convert"
several widely used occupation coding
systems to current SOC codes.[7]
The descriptions used by Census, BLS,
and O-Net regarding occupations were the
same.
Identification
of Occupations for Estimates of Paid CHWs
Since the current SOC System did not
have a job title or an occupational category
specifically named, or designated for,
community health workers, using descriptions
of the work performed by CHWs and the
tools provided by O-Net, Census Bureau,
and BLS, it was possible to identify occupational
titles in which CHWs were most likely
to be classified in the current data collection
systems. It was assumed that information
collected by both the Census Bureau and
BLS about CHWs was stored in existing
SOC categories for workers with job duties
that were similar to or overlapped with
those of CHWs.
Using the descriptions provided in the
literature of the roles and functions
fulfilled by working CHWs, as well as
the titles used to identify CHWs, the
research team identified an initial set
of occupational classifications (SOC codes).
In addition, skills outlined in the National
Community Health Advisor Study[8]
and other studies provided guidance in
identification of CHWs within SOC codes.
These skills included:
- Advocacy skills - Ability
to "speak up" for patients
and communities to overcome barriers;
ability to act as an intermediary with
bureaucracy
- Bilingual skills - Fluency
in the preferred language of clients
and ability to translate technical terms
- Capacity-building skills -
Empowerment skills; leadership skills;
ability to influence communities and
individuals to change behavior and take
more control of their own health
- Communication skills - Ability
to listen and use oral and written language
confidently
- Computer skills - Performing
data entry and using the Internet to
locate health information
- Confidentiality skills - Ability
to keep matters private, comply with
HIPAA laws
- Interpersonal skills - Friendliness,
sociability, counseling and relationship
building skills; ability to provide
support and set appropriate boundaries
- Organizational skills - Ability
to set goals and develop an action plan,
manage time, keep records
- Service coordination skills
- Ability to identify and access resources;
ability to network and build coalitions;
ability to make and follow up on referrals
- Teaching skills - Ability
to share information, respond to questions,
and reinforce ideas; ability to adapt
methods to various audiences
From all available occupational titles,
those that best fit the CHW tasks described
in the literature were those of persons
employed in health and social services
occupations (SOC codes 21-, 29-, 31-).
These categories included:
21-0000 Community and Social Services
Occupations
21-1011 Substance Abuse and Behavioral
Disorder Counselors
21-1012 Educational, Vocational, and School
Counselors
21-1013 Marriage and Family Therapists
21-1014 Mental Health Counselors
21-1015 Rehabilitation Counselors
21-1019 Counselors, All Other
21-1090 Miscellaneous Community and Social
Service Specialists
21-1091 Health Educators
21-1092 Probation Officers and Correctional
Treatment Specialists
21-1093 Social and Human Service Assistants
21-1099 Community and Social Service Specialists,
All Other
29-0000 Healthcare Practitioners and
Technical Occupations
29-1000 Health Diagnosing and Treating
Practitioners
29-1010 Chiropractors
29-1020 Dentists
29-1030 Dietitians and Nutritionists
29-1040 Optometrists
29-1050 Pharmacists
29-1060 Physicians and Surgeons
29-1070 Physician Assistants
29-1080 Podiatrists
29-1110 Registered Nurses
29-1120 Therapists
29-1130 Veterinarians
29-1190 Miscellaneous Health Diagnosing
and Treating Practitioners
29-2000 Health Technologists and Technicians
29-2010 Clinical Laboratory Technologists
and Technicians
29-2020 Dental Hygienists
29-2030 Diagnostic-Related Technologists
and Technicians
29-2040 Emergency Medical Technicians
and Paramedics
29-2050 Health Diagnosing and Treating
Practitioner Support Technicians
29-2060 Licensed Practical and Licensed
Vocational Nurses
29-2070 Medical Records and Health Information
Technicians
29-2080 Opticians, Dispensing
29-2090 Miscellaneous Health Technologists
and Technicians
29-9000 Other Healthcare Practitioners
and Technical Occupations
29-9010 Occupational Health and Safety
Specialists and Technicians
29-9090 Miscellaneous Health Practitioners
and Technical Workers
31-0000 Healthcare Support Occupations
31-1010 Nursing, Psychiatric, and Home
Health Aides
31-2000 Occupational and Physical Therapist
Assistants and Aides
31-2010 Occupational Therapist Assistants
and Aides
31-2020 Physical Therapist Assistants
and Aides
31-9000 Other Healthcare Support Occupations
31-9090 Miscellaneous Healthcare Support
Occupations
The review found that the occupations
associated with health care required that
the persons have specific professional
training or technical skills or be associated
with providing direct personal services.
