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Section 4. Training and Support

Implementation Approaches

October 2021
Authored by:
Center for Health Care Strategies
Download Resource Guide
Download Resource Guide

This section describes considerations for training CHW/Ps and organizations and supervisors, including principles and methodologies, engagement of CHW/Ps as codesigners, structure, and implementation.

For the full “Key Implementation Approaches” (PDF) section on training and supporting CHW/Ps, access the Resource Guide.

Training for CHW/Ps

Training programs for CHW/Ps range from a few hours of training to certificate programs that last a year or more at community colleges or other academic institutions. CHW/P training should include multiple distinct but interrelated levels, including training and ongoing professional development on core CHW/P competencies, specialized programs, and organizational practices and workflows.

As California MCPs develop or refine programs to include CHW/Ps as part of CalAIM initiatives, they can pursue multiple paths for training CHW/Ps. Broadly, these options include direct development and administration of training, an agreement with an external training organization to develop and administer training, or a hybrid approach that divides training responsibilities.

Regardless of what organization is administering the training, MCPs should help develop the training approach that will support a successful program and workforce, including (1) designing training curricula, with the active engagement of CHW/Ps, based on educational principles and methodologies; (2) establishing learning objectives and topics across each level of training; and (3) designing a training structure to support participants’ access to training, such as duration, modality, frequency, languages offered, and costs. For more information, see the Resource Guide (PDF).

The training has to be reflective of the CHW’s experience and what they need and the community they want to help.

—California CHW/P

CHW/Ps bring a deep knowledge of the community to their position based on shared lived experience, and training principles and methodologies should amplify this knowledge. The “popular education” methodology, which builds on the experiential knowledge of CHW/Ps and has rich historical roots, is considered a best practice in CHW/P training. Elements of popular education include (1) drawing out and centering the existing knowledge of participants, (2) connecting participants’ personal experiences with their broader social context, and (3) supporting participants in collectively taking action.

CHW/Ps should be fully engaged at every step of training design, implementation, and evaluation. When CHW/Ps serve in leadership roles in the design of training programs, they can identify learning objectives and training topics most relevant to other CHW/Ps. They can also use popular education methods to design these sessions. Effective training programs often engage experienced CHW/Ps as facilitators of training modules, as CHW/P facilitators can be strong teachers for incoming CHW/Ps.

Training can provide a supportive environment to CHW/Ps as they train with others who have or will have similar day-to-day experiences, or with organizational colleagues who may have different positions. The different mediums for training may include formal instruction in a classroom, virtual education, and one-on-one experiential mentoring, with many training programs involving a combination of these mediums. Regardless of the medium, training for CHW/Ps should be highly interactive and use adult learning theory principles to encourage active learner involvement. Moving outside the classroom, training programs can include practicum experiences that allow CHW/Ps to shadow experienced CHW/Ps.

The four levels of CHW/P training include the following:

  • Training for core CHW/P competencies. The first level of training for CHW/Ps focuses on developing and strengthening core competencies and preparing individuals to lead in their communities. Learning objectives should be designed to prepare training participants to perform at the top of their practice rather than presuming a very limited scope. For example, CHW/P roles can include coaching, home visiting, case management, and group facilitation. Core competency training can address related skills to support CHW/Ps in working at their full scope of practice across settings. Employers should identify the areas of knowledge, skills, and abilities that will support CHW/Ps’ effectiveness within their roles and ensure that trainings address each of these areas. CHW/Ps may participate in different ways in this core competency training, which varies widely in duration and scope.
  • Training for specialized programs. The second level of training concentrates on specific program focus areas, with learning objectives and topics tailored to the skills required for distinct program and population needs. MCPs will likely emphasize training modules focused on foundational knowledge about Medi-Cal and CalAIM, as well as on knowledge areas and required skills to provide services under the ECM and ILOS benefits. For CalAIM, trainings should focus on the needs of populations prioritized for ECM or on specific requirements of MCPs related to ECM and ILOS. CHW/Ps have had a growing presence as part of behavioral health teams and in working across primary care and specialty behavioral health settings with people with behavioral health needs. As one example, specialized curricula to prepare CHW/Ps to support integrated physical-behavioral health care in primary care settings may include topics such as an overview of behavioral health conditions, use of screening tools, skills for collaborating with behavioral health clinicians, training in activity planning (an evidence-based treatment of depression), and strategies to combat stigma.

Related Resource IconRELATED RESOURCES: Required elements for CalAIM ECM and ILOS can be found in the Model of Care Template (PDF). Appendix C in the Resource Guide, “CHW/Ps in CalAIM’s Enhanced Care Management and In Lieu of Services,” provides a model of care crosswalk that maps core service components to CHW/P roles.

  • Training on organizational processes and workflows. The third level of training focuses on supporting CHW/Ps to be effective within the policies and protocols of their employing organization and any contracted partners. At this level, CHW/Ps can receive training on topics such as the roles of the interdisciplinary team within their organizations, including communications protocols to share information about members; a broad overview of managed care operations and policies, including an overview of how members receive care and how this care is paid for; and organizational safety protocols and reporting dangerous behaviors, especially as they relate to home visits. Employing organizations will often directly provide this training, since it is specific to the role and setting. Training can be supported through on-the-job mentorship by existing CHW/Ps to support new CHW/Ps in understanding best practices through practical experience. While training on organizational processes will usually be conducted at the beginning of employment, refresher training will be necessary when organizational practices are adjusted.
  • Continuing education and professional development. Finally, employers must provide ongoing professional development opportunities and supplemental trainings to ensure CHW/P skill and competence development, respond to emerging issues or changes affecting workflows, and support CHW/Ps’ growth in their positions and commitment to their organizations. CHW/Ps can collaborate with supervisors to identify trainings of interest for ongoing education. Employers can also solicit CHW/P input during ongoing professional development opportunities to invite CHW/P ideas for continuous quality improvement, or feedback on proposed workflow changes. CHW/Ps work in environments that can rapidly change due to factors such as public health emergencies and new laws and regulations. When emerging best practices for CHW/Ps evolve quickly to address changes in the landscape, professional development can support CHW/Ps and their organizations in adapting to these changes. For example, CHW/P professional development during the COVID-19 pandemic supported CHW/Ps in quickly responding to the rapid scaling up of virtual visits.

