Promotor(a)/Community Health Worker (CHW) Training and Certification
Advisory Committee Minutes
May 18, 2012
Members present onsite: Oscar Muñoz, MPA; Larry Morning Star, Dr. P.H. MPH; Jean
Diebolt, MSN; Mérida Escobar; Venus Ginés, M.A.; Sonia Hernandez; Julie St. John, MPH;
DSHS Staff: Sam Cooper, Beverly MacCarty, Anna Garcia, Jan Maberry, Markel Rojas, Liz
Engle (DSHS intern)
Guests: Carl Rush - UT Institute of Health Policy at San Antonio, Mona Izquierdo and Ron
Morales - El Buen Samaritano Episcopal Mission – Austin, Tina Gutiérrez and Stephanie Smith
– Presa Community Center – San Antonio, Maria García and Vicente García – East Side
Promotoras – San Antonio
Welcome and Introductions: Oscar Muñoz, Presiding Officer, welcomed committee
members, guests and DSHS staff.
Approval of Minutes: Dr. Morning Star noted a couple of spelling corrections to the minutes of
the March 30, 2012 Advisory Committee Meeting. The Advisory Committee approved the
minutes from the March 30, 2012 Advisory Committee meeting with these corrections.
Public Comment: None
CHW Advisory Committee Activities 2012 Workgroup Update & Discussion
At the March 30, 2012 Advisory Committee meeting, Committee members discussed 2012
activities and the four workgroups – Program Rules, Communication and Outreach,
Training/Workforce Development, and Certification/Employment Opportunities. Each member
selected a workgroup(s) to participate on. Members agreed to meet and discuss Committee
2012 Activities with their respective workgroups prior to the May 18, 2012 and to provide a
report to the Committee at the May 18, 2012 meeting.
1. Program Rules - Advisory Committee members will have a conference call and provide a
report with direct recommendations for Committee review at the July meeting. Dr. Morning
Star reported that it would be important to have a CHW member join the workgroup. New
committee member, Claudia Bustos, will consider joining one or more of the four workgroups
and notify Mr. Muñoz of her decision.
2. Communication and Outreach - This workgroup has one member (Dr. Morning Star). Mr.
Muñoz asked that the two new Committee members join one or more of the four workgroups
and let him know of their decision.
3. Training/Workforce Development – Venus Ginés convened a conference call on May 9,
2012 with, Merida Escobar, Julie St. John, and Claudia Bustos. This workgroup discussed
ideas related to training program and instructor applications and the importance of ensuring
training program approval of instructor affiliation. The group had some questions about the
process of verifying experience for instructor applications based on experience. The
workgroup was encouraged to consider draft recommendations through the rule review
process to provide input to DSHS and HHSC on related components of the rules.
4. Certification/Employment Opportunities – Dr. Morning Star shared information about two
studies and expressed a desire to look at sustainable models.
Mr. Muñoz will check in with the workgroups third week in June.
HB2610 CHW Study Update
Sam Cooper and Carol Rush gave a brief overview of the legislative study required under
Sam Cooper noted that the HB2610 CHW study is on track. Focus groups will be conducted
with community health workers, employers, and potential employers in June and early July in six
cities across the state.
Carl Rush discussed the research team process reviewing specific CHW models within Texas
and from other states and identifying potential benefits and challenges of each model. He noted
that it is exciting to have this kind of in-depth review with multiple sources of information and
expert advice. The next steps include focus groups rolling out next month and an online survey
of current and potential employers. Invitations will be sent to Committee members.
Focus group dates and locations:
El Paso - June 7, 2012
Lubbock - June 8, 2012
Houston - June 12, 2012
Weslaco - June 13, 2012
Dallas - July 9, 2012
San Antonio - July 10, 2012
UTSPH will provide DSHS with a draft report by end of Summer 2012.The report will be
finalized and submitted to the Legislature by December 01, 2012.
Medicaid Transformation Waiver (1115 Waiver)
Jan Maberry provided an overview of the Texas 1115 Waiver. HHSC received federal approval
of a waiver that allows the state to expand Medicaid managed care while preserving hospital
funding, provides incentive payments for health care improvements and directs more funding to
hospitals that serve large numbers of uninsured patients.
The Texas Healthcare Transformation and Quality Improvement Program (the transformation
waiver) allows the state to expand Medicaid managed care while preserving federal hospital
funding historically received as Upper Payment Limit (UPL) payments—supplemental payments
to make up the difference between what Medicaid pays for a service and what Medicare would
pay for the same service. Replacing the UPL payment methodology are two funding pools – the
Uncompensated Care and Delivery System Reform Incentive Payment (DSRIP) pools.
