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The Alaska Community Health Aide Program

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Don Lemieux BSc,CAT
Health Science Lecturer
(2/11/10, Workshop 3, 12.30)

Published in: Health & Medicine
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    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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The Alaska Community Health Aide Program

  1. 1. The Alaska Community Health Aide Program November 2010, HINZ Conference Don Lemieux, BSc, CAT, Health Science Lecturer
  2. 2. Community Health Aide Program (CHAP) <ul><li>Unique to Alaska and the Indian health service (IHS) </li></ul><ul><li>Developed as a solution to: </li></ul><ul><ul><li>Geography </li></ul></ul><ul><ul><ul><li>Villages off road, accessible by boat or plane only </li></ul></ul></ul><ul><ul><li>Populations too small to support physician or midlevel provider </li></ul></ul><ul><ul><li>Harsh and unpredictable weather </li></ul></ul><ul><ul><li>High cost of travel and transport </li></ul></ul><ul><ul><li>Difficulty recruiting and retaining trained health care providers </li></ul></ul>Anaktuvuk Pass, AK
  3. 3. State of Alaska vs. USA Size Comparison NZ land mass
  4. 4. Community Health Aides and Practitioners (CHA/Ps) <ul><li>Local people </li></ul><ul><li>Initially described as “the eyes, and ears of the physician” </li></ul><ul><li>Increasing role in provision of primary services </li></ul><ul><li>Includes emergency, acute, chronic, and preventative health components </li></ul><ul><li>Training is “skills”based </li></ul><ul><ul><li>Does not include in depth pathophysiology or differential diagnosis </li></ul></ul><ul><li>Under supervision of a licensed physician~ many miles away. </li></ul>
  5. 5. Community Health Aides and Practitioners (CHA/Ps) <ul><li>Clinical skills include: </li></ul><ul><ul><li>History taking </li></ul></ul><ul><ul><li>Physical Exam and Lab skills </li></ul></ul><ul><ul><li>Use of the CHAM to make assessments </li></ul></ul><ul><ul><li>Ability to follow plans </li></ul></ul><ul><ul><li>Giving patient education </li></ul></ul><ul><ul><li>Administering medicines </li></ul></ul><ul><ul><li>Performing certain treatment procedures </li></ul></ul><ul><ul><li>Documenting patient encounter </li></ul></ul><ul><ul><li>Physicians may grant standing orders for specific care plans. </li></ul></ul>
  6. 6. CHAP History <ul><li>1950s Chemotherapy Aides </li></ul><ul><ul><ul><li>Direct Observed Therapy for TB patients </li></ul></ul></ul><ul><ul><ul><li>Addressed high rates of infant mortality and injuries </li></ul></ul></ul><ul><ul><ul><li>Volunteers </li></ul></ul></ul><ul><li>1956 </li></ul><ul><ul><ul><li>Dr. Walter Johnson, staff physician at Bethel ANS Hospital proposed training of village medical aides. </li></ul></ul></ul><ul><li>1964 </li></ul><ul><ul><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></ul></ul>Dr Walter Johnson, MD http://jukebox.uaf.edu/CHA/htm/wjohnson1.htm
  7. 7. CHAP History <ul><li>1968 </li></ul><ul><ul><li>Formal Training/Federal Funding received </li></ul></ul><ul><li>1976 </li></ul><ul><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></ul><ul><li>1988 </li></ul><ul><ul><li>Federal funding doubled-looked at quality factors and sought to develop a good workforce </li></ul></ul>Dr Walter Johnson, MD 1968 Community Health Aides
