Beyond a dedicated service corps to scale enhanced contact tracing, states should also rapidly deploy and expand the ranks of community health workers and promotores (CHW/Ps). (A promotore is a lay Hispanic/Latino community member trained to provide a range of basic community-based health education and promotion services.) As trusted public health workers who live in and share culture, language, and life experiences with the members of the communities they serve, CHW/Ps leverage unique skills, relational expertise, and a range of activities to improve health and build individual and community capacity.
Before COVID-19, federal and state regulations had started to expand the use of CHW/Ps in recognition of their effectiveness in driving positive health care and public health outcomes. While there are as few as 59,000 CHW/Ps employed across the country (only 1 for every 5,500 residents), there are number of ways they can help hard-hit communities right now. For example, CHW/Ps can organize hand hygiene stations for homeless families, provide phone and video check-ins for elderly and other at-risk neighbors, help run telehealth group visits for vulnerable patients, and accelerate social needs screening and other health care–social service integration efforts recommended by the National Academies of Sciences, Engineering, and Medicine. With the aid of geospatial software and publicly available measures of social vulnerability, state and county public health departments can deploy CHW/Ps to help reach the most vulnerable residents.
To bolster psychological first aid, social supports, and primary care services in vulnerable communities, states should immediately expand the roles and ranks of CHW/Ps.
- First, as the Penn Center for Community Health Workers has recommended, states should submit urgent Medicaid State Plan Amendments to expand the range of recognized and reimbursable CHW/P services.
- Second, as the National Association of Community Health Workers has recommended, states and local leaders should recognize and protect CHW/Ps as “essential critical infrastructure workers,” following guidance from the Department of Homeland Security.
- Next, to expand the hiring of CHW/Ps, state public health, Medicaid, and workforce agencies should leverage and braid federal funds from section 1115 waivers and National Dislocated Worker Grants, as well as funds available through the CARES Act (for example, Public Health and Social Services Emergency Fund, Administration for Community Living, Emergency Solutions Grants).