In California, one of the most culturally diverse states in the country, health care must bridge cultural and linguistic divides to serve all communities equitably. As trusted community members with lived experience, community health workers and promotores (CHW/Ps) have a long history of connecting those not well served by the traditional health care system with culturally competent health and social services.

There is increasing recognition in California that CHW/Ps are a critical part of the health care workforce. In 2019, the California Future Health Workforce Commission recommended scaling the CHW/P workforce to broaden access to preventive and social support services as well as team-based, integrated primary and behavioral health care.

Little is known about CHW/P employment across employer types in the health care sector in California, and little is known about why organizations choose to employ or not employ CHW/Ps. This report describes current hospital and community health center employer practices and prospective hospital and community health center employer opinions related to the employment of CHW/Ps in their organizations.

Key Findings

• A minority of hospital-based employers who responded to the survey (39%) employed CHW/Ps. In contrast, the vast majority of clinic-based employers who responded to the survey (79%) employed CHW/Ps.
• Among hospitals and community clinics that employed CHW/Ps:
  • Most hospitals and community clinics reported that their CHW/P employees worked full-time. Both hospital and community clinic employers reported that a majority of their CHW/P employees worked 32 hours or more per week.
  • Wages differed according to employer type. Hospital-based employers provided higher wages for CHW/Ps compared to clinic-based employers at both entry and senior levels.
  • Nearly all respondents had a minimum education requirement for CHW/P employment. Most hospital-based and clinic-based employers reported that the minimum educational requirement for entry-level CHW/Ps was a high school diploma.
  • Only 29% of hospital-based and 10% of clinic-based employers required CHW/P-specific training for employment.
  • Compared to hospital-based employers, clinic-based employers more often reported that CHW/Ps were strategically very important to several organizational goals.
  • Eighty-five percent of clinic-based employers reported there were opportunities for CHW/Ps to advance in the organization, compared to just 36% of hospital-based employers.
  • Both hospital- and clinic-based employers planned to hire more CHW/Ps in the next 12 months. However, hospital employers reported that if funding were not a barrier, they would ideally hire about 12 times more CHW/Ps than they planned to hire, and community clinic employers reported that they would ideally hire about three times more CHW/Ps than they planned to hire.
  • Hospital- and clinic-based employers had relatively similar concerns about the sustainability of CHW/P employment in their organizations, including funding for the role and finding and retaining qualified CHW/Ps. However, every clinic-based employer, compared to only 60% of hospital-based employers, reported sustainability concerns.
• Among hospitals and community clinics that did not employ CHW/Ps:
  • Anticipated hiring of CHW/Ps differed between hospital and community clinic employers. Nearly all hospitals reported that they did not anticipate hiring CHW/Ps in the next 12 months. By contrast, a majority of community clinics did anticipate hiring CHW/Ps in the next 12 months.
  • The perceived impact of statewide certification of CHW/Ps on hiring barriers differed according to employer setting. Few hospital-based employers felt that certification would help alleviate CHW/P hiring barriers in their organizations, compared to over half of clinic-based employers, who said that statewide certification would help with hiring barriers.

This report is part of a series that aims to paint a more complete picture of the CHW/P workforce in California, as well as challenges and opportunities related to training and employment. Explore the full CHW/P workforce series.

About the Authors

Timothy Bates, MPP, is a senior research data analyst with the Philip R. Lee Institute for Health Policy Studies (IHPS) at UCSF. Susan Chapman, RN, PhD, FAAN, is a professor of social and behavioral sciences in the School of Nursing at UCSF and is a faculty affiliate of IHPS and Healthforce Center at UCSF. Jacqueline Miller, BA, is a senior research data analyst with IHPS at UCSF and is affiliated with Healthforce Center at UCSF.