NOVEMBER 2022 Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps AUTHORS Susan Chapman, RN, PhD, FAAN, Timothy Bates, MPP, and Jacqueline Miller, BA, Healthforce Center at UCSF About the Authors Susan Chapman, RN, PhD, FAAN, is a pro- fessor of social behavioral sciences in the School of Nursing at UCSF and is a fac- ulty affiliate of the Philip R. Lee Institute for Health Policy Studies (IHPS) and Healthforce Center at UCSF. Timothy Bates, MPP, and Jacqueline Miller, BA, are senior research data analysts with IHPS at UCSF and are affiliated with Healthforce Center at UCSF. IHPS is an interdisciplinary collection of concerned researchers who share a mission - to improve health and transform health care in the United States by working across competing interests, collecting evidence, informing policy, and improving practice. About the Foundation The California Health Care Foundation (CHCF) is dedicated to advancing meaning- ful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford. CHCF informs policymakers and industry leaders, invests in ideas and innovations, and connects with changemakers to create a more responsive, patient-centered health care system. DESIGN BY DANA KAY DESIGN Contents ao F&F BF WwW 21 Executive Summary Methodology Limitations Findings Job Title and Current Employment CHW/Ps Employed in Paid Positions CHW/Ps Working in Volunteer Positions Appendices A. Advisory Group B. Job Titles Understanding California's Community Health Worker/Promotor Workforce: The Series Despite being a critical part of California's health workforce, there are relatively little comprehensive data on community health workers and promo- tores (CHW/Ps) in California. With funding from CHCF, Healthforce Center at UCSF fielded surveys of CHW/Ps, the institutions that train them, and the organizations that employ them. The survey data, published in a series of reports, paint a more complete picture of the current CHW/P workforce as well as challenges and opportunities related to training and employment. This picture can inform policy decisions as the state looks to support and expand this important workforce. To learn more, visit www.chcf.org/collection/ understanding-californias-community-health-worker- promotor-workforce Executive Summary In California, one of the most culturally diverse states in the country, health care must bridge cultural and linguistic divides to serve all communities equitably. As trusted community members with lived experi- ence, community health workers and promotores (CHW/Ps) have a long history of connecting those not well served by the traditional health care system with culturally competent health and social services. There is increasing recognition in California that CHW/Ps are a critical part of the health care workforce. In 2019, the California Future Health Workforce Commission recommended scaling the CHW/P workforce to broaden access to preventive and social support services as well as team-based integrated primary and behavioral health care. It is important for CHW/Ps themselves to share their experiences and voice their opinions about their profession. The purpose of this report is to describe the attributes and perspectives of CHW/Ps. CHW/Ps across the state and in a variety of workplace set- tings were asked to voluntarily fill out a survey between October 2021 and January 2022. Given this timing, the survey surfaces data surrounding respondent CHW/Ps' work during the COVID-19 pandemic. The survey results presented are primarily of CHW/Ps who were working in a paid CHW/P position at the time they completed the survey. Additionally, a short descriptive section includes data on 22 CHW/Ps who reported working in volunteer positions at the time they completed the survey. Data from this group of volunteer CHW/Ps are also included in Figures 1 to 5. Responses from CHW/Ps who had previously worked in a paid or volunteer position within the past five years (17 and 7 CHW/Ps, respectively) are included in Figures 1, 2,4, and 5, but additional data from these groups are not included in the report because of the low number of responses. CHW/Ps who reported previously working in a paid or volun- teer position more than five years ago were exited out of the survey after the first question. These data are excluded from this report. Summary of Key Findings A majority of respondents were employed full-time in a paid CHW/P position. Ninety-one percent (n = 300) of survey respondents said that they were cur- rently employed, and more than 80% (n = 246) of those currently employed said they were employed in a full-time, paid position. Among