Why Louisiana Doesn’t Certify Community Health Workers

May 10, 2023 | Shelby Rowell

adult-learners-classroom-setting-taking-notes.jpgCommunity Health Workers (CHWs) connect clients to resources, contribute to positive changes in a client’s health, interact with fellow community members, and provide social support. For many employers, CHWs are the best suited to engender trust and connect with hard-to-reach populations. Most states have—or are considering—CHW certification programs. A certification process can provide clear guidance on the scope of practice and the core competencies CHWs must demonstrate to obtain a formal credential.

Given every jurisdiction’s varied needs and policies, deciding whether to implement such a certification program is personal. Indeed, in some states, CHWs and their health agency partners have opted not to pursue state certification, instead focusing on alternative pathways to support workers and build career ladders.

Louisiana is an example of a state that chose not to pursue CHW certification following a process that engaged the CHW workforce in shared decision-making about how to best support and expand the workforce in the state. ASTHO spoke with Colleen Arceneaux and Jantz Malbrue from the Louisiana Department of Health to discuss why forgoing certification was the right course of action for them.

What was the impetus for Louisiana’s recent efforts to expand its CHW policies and programs?

In 2019, through SCR 70, the state legislature created the Louisiana Community Health Worker Workforce Study Committee. This committee worked on providing policy recommendations to the Louisiana Department of Health on how best to support and expand the state’s CHW program.

The committee examined major CHW policy issues, including the following:

  1. The state's definition of CHWs.
  2. Skills, roles, and competencies for CHWs.
  3. CHW training.
  4. Enhancing employer readiness to hire CHWs.
  5. Methods of tracking CHW employment.
  6. Sustainable mechanisms for financing CHWs.
  7. Whether certification is necessary if desirable in Louisiana.

Once formed, how were CHWs involved in the committee?

As written in SCR 70, the committee was required to be at least 50% CHWs, which aligns with APHA CHW leadership guidelines. The committee included CHWs from various backgrounds, including those from the Louisiana Community Health Outreach Network (LACHON), Women with a Vision, the Louisiana Office of Public Health, the DePaul Community Health Center, the Formerly Incarcerated Transitions Clinic, Volunteers of America, and Tulane University.

The committee met six times, and two subcommittees focused on training and financing met two to three additional times each. In addition, the members reviewed best practices and examined peer-reviewed literature on CHW policies. They also distributed a survey and conducted in-depth interviews with CHWs and employers.

Why did Louisiana decide not to pursue CHW certification?

After creating a database of CHWs and their employers throughout the state, the committee surveyed 65 CHWs and 37 employers and interviewed 21 CHWs and 15 employers to inform the committee’s policy recommendations. Ultimately, feedback from these meetings led us to forgo CHW certification, as CHWs and other stakeholders had concerns that certification could become a barrier to those in the workforce.

CHWs communicated that they would not be able to afford certification and believed that an employer should cover such fees. Additionally, some employers indicated they believe experienced CHWs are effective even without a formal certification. They were concerned that the certification process would take time away from CHWs’ work helping people. There were also concerns that language barriers and requiring applicants to consent to background checks could be problematic.

Instead, we found that standardizing training for CHWs would achieve many of the perceived benefits of certification. As an alternative to certification, we recommended that the CHW workgroup create a process to evaluate standardized CHW core competency training programs to ensure that CHWs receive sufficient training and support.

How do training programs in place of certification strengthen the workforce?

Many CHWs working in Louisiana are trained on the job by community-based organizations or through training programs located in other states. Additionally, the Louisiana Community Health Worker Institute and LACHON have collaborated to offer core competency training to roughly 150 people.

Louisiana does not mandate that practicing CHWs complete standardized training. However, the Louisiana CHW Workforce Coalition developed an optional application process for organizations interested in having their CHW core competency training programs certified. Members of this coalition review the organizations’ applications, which describe the program structure and curriculum, and then conduct a site visit (in-person or virtual). The coalition will then either approve or recommend changes to the curricula. A state public health agency representative is one of three review leads on the coalition. Since this process started, the coalition has certified several training programs with additional applications in the pipeline.

Without certification, how would a potential employer screen potential CHW applicants?

We found that CHWs with life experiences that allow them to connect to the community are crucial. While health-related backgrounds, clinical experience working in a healthcare setting, and being able to relate to people are important attributes of potential CHWs in lieu of formal education or professional requirements, we screen for a CHW position by focusing on the background and lived experience of applicants. We hire individuals who are unhoused, formerly incarcerated, or have other shared lived experiences with the communities and populations we are trying to reach.

What advice would you give to state and territorial health departments assessing if a CHW certification program is right for them?

What works for one state may not work for another, so it is critical to include CHWs in all aspects of the decision-making process. They may have feedback on considerations such as out-of-pocket costs for certification and recertification, the impact of time away from work, the type of trainings offered (e.g., formal exam, hands-on training, experience, hybrid, etc.), which entity/entities should conduct the trainings and continuing education, and the effects of certification versus non-certification on a CHW’s salary. By including CHWs in each step of the decision-making process and spreading awareness of the factors mentioned above, your state can determine the best course of action.

State comments edited for length and clarity.

The development of this product is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services under grant number 2 UD3OA22890-10-00. Information, content, and conclusions will be those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.