Community Health Workers (CHW), also known throughout the state of Texas as Promotor(as), have been around for decades, and the value they bring to diverse programs has been documented extensively. Some community health workers are men, but most are women who are typically well-known leaders in their communities. Historically, they began as a volunteer workforce mostly for public health and non-profit organizations, disseminating education and resources throughout colonias along the border and other impoverished neighborhoods.

Just as health care has evolved, the same is true of the CHW para-profession. The breadth of the job functions and duties CHWs are capable of performing has also expanded. The trend has also shifted from volunteerism to full-time paid employment for CHWs. This shift began in 1999 when Texas became the first state to recognize CHW contributions and, through House Bill 1864, established a temporary committee that could make recommendations towards the training and certification of community health workers.
Since 1999, the CHW movement has grown beyond expectations. According to the 2015 annual report prepared by the Department of State Health Services’ Promotor(a) or Community Health Worker Training and Certification Advisory Committee, the number of certified CHWs has grown exponentially from 573 (2008) to 3,628 (2015). A total of 1,150 were trained or grandfathered into the program in 2015 alone.

So how many CHWs are entering the health care workforce? Texas data is not available to answer this question, but the Department of Labor has national data reporting industries with the highest levels of CHW employment include outpatient care centers, general medical and surgical hospitals, and physician offices. Texas is also listed as one of the states with the largest CHW populations, and the Texas labor market projects that the field will grow by 26% from 2010 to 2022.

Educational backgrounds for CHWs varies, ranging from on-the-job training to bachelor prepared workers. Some states, like Texas, have a mandated certification/training process. CHWs are prepared to work in health care through program specific modules geared towards identified disease processes such as hypertension, diabetes and asthma. Training CHWs to work as patient navigators and chronic disease managers is common in many health care facilities. CHWs also received motivational interviewing training along with different chronic disease management models.

One of the advantages of utilizing CHWs for health care teams is the cultural competency and humility they bring. CHWs also receive additional cultural competency, health literacy and interpersonal skill training. Natural attributes demonstrated by CHWs include being a leader in their communities. Outreach, education, recruitment and other abilities demonstrated by CHWs are characteristics of effective job functions that have made them valuable members of the health care workforce. CHW education revolves around the needs of the industry seeking to hire them. The value the health care industry is beginning to place on CHWs will propel the growth and synergy of institutions that train CHWs in order to maintain the marketability of the profession.

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Debra Flores
Dr. Debra Flores is Managing Director for T-CORE and West Texas AHEC at the F. Marie Hall Institute for Rural and Community Health in Lubbock, TX.