Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity

Area of Science:

• Public Health
• Health Workforce Studies
• Community-Based Participatory Research

Background:

• The Community Health Representative (CHR) program is the oldest federally funded Community Health Worker (CHW) workforce in the U.S.
• CHRs serve American Indian communities, addressing medical and social needs, with approximately 1,700 CHRs nationally representing 264 Tribes.
• In Arizona, 19 of 22 Tribes operate CHR programs, employing ~250 CHRs, representing 30% of the state's CHW workforce.

Purpose of the Study:

• To describe the impetus, process, and results of a 2019-2020 CHR workforce assessment in Arizona.
• To highlight CHR core roles, competencies, and contributions to social determinants of health and well-being.
• To assess the integration level of CHRs within healthcare systems and teams.

Main Methods:

• A community case study approach was employed for a multi-phase CHR workforce assessment.
• Data collection focused on CHR core roles, competencies, social determinant contributions, and system integration.
• Analysis informed recommendations for workforce strengthening and sustainability.

Main Results:

• The study identified key CHR roles and competencies essential for addressing the medical and social needs of American Indian communities.
• CHRs significantly contribute to improving social determinants of health and well-being.
• The assessment revealed varying levels of CHR integration within healthcare systems and teams.

Conclusions:

• Recommendations are provided for strengthening the CHR workforce, enhancing awareness of their roles, and improving integration into healthcare systems.
• The findings support the need for standardized training, certification, supervision, and financing for CHRs.
• The Arizona CHR Workforce Movement advocates for CHR inclusion in policy dialogues to ensure workforce sustainability and advancement.