Systems Change to Support a Community Health Workforce

Across Washington State, many people — especially those in historically underserved communities — continue to face significant health inequities. These gaps are driven by social and structural factors such as housing, income, transportation, and access to care — challenges that traditional health systems cannot solve alone.

Community-Based Workers (CBWs) are essential in addressing these inequities. This workforce includes Community Health Workers, promotores de salud, doulas, peer specialists, and other trusted frontline helpers. They connect people to services, help them navigate complex systems, and build bridges between communities and public institutions.

Yet despite their impact, CBWs often lack stable funding, clear career pathways, and aligned policies — leaving the workforce fragmented and under-resourced.

EPIC’s Role

We’re partnering with state agencies, community organizations, regional networks, and CBWs to strengthen and expand this critical workforce. Using a human‑centered design approach grounded in research and lived experience, our team is partnering with public health leaders across the state to:

Understand the day‑to‑day realities of CBWs
Identify systemic barriers that affect workforce stability
Co‑create sustainable models for training, supervision, compensation, and career advancement

This multi‑year effort aims to help community-based programs grow beyond isolated initiatives and evolve into coordinated, equitable, and scalable systems that improve health and well‑being across Washington State.

We’re grateful to share a new report from the Evans Policy Innovation Collaborative (EPIC), developed in partnership with many of you over the past 18 months.

This work began with a simple but urgent question: What will it take to meaningfully improve persistent health disparities in Washington State? Through literature review, interviews, and deep engagement with leaders and community-based workers (CBWs) across the state, one opportunity became clear: strengthening the systems that support and scale the community-based workforce.

What we found is both encouraging and concerning. Across Washington, CBWs are doing critical work—building trust, helping people navigate complex systems, and addressing root causes of health inequity. At the same time, the systems meant to support this work remain fragmented, under-resourced, and often disconnected from frontline realities. As needs rise, the workforce is under increasing strain, and without coordinated action, we risk losing a vital foundation for health equity.

This report lifts up three priority areas for action:

Centering CBW voices in policy and implementation
Building an evidence base that reflects frontline context
Aligning policy and funding to support sustainable, community-rooted practice

We see this report not as a final product, but as an invitation. An invitation to reflect, to engage, and to work together to advance solutions that match the scale and urgency of the challenge.

Importantly, this is the first report of its kind from EPIC. It represents a milestone in how we aim to partner with communities—through ongoing learning, shared ownership of insights, and a commitment to shaping work alongside those most impacted. In that spirit, we consider this a living document. The story it tells is still unfolding.

We welcome your feedback, perspectives, and ideas for what comes next. We would value the opportunity to continue learning with you and to support efforts already underway to strengthen Washington’s community-based workforce.

Thank you for your partnership, your leadership, and your commitment to this work.

Read the Report

Project Overview

Washington State is building a stronger, more connected community‑based workforce — people like Community Health Workers (CHWs), peer navigators, and other trusted frontline staff who help families access support, navigate complex systems, and feel seen and understood. The first two phases of our multi‑year effort set the foundation for collective action by bringing leaders together around a shared vision and listening deeply to the people doing the work every day.

Phase 1 — Creating shared understanding (completed February 2025)

Phase 1 brought state leaders, agencies, and community organizations together to build a common picture of the CBW landscape. Partners reviewed existing models, identified gaps in support and supervision, and aligned around shared priorities for the future. This phase set the table for long‑term collaboration and created a clear foundation for the work ahead.

Phase 2 — Listening to those on the frontlines (in progress)

In our current phase of work, we’re building on that foundation by turning directly to CBWs and community members for insight. Through interviews, workshops, and community‑centered research, this phase focuses on understanding what the workforce experiences each day — and what would make their work more supported, sustainable, and impactful.

What we’re focusing on:

Learning from CBWs themselves — listening closely to their day‑to‑day work, strengths, challenges, and the value they bring to their communities.
Gathering stories, experiences, and data directly from workers and community members so the picture we build reflects the people who know this work best.
Identifying what’s getting in the way — and what’s possible, surfacing barriers to growth and stability along with opportunities to strengthen and scale this essential workforce.

Looking Ahead: Phase 3 — Turning insights into action

As we begin to surface patterns and themes, our next phase will shift toward making sense of those findings and transforming them into early solutions. Pending funding and support from the field, our next phase would bring community voices and policymakers together to co‑design prototypes — new ideas for training, supervision, resources, and career pathways that respond directly to what workers and communities have shared. This creative, collaborative stage would be focused on shaping what a stronger, more sustainable workforce could look like.

Project Team

Jodi Sandfort
Amanda Bankston
Cali Jahn
Jessika Gill
Julianne Slate Weaver
Evelyn Nganga
Julia Karon

Contact

General inquiries about the project may be addressed to: evansepic@uw.edu.