Community health representatives (CHRs) are highly trained, well-established standardized frontline health workers who are trusted to serve the medical and social needs of American Indian communities, often in their homes. CHRs are tribally employed health workers and function as the oldest and only federally funded community health worker (CHW) workforce in the country. Nationally, the CHR workforce consists of approximately 2,000 CHRs representing 264 tribes. Of the 22 tribes in Arizona, 19 operate a CHR program and employ approximately 275 total CHR and supervisors—about 30% of the total CHW workforce in Arizona which totals about around 1,000 CHWs throughout the state. To read more about the power of CHRs visit the Center for Health Equity Research CHW page. The Arizona Advisory Council on Indian Health Care (AACIHC), in partnership with seven Tribes and Northern Arizona University’s Center for Health Equity Research (CHER), was awarded a three-year, $6 million grant from the Centers for Disease Control and Prevention (CDC) to expand the tribally employed community health worker workforce to address health equity. Building on nine years of collaboration between the AACIHC, CHER and Arizona CHR programs in CHR workforce development and advocacy, the award provides $2 million annually to fund the Community Health Representative Workforce Integration in Tribal Health Systems to Address COVID-19 or CHRs WITH uS! This grant will enhance the CHR workforce’s ability to build their communities’ resilience to public health emergencies and promote health equity with and for American Indian communities across the state. “Through its ripple effect, the CHRs WITH uS! collaborative will support critical workforce development efforts across all 19 CHR programs operating in Arizona and will improve the lives of both CHRs and the communities they tirelessly serve,” said Kim Russell, AACIHC director. “We spent time listening to the workforce and discovered how we could assist them.” CHRs WITH uS! directly involves a consortium of seven tribally operated CHR programs including Cocopah Indian Tribe, Colorado River Indian Tribes, Gila River Health Care, Hopi Tribe, Hualapai Tribe, Salt River Pima-Maricopa Indian Community and White Mountain Apache Tribe. Together, their work addresses challenges and major policy opportunities to better integrate CHRs into health care and public health systems and teams identified by CHR Programs in the 2020 CHR Workforce Assessment. For the Cocopah Tribe, the CHRs WITH uS! funding allowed them to fully fund a new Tribal Health Maintenance Program director, Sheryl Taylor, and two new CHRs, Lucrecia Jeronimo and Fee’a Maske, from the local community. The grant is partially paying for two other transportation CHRs and administration support for the Cocopah CHR Program. Since their CHR program expansion, the team is now partnering with the Cocopah Head Start Program and is a daily, reliable presence for parents, grandparents and eventually anyone who needs assistance at the Head Start facility. The Cocopah CHR program also collaborates with other tribal programs such as the Cocopah Alcohol/Drug Abuse Prevention Program (ADAPP) and Health Promotions. They also coordinated two community-wide physical activity-focused events—a color run in February and “Get Air” trampoline event to raise awareness with tribal youth about blood pressure and stroke prevention. Visit their Facebook page for more program information. “CHRs WITH uS! has allowed community members to learn how to support each other in the best ways possible,” said Jeronimo. “It has improved our access to education opportunities that best fit the needs of our specific tribe.” In all, the CDC’s Community Health Workers for COVID Response and Resilient Communities (CCR) initiative is providing more than $300 million nationally in financial support and technical assistance to 69 state and local governments, tribes and health service providers to tribes to increase the number and capacity of CHWs in communities hardest hit by COVID-19 because of health disparities related to discrimination, income inequality, geographic location and other social determinants of health. “This is an historical investment in the U.S. community health worker and community health representative workforce by the CDC. Our collaborative is one of only eight tribally funded programs and serves as a national model for CHR workforce development and collaboration,” said Samantha Sabo, associate professor of Health Sciences and the Center for Heath Equity. Grant goals include developing a CHR Workforce Development Hub to identify and provide critical training and support for CHW voluntary certification. The AACIHC has established a team of trainers to meet the workforce needs and to develop workforce capacity through robust train-the-trainer models, which can persist after grant funds end. “Our team is incredibly honored to serve the workforce development needs of CHRs of Arizona. Through a training, mentorship and collaboration approach, the CDC-CCR Grant funds allow the program to be designed to address immediate workforce needs in a sustainable way,” said Bella Denton, grant manager, AACIHC. “We are especially proud of our CHR Annual Summit which provides not only powerful training designed for CHRs but serves as a space to honor these individuals and programs for serving their tribal communities.” The November 2022 CHR Summit, largely funded by the grant, was attended by more than 140 CHRs, tribal leaders, tribal health advocates, Indian Health Services officials and other stakeholders representing than 25 Tribal organizations and CHR programs across Arizona, the Southwest and as far away as Washington, Minnesota and South Dakota. Most innovative to CHRs WITH uS! is the Program-to-Program Mentoring (PPM) model designed by CHR managers to match CHR programs that have demonstrated effective integration systems, policies, and protocols, with CHR programs that do not have such experience and systems but have the desire to implement them. In February 2022, CHR program managers identified their program strengths and weaknesses that could be enhanced through program-to-program mentorship and shadowing. In the summer of 2022, CHR managers of Gila River Health Care (GRHC) CHR and White Mountain Apache CHR worked together to increase the White Mountain Apache Tribe CHR Program’s data tracking and management by learning from Gila River CHR experience, protocols, and data tracking systems. The partners had two virtual meetings to discuss the types of information, protocols and forms that could be shared. They arranged and planned a full day site visit that included a program overview, staff shadowing, a tour of the Gila River Indian Community homelands and unstructured time for questions and answers between the programs. “We have so much to learn from Gila River CHR. For instance, I want our CHR program to move away from our model of keeping clients for years with no clear goals and move toward a case management model where CHRs establish a care plan and set goals with their clients,” said J.T. Nashio, CHR manager at WMAT in discussing her vision for partnering with GRHC. “CHR WITH uS! means building stronger tribal communities with CHRs who have a true desire to help improve the health outcomes of their people,” said Janet Yellowhair, CHER evaluation team. To follow the program, visit the CHRs WITH uS! page. CHR WITH uS! is funded by the Centers for Disease Control and Prevention (CDC).Who are CHRs?
What is CHRs WITH uS?
Sabo is a founding member of the Community Health Representative Coalition and the Community Health Worker Workforce Coalition and is the current chair of the Arizona Community Health Workers Association.CHRs WITH uS!—Empowering CHRs with education, connection and advocacy