U.S. Department of Health and Human Services

IHS Activities Timeline

IHS CHAP Expansion Historical Timeline Summary of Actions to Date

1960's

1968 - Indian Health Service (IHS) establishes the Community Health Aide Program (CHAP) in Alaska (This only included mid-level medical providers who were Community Health Aides).

For a detailed timeline of the CHAP within the state of Alaska, please see CHAPCB Timeline 2016-05 Published by the Alaska Native Tribal Health Consortium. For a detailed history of the Community Health Program in Alaska, see “The Alaska Health Aide Program” by Philip Nice and Walter Johnson, available from the Alaska Center for Rural Health and Health Workforce, University of Alaska Anchorage.

1970's

1976 - Congress amends the Indian Health Care Improvement Act (IHCIA) to authorize the CHAP (PL 94-437).

1990's

1992 - Congress amends IHCIA to authorize the CHAP in Alaska (§119) under 25 U.S.C §13 and required a Certification Board (PL 102-573).
1998 - IHS creates a national Community Health Aide Program Certification Board (CHAPCB). The CHAPCB formalized the process and maintained training, practice standards, and policies. The Alaska Area Native Health Area Director supervised the established of an eleven (11) member board. (See Alaska Area Native Health Service Circular 98-150)

Early 2000's

2003 - State of Alaska authorizes the use of Dental Health Aides (DHAs).
2004 - Alaska certifies the first cohort of DHAs.
2007 - Alaska adds DHAs under their CHAP.
2008 - Alaska adds Behavioral Health Aides (BHAs) under their CHAP.
2009 - Alaska certifies the first cohort of BHAs.
2009 - State of Maine authorizes the use of DHAs.
2009 - State of Minnesota authorizes the use of DHAs.
2010 - IHCIA is amended to authorize IHS to create a national CHAP. This excludes Dental Health Aides, unless in a state that authorizes its use.

2016

June 1 - Dear Tribal Leader Letter (DTLL) initiates consultation on a draft policy to expand the CHAP (Consultation Sessions were held on 9/19, 10/4, and 10/9).
June 2 - State of Vermont authorizes the use of DHAs.
October 27- Tribal consultation concludes.

2017

January 4 - IHS issues Report on Tribal Consultation for IHS Policy Statement on Creating National IHS CHAP.
February 21 - State of Washington authorizes the use of DHAs.
March 20 - IHS hosts a graduate student to develop an evaluation proposal for the BHA program under the IHS Dartmouth College MOU. The student's internship ends on June 2, 2017.
March 27 - IHS CMO (RADM Michael Toedt) and Deputy Director of Intergovernmental Affairs (DDIGA) (Ben Smith) meet with Acting OCPS Director (Dr. Sarah Linde) to develop a plan to move forward and appoint an IHS office to lead the efforts.
April 13 - IHS Chief of Staff (RADM Kelly Taylor) directs Office of Clinical and Preventive Services (OCPS) Acting Director (Dr. Sarah Linde) to move forward with efforts to expand the CHAP nationally.
April 13 - IHS Chief of Staff (RADM Kelly Taylor) directs Office of Clinical and Preventive Services (OCPS) Acting Director (Dr. Sarah Linde) to move forward with efforts to expand the CHAP nationally.
April 14 - (OCPS) Acting Director (Dr. Sarah Linde) meets with OCPS Division Leadership.
May - OCPS Division Leadership assign leads for each aide program under the proposed national CHAP; Behavioral Health Aide (Minette C. Galindo), Dental Health Aide (Dr. Chris Halliday).
June 22 - BHA Lead (Minette C. Galindo) visits Anchorage, AK and Dillingham, AK to meet with Alaska Native Tribal Health Consortium (ANTHC) and Bristol Bay Area Health Corporation to learn about the BHA program and its implementation.
June 22 - BHA/CHAP Lead (Minette C. Galindo) hosts a Behavioral Health Aide Briefing at the 2017 National Combined Councils (NCC) Meeting with the National Council on Behavioral Health (NCBH) to get feedback for the proposed BHA program.
July 18 - CHAP Leads present an update on the expansion at the 3rd Quarter Tribal Self-Governance Advisory Committee (TSGAC) Meeting in Washington, DC.
August 23 - CHAP Leads present updates and host a listening session on the CHAP Expansion at the Community Health Representative Summit III in Camp Verde, AZ.
November 17 - IHS issues the CHAP TAG Charter out for agency wide review and comment.
December 8 - The comment period for the CHAP TAG Charter closes.

