FAQs

A: Community Health Representatives are a highly trained workforce serving the medical and social needs of American Indian and Alaska Native (AI/AN) communities across the country since 1968. As a Tribally operated and directed program funded by Indian Health Service (IHS), CHRs are a trusted and vital bridge between communities and health and social systems.

CHRs are part of the U.S. Bureau of Labor recognized workforce known as Community Health Workers (CHWs). In alignment with the broader Community Health Worker workforce standards, CHRs have a comprehensive scope of practice that enhances effectiveness and improves the outcomes of team-based preventive care.

A: Key roles and services provided by CHRs:

• Provide culturally relevant health and prevention education
• Monitor and support chronic disease management and goal setting
• Facilitate referrals to and from various health and social services
• Support the completion of necessary health care by identifying patients due for screening/care, scheduling appointments, providing appointment reminders, and arranging or providing non-emergency medical transportation
• Identify and address social drivers of health
• Assist with care coordination
• Conduct and document basic health screening
• Conduct home visits
• Advocate for patients and communities
• Provide social support and coaching
• Facilitate patient-provider communication, including interpretation or translation
• Support vaccination outreach, education, and clinics

A: When CHRs are based in the clinic, they can easily be invited to weekly care coordination meetings. When based outside the clinic, the CHR manager may attend in-person or virtual meetings with clinical care coordinators, case managers, or discharge planners.

During the discharge process, CHRs can participate in care planning and discharge planning sessions making the coming home process simpler for the patient.

A: The evidence strongly supports including CHRs in regular meetings or “huddles” in regard to care coordination. Keeping CHRs in the loop improves care coordination and care team understanding of the social, environmental and cultural factors affecting patients.

A: Person-centered care is especially important for high-risk clients, including elders and those with medically and socially complex situations, whose care involves multiple providers and social/community services. CHRs can facilitate cultural and linguistic topics, provide components of care that do not require a clinician, and provide regular welfare checks on high-risk clients.

A: While some CHR programs may be known primarily for providing non-emergency medical transportation, their full scope of practice is much broader and aligns with the national Community Health Worker workforce standards as outlined by the U.S. Department of Labor.

A: Though there are some similarities, there are key differences between CHRs and community health aides:

• Training and Certification: CHRs receive training specific to Community Health Worker core competencies.
• CHRs have a broader scope of work, including educating and connecting communities with healthcare systems, conducting home visits, patient monitoring and direct services, outreach, health programs, and health clinics.
• CHRs work in more localized communities, health programs, and heathcare settings.

A: CHRs are unique from other health professions because they increase individual and collective control, represent tribal communities, advocate for health equity, and improve the quality of healthcare. They play a critical role in public health by connecting individuals with resources and addressing issues that interfere with good health. In addition, they are strong advocates, increasing the trust between healthcare professionals and the patients and communities they serve.

A: To become a Community Health Representative (CHR) in the Indian Health Service (IHS), you need to:

• Complete CHR training, which includes 18 modules covering three tracks: Core Skills, Chronic Illness, and Healthy Living.
• Have a high school diploma, although some employers prefer postsecondary education.
• Complete hours of on-the-job training, which may also include classroom study and job mentoring.