Community Health Aide Training
See also Community Health Aide Program
The YK Delta has 42 village clinics and 5 sub-regional clinics. All of those clinics are staffed with Community Health Aides (CHAs) and the Community Health Aide Training (CHAT) Center in Bethel is responsible for training most of the CHAs in the YK Delta. There are three other training centers in the state—in Nome, Anchorage, and Fairbanks. Bethel trains the largest number of health aides, and has the largest number of health aides in any tribal health corporation in the state. There are 161 positions for CHAs at YKHC.
Scope of Services:
The Basic Training for CHAs consists of four sessions. Ideally, a student would progress from Session I to Session IV in a two-year period, but some students take longer. A potential student applies for the position and is interviewed. They must take the Test of Adult Basic Education (TABE) and have an eighth grade reading and math level to be considered for admission to training. They must also have Emergency Trauma Technician (ETT) training. The training sessions are four to five weeks in length and have both didactic and clinical time. The training follows the statewide curriculum and also adheres to the Community Health Aide Program Certification Board Standards. After successful completion of a session, a CHA is certified at the state level. Certification is good for two years and CHAs are responsible for obtaining 48 continuing education credits prior to re-certification. A certified CHA can bill for services.
The students earn credit through the University of Alaska Fairbanks (UAF). At the completion of training, they have 32 college credits and are awarded a Certificate in Community Health.
CHAs see patients in the village clinics and sub-regional clinics. They are able to take a history, perform a physical exam, make an assessment and carry out a plan. All of this is done following the Community Health Aide Manual (CHAM). The CHAM is what a CHA uses for every patient encounter, and outlines their scope of practice; it is commonly referred to as the “CHA Bible.” The CHAM is now in an electronic format and the CHAs can access it from a desktop computer or an iPad. Health Aides are also provided standing orders for certain assessments/diagnoses based on their training level. Standing orders allow them to treat patients without reporting to a referral provider. Everything that a health aide does in regards to patient care is guided by the CHAM. It is vital that providers working with CHAs have a basic knowledge of the CHAM.
In training, the CHAs are taught a wide variety of skills, all of which are based on the CHAM. They learn physical exam techniques, blood drawing, IV starts, wound care, prenatal care, emergency care, and well child care. They learn about the major body systems and different illnesses related to those body systems. It is not possible to teach a health aide everything they will need to know to provide care.
The Alaska Community Health Aide Program (www.akchap.org) provides information on the program, CHAM updates, continuing education for the CHA, and more. Access to the eCHAM is restricted and is given to employees of YKHC who have direct involvement with the CHAs. Once a BTI (or other provider) has a YKHC email address, they can be granted access to the CHAM.
Part of the health aide training is instruction on the use of the telemedicine carts. All village clinics and sub-regional clinics have telemedicine carts and health aides frequently take pictures or use video teleconference when reporting patients to Bethel providers. The CHAs are provided training on use of the telemedicine carts. See: Telemedicine
Unit (facility) Description:
The training center is located in the Community Health Services Building (CHSB). There is a large classroom and separate exam rooms in which to instruct the students. There are ample supplies for student use as well as manikins and a variety of different body system parts. The health aides have clinical requirements as part of their training. Most of the clinical time is spent in the outpatient clinic, but sometimes the clinicals are done in the CHA’s home village.
CHAT instructors are Nurse Practitioners, Physician Assistants, and a Community Health Practitioner. When the training center is fully staffed, 12 students can be trained each session. The staffing ratio during training is one instructor for every two to three students. The official title of an instructor is Basic Training Instructor (BTI).
To maintain credentialing at YKHC, the BTI must also see patients in the outpatient clinic. The schedule made to allow each BTI to have independent clinical time. While in the clinic, the BTI follows all YKHC Guidelines as do all other providers. There is the opportunity for BTIs to become involved in committees or be an elected member to the Medical Staff Executive Committee (MSEC).
The BTIs are responsible for the evaluation of CHAs in the village and will travel to do that. They typically do not take on a patient care role however. If an emergency arises the BTI steps in to help with patient care. There is a requirement of three to six village trips per year.
The orientation to the role of a BTI occurs both in the training center and the outpatient clinic. The new BTI goes through New Employee Orientation, followed by EHR (i.e. RAVEN) training. They spend four weeks in the outpatient clinic shadowing other providers and ultimately see patients independently. See Outpatient Clinic
After the completion of outpatient clinic orientation, the BTI begins learning the role of Health Aide Instructor. The BTI will observe how other instructors teach in the classroom and in the clinical setting. There is an in-depth explanation and discussion about the curriculum and how each lesson is taught. There is a wide variation in teaching techniques utilized, as no two people teach the same way. The curriculum must be followed for each lesson. Various skills and body systems are taught during different sessions and the curriculum outlines the time that should be spent on each lesion. The BTI must also learn how CHAs use RAVEN, as the CHA documentation is different from the other providers.
Part of orientation includes a town tour of Bethel. New employees are encouraged to explore the city and become a part of the community. A big part of life in Bethel is getting out and being involved. See BTI Orientation Checklist.