Tips for Designing Community Health Worker Training Programs

The 11 core competencies for community health workers

Although there is no “core curriculum” for community health worker training, Francis said there are some standard core competencies that he and his team aim to have trainees learn. Those competencies include:

• Communication Skills
• Interpersonal and Relationship-Building Skills
• Service Coordination and Navigation Skills
• Capacity Building Skills
• Advocacy Skills
• Education and Facilitation Skills
• Individual and Community Assessment Skills
• Outreach Skills
• Professional Skills and Conduct
• Evaluation and Research Skills
• Knowledge Base

CWHI adopted these core competencies from the C3 Project, or the Community Health Worker Core Consensus Project. These 11 core competencies have also been adopted as part of the South Carolina Community Health Worker Association’s formal list of core competency domains, Francis said.

Aspiring community health workers should walk away from training with those core competencies, as well as status as a trusted community member, passion for building interpersonal connections, and cultural humility, which Francis asserted is different from cultural competence. Cultural competence implies individuals know everything about every culture—but that’s impossible to achieve.

Cultural humility implies individuals can respond to another’s culture, not make assumptions, and use the knowledge they’ve gained to make improvements.

“Cultural humility is coming into a situation where you're working with someone and you're willing to say, hey, these are the things I know and I also know that there's plenty that I don't know,” Francis explained. “So I want to accept what you tell me is the reality and use that so that we can take steps forward. If there's something that I don't know, I would hope that you are willing to teach me.”

Building a training program timeline

Getting to that point is not a linear process; Francis said cultural humility and other competencies require considerable discussion and practice. The CHWI community health worker training includes 80 total hours of learning and 80 hours of practicum work under a preceptor. Before the COVID-19 pandemic, this training happened in person, but the organization has made a shift to virtual learning, too.

These are not mandated benchmarks, as there is no formal curriculum or training hours for community health worker training. However, this training program was designed to help aspiring community health workers to achieve the 11 core competencies through experiential learning.

Using role-plays, case studies to understand core competencies

As noted above, community health worker training much more reflects experiential learning than reading a textbook or listening to a lecture. Francis said he and his colleagues use a lot of role-playing to help trainees practice the core competencies they’ve reviewed through class discussion.

For example, the meeting that day might relate to home visits, and Francis might first lead the group through a conversation about how to manage certain situations during home visits.

“Then we might do a role-play between me and a participant or groups of participants and we all take turns,” he said. “Within that role-play and even the case study, we're going to create a situation where individuals have an opportunity to be culturally humble.”

For example, the group might role-play how to handle a home visit where the home is filled with vermin. This could be uncomfortable for the community health worker, who has a right to feel comfortable while doing her job. But community health workers also need to make their clients feel respected and be culturally humble, meaning they need to use their interpersonal skills to navigate the situation.

It's a sticky situation, Francis admitted, and that’s by design. Some trainees might give up and say they don’t know how to handle the situation, but as a trainer Francis said he likes to wait and see who can come up with a creative solution.

“Maybe it would be better if we went for a walk and talked for a little while. Let's get some fresh air, let's have a conversation,” Francis offered as one potential solution. “I appreciate you asking me to have a seat. I actually just got from being at my desk in the office. Is it okay if I continue to stand, that would make me a lot more comfortable because I have to stretch my legs,” he offered as a second recommendation.

These responses might not even work in the real world, Francis added, but the exercise pushes aspiring community health workers to think differently about how they interact with people.

“But working on ways to not tear down a person's living condition or current status, and still be able to maintain the safety that you have, to maintain the professionalism that you have in the process of doing that,” he noted.

In another role play, Francis said he might push trainees to explore how they’d react to an old friend who is upset the trainee will not engage in potentially destructive behavior, like partying, with them. Community health workers need to maintain boundaries to continue doing their jobs, but also need the trust of that community they come from, which makes this a particularly tough role-play.

“Someone might say, ‘hey, I miss being able to hang out with you too, because of the position that I have now, I'm not allowed to be in certain settings with you, and that's something set forward by my employer,” Francis suggested. “’Please know that I care about you genuinely, and I do not look down on you. That's even why I'm here now—because I care about you and I want to help you reach your health goals.’”

There aren’t always correct answers to these situations, especially because they are not perfectly replicable in the real world. But through this participatory, experiential learning model, Francis said community health workers can develop the competencies that will help them thrive when they do encounter real patient situations.