Integrating Community Health Workers into Primary Care Practice A Resource Guide for HCH Programs

1: CHWs and HCH		4: Training CHWs
2: CHW Roles and Responsibilities		5: Supervision of CHWs
3: Hiring CHWs		6. CHW Integration and Support

4. Training CHWs

“Clearly, there are plenty of other causes of homelessness besides untreated mental health issues, unresolved trauma, and cognitive disabilities, but these are the issues I seem to work with the most” ~ Community Health Worker

State Initiatives 

Training resources for CHWs, both online courses and in-person classes, are abundant and readily available. In an effort to create more sustainable opportunities for CHWs in the workforce, many states have begun standardizing their trainings and developing certification programs. Currently, 30 states offer some type of standardized training for CHWs. Eleven states have certification programs for CHWs with seven more in the process of developing certification programs.

For more information about state initiatives and laws regarding CHWs, visit the NASHP’s State Community Health Worker Models.

Core Competencies

Within the HCH setting, CHWs should build their knowledge around the primary issues client’s face. The following table describes topics and issues pertinent to delivering care to people experiencing homelessness, core questions the CHW should be able to answer, and a sample of training resources.

Topic	What the CHW Needs to Know	Resources
Substance abuse and addiction	What are commonly abused substances among the population? Are there any current substances that are particularly prevalent and problematic? (Spice/K2, etc.) What are signs and symptoms of impairment? What should I do if my client is high or drunk? What are the signs of an overdose and how should I respond? What are treatment options?	Opioid Overdose Prevention Toolkit Neurobiology of Addiction Training Alcoholics Anonymous
Mental health diagnoses and treatment	What are common mental health diagnoses among this population? What are signs and symptoms of these mental health diagnoses? What should I do if I have a client in a mental health crisis? What common medications are taken by clients with severe and persistent mental illness?	Adult Acute Urgent Mental Health Response Behavioral Health Services for People Who are Homeless (Part 1) Mental Health First Aid Course
Trauma response and trauma informed care	What is trauma? How does trauma affect someone’s behavior? How are trauma and substance use connected? What is trauma informed care? How is our agency trauma informed? What can I do to provide trauma informed care to clients?	Healing Hands: Delivering Trauma Informed Services Trauma-Informed Approach and Trauma-Specific Interventions Issue Brief: Key Ingredients for Successful Trauma-Informed Care Implementation
Cognitive disabilities and traumatic brain injury (TBI)	How do I assess a client’s cognitive abilities? What are signs and symptoms of a TBI? How do cognitive disabilities effect behavior and decision making? What treatment/therapies are available to clients with TBI?	Healing Hands: Traumatic Brain Injury: Emerging Tools for Assessment and Care MedlinePlus – Traumatic Brain Injury
Common chronic diseases, treatments, medications, and specific challenges	What are the most common chronic conditions? What are the signs, symptoms, treatments, and common medications for the following: Hypertension Asthma Diabetes HIV/AIDS Hepatitis C Cardiovascular disease Oral health problems What basic reproductive health information do I need to know to assist my clients? How does our clinic treat clients with chronic pain?	Medline Plus – Hypertension Medline Plus – Asthma Medline Plus – Diabetes Medline Plus – HIV/AIDS Medline Plus – Hepatitis C Medline Plus – Cardiovascular disease Medline Plus – Oral Health A Training Manual for Preventing Heart Disease and Stroke: The Community Health Worker’s Sourcebook
Harm reduction	What is the philosophy of harm reduction? What are best practices in harm reduction? What are the stages of change?	Harm Reduction Training
Confidentiality	Why is confidentiality important for my clients? What is HIPAA and what are my responsibilities under HIPAA? If a client discloses an intent to hurt someone or themself but asks me not to tell anyone, what should I do? If I’m accompanying a client to an appointment outside of the clinic and they want access to their health information, what is the proper process?	Confidentiality: Ethics in Medicine Confidentiality Resources: UCLA Center for Mental Health in Schools
Cultural humility	What is cultural humility? How does oppression affect homelessness and health care? Why is it important for CHWs to be culturally appropriate? How is our organization providing culturally appropriate care?	Organizing Health Services for Homeless People: A Practical Guide: Cultural Competence Gender Minority and Homelessness: Transgender Population Aging and Housing Instability: Homelessness Among Older and Elderly Adults
Basic medical terminology	What are the most frequent medical terms used in our clinic? What are common medical abbreviations? How do we chart medical information at our clinic? Will I be using our EMR? If so, what is the proper way to document client notes?	Des Moines University: Online Medical Terminology Course

The core competencies listed above will help CHWs better understand clients and the ways they can assist clients in navigating the health care system. In addition to these competencies, there are skills CHWs need to develop because of their close work with complex and vulnerable individuals. The following topics are important to revisit on an annual basis, either through formal training or supervision, in order reinforce the knowledge and skills needed for their day-to-day work and to prevent burn-out.

