Data Systems Change that Reflects Innovation in Training and Supports Community Health Representatives (CHRs) as Members of Health Teams

Over 1,600 CHRs serve more than 250 Tribes in 12 areas. Tasked legislatively to provide a quality training program for “Indian health paraprofessionals” and to demonstrate program worth, the IHS Headquarters (HQ) CHR Program collects and summarizes the CHR Patient Care Component (PCC) data software application to document patient services and activities which CHRs provide. Historically, non-CHR data instructors, unfamiliar with CHR practices or CHRs' wide range of services, unintentionally enabled minimal consistency or standardization of content and delivery. CHRs initiated the idea to engage CHRs, already culturally competent, as volunteers to teach coding, data entry and reporting in a train-the-trainer format. A CHR Subject Matter Expert (SME) was identified to coordinate planning and training efforts. Qualifications for student-instructors were jointly addressed; in deference to tribal sovereignty, forms were developed specifying selection and participation criteria along with Tribal approval for volunteer selection. The training approach consisted of in-person group instruction, online assignments, monthly phone calls and testing. Challenges and barriers to training and ways those were overcome will be described. In July 2008, six students (22 started originally) certified as Coding Instructors. Those 6 currently train CHRs in their own Tribal CHR Programs, in their Areas (IHS regions) and as needed, nationwide. Their participation has enhanced the data system locally, at the area and nationally, facilitating integration of CHRs into clinical health teams and allowing CHRs to use their data to improve access to health services, target specific population groups for services and identify training needs.