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

2. 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 and direct oral health care and works under the supervision of a licensed dentist and follows a four tiered practice level
Dental Health Aide

3. 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 (TAG) established
2019- IHS and the CHAP TAG continue work to establish a policy/circular for the National CHAP
2019 – the policy/circular will serve as a guiding document for IHS officials as they review Tribe’s proposals to include CHAP as a PSFA in their Title I and V ISDEAA agreements.

4. Certification/Training
Workforce Barriers
Certification/Training
Cultural Inclusion
Reimbursement
Tribal Consultation
Consultation
Listening Sessions
Roundtables
180+
comments
During the 2016 tribal consultation, we amassed over 180 comments and all those comments were aggregated into categories (the green). Those comments were shared with the CHAP TAG as they worked to make recommendations to the IHS on establishing the national CHAP.

5. P: Philbert Watahomigie Sr. A: Brook Bender
P: Tim Davis
A: Conrad Fisher
P: Mark Fox
A: Larry Wright Jr.
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: Dee Sabattis
P: Sandra Ortega
A: Adrianne Tiller
As we mentioned, the CHAP TAG was established in Since then, we have had numerous in-person and virtual meetings to provide our advice and recommendations to IHS as they work to structure what the national CHAP would look like once established. The CHAP TAG is made up of 1 primary and 1 alternate for each Area and 1 representative from DSTAC and TSGAC.
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

6. 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 deemed 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 provides a glimpse crosswalk of what the law says we need for the nationalization of CHAP, how we have begun to capture 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). There is much more than this highlights but provides a framework for how IHS and the CHAP TAG have been working together to ensure that the legal requirements are met and the structure of the national CHAP benefits Tribes who are working to establish CHAPs or already have done so.
Because CHAP expansion efforts at this time are unfunded, the circular language will be critical for IHS officials who are reviewing a Tribe’s proposal to include CHAP as a PSFA in their ISDEAA agreements. The circular also provides language for IHS Service Units.

7. The structure of the certifying bodies has been a critical part of the conversation. Certification will be an inherent federal function. The National Certification Board will be comprised of Area Certification Boards. At this time, it is proposed that IHS Area Directors will consult with Tribes to establish the membership of Area Certification Boards. The National Certification Board will develop national training standards, supervision responsibilities, and certification processes based on input from the Area Certification Boards. Area Certification Boards will be able to recognize certified CHAPs across geographic boundaries and partner to form regional boards. Area Certification Boards will also be able to partner around the operation and management of the certification boards. However, it is important to note that a federal representative must sit on the board and certification forms must be signed by the respective IHS Area Director. This mirrors the process in Alaska.
Finally, the Academic Review Committees may make recommendations to Area Certification Boards for area specific additions to the national standards to ensure services are culturally appropriate or services delivered in a manner that meets the needs of that particular area. These recommendations may not override the national standards.

8. CHAP Expansion Website
For more information on CHAP activities, IHS maintains a website:

9. Next Steps
Issue a Dear Tribal Leader Letter
Consult on the IHS Draft CHAP Policy/Circular
Prepare to establish the National Certification Board and the national training and practice standards for CHAPs

10. 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 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

11. Questions
Jen Downs, Interim CHAP Secretary