Frontiers in Public Health (Mar 2023)

Community Health Representative Workforce: Integration across systems and teams to address the social determinants of indigenous health and wellbeing

  • Samantha Sabo,
  • Louisa O'Meara,
  • Janet Yellowhair,
  • Joyce Hamilton,
  • J. T. Neva Nashio,
  • Brook Bender,
  • Fernando Flores,
  • Marianne Bennett,
  • Rema Metts,
  • Isabella Denton,
  • Kim Russell

DOI
https://doi.org/10.3389/fpubh.2023.1047152
Journal volume & issue
Vol. 11

Abstract

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Tribally employed, Community Health Representatives (CHRs) serving Indigenous and American Indian and Alaskan Native (AIAN) peoples are culturally and linguistically embedded community leaders, with the unique ability to serve as the link and intermediary between community members and systems. Unique to the CHR workforce scope of practice is the expectation for high level integration within the medical and social service care team. This explicit role outlined in the scope of work sets an expectation for both CHR and care teams to deliver integrated patient, family, and systems level care coordination and case management. This paper aims to build from our previous manuscript published in Volume 1 of the special issue Community Health Workers Practice from Recruitment to Integration. In that Volume, we explored through a Community Case Study CHR Managers' perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving AIAN. In this paper, we offer new information about the current CHR and CHR Managers' involvements and perceived level of integration within health care teams and the broader public health systems addressing the social and structural determinants of health. We approach this topic considering the COVID-19 pandemic and how CHRs and CHR Programs were included and not included in tribal pandemic response efforts.

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