DSRIP Pool Payments are incentive payments to hospitals and other providers that develop
programs or strategies to enhance access to health care, increase the quality of care, the cost-
effectiveness of care provided and the health of the patients and families served. Under the
transformation waiver, eligibility to get Uncompensated Care or DSRIP payments will require
participation in a regional healthcare partnership. Within a partnership, participants include
governmental entities providing public funds known as intergovernmental transfers (IGT),
Medicaid providers and other stakeholders. Participants will develop a regional plan identifying
partners, community needs, the proposed projects, and funding distribution. Each partnership
will have one anchoring entity, which acts as a primary point of contact for HHSC in the region
and is responsible for seeking regional stakeholder engagement and coordinating development
of a regional plan. Community health workers and other stakeholders may be included in these
regional partnerships and participate in the development of a regional plan. Additional
information may be found on HHSC’s website at http://www.hhsc.state.tx.us/1115-waiver.shtml.
CHW Healthy Texas Babies Conference Planning
Beverly MacCarty provided an update on the Community Health Workers Across Texas –
Working Together for Healthy Texas Babies conference to be held in San Marcos, Texas
August 6-8, 2012. Registration will open in early June and will include the opportunity for
scholarships for currently certified CHWs. Conference information is being shared via emails to
community health workers and other stakeholders and by mail to certified community health
workers. A call for presentations resulted in about 40 presentation proposals, including
presentations in Spanish. There will be 6 to 7 breakout sessions and a variety of presentations.
The conference will offer participants DSHS certified and non-DSHS certified continuing
education hours. CHW Advisory Committee members are encouraged to participate in the
conference. Registration fees will be waived Committee members.
Sam Cooper noted that the conference will support efforts related to the Healthy Texas Babies
Initiative to reduce infant mortality.
APHA Roundtable Session Update
Julie St. John shared that she is working with the CHW section planner regarding two sessions
related to CHW credentialing for the APHA Annual Meeting in San Francisco in October 2012.
The first will be a roundtable session with seven states sharing information on specified areas.
Individuals will have the opportunity to visit 3 or 4 tables and spend approximately 20 to 30
minutes at each table. A facilitated Oral Scientific Session will follow the roundtable session
with a panel and question and answer period Ms. St. John also shared information about APHA
scholarships for CHWs to attend the APHA Annual Meeting. Applications are due to APHA by
May 25, 2012.
Anna Garcia provided the program update:
The Committee was presented with a proposal to change the next Advisory Committee Meeting
(via conference call) from July 27, 2012 to July 20, 2012 due to a conflict with the Healthy Texas
Babies Expert Panel meeting also scheduled on July 27, 2012. Members voted to approve the
date change. The next Advisory Committee Meeting was rescheduled for July 20, 2012 from
10:00 a.m. – 12:30 p.m. Central Time.
Anna Garcia provided an update on Program Data:
Data as of May 1, 2012:
# of certified community health workers – 1,725
# of counties with at least one certified community health worker – 101
% of on-time renewals for March 2012 to April 2012 – 50% and 60%, respectively
% of renewals - including both on-time renewals and expired certificates renewed in the
same calendar year – 50%
# of CHW and Instructor Applications Approved (include initial, re-apply, and renewal
applications – 68 in March 2012 and 58 in April 2012 for a total of 126
# of Approved Initial Instructor Applications – 11 in March 2012; 3 in April 2012 for a total of
# of certified instructors as of May 1, 2012 - 131
# of training programs as of May 1, 2012 - 29
CHW Annual Report Review
Beverly MacCarty provided highlights from the 2011 Annual Report:
Certified CHWs As of December 31, 2011, there were 1583 certified CHWs, reflecting a 37%
increase from December 2011. The number of certified CHWs continues to increase each year.
There were a total of 554 CHWs newly certified in 2011 with 41% newly certified in 2011 based
on training and 59% based on experience. There were 115 certified instructors as of December
2011, 25% increase from December 2010. There were 29 newly certified instructors in 2011.
CHW Renewal Rate -Renewal rate is an important metric for the program. The renewal rate
increased over the last five years with about 60% on-time renewals in 2011. An additional 10%
renewed after expiration, but before the end of the calendar year. More than half of the 115
CHWs whose certificates expired in 2011 were for individuals who were newly certified in 2009.
Counties with CHWs - As of December 2011, there were certified CHWs in 101 of the 254
counties in Texas. Harris County has the most certified CHWs. As of December 2011, there
were four (4) counties with 100-199 CHWs – Hidalgo, El Paso, Dallas, and Bexar. There were
three (3) more counties with 50-99 CHWs – Cameron, Tarrant and Lubbock. Counties with 25-
49 certified CHWs included Maverick, Nueces, Travis, Fort Bend, and Webb. Many more
counties had between 1-9 CHWs as of December 31, 2011.
CHW Demographics – Gender: 90% female; 10% male. Race and ethnicity: 69% Hispanic;
19% Black/African American; 10 % White; and 2% Asian, and <1% Other. Age: CHWs 40 and
above are the largest group.
