CHR Newsletter
In this Issue
IHS CHR Program Develops Promotional Video Series
As part of a contract to provide communications start-up support, the Indian Health Service Community Health Representative Program developed a series of promotional videos. These videos portray the CHR program and its benefits through the lens of several American Indian and Alaska Native communities throughout the United States.
In 2023, the IHS CHR Program released its strategic plan, one of its priorities being raising awareness and advocating.
Four videos were filmed at different tribal sites nationwide to highlight this priority and support the strategic plan. They use visual storytelling to create compelling videos of the CHR program, services, and workforce. Each video shares firsthand information from interviews with CHRs, patients, and CHR program partners.
The IHS CHR Program would like to recognize and thank the following Tribal sites for their generosity and participation in this project. Each site provided access to leadership, program partners, patients, and local health systems to help with video development.
Tribal sites visited included:
- Kickapoo Tribe of Oklahoma
- Eastern Band of Cherokee Indians
- Northern Valley Indian Health
- Hopi Tribe
- Toiyabe Indian Health Project
"The goal for each story is to increase awareness of the CHR program and how it impacts our Indian communities, support the CHR strategic plan and related priorities, and provide real-world practices that speak to CHR roles and competencies," said Michelle Archuleta, CHR Consultant for the Division of Clinical and Community Services at IHS.
In addition to the videos, the CHR program has improved its visibility with increased social media, blog posts, and a newsletter. The focus has been on CHR programs, CHR partners, healthcare staff, and the public.
"As a frontline public community health workforce, our influences are evident in the social determinants of health and the health-related social needs that contribute to poor health outcomes. CHRs improve the health of community members through services such as health education, referrals to community resources, language interpretation and translation, informal counseling, and patient advocacy. This year, we raised the bar highlighting CHR program successes and impacts,"Archuleta added, "Going out to the five locations to film CHRs in action was a once-in-a-lifetime opportunity. We are especially thankful to each site for participating in this work."
Each of our videos will be available this fall! You will find them on the CHR website and through various online platforms to reeducate the public about the significant program impacts CHRs have in the communities they serve.
Hopi CHR Reflects on Cancer Navigation Training
Patient navigation is a significant health service delivery tool that promotes the timely movement of an individual patient with complex medical needs. The concept of the patient navigator has gained momentum, particularly in cancer treatment. An essential distinction between navigators and community health representatives (CHRs) is that navigators are typically assigned to specific patients and follow them for an extended period during diagnosis and treatment. At times, CHRs may work with patients similarly and have a variety of short-term interactions with patients and community members who are not currently patients of the provider organization.
A CHR provides navigation assistance to patients and community members through various activities involving preventing and managing chronic illnesses. These include education and counseling, addressing barriers to accessing screening or health services, supporting patients' attendance at appointments, and providing patient follow-up.
Charnel Talashoma is a CHR for the Hopi Tribe’s CHR program. She shared her reflections on a recent cancer patient navigation training she attended, which boosted her ability to navigate patients' health services and reduce treatment delays.
The training was a collaboration of hospitals and healthcare services, healthcare professionals, caregivers, community advocates, patient navigators, CHRs, clients’ families, and cancer survivors. The three-day event began with a traditional direction. Attendees prayed and smudged before being ready for deep discussions that would later evolve with each day of training.
This training helped Talashoma navigate relationships with each of her clients, especially those who are diagnosed and impacted by cancer. The disease has an overwhelming effect and is a life-changing event.
"To save lives from cancer, it starts with early detection and screenings. The knowledge of your family history is most important," she added. "The main goals of patient navigation are saving lives from cancer, improving quality of life, eliminating barriers to care, and ensuring timely delivery of services."
The resources and assistance received from this training will help implement more information and emotional support overall. She added that it taught her to be patient and coordinate clients' timely diagnoses and treatments.
In this Issue
CHR Mini-Cog© Pilot Raises Dementia Awareness
CHR professionals can play a key role in screening people with signs of dementia.
The Community Health Representative workforce significantly impacts patients in the home and community setting. They can do this by providing education and community awareness about dementia. This year, we learned from a multi-site pilot that CHRs can also play a critical role in detecting dementia.
According to the Centers for Disease Control and Prevention (CDC), one of every six American Indian and Alaska Native adults aged 45 and older reports experiencing subjective cognitive decline, which can be a precursor to dementia.
The Alzheimer's Program was established by Congress in 2021 and has been developing programs and services to help address the Alzheimer's and dementia crisis facing American Indian and Alaska Native Communities. In 2023, the Alzheimer's Program began a long-term collaboration with the IHS CHR program, recognizing the importance and value of the workforce in addressing the issues facing people living with dementia, their caregivers, and communities.
As part of a six-month pilot this year, we partnered with CHRs to test the feasibility of using the Mini-Cog© cognitive screening tool in community settings, including a referral process. We used peer-to-peer learning processes and developed detailed electronic coding and workflow job aids.
