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Abstract

Arkansas faces significant health disparities, including high rates of chronic diseases and limited healthcare access, especially in rural and underserved communities. Community Health Workers (CHWs) serve as essential links between the healthcare system and these communities and address the state’s significant health disparities through culturally appropriate care. This article describes the development of CHW programs in Arkansas, including early CHW training initiatives, the formation of the Arkansas Community Health Workers Association (ARCHWA), the state’s adoption of standardized CHW training, the establishment of a CHW certification process, including an apprenticeship program and college credit, and the introduction of upskilling opportunities. The article describes both failed and successful legislative efforts. By detailing how collaborative efforts among healthcare organizations, community stakeholders, and public health entities have supported ongoing education, career development, and policy advocacy, this article may provide an example for other states striving to enhance their CHW workforce.

Keywords

Community Health Workers (CHWs)health disparities health equity training programs workforce development C3 Core competencies upskilling

Introduction

Arkansas has significant health disparities compared with the rest of the United States, with higher rates of diabetes, cancer, obesity, heart disease, and maternal and infant mortality.^1,2 Health disparities in Arkansas reflect a complex interplay of socioeconomic, cultural, and systemic factors that disproportionately affect rural and racially/ethnically minoritized populations.^3,4 Fifty-nine (59) of 75 Arkansas counties are medically underserved, and another 15 are partially underserved.⁵ Forty-four percent (44%) of residents live in rural areas,⁶ and rural communities in Arkansas struggle with limited access to medical facilities, leading to delayed or inadequate healthcare services.⁷ Additionally, communities with a higher proportion of minoritized community members experience disparities in healthcare access and health outcomes.^8-12 Efforts to address health disparities in Arkansas require a multifaceted approach, including improving equitable access to healthcare services in underserved communities and enhancing culturally appropriate health education.

Community Health Workers (CHWs) can play a crucial role in effectively addressing health disparities.^13,14 CHWs are trained to provide a range of health-related services within their communities.¹⁵ Also known as lay health workers or promotores de salud, CHWs bridge the gap between formal healthcare systems and underserved populations, particularly in areas with limited access to medical facilities or resources.¹⁵ CHWs often share cultural, linguistic, and social ties with the communities they serve, enabling them to effectively deliver culturally competent and contextually appropriate care.¹⁶

CHWs engage in a variety of roles, including health education and assistance with healthcare navigation.^13,14,17-21 CHWs empower individuals and families to make informed decisions about their health, encouraging healthier lifestyles and improved self-management of chronic conditions.^{13-15,18-20,22,23} Numerous studies have shown that CHW-led interventions can lead to better management of chronic diseases,^13,14,19,24 increased vaccination rates,²⁵ and improved maternal and child health.²⁶ Furthermore, CHWs contribute to cost savings in healthcare systems by preventing hospitalizations, promoting preventive care, and fostering early disease detection.^{13,14,18,19,27,28} Their work has been linked to increased utilization of primary care services and a reduction in inappropriate hospitalization^14,19,29 and emergency department visits.^{13,14,17-19,21,28} CHWs play a crucial role in addressing health disparities by providing accessible and culturally tailored care to underserved communities.^14,15,30

The purpose of this article is to describe how Arkansas has collaborated to advance the role of CHWs throughout the state. The state partnership included community-based, nonprofit organizations, health care organizations, university faculty and staff, community members, and legislators, with varying levels of participation over time. A timeline summarizing the key events and developments in Arkansas’ efforts to train and support CHWs is presented in Figure 1.

Figure 1.

CHW timeline.

Key Collaborations and Milestones

Early Utilization of CHWs

The first documented CHW training project was conducted by the Arkansas Human Development Corporation in 1998, who trained CHWs focused on helping community members in making better health choices and navigating the healthcare system. The Tri County Rural Health Network (Tri County) began training CHWs in 2002, and state- and federally-funded pilot programs were implemented by CHWs. These pilot programs demonstrated success in reducing cost, nursing home admissions, and unmet long-term care needs and increasing access to home and community-based services.^31,32 These foundational efforts laid the groundwork for subsequent CHW initiatives in Arkansas, emphasizing the importance of CHWs in bridging gaps in healthcare access and improving health outcomes through education and support.