Therefore, two occupations categories
that initially appeared to hold potential
as CHW occupations were eliminated when
job descriptions from O-Net were examined.
These occupations were: Other Healthcare
Practitioners and Technical Occupations
(29-9000) and Healthcare Support Occupations
(31-0000).
The occupation category that held the
most potential to identify community health
workers was Community and Social Services
Occupations (21-0000). The specific occupations
category that seemed likely to be useful
in identifying CHWs in PUMS data was Miscellaneous
Community and Social Service Specialists
(21-1090). Three of the four occupations
in this category seemed best suited as
occupations most closely related to work
CHWs do:
21-1091 Health Educators
21-1093 Social and Human Service Assistants
21-1099 Community and Social Service Specialists,
All Other
The selected set was reviewed again by
members of the research team and some
of their advisors for further assessment
of occupational titles. A second set of
codes was identified as possible occupational
categories in which CHWs might be classified:
21-1010 Counselors
21-1090 Miscellaneous Community and Social
Service Specialists
29-1129 Therapists, All Other
29-2090 Miscellaneous Health Technologists
and Technicians
29-9000 Other Health Care Practitioners
and Technical Occupations
31-909X Medical Assistants and Other Health
Care Support Occupations
The list of classified positions was
then reviewed by a task force of individuals
identified by the office of the State
of Texas Regional and Local Services Division.
This office oversees CHW accreditations
in Texas.[9]
The individuals of the task force were
chosen because of their knowledge about
CHWs and professional interest in this
emerging workforce. This review task force
included representatives from:
- Regional and Local Services Division,
Texas Department of State Health Services
- Forecasting and Research, Texas Health
and Human Services Commission
- Center for Health Statistics, Texas
Department of State Health Services
In comparing the descriptions of specific
subgroups for specific occupational categories
to the work that CHWs perform, members
of the Texas task force identified the
following categories as those most likely
to include CHWs:
21-1011 Substance Abuse and Behavioral
Disorder Counselors
21-1012 Educational, Vocational, and School
Counselors
21-1014 Mental Health Counselors
21-1019 Counselors, All Other
21-1091 Health Educators
21-1093 Social and Human Service Assistants
21-1099 Community and Social Service Specialists,
All Other
The review by the Texas task force was
followed by an informal review by the
research team of the Center for Health
Workforce Studies (CHWS) at the State
University of New York at Albany, which
had been engaged as a subcontractor for
another component of the study. The Albany
research team had past experience using
data from the BLS and agreed with the
SOC codes identified by the Texas task
force.
In conclusion, the SOC codes in Table
B.2 were those found most likely to include
employed CHWs.
Table B.2 Standard
Occupational Classification (SOC) Code
Included in Methodology for Estimates
of Paid CHWs
SOC
Code |
Description
|
21-1010*
|
Counselors
|
21-1011
|
Substance
Abuse and Behavioral Disorder Counselors
|
21-1012
|
Educational,
Vocational, and School Counselors
|
21-1014
|
Mental
Health Counselors |
21-1090*
|
Miscellaneous
Community and Social Service Specialists
|
21-1091
|
Health
Educators |
21-1093
|
Social
and Human Service Assistants |
21-1099
|
Community
and Social Service Specialists, All
Other |
*Broad categories reported in PUMS data.
