title: Texas' community health workforce: from state health promotion policy to community-level practice.
abstract: BACKGROUND
  Imagine yourself in Texas as a newly arrived immigrant who does not speak English. What would you do if your child became ill? How would you find a doctor? When you find one, will the doctor speak your native language or understand your culture? In a state of approximately 22 million people, many Texas residents, marginalized by poverty and cultural traditions, find themselves in this situation. To help them, some communities across Texas offer the services of promotores, or community health workers, who provide health education and assist with navigating the health care system.
  
  
  BACKGROUND
  In 1999, Texas became the first state in the nation to recognize these workers and their contributions to keeping Texans healthy. This paper examines a state health promotion policy that culminated in a training and certification program for promotores and the impact of this program on the lay health education workforce in Texas.
  
  
  METHODS
  In 1999, the Texas legislature established the 15-member Promotor(a) Program Development Committee to study issues involved in developing a statewide training and certification program. During its 2-year term, the committee met all six of its objectives toward establishing and maintaining a promotor(a) certification program.
  
  
  CONCLUSIONS
  By the end of December 2005, it is estimated that there will be more than 700 certified promotores in Texas. State certification brings community health workers into the public health mainstream as never before.
  
  
  CONCLUSIONS
  Promotores, a community health safety net and a natural extension of the health and human services agencies, improve health at the neighborhood level. Certification brings renewed commitment to serving others and a distinction to those who have been the unsung heroes of public health for decades.
authors.affiliation: Center for Policy and Innovation, Texas Department of State Health Services, 1100 West 49th Street, Austin, TX 78756, USA. donna.nichols@dshs.state.tx.us
authors.forename: Donna C
authors.initials: DC
authors.lastname: Nichols
authors.forename: Cecilia
authors.initials: C
authors.lastname: Berrios
authors.forename: Haroon
authors.initials: H
authors.lastname: Samar
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000331:legislation & jurisprudence*; D006266:Health Education; D006291:Health Policy / Q000331:legislation & jurisprudence; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D013781:Texas; D000078329:Workforce