National Community Health Aid Program Tribal Advisory Group Update Jennifer McCleod, CHAP TAG, Tribal Co-Chair Beverly Cotton, CHAP TAG, Federal Co-Chair April 1, 2019 2019 Tribal Self-Governance Conference Grand Traverse, MI

Behavioral Health Aide Community Health Aide Program Behavioral Health Aide Community Health Aide The Community Health Aide Program is a robust system of mid-level health providers representing the fields of community/primary, behavioral, and dental health. These providers essentially expand our system of care. No longer does it have to be just the doctor, or just the psychologist, or just the dentist but rather a support system of skilled providers who can assist in the assessment and treatment of the people we serve in these respective discipline. These health aides and practitioners are trained in the latest in the field and are embedded in the communities they serve. These providers expand the traditional healthcare delivery web. The behavioral health aide focuses on behavioral health topics works under the supervision of a licensed clinician and follows a four tiered practice level. The community health aide works under the supervision of a physician or physician assistant to provide responses to medical situations and also follows a four tiered practice level. The dental health aide focuses on preventive oral health care and works under the supervision of a licensed dentist and follows a four tiered practice level The dental Dental Health Aide

CHAP Expansion Recap 2016- Tribal Consultation initiated on CHAP Expansion 2017- IHS issues report on consultation and policy statement on decision to move forward with expansion 2017- Agency continues to engage stakeholders to begin laying foundation for expansion 2018- CHAP Tribal Advisory Group established

Certification/Training Workforce Barriers Certification/Training Cultural Inclusion Reimbursement Tribal Consultation Consultation Listening Sessions Roundtables 180+ comments We have a matrix of all the comments from consultation, the listening sessions, roundtables. We amassed over 180 comments and all those comments we aggregated into categories (the green).

P: Philbert Watahomigie Sr. A: Brook Bender P: Tim Davis A: Conrad Fisher P: TBD A: TBD P: Jennifer McLeod A: Julie Beeney P: John Stephens A: Andy Joseph P: Philbert Watahomigie Sr. A: Brook Bender P: Russell Begaye A: Glorinda Segay P: Teresa Sanchez A: Guadalupe Luna P: Clarissa Sabattis A: TBD P: Sandra Ortega A: Adrianne Tiller The CHAP TAG currently has 1 primary, 1 alternate, for each Area and 1 from DSTac and TSGAC and some areas have technical advisors. P: TBD A: TBD P: Annette James A: Amanda Wyatt P: Crystal Stordahl A: Robert Onders TSGAC P: Shawn Duran A: Kay Rhoads DSTAC P: TBD A: TBD

IHS Draft Circular IHCIA requires… Draft Circular… CHAP TAG Recommends… IHS cannot fill dentist vacancy with DHAT Clearly outlines this restriction for IHS Provides clarification this does not apply to Title I or Title V ISDEAA Tribes Certification Will include National Certification Board and Area Certification Boards that will be deems federal boards Including tribal consultation to ensure tribal representation is included on certification boards State authorization for DHAT Federal law (IHCIA) authorizes DHAT services in states that authorize the use of DHATs. It is a requirement of Federal law versus state law. Need to specify Title I and Title V ISDEAA Tribes are not subject to this restriction. *IHS agrees; however, services provided under an ISDEAA compact/contract, must comply with the requirements specified in the IHCIA. This breakdown shows a crosswalk of what the law says we need for the nationalization of CHAP, how we captured that in the interim policy, and how we plan to build it out (keeping in mind the execution could continue to develop as our work with the TAG continues). Because CHAP expansion efforts at this time are unfunded, we’d be leaning on the information we have from Alaska (i.e.: CHAPCB S&P) to provide guidance on how the program would operate. The TAG through a resounding recommendation wants a national/regional structure which we hope to work towards for the future CHAP policy but the interim policy at the moment (because of funding) supports a national board utilizing a three part function to support the different disciplines. Highlight the major different with the IP and FP is the certification board structure. The certifying of aides is also an inherent federal function as written.

This roll up approach is what was suggested by the TAG with one additional addition in responsibility. Developing uniformed standards for the country. Area boards can develop additional requirements that any aide practicing in that area must adhere to. The academic review committee can make suggestions on national that must be filtered through ACB to NCB. The ACB can also make recommendations on Area requirements that the ACB can choose to adopt. National standards and procedures are adopted in part from Alaskas. This ensures we are “consistent”, we can approach evaluation later down the line in consistent manner. We will remove things that are counterintuitive to the national provisions or remove the flexibility from ACBs. (e.g.: setting their own structure in meeting times, etc.)

CHAP Expansion Website We are still working through vacancies and will lean on leadership for their support to assist us with filling these positions through Area offices. www.ihs.gov/chap

Next Steps Issue a Dear Tribal Leader Letter Consult on the IHS Draft CHAP Policy/Circular Prepare for National Certification Board and establishing the National Training Standards for CHAPs

Resources General Behavioral Health Aide Dental Health Aide IHS Dear Tribal Leader Letter (6/2016) IHS CHAP Press Release (1/2017) IHS Policy Statement on CHAP Expansion Alaska CHAP IHS Circular 18-01 Community Health Aide Program Tribal Advisory Group Charter (2/2018) IHS CHAP Website IHS CHAP Expansion Overview Behavioral Health Aide Behavioral Health Aides: A Promising Practice for Frontier Communities An Action Plan for Behavioral Health Workforce Development Alaska Behavioral Health Aide Program Alaska BHAs 101 Dental Health Aide Alaska Dental Health Aide Program Sample Dental Therapy Curriculum for Community Colleges Current Use of DHATs in Indian Country and Beyond Dental Health Aides 101

Questions Jen Downs, Interim CHAP Secretary jennifer.downs@ihs.gov