Workforce Studies

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2007 Minnesota
Community Health Worker
Work Force Analysis

Summary of Findings for Southern Minnesota

INTRODUCTION

The Minnesota Community Health Worker Project (MCHWP) is a statewide collaborative partnership of higher education, rural and urban health care systems and major payers, non-profit and government organizations whose vision and charge is to facilitate the standardization of the community health worker (CHW) profession in Minnesota. The MCHWP has succeeded in developing a process for educating CHWs and is now working through the health care system, community organizations, policy makers and CHWs themselves to establish a sustainable CHW workforce. The project seeks to serve its members, the CHW profession and the health care system on issues affecting CHWs in Minnesota.

As part of its mission to help create a stable workforce for CHWs and their employers, The MCHWP conducted the following assessment of the local CHW workforce. The objectives of the work force survey were to gather information that current and prospective CHWs, their employers and the health care system can use to gauge the CHW job market and better understand CHW employers and their expectations; to gather information CHW employers can use to develop recruiting and hiring plans; and to provide comprehensive data that, schools and employers can use to benchmark their training and recruiting activities against.

METHODOLOGY

Sixty- three organizations in Southern Minnesota completed the survey for the sample. Invitees included members of the government agencies, hospitals, community clinics, nursing homes, assisted living facilities, community-based and non-profit organizations believed to employ CHWs in the this area. The majority of respondents were human resource representatives, supervisors of CHWs or administrators. Respondents linked to an on-line survey. 

Participants

Respondents by Organization Type

By and large, government agencies (43%) and nursing homes/assisted living facilities (24%) were the most responsive participants.

KEY FINDINGS

• The job market for CHWs is strengthening and growing in the Southern Minnesota area.

• 43 fulltime and 39 CHW part time positions were identified in the course of this work force study.

• 20% of CHW employers indicated they plan to hire additional CHWs in the future. Lack of Funding was the top reason for not hiring more CHWs.

• Government agencies employ more CHWs than any other type of organization.  Government grants are the primary funding source for CHW positions across all organizations.
  • 100% of all CHWs serve non-English speaking populations. Top languages (other than English) spoken are Spanish, Somali and Hmong.

  General Questions

  • A total of 82 CHWs positions were identified in the study

  

  • 43 full-time
  • 39 part-time
  • Of this group, 20% reported they would be LIKELY to hire additional CHWs in the future.
  • 36% plan to hire in the next 6 months           
  • 21% plan to hire in the next year to year and one half
  • 54% of CHW employers will not hire additional CHWs due to a lack of funding
  • Job titles used to classify CHW positions:
  • 15% - Community Health Worker
  • 8% - Health Advocate
  • 8% - Health Educator
  • 4% - Outreach worker
  • 65% - OTHER, meaning the title was not listed as an option in the survey.

  Titles included: care coach, interpreter, social worker and Home Health Aide

  • 35% of organizations surveyed have employed CHW positions for 10 years or longer; 9% for 7-10 years; 17% for 4-6 years; 22% for 1-3 years.

  11% of respondents reported that they do not currently employ CHWs:

  • 26% of these employers indicated that they are likely or somewhat likely to employ CHW positions in the future. 
  • Employers that do not currently employ CHWs are UNLIKELY to hire CHWs in the future either because they perceive no need for this type of position at their organization (29%) or because of a lack of funding (37%).

  Recruitment Methods

  • The Local newspaper is the main recruitment vehicle (40%) used by CHW employers.
  • 25% use Online Recruitment.
  • 13.5% recruit at Community Events and Job Banks.
  • 21.5% reported they use OTHER methods not listed as options in the survey. These methods include: word of mouth and referrals from staff members.

  Percentage of recruitment methods:

  

  Qualifications

  Entry level and experienced level CHWs can be distinguished by experience, education, scope of work and wages. A high school diploma and one or more years of related experience typically qualify the entry level candidate for employment while an associates or bachelor’s degree and up to three years experience are more characteristic of an experienced level CHW.

