CHW/P/R Training Program Best Practices Framework

Framework Categories#

1. Training Philosophy and Method
2. Core Competencies
3. Training Structure
4. Training Program Transparency
5. Training Instructor Qualifications
6. Training Format
7. Training Participant Assessment
8. Training Enrollment Requirements
9. Training Fees and Costs
10. Training Program Evaluation
11. Training Organization Credibility and Qualifications
12. Other Good Practices

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1. Training Philosophy and Method#

• Value and build on the real-life experience CHW/P/Rs bring from their life, work, and communities.
• Base the training on respect and cultural humility. This means being open to learning from others’ cultures and always giving credit when using different cultural ideas or practices.
• Adapt the training to each person’s language needs. Consider their reading level, technology skills, and preferred way of learning. This ensures training remains accessible to everyone.
  • If training can’t be in the local community language, support CHW/P/Rs to translate lessons and materials into their own language or dialect.
• Use interactive learning methods rather than relying on lectures. These could include:
  • Discussions
  • Practice conversations (role-plays)
  • Mock situations (simulations)
  • Real-world examples (case studies)
  • Projects
  • Job shadowing
  • Learning with peers

These activities can help build skills and understanding in a practical way.

2. Core Competencies#

• Training should cover the 11 core skills described in the National C3 Council’s competencies. This guide outlines what CHW/P/Rs should know and do.
• Training should cover the main C3 sub-skills. It should also cover additional sub-skills suggested by community and training partners. These skills are listed on the table below.
• Programs can decide how much detail to teach for each skill. This choice depends on community needs and the roles of CHW/P/Rs. Some programs may teach certain skills in greater depth than others.
• Teach these skills in ways that fit the local culture and region. Consider the context of the CHW/P/Rs and their communities

