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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Community health representative: The first tribally contracted program, since 1968 - American indian paraprofessional healthcare providers

Program Management and Guidance

Standards of Practice

  1. 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.
  2. 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.
  3. 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.
  4. 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.
    1. 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 together;
        • CHR PCC Package training; and
        • Radio/communication skills for local/community needs, i.e., "CB" radio.
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    3. Core Service Standards - Within 6 months to a year of employment, each CHR shall at a minimum, receive training and skill certification in the following:
      • Knowledge Base
        • Basic anatomy/physiology
        • Normal medical values, i.e., 98.6, the normal temperature reading etc.;
        • Basic medical terminology;
        • Basic nutritional and dietary needs;
        • Disease etiology;
        • Community organization and resource; and
        • The norms, i.e., knows and respects tribal beliefs and customs
      • Range of Skills:
        • First Aid/CPR;
        • Vital signs/equipment use;
        • Assessment/referral skills;
        • Report verbally and written (Subjective/Objective) Assessment Plan);
        • Communication, translate, interpret, persuasion, motivation;
        • Investment skills;
        • Teamwork; and
        • Advocacy.
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    4. Core Certification - Certification, at a minimum, shall apply to the following standards of practice. Additional certification may be required for some standards of practice.
      • Basic CAR Training;
      • Advanced Training;
      • Continuing Education Units;
      • Optional credentialing/certification, i.e., college certification/degrees and other credentialing;
      • Driver’s License;
      • Defensive Driving Certificate; and
      • Liability Insurance.
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    6. 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.
      • Knowledge Base:
        • Community Resources
        • Health Care Resources
        • Community Disease Profiles
        • Cultural Norms
        • Behavioral Modification Techniques
        • Political Climate/Structure
        • Program/Community/Contract Priorities
        • Health Promotion/Disease Prevention
        • Group Dynamics
        • Disease Etiology
      • 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 presentations
        • Public Speaking
        • Apply behavior modification techniques
        • Diplomacy
        • Research
        • Audio-visual equipment operation
        • Group management
        • Motivation
        • Illustrative talent
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    8. 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.
      • Knowledge Base:
        • Screening Equipment
        • Demographics/ Community
      • Range of Skills:
        • Specific Screening Equipment Us
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    10. 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.
      • Knowledge Base:
        • Local Health Care System/ Resources
        • Medical Terminology
        • Relationships of the Local Health Care
        • Advanced Health Care Concepts
      • Range of Skills:
        • Assessment of Patient, Family and Environment
        • Logical Decision Making Ability
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    12. 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.
      • Knowledge Base:
        • Specific Screening Equipment
        • Specific Medical Terminology
        • Specific Medical
        • Individual Patient Care/ Treatment Items
        • Counseling Techniques
        • Specific Disease Profile
        • Standing Orders/ Protocol
      • Range of Skills:
        • Counseling Skills
        • Assessment
        • Referral/Follow-up
        • Equipment Operation and Maintenance
        • Triage Techniques
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    14. 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.
      • Knowledge Base:
        • Community Emergency Care System
        • Panic Medical Values i.e., heart attack, shock, etc.
        • Disaster Plan
      • Range of Skills:
        • First Responder
        • Triage
        • Crowd Control/Communication
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    15. 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 illnesses.
      • Knowledge Base:
        • Specific Medical Treatment
        • Individual Patient Care/Treatment Items
        • Counseling Techniques
        • Specific Disease Profile
        • Standing Orders/Protocols
      • Range of Skills:
        • Basic Counseling Skills
        • Assessment
        • Referral/Followup
        • Equipment Operation and Maintenance
        • Triage Techniques
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    17. 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.
      • Knowledge Base:
        • Specific Nutritional needs
        • Hygiene
        • Home Safety
        • Responsible Friend/Family Members
      • Range of Skills:
        • Home Visit Techniques: - Patient handling techniques - Personal care/hygiene
        • Homemaker Services
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    18. 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 treatment.
      • Knowledge Base:
        • State Traffic Laws
        • Vehicle Maintenance/Safety
        • Road System
      • Range of Skills:
        • Driving
        • Work Scheduling
        • Patient Transfer Techniques
        • Minor Vehicle Repair i.e., tire changing, etc.
        • Communication/Radio
      • Communication:
        • Driver’s License
        • Defensive Driving/Traffic Safety
        • Vehicle Insurance as Required
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    20. Delivery - Delivering items such as medications, . supplies and equipment, to the patient’s home.
      • Knowledge Base:
        • Vehicle maintenance/Safety
        • Road System
        • Lab Specimen/Massage/Supplies/Medication and/or Equipment Care and Handling Requirements
        • State Traffic Laws
      • Range of Skills:
        • Driving
        • Work Scheduling
        • Minor Vehicle Repair
        • Communication/Radio
        • Demonstrate Use of Equipment/Supplies Delivered
      • Communication:
        • Driver’s License
        • Defensive Driving/Traffic Safety
        • Vehicle Insurance as Required
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    22. 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 another.
      • Knowledge Base:
        • Basic Pharmacology
        • 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)
        • Illustrative Talents
        • Understand Health Record Information
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    24. Environmental Health -I nspecting the community’s environment in one or more of the following: water/waste-water management; vector control; air quality; solid waste; and, food handling.
      • Knowledge Base:
        • Ability to recognize, evaluate and promote the control of biological, chemical, and physical factors, which have an adverse effect on the health of the population.
        • Injury Control
        • Building Inspection
        • Community Disaster Plan
        • Food Quality
        • Communicable Disease
        • Community Clean-up
        • Rabies Control
        • Applicable Rules/Regulations
      • Range of Skills:
        • Initiative
        • Pest Control
        • Acceptable Methods of Testing/Treatment
        • Record Keeping
        • Referral
        • Environmental Health Service Surveys:
          - Food
          - Water
          - Solid Waste
          - Injury Control
      • Communication:
        • Local Medical/Environmental Credentialing as Required
        • Defensive Driving/Traffic Safety
        • Vehicle Insurance as Required

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