National Community Health Aide Program

The  CHAP is a unique program that leverages centuries old traditional healing of Indigenous communities with the modern infrastructure of medicine to ensure care delivered to Indigenous populations looks and feels appropriate to the people it aims to serve. Lack of routine access in rural communities coupled with the missed recognition of sovereignty in all aspects of life, CHAP  serves as an opportunity to utilize self determination in meeting those needs based on ancestral healing and modern tools. 

Utilizing a unique authority from the US Congress, CHAP creates a new workforce of paraprofessionals in the fields of primary, behavioral, and oral health care in a manner that is culturally tailored and addresses key social determinants of health. Born out of the development of a program designed to serve Alaska Natives, this initiative seeks to make room for all Tribes to develop a system of care tailored to their culture.

Access to care has long been an issue in rural and remote communities. Coupled with intergenerational trauma and missed opportunities to fully honor and support Tribal sovereignty, the problem becomes clear. 

Indigenous communities face disproportionate health disparities in nearly all aspects of life, but the resilient and colorful history asserts that the trajectory does not need to continue on that path. 

In primary care, patient wait times in an emergency department make it especially difficult for routine care. The distance from the sacred lands of Indigenous populations to quality care exacerbates that point. The revolving door of care in public healthcare systems further hones in on the need to have teams of providers that are from the community, understand the teachings, and can practice the traditions in the delivery of care. 

In behavioral health, the third leading cause of death for Indigenous youth between 10-24 is suicide. 

In oral health, by the age of five, 76% of Indigenous youth are impacted by dental caries. 

The problem whether in one Indigenous community or seen in all 573 is too big to ignore. The CHAP leverages legislative authority, unique traditions, and the existing health structure to create a tailored health care workforce. 

The National CHAP creates a network of health aides in primary, behavioral, and oral health care trained to provide care to Indigenous populations. Born out of the Alaska CHAP to provide culturally attuned care, this program combines traditional healing, training, and direct patient care in a way that's sustainable for Tribes to not only create a new workforce and job opportunities, but it expands the system of care through the introduction of these new provider types. Increasing the touch points of care for patients to increase access and reduce health disparities. 

The program seeks to provider better access for better outcomes. 

Through the authorities from Congress, this program also creates a training network including Tribal colleges so the investments reach far beyond just the provider but the entire community further creating a manner that addresses key social determinants of health in a way that centers Tribal sovereignty and traditional healing with modern medicine as a compliment. 

These providers also demystify the need to provide care in four walls. Recognizing that health care is more than a doctor visit, aides can meet patients where they are to address their physical and mental health needs. 

This program is a national initiative using the permanent re-authorization of the Indian Healthcare Improvement Act of 2010 and it expands the Alaska CHAP to the contiguous 48 states. This program allows for Tribes and Federal facilities to hire this new workforce to serve their respective patient population. It is currently utilized in Alaska and would expand to serve the remaining 344 Federally recognized Tribes in the contiguous US. 

The engagement for this specific solution began in 2016, through the initiation of Tribal consultation on Tribe's disposition on expanding this program using the authorities. Since 2016, through consultation, Tribal engagement, focus groups, partnership, and policy making the program was actualized. This particular solution would be centered on further researching how to address each issue identified in 2016 by Tribes to address through the programs design and ultimate implementation. The key themes emerged from Tribal consultation in 2016 was the need to address workforce barriers, cultural inclusion, training, certification, and reimbursement to ensure financial sustainability of this workforce model. These themes were born out of Tribes emphasized barriers that exist to quality healthcare including broadband access when using telehealth, equipment so health aides who are mobile can put in field notes when they are out delivering care, the need to ensure that each Tribe's culture is considered. Using traditional medicine to heal while ensuring that Tribes can bill third party for these specific services. 

This solution, through academic research, continues to unpack these themes and identify resources that exist across the democracy that could be used to position Indigenous communities for success. 

This particular solution trains these health aides in primary, emergency, behavioral, and health care so they as as extenders of their physicians, dentists, and licensed behavioral health providers. This in turn expands the system of care. Rather than a patient seeing one or two people their visit, they have a dedicated team of health professionals. 

This solution also recognizes the importance of self-determination and the centering of Indigenous culture in care delivery. It prioritizes culturally attuned care both in practice and incorporation. Health aides can bill for services that are unique to culture making it sustainable for Indigenous communities in economic independence.

Lastly, this solution builds on a community context to grown our own. It works to train, hire, and grow a workforce of professionals from the community so the intention of relationship based care is actualized. It addresses the issue of retention in health professionals in Indigenous communities and ensures that there is representation in the healthcare team. 

These things address key tenents of social determinants of health for all 573 Federally recognized Tribes. 

Indigenous communities have centuries of power in their lineage. As the architects of many of the modern musings we see in everyday life and the continued display of resiliency, it is more than evident that the power and richness of Indigenous communities is omnipresent is many forms of life. 

This solution builds on the traditional healing and desire to meet those we care for where they are when discussing access to health. This solution uses modern medical technology, and unique authorities to drive social and economic change for Indigenous communities. This solution prioritizes better access for better outcomes.