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U.S. Department of Health and Human Services
Indian Health Manual

Chapter 12 - Health Education

Part 3 - Professional Services

Title Section
Introduction 3-12.1
        Purpose 3-12.1A
        Policy 3-12.1B
        Authority 3-12.1C
        Health Education and the Health Care Provider 3-12.1D
        Mission 3-12.1E
        Goals and Objectives 2-12.1F
Responsibilities 3-12.2
        Chief Medical Officer, IHS 3-12.2A
        National Health Education Consultant, IHS 3-12.2B
        Area Director 3-12.2C
        Area CMO 3-12.2D
        Area Health Education Consultant 3-12.2E
        Facility CEO 3-12.2F
        Facility Health Education Lead 3-12.2G
Health Education Program Requirements 3-12.3
        Requirements 3-12.3A
Health Education Services 3-12.4
        Patient Education Services 3-12.4A
        School Health Programs 3-12.4B
        Community Health Education Services 3-12.4C
        Worksite Health Education Services 3-12.4D
Program Goals and Professional Performance 3-12.5
        Program Reviews 3-12.5A
Exhibit Description
Manual Exhibit 3-12-A [PDF - 137 KB] Example Health Education Program Review

3-12.1   INTRODUCTION

  1. Purpose.   This chapter establishes goals, objectives, responsibilities, and guidelines for Indian Health Service (IHS) Community and Public Health Education activities with recommendations for Tribal and Urban Indian communities.
  2. Policy.   The IHS strives to maintain health education components within American Indian and Alaska Native (AI/AN) communities. The IHS, working with health education staff, will ensure that this policy will apply to all IHS Health Education Programs, in all stages of assessment, planning, implementation, and evaluation of health education activities and, as appropriate, to all Tribal and Urban Indian Health Education programs while respecting AI/AN communities inherent cultural strengths and unique challenges.
  3. Authority.  
    1. Indian Health Care Improvement Act, 25 U.S.C. § 1601 et seq.
    2. Snyder Act, 25 USC § 13
    3. Transfer Act, 42 USC § 2001
  4. Health Education and the Health Care Provider.   Health education follows seven areas of responsibilities from the National Commission for Health Education Credentialing (NCHEC), which consists of assessment, planning, implementation, evaluation, administration, communications, and advocacy. Health education staff develop and conduct evaluations to promote and measure behavior and education outcomes, as well as document every patient encounter.

    A major focus of the IHS Health Education Program is to provide in-service training in educational methods and techniques to other health care providers. Additionally, health education reviews community epidemiology, assessment, program planning, and evaluation, and assists in the development of cohesive, coordinated risk reduction strategies for multi-disciplinary health care teams.
  5. Mission.   Provide opportunities for AI/AN families and communities to prevent disease and improve holistic health and well-being by promoting culturally tailored health education. The IHS Health Education Program emphasizes health education, holistic wellness, and disease prevention to obtain optimal health for AI/AN populations.
  6. Goals and Objectives.  
    1. Program Goal - The goal of the IHS Health Education Program is to support AI/AN populations to adopt healthy lifestyles through culturally tailored preventative wellness strategies.
    2. Objectives - To guide the use of health care resources and services; to support leadership in the advocacy for health care; to promote continued professional development for health education specialists; and to influence policy and planning of health education issues and priorities.

3-12.2   RESPONSIBILITIES

  1. Chief Medical Officer, IHS.   The IHS Chief Medical Officer (CMO) is administratively responsible for the issuance of this policy.
  2. National Health Education Consultant, IHS.   The National Health Education Consultant serves as the coordinator, consultant, and advisor for all matters relating to the provision of health education services throughout the IHS.
  3. Area Director.  
    1. Ensuring that administrative support and necessary resources are available at IHS Health Education Programs in their respective Area in order to implement this policy.
    2. Ensuring that this policy is fully implemented.
  4. Area CMO.   The Area CMO is responsible for monitoring IHS facilities for compliance with this policy.
  5. Area Health Education Consultant.   The Area Health Education Consultant serves as the coordinator, consultant, and advisor to the National Health Educator Consultant, Area Director, Area program staff, and Service Unit (SU) staff on all matters relating to the provision of health education services. Also, respond to Urban Indian health programs as needed.
  6. Facility Chief Executive Officer.   The SU Chief Executive Officer (CEO) ensures that the Health Education Lead develops the facility's health education policies. The CEO is responsible for approving and ensuring this policy is fully implemented, and reviewed per Area Governing Board procedures.
  7. Facility Health Education Lead.   The Facility Health Education Lead serves as the coordinator, consultant, and advisor to the Area Health Educator Consultant, Facility CEO, and SU staff on all matters relating to the provision of health education services. Tribes and Tribal organizations that have assumed programs, functions, services, and activities may request consultation services from the IHS. The IHS will use fee-for-services under buyback agreements.