Organizations that employ CHW/Ps can either directly develop and administer each level of training for CHW/Ps and other organizational staff, or they can contract with external entities to lead these trainings. Different approaches may work better for the diverse types of training for CHW/Ps and for their organizational staff and supervisors.

  • MCPs may hire an external training organization to develop and administer trainings on core competencies and specific program or population characteristics. This could include partnering with an academic institution or CBO with expertise preparing CHW/Ps, providers, or health care organizations such as ECM and ILOS providers.
  • MCPs may extend some of their existing generalizable training to CHW/Ps working within these programs. However, given the importance of training specific to the CHW/P to support this workforce, MCPs should carefully consider whether they have the internal knowledge and capacity to develop CHW/P core competency trainings. A CBO or FQHC that employs CHW/Ps and contracts with an MCP may have strong internal expertise and experience in developing and facilitating CHW/P training, as well as the infrastructure to lead a standardized curriculum for a newly hired CHW/P workforce.

CHW training must include on-the-job training, and there are different entities that can provide this training, from community-based organizations to CHW entities to universities. MCPs need to be involved in the training of CHWs, whether by leading it or partnering with the other organizations.

— Lakshmi Dhanvanthari, Health Plan of San Joaquin

Training for Organizations and Supervisors

To ensure that CHW/Ps are effectively supported, organizational training must extend beyond CHW/Ps and include interdisciplinary teams. Organizational training should ideally take place before the hiring process so that managers, department leads, and interdisciplinary team members fully understand core CHW/P competencies, their strengths in working in communities, and best practices in CHW/P integration and support. Participants in these trainings will likely develop a greater understanding of which barriers may cause challenges for CHW/P programs — and can adjust their workflows and identify solutions. For more information, see the Resource Guide (PDF).

  • Organizational readiness for introduction of CHW/Ps. Before launching new programs, employers need to assess their readiness and identify areas to be addressed in training. Organizational readiness for CHW/P programs includes developing the structures, supports, and workflows to integrate CHW/Ps, as well as identifying training needs for employer organizations and leadership. MCPs will need to assess their cultural and organizational norms and evaluate whether specific practices — such as employee performance management — must be adapted to ensure optimal integration and impact of CHW/Ps. As one example of a training program designed to support effective CHW/P integration, Promotores Academy offers an organizational readiness training to supervisors, leadership, and team members who work with CHW/Ps. This training is customized around the needs of each organization and includes background on CHW/Ps and their value, guidance on integration and maximizing CHW/P competencies, resources to support role delineation, and evaluation and assessment of CHW/P integration.
  • Learning objectives and topics. The learning objectives for CHW/P organizational trainings will help establish a strong foundation for CHW/P integration. Trainings for organizational staff and leadership should cover core topics such as the history and value of CHW/Ps, competencies and roles of CHW/Ps, strategies for integration of CHW/Ps within programs and across teams, and key principles such as anti‑racism, health equity, and implicit bias.
  • Training structure and facilitation. Organizations should consider the value of broad participation in CHW/P trainings by organizational staff, including the full interdisciplinary team engaging with CHW/Ps and organizational leaders. Other recommended practices include (1) engaging CHW/Ps in the development of the training and as presenters to ensure that the voices and skills of CHW/Ps are elevated; (2) training all staff working with CHW/Ps on the importance of creating a safe environment, including through a trauma-informed approach and empathetic listening; and (3) aligning training with comprehensive changes in workflows and processes so that CHW/Ps can work to the top of their capabilities. Training staff across multiple levels of an employer organization on the role of the CHW/P will help create buy-in, which is critically important for developing an effective interdisciplinary team. In-depth descriptions of the specific responsibilities of CHW/Ps — and the members they will engage — will also bring clarity for other staff in understanding this role. As CHW/Ps often spend most of their time in the field, organizational staff will rely on this initial training to illuminate the day-to-day work undertaken by CHW/Ps.
  • Training for CHW/P supervisors. Supervisors should participate in training that addresses the unique roles, backgrounds, and care settings of CHW/Ps. “Supportive supervision” is an effective approach for managing CHW/Ps. Training in trauma-informed supervision and strength-based supervision may prepare supervisors to effectively support this workforce and respond to challenges such as stress and burnout. Because supervisors will be responsible for managing CHW/Ps and supporting integration onto interdisciplinary teams, their training on CHW/P roles and workflows must be comprehensive. CHW/P supervisors should also participate in some portion of the CHW/P training sessions, as well as organization-level training. Additionally, CHW/P supervisors will benefit from ongoing performance reviews and professional development to grow their management skills and to support CHW/Ps in responding to changing environments and workflows. Having supervisors shadow or “walk in the shoes” of CHW/Ps can help supervisors develop a nuanced understand of the role and will strengthen the ability of supervisors to effectively support CHW/Ps. CHW/Ps should also have access to leadership and managerial training for advancement into CHW/P supervisor roles.

It’s important for staff to understand that CHWs spend most [of their] time out in communities. They may think that if we’re not in the building we aren’t working, but that is not the case.

—California CHW/P