Community Health Representatives
To provide quality outreach health care services and health promotion/disease prevention services to American Indians and Alaska Natives within their communities through the use of well-trained CHR’s as mandated by Section 107 of P.L. 100-713, dated November 23, 1988.
The CHR Program was implemented to improve the health knowledge, attitudes and practices of Indian people by promoting, supporting, and assisting the I H S in delivering a total health care program on the community level. The efforts of CHR program staff have produced an American Indian and Alaska Native health service delivery system, which provides for follow-up and continued contact with the health care delivery system at the community level, thereby meeting the most basic needs of the American Indian and Alaska Native population.
The goal of the CHR Program is to address health care needs through the provision of community-oriented primary care services, including traditional Native concepts in multiple’ settings, utilizing community-based, well-trained, medically-guided health care workers.
History & Background Development of the Program
It is generally accepted that the CHR program began in 1968, but the CHR program was not a creation of the Indian Health Service. The Office of Economic Opportunity (OEO) initially funded the Community Health Aide Program in 1967. In 1969, IHS requested funds to train 250 Community Health Aides in Alaska. By 1972, the last OEO-CHR program was transferred to IHS, which increased its support and training of CHRs to 1,003 in FY ’74. IHS has held that the CHR program was created to meet four needs:
- The need for greater involvement of American Indians/Alaskan Indians in their own health programs, and greater participation by Native Americans in the identification and solving of their health problems.
- The need for greater understanding between the Indian people and the Indian Health Service Staff.
- The need to improve cross-cultural communication between the Indian community and the providers of health service.
- The need to increased basic health care and instruction in Indian homes and communities.
The CHR program was not initiated by the tribes, but rather was assumed by IHS to be useful in providing the tribes an opportunity to become involved in health by paying staff to perform an outreach, community organization function. The CHR program was a result of Native American Tribes identifying the need for such a program, lobbying for it, and acquiring funding.
“Neighborhood workers” also known by other titles such as CHRs, etc., were, in traditional OEO style, afforded too little training and almost none in substantive areas. Had the program remained in OEO, the question of function of CHRs might never have arisen and they might have continued to play a useful but ephemeral “helping” role. What was different in this case was that federal responsibility for the program passed from OEO to IHS; from the Community Action Program to the tribes themselves; and it was transferred at time when IHS was seeking a mechanism for Native Americans to achieve self-determination in health.
The job related tasks of the CHR have changed somewhat throughout the years, but the original intent of IHS was that the CHRs become a community health promoter /educator, a health advocate, and a health paraprofessional who would regularly visit the homes of clients and conduct health assessments and provide transportation, when needed.
Today, the history of the CHR is well documented and an integral part of the health delivery system of most tribes, nations, and villages. The CHR is seen as an agent of the people, helping their clients tend to their health needs.
Today, the CHR program has grown to over 1,400 CHRs representing over 250 tribes in the 12 service areas. Many areas have their own CHR association, designed to meet and share ideas. The Oklahoma Area Association of CHRs continues a strong existence by meeting educational needs of the CHRs as well as providing a large educational conference attended by many out of state tribes as well as the Oklahoma Tribes, PHNs, LPN and RNs working in community based programs. The National Association of Community Health Representatives (NACHR) has a representative from each area to recommend national policies and share program ideas.
The Community Health Representative (CHR) Program evolved to become the largest program originally contracted to the tribes, not only in dollars and number of people involved, but also in the number of tribes holding contracts. The first CHR activity was designed to contain the spread of tuberculosis throughout several American Indian communities. CHR contracts were held by 256 tribes who employed over 1,200 CHRs and CHAs. In terms of accomplishments, the program was most successful. The I H S described it as the tribes’ own program and distributed a variety of literature and public statements praising its accomplishments.
The Need For CHRs
CHRs are in growing demand. It has already been seen how much they assist and connect the community and their work has become essential to the Indian Health Service facilities. The CHRs are a good advocate because they come from the community of which they serve and know the specific tribal healthcare needs; their dedication to their work has helped many of which who otherwise have trouble fulfilling their healthcare needs. The efforts the representatives put into health promotion and disease prevention has also done extremely well and has limited the people from facing the problems of ill health. They have been tremendously helpful in lowering the mortality rates through their teachings and as a result of that reducing the tribal healthcare expenses. CHRs reach out and help people on an individual basis and are an important part of the I H S facilities.
Muscogee (Creek) Nation CHR Program
The MCN CHR Program is staffed with five administrative staff and twenty-four Generalist positions and 4 transporter positions.
The counties covered includes Okmulgee, Okfuskee, McIntosh, Hughes, Muskogee, Wagoner, Creek, Tulsa and eastern Seminole Counties. Currently the CHR Program serves 900 active clients with services such as Home Visits, Advocacy, Community Health Education, Case Management, Monitor Patient, Transportation, refer for Environmental Service and Medication delivery (limited basis).
- Reside within the Creek Nation service area.
- Have no other means or resources for transportation.
- Be an enrolled member of a federally recognized tribe.
- Have a scheduled appointment at an I.H. S. or Creek Nation health facility.
CHR Program Guidelines
- Appointments should be called in at least ten (10) days to two (2) weeks in advance.
- All service requests for McIntosh, Hughes, Okmulgee, Okfuskee, Muskogee, Seminole and Creek counties must be called in to the Okemah Office at 918-623-1925.
- All service requests for Wagoner and Tulsa counties must be called in to the Koweta Office at 918-279-3483.
- A family member, friend or guardian must accompany any patient having a surgical procedure.
- Patients must have a written referral on file prior to transports to private facilities.
- Minors (under 18 years of age) must be accompanied by a parent(s) or legal guardian.
- Transportation is not provided to clients in nursing homes, jail, prisons or rehabilitation centers.
- All passengers are required to use seatbelts.
- Clients must be returned to the original pick-up location.
- Clients must be able to manage their own oxygen supplies
- No transports for seriously ill or anyone having chest pains, shortness of breath, active labor or other conditions requiring emergency care.
Some of the awareness activities conducted by the CHRs includes:
- oDistracted Driving Awareness focusing on driving and texting in teen drivers.
- oPoison Prevention Awareness
- oStranger Danger
Programs that the CHRs are participating:
- Ombudsman volunteer program
- Women’s Health Summit in Holdenville
- Applications for Emergency Medical Alert Device
- Colorectal Cancer Awareness and Promoting Screening
- Challenge Bowl Volunteers
- Spring Fling Activities
- JOM Conference BP/BS screeners.
Annual training includes:
- Defensive Driving
- Vital Signs competency
- CPR/First Aid/AED
- Patient Care Component reporting
- Current Health Issues
Okemah Office: 1800 Coplin, Okemah, OK 74859 (918) 623-1424
Koweta Office: 31870 E. Highway 51, Koweta, OK 74429 918-279-3483