Higher Education Institutions Providing Curriculum

Core Competencies

Professionalism and Conduct

Professional skills for CHWs include how to handle ethical challenges facing the individual and communities they serve. Individual confidentiality and privacy rights must be protected in the context of employer and legal reporting requirements. Care for individuals must be balanced with care for self through the knowledge of professional boundaries. The CHWs must be able to act decisively in complex circumstances but also to take full advantage of supervisor support and professional collaboration. They must observe organizational rules and applicable laws and regulations governing public and private resources while exercising creativity in helping community members meet their individual and family needs.
Competency includes the ability to:

  • Practice in compliance with the Missouri Code of Ethics for Community Health Workers.
  • Observe the scope and boundaries of the CHW role in the context of the organizational team and organizational policy.
  • Respect individual rights under the Health Insurance Portability and Accountability Act (HIPAA) and applicable organizational rules.
  • Understand issues related to abuse, neglect, and criminal activity that may be reportable under law and regulation according to organizational policy.
  • Maintain appropriate boundaries that balance professional and personal relationships, recognizing dual roles as both CHW and community member.
  • Seek assistance from supervisors as necessary to address challenges related to work responsibilities.
  • Establish priorities and organize one’s time, resources, and activities to achieve them.
  • Utilize and advocate as necessary for supervision, training, continuing education, networking, and other resources for professional development and lifelong learning for self and colleagues.
  • Conduct outreach with attention to possible safety risks for self, individuals, and colleagues.
  • Use a range of outreach methods to engage individuals and groups in diverse settings.
  • List personal safety strategies.
  • Create a personal safety plan.
  • Identify and utilize coping strategies for managing stress and staying healthy.
  • Explain principles of a helping relationship.

Self-Awareness

CHWs understand that it is necessary to be aware of one’s own emotional and behavioral responses to individuals and community members and to manage personal feelings productively in order to maintain effectiveness.
Competency includes the ability to:

  • Explain how one’s own culture and life experience influence one’s work with individuals, community members, and professional colleagues from diverse backgrounds.
  • Recognize and assess how one’s personal values, beliefs, and emotional responses to situations influences how one acts and how one is perceived.
  • Recognize and assess awareness of one’s personal values, beliefs, and emotional responses and uses this information to guide one’s thinking and actions in a favorable manner.

Service Coordination and System Navigation

Coordination of care and system navigation for individuals and families means that CHWs assist licensed health care providers in the coordination of care, help people understand and use the services of health providers and other service organizations. They also help address practical problems that may interfere with people’s abilities to follow provider instructions and advice. The CHWs help bridge cultural, linguistic, knowledge and literacy differences among individuals, families, communities and providers. They help improve communications involving community members and organizational or institutional professionals. The CHWs understand and share information about available resources, and support planning and evaluation to improve health services.

Competency includes the ability to:

  • Obtain, document and share up-to-date eligibility requirements and other information about health insurance, public health programs, social services, and additional resources to protect and promote health.
  • Work collaboratively as part of a care team.
  • Assist in developing and implementing care plans, in cooperation with individuals and professional colleagues. (Care plans should be based on needs and resource assessments. Plans should describe how each party involved will help meet the goals and priorities defined in collaboration with clients.)
  • Provide care coordination, which may include but not be limited to facilitating care transitions, supporting the completion of referrals, and providing or confirming appropriate follow-up.
  • Provide support for individuals to use provider instructions or advice, and convey individual challenges to providers.
  • Provide support for people to understand and use organizational and institutional services.
  • Make referrals and connections to community resources to help individuals and families meet basic social needs.
  • Build individuals’ ability to participate in making decisions about their care.
  • Inform care providers, to the extent authorized, about challenges that limit the ability of individuals to follow care plans and navigate the health care system, including barriers outlined in the Americans with Disabilities Act.
  • Identify, document and share appropriate information, referrals, and other resources to help individuals, families, groups, and organizations meet their needs.

Education to Promote Healthy Behavior Change

Education for healthy behavior change means providing people with information, tools, and encouragement to help them improve their health and stay healthy over time. The CHWs respect people’s experience and their abilities to learn, take advantage of resources, and set priorities for changing their own behavior. The CHWs work with individuals, family and community members, and providers to address issues that may limit opportunities for healthy behavior. The CHW acts as educator and coach, using a variety of techniques to motivate and support behavior change to improve health. As new modules are developed and new information is released, CHWs stay up to date on current resources.

