Establishing a health profession: What oncology patient navigators can learn from the National Association of Community Health Workers

Authors: Carl H. Rush MRP, Denise Octavia Smith MBA, CHW, PN, Durrell J. Fox CHW, Ashley Wennerstrom PhD, MPH
Year: 2022
State: NatDoc: National Document
Website link:
Publicly Available: Yes
Certification: CHW role scope of practice, Competencies, Specialty tracks and supervisor training
Policy: Building partnerships
Sustainable Financing: Engaging state partners in general, Expand evidence base, How to engage and work with Medicaid, Including community-based CHWs, National-level guidance, Documentation of how CHWs can work within care teams, Surveys and assessment tools to define and develop workforce
Workforce Development: CHW training programs (not cert.), Data sharing between social services and clinical teams, General other (including mention of “employment practices”), Recruiting and convening CHWs stakeholders

Persons who identify as community health workers (CHWs) may hold other titles and/or certifications, including the title of patient navigator (PN). PN roles first emerged from Dr. Harold Freeman’s initiative at Harlem Hospital as a strategy to reduce disparities in access to health care, whereas CHW roles extend beyond health systems and are predominantly found in community-based organizations and nonprofits. Although CHWs’ origins in the United States predate those of PNs, the growth of CHWs’ professional identity and national representation trails that of PNs despite evidence of CHWs’ effectiveness since the 1960s. Barriers to progress have included a pattern of short-term and inequitable funding for CHW positions, a lack of employer support for participation in association business, and broad diversity in CHW roles and work settings. The National Association of Community Health Workers (NACHW) was launched in 2019 and built on earlier organizing efforts by multisector, multicultural CHWs and allies in the CHW section of the American Public Health Association and on efforts to create the American Association of Community Health Workers (2006-2009). Trends in health care financing, increasing calls for racial equity, and the coronavirus disease 2019 (COVID-19) pandemic have amplified the unique abilities and trust that CHWs apply to under resourced, marginalized, and multiethnic populations to address both the social determinants of health and health system access, cost, and quality. As a result, the NACHW has been at the forefront of efforts to improve federal funding for COVID responses, to sustain funding for CHWs and their organizations beyond the pandemic, and to drive equity in the rebuilding of public health infrastructure and the transformation of payment models and health systems. Lessons learned from this process that have implications for the oncology patient navigation field include the persistent need to reinforce the value of self-determination for the profession in matters of policy; the importance of actively cultivating unity among diverse cultural and practice groups within the profession; the essential roles of active volunteer leadership, early staffing, and substantial financial support over an extended startup period; the ongoing need for leadership development within a workforce with limited exposure to a professional association culture; the vital importance of ongoing efforts to collaborate with and build capacity among state-level CHW networks; and the value of opportunistic national collaborations in a rapidly evolving policy environment.

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