Community Health Worker

ABSTRACT:

Poor quality housing is an ongoing environmental injustice placing a significant burden on low-income and minority families. The Green & Healthy Homes Initiative (GHHI) in Baltimore, MD, grew out of the historical healthy homes work of the Coalition to End Childhood Lead Poisoning, an organization dedicated to using housing as a platform for health to ensure environmental and socialjustice for families and children in low-income communities. GHHI’s Healthy Homes Demonstration Project utilized the standards and practices created by GHHI: A Holistic Housing Assessment coupled with environmental health education and combined as an integrated environmental health and energy housing intervention for children with asthma, ages 2–14. The project braids resources from healthy homes, lead hazard reduction, weatherization, and energy efficiency projects to form a single multi-component, multi-factorial intervention. Findings from the health surveys at intake and six months after the intervention provide evidence of the impact on the reduction of asthma symptomatic episodes, emergency room visits, and hospitalizations, while showingimprovementsin school attendance and parents’ work attendance. Findings will provide evidence that improved health outcomes and more stable and productive homes in primarily African American, low-income neighborhoods are related to the mitigation of asthma triggers and home-based environmental health hazards. Upstream integrated housing interventions are an effective means to improve health, economic, and social outcomes for children diagnosed with asthma.

State CHW Programs

Legislative Tracking

ASTHO's State Health Policy team tracks and analyzes legislation across the states to identify trends and emerging issues impacting public health and state health agencies. Real-time state legislative tracking on Community Health Workers is available on this web page under "Licensure and Certification".

Click here for a map of the current status of state CHW certification standards, a chart illustrating what states have which program requirements/elements in their CHW law, and chart outlining the summaries of each state’s CHW certification bill as of December 2014.

Low-income adults with uncontrolled asthma saw both their asthma control and quality of life improve with the help of an in-home, self-management asthma support program delivered by community health workers (CHWs), according to a report published online by JAMA Internal Medicine.

Asthma affects 24.6 million American, including 17.5 million adults. Control of asthma is inadequate despite the availability of effective methods to manage it. Home-based self-management support to improve asthma control among children is well established. However, the effectiveness of home visits for adults has not been well studied.

James Krieger, M.D., M.P.H., of Public Health-Seattle and King County, Washington, and co-authors report on the Home-Based Asthma Support and Education trial (HomeBASE). The study enrolled 366 participants with uncontrolled asthma: 189 to usual care and 177 to the intervention, which included CHWs who provided education, support and service coordination during home visits. The CHWs provided an average of 4.9 home visits during a one-year period.

The intervention group had greater increases in the average number of symptom-free days over two weeks (2.02 days per two weeks more) and quality of life as measured on a questionnaire increased an average of 0.50 points. However, average urgent health care use episodes in the past 12 months decreased similarly in both groups from an average of 3.46 to 1.99 episodes in the intervention group and from an average of 3.30 to 1.96 episodes in the usual care group.

“We anticipate that this intervention could be readily replicated by health organizations serving diverse, low-income clients, suggesting that it could reduce asthma-related health inequities. Intervention protocols can be implemented without specialized training or resources. The cost per participant was approximately $1,300 (2013 U.S. dollars), substantially less than one year’s supply of an inhaled corticosteroid,” the study concludes.