Venus Ginés asked about CHRs – Community Health Representatives in the Native American
population, noting that CHRs have been around for a long time. CHW data indicates that no
current CHWs identified their Race/ethnicity as Native American.
Employment Status - Data from the most recent applications noted 70% paid employment,
21% volunteer, and 9% unemployed. Applications may note employment in a job title other than
The 2011 Annual report can be found online at
Committee Business - Training Program Applications for Review/Recommendations
Texas A&M School of Rural Public Health - Center for Community Health Development is
currently approved to provide CHW and CHW instructor continuing education and the 160 hour
CHW Instructor course. Julie St. John presented information on the request to amend their
current training program application to include the 160 hour CHW certification course. DSHS
staff noted that the application amendment meets program requirements. A motion was made
and seconded to recommend to the department for approval of the amendment. Motion carried.
El Buen Samaritano - Mona Izquierdo, Director or Education & Healthy Living, provided a brief
overview of the organization and its strategic plan for the proposed training program to provide
initial certification training and continuing education for community health workers in Austin. El
Buen Samaritano will use the approved Northwest Vista College curriculum with permission. El
Buen Samaritano is celebrating their 25th Anniversary. They have had a promotora program at
El Buen Samaritano since its inception, but on a small scale. Ms. Izquierdo added that they
were privileged to have Venus Ginés/DML offer CHW training at their site two years ago and, as
result, four of El Buen’s CHWs are currently certified CHWs. DSHS staff noted that the
application meets program requirements. A motion was made and seconded to recommend to
the department for approval of the amendment. Motion carried
Presa Community Center - Stephanie Smith, Executive Director of Presa Community Center in
San Antonio since 2006. Presa Community Center has been in existence for 35 years and has
been very successful. It is a grassroots organization working with schools and teaching non-
traditional learners through their small business academy. Presa Community Center serves
about 8,000 families every year, providing transportation serves, services for elderly and
persons with disabilities, emergency food services, after school programs. They are currently in
seven schools and expect to grow in another seven within a five mile radius. There is a lot of
opportunity to outreach and to grow. Presa Community Center has a goal to help people put
tools in their toolbox to be successful. Tina Gutiérrez, Presa Community Center promotora for
10 years, added that they selected and received permission to use the Minnesota curriculum
because of the success of the program. DSHS staff noted that the application meets program
requirements. A motion was made and seconded to recommend to the department for approval
of the amendment. Motion carried.
South Texas Promotora Association (STPA) is currently approved to provide CHW continuing
education. Mérida Escobar presented information on the request to amend their current training
program application to include the 160 hour CHW certification course. STPA will use Dia de La
Mujer Latina (DML) curriculum with permission. DSHS staff noted that the application
amendment meets program requirements. A motion was made and seconded to recommend to
the department for approval of the amendment. Motion carried.
Committee Member Updates
Jean Diebolt – No updates.
Claudia Bustos – Ms. Bustos reported that the Northern Texas Community Health Worker
Resource Coalition will meet May 19, 2012. Ms. Bustos will provide an update at the next
Advisory Committee meeting.
Sonia Hernández – Ms. Hernández shared challenges she has experience in working with
individuals moving to managed care health plans.
Venus Ginés – Ms. Ginés announced that Dia de la Mujer Latina is planning a 2nd CHW
conference in Dallas with a focus on environmental health. Dates for the conference have not
yet been set.
Mérida Escobar – Ms. Escobar reported that they wrapped up National Immunization Week with
conferences in Cameron County, Hidalgo County, and Star County and health fairs. STPA is
expanding and started a charter in Brownsville; soon to start one in Laredo; one in Corpus
Christi by the end of the year. Ms. Escobar is working on plans for the October Border Bi-
National Health conference.
Julie St. John – Ms. St. John reported that they have developed additional training modules on
cancer. They are in year two of their Cancer Prevention Research Institute of Texas (CPRIT)
grant project. They have a hybrid CHW certification course planned in June and an instructor
course in June or July. Ms. St John announced that she is now an official doctoral candidate.
Dr. Morning Star – Dr. Morning Star shared that he is working with the Colonias Program and
Bexar Metropolitan Health District and University Health System to look at a CMS
cardiovascular pilot. He is also collaborating with Palo Alto College and the TAMU campus in
San Antonio on substance abuse and prevention.
Oscar Muñoz – Mr. Muñoz announced that his new title is Director for the Colonias Program.
The A&M Colonias Program is no longer under The Center for Housing and Urban
Development. The Colonias Program is in the process of moving to a new office in San
Antonio. They have promotora training groups in San Antonio and Austin may look at
developing one in Corpus Christi.
Next meeting: The next meeting of the Promotor(a)/CHW Training and Certification Advisory
Committee will be held via conference call on Friday, July 20, 2012 10:00 a.m. – 12:30 p.m.
Agenda topic(s): CHW Advisory Committee members report on workgroup activities; CHW
leadership roles on the Committee.
Meeting Adjourned at 12:30 p.m.