these CHW/Ps employed in a paid position, key findings were as follows: > A majority of respondents were employed in the Bay Area. > Nearly two-thirds of respondents' employers required a high school diploma or less. > More than half of respondents worked in a community-based organization, and a plurality worked in a community clinic or a community health center. > Nearly half of respondents were paid $20 to $25 per hour. > Most respondents had completed relatively short CHW/P training (40 hours or less). Nearly 70% of survey respondents had completed CHW/P training. For most of these respondents, training was required and paid for by their employer. > The type of work that respondents most often reported performing included identifying/refer- ring people to community resources and case management/coordination/navigation. > The work of a plurality of respondents did not focus on specific health conditions. Among respondents whose work did focus on particular health conditions, chronic health conditions and Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 3 complex health or social needs were most often reported. > The work of a plurality of respondents did not focus on serving specific populations or groups of people. > Respondents were divided about whether they saw potential to advance in their role as a CHW/P. While most respondents saw an opportunity to advance in their role, 49% said that there was no opportunity or that they were unsure of their opportunities to advance. > Documentation of services (i.e., documenting services provided to clients in an electronic health record [EHR], paper medical record, or a sepa- rate record-keeping system) was an important component of the CHW/P role. Nearly one-third of respondents spent 10 hours a week or more on documentation in an EHR. > The COVID-19 pandemic increased the amount of CHW/P work that was conducted virtually. As a result of COVID-19, most respondents antici- pated that computer skills, general knowledge of COVID-19, and resilience would be the most important skills and/or attributes to have in the next three to nine months. > A majority of respondents were women and Latinos/x. Methodology The CHW/P survey created and analyzed for this report was part of a larger project about the current CHW/P workforce. Funded by the California Health Care Foundation, this project was conducted by researchers at UCSF. The project was approved by UCSF's Institutional Review Board. The CHW/P survey was created by the research team at UCSF with the assistance of an advisory group composed of representatives from the Hospital Association of Southern California, the California Primary Care Association, a nationally rec- ognized CHW/P educator, CHW/P policy experts, and representatives of the CHW/P community (see Appendix A). The survey was distributed to a convenience sam- ple of CHW/Ps. The researchers and the advisory group called upon their contacts, largely comprising community-based organizations, to help dissemi- nate the survey. The survey was also advertised in statewide communications specific to the CHW/P profession. The survey was fielded from October 2021 through January 2022. The survey instrument was fielded using Qualtrics, allowing CHW/Ps to take the survey anonymously on their computer or on a mobile device. If desired, all CHW/Ps who completed the survey could enter a raffle to win 1 of 10 gift cards worth $100 at the store of their choice via Tango Card by Rewards Genius. Winners of the raffle were randomly selected using a random generator online. Once the survey closed, our research team ana- lyzed the survey data with Stata, a statistical analysis software program. The results of this data analysis are presented in this report. Limitations Because a database of all CHW/Ps in the state does not exist, this survey was conducted using a conve- nience sample. Thus, the findings presented here are not representative of the entire CHW/P popu- lation in California. Additionally, the survey was available to complete only in English or Spanish. This survey was conducted from October 2021 through January 2022, during the COVID-19 pan- demic, which may have contributed to the lower response rate. California Health Care Foundation www.chcf.org 4 Findings Throughout the Findings section, the total number of respondents who answered each question (n) is different. Survey respondents were able to skip sur- vey questions if they did not want to or could not answer a particular question. Thus, not all survey respondents answered every single question; this circumstance is reflected in the varied population