Understanding the Community Health Worker/Promoter Workforce in California: A Survey of CHW/Ps

In California, one of the most culturally diverse states in the country, health care must overcome cultural and linguistic differences to serve all communities equitably. As trusted community members with lived experience, community health workers and prosecutors (CHW/Ps) have a long history of connecting those underserved by the traditional health care system with culturally competent health and social services.

In California, CHW/Ps are increasingly recognized as a critical part of the health care workforce. In 2019, California’s Commission on the Future Health Workforce recommended scaling the CHW/P workforce to expand access to preventive and social support services, as well as team-based integrated primary and behavioral health care.

It is important that CHW/Ps themselves share their experiences and voice their opinions about their profession. CHW/Ps across the state and in various workplaces were asked to complete a survey between October 2021 and January 2022. This report summarizes the results and attempts to crystallize the attributes and perspectives of CHW/Ps. Given this time, the study shows data on the performance of CHW/Ps during the COVID-19 pandemic.

Key findings

The majority of respondents were employed full-time in a salaried CHW/P position. Among these respondents, key findings include:

  • The majority of respondents were female and Hispanic/x.
  • Most of the respondents were employed in the Bay Area.
  • Nearly two-thirds of respondents’ employers require a high school diploma or less.
  • More than half of the respondents worked in a community-based organization, and the majority worked in a community clinic or community health center.
  • Nearly half of respondents were paid $20 to $25 an hour.
  • Most respondents completed relatively short CHW/P training (40 hours or less). Nearly 70% of respondents completed CHW/P training. For most of these respondents, the training was mandatory and paid for by their employer.
  • The type of work respondents most often reported doing included identifying and referring people to community resources and case management, coordination, and navigation.
  • The work of multiple respondents did not focus on specific health conditions. Among respondents whose work focused on specific health conditions, chronic health conditions and complex health or social needs were most commonly reported.
  • The work of multiple respondents does not focus on serving specific populations or groups of people.
  • Respondents were divided on whether they saw potential for advancement in their CHW/P role. Although most respondents see an opportunity for advancement in their role, 49% say there is no such opportunity or that they are unsure of their advancement opportunities.
  • Documentation of services (ie, documentation of services provided to clients in an electronic health record [EHR], paper medical record or separate record keeping system) was an important component of the CHW/P role. Nearly a third of respondents spend 10 hours per week or more documenting in the EHR.
  • The COVID-19 pandemic has increased the amount of CHW/P work being done virtually. As a result of COVID-19, most respondents expected that computer skills, general knowledge about COVID-19, and resilience would be the most important attributes in the next three to nine months.

The authors note that the findings are not representative of the entire CHW/P population in California. Additionally, the survey was only available for completion in English or Spanish.

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