Topic	What the CHW Needs to Know	Resources
Establishing and maintaining healthy boundaries	How can I establish healthy boundaries with my clients? Why are health boundaries important for both me and my clients?	Crossing the Line Dual Relationships and Boundary Management in Social Work Practice
Understanding the stages of change	What are the stages of change? Why are the stages of change important in my work with clients? How can I be supportive and non-judgmental of clients who are not ready to make changes? How can I be creative in goal setting with clients?	NHCHC CHW Training: Facilitating Behavior Change
Processing grief and loss	What are the stages of grief? What is my support system both professionally and personally?	Taking Care: Coping with Grief and Loss
Self-care strategies	How can I establish healthy work place boundaries? What are signs that I am not prioritizing self-care? What are some go-to activities I can turn to when I’m feeling overwhelmed or stressed?	NHCHC CHW Training: Vicarious Trauma
De-escalation techniques	What are some techniques I can use when one of my clients gets angry and/or aggressive? What safety protocols do we have in place? When is it appropriate for me to contact security or law enforcement?	QPR Suicide Prevention Training Workplace Violence: Prevention and Intervention
Motivational interviewing	What is motivational interviewing? What are the benefits of motivational interviewing when working with the homeless population? What are motivational interviewing techniques?	Motivational Interviewing Training Spotlight on PATH Programs and Practices: Motivational Interviewing

Professional Skills Training

For some CHWs, this job may be the first time or the first time in a long time they have worked in a professional setting. There are certain skills and behaviors people who have worked in an office or clinic setting have learned that may not be in the repertoire of a new CHW. CHWs who have never worked in a professional atmosphere may have difficulty acclimating to the culture, learning the work ethic, and being productive at their jobs. In a study on the impact of CHWs on patient behavior conducted by The U.S. Public Health Service (USPHS), researchers found some CHWs who were new to the workforce had “high absenteeism rates, wore inappropriate clothing, and/or did not know how to speak in a professional manner to patients on the telephone or in person.”^[i] CHWs need guidance from their supervisors and may need additional training. Here are training topics to consider:

• Typing skills
• Checking, sending, and organizing email
• Conference call etiquette
• Time management

“Our CHW’s computer skills are slow but she’s so good at what she does that it’s not that important. Computer and writing skills are a plus but shouldn’t take priority.” ~ Supervisor, Massachusetts

 

PROJECT SPOTLIGHT Encourage the CHW to take advantage of any opportunity to learn more about what’s going on in their community. A CHW in Massachusetts had the opportunity to tour of a local prison and she shared that this experience increased her understanding of the trauma of incarceration. Often members of the HCH client population have spent time incarcerated, so familiarizing herself with the realities of prison life helped in her outreach to formally incarcerated clients. She says “I recommend all CHWs do something like that in their community. It really makes a difference.”

 

CHW Trainings Resources

Peer Specialist Certification Program

According to the Department of Behavioral Health, “A certified peer specialist is an individual living in recovery with mental illness and/or substance use disorder or a family member who has been trained and certified by the Department of Behavioral Health to assist others in recovery and wellness. A certified peer specialist is a model for personal recovery and performs a wide range of tasks to assist individuals to regain control over their lives and their own recovery process.” Hours of training required, fees, and eligibility criteria vary by state.

Minnesota CHW Certification

Minnesota has a statewide competency-based CHW educational program based in accredited post-secondary schools across the country. This 14 credit program is a blend of classroom and field-based learning. At minimum, a high school diploma or GED is required. Fees vary based on location.

City College of San Francisco: Community Health Worker Certificates

The CHW Certificate Program at City College of San Francisco is a 20 unit program, designed to prepare individuals for work in community-oriented health and social service fields. Classes are offered in the evenings and the certificate takes approximately 2 semesters to complete. Students also complete an internship of 128 hours at a clinic or community organization. The fee is currently $36 per unit.

 

References

[i] Zuvekas, A, L. Nolan, C. Tumaylle, and L. Griffin. (1999). Impact of Community Health Worker on Access, Use of Services, and Patient Knowledge and Behavior. Journal of Ambulatory Care Management, 22 (4)