C3 Core Skills	C3 Sub‑Skills	More Sub-Skills
1. Communication skills (How to share and receive information clearly)	– Active listening (paying close attention and showing understanding) – Documentation (writing down important information clearly)	– Trauma-informed communication (being mindful that people might have past trauma and choosing words carefully) – Documenting accurate and relevant information (writing down important details correctly)
2. Interpersonal and relationship‑ building skills (How to build trust and positive connections with others)	– Motivational interviewing (a way of talking that helps people find their own reasons to make healthy changes) – Conflict management and resolution (helping people work through disagreements) – Cultural humility (being open to learning about others’ cultures and experiences) – Coaching and support (helping people build skills and confidence)	(No “more sub-skills” for this category)
3. Service coordination and navigation (Helping people find help, solve problems, and use health and social services)	– Identifying barriers to care (understanding what gets in the way of getting care) – Coordinating care (helping people get resources, overcome problems, and get referrals) – Case management (following up, keeping track of care, and checking referral results)	– Working with teams from different fields (public health, social services, health care) – Understanding how to navigate federal, state, and Tribal health systems
4. Capacity building (Helping people and communities build skills. They gain confidence and power to improve their own health.)	– Community organizing (bringing people together to solve shared problems and take action)	(No “more sub-skills” for this category)
5. Advocacy (Supporting people and communities so they can speak up for their needs and rights)	– Speaking up for individuals and communities (helping people share concerns and ask for what they need)	– Understanding policy advocacy basics (learning how laws, rules, and decisions are made, and how to participate in that process)
6. Education and facilitation (Teaching people and helping groups learn in clear, supportive ways)	– Empowering, and learner‑centered teaching (Teaching that builds people’s confidence. It focuses on their needs, questions, and goals.)	– Culturally competent and whole person–centered care (understanding a person’s culture, experiences, and full life situation when providing support)
7. Individual and community assessment (Collecting information to understand a person’s needs. This also helps CHWs learn about the conditions in their community.)	(No sub-skills for this category)	– Gathering and documenting community concerns (listening to community members and writing down their health‑related concerns clearly) – ACEs screening (Looking for Adverse Childhood Experiences [ACEs]. These are hard or traumatic events from childhood. They can impact health and need for services. Ask questions to find these experiences.)
8. Outreach skills (Finding people who need help and staying connected with them)	– Case finding (actively looking for people who may need services) – Recruitment (inviting people to participate in programs or services) -Follow up (checking in to see how people are doing) – Keeping a resource directory (creating or updating a list of local services and contacts)	– Doing outreach in the community. Outreach in the community can happen at health fairs. It also takes place at local events and Tribal cultural gatherings.
9. Professional skills and conduct (How to act responsibly, safely, and ethically at work)	– Ethics, HIPAA, and confidentiality (following rules to protect people’s private information) – Setting boundaries and practicing self-care (managing stress and using healthy coping tools) – Reducing secondary trauma (protecting yourself when helping people who have experienced trauma) – Personal safety (staying safe while working in the field or community) – Lifelong learning (continuing to learn and grow professionally) – Workplace conduct (knowing how to handle disagreements respectfully) – Basic technology use (being able to use computers, phones, or other digital tools needed for work)	– Understanding scope of practice (knowing what tasks CHW/P/Rs are allowed to do in their role) – Basic computer and digital skills (using email, online tools, and simple software)
10. Evaluation and research (Basic skills for understanding what works and why, using simple data and observations)	(No sub-skills for this category)	– Basic evaluation and research methods (simple ways to collect information and understand whether programs are helping people)
11.Knowledge base (Basic information CHW/P/Rs need to understand health issues, systems, and communities)	– CHW/P/R field, history, and role (how the profession began and what CHW/P/Rs do) – Introduction to public health. Public health focuses on how communities stay healthy. It also examines how health systems work to support this. -Basics of US health programs including Medi-Cal and Medicare. Medi-Cal is California’s Medicaid. Medicare is federal health insurance. There are also social services programs. They help with food, housing, and income support. – Social determinants of health are everyday factors. They are housing, food, transportation, and safety. These factors affect health. Health disparities are differences in health. They happen because of unfair conditions. – Important health issues that CHW/P/Rs may encounter including: -Emotional and mental health needs -Chronic diseases (long-term illnesses) -Infectious diseases (illnesses from germs), like COVID-19 – Health behavior change (supporting people as they try to make healthier choices and form new habits)	– Trauma-informed care basics (understanding how past trauma can affect health and how to offer support safely) – Emotional and mental health basics(understanding common mental and emotional health needs) – Chronic diseases (long‑term health conditions like diabetes and heart disease) – Infectious diseases (illnesses caused by germs, like COVID‑19) – Social determinants of health (conditions like housing, food access, transportation, and environment that affect health)

3. Training Structure#

Training structure includes the following:

• Length of training
• Fieldwork (supervised practice)
• Specialty training
• Continuing education (learning after foundational training)

CHW/P/R training can happen in different settings. It can happen in the community, colleges, universities, health plans, or at workplaces. Training in these settings may be of different lengths, have different goals, and use different training styles. All are important to help meet the needs of different communities. Although training programs may differ, the following best practices can apply across all:

• Provide at least 80 hours of training for CHW/P/Rs to get a certificate of completion. This training should include the topics described in Section 2, “Core Competencies.” It should have supervised field work. It also should have specialty training. Training programs can customize the curriculum to best serve the needs of the community.
• Fieldwork is key in CHW/P/R training. It should last long enough to be valuable for employers. Ideally, CHW/P/Rs should be paid, to encourage participation in fieldwork. Fieldwork can include time CHW/P/Rs spend working in the community after training. This is fine as long as it’s supervised. This supervision can include check-ins, co-visits, or group case conferences with an instructor from the training organization. Best practice fieldwork should involve hands-on experiences that reflect what CHW/P/Rs do in real life. This could include simulation labs, shadowing partners, community-based organizations or health plans, and virtual or in-person service delivery. Training organizations should give clear guidelines to fieldwork sites and supervisors. This should include giving clear goals, tasks, responsibilities, guidance for how to track hours, and how to test CHW/P/R fieldwork performance.
• Organizations employing CHW/P/Rs should provide, or refer out to training programs to provide, at least six hours of ongoing professional development annually, following foundational training. This additional education may be provided in person or virtually depending on topic. Sample best practice topics in ongoing professional development include the following:
  • Education on a specific topic needed to respond to a new community need
  • Additional education, training, or degrees to advance in the CHW/P/R field
  • Additional specialty training to meet a specific need in the community (e.g., chronic disease, behavioral health, substance abuse)
  • Peer-based learning with other CHW/P/Rs about best practices
  • Additional training recommended by a supervisor
  • Knowledge about changes in government rules, laws, guidance, or practices
• CHW/P/R employers and training programs should offer ongoing professional development for all CHW/P/Rs. This includes CHW/P/R employees, contractors, co-op members, and those not working. This helps all CHW/P/Rs learn, grow, and serve their communities. It also helps them progress in their careers.

