February 14, 2025 | Erin Bluvas, bluvase@sc.edu

Three years into its rapid growth and widespread impact, the multi-institutional partnership known as envision will find a new home at the Arnold School’s Center for Community Health Alignment. The center has been a major partner in envision since it was established in 2021, and the work will fall under the guidance of director of community health worker leadership Lisa Renee Holderby-Fox, who will take on the additional title of envision executive director.

“The envision work is focused on workforce development for community health workers,” says Julie Smithwick, executive director for the Center for Community Health Alignment. “As the center is led by a diverse team of community health workers and our portfolio also involves community health worker workforce development, we are well-suited to take on this role and continue to expand our impact.”

Smithwick and Holderby-Fox crossed paths for years before they helped form envision. Their decades as community health workers and leaders in the field led them to work together on committees and at national conferences and initiatives.

When Smithwick joined forces with four other groups* to provide technical assistance and training to community health workers supporting the communities most impacted by COVID-19, envision was born. Funded by a $2.3 million grant from the Centers for Disease Control and Prevention, the Center for Community Health Alignment’s track record for providing technical assistance made the center a natural fit for leading this aspect of the envision program.

And Holderby-Fox’s experience and leadership in the field made her the seamless fit to lead it.

“I was the first full-time envision staff member at the Center for Community Health Alignment,” Holderby-Fox says. “I knew this would be an amazing opportunity to provide technical assistance in a structured way to folks across the country.”

Over the next three years, envision provided training and technical assistance to the 67 recipients who received the Community Health Workers for COVID Response and Resilient Communities funding from the CDC to build the capacity of their community health worker workforce. These groups were located in many states in the continental U.S. as well as Hawaii, Alaska, Puerto Rico, and various territories, freely associated states and tribal nations.

The grantees ranged from veteran to novice in terms of their experience in supporting and deploying community health workers to stop the spread of the virus and to advance healthy communities through their work. The envision team met them where they were to get them up and running, improve their processes, and create sustainability plans to ensure their long-term impact in the communities they served. 

“One of the biggest outcomes of our work from the past three years has been the creation of a Community Health Worker Financial Sustainability Toolkit,” Holderby-Fox says. “It is essential that we teach the organizations we partner with how to seek sustainable funding, access training, utilize Medicaid and Medicare funding, hire and provide supportive workplaces for community health workers, and all of the other best practices of this work so they can carry it forward.”

Holderby-Fox’s area of expertise is leadership, and she provides training and technical assistance workshops for community health workers and allies across the country. The sessions provide hands-on learning opportunities (e.g., organizational readiness, communication skills, building consensus, community engagement, ethics) for leaders ranging from reluctant to experienced.

Holderby-Fox’s own leadership journey began shortly after she became a parent at the age of 18. She studied criminal justice for her associate’s degree but couldn’t find a good match when looking for jobs. Besides, fate had other plans.

“I stumbled across an opportunity to work for a federally funded demonstration project in Massachusetts that was working to address high infant mortality rates for African Americans and Latinas in the state,” says Holderby-Fox. “They were looking for mothers like me who had children early and who might be able to connect with others like them through home visits and outreach, particularly for women whose pregnancies were considered high risk.”

The phrase, community health worker, hadn’t been embraced yet, but that’s what she was doing. And she fell in love with the work.

Over the next decade, Holderby-Fox continued working in maternal and child health, including programs like WIC and Head Start – programs she also understood from the perspective of a beneficiary and young mother. Around 2000, she became very engaged in organizing community health workers, eventually collaborating with the Department of Health and community health workers across the state to create the Massachusetts Association of Community Health Workers.

After the Blue Cross Blue Shield Foundation funded the formerly volunteer-led organization, Holderby-Fox was hired as its executive director. This is when she really began to hone her abilities to teach leadership and advocacy skills while simultaneously elevating community health worker roles statewide.

During this time, Holderby-Fox also had the opportunity to co-author two bills that were signed into law – one that requested a study by the Department of Public Health to look into the role of community health workers in advancing health equity and eliminating health disparities and a second that established a board of certification for the profession.

This type of work was happening in other states as well, and leaders like Holderby-Fox and Smithwick began convening to organize at the national level. Thanks to the efforts of the American Public Health Association’s Community Health Worker Policy Committee, which was chaired by Holderby-Fox, the U.S. Department of Labor finally recognized community health workers as a profession in 2010.

These integrated advocacy efforts also led to events like the annual Unity Conference, the establishment of the National Association of Community Health Workers, and collaborative projects like the one that led to the creation of envision. As the funding wraps up for its initial purpose, the team is working on their own sustainability plan.

They recently received an additional year of funding to support sustainability efforts of the existing programs and $1 million from the CDC to continue strengthening the nationwide community health worker workforce through a cooperative agreement. With the full national envision team now at 17 team members and relying on Holderby-Fox’s leadership expertise, the original partners determined that the Center for Community Health Alignment would be the best home for envision as they move forward into this next phase. 

“The Center for Community Health Alignment is a community health worker-led organization that believes and promotes community health worker leadership as a crucial component of community health worker programs and the sustainability of the workforce,” Holderby-Fox says. “The entire technical assistance team of envision, and many of the other team members, are community health workers, so the Center for Community Health Alignment, and its supportive home at the University of South Carolina and the Arnold School of Public Health, is the perfect place for envision to thrive.”

An additional $300K in funding from the New York Health Foundation and incoming contract work requests will also help ensure envision’s longevity. They held their first Community Health Worker Sustainability Summit in 2024 and expect that they will continue supporting new programs with the rollout of the Community Health Worker Financial Sustainability Toolkit to help these critical organizations get on their feet and succeed long-term.

*Other partners involved in the envision partnership include the University of Wisconsin Population Health Institute, the Wisconsin Department of Health Services, Louisiana State University Health, KineticHealth and the envision CHW Council.

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