COMMUNITY HEALTH WORKER TRAINING PARTICIPANT AFFIDAVIT

In order to comply with mandates from the State of Indiana and the Indiana Community Health Worker Association (INCHWA), HealthVisions Midwest, Inc. is asked to ensure that Community Health Worker participants possess, in sum or in part, the following attributes and characteristics to be a successful Community Health Worker.

  • Connected to the Community – A community member OR having a close understanding of the community they serve with shared life experiences and strong desire to help the Community.
  • Interpersonal Warmth – The ability to listen and respond to clients and communities with compassion and kindness.
  • Trustworthiness and Mature – Being honest, allowing others to confide in you, maintaining confidentiality, and upholding professional ethics.
  • Open-Mindedness – The willingness to embrace others’ differences, including their flaws, and be non-judgmental in your interactions with them.
  • Objectivity – Striving to work with and view clients and their circumstances without the influence of personal prejudice or bias.
  • Sensitivity – To be aware of, and truly respect the experience, culture, feelings and opinions of others.
  • Competence – Developing the knowledge and skills required to provide quality services to all the clients and communities being served.
  • Commitment to Social Justice – The commitment and heart to fight injustice and to advocate for social changes that promote the health and well-being of the clients and communities.
  • Good Psychological Health – Having the mental and emotional capacity to perform your work professionally without doing harm to clients, colleagues or yourself.
  • Self-Awareness and Understanding – Being willing and able to reflect upon and analyze your own experiences, biases and prejudices, to ensure that they do not negatively affect your interactions with clients and colleagues.
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Participant
Authorized Representative Signature
PLEASE COMPLETE FORM AT LEAST 7 DAYS PRIOR TO TRAINING

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