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The Alaska Community Health Aide Program

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Victorie Heart, MS, RN …

Victorie Heart, MS, RN
Director, CHAP/Rural Health

Don Lemieux, BSc, CAT
School of Nursing and Health Studies
Waiariki Institute of Technology

Published in Health & Medicine , Education
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  • Regarding NZ Contact:

    I am no longer employed with Waiariki Institute of Technology but may be contacted at Ph:07 878 7275, Cell: 021 022 09477 or dlemieux2002@yahoo.com.

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    Don Lemieux
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  • 1. TheAlaska Community Health Aide Program
    December 2009
    Victorie Heart, MS, RN
    Director, CHAP/Rural Health
  • 2. Overview
    • CHAP Role
    • 3. CHAP History
    • 4. CHA Training
    • 5. Program Standards
    • 6. Quality Assurance
    • 7. Disparities in Indigenous health
    • 8. Questions-Discussion
  • Anaktuvuk Pass, AK
    CommunityHealth Aide Program (CHAP)
    • Unique to Alaska and the Indian health service (IHS)
    • 9. Developed as a solution to:
    • 10. Geography
    • 11. Villages off road, accessible by boat or plane only
    • 12. Populations too small to support physician or midlevel provider
    • 13. Harsh and unpredictable weather
    • 14. High cost of travel and transport
    • 15. Difficulty recruiting and retaining trained health care providers
  • State of Alaska vs. USA Size Comparison
    NZ land mass
  • 16. Community Health Aides and Practitioners (CHA/Ps)
    • Local people
    • 17. Initially described as “the eyes, ears and hands of the physician”
    • 18. Increasing role in provision of primary services
    • 19. Includes emergency, acute, chronic, and preventative health components
    • 20. Training is “skills”based
    • 21. Does not include in depth pathophysiology or differential diagnosis
    • 22. Under supervision of a licensed physician~ many miles away.
  • Community Health Aides and Practitioners (CHA/Ps)
    • Clinical skills include:
    • 23. History taking
    • 24. Physical Exam and Lab skills
    • 25. Use of the CHAM to make assessments
    • 26. Ability to follow plans
    • 27. Giving patient education
    • 28. Administering medicines
    • 29. Performing certain treatment procedures
    • 30. Documenting patient encounter
    • 31. Physicians may grant standing orders for specific care plans.
  • CHAP History
    1950sChemotherapy Aides
    • Direct Observed Therapy for TB patients
    • 32. Addressed high rates of infant mortality and injuries
    • 33. Volunteers
    1956
    • Dr. Walter Johnson, staff physician at Bethel ANS Hospital proposed training of village medical aides.
    1964
    • A recommendation was made, though not unanimous, to seek funds from the U.S. Congress to train and employ village medical aides.
    Dr Walter Johnson, MD
    http://jukebox.uaf.edu/CHA/htm/wjohnson1.htm
  • 34. CHAP History
    1968
    • Formal Training/Federal Funding received
    1976
    • Twenty additional CHA positions were approved by the U.S. Congress in the ANHS budget, increasing these from the original 185 positions in 157 villages to 205 positions in 185 villages
    1988
    • Federal funding doubled-looked at quality factors and sought to develop a good workforce
    Dr Walter Johnson, MD
    1968 Community Health Aides
  • 35. CHAP History
    2001
    • work force issues-3 million in federal funding to increase dental health and behaviour health aides
    2003
    • Dental Health Aides Certified
    2009
    • Behavioral Health AidesCertified
    Dr Walter Johnson, MD
    Current Dental Health Aide Therapists
  • 36. 180 Village Clinics 550 Community Health Aides/Practitioners270,000 Patient Encounters
  • 37.
  • 38. CHA Training
    Community Health Aide
    Training Centers:
    • Alaska Native Tribal Health Consortium, Anchorage
    • 39. Norton Sound Health Corporation, Nome
    • 40. Southeast Alaska Regional Health Consortium, Sitka
    • 41. Yukon Kuskokwim Health Corporation, Bethel
  • CHA Selection & Training
    • TABE Testing-reading/comprehension/math
    • 42. Hired by tribal health organization
    • 43. Presession: Intro to CHAM/CHA role/ETT