  8. 8. CHAP History <ul><li>2001 </li></ul><ul><li>work force issues-3 million in federal funding to increase dental health and behaviour health aides </li></ul><ul><li>2003 </li></ul><ul><li>Dental Health Aides Certified </li></ul><ul><li>2009 </li></ul><ul><li>Behavioral Health Aides Certified </li></ul>Dr Walter Johnson, MD Current Dental Health Aide Therapists
  9. 9. 180 Village Clinics 550 Community Health Aides/Practitioners 270,000 Patient Encounters
  10. 11. CHA Training <ul><li>Community Health Aide </li></ul><ul><li>Training Centers: </li></ul><ul><ul><ul><li>Alaska Native Tribal Health Consortium, Anchorage </li></ul></ul></ul><ul><ul><ul><li>Norton Sound Health Corporation, Nome </li></ul></ul></ul><ul><ul><ul><li>Southeast Alaska Regional Health Consortium, Sitka </li></ul></ul></ul><ul><ul><ul><li>Yukon Kuskokwim Health Corporation, Bethel </li></ul></ul></ul>
  11. 12. CHA Selection & Training <ul><li>TABE Testing-reading/comprehension/math </li></ul><ul><li>Hired by tribal health organization </li></ul><ul><li>Presession: Intro to CHAM/CHA role/ETT </li></ul><ul><li>Session I: 4 wks  60 hrs in village clinic </li></ul><ul><li>Session II: 4 wks  200 hrs in village clinic </li></ul><ul><li>Session III: 3 wks  200 hrs in village clinic </li></ul><ul><li>Session IV: 4 wks  200 hrs in village clinic </li></ul><ul><li>Preceptorship: 1 wk: skills & pt encounters; exam </li></ul>
  12. 13. Alaska Community Health Aide/Practitioner Manual (CHAM) <ul><li>A guide to the CHA/P for every patient encounter </li></ul><ul><li>Easy to comprehend text </li></ul><ul><li>Multiple cross references </li></ul><ul><ul><li>Patient Care Visit manual </li></ul></ul><ul><ul><li>Reference and Procedure </li></ul></ul><ul><ul><li>Medicine Handbook </li></ul></ul><ul><ul><li>Emergency Field Handbook </li></ul></ul>
  13. 14. Alaska Community Health Aide/Practitioner Manual (CHAM) <ul><li>Current treatment guidelines based on “best practices” as agreed upon by panel of medical reviewers </li></ul><ul><li>124 reviewers </li></ul><ul><ul><li>43 MD Physicians of various specialties </li></ul></ul><ul><ul><li>33 Advanced Nurses or RN’s </li></ul></ul><ul><li>Supported by 28 independent tribal organisations </li></ul>
  14. 15. Alaska Community Health Aide/Practitioner Manual (CHAM) <ul><li>Current treatment guidelines based on “best practices” as agreed upon by panel of medical reviewers </li></ul><ul><li>124 reviewers </li></ul><ul><ul><li>43 MD Physicians of various specialties </li></ul></ul><ul><ul><li>33 Advanced Nurses or RN’s </li></ul></ul><ul><li>Supported by 28 independent tribal organisations </li></ul>
  15. 16. <ul><li>The Alaska Community Health Aide/Practitioner Manual is used as a guideline for every patient visit and follow-up with the physician. </li></ul>Alaska Community Health Aide/Practitioner Manual
  16. 17. CHA Selection & Training <ul><li>Alaska Native people are selected by their communities, attend training, and work in their village clinics. </li></ul>lllllllllllllllllllll
  17. 18. Quality Assurance <ul><li>Village Supervision by Clinical Instructors </li></ul><ul><ul><li>Clinical Supervision </li></ul></ul><ul><ul><li>Chart Review </li></ul></ul><ul><li>Referral Physician </li></ul><ul><ul><li>Standing Orders </li></ul></ul><ul><ul><li>Routine Reporting </li></ul></ul><ul><ul><li>Field Visits </li></ul></ul><ul><li>Individual CHA/P, DHA, and BHA Certification </li></ul><ul><li>Training Center Certification </li></ul>