sizes given for the figures. Job Title and Current Employment Nearly two out of three survey respondents most strongly self-identified as a community health worker (Figure 1). Examples of write-in responses for "other" identities included care coordinator, patient navigator, health coach, and public health outreach worker. Later in the survey, all respondents were asked to write in their exact job title. A list of all reported job titles other than "community health worker," "promotor/a," and "promotor/a de salud" can be found in Appendix B. Ninety-one percent of survey respondents reported that they are currently employed in a CHW/P role (Figure 2). Among respondents who reported they are not currently working/employed in a CHW/P role, 45% indicated they had been previously employed in a paid position (approximately 28% stopped working within the 12 months prior to the survey); the remaining 55% of this group reported they were previously employed in a volunteer posi- tion and left that role sometime between one and five years prior to the survey. Individuals no longer working in a CHW/P role cited three reasons why: having been laid off, losing grant funding, or having a temporary contract end. Figure 1. Self-Reported Identity for CHW/Ps Promotor/a sey Cory a aTalela iA health worker a Figure 2. Current Employment Status of CHW/Ps Not working/volunteering Working/ volunteering a FIGURES 1 AND 2: Source: Author survey of CHW/Ps, October 2021 through January 2022. Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps More than 80% of survey respondents who reported they were currently employed or working as a CHW/P indicated they held a paid, full-time position (Figure 3). Individuals working in volunteer positions accounted for just 8% of survey respondents. Figure 3. Employment/Volunteer Status of CHW/Ps At this point in the survey, respondents were diverted to different branches depending on their employment status. CHW/Ps who were currently working in paid or volunteer positions or who had worked in a paid or volunteer position within the previous five years completed the survey. Figure 4. Employment Change Resulting from COVID-19 Volunteer part time Volunteer full time Paid part time 10% Paid full time ty Note: These data include only persons who reported current employment in either a paid or volunteer position. FIGURES 3 to 5: Source: Author survey of CHW/Ps, October 2021 through January 2022. One-third of survey respondents reported that COVID-19 had affected their employment status (Figure 4). Among this group, more than 60% indicated that their work hours increased (Figure 5). "Other" changes to employment status reported by respon- dents included shifting work responsibilities, taking on new roles, resigning from their positions, or being laid off. Figure 5. CHW/P Description of Employment Change from COVID-19 Other impact 24% Hours Hours decreased increased 15% ou California Health Care Foundation www.chcef.org 6 CHW/Ps Employed in Paid Positions Most survey respondents (251) reported their pri- mary work/employment status as full-time (32 hours or more) (n = 220) or part-time (31 hours or less) (n = 31) in a paid position. Regional Employment Survey respondents far more frequently reported working as a CHW/P in one of the counties of the Greater Bay Area compared with other regions across the state. Figure 6. Geographic Region of Employed CHW/Ps Greater Bay Area 114 Central Coast ui ou Los Angeles w Oo Inland Empire 1) N San Joaquin Valley vA A Northern and Sierra of San Diego Area Sacramento Area Orange 2 Notes: n = 242. Counties were aggregated into California Health Interview Survey (CHIS) regions. Survey respondents could select multiple regions if they worked in multiple regions. Years of Experience as a CHW/P Nearly half of all survey respondents (49%) reported that they had between 1 and 3 years of experience working in a CHW/P role. Nearly twenty-five per- cent indicated they had 10 years or more of CHW/P work experience. Figure 7. Years of Experience Working as a CHW/P 6 to 9 years ce 1 to 3 years Ce 4 to 5 years Ca FIGURES 6 and 7: Source: Author survey of CHW/Ps, October 2021 through January 2022. Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 7 Educational Requirements Approximately two-thirds of survey respondents reported that their current employer had either no diploma or degree requirement (27%) or required only a high school diploma (40%) as a condition for employment as a CHW/P. Figure 8. Educational Requirements for as a CHW/P Training Requirements Two out of three survey respondents reported having completed formal CHW/P training. Of this group, 70% indicated that the training was required by their employer. Figure 9. CHW/Ps Who Completed Training No educational requirement Pah High school diploma/ equivalent ney Bachelor's degree Ya Graduate degree Associate degree Note: Segments do not sum to 100% due to rounding. FIGURES 8 and 9: Source: Author survey of CHW/Ps, October 2021 through January 2022. Completed Training Training Was Required by Employer (of the 66% who completed training) California Health Care Foundation www.chcf.org 8 Two-thirds of respondents who completed for- mal training reported that it was paid for by the employer (Figure 10) and that the training took 40 or fewer hours to complete (Figure 11). Figure 10. Source of Funding for CHW/P Training Don't know 16% Figure 11. Length of CHW/P Training More than 80 hours eh 41 to 80 hours 17% 40 hours or less 64% FIGURES 10 to 12: Source: Author survey of CHW/Ps, October 2021 through January 2022. Number of CHW/Ps in Organization Approximately 60% of survey respondents reported working in an organization with 10 or fewer CHW/Ps on staff; 20% of respondents indicated they worked on a staff with more than 20 other CHW/Ps. Figure 12, Number of CHW/Ps Employed by Current Organization 16 to 20 Tha Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 9 Organization Type CHW/Ps were asked to describe the type of orga- nization that currently employed them. Nearly 60% reported employment with a community-based organization, while close to 20% indicated they were employed by a Federally Qualified Health Center (FQHC). "Other" types of employer orga- nizations that were reported included religious or faith-based organizations, managed care organiza- tions, and agencies offering either mental health or social services. Figure 13. Types of Employer Organizations for CHW/Ps Public health department Tribal health clinic (1%) Kos} oN] AN-Yel MANY T CaN ey Federally Qualified Health Center he Community-based organization By Note: Segments do not sum to 100% due to rounding. Work Setting The primary work setting most frequently reported by CHW/Ps was either a community clinic or com- munity health center, followed by community center (non-clinic) and home-based settings (Figure 14). "Other" primary work settings reported included managed care plans, housing agencies, and long- term care/rehabilitation facilities. Figure 14. Primary Work Settings for CHW/Ps Community clinic / community health center 103 Community center x ° 3 oO cS w fon 2) Agricultural sites / farms / orchards 0) ; Food pantry/bank I} oe) n a a> ° o No ; x 9 n ZF g. » i = Homeless facility / on the street ary Se} Local business / public community settings 15 Social services agency 12 Mental health / substance use disorder services provider QO ct > -y 2 1) 29 Notes: n = 229, Respondents could select up to three different work settings. Home could have been interpreted as either working from home in general or working with clients in home-based settings. FIGURES 13 and 14: Source: Author survey of CHW/Ps, October 2021 through January 2022. California Health Care Foundation www.chcf.org 10 Advancement Approximately half of all CHW/Ps reported having had an opportunity to advance in their role as a CHW/P. Figure 15. Opportunities to Advance as a CHW/P The most frequently reported types of opportu- nities to advance were training, supervising, and mentoring other CHW/Ps. Figure 16. Advancement Opportunities as a CHW/P Note: Segments do not sum to 100% due to rounding. Training other CHW/Ps Supervising other CHW/Ps Mentoring other CHW/Ps Office/clinic management Note: Respondents (n = 111) who reported having had an opportunity to advance in their CHW/P role could select more than one type of opportunity. FIGURES 15 and 16: Source: Author survey of CHW/Ps, October 2021 through January 2022. Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 11 Hourly Wage Approximately half (49%) of all CHW/Ps reported earning an hourly wage between $20 and $25 per hour; another 29% reported earning $25 per hour or more. Figure 17. Hourly Wages Earned by CHW/Ps $15 or less 1%) $30.01+ ibs $15.01 to $20 21% $25.01 to $30 aS $20.01 to $25 a FIGURES 17 and 18: Source: Author survey of CHW/Ps, October 2021 through January 2022. Types of Work Survey respondents were asked to describe the kind of work they primarily do in their CHW/P role. The most frequently reported types of work were identi- fying and referring people to community resources, and providing services related to case manage- ment (Figure 18). "Other" types of work reported included helping people find jobs, helping