Understanding the California Community Health Worker/Promoter Workforce: A Survey of CHWs/HPs

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 promoters (ASC/P) have a long history of connecting people underserved by the traditional health care system with culturally competent health and social services.

In California, CHW/Ps are increasingly recognized as an essential part of the healthcare workforce. In 2019, the California Future Health Workforce Commission recommended increasing the CHW/P workforce to expand access to preventive and social support services as well as team-integrated primary and behavioral health care.

It is important that CHWs/SPs themselves share their experiences and express their opinions about their profession. ASC/Ps across the state and in various workplaces were asked to complete a survey between October 2021 and January 2022. This report summarizes the results and attempts to crystallize ASC/P attributes and perspectives. Given this moment, the survey brings up data regarding the work of CHWs/Ps during the COVID-19 pandemic.

Main conclusions

The vast majority of respondents were employed full-time in a paid CHW/P position. Among these respondents, key findings included:

  • The majority of respondents were women and Latinos/x.
  • The majority of respondents worked in the Bay Area.
  • Almost two-thirds of respondents’ employers required a high school diploma or less.
  • More than half of the respondents worked in a community organization and a plurality worked in a community clinic or a community health centre.
  • Almost half of the respondents were paid between $20 and $25 an hour.
  • Most respondents had completed relatively short ASC/P training (40 hours or less). Nearly 70% of survey respondents had received ASC/P training. For most of these respondents, the training was required and paid for by their employer.
  • The type of work respondents most often reported doing included identifying and referring people to community resources, as well as case management, coordination and navigation.
  • The work of a plurality of respondents did not focus on specific health conditions. Among respondents whose work focused on specific health conditions, chronic conditions and complex health or social needs were most commonly reported.
  • The work of a plurality of respondents was not intended to serve specific populations or groups of people.
  • Respondents were divided on whether they saw potential for advancement in their role as CHW/P. While most respondents saw an opportunity for advancement in their role, 49% said there was no opportunity or they were unsure of their advancement opportunities.
  • Documentation of services (i.e. documentation of services provided to clients in an electronic health record [EHR], paper medical record, or a separate record-keeping system) was an important component of the CHW/P’s role. Nearly a third of respondents spent 10 hours a week or more on documentation in an EHR.
  • The COVID-19 pandemic has increased the amount of CHW/P work conducted virtually. In the wake of COVID-19, most respondents anticipated that computer skills, general knowledge about COVID-19, and resilience would be the most important attributes to possess over the next three to nine months.

The authors note that the results are not representative of the entire CHW/P population in California. Furthermore, the survey could only be completed in English or Spanish.

Michael A. Bynum