Guide to YKHC Medical Practices:Community Health Aide Program (CHAP)

Overview

The Community Health Aide Program was developed to meet the healthcare needs of rural Alaska in the 1950s and 1960s. When the TB epidemic was sweeping through Alaska in the 1950s the possibility of home treatment provided the opportunity to utilize village workers in the Bethel region to distribute antibiotics. This successful demonstration of the use of local people as health care providers led to the concept of the Community Health Aide Program (CHAP), which was established with funding from the Indian Health Service in 1968.

The Community Health Aide Program has become essential in rural communities. Alaska has approximately 550 Community Health Aides/Practitioners (CHA/Ps) in more than 170 rural Alaska villages. The Yukon-Kuskokwim Health Corporation manages the largest area, number of clinics, and number of Health Aides.

YKHC has approximately 170 CHA/Ps in 47 communities. These local CHA/Ps provide front-line medical care providing on-call and emergency services 24 hours a day, 7 days a week while maintaining regular clinic hours to provide primary, preventive, and acute care. The Community Health Aide Manual (CHAM) outlines assessment and treatment protocols and they work under the clinical supervision of providers in Bethel or Subregional Clinics (SRC) to provide these services. Communication with providers happens with what we still call Radio Medical Traffic (RMT) from back when VHF radios were the only way to communicate from the village to Bethel (or often from village to village to Bethel).

As this program has evolved, the services provided by the Community Health Aides have also progressed. When the program began, infectious diseases were the major emphasis with tuberculosis and meningitis causing great morbidity and mortality in the villages. Since then, infectious diseases are not as prominent and services have progressed from providing only acute, urgent and emergent care. The CHAM has best practice algorithms for chronic conditions embedded in it as well so CHA/Ps are also able to provide preventive and chronic care to meet the changing needs of their communities.

The Community Health Aide Program 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. However, being a Community Health Aide/Practitioner is a demanding position with the health care of the community being their responsibility 24 hours a day. It’s important that they are supported by everyone, including their family, their community members, village leadership, their coworkers and supervisors, and corporate leadership.

In 2010, the Community Health Aide Program was established as a federally recognized national program with the Indian Health Care Improvement Act Reauthorization. This allows establishment of a national Community Health Aide Program in accordance with the Alaskan program.

Community Health Aide Training

Community Health Aides (CHAs) are selected by their communities and the CHAP department to receive training in Bethel but they may be selected for openings in one of the other three training centers in the state: Anchorage, Nome or Fairbanks. CHAs take part in four sessions of training and each lasts three to four weeks. Between sessions, the CHAs work in their clinics completing a skills list and practicum. Completion of the four-session training curriculum and successful completion of a clinical skills preceptorship and examination qualify the CHA as a Community Health Practitioner (CHP). CHA/Ps at any level of training may obtain certification by the Community Health Aide Program Certification Board.

The Health Aide training centers provide the opportunity for intensive training to Community Health Aides in four sessions. The curriculum is standardized and is always in a dynamic state of change to accommodate advances in medical practice, medication regimes, and technology. Students are taught a comprehensive approach to each patient including how to obtain a history, how to perform a physical examination, how to make an assessment and how to develop a treatment plan following specific guidelines. The Alaska Community Health Aide/Practitioner Manual (CHAM) and the Community Health Aide Program Certification Board Standards and Procedures provide training and standard of care guidelines.

Trainee Requirements: Trainees in the YK Delta are selected by their community and CHAP department and are employed by YKHC. Trainees must test at eighth grade or above math/reading skills, complete and maintain Emergency Medical Services (EMS) training and have a desire to stay and work in his/her community. Bethel’s Training Center has eight budgeted positions for Basic Training Instructors (BTIs). BTIs are usually either Nurse Practitioners or Physician Assistants although may also be staffed by CHPs and Physicians. When fully staffed, the Bethel training center can train up to 12 Community Health Aides per session, although staff shortages can have a negative effect on the number of CHA/Ps trained.

Field Supervision

Community Health Aides in village clinics are supervised by the Field Supervision department. The staff in this department work closely with tribal leaders in each community to work to keep clinic doors open with Health Aides and Office Assistants available to see patients, maintain supplies, and keep up clinical quality improvement. The Field Supervision Coordinator is the head of this department and oversees the Supervisor Instructors (SI) who supervise CHA/Ps to maintain established corporate department policies and procedures, objectives, Quality Improvement programs, and safety standards. The staff in this department actively serve as resource people for CHA/Ps, Tribal Councils and communities in matters of YKHC policies and CHAP procedures. They work to identify needs, provide information and provide training as able and/or refer to other resources as appropriate.

Well Child / Immunizations

The Well Child Program helps children and young adults in the Yukon-Kuskokwim Delta grow up into healthy adults. Well Child services are offered to all children and young adults from ages 0–20. Community Health Aides/Practitioners from villages around the YK-Delta are trained to provide these preventative health services. Our program assists in the training of all Health Aides that provide Well Child Exams. Our program focuses on preventative health care. Preventative health care is key in teaching us how to take care of ourselves so we can avoid diseases and other health problems. It also helps identify problems early when treatment is easier and more effective.

The Immunization Program focuses on educating and providing immunizations to all people in the YK Delta. Our main focus is making sure that all children under 18 are receiving the appropriate immunizations for their age. We also want to make sure that all adults receive their immunizations. We work with all providers and assist in the Immunization training of all Health Aides.

Compliance

This department has staff to act as a resource to answer questions when it comes to compliance and YKHC’s relationship with The Joint Commission. This position also serves in a practical sense to inspect clinic facilities and ensure Joint Commission Standards are being met adequately. This department works closely with Field Supervision and Supervisor Instructors to improve the quality of CHAP’s processes, increase efficiency, reduce waste and ensure that patient safety standards are being met. This department also works closely with the Office of Environmental Health and Facilities departments to make sure village clinic findings are addressed.