Strengthening the role of Community Health Representatives in the Navajo Nation

Abstract

BackgroundStrengthening Community Health Worker systems has been recognized to improve access to chronic disease prevention and management efforts in low-resource communities. The Community Outreach and Patient Empowerment (COPE) Program is a Native non-profit organization with formal partnerships with both the Navajo Nation Community Health Representative (CHR) Program and the clinical facilities serving the Navajo Nation. COPE works to better integrate CHRs into the local health care system through training, strengthening care coordination, and a standardized culturally appropriate suite of health promotion materials for CHRs to deliver to high-risk individuals in their homes.MethodsThe objective of this mixed methods, cross sectional evaluation of a longitudinal cohort study was to explore how the COPE Program has effected CHR teams over the past 6 years. COPE staff surveyed CHRs in concurrent years (2014 and 2015) about their perceptions of and experience working with COPE, including potential effects COPE may have had on communication among patients, CHRs, and hospital-based providers. COPE staff also conducted focus groups with all eight Navajo Nation CHR teams.ResultsCHRs and other stakeholders who viewed our results agree that COPE has improved clinic-community linkages, primarily through strengthened collaborations between Public Health Nurses and CHRs, and access to the Electronic Health Records. CHRs perceived that COPE’s programmatic support has strengthened their validity and reputation with providers and clients, and has enhanced their ability to positively effect health outcomes among their clients. CHRs report an improved ability to deliver health coaching to their clients. Survey results show that 80.2% of CHRs feel strongly positive that COPE trainings are useful, while 44.6% of CHRs felt that communication and teamwork had improved because of COPE.ConclusionsThese findings suggest that CHRs have experienced positive benefits from COPE through training. COPE may provide a useful programmatic model on how best to support other Community Health Workers through strengthening clinic-community linkages, standardizing competencies and training support, and structuring home-based interventions for high-risk individuals.

Community-based outreach associated with increased health utilization among Navajo individuals living with diabetes: a matched cohort study

“…At the patient level, we have described how patient selfefficacy is strengthened through emotional support, health coaching, and navigation support from CHRs to access care such as appointments and medication refills [22]. At the provider level, we have described how the intervention enhances CHRs' ability to deliver standardized, evidence-based, culturally-tailored outreach to their patients and communicate more effectively with clinic providers about patient issues [23]. At the system level, we have demonstrated that the intervention strengthens community-clinic linkages, validating CHRs as members of the care team and increasing care coordination among clinic providers and CHRs [24].…”

Glycemic control and healthcare utilization following pregnancy among women with pre-existing diabetes in Navajo Nation

“…As part of an ongoing program evaluation by COPE, deidentified data were extracted from the IHS electronic health record for all patient encounters on the reservation from 2009 to 2016 with a DM Audit Problem Diabetes Diagnosis taxonomy, which includes ICD-9 and ICD-10 codes for diabetes mellitus [18]. Permission to access health data was given by the Navajo Area IHS, and this project was approved by the Navajo Nation Human Research Review Board and the Partners Healthcare Institutional Review Board.…”

Community–clinic linkages: qualitative provider perspectives on partnering with community health representatives in Navajo Nation

“…Navajo CHRs are required to be trained as a Certified Nursing Assistant (CNA) and must speak Navajo. Many CHRs have additionally obtained certification and credentialing beyond the CNA required for the job, including CHW certification through the state of New Mexico 21. Typical services provided by Navajo CHRs include home visits to monitor vital signs and provide health education, referrals for additional services and resources needed by their client, community outreach for urgent or emergent issues, and health fairs and other health promotion activities.…”

“…Specific templates were created for providers to make referrals to CHRs and for CHRs to document their home visits. Improvements in communication were shown as a result of this system change 21…”