    • 44. Session I: 4 wks60 hrs in village clinic
    • 45. Session II: 4 wks200 hrs in village clinic
    • 46. Session III: 3 wks200 hrs in village clinic
    • 47. Session IV: 4 wks200 hrs in village clinic
    • 48. Preceptorship: 1 wk: skills & pt encounters; exam
  • Alaska Community Health Aide/Practitioner Manual (CHAM)
    • A guide to the CHA/P for every patient encounter
    • 49. Easy to comprehend text
    • 50. Multiple cross references
    • 51. Patient Care Visit manual
    • 52. Reference and Procedure
    • 53. Medicine Handbook
    • 54. Emergency Field Handbook
  • Alaska Community Health Aide/Practitioner Manual (CHAM)
    • Current treatment guidelines based on “best practices” as agreed upon by panel of medical reviewers
    • 55. 124 reviewers
    • 56. 43 MD Physicians of various specialties
    • 57. 33 Advanced Nurses or RN’s
    • 58. Supported by 28 independent tribal organisations
  • Alaska Community Health Aide/Practitioner Manual (CHAM)
    • Current treatment guidelines based on “best practices” as agreed upon by panel of medical reviewers
    • 59. 124 reviewers
    • 60. 43 MD Physicians of various specialties
    • 61. 33 Advanced Nurses or RN’s
    • 62. Supported by 28 independent tribal organisations
  • CHA Selection & Training
    lllllllllllllllllllll
    Alaska Native people are selected by their communities, attend training, and work in their village clinics.
  • 63. Alaska Community Health Aide/Practitioner Manual
    The Alaska Community Health Aide/Practitioner Manual is used as a guideline for every patient visit and follow-up with the physician.
  • 64. Quality Assurance
    • Village Supervision by Clinical Instructors
    • 65. Clinical Supervision
    • 66. Chart Review
    • 67. Referral Physician
    • 68. Standing Orders
    • 69. Routine Reporting
    • 70. Field Visits
    • 71. Individual CHA/P, DHA, and BHA Certification
    • 72. Training Center Certification
  • Certification
    • CHAP Certification Board
    • 73. Federal Authority, 11 members
    • 74. FTCA coverage
    • 75. Standards and Procedures
    • 76. Individual CHA/Ps, DHAs, BHAs, Training Centers
    • 77. 353 CHA/Ps certified
    • 78. 291 meet criteria for reimbursement for services to Medicaid eligible clients (10/09)
    • 79. 34 Dental Health Aides certified
    • 80. 7 Behavioral Health Aide Standards certified
  • Disparities in Indigenous Health
    • “In nearly every health status indicator assessed, disparities
    ( both absolute and relative ) were more pronounced for Maoris than for American Indians/Alaska Natives” (AI/AN)
    • For immunizations no disparities observed for AI/AN
    • 81. Authors acknowledge the role of the IHS in addressing disparities
    http://en.wikipedia.org/wiki/File:Flag_of_New_Zealand.svg
    http://en.wikipedia.org/wiki/File:Flag_of_the_United_States.svg
    Bramley,D., Hebert,P., Tuzzio, L.,Chassin,H.,Disparities in Indigenous Health: A Cross-Country Comparison Between New Zealand and the United States. Am J Public Health 2005;95:844-850
  • 82. Community Health Aide Program
    CHAP is a sustainable, successful, and culturally acceptable health care delivery system in Alaska Native villages.
  • 83. Contact Information
    Victorie Heart, MS, RN
    Director, CHAP/Rural Health
    (907)729-3642 email: vheart@anth.org
    Carol Odinzoff, RN, MHCA
    Assistant Director, CHAP/Rural Health
    (907)729-3651 email: codinzoff@anthc.org
     Mary Williard, DDS
    Dental Consultant
    (907)729-5600 email: mewilliard@anthc.org
    Kathleen Graves, PhD
    Behavioral Health Consultant
    (907)729-4594 email: ksgraves@anthc.org
    Community Health Aide Program www.akchap.org
    www.anthc.org/cs/chs/chap/
    Dental Health Website: www.anthc.org/cs/chs/dental/
    Behavioral Health Website: www.anthc.org/cs/chs/behavioral/
  • 84. NZ Contact Information
    Waiariki Institute of TechnologySchool of Nursing and Health StudiesMokoia Drive, Rotorua, New ZealandPrivate Bag 3028, Rotorua 3201
    Don Lemieux, BSc, CAT Health Studies Lecturer,
    Phone: 07 346 8754 email: don.lemieux@waiariki.ac.nz
    Patrea Andersen , Ph D, RN– Associate Director
    Phone:  07 346 8753email: patrea.andersen@waiariki.ac.nz
    Alison Anderson , RN– Lecturer BNRN programme
    Phone: 07 346 8707email: alison.anderson@waiariki.ac.nz