North American
Industry Classification System (NAICS)
According to the Census Bureau,[10]
"Federal statistical data published
for reference years beginning on or after
January 1, 2002, should be published using
the 2002 NAICS United States codes. Agencies
may adopt the 2002 NAICS earlier at their
discretion. Publication of a 2002 NAICS
United States Manual is planned for
January 2002." Some of the new features
of NAICS 2002 include: (1) Relevance:
new, emerging, and advanced industries
are included; (2) International comparability:
Canada and Mexico both cooperated in development
of the latest industry classification;
and (3) Consistency: businesses that use
similar production processes are grouped
together.[11]
Similar to a crosswalk provided by O-Net
for occupational categories, a crosswalk
was available from the Census Bureau to
assist in converting current NAICS to
previous versions of NAICS and to Standard
Industrial Classification (SIC).[12]
Identification
of Industries for Estimates of Paid CHWs
Since the SOC code 21-1090, Miscellaneous
Community and Social Service Specialists,
was found to be the one most promising
for identifying CHWs, after selecting
only individuals with SOC code 21-1090,
a list of industries was produced using
PUMS data:
5241 Insurance Carriers
6112 Junior Colleges
6113 Colleges, Universities, and Professional
Schools
6213ZM Offices of Other Health Practitioners
621M Other Health Care Services
622 Hospitals
623M Residential Care Facilities, Without
Nursing
6242 Community Food and Housing, and Emergency
Service
6244 Child Day Care Services
6243 Vocational Rehabilitation Services
711 Independent Artists, Performing Arts,
Spectator Sports
712 Museums, Art Galleries, Historical
Sites, and Similar Institutions
713Z Other Amusement, Gambling, and Recreation
Industries
721M Recreational Vehicle Parks and Camps,
and Rooming and Boarding Houses
8121M Nail Salons and Other Personal Care
Services
8129 Other Personal Services
8132 Grant Making and Giving Services
8133 Social Advocacy Organizations
81393 Labor Unions
813M Civic, Social, Advocacy Organizations,
and Grant-Making Institutions
814. Private Households
9292 State Government, Exclusive Education
and Health
9393 Local Government, Exclusive Education
and Health
While CHWs may work in these industries,
it was found to be unlikely that hospitals,
offices of health practitioners, other
health care services, etc., were actually
employing many persons who work in the
community. The review reduced the list
of industries likely to employ community
health workers to the following: Community
Food and Housing, and Emergency and Other
Services (6242) and Civic, Social, Advocacy
Organizations, and Grant-Making Institutions
(Census NAICS 813M). The BLS provided
sub-categories for NAICS 813M: Grant-Making
and Giving Services (8132), Social Advocacy
Organizations (8133), and Labor Unions
(81393).
After the SOC codes were reviewed and
the additional SOC of 21-1010 was identified,
the research team repeated the process
described earlier to identify another
set of industries (NAICS codes) most likely
to employ CHWs.
As with the SOC codes, the list of NAICS
codes identified were reviewed by members
from the Texas task force, the research
team in New York, and members from the
Center for Sustainable Health Outreach[13]
(CSHO) at the University of Southern Mississippi.
Matching of Verified
Employers to State Employment Data Sets
Each State collects employer and their
wage and salary employee records in order
to collect payments on unemployment compensation.
This information is collected for almost
97 percent of all persons working in the
civilian labor force. Under special confidentiality
agreement for this project, it was possible
to use a selected number of records to
match the names of organizations verified
as employers of CHWs to the BLS list of
employers.
The record of verified employers in 10
States[14]
(N=1,327) was used to locate the employer
record in the American Labor Market Information
System. The matching process started with
searching one verified record at a time
by telephone number, followed by address,
city, and last by organization name.
Of the verified employers in these selected
States, 57 percent (759 of 1,327) were
successfully matched against the employer
records database. For the successfully
matched records, 92 percent (701 of 759)
corresponded to the industries identified
for inclusion in the estimates of paid
CHWs. The industries with the most overlap
included 6214 or Outpatient Care Centers,
6241 or Individual and Family Services,
8133 or Social Advocacy Organizations,
and 9231 or Administration of Education
Programs.
