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The Alaska Community Health Aide Program
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  • Corrected Contact Details:

    Don Lemieux,
    19 Tawa Street, Te Kuiti, New Zealand 3910
    Ph: 07 878 7275
    Cell: 021 022 09477
    Email: dlemieux2002@yahoo.com

    Kind regards,

    Don Lemieux
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  • Alaska Native Tribal Health Consortium was formed in 1998.  A question i pose with this picture is “ Is this the NZ workforce of the future?”
  • The Indian Health Service is a federal programme dedicated to improving the health and well being of Alaska Natives and American Indians. Anatuvik pass 302 pop
  • NZ is one sixth the land mass of Alaska. The state of Colorado is approximately the same size as New Zealand.
  • The training is competency based.
  • Please note I said administer drugs rather than prescribe. There are instances in some of the remote Islands where automated drug dispensers are employed.
  • Dr Walter Johson one of the original docs to work with TB patients still resides in Anchorage. In the 60's, it was still a volunteer programme primarily ISD Act. Fed's listened to tribes... 1988 doubled federal funding. looked at quality factors and sought to develop a good workforce. 2001 work force issues- Got 3 million in federal funding.need to increase dental health and behaviour health aides I noted that it was not unanimous to emphasise that is was scrutinised and is still in existence today.
  • Dr Walter Johson one of the original docs to work with TB patients still resides in Anchorage. In the 60's, it was still a volunteer programme primarily ISD Act. Fed's listened to tribes... 1988 doubled federal funding. looked at quality factors and sought to develop a good workforce. 2001 work force issues- Got 3 million in federal funding.need to increase dental health and behaviour health aides
  • 1988 doubled federal funding. looked at quality factors and sought to develop a good workforce. 2001 work force issues- Got 3 million in federal funding.need to increase dental health and behaviour health aides The University of Otago played a role in training some of the initial Dental Health Aides that started in New Zealand. December 3, 2004 The first Alaskan dental therapists educated and trained at the University of Otago will be awarded their Diplomas at the University’s graduation ceremony tomorrow (Saturday 4 December).
  • Note a combination of health professionals used in Alaska. RN,s NP’s, Physician Assistants, Community Health Aides, GP,s etc
  • TABE is the test of adult basic education. One to one model preceptorship- 1983 1985 Presession I developed Give basic tools in patient care 1981 I’ve left this info here though probably not relevant for you at this time
  • Dr Rob Burgess, CHAM 1987 And that book made a significant change in how the material was organized for health aides.  It allows you to go in with a symptom, and from that symptom, go in and collect a complete, focused, problem-specific history, exam, lab tests, and then it takes you to charts that allow you to analyze the information, sort of what we call compare and match, history and exam, for an assessment, and from that assessment, takes you directly to the page number for the plan.
  • Put this slide here to denote that the manual has been well reviewed in the medical community
  • CHA’s are regulated through a number of mechanisms. Physicians make visits to CHA’s at least twice a year and CHA’s must have specified CME’s credits to maintain certification.
  • Certification allows for billing into the Medicaid system 1980’s IHS
  • Certification allows for billing into the Medicaid system 1980’s IHS I put this slide in to denote that a mature programme can represent a significant programme financially.
  • This slides emphasises that Alaska Natives/ American Indians are not the worse off Health wise, which I have heard anecdotally. Rather Maori have worse health disparities with Australia taking the lead of the three.

