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

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

The aim of this paper was to build from the previously published manuscript Community Health Workers Practice from Recruitment to Integration, which explored Community Health Representative (CHR) Managers’ perspectives on the challenges and opportunities for full CHR integration into health systems and teams serving American Indian and Alaskan Native (AIAN) peoples. Building on this, researchers present new information in this paper about the current CHR and CHR Managers’ involvements and perceived level of integration within health care teams, and outline the broader public health systems addressing the social and structural determinants of health. Researchers present evidence they identified of the following factors related to integration: respondents reported working as part of a care team; mechanisms exist for CHRs and care teams to communicate; and CHRs work in close physical proximity to care team members. Other factors that contribute to quality integration were also identified including: CHRs having access to electronic or other medical record systems; and CHRs having a known champion or leader within the team that supports their integration into the broader healthcare system. Researchers highlight the need for more investigation of protocols that guide CHR participation in regular meetings with care teams and reduce structural barriers to their engagement in certain aspects of care. Such research can helpenhance the integration of CHRs into health systems while addressing social determinants of health among AIAN peoples.