  18. 19. Certification <ul><li>CHAP Certification Board </li></ul><ul><ul><li>Federal Authority, 11 members </li></ul></ul><ul><ul><li>FTCA coverage </li></ul></ul><ul><li>Standards and Procedures </li></ul><ul><ul><li>Individual CHA/Ps, DHAs, BHAs, Training Centers </li></ul></ul><ul><li>353 CHA/Ps certified </li></ul><ul><ul><li>291 meet criteria for reimbursement for services to Medicaid eligible clients (10/09) </li></ul></ul><ul><li>34 Dental Health Aides certified </li></ul><ul><li>7 Behavioral Health Aide Standards certified </li></ul>
  19. 20. Funding Model 2007 Overview <ul><li>Annual Estimated Funding </li></ul><ul><ul><li>$55 m, tribal, federal, private, and state funding </li></ul></ul><ul><ul><ul><li>33.3m IHS </li></ul></ul></ul><ul><ul><ul><li>2.7m Medicaid </li></ul></ul></ul><ul><ul><ul><li>2.0m State Grants </li></ul></ul></ul><ul><ul><ul><li>17.0m Tribal health Programmes </li></ul></ul></ul>Gage, S. Community Health Aide Program Overview 2007, Alaska Association of Community Health Aide Program Directors
  20. 21. Disparities in Indigenous Health <ul><li>“ In nearly every health status indicator assessed, disparities </li></ul><ul><li>( both absolute and relative ) were more pronounced for Maoris than for American Indians/Alaska Natives” (AI/AN) </li></ul><ul><li>For immunizations no disparities observed for AI/AN </li></ul><ul><li>Authors acknowledge the role of the IHS in addressing disparities </li></ul>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
  21. 22. Community Health Aide Program <ul><li>CHAP is a sustainable, successful, and culturally acceptable health care delivery system in Alaska Native villages. </li></ul><ul><li>With focused training and support, community health professionals can deliver quality care in rural environments. </li></ul><ul><li>Addresses health care staffing shortages and rural staffing shortages </li></ul><ul><li>Improves efficiencies and savings throughout the health care system </li></ul><ul><li>Mechanism for the devolution of health care </li></ul>
  22. 23. Community Health Aide Program <ul><li>CHAP is a sustainable, successful, and culturally acceptable health care delivery system in Alaska Native villages. </li></ul><ul><li>With focused training and support, community health professionals can deliver quality care in rural environments. </li></ul><ul><li>Addresses health care staffing shortages and rural staffing shortages </li></ul><ul><li>Improves efficiencies and savings throughout the health care system </li></ul><ul><li>Mechanism for the devolution of health care </li></ul><ul><li>http://acrh-ahec.uaa.alaska.edu/projects/nice.html </li></ul>
  23. 24. Contact Information <ul><li>Victorie Heart, MS, RN </li></ul><ul><li>Director, CHAP/Rural Health </li></ul><ul><li>(907)729-3642 email: [email_address] </li></ul><ul><li>Carol Odinzoff, RN, MHCA </li></ul><ul><li>Assistant Director, CHAP/Rural Health </li></ul><ul><li>(907)729-3651 email: [email_address] </li></ul><ul><li>  Mary Williard, DDS </li></ul><ul><li>Dental Consultant </li></ul><ul><li>(907)729-5600 email: [email_address] </li></ul><ul><li>Kathleen Graves, PhD </li></ul><ul><li>Behavioral Health Consultant </li></ul><ul><li>(907)729-4594 email: [email_address] </li></ul><ul><li>Community Health Aide Program www.akchap.org </li></ul><ul><li>www.anthc.org/cs/chs/chap/ </li></ul><ul><li>Dental Health Website: www.anthc.org/cs/chs/dental/ </li></ul><ul><li>Behavioral Health Website: www.anthc.org/cs/chs/behavioral/ </li></ul>
  24. 25. NZ Contact Information <ul><li>Don Lemieux, BSc, CAT Health Studies Lecturer </li></ul><ul><li>Phone: 07 878 7275 Cell 02102209477 email: don.lemieux2002@yahoo.com </li></ul><ul><li>  </li></ul><ul><li>  </li></ul>19 Tawa Street, Te Kuiti 3910

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