people work through trauma, participating in evaluation and research, conducting needs assessments, and providing services related to COVID-19. Figure 18. Types of Work Performed by CHW/Ps Identifying/referring people to community resources 101 Case management/coordination/navigation Outreach to new people/patients 55 Providing community education 55 Building community capacity / community organizing / advocacy 53 Chronic disease prevention and/or management Helping people enroll in social services programs 37 Counseling/coaching/motivational interviewing N ; Facilitating/co-facilitating group meetings y A Helping people enroll in health insurance v ls Helping people secure housing = oO Helping people with mental wellness wn © ® < Q ® n " o a 2 ® o ot 3 Q O s 0 as 'Oo my ary . =v ol Other i} Se} Zz ° se oO za Oo wn 3 3 a a oO a a zs I = 223) could select up to three types of work. California Health Care Foundation www.chcf.org 12 CHW/Ps who indicated they provide community education reported that these services were most often related to COVID-19. Figure 19. Types of Community Education Provided by CHW/Ps COVID-19 General health = ou Nutrition ay ow Exercise utdoor/environmental exposures Oo Breastfeeding Sexual health Workplace safety om 0 ot > @o © Note: Respondents (n = 54) could select multiple types of community education. FIGURES 19 and 20: Source: Author survey of CHW/Ps, October 2021 through January 2022. Types of Health Conditions Survey respondents were asked to describe the health conditions they primarily address in their CHW/P role. They most frequently reported that either their work did not focus on any particu- lar health condition or that their work focused on providing services to people with either chronic conditions or complex health care needs. The most frequent "other" health condition that respondents reported addressing was COVID-19. Figure 20. Types of Health Conditions Addressed by CHW/Ps My work is not focused on any specific health conditions People who have complex health or social needs People with chronic health conditions People with behavioral health challenges People with mental health challenges | Recently been discharged from the hospital bs) | People who are pregnant my ui Related to COVID-19 my Lo) People with HIV/AIDS 9 & > @o s oy oy 21 Note: Respondents (n = 217) could select up to three health conditions. Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 13 CHW/Ps who indicated they focused on providing services related to managing chronic health condi- tions most frequently reported providing services to people who had diabetes, heart disease, or asthma. Figure 21. Chronic Health Conditions Addressed by CHW/Ps Diabetes ri | Heart disease i} Se} Asthma No ol Stroke 18 Other rl ; Note: Respondents (n = 52) could select multiple chronic conditions. Types of Populations Survey respondents were asked to describe the populations they primarily worked with in their CHW/P role. They most frequently reported that their work did not focus on serving any particu- lar populations or groups of people (Figure 22). Among those CHW/Ps who did indicate that they worked with a specific group, the groups most fre- quently reported were homeless persons, youth and families, or specific racial/ethnic/cultural popula- tions. "Other" groups served by CHW/Ps included low-income and underresourced communities, indigenous persons, and people with substance use or mental health conditions. Figure 22. Populations Primarily Served by CHW/Ps No specific populations Homeless persons Oo Youth and families Specific to racial/ethnic/cultural populations rn Seniors/elders ; pa Farmworkers tS) ; Persons living in rural areas i) N Persons with disabilities N wo Justice-involved population oy Oo = a 3 a oO O 5 nn od oN ay ay < © a : Bi + a> oO s Nh aS Note: Respondents (n = 214) could select up to three populations. FIGURES 21 and 22: Source: Author survey of CHW/Ps, October 2021 through January 2022. California Health Care Foundation www.chcf.org 14 Types of Social Services Programs CHW/Ps were asked about different types of social service programs used by the clients they served. The most frequently reported programs were the Supplemental Nutrition Assistance Program (SNAP), programs focused on housing assistance, Medicaid and Medicare, and the Supplemental Security Income (SSI) program (Figure 23). Approximately 15% of respondents (n = 39) indicated that the cli- ents they served were not typically eligible for these types of social service programs. "Other" programs reported included In-Home Supportive Services (IHSS). Figure 23. Types of Social Service Programs Used by Population Served by CHW/Ps Supplemental Nutrition Assistance Programs (snap) / CalFresh Housing Assistance foe} w Medicaid N Se} Medicare N w Supplemental Security Income (ss) / State Supplementary Payment (ssP) Women, Infants, and Children (wic) 58 Legal Aid Clients/patients typically do not qualify for/use social services/programs w Temporary Assistance for Needy Families (TANF) w foe) Earned Income Tax Credit (EITC) 9 et > @ 2 iN) oO ry uo Note: Respondents (n = 178) could select multiple social service programs. Source: Author survey of CHW/Ps, October 2021 through January 2022. Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 15 Documentation of Services CHW/Ps were asked to report how much time they spend documenting service delivery in an EHR system. Nearly one-third of respondents indicated they didn't spend any time on EHR documenta- tion; another 22% reported spending between 1 and 5 hours per week on EHR documentation. Approximately 15% of respondents reported spending more than 20 hours per week document- ing services provided in an EHR system. Figure 24. Hours per Week Spent Documenting Services Provided in an EHR System No time 14% 21+ hours 16% 11 to 20 hours fo} Sie 1 to 5 hours 32% 6 to 10 hours Pa COVID-19 Impact Survey respondents were asked to describe how their work was impacted by COVID-19. The most frequently reported change in work arrangements were related to an increase in virtual engagements. These included more team meetings via phone and video, more client engagement via phone and video, and greater use of computers to perform respondents' work. Figure 25. Impact of COVID-19 on Service Delivery More client/patient engagement via phone/video More team meetings via phone/video More computer use Completing different types of tasks 33 Working in different settings more often 27 Other Note: Respondents (n = 108) could select multiple impacts. FIGURES 24 and 25: Source: Author survey of CHW/Ps, October 2021 through January 2022. California Health Care Foundation www.chcf.org 16 CHW/Ps were also asked about skills and knowl- edge they believed they would need to develop in the near future as a result of changes brought about by COVID-19. The most frequently reported needs included computer skills, general knowledge of COVID-19 (and how to adhere to COVID-19 guide- lines), and resilience. Figure 26. Reported Anticipated Skills and Knowledge Areas in Next Three to Nine Months Computer skills General knowledge of COVID-19 | [e) Resilience ™~ o Knowledge of adherence to COVID-19 guidelines 5 | Trauma-informed care gl Oo Conducting virtual visits . ea Documenting virtual visits w foe} Contract tracing Oo z > S © 0 - pty - N IN) IN} Note: Respondents (n = 170) could select multiple skills and knowledge areas. Demographics Gender Seventy-nine percent of survey respondents self- identified as a woman. Figure 27. Gender Composition of CHW/Ps Nonbinary Prefer not to answer Transgender (<1%) FIGURES 26 and 27: Source: Author survey of CHW/Ps, October 2021 through January 2022. Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 17 Race/Ethnicity Two out of three CHW/P survey respondents self- identified as Latino/x. "Other" race/ethnicities reported were groups indigenous to Mexico. Figure 28. Race/Ethnicity of CHW/Ps American Indian / Alaska Native Asian Native Hawaiian / Pacific Islander (2%) Other Prefer not to answer Latino/x 65% Age Approximately one-third (32%) of CHW/P survey respondents were between 26 and 35 years old, and the median age was 35 (Figure 29). Another one-third of respondents reported being age 46 or older. Among all respondents, ages ranged from 17 to 60. Educational Attainment Survey respondents were asked to report their high- est earned diploma or degree. Thirty-seven percent of CHW/Ps reported a high school diploma as their highest level of education, compared with 36% who reported a bachelor's degree (Figure 30). "Other" responses included "some college, no degree." Figure 29. Age Distribution of CHW/Ps 56+ years 12/3 46 to 55 years ya 26 to 35 years 32% 36 to 45 years 17% Note: Segments do not sum to 100% due to rounding. Figure 30. Educational Attainment of CHW/Ps High school diploma/ equivalent 37% Bachelor's degree 36% Associate fo [-Yol ge) sya FIGURES 28 to 30: Source: Author survey of CHW/Ps, October 2021 through January 2022. California Health Care Foundation www.chcf.org 18 Languages Spoken Survey respondents were asked to report the dif- ferent languages they speak. Almost 70% reported they spoke more than one language, and among this group, 84% indicated they spoke both English