In California, one of the most culturally diverse states in the country, healthcare must bridge cultural and language differences to serve all communities equitably. As trusted community members with lived experience, community health workers and sponsor (CHW/Ps) has a long history of connecting those underserved by traditional health systems with culturally competent health and social services.
In California, there is a growing recognition that CHW/Ps are a critical part of the healthcare workforce. In 2019, the California Future Health Workforce Commission recommended scaling the CHW/P workforce to expand access to preventive and social support services and team-based, integrated primary and behavioral health care.
Little is known about the employment of CHW/Ps by different types of healthcare employers in California, and little is known about why organizations do or do not hire CHW/Ps. This report describes current employer practices in hospitals and community health centers and the views of potential employers in hospitals and community health centers regarding the employment of CHW/Ps in their organizations.
- A minority of the hospital employers who responded to the survey (39%) employ CHW/Ps. In contrast, the vast majority of hospital employers who responded to the survey (79%) employed CHW/Ps.
- Among the hospitals and community clinics employing CHW/Ps:
- Most hospitals and community clinics reported that their CHW/P staff worked full-time. Hospital and community health employers reported that the majority of their CHW/P employees worked 32 hours or more per week.
- Wages varied according to the type of employer. Hospital employers paid CHW/Ps higher wages compared to clinical employers at both entry-level and managerial levels.
- Almost all respondents had a minimum educational requirement for CHW/P employment. Most employers in hospitals and clinics reported that the minimum educational requirement for entry-level CHW/Ps was a high school diploma.
- Only 29% of hospital employers and 10% of clinical employers required CHW/P-specific training for employment.
- Compared to hospital employers, hospital employers reported more frequently that CHW/Ps were strategically very important to multiple organizational goals.
- 85% of hospital employers indicated that there are opportunities for CHW/Ps to advance through the organization, compared to just 36% of hospital employers.
- Both hospital and clinic-based employers plan to hire more CHW/Ps over the next 12 months. However, employers in hospitals reported that if funding were not a barrier they would ideally hire about 12 times more CHW/Ps than they plan to hire, and employers in community hospitals reported that ideally they would hire about three times more CHW/ Ps set would set as planned.
- Employers in hospitals and clinics had relatively similar concerns about the sustainability of employing CHW/Ps in their organizations, including funding the role and finding and retaining qualified CHW/Ps. However, every hospital employer reported sustainability concerns compared to just 60% of hospital employers.
- Among the hospitals and community clinics that did not employ CHW/Ps:
- The likely hiring of CHW/Ps varied between hospital and community health employers. Almost all hospitals indicated that they do not expect to recruit CHW/Ps in the next 12 months. In contrast, the majority of community clinics expected to hire CHW/Ps in the next 12 months.
- The perceived impact of CHW/Ps statewide certification on hiring barriers varied by employer hiring. Few hospital employers felt that certification would help reduce hiring barriers for CHW/P in their organizations, compared to more than half of hospital employers who said that national certification would help with hiring barriers .
This report is part of a series aimed at providing a more complete picture of the California CHW/P workforce and the challenges and opportunities related to education and employment. Explore the full CHW/P Workforce range.
About the authors
Timothy Bates, MPP, is a Senior Research Data Analyst at the Philip R Lee Institute for Health Policy Studies (IHPS) at UCSF. Susan Chapman, RN, PhD, FAAN, is a professor of social and behavioral sciences in the School of Nursing at UCSF and a faculty member at the IHPS and health Center at UCSF. Jacqueline Miller, BA, is a Senior Research Data Analyst at IHPS at UCSF and is affiliated with the Healthforce Center at UCSF.