Why Kentucky Chose to Pursue Community Health Worker Certification

June 13, 2023 | Shelby Rowell

Community health workers (CHWs) play a critical role in improving public health outcomes by serving as a bridge between systems of care and the communities they serve. They are often trusted members of the communities they work in and can provide culturally appropriate and linguistically accessible health services and information to individuals who may have limited access to traditional healthcare settings.

Many states are considering certifying CHWs to ensure they have the necessary training and skills to provide high-quality care. Given every jurisdiction’s varied needs and policies, determining whether to pursue CHW certification should be discussed state-by-state.

Kentucky and Louisiana are examples of states that have taken two different approaches to supporting the CHW workforce. While Louisiana chose not to pursue CHW certification, Kentucky has opted to develop a CHW certification program. ASTHO spoke with Laura Eirich, Kentucky Office of Community Health Workers administrator, to discuss the state’s decision-making process behind implementing CHW certification and how the Kentucky Office of CHWs has maintained shared decision-making with their state’s CHW workforce.

When did Kentucky develop a CHW program within its state health department?

Kentucky has funded several programs to deploy CHWs across the state, including the first Kentucky CHW program in 1994 called Kentucky Homeplace and a CHW program that served migrant farm workers with outreach and case management services.

In 2014, the Kentucky Department for Public Health (KDPH) dedicated part-time staff to form a CHW Advisory Workgroup, which established three sub-committees (Certification, Curriculum, and Evaluation) that met monthly to draft a state CHW certification manual, core competencies, and a code of ethics. The work group brings together CHWs, representatives from state and local public health departments, federally qualified health centers, community-based organizations, universities, and other organizations who want to employ or otherwise advance the CHW workforce.

By 2017, KDPH formed the Kentucky Office of Community Health Workers (KOCHW) and hired an administrator.

What was the process for determining if Kentucky would have a certification program?

The CHW Advisory Workgroup held formal discussions regarding a potential certification program beginning in 2014. The workgroup reviewed other states’ CHW training curricula and certification processes to develop Kentucky’s draft core competencies.

In 2018 and 2019, Kentucky participated in a technical assistance project with ASTHO to renew its focus on CHW efforts. With ASTHO’s assistance, Kentucky conducted a statewide survey of CHWs to gather insight into attitudes towards the CHW profession and certification, which showed widespread interest in pursuing certification. Nearly half of the respondents identified as CHWs.

Between 2019 and 2022, KOCHW launched an approval process for CHW training organizations and instructors to be certified, as well as an official Continuing Education Unit approval process. In 2022, Kentucky’s legislature passed legislation that outlined statutory requirements for CHW certification, continuing education, certification renewal, and associated duties of KDPH. Kentucky Administrative Regulation authorized KDPH to promulgate administrative regulations for CHW certification.

How did Kentucky work with CHW groups to develop a CHW certification process?

Kentucky CHWs were initial advocates for pursuing certification. They were instrumental in helping with outreach, conducting research, and drafting a certification manual, policies, code of ethics, and core competencies. One of the top priorities of KOCHW was to ensure that the certification process was developed in partnership with Kentucky CHWs so that any resulting certification program would effectively meet their needs.

The launch of the Kentucky Association of Community Health Workers (KYACHW) provided an opportunity to connect and collaborate with more CHWs in the state. Staff from KOCHW have attended association meetings across the state to share updates and request KYACHW members to approve, deny, or suggest alternative wording or changes. For instance, we shared each iteration of the draft certification manual in-person at these KYACHW meetings and virtually to increase opportunities for feedback.

What were the benefits of certification that you identified in your discussions?

The most significant benefits and drivers of certification include the following:

• Increased recognition and respect for the profession.
• Increased confidence for individual CHWs.
• Opportunities for professional growth.
• Potential for future Medicaid reimbursement and financial sustainability of the profession.

However, it is important to note that the Centers for Medicare & Medicaid Services does not require certification as a requirement for Medicaid reimbursement; this decision is made on a state-by-state basis.

What measures do you take to ensure all interested CHWs can participate in your certification program?

Each year, KOCHW sends a survey to all known CHWs, providing an anonymous space for feedback. All formal and informal CHW feedback is cataloged, and KOCHW periodically holds discussions to dive deeper into concerns or issues. When we make changes to the CHW certification manual and process, KOCHW is transparent about the reasoning behind the changes.

It is worth noting that CHWs had (and currently have) the power to approve or reject any proposed changes. Soliciting and incorporating changes based on CHW feedback helps demonstrate that certification is for all CHWs. It’s important for CHWs to know that this is their certification and their voice matters. For example, KDPH and the CHW Advisory Workgroup suggested charging a fee for certification and renewal. KYACHW members felt it was important to assess a fee, but they decided on the price. To avoid creating a financial barrier, a fee of $50 for initial certification and $25 for renewal was decided upon by CHWs. These fees are now in the Kentucky statute.

One way to make certification more accessible was to change the GED/High School Diploma requirement to a “strong recommendation,” which allows those without formal degrees to become certified. Additionally, KOCHW does not perform background checks on applicants pursuing CHW certification, which allows those who have experience with the justice system to use that lived experience to assist others.

Did you communicate with states with existing CHW certification programs to inform your decision?

Yes! We met with representatives of several states, including Massachusetts, Texas, and Connecticut. We also learned from state and national experts, such as Carl Rush, MRP, and were fortunate to participate in two ASTHO learning communities supported by HRSA. These projects were integral to understanding the national CHW landscape, identifying best practices, and formalizing the process in Kentucky.

What advice would you give to states and territories currently assessing if a certification program is right for them?

1. Talk to your CHWs! Initiating and building relationships with existing programs and associations is essential to ensuring CHW voices are heard.
2. Take advantage of the existing plethora of resources! Talk to states and territories that have opted in and out of pursuing certification. The beauty of CHW work is that each state and territory is different, and there is no wrong path.
3. Consult subject matter experts, such as ASTHO and the National Association of Community Health Workers (NACHW) who have a wealth of knowledge and can help convene groups, identify goals, and formalize your process.

State comments have been edited for length and clarity.