The CHR program recruited six programs from different IHS Areas to participate in the demonstration project. Each recipient designed and implemented a local approach to using the Mini-Cog©. A Mini-Cog© is an evidence-based quick screening tool for early dementia. It can be done in just three minutes and may help identify the need for a full cognitive evaluation. It is intended for use by trained care professionals.
The six participating locations conducted 193 screenings, resulting in 34 positive screenings (17.6 percent).
"From this first pilot, we have learned so much about CHR training needs and suggestions for improving the screening and referral process," said Michelle Archuleta, IHS Division of Clinical and Community Services CHR Consultant. Archuleta believes the CHR workforce is uniquely positioned to help address dementia in their communities. She also sees expanded roles in the future for CHRs that include awareness, screening, and education, as well as roles in risk reduction and caregiver coaching and support.
National CHW Awareness Week 2024
A national campaign to celebrate and commemorate community health workers is taking place. The National CHR Program wants to share in this effort and thank all community health workers, community health representatives, and promoters for your dedication and service to your communities. Through your contributions, we are changing our communities!
Oklahoma Area Association of Community Health Representatives
Top Priority Is Education and Training
OAACHR President Cheryl Willis at an Active Shooter Training. The Oklahoma Area Association of Community Health Representatives, Inc. (OAACHR) focuses on providing education and training to all Community Health Representatives. OAACHR also advocates for Oklahoma tribes to ensure each program has a voice and is recognized for its unique work on a tribal level.
Among the top priorities for OAACHR is patient advocacy and continuity of care in the interim of their clinic visits. OAACHR also focuses on other patient issues like:
- Home safety
- Community education
- Home monitoring
- Meeting the immediate needs of citizens
"Since nearly 100 percent of the tribes in Oklahoma have had CHR programs since 1968, it is a well-recognized service program in all clinics," said OAACHR Secretary-Treasurer Cyndi Gilkes-Ayres. She added that the hope is to maintain "our long-standing status as a unique and specialized service on a grassroots level."
For more information on OAACHR, contact Cheryl Willis at 406-207-6640 or Cyndi Gilks-Ayres at 405-379-5552
SHINING A SPOTLIGHT ON YOUR CHR PROGRAM IN THE NEWSLETTER
We Want to Share Your Program Success!
In each CHR newsletter, we are interested in featuring CHR impact stories that tell all the ways CHRs help their communities.
Community Health Representatives are frontline public health workers who improve health equity, address the social determinants of health, and improve access to healthcare in American Indian and Alaska Native communities. Program examples include providing community education and outreach, conducting home visits, helping individuals access services, and assisting with follow-up appointments, which improve patient health and well-being.
If you want to submit a story for the IHS CHR newsletter, email us today!
In this Issue
E-Learning delivers training and education to the Community Health Representative workforce
New training track focuses on leadership, organization and program skills, and evaluation.
The E-Learning series of modules administered through the Indian Health Service (IHS) are self-paced and provide the learner with a convenient way to receive continued learning on essential topic areas to meet the needs of Community Health Representatives (CHRs) in all settings. The new advanced training track builds off of CHR basic training and is designed for those who would like additional training in leadership, organization, program development, and evaluation.
"The advanced training is a series of three modules that we consider the ‘next step’ for a Community Health Representative who is ready for leadership and change, community assessment, and program coordination," said Michelle Archuleta, National CHR Consultant for the IHS. The training introduces budget concepts, project management principles, evaluation processes, and community leadership concepts. In particular, "Leading at the Community Level is a new module we are excited to release because it brings in much of the identity of a CHR, the identity as a tribal member, and the connection to the community," Archuleta said.
As part of professional growth and development, "Many of our CHRs will have the opportunity to step into a supervisor role or possibly further their education. This training will help them do that,” she said. “It is a wonderful opportunity to grow from the foundational core role into a leadership role."
For information on E-Learning opportunities, visit the CHR Training page.
CHR ECHO Program
The Indian Country Community Health Representative (CHR) ECHO provides comprehensive information to support Indian Health Service, Tribal and Urban Indian Community Health Representatives, and community-based health workers.
The one-hour telehealth sessions offer community-based healthcare workers an opportunity to engage with peers and an interprofessional team of specialists working in Indian Country and to obtain a Certificate of Completion following participation in a didactic presentation.
The sessions are held virtually using Zoom on the third Monday of every month at noon PDT.
Find out more information and register.
Who’s New?