  Prior education, training and experience qualifications vary across organizations. However, a distinction can be drawn between the requirements of candidates applying at government agencies or hospitals and those applying at community organizations and clinics. Community organizations and clinics may accept a high school diploma and one year of prior health care experience for an entry level CHW position whereas candidates applying at government agencies or hospitals are more likely to work in a specialized service area and therefore may be required to have a minimum of an associate’s degree in a related field and two or more years of related experience.

  Comments made by respondents explain that when hiring CHWs, skills also highly valued by supervisors are their knowledge of the communities they serve and their bilingual language skills.

  In the table below employers report additional qualifications required but not listed as options in the survey:

  

  Compensation: Wages & benefits

  WAGES

  Overall CHWs within all employment settings earn a median minimum salary of $14.29 and a median maximum salary of $19.18 per hour. When compared by organization type, it appears that CHWs are compensated inconsistently. CHWs employed in community organizations and non-profits are more likely to be compensated less both in salary and benefits than their counterparts working in hospitals and government agencies.

  The most significant factors affecting wages and benefits offered are the type of organization, job specialization, employment qualifications, the number of CHWs employed in the organization and whether funding is short-term or long-term. Government organizations and hospitals are more likely to have stable funding.  Conversely, community organizations and nonprofits are likely to have short-term funding (less than 3 years).

  Benefits

  Full-time CHWs:

  • 71% of CHW employers offer medical coverage and paid vacation.
  • 44% are offered dental benefits.
  • 63% are offered paid sick leave
  • 54% are offered some type of pension or 401K plan.

  Part-time CHWs:

  • 41% are offered medical insurance
  • 56% offer paid vacations
  • 51% offer paid sick leave
  • 15% are offered dental insurance
  • 32% are offered pension or 401K.

  EDUCATION & TRAINING

  Work-related Training

  Survey findings show that the majority of CHW employers are willing to invest the time and resources necessary to ensure their workers have the skills they need to be effective on the job.  Over 47% of CHW employers reported that they provide an average of 18 hours of work-related training per year. Of this group, 56% percent reported that training is held both internally and off-site.

  Listed below are the types of training provided by employers. Knowledge base, information gathering, service coordination and communication were the competencies most frequently cited by employers, suggesting that these are the skills they value most.

  • Pre-screening skills – ability to use a survey instrument to aid health professionals in the assessment of health needs and risks
  • Knowledge Base – knowledge of specific health issues.  Knowledge of health and social service systems.
  • Advocacy skills – ability to assertively act as a spokesperson or intercede on behalf of an individual or community.
  • Communication skills – appropriate use of language and terminology.  Listening and observation skills.  Oral and written communications.
  • Interpersonal skills – ability to build trust.  Ability to establish rapport and relationships.
  • Service coordination skills – ability to identify resources, provide access and make referrals to health and social services.  Ability to network and partner with service providers.  Knowledge of how to navigate the health and social service systems.  Provide consistent follow through.
  • Capacity building skills – sharing or transferring skills and expertise considered relevant to individual, group or community needs.
  • Teaching skills – ability to confidently present and share information with individuals or in group settings.  Ability to lead.
  • Organizational skills – time management skills.  Multi-tasking skills.  Ability to prioritize and complete tasks efficiently.
  • Information gathering, management and documentation – knowledge of data privacy and confidentiality laws.  Ability to collect information for health and social service providers for the purpose of accurate assessment, diagnosis and treatment.  Ability to accurately document and report client information.
  • Diversity training.

  Standardized Training

  Overwhelmingly, CHW employers agree that standardized training is important to the effectiveness of CHWs in Minnesota. In the course of participating in the survey, some employers were learning about standardized training for the first time. Most were very interested and requested more information while others were skeptical and did not see a need for it outside of training they already provide for their CHWs.

