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Community Health Worker:
Community Health Workers (CHW) can be broadly
defined as individuals who connect health care
consumers and providers, promoting health particularly
among groups who have traditionally lacked access
to care. The CHW is a member of the community
and play an important role in identifying a
community’s problems and in developing
solutions. Examples of successful uses of the
CHW include: using ex-addicts to educate intravenous
drug users about AIDS risks and increasing breast,
cervical, and colon cancer screening in minority
communities. CHWs may play critical roles in
improving community health status by providing
cultural and technical linkages between community
members, primary care providers, and the health
care delivery system. Training may range from
weeks to months and may combine lectures with
supervised field experience. There is neither
a licensure mechanism nor scope of practice
laws specific to CHWs.
For more information on community health workers
read:
"Community Health Workers: Integral
Yet Often Overlooked Members of the Health Care
Workforce." Pew Health Professions Commission
(1995)
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Dentist:
The general dentist (DMD or DDS) is a primary
care professional for patients in all age groups.
Dentists take responsibility for the diagnosis,
treatment management and overall coordination
of services to meet the oral health needs of
patients. Most dental schools have a four-year
postgraduate program followed by a hands-on
state board examination to receive licensure.
Specialty practices such as orthodontics, pediatrics
or oral surgery etc. require 2-6 years of additional
education. The dentist is required to have licensure
in the state in which they practice.
For more information on dentists visit:
http://www.ada.org
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Health Educators:
Health educators teach clients, both individually
and in groups, about various health topics.
Although all members of the healthcare team
are charged with client education, health educators
are focused on providing adequate information
to the client to assure understanding of the
medical problem and treatment plan. These individuals
may focus their educational efforts in health
promotion and disease prevention activities
that reduce the burden of disease in the community.
Some health educators are utilized to provide
in-depth instruction to clients about specific
illnesses after being diagnosed. Many health
educators have bachelors or masters degrees
in health education or health promotion. There
are no mandatory education or certification
requirements for health educators.
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Interpreters:
Interpreters are invaluable members of the
healthcare team that assist other healthcare
professionals in communicating with the patients
in their native language. These individuals
make the patient comfortable in the medical
setting as well as allowing the patient to communicate
with the healthcare team. Interpreters also
assist the healthcare team members in explaining
information about medical conditions and treatments.
There is no formal licensing or accreditation
process for health care interpreters. Many receive
training in medical terminology in order to
interpret in a health care setting. Often, untrained
native speakers are employed or recruited as
volunteer translators for the sake of convenience
and cost.
For more information on Interpreters read:
Putsch Robert W (1985) Cross-cultural communication
the special case of interpreters in health care.
JAMA, 254 (23) 3334-3348
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Mental Health Provider
Professional training for individuals who provide
mental health services in community health settings
varies widely. They include psychiatrists (a
physician who completes a residency in psychiatry);
clinical psychologists (doctoral preparation
in clinical psychology followed by a clinical
internship); licensed clinical social workers
(see above); psychiatric clinical nurse specialists
(master’s prepared nurse with clinical
training in individual and family counseling);
licensed counselors with a master’s degree
in counseling, or an individual with no formal
training. In the District of Columbia only the
psychiatrist and psychiatric clinical nurse
specialist have prescriptive authority.
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Nurses
Advanced Practice Nurses (APN) today are required
to have a Master’s degree.
The term APN is a descriptor that includes
nurse practitioner (NP), clinical nurse specialist
(CNS), certified nurse-midwife (CNM), or certified
registered nurse anesthetist (CRNA). APNs must
hold current RN/APN licensure in the state in
which they practice. In 29 states, APNs must
pass a national certification examination to
practice. State Nurse Practice Acts detail legal
authority, reimbursement, and prescriptive authority
under which APNs practice. In DC, APNs have
full prescriptive authority and may practice
without any required collaborative agreement
with a physician. Specialty areas for NPs include:
family, adult, pediatric, gerontologic, women’s
health, school/college health, occupational
health, mental health, emergency and acute care.
The NP serves as a primary care provider for
individuals, families, and communities in ambulatory
settings.
The curriculum includes core content such as
research, health care policy, ethics, and health
promotion and disease prevention. Advanced practice
content considered essential for all advanced
practice students includes pharmacology, physiology,
pathophysiology, advanced physical assessment
and specialty content specific to specialization.
Intensive, supervised clinical experiences are
part of the educational preparation.
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Registered Nurse (RN):
Registered nurses (RN) may be educated at the
diploma (hospital-based), associate or bachelor’s
level. Today, most RNs are prepared through
associate and baccalaureate degree programs.
Most associate degree programs are at community
colleges and can be completed within 2-3 years.
Bachelor’s prepared nurses complete a four-year
university-based degree program, typically with
the first two years of course work devoted to
the sciences and the last two years to nursing
courses and clinical preparation. Upon graduation,
all nurses must pass a national licensing examination,
known as the National Council Licensing Examination
(NCLEX). Successful passing of this examination
is necessary for state licensure as a RN. RNs
are prepared as generalists with their educational
preparation providing theory and practice in
areas such as – medicine, surgery, pediatrics,
obstetrics, psychiatry, and public health. RNs
play an integral role in community clinics,
ranging from providing essential services to
the provision of home-based services through
the public health department and private agencies.
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Vocational or practical nurses:
These nurses usually receive up to 12 months
of basic nursing skills training. They practice
under the supervision of a registered nurse
or physician. They must practice a national
licensing examination to become a licensed vocational
nurse (LPN) and must obtain a license in a state
to practice.