3-12.3   HEALTH EDUCATION PROGRAM REQUIREMENTS

  1. Requirements   – The IHS Health Education Programs will use needs assessments, evidence-based practices, and evaluations to serve AI/AN populations, which are also recommended for Tribal and Urban Indian health education programs. Health Educators will maintain the following program requirements:
    1. Certification – Maintain, at a minimum, one of the following certifications:
      1. Certified Health Education Specialist (CHES).
      2. Master of Certified Health Education Specialist (MCHES).
    2. Ethics – Apply the Society of Public Health Education (SOPHE) Code of Ethics in practice of Health Education.
    3. Documentation – Document all patient/health education encounters using the Resource and Patient Management System (RPMS) Electronic Health Record or equivalent documentation system.
    4. Quality Assessment and Improvement – Comply with the SU Standards of Quality Assessment and Improvement.
    5. Policy and Planning – The IHS Service Units will align local policies and plans with:
      1. Center for Disease Control and Prevention (CDC) 10 Essential Public Health Services.
      2. CDC School Health Components of the Whole School, Whole Community, Whole Child (WSCC).
      3. Department of Health and Human Service Office of Disease Prevention and Health Promotion Healthy People 2030 objectives.

3-12.4   HEALTH EDUCATION SERVICES

  1. Patient Education Services   – Health Educators will provide and assist in the development, implementation, and evaluation of group and individual patient educational services for the facility and/or community Health Education Program.
    1. Assist, support, and maintain those aspects of accreditation for the facility as applicable to health education.
    2. Participate in individual, school, senior/elders center, and community patient and family education as directed by the facility, unless explicitly deleted from the position description or Scope of Work (SOW).
    3. Assist in the development of policies and procedures governing health education’s participation in the patient education process within the facility, local schools, senior facilities and community. For those health education programs that are exclusively community-oriented, they will document individual and group education services as required in the Health Education Departmental Policies and Procedures Manual where applicable.
    4. Develop departmental policies relating to the specific role(s) of the Health Educator in the development and/or provision of group and individual patient and family education.
    5. Adapt culturally relevant patient education materials and resources that are health literacy compliant as established by the IHS Health Education Program.
    6. Develop organizational plans and support for the provision of group and individual patient education, which should include (but not be limited to):
      1. Group and individual patient education policies and procedures.
      2. Group and individual evidence-based and/or local best practices for patient education teaching/lesson plans.
      3. Group and individual patient education budget/resources.
      4. Quality assurance/management participation.
  2. School Health Programs   – In consultation with the Tribe and local community, IHS Health Education Programs will assist in the development of school health education programs that serve AI/AN children from preschool/Head Start programs through grade 12 in public, private, and Bureau of Indian Education schools located on Indian reservations, where applicable and attainable. Tribes and Tribal organizations that have assumed programs, functions, services, and activities may request services from IHS. The IHS will use fee-for-services under the buyback agreement.
    1. Assist with the development and implementation of School Health Program Standards. Additional information on specific standards for students can be found in the CDC School Health Guidelines.
    2. Develop AI/AN culturally relevant coordinated School Health Programs that incorporate CDC Effective Health Education curriculum that emphasizes:
      1. Teaching functional health information (essential knowledge).
      2. Shaping personal values and beliefs that support healthy behaviors.
      3. Shaping group norms that value a healthy lifestyle.
      4. Developing the essential health skills necessary to adopt, practice, and maintain health-enhancing behaviors.
    3. Foster the physical and mental health of school employees. Fostering the physical and mental health of employees also helps to support students health and academic success.
    4. Integrate school-based, community-based, and other public and private health promotion efforts.
    5. Promote healthy school environments which are drug, violence, and commercial tobacco-free.
    6. Promote a safe school environment by providing suicide prevention for students, teachers, and other school staff members.
    7. Coordinate school-based health programs with existing services available in the community.
  3. Community Health Education Services   – The IHS Health Education Programs will provide community health education services to community members to become active participants in their own health care, and promote the adoption of healthy lifestyles.
    1. Assess needs, resources, and capacity for Health Education and Health Promotion within AI/AN communities.
    2. Assist the schools with the development of policies, programs, and events that promote and support healthy lifestyles.
    3. Coordinate with school designees to deliver health education and promotion interventions.
    4. Serve as a health education resource for AI/AN communities and schools.
    5. Promote and advocate for the health and the health education profession.
    6. Collaborate with the schools, Tribes, and stakeholders to address priority, emergent, and urgent health issues.
    7. Develop culturally appropriate and health literate educational materials.
    8. Provide strategic direction for developing a prevention/intervention plan to address health priorities.
    9. Monitor health impacts and outcomes of school prevention efforts/activities.
  4. Worksite Health Education Services   – the IHS Health Education Programs will promote healthy lifestyles by providing information and education to create a healthy worksite environment. The IHS Health Education Programs will:
    1. Assess the need for health education services in worksite settings.
    2. Develop, implement, and evaluate worksite programs in coordination with the IHS Area Director, health care providers, voluntary organizations, professional groups, and worksite staff.
    3. Have written procedures for coordinating and delivery of worksite health education services where applicable.
    4. Use group assessment tools for individual, group, and needs assessments to develop worksite wellness plans and policies where applicable.
    5. Implement activities that allow for easy access and consider time restrictions to maximize participation.
    6. Encourage the adoption of healthy lifestyles through policy (commercial tobacco-free campus), newsletters, electronic communication, and Public Service Announcements.
    7. Evaluate the effectiveness of worksite wellness activities.
    8. Coordinate with management to promote opportunities for adopting healthy lifestyles (i.e., change in vending machines to include healthy options, breaks for physical activity, etc.).
    9. Provide opportunities for employees to learn new skills and practices to enhance and maintain personal health.
    10. Explore appropriate technologies to promote worksite wellness activities.
    11. Coordinate and evaluate worksite wellness activities, including:
      1. Employee participation.
      2. Management support and participation.

