You don’t have to work exclusively with medical professionals, counselors, or politicians to improve health outcomes and address social drivers of health in the communities you serve.

Nonprofit employees, church members, care navigators in clinics, and everyday volunteers are often considered community health workers (CHWs) thanks to the impact they have on the clients they support every day. And while their skillset is immense, it’s not their credentials that set them apart and allow them to change lives, it’s their lived experience. 

Lived experience is any knowledge or expertise a CHW gains through their personal identity, culture, or background. Winning a battle with breast cancer, living (or caring for someone) with a disability, recovering from addiction, navigating the adoption process, or overcoming homelessness are all lived experiences that offer insights and empathy no training can replicate. 

Shared, lived experiences allow CHWs to break down barriers and connect with their clients and communities more deeply, making them especially beneficial to at-risk community members accessing support. And while there is no national standard for CHW certification, there are requirements and resources that current and potential CHWs can meet requirements for billing in states where eligible and improving their skills.

3 ways lived experiences improve health outcomes

There are few limits to the kinds of lived experiences that can make a community member or nonprofit worker an effective CHW. Merely sharing a gender identity, sexual orientation, or cultural background with community members qualifies as a lived experience. 

Other experiences that allow CHWs to add value to a nonprofit or community-based organization’s (CBO) efforts include:

• Shared race, ethnicity, or cultural origin
• Gender identity 
• Sexual orientation 
• Language
• Sociodemographic background 
• Pregnancy, adoption, and family planning
• Living with a disability
• Incarceration and reentering the community or workforce
• Homelessness or housing insecurity
• Domestic violence or abuse
• Substance use disorder and recovery 
• Identifying as a trans or non-binary person

But when it comes down to it, CHWs with lived experiences strengthen connection, trust-building, and advocacy between themselves or an organization and clients seeking social or health services. 

1. They build trust and rapport with skeptical community members 

For community members in the thick of a crisis or other adverse experience, one of the most common obstacles is feeling alone. Some may struggle to seek or accept help, believing professional care providers, even community health workers, CBO staff members, or volunteers can’t relate to them and therefore can’t help. 

Let’s say you work to address homelessness and housing insecurity in your community. You likely meet single parents living paycheck-to-paycheck or battling unemployment every day. These clients may initially feel shame or distrust, surrounded by people who are housed or seemingly don’t have to think about where next month’s rent is coming from. This sense of isolation prevents them from opening up or reaching out to your organization.

However, CHWs with lived experiences add authenticity, showing community members that their experiences are more universal than they realize and demonstrating a way forward or positive result made possible through education and intervention. 

2. They improve patient experiences and outcomes

Cultural sensitivity and lived experiences can make a significant difference when it comes to helping clients manage disabilities or chronic conditions. Working with CHWs who share conditions as well as cultural, religious, family, or physical attributes with community members can help CBOs and CHWs deliver more effective services. 

A 2003 trial studied the effectiveness of diabetes care and control among 186 urban African Americans with type 2 diabetes. Participants were instructed to perform their usual diabetes care on their own, with a nurse case manager, with a CHW, or both. 

After two years, the participants who worked with a CHW saw a more significant decline in blood sugar levels compared to those who worked alone. Those who worked with a nurse and a CHW saw improvements in triglycerides and diastolic blood pressure levels compared to those who worked alone. 

More recently, a 2023 report uncovered 16 random controlled trials on the impact of CHW intervention on healthcare services in the United States. Five of those trials showed a significant reduction in emergency room visits, hospitalization, or urgent care visits between 20% and 50%. And it further suggests that true connection with CHWs promotes overall health safety.

3. They drive advocacy and policy change

CHWs with lived experiences are in the best position to advocate for a client’s needs and affect policy changes that address social drivers of health. Let’s say your CBO works with elderly people in Latinx or Hispanic communities. A CHW with lived experiences in similar households or who is Spanish-speaking plays a crucial role in the effectiveness of the organization’s mission. 

For one, they can educate clients on the vocabulary and tools they need to advocate for themselves in social or clinical environments. Or they can act as translators between clients and medical staff, ensuring better care and health outcomes through clearer communication of treatment plans. 

Other CHWs tell their stories in legislative sessions and on social media to advocate for policy changes. In 2023, for example, the nonprofit Partners in Health organized a Congressional briefing to educate lawmakers on the value of CHWs and advocate for the long-term support of the CHW workforce. Organizers visited over 40 Congressional offices to engage in conversation and foster understanding of how CHWs promote health equity.

CHW continued education bridges lived experiences and professional development

Lived experiences open the door to connection, but first-hand knowledge can only take a CHW so far. Continued education and training can facilitate professional growth and development for new and long-time CHWs and community advocates. Training doesn’t devalue a CHWs experience but gives them the tools and up-to-date resources to share those experiences effectively. 

There are several avenues for current CHWs or potential CHWs who want to improve or up-level their core competency soft and technical skills. Soft skills include communication, rapport-building, leadership, public speaking, and conflict management. Technical skills include cultural competency, software, and documentation.

Along with these partners, Pear Suite offers complimentary professional training to all platform users, covering topics ranging from self-care for CHWs to navigating Medicaid billing policies. 

CHW core competencies and lived experience certification requirements

As of January 2024, community-based organizations in 24 states can file for Medicaid reimbursement, which means your organization may be eligible to bill for CHW services provided. But, in many cases, CHWs must meet Medicaid’s eligibility requirements before qualifying for payment.