4. Training Program Transparency#

• Clearly state what the training covers. Include content covered and training hours. Share clear expectations for fieldwork, learning, and assessment. Clearly state which jobs the training prepares graduates for. This helps CHW/P/Rs see how the training fits their personal and professional goals and makes smart choices.
• Hold an orientation for participants before training starts. Use the time to clearly explain requirements, how digital tools will be used, and what assignments to expect. This helps participants understand the time and effort needed to finish the training.
• Be clear about career services available. This could include job placement help, career counseling, and further education opportunities in fields like nursing, primary care, behavioral health, public health, and social work. Share information about networking and connecting with employers. Where possible, share sample CHW/P/R job descriptions, typical wage ranges, and advancement pathways. All this can help CHW/P/Rs find jobs and plan their career after completing the training.

5. Training Instructor Qualifications#

• Conduct trainings led or co-led by experienced CHW/P/Rs. They should have lived experience related to the community being served. Pair the CHW/P/R instructors with the right co-leads based on the setting. In academic settings, pair them with faculty. In clinical settings, pair them with clinicians. In public health, social services, and other health settings, pair them with the right providers.
• Instructors should have some experience with training methods such as:
  • Adult learning
  • Popular education (a teaching style that helps people learn from their own life experiences).
  • Participatory learning
  • Experiential learning
  • Trauma-informed approaches
• Ensure CHW/P/R instructors model the above approaches in their instructional approach.
• Ideally, CHW/P/R instructors are proficient in the language in which the training is provided.
• Instructors should stay current on developments in public health and community health. They should also know about social factors affecting health. This helps them see trends and support CHW/P/Rs in facing new health challenges.
• Engage CHW/P/Rs in the development of training curriculum.
• Regularly update the training curricula with feedback from CHW/P/Rs and their experiences in the community.
• Evaluate instructors at least annually for quality and consistency of performance. This could include self-evaluations, and feedback from participants, peers, and supervisors. Pair these evaluations with coaching and support to help instructors grow.
• When helpful, programs should invite guest speakers or experts to teach about specific topics.

6. Training Format#

• Some parts of the training should happen in person. This allows instructors to see how well CHW/P/Rs understand the lessons and integrate the skills. Fieldwork and hands-on practice should be in person.
• Some parts of the training should also happen online. This makes training more accessible and allows CHW/P/Rs to practice providing services online:
  • Online classes allow CHW/P/Rs to participate while working or taking care of family. For example, training programs could hold online classes on weekday evenings and in-person classes on weekends.
  • More CHW/P/R work now happens online or by phone, such as helping clients by phone or doing online outreach. Online training helps CHW/P/Rs learn these skills.
• Training programs should consider local community needs when deciding whether to offer online training. Some communities, especially rural ones, may not have good internet service. In those cases, online training may not work, and training should be held in person. Since travel distances in rural areas can be long, hold in-person trainings near where CHW/P/Rs live.
• Provide extra help for CHW/P/Rs less comfortable with technology. This could include help accessing the internet. Or using the digital tools needed to participate in online training.
• Use live classes, in person or online, for real-time practice in:
  • Motivational interviewing
  • Communications skills
  • Learning how to build relationships
  • Sharing and building on participants’ skills, knowledge, and cultural background
  • Working together as a group, practicing, and learning from mistakes
  • Learning from peers
• Programs should limit the use of asynchronous methods such as recorded or self-paced lessons for:
  • Self-study
  • Reviewing materials
  • Taking quizzes
  • Engaging with peers on discussion boards
    