David Jacobs, M.D., Tucson Area Chief Medical Officer and CHR Consultant
Before joining IHS, Dr. Jacobs was a subject matter expert and Chief Medical Officer (CMO) in a Tucson-based health informatics company. Additionally, Jacobs is board-certified in Physical Medicine and Rehabilitation. He practiced in his chosen field throughout his career in Southern Arizona. He served as Medical Director of a Rehabilitation hospital and conducted an outpatient practice during his tenure. Originally from the northeast, Dr. Jacobs trained at New York University Medical Center and Harvard’s Beth Israel/Deaconess Medical Center. Dr. Jacobs will also provide guidance and technical assistance to the Tucson CHR Programs.
In this Issue
- CHR Strategic Plan To Achieve Vision Over Next Five Years
- CHR Program Champion
- Professional Development/Events
- Who's New?
A Guide to Success! June 2024
CHR Strategic Plan To Achieve Vision Over Next Five Years
The Indian Health Service (IHS) Community Health Representative (CHR) Program, in collaboration with its partners, has developed a plan aimed at propelling the national program forward. The National CHR Strategic Plan 2023-2028 is a blueprint that defines the program's vision, goals, objectives, strategies, and metrics for success for the next five years.
Aligned with the overarching strategic plans of IHS and the U.S. Department of Health and Human Services, the CHR Program’s strategy focuses on five priority areas to achieve its vision:
- Advocacy and Awareness
- Partnerships
- Sustainability
- Workforce Strengthening
- Data Systems
CHR programs and partners nationwide are encouraged to use the Strategic Plan as a roadmap to enhance their efforts in promoting the health and well-being of AI/AN individuals, families, and communities.
Download the CHR Strategic Plan.[PDF - 1.5 MB]
CHR Program Champion: Rapid City – Oglala Sioux Tribe Begins Billing Medicaid for CHR Services
In a groundbreaking move, the Oglala Sioux Tribe (OST)-Rapid City (RC) CHR Program has begun billing Medicaid for CHR services, marking a significant milestone for IHS. They are the first Tribal CHR program to begin billing state Medicaid.
The OST-RC CHR Program can now increase billing revenue, resulting in program stability and expansion for additional services that are so desperately needed in the Rapid City area.
Catherine Jeffries, the director of CHR OST-RC, shed light on the pivotal impact this initiative has had on the community.
The journey towards Medicaid billing began with the creation of a comprehensive policy and procedure manual in 2019, spearheaded by Jeffries. It not only streamlined processes but also facilitated essential training for staff, enabling them to navigate complex systems and the Medicaid portal confidently.
One of the program's critical successes lies in its ability to address social determinants of health, leveraging billing codes to provide critical services from training to case management and mental health support.
This work has not been without challenges, mainly arising from the complex day-to-day realities CHR specialists grapple with. Their program has had to work to overcome hurdles like learning to navigate secure computer systems and emotional strains arising from the nature of their work.
Vicki Palmreuter, Tribal Liaison and Program Assistant for Community Health Worker Collaborative of South Dakota (CHWSD), said it had taken about two years of meetings with OST-RC to build a relationship and get to a point where the CHR program was ready and prepared to submit its first claim to South Dakota Medicaid.
"But by them going through it, we have sort of a case study to take out to other CHR programs who might be interested, and we’ve already started to do that. Rapid City has sort of blazed the trail for that [billing process] and having one tribe approve a CHR program to bill state Medicaid."
Professional Development/Events
IHS CHR Program Partners With Northwest Portland Area Indian Health Board
The IHS CHR Program and the Northwest Portland Area Indian Health Board (NPAIHB) are continuing their successful webinar partnership series Indian Country CHR (CHR) ECHO Program on the 3rd Monday of every month.
The Indian Country CHR ECHO Program will provide comprehensive information for Indian Health Service, Tribal, and Urban Indian CHRs to decrease barriers, improve access and provide holistic, culturally appropriate care locally for AI/AN people. Free Certificates of Completion will be provided.
To receive updates, reminders to join, monthly connect details for the ECHO and session recordings - please sign-up!
Read more about the Indian Country CHR ECHO program and email for more information.
Who’s New? Oklahoma City CHR Consultant
Whitney Moseley, BSN, RN, has been named as the new Oklahoma City Area CHR Consultant and also currently serves as the Oklahoma City Area Health Promotion Disease Prevention Coordinator. Whitney is from rural Oklahoma and is an enrolled member of the Cherokee Nation.
She earned her Bachelor of Science in Nursing from Oklahoma City University in 2012, and a bachelor’s degree in Spanish and International Business in 2010.
She is currently pursuing a Master of Science in Managerial Leadership and has served the IHS at different Oklahoma locations as a Public Health Nurse, Informaticist and other acting roles in leadership. Whitney brings 24 years of experience in healthcare to Oklahoma and a passion for public health to her new role.
Whitney is pictured with the United States Public Health Service (USPHS) mascot, LCDR Abigail. This dog is a Warrior Canine Connection dog trained to provide therapeutic care and symbolizes the USPHS’s commitment protecting the Nation’s health.
