Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.
Arizona Advisory Council on Indian Health Care, Phoenix, AZ, United States.
Front Public Health. 2021 Jul 21;9:667926. doi: 10.3389/fpubh.2021.667926. eCollection 2021.
In 2018, the Community Health Representative (CHR) workforce celebrated their 50th year and serve as the oldest and only federally funded Community Health Worker (CHW) workforce in the United States. CHRs are a highly trained, well-established standardized workforce serving the medical and social needs of American Indian communities. Nationally, the CHR workforce consists of ~1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ ~250 CHRs, equivalent to ~30% of the total CHW workforce in the state. Since 2015, Tribal CHR Programs of Arizona have come together for annual CHR Policy Summits to dialogue and plan for the unique issues and opportunities facing CHR workforce sustainability and advancement. Overtime, the Policy Summits have resulted in the Arizona CHR Workforce Movement, which advocates for inclusion of CHRs in state and national level dialogue regarding workforce standardization, certification, training, supervision, and financing. This community case study describes the impetus, collaborative process, and selected results of a 2019-2020 multi-phase CHR workforce assessment. Specifically, we highlight CHR core roles and competencies, contributions to the social determinant of health and well-being and the level to which CHRs are integrated within systems and teams. We offer recommendations for strengthening the workforce, increasing awareness of CHR roles and competencies, integrating CHRs within teams and systems, and mechanism for sustainability.
2018 年，社区卫生代表 (CHR) 队伍迎来了他们的 50 周年纪念日，是美国历史最悠久、也是唯一一支获得联邦资助的社区卫生工作者 (CHW) 队伍。CHR 是一支经过高度培训、成熟且标准化的队伍，满足美国印第安人社区的医疗和社会需求。在全国范围内，CHR 队伍由约 1700 名 CHR 组成，代表 264 个部落。在亚利桑那州的 22 个部落中，有 19 个部落运营着 CHR 项目，雇佣了约 250 名 CHR，相当于该州 CHW 总劳动力的 30%。自 2015 年以来，亚利桑那州的部落 CHR 项目每年都会举行 CHR 政策峰会，就 CHR 劳动力可持续性和发展所面临的独特问题和机遇进行对话和规划。随着时间的推移，这些政策峰会促成了亚利桑那州 CHR 劳动力运动的形成，该运动倡导将 CHR 纳入州和国家层面的劳动力标准化、认证、培训、监督和融资对话中。本社区案例研究描述了 2019-2020 年多阶段 CHR 劳动力评估的动力、协作过程和部分结果。具体来说，我们强调了 CHR 的核心角色和能力、对健康和福祉的社会决定因素的贡献，以及 CHR 在系统和团队中的整合程度。我们为加强劳动力队伍、提高对 CHR 角色和能力的认识、将 CHR 整合到团队和系统中以及可持续性机制提供了建议。
