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“Community Health Worker” (CHW) is a term inclusive of many job titles, such as community health advisors, lay health advocates, promotoras , outreach educators, community health representatives, peer health promoters and educators, etc. The common general attribute is that the CHWs are members of, or have a close relationship to, the community served. They generally are lay members of an underserved community who work in association with the health care system to offer interpretation and translation services, provide culturally appropriate health education and information, assist people in getting the health services they need, provide informal counseling and social support, advocate for individual and community health needs, and provide direct services such as first aid and blood pressure screening. [37]
In May 1999, the 76th Texas Legislature passed House Bill 1864 which directed the Texas Department of Health (TDH), now the Department of State Health Services (DSHS), to establish a committee to study the feasibility of voluntary training and certification of promotores or community health workers (CHWs). As a result, the 15 member Promotora Program Development Committee (PPDC) was formed. During the first year of its existence, the PPDC reviewed the curricula and certification guidelines from existing programs, held public hearings across the State, “exchanged dialogues” with CHWs and their employers, and exchanged information with CHW program representatives from across the Nation. The efforts culminated in the adoption, by the Texas Board of Health, of the Rules Regarding Training and Certification of Promotores(as) or Community Health Workers which serves as the model for the training and certification program managed by the DSHS. [38]
Two additional bills were passed in May 2001 during the 77 th Texas Legislature: Senate Bills 1051 and 751. Both bills mandate certification for compensation and became effective on September 1, 2001. [39] Senate Bill 1051, regarding the training and certification of promotores or CHWs, required TDH, now DSHS, to develop and implement a promotoras /CHW training and certification program which would ensure that CHWs who receive compensation for their services meet minimum standards and guidelines. While the program is voluntary for promotoras who are not paid for their services, it is mandatory for those who are compensated.
Senate Bill 751, relating to providing the services of promotoras for outreach and education programs for recipients of medical assistance, states that the Texas Health and Human Services Commission require health and human services agencies to use certified promotoras/CHWs to the extent possible for citizens receiving medical assistance. 37 In 2003, there were 224 certified CHWs in Texas. [40] As of September 2005, there were 520 certified CHWs in Texas. Of these, about 75 percent resided in five counties, four of which are located adjacent to the U.S.-Mexico Border: El Paso (88), Cameron (46), Hidalgo (66), Harris (85), and Webb (45) Counties. Outside of certified CHWs, it is not known how many CHWs or promotores(as) are currently working in Texas. The Community Health Worker National Workforce Study (described below) will compute a set of estimates for paid CHWs using data from the U.S. Census Bureau's Public Use Microdata Sample (PUMS) and Staffing Patterns data from the Bureau of Labor Statistics for every State in the country. In addition, an estimate of the number of volunteer CHWs will also be calculated at the State and national level. Results from the National Community Health Advisor Study (1998) indicated that there were at least 12,500 CHWs working throughout the United States.
The Community Health Worker National Workforce Study, which began on October 1, 2004, under a 2-year contract by the RCHWS at The University of Texas Health Science Center at San Antonio with the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Bureau of Health Professions, is aimed at drawing an accurate profile of the CHW workforce. The study consists of a thorough analysis of the quality and size of CHW employment and potential job market. Data on the number of paid and volunteer CHWs, their duties, work conditions, compensation, training/education and career opportunities are collected, organized, verified, and explained. The study also examines related issues, such as training and credentialing standards, the availability of funding streams for education and compensation as well as current State/Federal policy trends and options. The final report will provide a national profile and detailed assessments of the CHW workforce in four States that will inform policy and strategic interventions on existing application of CHW capabilities in improving access, reducing disparities, and enhancing quality improvement and cost-containment efforts. Texas is the first of these States where an in-depth investigation of the CHW workforce will be included for the overall study.
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