Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity.

Samantha Sabo,Corey Hemstreet,Mae-Gilene Begay,J T Nashio,Louisa O'Meara,Brook Bender,Kim Russell,Joyce Hamilton

doi:10.3389/fpubh.2021.667926

Abstract

In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019–2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability.

Highlights

In 1968, the Indian Health Service (IHS) funded the Community Health Representative (CHR) program through P.L. 100–713 as a component of healthcare services for American Indian and Alaskan Native (AI/AN) people [1]
More than half (58%) of CHR Programs offered CHR Basic Certification upon hire through the IHS, only 25% of programs provided Patient Care Component (PCC) system coding and Resource and Patient Management System (RPMS) data entry training upon hire
CHR core roles and competencies make them a valuable member of the public health and healthcare system serving American Indian communities with the training, cultural, linguistic, and traditional knowledge to play a critical role in care coordination and case management

Summary

INTRODUCTION

In 1968, the Indian Health Service (IHS) funded the Community Health Representative (CHR) program through P.L. 100–713 as a component of healthcare services for American Indian and Alaskan Native (AI/AN) people [1]. All 12 participating Arizona CHR Programs identified the CHR workforce core roles and competencies included the IHS standard of practice of: health education, case finding and screening, care management and coordination, and patientcare and monitoring. One CHR manager described how EHR access has improved and facilitated the referral and information sharing processes with their 638-health care facility They explained that while CHRs had been limited to basic data entry into the RPMS, with the EHR they are able to more fully understand and contribute to their clients’ care: And so they have the capacity to read and understand what’s going on with their patients, do some good chart reviews, that kind of thing about what’s going on and we’re starting to train them to put notes in. Because if they’re doing the work, we shouldn’t be getting in the way of them talking about what they saw and observed

DISCUSSION

Findings

DATA AVAILABILITY STATEMENT