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Community Health Workers (CHWs) have been gaining attention from policymakers because of their unique role in addressing health disparities and socioeconomic drivers of disease, and because of their potential integration into the health care delivery system. To date, there has been limited research specifically describing the variation in CHWs’ roles and relationships, and how that variation relates to management, to financing, to health system integration, and to the competencies CHWs should have in different contexts.

The purpose of this report is to better understand the varied landscape; to offer categories of analysis that may help inform policy, management, and research; to explore what CHW‐health system integration looks like today; to reflect on the range of competencies that may be relevant to different CHW programs; and to explore Medicaid financing opportunities for the CHW workforce.

The report is informed by a database of 76 programs that utilize CHWs, interviews with 21 CHW program leaders and other thought leaders, and a systematic literature review. After a background and literature review, Part II of the report walks through results from our database, summarizing the structural elements of CHW programs that we believe may influence integration. This is followed by a presentation of three case studies from our database that explore how various relational elements contribute to preservation of the CHW concept in different types of integrated program models.

Part IV examines the evolution of CHW competencies and offers a framework through which to view the mechanisms, or “modes of impact”, that underlie the CHW profession. We propose additional competencies that may need to be included to address what is needed to be effective in integrated settings. Finally, Part V discusses the lack of permanent, stable funding for CHW programs and describes recent and proposed Medicaid rule changes that may provide opportunity for steady funding in a way that could enhance and broaden the CHW profession.


This report was published in: Malcarney M, Pittman P, Quigley L, Horton K, Seiler N. 2017. The Changing Roles of Community Health Workers. Health Services Research, 52(S1): 360-382. doi:10.1111/1475-6773.12657

Poster and Executive Summary also available.

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