Making a Difference - It's What We Do
CHRs at work in their communities.

As the CHR program celebrates 40 years as the foundation of care in Native communities, it is appropriate to recognize some of the many great CHR programs that work with their local healthcare programs to make a difference. The following are just a few examples of CHR collaborations that benefit their communities.

• The Shoshone-Bannock CHRs assist Dr. Douglas Williams in the IHS Podiatry Clinic, which provides foot care education and medical services to all people with diabetes and community members. The CHR staff has been trained by Dr. Williams or other podiatrists on foot care exams and educational needs. They work directly under the staff podiatrist.
  
• The Sac & Fox Tribe of Iowa CHRs work with the Meskwaki Health Clinic recruiting and referring hypertensive/pre-diabetes patients, and making follow-up home visits when patients miss appointments. They also work closely with the Diabetes Program (Wellness Center) to help provide education for the prevention or delay of complications from diabetes and hypertension, as well as providing information on risk factors for cancer.
  
• A CHR in the Northern Cheyenne CHR program from the Billings Area works as an oncology coordinator. In this role she works closely with an IHS family practitioner on referrals related to cancer. In this remote area, the CHR program also provides transportation for patients who need to travel up to 100 miles for appointments.
  
• Creek Nation CHRs from McIntosh County in Oklahoma work closely with the Public Health Nurses in their communities. They helped coordinate three health fairs for area communities, and assisted with the coordination of a Men’s Cancer Awareness Day. CHRs also help a PHN with monthly BP/BS screenings, sign up patients for Flu vaccines and make referrals for PHN home visits when a patient is too ill to go to the clinic.
  
• CHRs from the Forest County Potawatomi program in Wisconsin go door to door to identify prevention needs. If they find a tribal member has not had their mammogram, optical exam, Pap smear or other regular screenings, the CHR contacts the clinic to make sure an appointment is scheduled. The CHRs will also accompany tribal members to their appointments.
  
• CHRs from the Port Gamble S'klallam Tribe in Washington State do home visits with home health nurses and meet weekly with the nurses to go through "The Book" of scheduled clients to plan for the following week. As they discuss what kind of follow-up care needs to be done with individuals they are able to decide who will do each task. These CHRs also work to educate men on the importance of getting checked for colorectal cancer. CHRs and the nursing staff track elder medication lists and share information about any changes in their health or meds. Finally, the CHRs fill out PCC or case management forms after each elder doctor appointment and turn them in to the clinic providers so they stay informed about the health and needs of the people.
• The Rosebud Sioux Tribe CHR program Elder Team works closely with the geriatrics physician.  They provide elders with health education, handle triage, walk elders to and from x-ray or lab areas, explain tests and why they need to be done, and provide translation for elders speaking their Native language. These services are provided at weekly clinics and a two-week long specialty clinic each summer.
• Pascua Yaqui Tribe CHNs and CHRs share caseloads. The CHRs follow more stable clients, escorting them to appointments and staffing these clients periodically. New CHRs accompany CHNs in the field so that they can get the CHN perspective and learn more about becoming an LPN or RN. These two groups share daily exchanges of information that benefit their clients.
• Bemidji Area CHRs cover a lot of ground through a diversified approach. One CHR does podiatry scheduling and diabetes outreach for the SDPI grant. She also does home visits for diabetic clients and is responsible for the DM registry. Another CHR works with the pediatric population, doing reminders and recalls and data entry into the state immunization database. She also coordinates WIC clinics, sends out health check reminders and acts as a doula for new mothers. A third CHR handles transportation to and from the clinic and to outside agencies twice weekly. She also fits people with their eyeglasses and places orders for frames and glasses. Soon she will be trained as a prevention coordinator in helping patients with smoking cessation.
• Zuni CHRs have taken PHNs door to door to provide influenza vaccines for elders.

If you’d like to share some ways your CHR program works with the healthcare system in your community, please send your information to feedback@nachr.net.