Formation of ARCHWA

In the fall of 2012, a CHW Stakeholder Partnership Interest Group was formed, and in 2013 this interest group became the Arkansas Community Health Workers Association (ARCHWA). The mission of ARCHWA is “to support Arkansas community health workers in promoting improvements in health and healthcare.”³³ ARCHWA was officially incorporated in January 2015 and received IRS designation as a 501(c)(3) charitable organization in May 2015. At inception, ARCHWA had a board of directors, but as a grass roots organization with a limited budget, they did not have any staff. The board of directors conducted all activities on a volunteer basis. In 2022, they hired their first paid executive director. The executive director has allowed ARCHWA to accelerate training and policy efforts. One of the first activities ARCHWA conducted was an annual survey of organizations who employ CHWs to determine the number of organizations across Arkansas who employed/engaged CHWs, the total number of CHWs employed/engaged across the state, and whether and how CHWs were paid for their work or volunteers. The survey has been conducted since 2013. This survey provides information about the number of CHWs in the state and the types of organizations that employ CHWs.

ARCHWA hosted the first CHW Summit in June of 2013, and the CHW Summit continues to be held annually. The ARCHWA Summit is a 2-day event that provides an opportunity for CHWs, community health stakeholders, and CHW advocates to convene and share information and resources to empower CHWs. Agenda topics include a keynote speaker, breakout sessions, regional CHW meetings, a general membership meeting, and an award and scholarship reception. Formal continuing education units are offered to attendees. Annual attendance is approximately 250 attendees, and most of the attendees are CHWs.

Codification of Core Competency and Trainings

In 2014, ARCHWA representatives participated in the National Community Health Worker Core Consensus Project (C3). The C3 Project was designed to “expand cohesion in the field and to contribute to the visibility and greater understanding of the full potential of CHWs.”³⁴ The C3 Project had 3 main objectives: (1) outlining the detailed roles and competencies of CHWs, (2) achieving national agreement on these standards, and (3) providing recommendations for enhancing CHW practices and policies. The C3 competencies are built on the evidence base for CHWs.³⁵ ARCHWA endorsed the C3 Project’s core competencies. In 2016, Tri County, a local nonprofit organization focused on training and deploying community health workers, worked with ARCHWA to pilot a standardized CHW basic training that incorporated the C3 competencies. The inclusion of the C3 roles and competencies in core CHW training continues to be the standard throughout the state. These competencies were codified in Act 435³⁶ as a way to bring standardization in training and clarity in scope of service.

In early 2020, ARCHWA established a broad Stakeholder Advisory Group of over 80 CHWs and stakeholders from various sectors, including healthcare organizations, public health, nursing, community-based organizations, academia, and health equity champions from across the state. Stakeholders convene monthly to discuss the CHW scope of work, CHW policies, and the role of CHWs in addressing health disparities for underserved communities. There is a commitment to ensure that CHWs are involved and that their voices are heard throughout this process. In the instances when no or few CHWs are able to participate in meetings, decisions are often tabled until such time that CHWs are available to weigh in and provide input.

The initial goal of the stakeholder group was to explore the issue of CHW certification, specifically whether formal certification was needed and supported by the CHW workforce and what certification should look like in Arkansas. An almost immediate consensus was reached that a formal certification pathway was desirable. In 2021, an official CHW Certification Commission was established, and the first formal certification of CHWs was implemented. Certification processes were established for both trained and experienced CHWs. The Certification Commission, with CHW-majority membership and representation by the Arkansas Department of Health (ADH), serves as the official certifying body for CHWs and CHW training programs in Arkansas. There are currently 3 organizations approved to provide certified CHW training: Tri County, the Arkansas Rural Health Partnership, and the UAMS Institute for Community Health Innovation. To date, these organizations have trained over 250 CHWs in Arkansas.

The current CHW certification training programs are outlined in Table 1. For both training tracks, CHWs must be at least 18 years of age and have a high school diploma. ARCHWA’s Certification Commission meets regularly to review applications, and 2 to 3 Certification Commissioners are assigned to review each application and provide recommendations to the full Commission, who may approve or deny an application. Once approved, the certified CHW receives a certificate. Denied applications are returned with notification of the status of their application and include comments for corrections or clarification. The CHW can reapply if eligible.