  • 59% of employers either agree that standardized training is important to the success of CHWs working in Minnesota.
  • 62% of CHW employers replied “yes” or “maybe” when asked whether or not they would send their CHWs to standardized training.
  • 6% of employers reported that they would NOT send their CHWs through standardized training for the following reasons:
    • Lack of Funds
    • Driving Distance to training

  Funding

  Not surprisingly, more than 12% of CHW employers in the Southern Minnesota area report that government grants and foundations are their primary source of funding for financing CHW positions at their organizations, while 18% indicated the position is funded internally. Over 15% of employers indicated funding for CHWs is considered short term (1-3 years), and during interviews, many expressed concern about funding issues. Government agencies are much more likely to have long-term (4 years or more) funding although they are also funded through state and federal grants. Community organizations, non-profits and community clinics are more likely to have a combination of government grants and foundation funding. While foundations are considered a major source of funding for many organizations, grants seldom extend beyond three years.

  

  SERVICE FOCUS

  Survey respondents, almost universally, reported that their CHWs work with underserved populations serving as the conduit to health care information and services. Survey finding also reveal that CHWs cover a wide range of health issues from general health promotion to specific health issues such as chronic disease management with many CHWs assisting clients or patients with multiple issues at a time.

  Key service areas:

  • CHWs educate clients on how to access and navigate the health care system.
  • CHWs promote preventative health care education and general health.
  • CHWs conduct health screenings.
    • CHWs:
      • Assist clients with managing chronic diseases such as diabetes, high blood pressure, cancer.
      • Link the uninsured to health care coverage, help with health care paperwork.
      • Work with pregnant and parenting women and their infant children.
      • Educate clients on good nutrition
      • and preventive dental services

    Populations Served & LANGUAGES SPOKEN
    
    The majority of employers reported their CHWs largely serve non-English speaking and African-American populations who face significant barriers with accessing quality health care due their economic and racial status.  According to this study, Latino and African populations represent the top two populations served by CHWs working in the area. Latinos are the primary population served and employers expect these populations to grow considerably over the next few years.

    Of the populations served Somali, Hmong, Vietnamese and Spanish were the languages of the majority of clients.

    Evaluation

    Evaluation is critical for documenting the effectiveness of CHWs, enhancing programs and sharing progress. Outcome and Goals based evaluations were used to measure the effectiveness of their CHWs and programs, with outcomes-based evaluation being the method favored by employers. It should be noted that outcomes-based evaluation is also the method most accepted by funders.

    CONCLUSION

    Low socioeconomic status, lack of health insurance, lack of culturally sensitive health professionals, immigration or refugee status, lack of transportation, and unequal treatment in the health care system are all barriers to some individuals and families accessing quality health care in Minnesota.

    As identified in this report, Minnesota Community Health Workers possess a wide range of skills and attributes that help communities in need overcome barriers to quality health care. 

    Employment:
    Employers commented that CHW skills are highly valued by supervisors because of their knowledge of the communities they serve and their bilingual language skills.  100% of all CHWs serve non-English speaking populations. 

    • 82 CHW positions were identified in this study and the job market seems to be growing.  
    • 43 of the positions are full time and 39 part time.  

    Government agencies employ more CHWs than any other type or organization and are more likely to have long-term funding for CHWs. 

    Education and Training:

    • 58% of employers agree that standardized training is important to the success of CHWs working in Minnesota. 
    • 36% of the employers would hire additional CHWs if funding were not an issue. 

    Survey findings show that the majority of CHW employers are willing to invest the time and resources necessary to ensure their workers have the skills they need. 

    Compensation:

    • CHWs earn a minimum salary of $14.29 and a maximum of $19.18 per hour.
    • 78% are offered benefits.

    Funding:

    • 15% of funding is considered short-term and many employers expressed concern about funding issues.
    • 27% of funding is considered long-term (4 or more years)

    This report has not revealed new or unknown challenges for the CHW work force. However, it confirms the need for CHW employers, the health care system, policymakers, community organizations and government agencies to focus on addressing them in order to stabilize, strengthen and increase the effectiveness of the CHWs working in Minnesota.

    Next Steps:
    The next step will be identifying and gathering information and documentation on the cost-benefit that CHWs bring to the health care system and the overall savings as it relates to meeting the needs of all Minnesotans

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