265242 Scaling community-clinic coordination and outreach: Chronic disease prevention in Navajo Nation

Monday, October 29, 2012

Christine Hamann , Divison of Global Health Equity - COPE Project, Brigham and Women's Hospital, Boston, MA
Elvira Martin, MPH , CHR Outreach Program, Navajo Nation Divison of Health, Window Rock, AZ
Sonya S. Shin, MD, MPH , Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, Boston, MA
Mae-Gilene Begay, MSW , Community Health Representative/Outreach Program, Navajo Nation Division of Health, Window Rock, AZ
Rebecca Hutchinson, MD , Department of Internal Medicine, Beth Israel Deaconness Medical Center, Boston, MA
Maricruz Merino, MD , Indian Health Services, Gallup Indian Medical Center, Gallup, NM
As in many places around the world, poverty and disease go hand-in-hand in Navajo Nation. The chronic disease burden is disproportionally shouldered by the poor—many of whom are unable to access the healthcare system available through Indian Health Services (IHS). The COPE project, a formal collaboration between Navajo Nation Community Health Representative Outreach Program (CHR), IHS, and Brigham and Women's Hospital (Boston, MA) aims to strengthen the Navajo Nation Community Health Representative (CHR) Program through training, enhanced community-clinic coordination, and a culturally-relevant health promotion curriculum. CHRs, in turn, deliver intensive home-based outreach to promote healthy behavior changes among individuals with uncontrolled chronic health problems, such as diabetes and obesity. The COPE project has already seen improvements in both clinical outcomes of enrolled patients and also coordination between the community and clinic levels of care. Starting in 2012, the COPE project began to scale from its initial pilot phase in two service units of Navajo Nation (Gallup and Shiprock) to two additional service units. At the invitation of Navajo Nation, COPE will continue this phased scale-up to the entire Navajo Nation by 2015. COPE will share lessons learned during this phased implementation of scale-up, including: collaborating with tribal and federal health care teams, overcoming structural challenges in new service units, increasing local training and supervisory capacity, creating culturally-appropriate adaptations of health education materials and trainings, standardizing education and training for CHRs, generating ongoing program evaluation and quality improvement, and ensuring the long-term sustainability of these programs to prevent chronic disease.

Learning Areas:
Administer health education strategies, interventions and programs
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
1. Describe key program factors for ensuring the long-term sustainability of a health outreach program in Navajo Nation 2. Discuss IHS health care system structure 3. Explain chronic disease challenges faced by Navajo and other AI/AN populations

Keywords: Navajo, Community Health Programs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Supervisor for the Community Health Representative, Chinle Service Unit, Navajo Nation Division of Health. The COPE project is working with my team for health education trainings and community outreach.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.