Table 1.

CHW Certification Paths in Arkansas.

Track	Training	Core competencies	Experience as a CHW
Experiential	Not required	Evidence of proficiency in 11 core competencies	• 4 years of full-time experience (8240 h) within the last 10 years; at least half of the hours must have been in the last 5 years.
Traditional	Approved CHW Training Program which consists of 80 h of didactic training and 40 h guided fieldwork		• 2 years (4160 h)
Apprenticeship	Approved CHW Training Program which consists of 80 h of didactic training and 80 h of supplemental training		• 1 year supervised on-the-job experience (2080 h) • Assigned CHW mentor • Supervisor who has completed CHW Supervisor Training

CHWs and the COVID-19 Pandemic

CHWs played a critical role during the COVID-19 pandemic. In 2020, the Hispanic and Marshallese communities represented only 19% of the population in the northwest corner of the state, but they accounted for 64% of COVID-19 cases and 57% of COVID-19 related deaths.³⁷ During the initial months of the pandemic, CHWs played a crucial role in addressing gaps in healthcare. In Arkansas, CHWs took the lead in creating and executing programs aimed at offering culturally tailored education and support to families during quarantine. This support encompassed delivering food boxes, establishing a trilingual contact tracing center, and providing navigation services to ensure that families’ basic needs were met.^38-40

In 2021, a state-wide COVID-19 vaccine initiative was launched to increase vaccine confidence and uptake. The project required a 40-h fast track basic CHW Core Competency training to equip CHWs across the state to support COVID-19 vaccine deployment and included programs training CHWs and their supervisors to assist local health teams with vaccination efforts during the COVID-19 pandemic. The overarching goal was to train and engage as many CHWs as possible across the state to support COVID-19 vaccination efforts. In addition to the 40-h fast-track CHW training, CHWs also received 20 h of COVID-19-specific training. During the first 90 days of the project, 184 CHWs received the 40-h training, and 109 (90%) were trained in the first 30 days. CHWs played a critical role during the COVID-19 pandemic, focusing primarily on education, outreach, resource navigation, and vaccine implementation. In addition to COVID-19, CHWs have worked in both formal and informal roles to address diabetes, hypertension, cancer, and maternal and child health.^16,41,42

Training and Apprenticeship Program

The co-occurrence of the pandemic and the continuing development of the certification process underscored the importance of CHW work and prompted the expansion the CHW workforce. This convergence encouraged CHW organizations to re-think how CHW certification could be provided. Due to the unique nature of the CHW role, ARCHWA supports 3 pathways to certification: Apprenticeship, Traditional, and Experiential.

CHWs with 4 or more years of documented experience (8240 h) are eligible for the Experiential track. All hours must have been accumulated within the last 10 years, with at least half of the hours completed in the last 5 years. All applicants undergo a background check. While they are not required to complete a didactic training program, they are required to document core competencies. CHWs with some experience, but less than 8240 h, often choose the Traditional track, which requires completion of the approved training program (80 h of didactic training, plus 40 h of guided fieldwork), plus 2 years (4160 h) of experience.

In 2022, UAMS developed the CHW Training and Apprenticeship Program (TAP) for individuals employed in a CHW-related profession. The TAP includes 80-h of (didactic) core training plus an additional 80 h of supplemental training and consolidates the on-the-job experience to 1 year (2080) rather than 2. This year of experience includes a mentor and close supervision. The mentor must be a certified CHW in the state of Arkansas, and the supervisor must have completed CHW Supervisor Training. The mentors meet with mentees at least twice per month in the first 3 months, and monthly thereafter, with each meeting lasting a minimum of 1 h. These sessions provide the opportunity to discuss barriers and successes encountered by a CHW.

These pathways were designed to ensure that CHWs, regardless of their path to certification, demonstrate proficiency in the core competencies. The different pathways to certification can be found in Table 1.

Upskilling

In 2024, the state began to offer upskilling curriculum, developed through collaborations between UAMS and ARCHWA, for more specialized CHW roles, such as diabetes peer educators, perinatal home visitors, perinatal mental health support, certified lactation counselors, community-based doulas, senior support experts, wellness coaches, and support group facilitation.