7. Training Participant Assessment#

• Programs should assess what CHW/P/Rs have learned in different ways. This could include observing them practice the skills learned in the training, having them teach the lessons back to the class in their own words, testing before and after lessons, and quizzes. It could also include asking them to rate their learning, group projects, reports, and role-plays.
• Programs should use assessments that let CHW/P/Rs demonstrate their skills in real-life situations. This could include role-plays, motivational interviewing, conducting client assessments, and creating client support plans. These assessments should respect culture. They should be trauma-informed. Focus on strengths, instead of weaknesses. Participants should be allowed to try again and get feedback.
• Participants should also be able to give feedback on their instructors and to each other.
• Training programs should engage CHW/P/Rs to help create the assessments. This way, assessments have shared value and meaning for both instructors and participants.
• Instructors should be trained and skilled in how to do the kinds of assessments described above.

8. Training Enrollment Requirements#

• Minimize enrollment requirements for the training program. This can make it easier for all aspiring CHW/P/Rs to enroll. Not requiring a high school diploma or GED, English language skills, and digital literacy can make trainings more accessible.
• If there are more applicants than training spaces available, organizations should select the best group of participants. Selection criteria could include applicant motivation, experience in the community being served, and readiness to complete the training. To assess applicant motivation, request a letter of interest where the applicant explains why they want to take the training.

9. Training Fees and Costs#

• Keep costs to take part in training free or close to free so it is not a barrier to aspiring CHW/P/Rs.
• A small training fee from CHW/P/R participants can boost their commitment. It also encourages them to attend and continue training.
• If free or low-cost training isn’t possible, provide financial aid and scholarships to cover all fees. Also, lend textbooks to aspiring CHW/P/Rs with limited resources.
• If CHW/P/R participants are employed with an organization during training, the employer should pay them their regular wages.
• If CHW/P/R participants aren’t employed during training, consider offering a stipend for fieldwork or internships.
• Seek public funding, subsidies, or partnerships that can help cover CHW/P/R training fees.

10. Training Program Evaluation#

• Programs should regularly evaluate how well the training is working. This helps the training stay useful for CHW/P/Rs and, where possible, for employers too.
• Programs should regularly evaluate different parts of the training, such as:
  • How well CHW/P/Rs understand the material
  • Whether they are building the right skills
  • Whether the pace of the training works for CHW/P/Rs
  • Whether the training format (online or in‑person) works
  • How satisfied participants are with their instructors
  • The quality of teaching and training materials
  • Whether language support is available
  • Whether the training spaces and technology work well
  • Whether the training respects culture
  • Programs should also survey participants 6–12 months after the training to check if they found jobs and are using their skills
• At the end of each training, programs should conduct an anonymous survey of participants. The survey should allow participants to share their evaluation of the training and suggest improvements.
• Programs should review participant evaluations at least every three months and make changes to improve training. CHW/P/Rs could be a part of these reviews and the action-recommendation process.
• To continually improve training quality, training programs and instructors should talk to and learn from other training programs. Newer programs should also learn from programs that have been around longer.

11. Training Organization Credibility and Qualifications#

CHW/P/R training organizations need to be rooted in the communities they serve. This builds trust and support.
Below are some minimum ways a training program can demonstrate it is truly part of the community:

• Explicitly state the key values that drive the organization, such as:
  • Caring for the community
  • Protecting families
  • Promoting health
  • Helping those facing barriers
• Be located in or close to the community being served. Have experience working in and strong relationships with the community.
• When possible, have active CHW/P/Rs help govern the organization. This can include serving on the board or in a CHW/P/R advisory group.
• Understand the CHW/P/R field and have a track record of offering CHW/P/R training.
• Be familiar with California laws, and understand health programs and the challenges people face in getting care.
• Design and conduct training in partnership with experienced CHW/P/Rs.

12. Other Good Practices#

• Programs should help CHW/P/R graduates stay connected after they complete training. This can include creating a network, group, or community for graduates to support one another.
• If CHW/P/Rs can’t attend training due to lack of childcare, transportation, or other support, consider helping to meet these needs.