Massachusetts Board of Certification of Community Health Workers
Core Competencies for Community Health Workers

Approved by the Board, August 13, 2013

Core Competency #1: Outreach Methods and Strategies

Introduction: Outreach is the process of contacting, engaging with, and helping people to learn about and use resources to improve their health and well-being. Outreach may be conducted with individuals, groups, organizations, and at the community level. In outreach, CHWs “meet people where they are,” building relationships based on listening, trust, and respect.  This can take place in diverse settings, including where people live, work, learn, worship, socialize, play, exercise, and conduct business.  There are a variety of outreach methods, such as phone calls, in-person conversations, group presentations, distribution of print and electronic information, and social media.  Effective outreach is based on learning about community needs and strengths, knowledge about available resources, and sensitivity to personal and cultural dynamics that affect behavior and relationships.

Competency includes the ability to:

  1. Implement outreach plans based on individual and community strengths, needs and resources and developed in collaboration with others in order to accomplish assigned work or objectives.
  2. Identify and share appropriate information, referrals, and other resources to help individuals, families, groups, and organizations meet their needs.
  3. Communicate effectively with diverse individuals and groups in a variety of community and service provider settings.
  4. Adapt and employ effective, culturally responsive strategies to address targeted issues and behaviors.
  5. Initiate and sustain trusting relationships with individuals, families, and social networks.
  6. Establish and maintain cooperative relationships with community-based organizations and other resources to promote client services, care, education, and advocacy.
  7. Conduct outreach with attention to possible safety risks for self, clients, and colleagues.

Core Competency #2:  Client and Community Assessment

Introduction: Assessment is the collection, synthesis, and use of information to help understand the needs, strengths, and resources of the individuals and communities CHWs serve.  CHWs share this information with clients, professional colleagues, and community partners to help plan and carry out effective programs, services, and advocacy based on shared priorities. CHWs employ a wide range of personal attributes and professional skills in establishing trusting relationships.  They engage people in honest and often difficult discussions about health status and behavior, gain insights about needed resources and changes, and share their understanding with appropriate parties in order to help achieve desired outcomes.  Assessment is an ongoing process that, when combined with regular evaluation of progress, helps assure effective, client and community-centered care.

Competency includes the ability to:

  1. Gather and synthesize information from different sources to better understand clients, their families and their communities, including, but not limited to, performing interviews, researching community resources, and understanding dynamic issues that affect the health of the community.
  2. Assess a client's ability to function in the home environment and barriers to participate in the community.
  3. Assess barriers to accessing health care and other services.
  4. Use assessment information to develop a plan to address health and related client needs in cooperation with the client and based on client priorities.
  5. Encourage openness in helping people to identify their goals, the barriers and supports for change, including personal strengths and problem-solving abilities.
  6. Share results of individual assessments with clients and colleagues to assist in helping clients achieve their plan objectives.
  7.  Share community assessment results with colleagues, and community partners to inform planning and health improvement efforts
  8. Continue assessment as an on-going process, taking into account changes in client circumstances and the CHW-client relationship. 

Core Competency #3: Effective Communication

Introduction: Effective and purposeful communication is listening carefully and communicating respectfully in ways that help build trust and rapport with clients, community members, colleagues and other professionals.  Effective communication includes a mix of listening, speaking, gathering and sharing information, and resolving conflict. CHWs are open about their roles, responsibilities, and limits.  CHWs protect client privacy and confidentiality. They convey knowledge accurately, clearly, and in culturally aware and responsive ways.  They are able to use language and behavior that is responsive to the diversity of cultures they encounter in their work, including with community members and other professionals.

Competency includes the ability to:

  1. Be respectful and culturally aware during interactions with clients.
  2. Listen carefully, repeating back important information as necessary to confirm mutual understanding. and continually work to improve communication and revisit past topics as trust develops with client.
  3. Pay attention to expressive (non-verbal) behavior.
  4. Ask neutral, open-ended questions to request relevant information.
  5. Speak clearly and honestly.
  6. Use language that conveys caring and is non-judgmental.
  7. Explain terms or concepts whose meanings may not be obvious to clients, community members or to professional colleagues.
  8. Clarify mutual rights and obligations, as necessary, such as client confidentiality or CHW reporting responsibilities.
  9. Use written and visual materials to convey information clearly and accurately.
  10. Take care to prevent situations involving conflict.  Address conflicts that may arise in a professional and safe manner.
  11. Seek assistance from supervisors as necessary to address language barriers, personal relationships, or other challenges.