Competency includes the ability to:

  • Apply and document information from individual and community assessments to health education strategies.
  • Develop health improvement plans in cooperation with individuals and professional colleagues that recognize and build upon individual goals, strengths, and current abilities to work on achieving their goals.
  • Apply multiple techniques for helping people understand and feel empowered to address health risks for themselves, their family members, or their communities. (Examples may include informal counseling, motivational interviewing, active listening, harm reduction, community-based participatory research, group work, policy change, and other strategies.)
  • Coordinate education and behavior change activities with the care that is provided by professional colleagues and team members.
  • Provide on-going support and follow-up as necessary to support healthy behavior change.
  • Ensure continuity of care with health care team regarding educational needs of the individual.

Advocacy

Advocacy is working with or on behalf of people to exercise their rights and gain access to resources. Advocacy involves supporting individuals and the community by bringing awareness to issues impacting health. Advocacy and capacity building go hand-in-hand and can help create conditions and build relationships that lead to better health.

Competency includes the ability to:

  • Advocate on behalf of individuals and communities, as appropriate, to assist people to obtain needed care or resources in a reasonable and timely fashion.
  • Build and maintain networks, and collaborate with appropriate community partners in capacity building activities.
  • Promote client services, care, education, and advocacy.
  • Advocate for individual self-determination and dignity.

Individual and Community Capacity Building

Capacity building is helping people develop the confidence and ability to assume increasing control over decisions and resources that affect their health and well-being. Community capacity building involves promoting individual and collective empowerment through education, skill development, networking, organizing, and strategic partnerships. Capacity building requires planning, cooperation, and commitment, and it may involve working to change public awareness, organizational rules, institutional practices, or public policy.

Competency includes the ability to:

  • Encourage individuals to identify and prioritize their personal, family, and community needs.
  • Encourage individuals to identify and use available resources to meet their needs and goals.
  • Provide information and support for people to advocate for themselves over time and to participate in the provision of improved services.
  • Apply principles and skills needed for identifying and developing community leadership.
  • Build and maintain networks, and collaborate with appropriate community partners in capacity building activities.
  • Use a variety of strategies, such as role-modeling, to support individuals in meeting objectives, depending on challenges and changing conditions.
  • Establish and maintain cooperative relationships with community-based organizations and other resources.

Effective Communications Strategies

Effective and purposeful communication is listening carefully and communicating respectfully in ways that are meaningful to the individual. Effective communication includes a mix of listening, speaking, gathering and sharing information, resolving conflict and checking for understanding. The CHWs are open about their roles, responsibilities, and limits. The CHWs protect individual privacy and confidentiality. They convey knowledge accurately, clearly, and in culturally aware and responsive ways, and, if necessary collaboratively with an interpreter. They are able to use language and behavior that is responsive to the diversity of cultures they encounter in their work. The CHWs are able to check for client understanding of information presented.

Competency includes the ability to:

  • Be respectful and culturally aware during interactions with individuals.
  • Practice active listening and teach back techniques to confirm mutual understanding, continually working to improve communication and revisit past topics as trust develops with individuals.
  • Pay attention to non-verbal behavior.
  • Ask neutral, open-ended questions
  • Use language that conveys caring and is non-judgmental.
  • Explain terms or concepts whose meanings may not be obvious to individuals, community members, or professional colleagues.
  • Clarify mutual rights and obligations, as necessary, such as individual confidentiality or CHW reporting responsibilities.
  • Use verbal, written and visual materials to convey information clearly and accurately.
  • Address conflicts that may arise in a professional and safe manner.
  • Communicate with providers and service organizations to help them understand community and individual conditions, culture, and behavior to improve the effectiveness of services they provide.
  • Facilitate constructive discussion in informal and group settings with individuals and their families.

Cultural Responsiveness

Culture is defined here as beliefs, values, customs, and social behavior shared by a group of people with common identity. The CHWs act as cultural mediators. The CHWs improve services and reduce disparities. Identity may be based on race, ethnicity, language, religion, sex, gender identity, sexual orientation, disability, health condition, education, income, place, profession, history, or other factors. Culture also includes organizational cultures, which are reflected in how organizations deliver services. The CHWs encourage and help enable individuals to participate in decisions that affect their lives, families, and communities.

Competency includes the ability to:

  • Recognize different aspects of community and culture and how these can influence peoples’ health beliefs and behavior.
  • Recognize ways the organizational culture within provider agencies and institutions can affect access, quality, and individual experience with services.
  • Employ techniques for interacting sensitively and effectively with people from cultures or communities that differ from one’s own.
  • Support the development of authentic, effective partnerships between individuals and providers by helping each to better understand the other’s perspectives.
  • Implement accommodations to address communication needs accurately and sensitively with people whose language(s) one cannot understand.
  • Advocate for and promote the use of culturally and linguistically appropriate services and resources within organizations and with diverse colleagues and community partners.
  • Initiate and sustain trusting relationships with individuals, families, and social networks.