2018

January 26 - BHA/CHAP Lead (Minette Galindo) and DHA Lead (Chris Halliday) present an update at the California Rural Indian Health Board Directors Meeting.
February 6 - IHS Circular 18-01, creating the CHAP TAG, is published in the Indian Health Manual.
February 13 - BHA/CHAP Lead and DHA Lead present updates on the CHAP to the Direct Service Tribes Advisory Committee.
February 27 - IHS Acting Director (RADM M. Weahkee) issues a DTLL providing updates on the CHAP efforts.
February 28 - BHA/CHAP Lead (Minette Galindo) provided brief updates during a Tribal Delegation Meeting with Northwest Portland Area Indian Health Board.
March 20 - CHAP TAG convened a caucus and nominated Dr. Glorinda Segay of the Navajo Nation to serve as the Tribal Chair, per IHS Circular 18-01.
March 21-22 - IHS hosted the first two-day in person meeting for the CHAP TAG in Arizona at the Crowne Plaza Phoenix Airport.
April 27 - CHAP TAG convenes for a virtual meeting
May 31 - Behavioral Health Aide and Dental Health Aide workgroups form
August 17 - CHAP TAG convenes at the Henry M. Jackson Federal Building in Seattle, WA
October 10, 2018 - The CHAP TAG convenes for their 3rd in person meeting at IHS Headquarters in Rockville, MD to discuss the expansion of the CHAP to the lower 48.
November 2018 - The CHAP TAG convenes virtually to advise on the CHAP Policy.

2019

February 8 - CHAP TAG convenes virtually to advise on the CHAP Policy and consultation process.
February 22 - CHAP TAG convenes a caucus and nominate Jennifer McLeod of the Sault Ste. Marie Tribe of Chippewa to serve as the Tribal Chair, per IHS Circular 18-01.
February 22 - CHAP TAG convenes virtually to advise on the CHAP Policy and consultation process.
March 15 - CHAP TAG convenes virtually to advise on the CHAP Policy and consultation process.
April 3 - During the 2019 Tribal Self-Governance Conference, IHS and the CHAP TAG met in person to discuss draft CHAP Circular, Dear Tribal Leader Letter language, and broad consultation process.
May 8 - The IHS Principal Deputy Director issued a Dear Tribal Leader Letter to initiate Tribal consultation on the draft Community Health Aide Program (CHAP) Policy. The 30-day comment period closes on June 7, 2019.
June 7 - The IHS Principal Deputy Director issued a DTLL extending consultation on the draft CHAP Policy for an additional 30-days with comments being accepted until July 8th.
July 8- Draft CHAP Policy comment period closed.
July 11 - OCPS provided an update on Tribal Consultation on the All Tribal and Urban Indian Leaders call.
July 16 - OCPS provided an update on the draft CHAP policy at the Tribal Self Governance Advisory Committee quarterly meeting.
August 13 - The CHAP TAG virtually to provide an overview of Tribal Consultation on the draft national CHAP policy. IHS provided the full list of comments directly to the CHAP TAG.
September 8 - The CHAP TAG convened in person at IHS HQ (Rockville, MD) to review the comments from consultation and gather the final recommendations.
September 30 - The CHAP TAG sent a letter to IHS citing concerns and specific recommendations on how to reconcile comments and address key policy concerns.

2020

February 21 – The CHAP Tribal Advisory Group convened for a virtual meeting. IHS reviewed each change to the policy and identified policy recommendations not adopted. The CHAP provided verbal support in moving the policy forward.
October 30 – In partnership with the IHS, the Office of Minority Health announced a new initiative [PDF - 111 KB] to support the implementation of the national Community Health Aide Program (CHAP).