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Career advancement for Community Health Workers (CHW) is important to consider when expanding an organization’s workforce to include CHWs.  As the CHW workforce grows and becomes more accepted within Connecticut’s State Innovation Model Community and Clinical Integration Program (CCIP) within the Advanced Networks and the Patient Centered Medical Home Plus program, job security and advancement must be incorporated into the organization’s plans.

As an employer begins to incorporate CHWs into their practice, it is important to look ahead at how the CHW can move up in the organization as they master their position and look to expand the horizon of their work. As the CHW gets acclimated to their position and becomes a valued member of the team, it is important to recognize their contributions to the organization. This can be accomplished by providing opportunities for CHWs to grow through continuing education, specialization, and expansion of duties, which may include supervisory roles, and providing training for other CHWs. The agency/organization may plan for the CHW to grow further within the agency though possible career ladders.

In the Center for Disease Control’s CHW E-Learning Series, they describe three specific needs for improving career development for the CHW workforce:
  • CHWs need a career ladder with advancement options.
  • They need pathways to related careers and special supports in pursuing them.
  • CHW employment should be viewed as a possible entry to the workforce for welfare recipients, and for people who were formerly incarcerated.[1]

It is recommended that CHW employers keep these needs “front and center” as they build their CCIP team.

The Centers for Disease Control describes how employers can create career ladders for CHWs:  “As with many entry-jobs, employers may offer salary increases and upgraded job titles for increasing levels of independent responsibility, including graduated levels of supervisory responsibility.”[2]  As CHWs gain experience, and participate in continuing educational opportunities, they often serve as mentors to new CHWs staff, and eventually may serve as trainers. This is often a part of the inherent qualities of the CHW, not only to provide and serve their clients, but also to enhance the capabilities of their peers.

“Experienced CHWs can make excellent trainers, and this responsibility can offer job enrichment as well as opportunities for higher pay. Another option is to create specialist CHW positions, such as breast-feeding counselor within a WIC program, or becoming a trained medical interpreter.  Certification for specialized duties can carry an enhanced job title and supplemental pay.  Finally, larger employer organizations may wish to create senior CHW positions as troubleshooters or consultants, who assist other CHWs or teams with problem solving or setting up special projects.” [3]

Examples of possible levels for a CHW Career Ladder:
  • CHW 1: Health Education, Basic Health Assessment; Visual screening for red flags. A specialty topic could dictate a ladder, such as:  Women’s Health, Diabetes, Asthma, Breastfeeding,Children’s Health, Behavioral Health, Dental, HIV, etc.
  • CHW 2 : Eligibility screening, Health Insurance Enrollment, Prevention Screening, Lifestyle change counseling, e.g., exercise classes, etc.
  • CHW 3:  Patient Engagement with PCP for Preventive/Routine Care, Medical Interpreting, Provides Training and Job Shadowing for new CHWs
  • CHW Lead:  Supervision of CHWs, Leads Team meetings, Participates in Grand Rounds

Certification can be required of all CHW levels of the career ladder, or may begin with CHW II or III. The CHW Lead should be certified.

It is important to recognize that a CHW may choose to have community health work as a lifelong career, or they may utilize a CHW positions as “steppingstones to other health-related occupations.”[4]   Also called “Up and Out” (of CHW work), employers may enable CHWs to be exposed to and provide access “to established health career tracks in areas such as patient care, clinical technician, or medical administration.” [5]


[3] IBID.
[5] Scott, Geri and Wilson, Randall.  “Community Health Worker Advancement: A Research Summary”, Jobs for the Future April 2006, Report funded by the Robert Wood Johnson Foundation.