Legislative Definitions of Community Health Workers: Examples from Other States to Inform Hawai’i

Authors: Stephanie L. Cacal BA; Napualani Spock MA, MBA-PHA; Michelle L. Quensell MPH; Tetine L. Sentell PhD; and David A. Stupplebeen MPH
Year: 2019
State: HI
Website link: https://nachw.org/wp-content/uploads/2023/02/Cacal-2019-legis-examples-for-HI.pdf
Publicly Available: Yes
Certification: CHW role scope of practice, Competencies, Grandparenting language and processes, Lessons learned from other states, Role of state government
Evidence Generation: Documentation of how CHWs can work within care teams
Policy: Building partnerships, General language around CHW WD, Identifying policy expertise within state, Legislative language, Lessons learned from other states
Sustainable Financing: Engaging state partners in general

Community health workers (CHWs) have been important contributors to the health and wellness of disenfranchised and minority communities for more than 50 years in the United States. Recently the Centers for Disease Control and Prevention (CDC) recommended several policy initiatives to support and advance the CHW workforce, including formalizing a state-level definition for CHWs. Such state-wide standards can lay the groundwork for health insurance reimbursement for CHW services, help establish a professional identity, and generate cohesion among CHWs. Some states have already adopted a formal definition of CHWs. Hawai‘i has had grassroots and political movement in this direction, although no widespread, formal consensus has been reached. This paper reviews decisions in other states in formally defining CHWs in order to inform efforts in Hawai‘i. As of February 2019, data has been collected on states which have formally defined CHWs. Two independent reviewers compared the definitions used in 15 states with formalized definitions using the American Public Health Association (APHA) CHW Section definition. We found that most states built upon the APHA definition to create working definitions that were codified into law, sometimes with minor modifications for relevance to their communities. Given the widespread use of the APHA definition, Hawai‘i may also find benefit from using the APHA definition as a backbone for a state-level definition. Critically, following best practices, it will be important to take steps to ensure CHW self-determination in all aspects of the processes towards a state-level definition of and scope of care for CHWs.

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