The processes just described resulted
in the identification of NAICS codes most
likely to include employed CHWs. They
are listed in Table B.3.
Table B.3 North
American Industry Classification System
(NAICS) Codes Included in Methodology
for Estimates of Paid CHWs
NAICS
Code |
Description
|
6111
|
Elementary
and Secondary Schools |
6113
|
Colleges
and Universities |
6211
|
Offices
of Physicians |
6214
|
Outpatient
Care Centers |
6219
|
Other
Ambulatory Health Care Services |
6221
|
General
Medical and Surgical Hospitals |
6241
|
Individual
and Family Services |
6244
|
Child
Day Care Services |
8131
|
Religious
Organizations |
8133
|
Social
Advocacy Organizations |
8134
|
Civic
and Social Organizations |
8139
|
Professional
and Similar Organizations |
9211/9992
|
Executive,
Legislative, and General Government
|
9231/9993
|
Administration
of Education Programs |
BLS data contain two BLS-designated NAICS
codes, 9992 - State Government sector
and 9993 - Local Government sector, which
are not found in the 2000 PUMS data. It
was determined that these two BLS-designated
NAICS categories are comparable to the
NAICS categories 9211 - Executive, Legislative,
and General Government and 9231 - Administration
of Education Programs and will be used
as counterparts in the State and national
comparisons.
Data from the BLS were used to determine
a proportion of individuals employed in
each NAICS industry in cases where two
or more NAICS codes were combined in the
2000 PUMS data. This assumed that the
proportions of the combined NAICS industry
codes represented in the BLS data were
appropriate to use with the 2000 PUMS
data.
Adjustment factors
The list of SOC and NAICS codes provided
the occupational/industry categories within
which employed CHWs were likely to be
classified.
Next, it was determined that an adjustment
factor should be employed to reflect the
proportion of persons working as community
health workers within the identified occupation
and industry combinations.
As for the selection of the occupational
codes, the adjustment factors were selected
by the research team in consultation with
their technical advisors and State task
force. The agreed-upon proportions were
used to adjust the estimate of persons
working in each NAICS/SOC category obtained
from PUMS or BLS.
The adjustment factors used in the final
set of estimates are shown in Table B.4.
Table B.4 Adjustment
Factors Applied to NAICS/SOC Categories
for Final Estimates
NAICS
Code |
Description
|
21-1010
|
21-1090
|
6111
|
Elementary
and Secondary Schools |
0.00
|
0.05
|
6113
|
Colleges
and Universities |
0.00
|
0.05
|
6211
|
Offices
of Physicians |
0.10
|
0.20
|
6214
|
Outpatient
Care Centers |
0.05
|
0.50
|
6219
|
Other
Ambulatory Health Care Services |
0.05
|
0.30
|
6221
|
General
Medical and Surgical Hospitals |
0.03
|
0.20
|
6241
|
Individual
and Family Services |
0.05
|
0.30
|
6244
|
Child
Day Care Services |
0.05
|
0.20
|
8131
|
Religious
Organizations |
0.10
|
0.40
|
8133
|
Social
Advocacy Organizations |
0.10
|
0.40
|
8134
|
Civic
and Social Organizations |
0.10
|
0.40
|
8139
|
Professional
and Similar Organizations |
0.10
|
0.40
|
9211/9992
|
Executive,
Legislative, & Gen Government
|
0.05
|
0.05
|
9231/9993
|
Administration
of Education Programs |
0.10
|
0.25
|
Table B.4 reflects the fact that, as
with SOC categories, the Census Bureau
collapses some detailed NAICS codes into
a single broad industry category. For
the final estimates, the adjustment factor
for the broad category of 813M as used
by PUMS was assigned to all the specific
NAICS categories provided in the BLS data.
Reviews of the
Methodology
Several groups reviewed the entire methodology
in different stages of completion before
the final estimates were computed by the
IDSER/UTSA group. Those who participated
in the reviews included the Texas State
task force, research team members from
the CHWS in New York, and specialists
at the CSHO from The University of Southern
Mississippi.
