Community Health Representative Workforce: Meeting the Moment in American Indian Health Equity

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 similar to 1,700 CHRs, representing 264 Tribes. Of the 22 Tribes of Arizona, 19 Tribes operate a CHR Program and employ similar to 250 CHRs, equivalent to similar 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.

Automated summary

The Community Health Representative (CHR) workforce in the United States, celebrating their 50th year in 2018, is the oldest and only federally funded Community Health Worker (CHW) workforce. In Arizona, 19 out of 22 Tribes operate a CHR Program, employing around 250 CHRs, representing 30% of the total CHW workforce in the state. The Tribal CHR Programs in Arizona hold annual CHR Policy Summits to address unique issues and opportunities for CHR workforce sustainability and advancement.