Transcript

  • 1. The Alaska Community Health Aide Program November 2010, HINZ Conference Don Lemieux, BSc, CAT, Health Science Lecturer
  • 2. Community Health Aide Program (CHAP)
    • Unique to Alaska and the Indian health service (IHS)
    • Developed as a solution to:
      • Geography
        • Villages off road, accessible by boat or plane only
      • Populations too small to support physician or midlevel provider
      • Harsh and unpredictable weather
      • High cost of travel and transport
      • Difficulty recruiting and retaining trained health care providers
    Anaktuvuk Pass, AK
  • 3. State of Alaska vs. USA Size Comparison NZ land mass
  • 4. Community Health Aides and Practitioners (CHA/Ps)
    • Local people
    • Initially described as “the eyes, and ears of the physician”
    • Increasing role in provision of primary services
    • Includes emergency, acute, chronic, and preventative health components
    • Training is “skills”based
      • Does not include in depth pathophysiology or differential diagnosis
    • Under supervision of a licensed physician~ many miles away.
  • 5. Community Health Aides and Practitioners (CHA/Ps)
    • Clinical skills include:
      • History taking
      • Physical Exam and Lab skills
      • Use of the CHAM to make assessments
      • Ability to follow plans
      • Giving patient education
      • Administering medicines
      • Performing certain treatment procedures
      • Documenting patient encounter
      • Physicians may grant standing orders for specific care plans.
  • 6. CHAP History
    • 1950s Chemotherapy Aides
        • Direct Observed Therapy for TB patients
        • Addressed high rates of infant mortality and injuries
        • 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
  • 7. 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
  • 8. 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 Aides Certified
    Dr Walter Johnson, MD Current Dental Health Aide Therapists
  • 9. 180 Village Clinics 550 Community Health Aides/Practitioners 270,000 Patient Encounters
  • 10.  
  • 11. CHA Training
    • Community Health Aide
    • Training Centers:
        • Alaska Native Tribal Health Consortium, Anchorage
        • Norton Sound Health Corporation, Nome
        • Southeast Alaska Regional Health Consortium, Sitka
        • Yukon Kuskokwim Health Corporation, Bethel
  • 12. CHA Selection & Training
    • TABE Testing-reading/comprehension/math
    • Hired by tribal health organization
    • Presession: Intro to CHAM/CHA role/ETT
    • Session I: 4 wks  60 hrs in village clinic
    • Session II: 4 wks  200 hrs in village clinic
    • Session III: 3 wks  200 hrs in village clinic
    • Session IV: 4 wks  200 hrs in village clinic
    • Preceptorship: 1 wk: skills & pt encounters; exam
  • 13. Alaska Community Health Aide/Practitioner Manual (CHAM)
    • A guide to the CHA/P for every patient encounter
    • Easy to comprehend text
    • Multiple cross references
      • Patient Care Visit manual
      • Reference and Procedure
      • Medicine Handbook
      • Emergency Field Handbook
  • 14. Alaska Community Health Aide/Practitioner Manual (CHAM)
    • Current treatment guidelines based on “best practices” as agreed upon by panel of medical reviewers
    • 124 reviewers
      • 43 MD Physicians of various specialties
      • 33 Advanced Nurses or RN’s
    • Supported by 28 independent tribal organisations
  • 15. Alaska Community Health Aide/Practitioner Manual (CHAM)
    • Current treatment guidelines based on “best practices” as agreed upon by panel of medical reviewers
    • 124 reviewers
      • 43 MD Physicians of various specialties
      • 33 Advanced Nurses or RN’s
    • Supported by 28 independent tribal organisations
  • 16.
    • The Alaska Community Health Aide/Practitioner Manual is used as a guideline for every patient visit and follow-up with the physician.
    Alaska Community Health Aide/Practitioner Manual
  • 17. CHA Selection & Training
    • Alaska Native people are selected by their communities, attend training, and work in their village clinics.
    lllllllllllllllllllll
  • 18. Quality Assurance
    • Village Supervision by Clinical Instructors
      • Clinical Supervision
      • Chart Review
    • Referral Physician
      • Standing Orders
      • Routine Reporting
      • Field Visits
    • Individual CHA/P, DHA, and BHA Certification
    • Training Center Certification
  • 19. Certification
    • CHAP Certification Board
      • Federal Authority, 11 members
      • FTCA coverage
    • Standards and Procedures
      • Individual CHA/Ps, DHAs, BHAs, Training Centers
    • 353 CHA/Ps certified
      • 291 meet criteria for reimbursement for services to Medicaid eligible clients (10/09)
    • 34 Dental Health Aides certified
    • 7 Behavioral Health Aide Standards certified
  • 20. Funding Model 2007 Overview
    • Annual Estimated Funding
      • $55 m, tribal, federal, private, and state funding
        • 33.3m IHS
        • 2.7m Medicaid
        • 2.0m State Grants
        • 17.0m Tribal health Programmes
    Gage, S. Community Health Aide Program Overview 2007, Alaska Association of Community Health Aide Program Directors
  • 21. 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
    • Authors acknowledge the role of the IHS in addressing disparities
    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 http://en.wikipedia.org/wiki/File:Flag_of_New_Zealand.svg http://en.wikipedia.org/wiki/File:Flag_of_the_United_States.svg
  • 22. Community Health Aide Program
    • CHAP is a sustainable, successful, and culturally acceptable health care delivery system in Alaska Native villages.
    • With focused training and support, community health professionals can deliver quality care in rural environments.
    • Addresses health care staffing shortages and rural staffing shortages
    • Improves efficiencies and savings throughout the health care system
    • Mechanism for the devolution of health care
  • 23. Community Health Aide Program
    • CHAP is a sustainable, successful, and culturally acceptable health care delivery system in Alaska Native villages.
    • With focused training and support, community health professionals can deliver quality care in rural environments.
    • Addresses health care staffing shortages and rural staffing shortages
    • Improves efficiencies and savings throughout the health care system
    • Mechanism for the devolution of health care
    • http://acrh-ahec.uaa.alaska.edu/projects/nice.html
  • 24. Contact Information
    • Victorie Heart, MS, RN
    • Director, CHAP/Rural Health
    • (907)729-3642 email: [email_address]
    • Carol Odinzoff, RN, MHCA
    • Assistant Director, CHAP/Rural Health
    • (907)729-3651 email: [email_address]
    •   Mary Williard, DDS
    • Dental Consultant
    • (907)729-5600 email: [email_address]
    • Kathleen Graves, PhD
    • Behavioral Health Consultant
    • (907)729-4594 email: [email_address]
    • 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/
  • 25. NZ Contact Information
    • Don Lemieux, BSc, CAT Health Studies Lecturer
    • Phone: 07 878 7275 Cell 02102209477 email: don.lemieux2002@yahoo.com
    •  
    •  
    19 Tawa Street, Te Kuiti 3910