The methodology was shared with the entire
State task force at a meeting in January
2005. Since Texas was the only State in
the Nation requiring the certification
of CHWs, availability of that group was
significant as it included very knowledgeable
individuals about CHWs, researchers, statisticians,
and CHWs. The State task force members
are listed in Table B.5.
Table B.5 List of
Texas State Task Force Members
Name/title
|
Organization
|
Category
|
City
|
Cecilia
Berrios, MA, Community Health Promotion
Specialist |
Regional
and Local Services, DSHS |
Workforce
Development |
Austin
|
Oscar
J. Muñoz, Regional Director |
TAMU
Center for Housing and Urban Development
|
Employer/Workforce
Development/DSHS Advisory Committee
|
Laredo
|
Graciela
Camarena, CHW |
Migrant
Health Promotions |
CHW/DSHS
Advisory Committee |
Mercedes
|
Lorenza
Hernandez, CHW |
Texas
Tech University, Office of Border
Health |
CHW/DSHS
Advisory Committee |
El
Paso |
Elizabeth
A. Kelly, PhD., Volunteer Consultant
|
De
Madres a Madres |
Workforce
Development/DSHS Advisory Committee
|
Houston
|
Martha
Quiroz-Romero, M.D. |
|
DSHS
Advisory Committee |
Arlington
|
Larry
Morningstar., PhD., MPH, Executive
Director |
Texas
Tech Health Science Center |
Employer/Workforce
Development/DSHS Advisory Committee
|
El
Paso |
Frank
Cantu, Field Director |
Division
of Border Health, Health Resources
and Services Administration (HRSA)
|
Workforce
Development |
Dallas
|
Margarita
Figueroa- Gonzalez, MD,
Medical
Officer |
Office
of Rural Health, Health Resources
and Services Administration (HRSA)
|
Workforce
Development |
Dallas
|
Humberto
(Bert) Ramos, Outreach Coordinator
|
CHRISTUS
SPOHN Hospital |
Employer
|
Corpus
Christi |
Catherine
Gorham, MPA, LSW, CHES |
Texas
Workforce Commission |
Workforce
Development |
Austin
|
Jeanette
Chardon, MSA |
East
Austin Community Health Promoters
Project, People's Community Clinic
|
Employer
|
Austin
|
Donna
C. Nichols, MSEd., CHES, Senior Prevention
Policy Analyst |
Center
for Policy and Innovation, DSHS |
Workforce
Development |
Austin
|
Edli
Colberg, PhD. |
Forecasting
and Research, HHSC |
Data/CHW
Estimates |
Austin
|
Kim
Davis |
Medicaid/CHIP,
HHSC |
Employer
|
Austin
|
Lee
Lane, Executive Director |
Texas
Assoc. of Local Health Officials |
Employer
|
Cedar
Park |
Sonia
Lara |
Texas
Assoc. of Community Health Centers
(TACHC) |
Employer
|
Austin
|
R.
J. Dutton, PhD., Director |
Office
of Border Health, DSHS |
Workforce
Development |
Austin
|
Camille
Pridgen, EdD, Program Director, Instructional
Programs, Health Professions Specialist
|
Texas
Higher Education Coordinating Board,
Community and Technical Colleges Division
|
Workforce
Development |
Austin
|
Dr.
