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Context: It is critical to evaluate community health worker (CHW) programs to maximize effectiveness. However, there is little consensus, and structure, for how to evaluate such programs., Objective: The purpose of this study was to develop a flexible framework for evaluating components of CHW programs in community and clinical settings., Design: Semistructured interviews were conducted with CHWs and their supervisors to determine evaluation categories for the framework. A survey was then administered to pilot the framework at federally qualified health centers and community-based organizations with existing CHW programs., Setting: Eighteen federally qualified health centers and community-based organizations in Louisiana, Mississippi, Alabama, and Florida., Participants: Participants consisted of 23 CHWs and 19 CHW supervisors., Results: Interview participants directly informed the development of an evaluation framework for CHW programs. The framework consists of 7 evaluation categories: client relations, intraorganizational relations, interorganizational relations, capacity development, program effectiveness, cost-efficiency, and sustainability. Survey respondents specified best practices for program implementation for each evaluation category. Recommendations for CHW program evaluation include tailoring evaluation efforts and data collection methods to program context, using mixed-methods approaches for collecting evaluation data, and streamlining evaluation efforts with an organization's existing evaluation systems., Conclusions: The evaluation framework is a flexible and practical model for collecting information needed for monitoring and evaluating CHW programs. By relying on practitioners' perspectives, this study contributes to an evidence base for implementing and evaluating CHW programs., Competing Interests: The authors declare they have no conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc.)

Community health workers (CHWs) are recognized for bridging communities and health care systems; yet, there is limited discussion of CHWs' roles as organizational actors within and outside clinics. Individual semistructured interviews (n = 21) were conducted in 4 Gulf Coast states with CHWs and supervisors to examine the bridging function of CHWs from a community health center's perspective. Results highlight that CHWs can function as gatekeepers and ambassadors who extend the clinics' reach in the community, enhance patient access to resources, and improve organizational efficiency. This study demonstrates the value that CHWs can bring for clients and clinics as organizational actors.

Objectives: To establish a validated, standardized set of core competencies for community health workers (CHWs) and a linked workforce framework., Methods: We conducted a review of the literature on CHW competency development (August 2015), completed a structured analysis of literature sources to develop a workforce framework, convened an expert panel to review the framework and write measurable competencies, and validated the competencies (August 2017) by using a 5-point Likert scale survey with 58 participants in person in Biloxi, Mississippi, and electronically across the United States., Results: The workforce framework delineates 3 categories of CHWs based upon training, workplace, and scope of practice. Each of the 27 competencies was validated with a mean of less than 3 (range = 1.12-2.27) and a simple majority of participants rated all competencies as "extremely important" or "very important.", Conclusions: Writing measurable competencies and linking the competencies to a workforce framework are significant advances for CHW workforce development. Public Health Implications. The standardized core competencies and workforce framework are important for addressing health disparities and maximizing CHW effectiveness.

Context: Community health workers (CHWs) are an increasingly viable component of the American health system. While organizations may be interested in incorporating CHWs into the health care workforce, there are challenges to doing so., Objective: This study characterizes the successes and lessons learned from implementing new CHW programs in clinical and community-based settings in 4 US Gulf states., Design: Semistructured interviews were conducted with CHWs and their supervisors., Setting: Interviews were conducted with participants in 16 community-based organizations and federally qualified health centers located in coastal counties and parishes of Louisiana, Florida, Alabama, and Mississippi., Participants: Study participants consisted of 22 CHWs and 17 CHW supervisors., Results: Although most challenges and strategies were reported by participants working in both clinical and community-based settings, some were workplace-specific. Participants from predominantly clinical settings described the importance of strengthening organizational cohesion and coordination, whereas participants from community-based participants discussed the need for specialized training for CHWs. In both work environments, participants indicated that CHW functioning was constrained by limited organizational resources, difficulty accessing the client population, and limited knowledge regarding the CHW's scope of practice. Strategies to improve CHW functioning in both settings included investing in local partnerships, streamlining resources, prioritizing strong communication and outreach, and establishing explicit operating procedures. The majority of participants noted that challenges lessened over time., Conclusions: Evaluating successes and lessons learned in CHW work is critical to maximize CHWs' abilities to address clients' health needs and promote health in underserved communities. This study provides important insights into how to successfully integrate CHWs into the public health workforce.