Real All About it…………

Community health workers now have the recognition they deserve. Community health workers (CHWs), lay health workers trained to deliver health education to their community members, have long-been recognized by health professionals for their integral role in reaching underserved populations. Now, they have more than accolades from employers and clients to offer professional recognition—they now have recognition by the U.S. Department of Labor as an official occupation.


The occupational category of ‘Community Health Worker’ was created by the U.S. Department of Labor (U.S. DOL) in 2009 and provides occupational recognition for those health workers who are members of the communities which they serve. Such volunteer and paid health workers are referred to as “paraprofessional health workers” in the U.S. DOL recognition, and include promotores, community health workers, peer specialists, peer counselors, outreach workers, parent liaisons, and patient navigators who assist in the delivery of physical and behavioral health services.


Originally, in May, 2008, the Standard Occupational Classification Policy Committee (SOCPC) proposed expanding the occupational classification of “Health Educator” to include Community Health Workers. Since the inclusion of CHWs in the Health Educator occupation, many concerns have been expressed regarding the differences in duties and training between these two occupations. The SOCPC concurred with the concerns and offered separate occupational classifications for “Health Educators” and “Community Health Workers.” The SOCPC reported the revised occupational classifications on January 21, 2009, in the Federal Register of the Office of Management and Budget as: “Health Educators collect and analyze data, as well as plan, implement, monitor, evaluate, and manage health education programs. Community Health Workers conduct outreach for medical personnel or health organizations and may provide information on available resources.”


CHWs and their advocates spent several years working toward this recognition. The recognition provides CHWs with more than sought-after professional identity; the official classification provides additional visibility for CHWs and, potentially, greater funding for their efforts. Currently, the U.S. Department of Health and Human Services’ (U.S. DHHS) Health Resources and Services Administration (HRSA) reports that there are no official estimates of the number of CHWs in the U.S. because CHWs, lacking their own professional designation, were reported under jobs that were similar to CHW work, but not the same. Without numbers to give credence to the extent to which CHWs serve their communities, it is difficult to justify need for resources for workers. The new official recognition allows workers to be counted and, thus, may open greater opportunities for federal, state, and local entities to secure resources to support CHWs. Currently in Texas, the Department of State Health Services’ (DSHS) Office of Primary Care is exploring how to better utilize CHWs. Further, DSHS is currently working to identify barriers and address challenges that limit the expansion of the CHW workforce.


HRSA explains that national socio-demographic changes in the past decade have resulted in a greater reliance on CHWs. Population changes, increasing numbers of younger low-income families, provider shortages, and an increased need for language interpretation and cultural understanding in health care delivery have place demands on the health care system most expediently met by CHWs. CHWs are considered an effective means to delivering health care and education to underserved and isolated communities. HRSA defines CHWs as

health workers are lay members of communities who work either for pay
or as volunteers in association with the local health care system in
both urban and rural environments and usually share ethnicity, language,
socioeconomic status and life experiences with the community members
they serve. They have been identified by many titles such as community
health advisors, lay health advocates, “promotores(as),”


outreach educators, community health representatives, peer health
promoters, and peer health educators. CHWs offer interpretation and
translation services, provide culturally appropriate health education
and information, assist people in receiving the care they need, give
informal counseling and guidance on health behaviors, advocate for
individual and community health needs, and provide some direct services
such as first aid and blood pressure screening.”

(Accessed 3.11.10 at


In 2001, Texas became the only state that had a process in place to formally certify CHWs.  On November 9th,
2007, the Texas Public Health Training Center (TPHTC) at the University
of North Texas – Health Science Center in Fort Worth obtained state
certification to become one of Texas’ community health worker (CHW)
training sites.


The Texas Public Health Training Center provides training and continuing education for CHWs in collaboration with certified CHW trainers, the Texas Schools of Public Health (UNT Health Science Center, UT Houston, Texas A&M) and other partners, including: area hospitals (John Peter Smith Health Network, Baylor Health System), other academic institutions (Tarrant County College, Texas Women’s University), the City of Fort Worth Public Health Department, and community and county organizations (Workforce Solutions for Tarrant County, Dallas Concilio).


The CHW training curriculum covers eight areas of competency: Communication skills, interpersonal skills, service coordination, capacity building, health advocacy, teaching, organizational skills, and chronic diseases. CHW certification requires 160 in-class hours and a $600 fee per participant.





U.S. Department of Labor Classification:



Texas Department of State Health Services CHW training and certification:

This page was last modified on January 27, 2015