and Spanish. Figure 31. Languages Spoken by CHW/Ps Non-English/non-Spanish (1%) Only Spanish Only English yy More than one language a Of the 69% who speak more than one language, these respondents speak... English and non-Spanish a English and Spanish er Note: Segments may not sum to 100% due to rounding. Source: Author survey of CHW/Ps, October 2021 through January 2022. CHW/Ps Working in Volunteer Positions Twenty-two survey respondents reported their primary work/employment status as full-time (32 hours or more) (n = 5) or part-time (31 hours or less) (n = 17) in a volunteer position. However, only 17 of these volunteers responded to a majority of the survey questions. In summary, many of the volun- teer CHW/P responses were similar to those of employed CHW/Ps. > Job title. Half (n = 11) of the volunteer respon- dents most strongly identified as a promotor or promotor de salud. > Regional employment. Nearly three-quarters reported working in the San Francisco Bay Area (n = 9) or Los Angeles (n = 7). > Years of experience. The number of years of experience reported was mixed, with the plural- ity of respondents (n = 6) reporting one to three years of CHW/P experience. > Training requirements. A majority (n = 13) reported completing a CHW/P training pro- gram, eight of whom said the training was required for their current volunteer position and seven of whom said the training was also paid for by their organization. Nearly one-third (n = 7) said that they received a certification of comple- tion for the training they completed. Total training length ranged from 10 to 1,000 hours and averaged 144 hours. > Number of CHW/Ps in organization. The number of CHW/Ps volunteering at each of their organizations varied; several reported larger numbers of volunteers, such as 11 to 15 (n = 3), 16 to 20 (n = 3), and more than 21 (n = 3). > Organization type. A plurality said they worked at a community-based organization (n = 9). Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 19 > Work setting. Most reported working in a community center (n = 9) or a community clinic/ community health center (n = 4). » Advancement. More than half (n = 12) said there had been opportunities to advance in their role, most of whom (n = 9) cited the train- ing of CHW/Ps as their only opportunity or one of few opportunities for career advancement. > Stipend. More than half (n = 12) reported receiving a stipend for their work. The amount they received and the frequency with which they received their stipend varied. Reported stipends were as low as $15 per month or $25 per three months and as high as $1,500 per month. Some volunteers received stipends quarterly or upon attending events. > Types of work. Volunteers reported performing many different tasks in their roles. Most often, volunteers reported identifying/referring people to community resources (n = 8) and providing community education (n = 7). > Types of health conditions. Several (n = 7) said their work did not focus on a specific health condition, but several others (n = 7) said that they helped people with complex health or social needs. > Types of populations. Many (n = 8) said that their work did not focus on a specific popula- tion, but many others (n = 8) reported primarily serving specific racial, ethnic, and cultural populations. > Types of social services programs. Half (n = 11) said that their CHW/P program was not limited to serving clients who used or received particu- lar social services. > Documentation of services. Many (n = 7) did not document provided services in an electronic health record system. Among volunteers who did document in an EHR, the time spent docu- menting ranged from 1.5 to 35 hours per week. COVID-19 impact. Nearly three-quarters of volunteers (n = 16) reported working during the COVID-19 pandemic. Most (n = 13) said that their volunteering position changed as a result, including using a computer more often and participating in more team meetings via phone or video call. Most (n = 12) anticipated needing general knowledge about COVID-19 as well as resilience in their position in the next three to nine months as a volunteer. Many also anticipated needing computer skills (n = 9), knowledge about how to adhere to COVID-19 guidelines (n = 9), and the ability to provide trauma-informed care (n = 7). Demographics. Most volunteers were women (n = 16) and Latino/x (n = 12). Ages ranged from 19 to 69, and volunteers averaged 46 years of age. >» Educational attainment. Educational back- grounds were mixed, with a plurality of volunteers (n = 6) reporting their highest earned diploma or degree as their high