Core Competency #4:  Cultural Responsiveness and Mediation

Introduction: CHWs act as cultural mediators.  They help clients and community members interact effectively with professionals working in different organizations to promote health, improve services, and reduce disparities. Culture is defined here as beliefs, values, customs, and social behavior shared by a group of people with common identity. Identity may be based on race, ethnicity, language, religion, gender, sexual orientation, disability, health condition, class, place, profession, history, or other factors.  Organizations have their own cultures, which are often expressed in how services are delivered. CHWs encourage and help enable clients to participate in decisions that affect their lives, families, and communities.  They also educate and support providers in working with clients from diverse cultures.

Competency includes the ability to:

  1. Understand how one’s own culture and life experience influence one’s work with clients, community members, and professional colleagues from diverse backgrounds.  
  2. Understand different aspects of culture and how these can influence people’s thinking and behavior, including provider organizational culture.
  3. Demonstrate understanding that health beliefs and practices vary across distinct cultures and communities and seek assistance from supervisors if there are communication difficulties.
  4. Employ techniques for interacting sensitively and effectively with people from cultures or communities that differ from one’s own.
  5. Employ an understanding of how people’s health may be affected by social, economic, or political injustice in working with and advocating for clients and communities.
  6. Employ practices that assist service organizations and the clients and communities they serve to better understand one another’s perspectives.
  7. Make accommodations to address communication needs accurately and sensitively with people whose language(s) one cannot understand.
  8. Advocate for and promote the use of culturally and linguistically appropriate services and resources within organizations and with diverse colleagues and community partners.
  9. Understand and advocate for client self-determination and dignity.

Core Competency #5:  Education to Promote Healthy Behavior Change

Introduction: Education for healthy behavior change means providing people with information, tools, and encouragement to help them improve their health and stay healthy over time. CHWs “meet people where they are,” respecting their experience and their abilities to learn, take advantage of resources, and set priorities for changing their own behavior. CHWs work with clients, family or community members, and with 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.

Competency includes the ability to:

  1. Apply information from client and community assessments to health education strategies.
  2. Develop health improvement plans in cooperation with clients and colleagues that recognize and build upon client goals, strengths and current stage of commitment and ability to act upon health behavior goals.
  3. Understand how to use multiple techniques for helping people understand and 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, and other strategies.)
  4. Learn and convey information accurately, using culturally and linguistically accessible methods and materials.
  5. Coordinate education and behavior change activities with the care that is provided by professional colleagues and team members.
  6. Facilitate constructive discussion in informal and group settings with clients and their families.
  7. Provide on-going support and follow-up as necessary to support healthy behavior change.
  8. 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.

Core Competency #6:  Care Coordination and System Navigation

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

Competency includes the ability to:

  1. Obtain and share up-to-date information about health insurance programs and eligibility, public health and social service programs, and additional resources to protect and promote health.
  2. Provide referrals and follow-up for services to help clients access needed services.
  3. Provide care coordination, including basic care planning with individuals and families based on engagement, needs assessment, and facilitating care transitions.
  4. Provide information and support for people in using agency and institutional services.
  5. Provide support for people to follow professional caregiver instructions or advice.
  6. Inform care providers about challenges that limit the ability of clients to follow care plans and navigate the health care system, including barriers as outlined in the current version of the Americans with Disabilities Act.

Core Competency # 7:  Use of Public Health Concepts and Approaches

Introduction: The knowledge base for CHW practice is strongly influenced by the field of public health. Public health is a science-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.  CHWs, like other public health practitioners, understand that individual health is shaped by family, community, neighborhood, and wider social conditions. These conditions include education, poverty, housing, safety, transportation and other “social determinants of health.” Areas of common focus may include maternal and child health, prevention of injuries, infectious diseases, chronic diseases, and mental and behavioral health problems.