Janet Lawson, Director |
Regional
and Local Services, DSHS |
Workforce
Development |
Austin
|
Trinidad
Soto, CHW, President, South Texas
Promotor Assoc. |
UT
Pan Am, Border Health Office |
CHW
|
Edinburg
|
Marlynn
May, PhD. |
Southwest
Rural Health Research Center, School
of Rural Public Health, Texas A&M
University System HSC |
Workforce
Development |
Bryan
|
Teresa
Hines, Program Director |
Health
Education Training Centers Alliance
of Texas (HETCAT), Texas Tech University
Health Science Center |
Workforce
Development |
El
Paso |
Sherry
Dallas Holt, CHW |
Maximus
|
CHW
|
Gun
Barrel City |
Leticia
Flores, RDH, MPH, CHES, Instructor/Coordinator
CHA Program |
El
Paso Community College |
Workforce
Development |
El
Paso |
Rosa
Torres |
El
Buen Samaritano |
Workforce
Development |
Austin
|
Melanie
Gilmore |
Harris
County Public Health and Environmental
Services |
Employer
|
Houston
|
The study advisory group reviewed the
entire methodology for the first time
on May 25, 2005. During the meeting, five
individuals were selected to participate
in a special task force. Members included:
Ms. Theresa Cosca, Bureau of Labor Statistics;
Dr. Susan Chapman, University of California
at San Francisco; Dr. Frederick Chen,
University of Washington at Seattle; Dr.
Steve Murdock, University of Texas at
San Antonio; and Dr. Robert Giffin, Insititute
of Medicine of the National Academies.
Members of the Estimates Task Force were
briefed twice in early 2006 on the progress
made to date on the estimates. The final
estimates were reviewed during a conference
call held on August 29, 2006.
The Estimates
Table B.6 shows a comparison of the estimates
of the total number of community health
workers (CHWs) nationwide for each of
the NAICS codes of interest for the 2000
PUMS and 2000 BLS data. Table B.7 shows
the combined totals of CHWs for all NAICS
categories by State. Summing the State
estimates produced a national estimate
of the number of paid CHWs.
Table B.6 CHW Estimates,
National Comparison by NAICS Code, PUMS-Based
and Staffing Patterns-Based
NAICS
Code |
PUMS
(2000) |
Staffing
Patterns (2000) |
6111
|
560
|
114
|
6113
|
188
|
144
|
6211
|
800
|
1,119
|
6214
|
4,545
|
9,272
|
6219
|
2,136
|
582
|
6221
|
2,501
|
2,504
|
6241
|
14,368
|
20,353
|
6244
|
1,677
|
1,569
|
8131
|
1,772
|
961
|
8133
|
12,378
|
4,875
|
8134
|
5,894
|
2,069
|
8139
|
3,579
|
806
|
9211/9992
|
1,099
|
3,467
|
9231/9993
|
7,887
|
7,925
|
All
NAICS codes |
59,382
|
55,759
|
Table B.7 Estimates
of Paid CHWs, PUMS-Based and Staffing
Patterns-Based
State
|
PUMS
(2000) |
Staffing
Patterns (2000) |
Alabama
|
566
|
669
|
Alaska
|
221
|
197
|
Arizona
|
980
|
784
|
Arkansas
|
443
|
549
|
California
|
6,834
|
5,522
|
Colorado
|
927
|
864
|
Connecticut
|
805
|
877
|
Delaware
|
164
|
149
|
District
of Columbia |
450
|
370
|
Florida
|
2,745
|
2,554
|
Georgia
|
1,518
|
1,209
|
Hawaii
|
337
|
206
|
Idaho
|
341
|
232
|
Illinois
|
2,632
|
2,423
|
Indiana
|
995
|
924
|
Iowa
|
663
|
537
|
Kansas
|
492
|
547
|
Kentucky
|
707
|
759
|
Louisiana
|
690
|
806
|
Maine
|
513
|
395
|
Maryland
|
1,630
|
989
|
Massachusetts
|
2,181
|
1,820
|
Michigan
|
1,700
|
1,914
|
Minnesota
|
1,565
|
1,240
|
Mississippi
|
362
|
418
|
Missouri
|
940
|
1,104
|
Montana
|
316
|
189
|
Nebraska
|
517
|
356
|
Nevada
|
224
|
243
|
New
Hampshire |
420
|
325
|
New
Jersey |
1,587
|
1,410
|
New
Mexico |
511
|
482
|
New
York |
5,459
|
6,319
|
North
Carolina |
1,543
|
1,277
|
North
Dakota |
162
|
190
|
Ohio
|
2,018
|
2,419
|
Oklahoma
|
626
|
585
|
Oregon
|
908
|
684
|
Pennsylvania
|
3,097
|
2,827
|
Rhode
Island |
324
|
155
|
South
Carolina |
810
|
519
|
South
Dakota |
157
|
150
|
Tennessee
|
832
|
935
|
Texas
|
2,856
|
3,339
|
Utah
|
426
|
309
|
Vermont
|
271
|
220
|
Virginia
|
1,692
|
1,337
|
Washington
|
1,509
|
1,534
|
West
Virginia |
344
|
490
|
Wisconsin
|
1,261
|
1,317
|
Wyoming
|
112
|
89
|
National
Total |
59,382 |
55,759 |
The difference between the estimates
from the Census PUMS and the BLS Staffing
Patterns Survey shown in Tables B.6 and
B.7 provides an estimated range for the
number of CHWs working within a State.