For more information on nurses visit:
http://www.nursingworld.org
http://www.aanp.org
http://www.aana.com
http://www.acnm.org
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Nutritionist:
The Registered Dietitian (R.D.) is a health
care professional trained in the single specialty
of nutrition science. Their goal is to promote
health and fight illness by fostering the practice
of proper nutrition to individuals and groups.
A RD has both theoretical and practical experience,
including a minimum of a bachelor’s degree
in food and nutrition from an accredited university
plus an extensive professional internship under
expert supervision. The RD must pass a comprehensive
examination for certification and continuing
education is required to maintain certification.
Twenty-seven of the 41 states with statutory
laws governing the practice of dietetics plus
the District of Columbia require licensure.
Thirteen states require certification.
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Pharmacists:
Pharmacists dispense drugs and medications
prescribed by physicians, physician assistants,
nurse practitioners, and dentists. They also
advise healthcare professionals and patients
on the use and proper dosage of medications,
as well as expected side effects and interactions
with other prescription and nonprescription
medicines. These professionals also order and
maintain supplies of medications and various
medical supplies required for use in the clinical
setting.
Pharmacists usually possess a bachelor’s
degree and are required to graduate from an
accredited school of pharmacy. Many continue
to study to obtain advanced degrees in pharmacy
or business. All states and the District of
Columbia require a license to practice pharmacy,
which may require an internship under the supervision
of the registered pharmacist.
For more information on pharmacists visit:
http://www.aphanet.org
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Physician
(MD):
Physician training begins with a bachelor’s
degree from a four-year college or university.
Medical school typically consists of two years
of course work followed by two years of clinical
experience. Course work emphasizes pathophysiology,
recognition of signs and symptoms of disease,
and application of scientific method to the
understanding of disease. Classes also include
training in history taking and in physical examination.
The clinical years include required clerkships
in internal medicine, pediatrics, surgery, obstetrics/gynecology,
psychiatry, neurology, and family medicine.
Elective clerkships are available in other areas
of specialization. Clerkships are primarily
hospital-based. Today, there is an increasing
interest in providing medical students with
ambulatory care experience and in the community.
After graduation from medical school, physicians
enroll in intensive post-graduate residency
training in a particular specialty, which lasts
at least three years. License to practice medicine
in an individual state is regulated by the State
Board of Medicine. Licensure is generally available
after one year of post-graduate training. Board
certification in a specialty is an elective
process that requires a minimum number of years
of residency in the specialty and successful
completion of oral and/or written examinations.
For more information on physicians visit:
http://www.ama-assn.org
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Physician Assistant (PA):
Physician Assistants practice medicine with
the supervision of a licensed physician. As
members of the health care team, PAs provide
a broad range of medical services. They are
educated in one of the 107 specially designed
2-year programs located at medical colleges
and universities, teaching hospitals, and through
the Armed Forces. The first year is based on
classroom learning of the basic medical sciences,
while the second year is spent predominately
in clinical rotations. The typical PA student
has a bachelor’s degree and over 4 years
of health care experience prior to admission
to the PA program. After graduation, PA’s
must pass a national certifying examination.
Physician Assistants must be licensed in the
state in which they practice. In the District
of Columbia, PA authority is derived from the
physician and requires agreement with a physician-collaborator
to obtain licensure. PAs have prescriptive authority
under this agreement and may be directly reimbursed
under Medicaid. PA’s have limited ability
to apply for reimbursement under Medicare. Board
Certification examinations are available in
Primary Care and/or Surgery. Not all states
require board certification for licensure. Recertification
requires 100 continuing education hours every
two years and by written examination every 6
years.
For more information on physician assistants
visit:
http://www.aapa.org
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Social Worker:
Training for professional social workers is
at minimum a bachelor’s degree in social
work (BSW). Most social workers possess a master
’s degree in social work (MSW). They provide
counseling, and enable individuals, families,
and communities to obtain social services. They
work with clients on issues of unemployment,
illness, disability, housing, abuse, and financial
problems. Social workers specializing in providing
mental health services and counseling are called
Clinical Social Workers. In the community, they
may be active in organizing communities to improve
health and social services. Social workers often
assist families in crisis situations and during
periods of transitions.
Master’s prepared social workers may become
licensed clinical social workers (LCSW) after
completing 3200 supervised hours of work experience
and completion of coursework in the areas of
individual and family counseling, child abuse,
sexuality, and chemical dependency. LCSW’s
may provide individual and family counseling
services. Licensure is at the state level and
occurs after completion of a written and oral
exam. Licensing permits social workers to bill
insurance companies for their services. All
states and the District of Columbia have licensing
and certification requirements for practice.
Clinical social workers require additional education,
training, and certification.
For more information on social workers visit:
http://www.naswdc.org
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Volunteers
Volunteers are individuals that that provide
services in the clinical setting with no monetary
payment. They may be retired healthcare practitioners
or citizens with a strong desire to provide
public service to the community. Many clinics
utilize these volunteers to perform a variety
of jobs, such as interpreters, filing, answering
telephones, or more patient oriented services,
such as taking vital signs, assisting patients
in completing forms, and assisting other health
care team members. To serve as a volunteer requires
no certification or license, just a strong willingness
to serve the community and assist in helping
provide health services to others.
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Other Team Members:
Other members of the interdisciplinary health
care team may include: Physical therapists,
occupational therapists, speech and language
therapists, and art or music therapists. The
availability of these additional members of
the health care team depends on the community
served and the health care services offered.
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