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Community Health Representative

RRM Category: Public/Community Health



The Community Health Representative (CHR) provides a bridge between the healthcare facility and the patient population in their community. When seeking healthcare services the American Indian and Alaska Native (AI/AN) communities face obstacles presented by poverty, travel distances, limited transportation options, as well as a high incidence of chronic diseases, particularly diabetes. The CHR program endeavors to address and improve these quality of life issues. While IHS does not certify CHRs as nurse aides, CHRs receive training to help them provide various services which enhance quality of care, provide self-management support to patients and improve access to care. CHRs’ services often function to link patients and providers to improve communication and understanding. A majority of CHR services are provided in the patient’s home but CHRs also work in community and clinical settings. Depending on the needs of the tribal community and the focus of tribal leadership, a significant portion of the CHR’s time may be spent in providing patient care, monitoring patients and case-finding and screening. The CHR also assists with case management as an extension of professional healthcare providers and delivers and reinforces health education. CHRs, as transporters of last resort, can assist patients with transportation to clinical appointments. Patients may be referred to the CHR from medical, nursing, dental, ancillary, behavioral, and social services providers, by other agencies, the patient’s family, and self referrals by the patient.

Per the requirements of the Indian Health Care Improvement Act (IHCIA) as amended, IHS maintains a system that provides close supervision of CHRs. Close supervision means that the CHR Supervisor should either 1) be a licensed health professional or 2) be supervised by a licensed health professional, have regular meetings with that licensed health professional regarding all aspects of patient services, and have experience in administering community-based health programs.

CHRs provide regular documentation of the service and work they do in the Resource Patient Management System (RPMS) CHR Patient Care Component (PCC) data application. RPMS CHR PCC is not a part of the Clinical Reporting System (CRS) but provides patient and workload data for individual Tribes, Areas and Headquarters. RPMS CHR PCC represents the only means by which IHS can report CHR services and activities to Congress for budget justifications and to respond to inquiries.

Service Description

Services may be grouped into the major categories of:

  • Health Education
  • Case-Find / Screen
  • Case Management
  • Monitor Patient
  • Emergency Care
  • Patient Care
  • Homemaker Services
  • Interpret/Translate
  • Other Patient Services
  • Environmental Service
  • Community Development
  • Transport

And the ancillary workload categories of:

  • Administrative/Management
  • Obtain Training
  • Leave Time
  • Provide Staff Training

Specific skills and services may include but are not limited to: Taking vital signs, making referrals, utilizing motivational interviewing techniques as part of self-management support, public speaking, case management, patient advocacy with providers and outside resources, ability to recognize signs of illness, providing culturally competent health education, wound care, foot care, assessing home safety, assisting with exercise programs, assisting with mobility issues and other activities of daily living, etc.

Staffing Criteria

Administrative Staff: 0.67 FTE for each facility with greater than 1320 user population plus 0.10 FTE for each additional 1.0 CHR FTE greater than 10 CHR.

Community Health Representative: 1.40 FTE per facility with a population greater than 1320 plus 0.95 FTE for each additional 500 user population to 14,999, 0.5 for population between 15,000 and 24,999 and 0.25 for population 25,000 or more.


Staffing Formulae

Personnel Categories:

CHR Supervisor

Driving Variables:

User Population

Minimum Staffing Levels


Personnel Category FTEs per Driving Variables Min Max
Administrative/Supervisor 0.67 Facility User Population 1320 n/a
CHR 1.4 Facility User Population 1320


Personnel Category FTEs per Driving Variables Min Max
Administrative Staff 0.10 1.0 CHR 10 n/a
CHR 0.95 500 User population 1321 14,999
  0.5   User population 15,000 24,999
  0.25   User population 25,000