The results indicate that the aggregate
estimates of CHWs based on BLS and PUMS
Census data are similar at the national
level (only a 6.1 percent difference between
the two estimates), but they differ substantially
for some States.
The estimates shown in Chapter 3 of the
report are averages of the BLS- and PUMS-based
estimates.
Estimates of Volunteer
Community Health Workers
There were no existing databases containing
information on the number of CHWs who
were serving the community in a volunteer
capacity. The only information available
was an estimate of all volunteer workers
by State.[15]
Two sources of data were used to calculate
the estimates of volunteer CHWs: the percent
of paid workers from the CHW National
Employer Inventory (CHW/NEI) and the estimates
of paid CHWs calculated using PUMS and
BLS data (discussed above).
The number of CHWs by paid and volunteer
status was extracted for every State from
the CHW National Employer Inventory. The
States were then clustered based on geographic
location into four groups designated as
"Census Regions": Northeast,
Midwest, South, and West.
Using the number of paid community health
workers reported in the CHW/NEI, the proportion
of paid workers was calculated for each
Census Region and State.
The standard deviation for the four Census
Regions was calculated, followed by a
standardized score for every State. This
process was carried out in order to identify
those States with an extreme proportion
of paid CHWs (either too large or too
small) as compared to the regional average.
According to the CHW/NEI Inventory, 67
percent of CHWs across the United States
received compensation by an employer.
The proportion of paid community health
workers using results from the CHW/NEI
and estimates of paid CHWs were then used
to calculate a total number of CHWs by
Census Region and State using the following
formula:
(Number of paid CHWs from estimates x
100) /
Proportion of paid CHWs from the CHW/NEI
Adjustments for the proportion of paid
workers were made for States that were
at least 1.0 unit from the standard deviation;
reported a proportion of 100 percent paid
from the Inventory; or had no responses
to the Inventory (only one State). Adjustments
were made as follows:
- One standard deviation was added to
the proportion of paid CHWs from the
Inventory for a negative standard deviation
of 1.0 or greater.
- One standard deviation was subtracted
from the proportion of paid CHWs from
the Inventory if a positive standard
deviation of 1.0 or greater was reported.
- One standard deviation was subtracted
from the proportion of paid CHWs for
States reporting a workforce that was
100 percent paid.
The number of volunteer CHWs was then
calculated by subtracting the number of
paid CHWs from the total number of CHWs.
Table B.8 shows the number of volunteer
CHWs per State.
Table B.8 Estimates
of Volunteer CHWs
State
|
No.
