California Community Health Worker Core Competencies

Community health workers (CHWs) have been working in California for years. CHWs, as well as promotores, community health representatives (CHRs) and other health promoters, help people in marginalized communities find food and insurance and manage chronic conditions such as diabetes and high blood pressure. They are major doers for people living in California who need a healthcare boost.

California recognizes the usefulness of CHWs and is pushing for a benefit for them in the Medi-Cal program. This means that CHWs can be paid for providing benefits and services to people enrolled in Medi-Cal.

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Are CHW core competencies required in California?

Many states set guidelines for CHW core competencies. California does not require certification of CHWs or provide licensure for them. But they may in the future. Many agencies, employers and organizations are staying up to date on competencies and providing training to CHWs in advance of any requirements.

Training for Core CHW Competencies

According to the California Health Care Foundation, which released a resource package providing information for training CHWs and promotores:

The first level of training for CHW/Ps (community health workers/promotores) focuses on understanding CHW/P positions, developing and strengthening core CHW/P competencies, and preparing individuals to lead in their communities. While CHW/P positions can vary widely, the core competencies … reflect common skills across many CHW/P positions. These core competencies are shared by many individuals in the community-connected health workforce across different settings, including within medical, public health, behavioral health, and CBO employers.

CHW Core Competencies for California

California has identified the following as the Core CHW/P Competencies:

1. Communication. The ability to break down complex concepts for patients, use active and empathetic listening, and identify and overcome communicational barriers between patients and care providers.
2. Interpersonal and relationship building. Build rapport with clients, use motivational interviewing techniques, and work as part of a team for the greater good.
3. Service coordination and navigation. Help clients access the care they need, whether this means facilitating transportation, providing instructions, or explaining how the healthcare system or insurance works.
4. Capacity building. Help individuals advocate for themselves by helping them understand their needs and rights, developing their capacities, and identifying local leaders that can aid the program’s mission.
5. Advocacy. Identify the community’s needs and speak up on their behalf in front of the necessary agencies or providers.
6. Education and facilitation. Encourage patients to learn about their own health risks and ways to prevent disease as well as facilitate the information for them to do so.
7. Individual and community assessment. Use formal assessment tools to determine the starting point for individuals and communities.
8. Outreach. Educate communities about the programs and services available to them and how to access them, as well as learn the best ways to communicate with a population and put those into practice for greater efficacy.
9. Professional skills and conduct. Effective management of time, resources, and priorities while making use of the tools and technology available for the program. Along with ethical standards and conducts such as laws, bills, and other institutional guidelines.
10. Evaluation and research. Use evidence-based practices for research and evaluate, identify, and find the root causes of issues in order to address them.
11. Knowledge base. Basic knowledge of public health principles and social determinants of health, as determined by the supervising provider.

Work Experience Pathway

California has identified the following recommendations for a work experience pathway for CHWs:

1. 2,000 hours working as a CHW in a paid or volunteer position within the previous three years, and demonstrated skills and practical training in core competencies, as determined by a supervisor.
2. A CHW demonstrating qualifications through the Work Experience Pathway, who does not have a certificate of completion as described above, shall earn a certificate of completion within one year of the first CHW visit provided to a Medi-Cal beneficiary.

More information is available from DHCS.

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