Documentation and Reporting

The CHWs help promote coordinated and effective services by documenting their work activities, including writing summaries of individual and community assessments accurately. They often present information to organizational colleagues or community partners about the individuals and issues they face while respecting peoples’ privacy. The CHWs need to be able to accurately document information.

Competency includes the ability to:

  • Reflect, organize and write in a way that communicates effectively with individuals, other community members, supervisors, and other professional colleagues.
  • Comply with reporting, record keeping, and documentation requirements in one’s work.
  • Use appropriate technology, such as computers, for work-based communication, according to employer requirements.
  • Recognize the importance of timely and accurate documentation to program evaluation, sustainability and to help individuals achieve their goals.

Use of Public Health/Community Health Concepts and Approaches

Public health/community health is an evidence-based discipline that focuses on protecting and promoting population health, preventing illness and injury, eliminating health inequities, and working to improve the health of vulnerable communities and populations. The knowledge base for CHW practice is strongly influenced by the field of public health/community health. The CHWs, like other public health professionals, understand that individual health is shaped by family, community, and wider “social determinants of health.” The CHWs often use their knowledge of the larger contexts of individuals’ lives to provide support for them to overcome barriers or improve conditions that affect their health.

Competency includes the ability to:

  • Use data and evidence-based practices in efforts to support individuals and communities in reaching their goals.
  • Gather and share information about specific health topics most relevant to the individual and communities being served.
  • Communicate how plans for supporting individuals, families and communities relate to wider social factors that influence health.
  • Identify health disparities related to social justice issues.
  • Promote efforts to prevent injury and disease, including those that require policy changes, and support effective use of the health care system.  
  • Promote health equity and efforts to reduce health disparities through engagement with others.
  • Engage in systematic problem solving — including assessment, information gathering, goal setting, planning, implementation, evaluation, documentation and revision of plans and methods, as necessary — to achieve shared objectives.

Individual Assessment

Assessment is an ongoing process that, when combined with regular evaluation of progress, helps assure effective, individual and community-centered care. They also gain insights about needed resources and changes and share their understanding with appropriate parties in order to help achieve desired outcomes. Individual Assessment is the gathering of information from direct communication with individuals to understand, identify and address the individual’s goals for optimal health. The CHWs facilitate health improvement planning with individuals and consult with the health care team to agree upon the plan, as appropriate.  

Competency includes the ability to:

  • Gather and combine information from different sources to better understand individuals, their families and their communities.
  • Assess barriers to accessing health care and other services.
  • Help people to identify their goals, barriers to change, and supports for change, including personal strengths and problem-solving abilities.
  • Continue assessment as an on-going process, taking into account changes in client circumstances and the CHW-individual relationship.
  • Develop and implement outreach plans in collaboration with colleagues, based on individual, family, and community needs, strengths and resources.

Community Assessment

In order to understand individual assessment, one must understand community assessment. Community Assessment is to identify barriers and resources within a community. A community assessment is necessary for advocacy and capacity building to occur.

Competency includes the ability to:

  • Gather and combine information from different sources to better understand individuals, their families and their communities.
  • Assess barriers to accessing health care and other services.
  • Share community assessment results with colleagues and community partners to inform planning and health improvement efforts.
  • Continue assessment as an on-going process, taking into account changes in client circumstances and the CHW-individual relationship.
  • Develop and implement outreach plans in collaboration with colleagues, based on individual, family, and community needs, strengths and resources.

Code of Ethics

A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community she or he serves. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support, and advocacy.

Purpose of this Code

The Community Health Worker Code of Ethics is based on and supported by the core values adopted by the American Association of Community Health Workers. The Code of Ethics outlined in this document provides a framework for Community Health Workers, supervisors, and employers of Community Health Workers to discuss ethical issues facing the profession.
Employers are encouraged to consider this Code when creating Community Health Worker programs. The responsibility of all Community Health Workers is to strive for excellence by providing quality service and the most accurate information available to individuals, families, and communities.

The Code of Ethics is based upon commonly understood principles that apply to all professionals within the health and social service fields (e.g. promotion of social justice, positive health, and dignity). The Code, however, does not address all ethical issues facing Community Health
Workers and the absence of a rule does not imply that there is no ethical obligation present. As professionals, Community Health Workers are encouraged to reflect on the ethical obligations that they have to the communities that they serve, and to share these reflections with others.

Article 1. Responsibilities in the Delivery of Care

Community Health Workers build trust and community capacity by improving the health and social welfare of the clients they serve. When a conflict arises among individuals, groups, agencies, or institutions, Community Health Workers should consider all issues and give priority to those that promote the wellness and quality of living for the individual/client. The following provisions promote the professional integrity of Community Health Workers.

