Introduction
The indicators proposed below rest on the following set of assumptions:
1. CHWs1 will be responsible for (i.e. involved in) collecting the data for many of these indicators. This is true, for example, of indicators that are included in
pre-post surveys/assessments with participants.
2. When they are fully disseminated for use to programs, the indicators will be accompanied by a manual that will include further explanation of the meaning
and intent of each indicator, so that those who collect the data are able to interpret them in culturally-centered ways.
3. We are proposing quantitative indicators because they are easiest to implement in a consistent and reliable way. We recommend that these indicators be
used along with qualitative methods that are specific to the culture/community and setting.
4. Whenever possible, we recommend that indicators be operationalized in existing data collection and/or case management tools, to reduce the burden on
CHWs and data management staff.
5. When we recommend an indicator be collected on a CHW Encounter Form, that can occur either on paper or via an online case management database like
RedCap, CareScope, ETO, SMART Sheets, etc.
6. Assessing CHWs’ contributions to improving population health (e.g. with community-level indicators) is crucial. However, it is beyond the scope of most or all
CHW programs to do that on their own; for this reason, among others, we are not recommending community-level indicators. We are, however,
recommending collection of a participant general health indicator (Indicator #6, below).
7. Many things are beyond the immediate control of the CI Project, such as the multiple titles used for CHWs. However, if we collect these data systematically,
some things should become more consistent, such as CHW job descriptions that are based on the APHA definition and the 10 core roles as identified in the
C3 Project.
8. For collecting initial assessment data, some CHW programs use Intake Forms, some use a pre-assessment, and some use both. Any of the participant
outcome indicators that we recommend for inclusion in a pre-assessment could also be included in an Intake Form, as long as that same indicator is
repeated at regular intervals to assess change
9. Along with assessment and assurance, policy development is one of the three core functions of public health (https://www.cdc.gov/nceh/ehs/10-essential-
services/resources.html). As essential public health professionals, Community Health Workers also engage with their communities in developing policies that
promote health, prevent disease, and ameliorate existing health inequities.
10. We acknowledge the importance of health care utilization and cost measures; however, it is impossible to create or identify one utilization measure that will
work in all cases, especially because not all CHW programs have access to this data.
NOTE: The indicator grid below includes the construct, its definition, a rationale for measuring that construct in programs that employ CHWs, and how to
operationalize the construct. To learn how to measure the construct, highlight the name of the construct and click on “open hyperlink.” This will take you to a
place lower down in the document where the measurement approach is explained.
Examples of “sustainable” CHW payment mechanisms:
- Medicaid Section 1115 Demonstration Waivers
- Dual Eligible Programs (individuals eligible for both Medicare and Medicaid)
- Medicaid State Plan Amendments (SPA)
- Managed Care Organization (MCO) Contracts
- Voluntary coverage by private health plans
- Alternative Payment Structures (bundled payments, supplemental enhanced payments, risk contracts)
- Internal financing by providers in anticipation of return on investment
- Federally Qualified Health Centers (FQHC) Prospective Payment Systems
- State general funds
- State tax millage
- Blended or braided funding (a mix of all of the above)