of Volunteer CHWs |
Alabama
|
274
|
Alaska
|
89
|
Arizona
|
62
|
Arkansas
|
308
|
California
|
3,149
|
Colorado
|
551
|
Connecticut
|
36
|
Delaware
|
62
|
District
of Columbia |
162
|
Florida
|
1,556
|
Georgia
|
1,886
|
Hawaii
|
30
|
Idaho
|
52
|
Illinois
|
993
|
Indiana
|
375
|
Iowa
|
338
|
Kansas
|
370
|
Kentucky
|
197
|
Louisiana
|
723
|
Maine
|
95
|
Maryland
|
544
|
Massachusetts
|
440
|
Michigan
|
917
|
Minnesota
|
517
|
Mississippi
|
440
|
Missouri
|
774
|
Montana
|
28
|
Nebraska
|
437
|
Nevada
|
99
|
New
Hampshire |
293
|
New
Jersey |
45
|
New
Mexico |
74
|
New
York |
2,350
|
North
Carolina |
557
|
North
Dakota |
360
|
Ohio
|
1,285
|
Oklahoma
|
431
|
Oregon
|
433
|
Pennsylvania
|
658
|
Rhode
Island |
303
|
South
Carolina |
429
|
South
Dakota |
60
|
Tennessee
|
349
|
Texas
|
1,879
|
Utah
|
56
|
Vermont
|
26
|
Virginia
|
210
|
Washington
|
500
|
West
Virginia |
214
|
Wisconsin
|
504
|
Wyoming
|
43
|
National
Total |
28,308
|
[1]
Standard Occupational Classification (SOC)
System [Internet]. Washington (DC): Bureau
of Labor Statistics, U.S. Department of
Labor; 2000 [updated 2006 Jun 13/cited
2005 Dec 14]. Available from http://www.bls.gov/soc/.
[2] The American Community
Survey is expected to replace the decennial
Census "long form" questionnaire beginning
in 2010.
[3] Census 2000 Occupational
Categories, With Standard Occupational
Classification (SOC) Equivalents, Census
2000 Code Order [Internet]. Washington
(DC): Bureau of Labor Statistics, U.S.
Department of Labor; 2001 [updated 2001
Jan 01/cited 2005 Dec 14]. Available from
http://www.census.gov/hhes/www/ioindex/occ2000t.pdf.
[4] Industry and Occupation
2002 [Internet]. Washington (DC): U.S.
Census Bureau, Housing and Household Economic
Statistics Division; 2005 [updated 2005
Mar 08/cited 2005 Dec 14]. Available from
http://www.census.gov/hhes/www/ioindex/ioindex02/txtnew02.html#21-1011.
[5] In 2002, industry
and occupation codes used by the Census
Bureau underwent a major renovation from
three-digit to four-digit codes in order
to accommodate the possible additions
of new industries and occupations.
[6] O-Net, administered
and sponsored by the U.S. Department of
Labor's Employment and Training Administration,
is a comprehensive database system that
replaced the Dictionary of Occupational
Titles as the primary source of occupational
information.
[7] Occupational Information
Network O-Net Online: O-Net Online Help
Crosswalk [Internet]. Washington (DC):
National Center for O-Net Development;
[updated 2005 Dec 14]. Available from
http://online.onetcenter.org/help/online/crosswalk.
[8] Rosenthal EL, Wiggins
N, Brownstein JN et al. The Final Report
of the National Community Health Advisor
Study. Tucson (AZ): University of Arizona,
1998.
[9] At the time, Texas
was the only State in the country that
required certification of CHWs when CHWs
were compensated for their work.
[10] Office of Management
and Budget. North American Industry Classification
System-Revision for 2002; Notice. Fed
Regist 2001; 66 (10).
[11] Ibid.
[12] 2002 NAICS United
States Structure, Including Relationships
to 1997 NAICS United States and 1987 Standard
Industrial Classification [Internet].
Washington (DC): U.S. Census Bureau; 2002
[updated 2004 Mar 23/cited 2005 Dec 14].
Available from http://www.census.gov/epcd/naics02/naicod02.htm.
[13] CSHO was the partner
in the study.
[14] States included:
California, Colorado, Connecticut, Florida,
Georgia, Hawaii, Kansas, New Jersey, New
York, and Texas.
[15] Points of Light
Foundation Announces State Volunteering
Rates, Research Highlights Impact of Volunteer
Center National Network [Internet]. Washington
(DC): The Points of Light Foundation;
2004 [updated 2004 Sep 13/cited 2005 Dec
14]. Available from http://www.pointsoflight.org/about/mediacenter/releases/2004/09-13.cfm.
|