Iowa Community Health Worker Implementation and Apprenticeship Program

What We’re Building

With guidance and leadership from the Iowa Community Health Worker Alliance, the Iowa Chronic Care Consortium (ICCC) is fostering the presence of a community health worker (CHW) workforce in Iowa. Increasing and supporting the CHW workforce aligns with the national trends aimed at improving the quality, delivery, and equity of care throughout the care continuum. Linking clinical care with community resources and improving healthcare navigation, particularly for those who are most vulnerable, is a key strategy; and CHWs are increasingly being deployed to accomplish these aims.

ICCC is advocating for an underutilized healthcare workforce in Iowa.  By developing a robust training infrastructure, supporting and studying the experiences of CHWs across diverse healthcare settings, ICCC believes a clear case will be made to expand this workforce, as is happening throughout the country.

Why Now, and Why CHWs?

Increasingly, the health care community is focused on new goals: impacting the health of total populations; and achieving an environment of health equity. Creating the opportunity for everyone to have a fair and just opportunity to reach their maximum health potential is an extraordinarily complex goal to achieve. To achieve these aims, health disparities (differences in health or in key determinants of health that adversely affect marginalized or excluded groups) must be reduced and even eliminated. Measurement of reduction in disparities provides a critical metric for assessing progress toward equity.[1]

People adversely impacted by the Social Determinants of Health (economic and social factors found where we live, work and play) lead to health disparities, and those in healthcare now understand that these factors must be addressed in order to truly improve health outcomes for the long term. The following chart, from County Health Rankings and Roadmap, illustrates this in graphic terms. While a variety of factors impact our health, it is the Social Determinants of Health that have the greatest impact on outcomes (40%). More than that, these factors often influence health behaviors (30%), and those with greater numbers of determinants are also more likely to be negatively impacted by their physical environment as well (10%). Considering these health factors together speaks to the steep hill healthcare must climb in order to reach the ultimate equity goal.

While strategies to improve the quality of care delivery are many and varied, there is a growing body of strategies aimed outward and into communities. This is where ICCC believes Community Health Workers (CHWs) offer a viable and important option that should be expanded and supported in Iowa.

According to the American Public Health Association and the World Health Organization, a Community Health Worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker 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. In short, CHWs build relationships to improve individual and community health.

The presence of the CHW workforce is not new but has seen rapid growth nationally in recent years. And, while there are instances of CHWs in place in Iowa; until now, there has been little coordinated activity that supports expansion of this workforce. This project is changing that.

Program Components

Recognizing the need to demonstrate the value of this workforce while also building infrastructure to train them, ICCC developed a two-pronged approach – a demonstration project and development of a robust course to advance the skills of the CHW workforce. With these components in place, ICCC expects to demonstrate value and legitimize CHW roles, so that state leaders and policymakers, along with health systems, payers and nonprofits, embrace the need to deploy and expand opportunities for this workforce in Iowa.

Demonstration

As part of the demonstration, ICCC has partnered with nonprofit organizations to place CHWs that will receive training and support over the course of one year. ICCC will support these nonprofits and the CHWs by providing the training as well as additional opportunities for networking and support for CHWs and their supervisors. CHWs will be placed in a range of health and human service organizations and serve in a variety of roles over this three-year demonstration designed to test the utilization and value CHWs bring to the healthcare team. In addition to the organizations’ own data collection, an overall evaluation of the demonstration will highlight strategies that have shown to be effective, assess satisfaction with the addition of CHWs to the health care team, and illustrate how CHWs have been instrumental in improving patient connection with services and outcomes.

In addition to the training component described below, participants in the demonstration will be provided additional opportunities to receive support, network, and further build skills through role play, case studies, and practice. Findings from the demonstration will be disseminated and an implementation guide developed to assist organizations in adopting and implementing this workforce.

Training course

ICCC has partnered with Iowa Workforce Development to develop a US Department of Labor-approved Registered Apprenticeship. For CHWs, this involves one year of on the job learning provided by the employer, and extensive classroom training that will be provided by ICCC. CHWs supported through the demonstration project will participate in the Registered Apprenticeship program. Upon successful completion, the CHW will earn a national credential as a CHW – a valuable asset should any CHWs move across state lines.

Alongside the Apprenticeship, the classroom component of the training course will be available as a stand-alone offering (CHW Professional Skills Training), for organizations without capacity to participate in the Registered Apprenticeship. CHWs may enroll in either component and learn together. Anticipated competencies and training components are listed in the table below.

While the demonstration portion of the project will span three years, ICCC expects the CHW training course and Registered Apprenticeship to be available for the long term, to meet the ongoing training needs of CHWs in Iowa.

Partnerships

ICCC could not do this work without the active engagement of partners. Employers are partnering to hire CHWs and participate in the dynamic across partner organizations to facilitate networking and learning from each other’s experiences. Iowa Workforce Development (IWD) is providing support and guidance and the US Department of Labor has approved the curriculum and approach, granting ICCC a Certificate of Registration for the CHW Apprenticeship Program in June 2019.  And, members of the Iowa CHW Alliance share insights, assist in sharing information with members own networks, and lend expertise and enthusiasm to the goals of the project.

Together, the two approaches will provide ample evidence of the value of this workforce in moving Iowa toward a state actively aimed at achieving a system of equity for its residents.

Outcomes

This approach to train CHWs and pilot their utilization in Iowa’s health and human services systems will provide experience needed to demonstrate the value of this workforce. But more than that, these experiences will have real and lasting impacts:

• At minimum, 11 CHWs will be placed, over the course of three years, in a variety of locations across Iowa. During that time, the CHWs will provide services to engage and link underserved individuals to healthcare and other supportive services.
• Training will be provided to those CHWs and more, across the state, thus advancing their skills to engage and work with target populations.
• A Registered Apprenticeship program and stand-alone CHW Professional Skills Training course will be established to serve as a resource over the longer term as this workforce grows in the state.
• Through active evaluation, the demonstration will illuminate the efficacy of CHW utilization in a variety of settings.
• Those served by CHWs will experience improved access to care and other needed services, thus improving short and long-term health outcomes.

For more information about Iowa’s CHW Implementation and Apprenticeship Program, contact Deb Kazmerzak – deb.kazmerzak@iowccc.com; or William Appelgate – willilam.appelgate@iowaccc.com.

[1] What is Health Equity and What Difference Does a Definition Make? Executive Summary, University of California San Francisco, Robert Wood Johnson Foundation May 2017.