文章基本信息

标题：Building a Consensus on Community Health Workers’ Scope of Practice: Lessons From New York
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作者：Sally E. Findley ; Sergio Matos ; April L. Hicks 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2012
卷号：102
期号：10
页码：1981-1987
DOI：10.2105/AJPH.2011.300566
语种：English
出版社：American Public Health Association
摘要：Objectives. We evaluated efforts in New York to build a consensus between community health workers (CHWs) and employers on CHWs’ scope of practice, training standards, and certification procedures. Methods. We conducted multiple-choice surveys in 2008 and 2010 with 226 CHWs and 44 employers. We compared CHWs’ and employers’ recommendations regarding 28 scope of practice elements. The participatory ranking method was used to identify consensus scope of practice recommendations. Results. There was consensus on 5 scope of practice elements: outreach and community organizing, case management and care coordination, home visits, health education and coaching, and system navigation. For each element, 3 to 4 essential skills were identified, giving a total of 27 skills. These included all skills recommended in national CHW studies, along with 3 unique to New York: computer skills, participatory research methods, and time management. Conclusions. CHWs and employers in New York were in consensus on CHWs’ scope of practice on virtually all of the detailed core competency skills. The CHW scope of practice recommendations of these groups can help other states refine their scope of practice elements. Under the Affordable Care Act (Pub L No. 111-148), the landmark health care reform legislation signed into law by President Obama, millions of Americans will have access to quality, affordable health care. However, cultural, language, or other vulnerabilities can prevent millions of people from benefiting from this care. Community health workers (CHWs) are in a unique position to help. CHWs can break down barriers so that people can receive the health care services they need, and they can assist them in benefiting fully from those services. 1 A growing number of studies have shown that CHWs can help ensure equitable access to care, decrease health care costs, and improve outcomes, including self-management of chronic diseases such as asthma or diabetes. 1–13 The valuable role CHWs can play is clear, and many groups are now working to outline the details of their roles across a spectrum of conditions and communities. In addition to the critical questions of how and for whom CHWs can most effectively provide these services, attention needs to be paid to ensuring that the CHW workforce is structured to respond to this demand. Surveys of the CHW workforce have concluded that although there may be as many as 120 000 CHWs in the United States today, 14 there are no national standards defining what a CHW does as a member of the health care team or what criteria might be used to qualify CHWs for reimbursement through sustainable funding such as Medicaid. National organizations such as the American Association of Community Health Workers and the American Public Health Association (APHA) have been working to support the development of CHW workforce standards, 15 and the Bureau of Labor Statistics has established a standard occupational code for CHWs. 16 The APHA CHW Section’s definition of a CHW is increasingly recognized as the nationally accepted definition: Community Health Worker (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community served. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy. 15 Setting workforce standards begins with the establishment of a scope of practice, the roles and tasks performed by practitioners, along with the usual education and competencies required for that practice. In 1998 the National Community Health Advisor Study (NCHAS), a milestone review of CHW roles and activities, listed 7 basic roles, 8 core skills or competencies, and 7 additional qualities supporting accomplishment of these CHW roles 17 ; however, these elements need to be reviewed and tailored as appropriate to ensure that they capture context-specific roles. Establishment of a scope of practice for credentialing is a state responsibility, and 17 states are now in the process of establishing standards for CHWs. 1,18,19 As is the case with members of any other profession establishing standards for itself, CHWs should lead in identifying appropriate scope of practice roles, and this is the approach that has been adopted in New York. 1 In 2005, the Mailman School of Public Health and the CHW Network of NYC began an academic–community partnership to elicit CHWs’ views on establishing practice and training standards. We learned that although CHWs felt they were recruited for qualities such as dedication to the community and trust, often employers valued a wholly different skill set that included informal counseling, teaching, and promotion of behavior change. CHWs saw themselves in terms of “who” they were in the community, whereas employers viewed them according to “what” they could do. 20 We concluded that if there is to be agreement on scope of practice, it is critical that each group, CHWs and their employers, agree on both the “who” and “what” questions. To develop a consensus scope of practice, we set out to determine CHWs’ perceptions of the most appropriate set of roles and skills for their profession, as well as potential employers’ perceptions of those roles and skills. We used a community-based participatory research approach to simultaneously obtain input from CHWs and employers on these topics that could be used in achieving a consensus, and here we report on the recommendations derived from this multiyear process.