Philosophy - P.L. 100-713 establishes the CHR Program
as a component of health care services of American Indian people.
It is an I H S funded,
tribally contracted/granted and directed program of well-trained,
community-based, health care providers, designed to integrate the
unique helping of tribal life with the practices of health promotion
and disease prevention.
Purpose of Standards - To provide a set of minimum
uniform practices for the operation of the CHR Program. which are
to be considered for adoption by each tribe, as applicable in their
scope of work.
Description of Standards - A statement of the
level of health services possible in the CHR Program SOW (Statement
of Work), to provide common guidance to aid individuals, families,
and communities, in achieving an optimal state of well being, in
any setting or stage in the human life cycle, by providing a common
practice base, which serves as minimum guidance for the provision
of health services, as part of a health team.
Standards and Practice - The following standards
and practice shall serve as the minimum applicable to a tribe’s
SOW. Additional standards and practice may be developed and approved
by the tribal governing body serving the community, in accordance
with accepted health practices.
Core Standards - At initial employment, each CHR
will be provided an orientation which shall include:
A copy of the CHR Program Standards.
Orientation to the Tribal Program:
Office/tribal organization policies and procedures;
Contract SOW relative to the person's job;
Introduction to health staff and how they interact/work
CHR PCC Package training; and
Radio/communication skills for local/community needs,
i.e., "CB" radio.
Standards of Practice - Health Education practice
is designed to provide individuals, families and communities
with the appropriate information to practice a healthy lifestyle.
Each CHR will be trained and tested for adequate knowledge
in the health area to be practiced.
Health Care Resources
Community Disease Profiles
Behavioral Modification Techniques
Health Promotion/Disease Prevention
Range of Skills:
Communication ability to:
explain a specific health problem
explain the practice of prevention
relate the dangers of uncontrolled health problems
relate how to live with specific health problems
relate the self-management of health problems
Organize, coordinate, conduct, plan, and evaluate
Case Find/Screen - Carrying out efforts for the
early detection of patients with diseases or conditions requiring
medical attention (e.g., hypertension, TB, pregnancy, etc.
This may be done by investigation in the community or with
screening tests. It may involve one individual or many.
Case Management/Coordinate - Developing a patient
care plan in conjunction with a community health nurse or physician,
deciding upon the various responsibilities for the people involved
in the patient’s care. Serve as a patient advocate by
arranging appointments, filing complaints, helping the patient
obtain services and coordinates with various service providers
to ensure continuity of care. Case management conferences and
discharge planning are also included.
Monitor Patient - Making periodic personal contact
with a patient with a known health problem or is high risk
for illness or disablement, by telephone or at home, to see
if he/she is feeling well, has enough food and/or medicine,
has unmet home health care needs, has adequate heating, etc.,
with immediate action taken to provide care for patient needs
detected through monitoring.
Provide Emergency Patient Care - Giving care to
a sick or injured person while arranging or waiting for transportation
to a hospital or clinic, contracting an ambulance or hospital
driver, transporting a seriously ill patient to medical care
or performing crisis intervention with an emotionally upset
or suicide patient.
Community Emergency Care System
Panic Medical Values i.e., heart attack, shock, etc.
Provide Non-Emergency Care - The taking of vital
signs or providing other clinical services, such as foot care,
to persons with a diagnosed illness. Also included, are services
such as: counseling for social, emotional, mental or other
related problems. When appropriate, provides for traditional
tribal services for the sick, and other services requiring
individual assessment, therapeutic and/or follow-up. Home health
care and maintenance of patient equipment such as: crutches,
wheelchairs, eyeglasses and hearing aids are included. The
services in this category are provided to patients with diagnosed
Homemaker Services - Assisting the disabled, homebound,
or bedridden with household chores, preparing food and feeding
incapacitated patients, or assisting with personal care such
as bathing or hair washing.
Specific Nutritional needs
Responsible Friend/Family Members
Range of Skills:
Home Visit Techniques: - Patient handling techniques
- Personal care/hygiene
Transport - The transportation of a patient, without
other means of transport, to/from an IHS or tribal hospital/clinic
when necessary for routine, non-emergency problems, which includes
waiting for a patient, such as a dental patient, to finish
Interpret/Translate - The taking of a statement
from one language and expressing the meaning, either orally
or in writing, in another language, so as to enable people
who do not speak the same language to communicate with one
Illness/Wellness/Death Concepts of the Local Culture(s)
Cultural Norms/Practices Care and Handling Requirements
Range of Skills:
Language of the Local Culture(s)
Fluency of Language
Translation (English to language of the local culture
and vice versa)