Policy Considerations for the Development and Integration of Community Health Workers in North Carolina

Community Health Workers (CHWs) are trained to address health needs within communities that have poor health outcomes due to cultural and language barriers and low socioeconomic status. The effectiveness of CHWs is attributed to their trusted relationship with the community, ability to speak the same language and present health information and services in a culturally sensitive manner. Many states are developing CHW programs through policies that build CHW infrastructure, professional identity, workforce development and financing of programs in order to decrease health care costs, improve health status, improve health care delivery and decrease health disparities among underserved, vulnerable populations. A logic model describes how the inputs of comprehensive CHW policies construct a pathway through which CHW activities are generated and the long-term outcomes of decreased health care costs, improved health status, improved health care delivery and decreased health disparities among target populations can be achieved. The logic model is used to evaluate the effectiveness of CHW interventions in two states, Massachusetts and Texas, which have developed comprehensive CHW policies. Although it is not possible to establish a direct causal link between the comprehensive policies and intended outcomes due to limited research, the evidence from the available studies conducted in Massachusetts and Texas suggest that policies that support CHW activities do promote the desired outcomes. Based on the evaluation, recommendations are presented for the development of a sustainable CHW program within the North Carolina public health and health care systems.Master of Public Healt