3-12.5   PROGRAM GOALS AND PROFESSIONAL PERFORMANCE

  1. Program Reviews   NOTE: These Reviews apply to IHS Direct Service Programs and are recommended applications for Tribal and Urban Indian health program reviews conducted by Tribal and Urban Indian health administrators, and the IHS Health Education Consultant as requested.
    1. The Health Education Program Review process will:
      1. Determine the effectiveness of the Health Education Program as evidenced by the statistical RPMS Clinical Reporting System Education Report where applicable.
      2. Assess the attainment of Health Education Program Goals and Objectives incorporated from the 3 to 5 Year, Health Education Strategic Plan.
      3. Assess the adherence to the Code of Ethics for Health Education Profession from the NCHEC.
    2. The Health Education Review Process will include quarterly and annual reports and an examination of the IHS Health Education Program’s annual plan.
    3. Reviews of the IHS Health Education Program will be conducted to identify stated goals and objectives and progression towards those goals and objectives; and/or problem areas, including program support issues, i.e. staffing, equipment, supplies, training, etc. (see Manual Exhibit 3-12 A Example Health Education Program Review).
    4. The Year-End Program Review and Quarterly Report will include the following:
      1. Assessment of the health status (indicators) of a given population; and/or assessment of specific issue(s) or problem(s) for the given population.
      2. Description of the approach used to address the issue or problem.
      3. A stated “Outcome” is evident based on the assessment, and analysis is applied to the outcome identified in increments within a specified timeframe. (Monthly, quarterly, etc.).
      4. Documentation and/or evidence of the completion of the goals and objectives or demonstrated progress made in accomplishing the goals and objectives within a specified timeline.
      5. Evidence of using process, impact, outcome, and summative evaluation to monitor progress and accomplishments.
    5. Health Education Program Support/Resource/Technical Core Functions of IHS Programs (Recommended for Tribal and Urban Indian operations).
      1. Program Support/Resources/Administration Standards of Review
        1. An annual budget/acquisition plan.
        2. Equipment needs assessment.
        3. Transportation documented as adequate/Inadequate (General Services Administration/ Other) for routine operations.
        4. Position descriptions and annual evaluations, updated.
        5. Health Education Policy and Procedure Manual (Indian Health Manual, Part 3, Chapter 12).
        6. Continuing Education Plan (where applicable)
        7. Program evaluation method/program effectiveness available.