1. A Practical Application of CHAs and BHAs for SUD Treatment
Sue Steward, CHAP Director
Northwest Portland Area Indian Health Board
Suquamish Casino & Hotel
January 22, 2019
It is a pleasure to be here with you all today. As follow up to the prior presentation regarding TOR I want to talk with you about how Tribal Community Health Providers (TCHP) like BHAs and CHAs can support clinical treatment of SUDs.

2. Northwest Portland Area Indian Health Board
Goals
Comparison of Community Health Worker types
CHAs and BHAs role in SUD treatment
We will look at some community worker types. I will then discuss the role of CHAs and BHAs in treatment.
Northwest Portland Area Indian Health Board

3. Community Health Worker
Community health worker are members of a community who are chosen by tribes to provide basic health and medical care to their community capable of providing preventive, promotional and rehabilitation care to these communities. Other names for this type of health care provider include village health worker, community health representative, community health promoter, health coach and lay health advisor.
Northwest Portland Area Indian Health Board

4. Northwest Portland Area Indian Health Board
Statistics
Median salary: $45,360 USD (2017)
Median hourly rate: $21.81 USD (2017)
Work experience in related occupation: None
Openings: 118,500 (2016)
Generically, CHWs are compensated from many different funding streams, including State, Federal and private. For instances, a health coach might be funded from STPI, State grants or private pay.
Northwest Portland Area Indian Health Board

5. Northwest Portland Area Indian Health Board
CHR v. CHA
Legislative Authority- CHAP is authorized under 25 USC § 1616 a-d while the CHR Program is authorized under IHCIA PL
Funding Sources- The Alaska CHAP is funded through the hospital and health clinics (H&HC) line item in the IHS budget and CHRs are funded through a specific CHR line item.
Scopes of Work- While the “community health” portion of the names are similar, the scope of work for a Community Health Aide and Community Health Representative are vastly different. CHAs are mid-level primary medical providers who can provide basic medical attention and can connect a patient to clinical care. CHRs provide health promotion, prevention, and outreach to community members.
I am going to start with a little clarification. The Community Health Aide Program and the Community Health Representative program are different.
They are authorized under different parts of the law, their funding sources are different, The CHR program has its own line item in the budget and it currently serves as the largest tribally contracted and compacted program with more than 95% of CHR programs being directly operated by Tribes under P.L of the Indian Self-Determination and Education Assistance Act, as amended.
The CHR scope of work differs from the CHA in that CHRs provide health promotion, some prevention services and outreach to community members. There are more than 1,600 CHRs representing over 250 tribes in all 12 IHS Areas.
Community health aides are midlevel health care workers who’s scope of work can be quite vast and they can perform a wide range of duties in health programs to improve access to quality care for American Indians and Alaska Natives. CHAs provide clinical care around substance use and suicide prevention, health education, communicable disease control, maternal and child health, environmental health, emergent/urgent first responders and other fields.
I would add that CHRs are a great place to recruit for CHAs.
Northwest Portland Area Indian Health Board

6. CHAP Compensation Average
CHA/T $29,250 to $37,050
CHA I certified $33,150 to $40,950
CHA II certified $37,050 to $44,850
CHA III certified $40,950 to $48,750
CHA IV certified $44,850 to $52,650
CHP Certified $48,750 to $68,250
AK THOs compensate their CHAs and BHAs very differently from organization to organization. For example, one organization pays all levels of CHA/P about $23 an hour as an exempt employee which means no on call or overtime pay. Another organization starts their CHA/T (trainees prior to session training) at $19.00 an hour and they provide a step raise for each level of training up to $38.00 for starting CHPs. They also consider all CHA/P’s as hourly employees and to compensate for after hours emergent/urgent on call they work a 6 hour day but are paid for 7.5 every day and then get overtime when called to respond afterhours.
Northwest Portland Area Indian Health Board

7. BHA Average Salary Range
BHA $29,250 to $37,050
BHA I/II certified $33,150 to $40,950
BHA III/IV/P certified $37,050 to $48,750
The BHA II culminates in an AS
The BHP culminates in an BSW
Northwest Portland Area Indian Health Board

8. SUD Treatment BHAs Role
BHA/P’s
Provide traditional healing/spiritual healing holistic care
Provide health education
Provide Patient Support and Advocacy
Arrange Transportation
Make Home Visits
A Behavioral Health Aide/Practitioner (BHA/P) is a culturally informed, community and/or residential based, behavioral services Tribal Health Provider (THP);
Behavioral Health THP’s are educated in traditional healing/spiritual healing as mentored by tribal respected practitioners providing holistic care for their community;
Care includes behavioral health prevention, intervention, aftercare and postvention services to elders, youth, families and individuals;
Treatment includes screening, case management, community education, substance abuse assessment and treatment, rehabilitative services, and quality assurance for case reviews;
The BHA/P Connects mental health and SUD services this includes supporting the medical care of the CHA/P for treatment and UA observation;
BHA/P care and services wrap around the patient in unison with the other two disciplines of CHAP THP (DHA/T and CHA/P) to provide holistic care.
Northwest Portland Area Indian Health Board

9. SUD Treatment CHAs Role
CHA/Ps
Provide health education
Provide patient support and advocacy
Make home visits
Provide history, vitals, exam, labs, treatment and care coordination.
MAT can be ordered by the advanced practice provider or physician at the hub clinic. The TCHP in the remote community can schedule the patient, get a history, vitals, labs if needed and provide MAT according to protocols. The visit can be conducted via telehealth VCT.
Northwest Portland Area Indian Health Board

10. Northwest Portland Area Indian Health Board
CHAs and BHAs Role
CHA/P Role
BHA/P Role
Check in
Vitals
History
Labs
Exam
Treatment
Follow up/Care Corodination
Order medication
Set up VTC
Observe labs
Village based counselor
Patient advocate
Patient liaison
Northwest Portland Area Indian Health Board

11. Northwest Portland Area Indian Health Board
Sustainability
Three critical issues are linked to the sustainability of community health aide programs (CHAP):
Evaluation
Financing
Credentialing/
Certification
Evaluation – Provides the compass for care. Evaluation of efficacy, evaluation of skills, evaluation of facilities, evaluation of services, evaluation of patient satisfaction and evaluation of access.
Financing – Affects ability to provide care and level of provider engagement.
Credentialing/Certification – Facility and provider credentialing needs to involve a process to assure policies provide adequate funding and time for facility and program inspections and corrective actions. It is also necessary to assure funding and time for adequate CE for provider credentialing and certifying.
Tying training, education, credentialing and certification to step performance raises provides incentive to providers, programs and communities.
Dr. Cooper and Glenn Schiff, Pharm D - Port Graham, AK
Northwest Portland Area Indian Health Board

12. Northwest Portland Area Indian Health Board
Questions?
Thank you and Safe Travels
Northwest Portland Area Indian Health Board