school diploma or GED. > Languages spoken. Many spoke English (n = 4), Spanish (n = 5), or both (n = 6). California Health Care Foundation www.chcf.org 20 Appendix A. Advisory Group We would like to thank the members of our advisory group, who helped developed the CHW/P survey and guided the overall project. In addition to the report authors, the advisory group comprised the following members: Joanne Spetz, director, Philip R. Lee Institute for Health Policy Studies, UCSF Carlina Hansen, senior program officer, California Health Care Foundation Teri Hollingworth, vice president of human resources and education services, Hospital Association of Southern California (HASC) Lisa Mitchell, workforce development program manager, HASC Cindy Keltner, director of care transformation, California Primary Care Association Timothy Berthold, retired faculty member, Health Education Department at City College of San Francisco Carl Rush, national community health worker expert, Community Resources Ashley Kissinger, environmental health investigations branch, Community Education and Exposure Prevention Section, California Department of Public Health Gabriela Gonzalez, community health worker/promotora and director, Promotores Programs, Esperanza Community Housing Esther Bejarano, community health worker/promotora, director of Health Programs, Comite Civico Del Valle Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps 21 Appendix B. Job Titles Survey respondents were able to write in the exact job title that they held, even if they identified as a commu- nity health worker or promotor. The following is a list of all reported job titles other than "community health ao worker, promotor/a" or "promotor/a de salud." More than 70 alternative job titles were reported. If a job title was reported more than once, the number of times that job title was reported appears in parentheses. Asthma educator (2) Asthma educator/training coordinator (2) Behavioral health care coordinator Behavioral community health worker (2) Behavioral health community health worker (3) Breast and cervical cancer screening program assistant Care coordinator Care coordinator | Care coordinator II Care management community health worker Care neighborhood community health worker (3) Caregiver Case manager (2) Case manager / care coordinator Case manager / phlebotomist Certified enrollment counselor Community empowerment liaison Community health advocate (2) Community health ambassador (3) Community health ambassador / outreach and engagement coordinator Community health care worker (2) Community health outreach worker (6) Community health promoter Community health representative (4) Community health rep/family social services Community health worker III Community health worker manager Community health worker supervisor Community health worker supervisor / certified medical assistant Comprehensive prenatal health worker (2) COVID-19 rapid response coordinator / coordina- dor de respuesta rapida de COVID-19 (2) COVID-19 rapid response promoter / promotor de respuesta raépida de COVID-19 (2) COVID-19 rapid response promotor / promotor de respuesta rapida COVID-19 (2) COVID-19 workplace outreach organizer Data analysis DHHS/PHB/ health ed specialist / HCV care coordination Director and harm reductionist Executive director (2) Front desk associate Health coach (2) California Health Care Foundation www.chcf.org 22 Health educator Health educator II (3) Health navigator Health worker | Hepatitis C coordinator HIV care navigator (2) HIV services intake coordinator Lead health coach Manejadora de casos Mixteco/Indigena community organizing project Navigator Outreach coordinator Outreach specialist Outreach specialist / family advocate / case management Peer community health worker (2) Pediatric care coordinator Perinatal and peds community health worker Perinatal and peds coordinator Perinatal behavioral health coordinator Perinatal community health worker Prenatal community health worker Prenatal health worker / centering pregnancy coordinator PrEP program manager Program coordinator Program manager (2) Program supervisor Project coordinator (2) Project lead Promotor de prevencién e intervencion temprana en violencia domestica y salud mental intervention temprana/ Promotor de prevencién e intervencion en violencia domestica y salud mentalo (2) Public health outreachment RICMS program manager Senior community health worker Senior community worker (4) Strategic director Testing and outreach manager Trabajador/a comunitario/a (6) Understanding California's Community Health Worker/Promotor Workforce: A Survey of CHW/Ps