title: The Changing Roles of Community Health Workers.
abstract: To examine what different types of employers value in hiring community health workers (CHWs) and determine what new competencies CHWs might need to meet workforce demands in the context of an evolving payment landscape and substantial literature suggesting that CHWs are uniquely qualified to address health disparities.
  
  
  
  We used a multimethod approach, including a literature review, development of a database of 76 programs, interviews with 24 key informants, and a qualitative comparison of major CHW competency lists.
  
  
  
  We find a shift in CHW employment settings from community-based organizations to hospitals/health systems. Providers that hire CHWs directly, as opposed to partnering with community organizations, report that they value education and training more highly than traditional characteristics, such as peer status. We find substantial similarities across competency lists, but a gap in competencies that relate to CHWs' ability to integrate into health systems while maintaining their unique identity.
  
  
  
  As CHW integration into health care organizations advances, and as states move forward with CHW certification efforts, it is important to develop new competencies that relate to CHW-health system integration. Chief among them is the ability to explain and defend the CHW's unique occupational identity.
authors.affiliation: Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
authors.forename: Mary-Beth
authors.initials: MB
authors.lastname: Malcarney
authors.affiliation: Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pittman
authors.affiliation: Trachtenburg School of Public Policy and Administration, The George Washington University, Washington, DC.
authors.forename: Leo
authors.initials: L
authors.lastname: Quigley
authors.affiliation: Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
authors.forename: Katherine
authors.initials: K
authors.lastname: Horton
authors.affiliation: Department of Health Policy & Management, Milken Institute School of Public Health, The George Washington University, Washington, DC.
authors.forename: Naomi
authors.initials: N
authors.lastname: Seiler
mesh_terms: D003150:Community Health Workers / Q000592:standards*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D011320:Primary Health Care / Q000458:organization & administration*; D011361:Professional Competence; D024382:Professional Role; D036301:Qualitative Research; D014481:United States
keywords: Determinants of health/population health/socioeconomic causes of health; health care organizations and systems; health workforce: distribution/incomes/training; integrated delivery systems