College Credit

Through a partnership with the University of Arkansas, 7 h of college credit can be earned for CHWs who complete the full 1-year apprenticeship program. For some CHWs, this offers them their first opportunity to obtain college credit, and they are encouraged to pursue additional educational opportunities if desired.

State Title, Appropriate Salary, and a Career Ladder

In 2023, a CHW career ladder was implemented that included state title changes and made “Community Health Worker” an officially recognized state title. The CHW career ladder established tiered responsibilities and set clear expectations for professional growth and compensation, offering defined pathways for advancement. This provides the necessary infrastructure to allow CHWs the opportunity for promotions and salary increases and ensures a transparent framework for professional development within the field.

Training for Organizations and/or Supervisors Working with CHWs

In 2023, UAMS and Tri County collaborated to develop a training for CHW supervisors. The CHW Supervisor Training was adapted from “Successful Supervision with Community Health Workers,” developed as part of a partnership between MassHealth, Center for Health Impact, and the Commonwealth Corporation. The supervisor training includes a 6-h interactive learning module, allowing flexibility and increasing accessibility to employers across the state. UAMS has trained 25 CHW supervisors, thus far.

In 2023, the UAMS Translational Research Institute adapted its nationally recognized Community Scientist Academy for CHWs to focus on teaching researchers how to collaborate with CHWs and how to develop opportunities for research partnerships. In 2024, UAMS further expanded its support by introducing specialty upskill certifications for CHWs, which offer CHWs pathways to broaden their roles in healthcare settings.

Policy

The first CHW reimbursement bill, Arkansas HB1275 To Create the Community Health Worker Act, was introduced in 2019 but did not move past committee.⁴³ In the 2025 legislative session, HB1427 (now Act 124) was approved and includes reimbursement for perinatal CHWs. Later in the same session, HB1258 was passed and codified as Act 435, which requires reimbursement for services provided by CHWs. Act 435 outlines reimbursable services such as culturally appropriate health education and information, care coordination, and case management; cultural mediation; navigation of health and social services; and provision of coaching and social support. The bill was drafted through a collaborative process that brought together a member of the Arkansas House of Representatives, CHWs, and CHW allies that had worked for years to establish the infrastructure for CHWs in Arkansas. This coalition ensured that the legislation reflected both the lived experiences of CHWs and the practical needs of the communities they serve, strengthening the foundation for sustainable reimbursement and integration into the state’s health system.

Conclusion

While there is significant evidence for the value of CHWs, little is documented about how states progress from their first training of CHWs to certification, continued support, policy, and sustainability. After several years of dedicated yet slow progress, Arkansas achieved significant acceleration in systems level change between 2022 and 2025. In those years, Arkansas implemented one of the first CHW apprenticeship programs in the nation, established state titles with a progressive career ladder, and created a pathway for college credit for those who choose it. In 2025, HB1427/Act 124 passed, requiring reimbursement for approved perinatal care provided by a CHW, and HB1258/Act 435 passed, requiring reimbursement for more general services provided by CHWs. Notably, the acceleration in CHW infrastructure and policy coincided with ARCHWA hiring an executive director. This article provides an overview of 1 state’s journey and can serve as an informative guide for other states.

Implications for Practice

This article can serve to inform other states’ policy and practice as it documents the state’s progress from their first training of CHWs to certification, continued support, and policy.

Implications for Policy

This article provides specific legislation that both failed and was passed and can inform other states seeking to pass reimbursement legislation.

Footnotes

ORCID iDs

Bonnie Faitak

Pearl A. McElfish

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this publication was supported by University of Arkansas for Medical Sciences Translational Research Institute funding awarded through the National Center for Advancing Translational Sciences of the National Institutes of Health (UL1 TR003107). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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Developing a Sustainable Community Health Workforce in Arkansas

Abstract

Keywords

Introduction

Key Collaborations and Milestones

Early Utilization of CHWs

Formation of ARCHWA

Codification of Core Competency and Trainings

CHWs and the COVID-19 Pandemic

Training and Apprenticeship Program

Upskilling

College Credit

State Title, Appropriate Salary, and a Career Ladder

Training for Organizations and/or Supervisors Working with CHWs

Policy

Conclusion

Implications for Practice

Implications for Policy

Footnotes

ORCID iDs

Funding

Declaration of Conflicting Interests

References