1.1 Honesty

Community Health Workers are professionals that strive to ensure the best health outcomes for the communities they serve. They communicate the potential benefits and consequences of available services, including the programs they are employed under.

1.2 Confidentiality

Codes of Ethics for Community Health Workers Page 2 of 4
Community Health Workers respect the confidentiality, privacy, and trust of individuals, families, and communities that they serve. They understand and abide by employer policies, as well as state and federal confidentiality laws that are relevant to their work.

1.3 Scope of Ability and Training

Community Health Workers are truthful about qualifications, competencies and limitations on the services they may provide, and should not misrepresent qualifications or competencies to individuals, families, communities, or employers.

1.4 Quality of Care

Community Health Workers strive to provide high quality service to individuals, families, and communities. They do this through continued education, training, and an obligation to ensure the information they provide is up to date and accurate.

1.5 Referral to Appropriate Services

Community Health Workers acknowledge when client issues are outside of their scope of practice and refer clients to the appropriate health, wellness, or social support services when necessary.

1.6 Legal Obligations

Community Health Workers have an obligation to report actual or potential harm to individuals within the communities they serve to the appropriate authorities. Additionally, Community Health Workers have a responsibility to follow requirements set by states, the federal government, and/or their employing organizations. Responsibility to the larger society or specific legal obligations may supersede the loyalty owed to individual community members.

Article 2. Promotion of Equitable Relationships

Community Health Workers focus their efforts on the well-being of the whole community. They value and respect the expertise and knowledge that each community member possesses. In turn,
Community Health Workers strive to create equitable partnerships with communities to address all issues of health and well-being.

2.1 Cultural Humility

Community Health Workers possess expertise in the communities in which they serve.
They maintain a high degree of humility and respect for the cultural diversity within each community. As advocates for their communities, Community Health Workers have an obligation to inform employers and others when policies and procedures will offend or harm communities, or are ineffective within the communities where they work.

2.2 Maintaining the Trust of the Community

Community Health Workers are often members of their communities and their effectiveness in providing services derives from the trust placed in them by members of these communities. Community Health Workers do not act in ways that could jeopardize the trust placed in them by the communities they serve.

2.3 Respect for Human Rights

Community Health Workers respect the human rights of those they serve, advance principles of self-determination, and promote equitable relationships with all communities.

2.4 Anti-Discrimination

Community Health Workers do not discriminate against any person or group on the basis of race, ethnicity, gender, sexual orientation, age, religion, social status, disability, or immigration status.

2.5 Client Relationships

Community Health Workers maintain professional relationships with clients. They establish, respect and actively maintain personal boundaries between them and their clients.

Article 3. Interactions with other Service Providers

Community Health Workers maintain professional partnerships with other service providers in order to serve the community effectively.

3.1 Cooperation

Community Health Workers place the well-being of those they serve above personal disagreements and work cooperatively with any other person or organization dedicated to helping provide care to those in need.

3.2 Conduct

Community Health Workers promote integrity in the delivery of health and social services. They respect the rights, dignity, and worth of all people and have an ethical obligation to report any inappropriate behavior (e.g. sexual harassment, racial discrimination, etc.) to the proper authority.

3.3 Self-Presentation

Community Health Workers are truthful and forthright in presenting their background and training to other service providers.

Article 4. Professional Rights and Responsibilities

The Community Health Worker profession is dedicated to excellence in the practice of promoting well-being in communities. Guided by common values, Community Health Workers have the responsibility to uphold the principles and integrity of the profession as they assist families to make decisions impacting their well-being. Community Health Workers embrace individual, family, and community strengths and build upon them to increase community capacity.

4.1 Continuing Education

Community Health Workers should remain up-to-date on any developments that substantially affect their ability to competently render services. Community Health Workers strive to expand their professional knowledge base and competencies through education and participation in professional organizations.

4.2 Advocacy for Change in Law and Policy

Community Health Workers are advocates for change and work on impacting policies that promote social justice and hold systems accountable for being responsive to communities. Policies that advance public health and well-being enable Community Health Workers to provide better care for the communities they serve.

4.3 Enhancing Community Capacity

Community Health Workers help individuals and communities move toward self-sufficiency in order to promote the creation of opportunities and resources that support their autonomy.

4.4 Wellness and Safety

Community Health Workers are sensitive to their own personal well-being (physical, mental, and spiritual health) and strive to maintain a safe environment for themselves and the communities they serve.

4.5 Loyalty to the Profession

Community Health Workers are loyal to the profession and aim to advance the efforts of other Community Health Workers worldwide.

4.6 Advocacy for the Profession

Community Health Workers are advocates for the profession. They are members, leaders, and active participants in local, state, and national professional organizations.

4.7 Recognition of Others

Community Health Workers give recognition to others for their professional contributions and achievements.