The Common Indicators Project
Community Health Workers (CHWs) are trusted community members who improve health through a variety of strategies. They have been important members of the US health workforce since the 1960s. Since the passage of the Affordable Care Act, CHWs (also called Promotores/as de Salud and Community Health Representatives, among other titles) have received increased recognition for their unique ability to improve health and reduce health inequities.
There is already more than 60 years of evidence about the effectiveness of CHW programs in the US. But processes and outcomes in CHW programs have been measured in many different ways. This means we have not been able to combine data from across programs to make a strong case for the value of what CHWs do and the outcomes they achieve.
The immediate objectives of the CHW Common Indicators (CI) Project are to:
- Identify a relatively brief set of specific process and outcome indicators that can be used across CHW programs, regardless of setting and community; and
- Identify a larger set of process and outcome constructs that can be recommended for CHW research and evaluation nationally, but which cannot be collected uniformly in all settings.
To achieve the full potential of the project, we will also need to develop a sustainable system to collect, combine, and analyze data, and report results.
The long-term goals of the CI Project, and how they are related to the objectives above, are explained below.
- Increase understanding and appreciation for what CHWs do: Currently, we do not have a clear understanding of what makes CHWs so effective. Collecting consistent, carefully-chosen process indicators will increase that understanding.
- Promote more sustainable funding for the CHW profession: While we have a lot of evidence for the effectiveness of CHW programs, we can’t currently combine data across programs and regions. Collecting consistent data will allow us to combine data at the state and national levels, encouraging funders to invest in the CHW profession.
- Assure that CHWs are supported to make their very best contribution: What we measure often influences what we do. Therefore, it’s important to choose process indicators that tell us more about what CHWs do, and outcome indicators based on the outcomes CHWs are best placed to achieve. This should lead to CHWs being supported to do those activities they are uniquely skilled to do, and to focus on those outcomes they are most likely to achieve.
- Contribute to the viability of grassroots CHW programs: While some CHW programs have access to large research and evaluation budgets, many do not. Easy-to-use indicators will allow those programs to reliably report outcomes to funders, as well as contributing to the evidence base for the CHW profession.
Activities to Date
Since 2015, the project partners have done the following:
- Developed a preliminary list of 10 process and 14 outcome constructs
- Built a national constituency of over 100 CHWs, CHW program staff, and CHW researchers and evaluators who are committed to developing common process and outcome indicators
- Met regularly via phone with a growing Advisory Group to advance the project
- Obtained funding from the Centers for Disease Control and Prevention (CDC) to develop specific indicators for a set of 10 priority constructs, with broad input from stakeholders
- Presented about the project and gathered input at multiple state and national conferences
This project was funded in part with support from the Vivian A. and James L. Curtis Research and Training Center at the University of Michigan School of Social Work.
Click To View References
- Act, P. P. (2010). Public Law 111-148, 42 USC 280g-11, § 399v.
- Fedder, D. O., Chang, R. J., et al. (2003). The effectiveness of a community health worker outreach program on healthcare utilization of west Baltimore City Medicaid patients with diabetes, with or without hypertension. Ethnicity & Disease, 13(1), 22-27.
- Johnson, D., Saavedra P., et al. (2012). Community health workers and medicaid managed care in New Mexico. Journal of Community Health, 37(3), 563-571.
- Martinez, J., Ro, M., et al. (2011). Transforming the delivery of care in the post-health reform era: what role will community health workers play? American Journal of Public Health, e1-5.
- Rosenthal, E. L., Brownstein, J. N., et al. (2010). Community health workers: part of the solution. Health Affairs, 1338-1342.
- Shah, M., Kaselitz, E., Heisler, M. (2013). The role of community health workers in diabetes: update on current literature. Current Diabetes Reports, 13(2), 163-171.
- Shah, M. K., Heisler, M., Davis, M. M. (2014). Community health workers and the Patient Protection and Affordable Care Act: an opportunity for a research, advocacy, and policy agenda. Journal of Health Care for the Poor and Underserved, 25(1), 17-24.
- Sinai Urban Health Institute. (2014). Best practice guidelines for implementing and evaluating community health worker programs in health care settings. Chicago: Sinai Urban Health Institute.
- Viswanathan, M., Kraschnewski, J., et al. (2009). Outcomes of community health worker interventions. Evidence Report/Technology Assessment Number 181. Rockville: Agency for Healthcare Research and Quality.
- Walker, R. J., Smalls, B. L., et al. (2014). Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review. Endocrine, Epub.
- Whitley, E. M., Everhart, R. M., Wright, R. A.. (2006). Measuring return on investment of outreach by community health workers. Journal of Health Care for the Poor and Underserved, 17((1 Suppl)), 6-15.
Noelle Wiggins, EdD, MSPH
Co-Principal Investiagor, CHW Common Indicators Project
National Common Indicators Project Collaborative
In October 2015, a group of national experts from five states gathered in Portland, Oregon to discuss the Common Indicators Project. Building on work conducted by the Michigan Community Health Worker Alliance (MiCHWA), and under the auspices of the Oregon CHW Consortium, staff from the Multnomah County Community Capacitation Center (CCC) organized the two-day Summit to make progress on identifying a set of common process and outcome evaluation indicators that can be used by CHW programs around the US, and potentially around the world. The 16 CHWs, researchers, evaluators and program staff from five states who participated in the Summit brought both substantial experience measuring the process and outcomes of CHW programs, and new and fresh perspectives to the work. Participants reviewed MiCHWA’s common indicators work as well as CHW program and evaluation work from their states and engaged in processes leading to consensus on the following proposed list of process and outcome indicators.
National Workshop at APHA 2016
The national group continues to meet and gather data from programs across the country. In October 2016, they hosted a pre-convention workshop at the American Public Health Association’s Annual Meeting. This workshop gathered over 90 CHWs and stakeholders (including researchers/evaluators, supervisors/program managers, and other allies) together for a half day of discussions on CHW evaluation. The program team was overwhelmed by the positive response! Thanks to all who attended.