Many states define “core competencies” as part of their minimum training and qualification requirements. Core competencies vary by state, but most include some form of skill in eight categories:

1. Communication
2. Relationship-building 
3. Advocacy 
4. Education, outreach, and facilitation
5. Individual and community assessment
6. Cultural responsiveness and mediation
7. Care coordination and documentation
8. Professional conduct

After that, states that certify CHWs for reimbursement all go about it differently. Overall, experience pathways make CHW certification more accessible to volunteers who may not be able to afford core competency training. 

California requirements

In California, for example, individuals or volunteers 16 and over (18 and over to qualify for Medi-Cal reimbursement) can become CHW-benefit eligible through the experience pathway or the training pathway. 

In the experience pathway, volunteers must:

• Self-attest to their lived experience.
• Provide documentation of 2,000 hours of prior work experience (employment or volunteering) in the past three years, 500 of which must be verified by an employer or other organization rep.
• Have a supervisor or organization rep attest to their proficiency in California’s core competencies.

In the training pathway, volunteers must:

• Self-attest to their lived experience.
• Provide a certificate of completion of a state-approved CHW training program no more than five years old.
• Submit proof of at least 10 hours of field experience as a supervised CHW.

Volunteers in the state can complete training programs provided by college or university-based programs or community organizations. The entry prices vary dramatically, from no-cost options to programs as high as $3,000.

Minnesota requirements

California’s experience pathway lowers the barrier to entry for people who have experienced things like incarceration. But in Minnesota, for example, their requirements can prevent volunteers with criminal records from becoming recognized CHWs. 

All volunteers must complete a training program through Minnesota State Colleges and Universities (MnSCU). Part of that program includes an 80-hour CHW internship where a student must complete a criminal background check to complete. And those who don’t have a clear background check may be barred from continuing. 

Texas requirements 

Although Texas doesn’t reimburse CHW services through its state Medicaid program, volunteers and nonprofit workers can still earn CHW credentials. Applicants must:

• Be 16 years or older.
• Demonstrate eight core competency skills.
• Complete a state-approved 160-hour CHW training program or verify at least 1,000 cumulative hours of community health worker services in the last three years.

In the Lone Star State, experience is limited to work or volunteer experience and not necessarily lived experience. 

Rhode Island requirements 

Rhode Island is well-known for having a strong CHW network. Any individual certified by the Rhode Island Certification Board (RICB) as a CHW can perform CHW services. And any certified CHW or person who becomes certified within 18 months can get reimbursed for some services through the state’s Medicaid program. 

The State of Rhode Island Department of Health lays out a four-step process for becoming a certified CHW:

1. Become a member of the Community Health Worker Association of Rhode Island (CHWARI) for free. 
2. Enroll in CHW training from groups like CHWARI, Clinica Esperanza/Hope Clinic, Community Health Innovations of Rhode Island, and even the Brown University School of Public Health.
3. Apply for CHW certification with proof of the following:
   • Six months or 1,000 hours of paid or volunteer work experience as a CHW or closely related role within the last five years.
   • 50 hours of supervised work in CHW domains.
   • 70 hours of education in nine domains: 
     • Engagement methods and strategies
     • Individual and community assessment
     • Culturally and linguistically appropriate responsiveness
     • Promote health and wellbeing
     • Care coordination and system navigation
     • Public health concepts and approaches
     • Advocacy and community capacity building;
     • Safety and self-care
     • Ethical responsibilities and professional skills
   • Submit a portfolio demonstrating activities and achievements in at least three of the following categories:
     • Community experience and involvement
     • Research activities
     • College-level courses/advanced or specialized training
     • Community publications, presentations, and projects
     • A statement of professional experience
     • Achievements and awards
     • Resume or CV
     • Performance evaluation

New York requirements

New York offers tailored CHW training programs through organizations, colleges, and universities, but does not require volunteers to be certified to work as CHWs. However, community health worker benefits for certain services are provided based on annual budgets. In cases where nonprofits and CBOs want to get reimbursed for these services, their CHWs must be certified. 

For example, in 2023, New York State Medicaid covered CHW services like health advocacy, education, and navigation for pregnant or postpartum women. To qualify for reimbursement, CHWs needed to have or meet the following criteria:

• Have lived experience in pregnancy or birth, housing status, mental health or substance use conditions, or chronic conditions
• Share the race/ethnicity/language/sexual orientation/community of those served
• Complete a minimum of 20 hours of training in CHW core competencies, and/or at least 1,400 hours of work experience as a CHW in formal paid or volunteer roles in the previous three years
• Complete basic HIPAA and mandated reporter training
• Work under the supervision of a Medicaid-enrolled, licensed provider.

CHW training powered by Pear Suite

We understand that economics can be a huge barrier to training and development, so we’re doing our part to provide free resources to CHWs. Last year, Pear Suite participated in the California Department of Health Care Access and Information’s (HCAI) statewide training program, Caring4Cal, opening training opportunities for CHWs and health workers in community-based organizations through Caring California. 

With the help of over 15 training partners, the program upskilled and empowered the workforce, developing the skill sets of over 44,000 home and community-based care providers who took over a 1 million incentivized course. 

Today, guides and free webinars are available on topics like domestic violence and the LGBTQ+ community, adverse childhood experiences, and more. And, Pear Suite offers additional on-demand resources to CHWs and others who provide community services in their area through its education arm.