The Alaska Community Health Aide Program

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

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

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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.

    Kind regards,

    Don Lemieux
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The Alaska Community Health Aide Program

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

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