role of community health representatives in building resilience in native communities pathways to...
TRANSCRIPT
Role of Community Health Representatives in Building Resilience in Native Communities
Pathways to Resilience III Conference
Halifax, Nova Scotia, Canada
June 17th-19th, 2015
Teufel-Shone NL, Begay MG, Sabo SJ,
Dreifuss HM, Reinschmidt KM and Chico TM
History of Community Health Representations (CHRs)
In the 1960s, Native communities in the US
requested support for local paraprofessionals to
improve cross-cultural communication between Native
communities and predominantly non-Native health
care providers.
The Indian Health Service (IHS)
funded the CHR Program.
Today, CHRs provide services in most of the 566
federally recognized tribes and in many urban centers
serving Native clients.
Roles and EvaluationCHRs share language and life experiences with community members.
CHRs are trained to perform home-based health assessments and culturally relevant health education.
Evaluation has focused on patient contact and services.
Although their role as health advocates is clearly outlined by IHS, their role as community leaders and change agents supporting healthy behaviors and building community resilience is less well documented.
Purpose of Listening Project
Gather information to understand CHR in–community advocacy –building community resilience
Assess the feasibility of adapting an evidence- based curricula developed by University of Arizona for community health workers serving Hispanic communities to the needs of CHRs
Document– CHRs’ experiences and opportunities to
engage in community advocacy and resilience
by engaging in systems and environmental
change
– CHRs’ interest in advocacy and resilience
training
Discuss based on listening outcomes
– interest in public health workforce training efforts
related to advocacy and resilience
Specific Aims
Methods
Written notes documenting listening sessions with CHR supervisors and CHR of three separate Arizona CHR programs
Qualitative analysis of notes to identify common issues within and across listening sessions
Outcomes shared with CHR programs
Identify next steps in workforce development
Results
Similarities and difference in CHRs’ role in community advocacy and building resilience were evident
Community AdvocacyCHRs described:
Presenting at township meetings or appealing to local leadership on behalf of clients, families and communities
Writing proposals to purchase exercise equipment and solar panels for homes
Promoting social engagement– Encouraging community members to attend
monthly township meetings
– Organizing fun events to bring people together to talk about issues
Community Advocacy
Topics often addressed environmental health and safety – Creation of bike and walking trails – Expansion of household electricity – Development of wheel chair ramps– Household septic tank cleaning services– Resources and care for homebound elder– Pavement of dirt roads
Advocacy
CHRs described:
Client and community apathy attributed to
paternalistic systems of education and health care
Absence of proactive culture, e.g., passive
patient-provider exchange related to language
barrier and fear or mistrust of the system
Lack of support systems for HIV/AIDS, cancer,
and diabetes outside the clinic
Strained relationships: IHS and CHR program
Building Community ResilienceCHRs interpreted resilience as helping clients and the
community to adapt to challenges
CHRs engage in the following actions
– Encourage and motivate clients and their community to
make their voices heard to outside leaders and policy
makers
– Inform clients and communities to access resources
– Combine personal and family support to improve
community infrastructure
“ When we do something, we bring people to the
table and it works out better. We get people
involved.”
Supporting CHRs to Build Community Resilience
Address CHR burn-out by providing – Stress relief training and techniques
– Bereavement outlet for CHRs who loose clients
Enhance communication skills
Address IHS and CHR relation by – Informing providers of CHRs’ ability to improve
health care utilization and health literacy
– Training clients to effectively interact providers
Broad Themes of Advocacy and Resilience in Three CHR Programs
CHR advocacy and resilience support is evident at the local level but does not impact system level change
CHRs’ skill set as potentially grassroots leaders is not realized or recognized
Community apathy is a barrier to change
Need for better integration with IHS outreach and collaborations with outside resources
Recommendations
Recognize and foster CHRs’ experiences and community-based strategies as a local resource
Integrate advocacy training into standard CHR preparation programs to enhance community resilience
Offer skills to prevent CHR burn-out
Acknowledgements
We would like to thank the CHR program staff for
their time and insights shared in these listening
sessions.
Funded by – Arizona Area Health Education Centers
– Arizona Health Sciences Center Senior Vice President for Health
Sciences Office
– Center for American Indian Resilience,
Grant #: 1P20MD006872
The content is solely the responsibility of the
authors and does not necessarily represent the
official views of funding agencies.
Contact Information
Samantha J. Sabo, DrPH, MPH
Kerstin M. Reinschmidt, PhD, MPH
Nicolette I. Teufel-Shone, [email protected]