Competency includes the ability to:

  1. Recognize the role of formal and informal data in setting program priorities and targets.
  2. Engage in systematic problem solving—including engagement, assessment, information gathering, goal setting, planning, implementation, evaluation, and revision of plans and methods, as necessary—to achieve shared objectives. 
  3. Understand differences as well as connections between public health and health care.
  4. Understand how individual health is shaped by family, community, neighborhood and wider social conditions (such as education, poverty, housing, safety, transportation and environmental quality).
  5. Understand the relationship between public health and social justice.
  6. Understand public health’s emphasis on prevention and the role of policy change in preventing injury and disease, and CHW roles in prevention strategies and reducing health inequities.
  7. Gain and share basic knowledge of specific health topics

Core Competency #8:  Advocacy and Community Capacity Building

Introduction: Advocacy is working with or on behalf of people to exercise their rights and gain access to resources.  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.  Advocacy and capacity building go hand-in-hand and can help create conditions and build relationships that lead to better health.  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:

  1. Encourage clients to identify and prioritize their personal, family, and community needs.
  2. Encourage clients to identify and use available resources to meet their needs and goals. 
  3. Provide information and support for people to advocate for themselves over time and to participate in the provision of improved services.
  4. Advocate on behalf of clients and communities, as appropriate, to assist people to attain needed care or resources in a reasonable and timely fashion.
  5. Apply principles and skills needed for identifying and developing community leadership.
  6. Build and maintain networks, and collaborate with appropriate community partners in capacity building activities.
  7. Use a variety of strategies, such as role-modeling, to support clients in meeting objectives, depending on challenges and changing conditions. 

Core Competency #9:  Writing and Work-based Communication

Introduction: CHWs help promote coordinated and effective services by documenting their work activities, including writing summaries of client and community assessments.  They often present information to agency colleagues or community partners about their clients and issues they face. Generally in Massachusetts, CHWs use computer technology and communicate in English, but alternative arrangements may be made in order to utilize valuable linguistic capacities, cultural experience, and community relationships that individual CHWs may bring to their work. 

Competency includes the ability to:

  1. Organize one’s thoughts and write at the level necessary for communicating effectively with clients, other community members, supervisors, and other professional colleagues.
  2. Comply with reporting, record keeping, and documentation requirements in one’s work.
  3. Use appropriate technology, such as computers, for work-based communication, according to employer requirements. 
  4. Provide assessment results in ways that support on-going agency and community planning and program evaluation. 

Core Competency #10:  Professional Skills and Conduct

Introduction: Professional skills for CHWs include how to handle ethical challenges as they address legal and social challenges facing the clients and communities they serve.  Client confidentiality and privacy rights must be protected in the context of employer and legal reporting requirements.    Care for clients must be balanced with care for self. CHWs understand that it is necessary to be aware of one’s own emotional and behavioral responses to clients and community members and to manage personal feelings productively in order to maintain effectiveness. CHWs must be able to act decisively in complex circumstances but also to utilize supervision and professional collaboration.  They must observe agency rules and the regulations governing public and private resources while exercising creativity in helping community members meet their individual and family needs.

Competency includes the ability to:

  1. Practice in compliance with the Massachusetts Code of Ethics for Community Health Workers.
  2. Observe the scope and boundaries of the CHW role in the context of the agency team and agency policy.
  3. Respect client rights under HIPAA and applicable agency rules.
  4. Understand issues related to abuse, neglect, and criminal activity that may be reportable under law and regulation.
  5. Maintain appropriate boundaries that balance professional and personal relationships, recognizing dual roles as both CHW and community member.
  6. Seek assistance from supervisors as necessary to address challenges related to work responsibilities.
  7. Establish priorities and organize one’s time, resources, and activities to achieve them.
  8. Work proactively and creatively to identify and address client, community, and agency needs.
  9. Utilize and advocate as necessary for supervision, training, continuing education, networking, and other resources for professional development and lifelong learning for self and colleagues.

 


This information is provided by the Division of Health Professions Licensure within the Department of Public Health.