Association for Public Policy Analysis & Management

Community health workers (CHWs) foster relationships that bridge health care, social services, and communities. The U.S. Community Preventive Services Task Force has found that interventions engaging CHWs for diabetes and cardiovascular disease prevention and management are effective and cost-effective. As state public health and health care systems work towards improved care and population health and reduced health care costs, they are increasingly engaging and integrating CHWs in the delivery of health services.

Policy interventions are one tool that states have employed to help build an infrastructure for supporting the CHW workforce and its employers. Many states have adopted or are considering adopting CHW workforce development policy, pertaining to scope of practice, training, and certification. Many states are also working on policy strategies to finance CHW services through state Medicaid programs and private insurance.

To better define and understand the role and potential impact of state CHW policy, the Centers for Disease Control and Prevention (CDC) Division for Heart Disease and Stroke Prevention (DHDSP) applied a structured approach to policy analysis. The application of this approach, the DHDSP Policy Research Continuum, included: 1) early evidence assessment, 2) policy surveillance, 3) implementation case studies, 4) impact assessment, and 5) dissemination.

Completion of these steps allowed DHDSP to leverage the best available evidence to identify 14 evidence-informed components of state CHW policy; describe the evidence-informed policy components adopted to date by 25 states and D.C.; and assess, in 9 case study states, the approaches, structures, barriers, facilitators, inputs, and expected outcomes and impact from evidence-informed state CHW policy implementation. Close collaboration with subject matter experts from the field throughout the research process helped to ensure relevance of the study to current policy interventions as well as effective dissemination. Input on the study was collected from key stakeholders, including CHWs, state health departments, Medicaid offices, health care employers, and community organizations.

This presentation will describe the outcomes of each step of the DHDSP Policy Research Continuum as applied to state CHW policy, and explain how results from the completion of each step informed subsequent action. The presentation will also discuss how the iterative and adaptive approach to applying the Continuum used in this study could be used by other researchers to assess, generate, and disseminate evidence in a dynamic policy arena.