Alaska Native Medical Center

Association of Alaska Community Health Aide Program Directors’ Meeting Minutes May 15-16, 2008 Anchorage, AK

DATE: May 15 - 16, 2008 CHAIR: Crystal Stordahl (TCC) VICE-CHAIR: George Drinkwater (MSTC) SECRETARY: Patrick Mahoney (BBAHC) RECORDER: Torie Heart (ANTHC)/Tamaree Kawagley (ANTHC) Guests/Organization Torie Heart ANTHC- Director of CHAP/Rural Health Rosie Habeich North Slope Borough- Member / Organization Member / Organization Member / Organization Carol Odinzoff ANTHC- Assistant Director of CHAP/Rural Health Cindy Lincoln Maniilaq- Community Health Service Director George Peter Akiachak Native Community A Gay Brewer Hoonah Indian Association A Helena Bock Ninilchik Traditional Cnc. E Kathleen Graves ANTHC- BH Consultant Tom East ANTHC- Division of Information Technology Annette Siemens APIAI E Alicia Lynn Reft Karluk Tribal Council A Grace Ng North Slope Borough P Linda Curda UAF-CRCD- CHAP Academic Liaison Shirley Thornton Norton Sound Health Corporation Patrick Mahoney BBAHC P Jud Brenteson Kodiak Area Native Assoc. P Vacant Norton Sound Health Corp. E Dan Thomas NSHC- Curriculum Coordinator David Akin Council of Athabascan Tribal Governments Jane Martin Chickaloon Village A Herman Geffe, Sr. Maniilaq Association P Dr. Donna Galbreath SouthCentral Foundation A Alberta Unok ANTHC- BH Melodye Gilbert Chitina Traditional Village Cnc. A Jeanette Cawyer Metlakatla FMC A Steve Gage SEARHC P Sue Stewart Chugachmiut A George Drinkwater Mt. Sanford Tribal Consort. P Crystal Stordahl Tanana Chiefs Conference P Crystal Talyat Copper River Native Assoc. P Etta Menadelook Native Village of Diomede A Josephine Grant Tanana Tribal Council A Lona Ibanitoru Council of Athabascan Tribal Gov’ts P Fannie Hernandez Native Village of Kwinhagak A Leslie Jones Yakutat Tlingit Tribe A Katherine Cart Eastern Aleutian Tribes A Casandra Trenton Native Village of Tyonek E Bill Schreiner YKHC P

SUBJECT DISCUSSION / RECOMMENDATION(S) RESOLUTION(S) FOLLOW-UP Review of Agenda Agenda adopted at 8:27 AM. 8:25 AM meeting called to order. 8:27 AM Motion to approve to agenda, Steve Gage, 2nd Herman Geffe. Unanimous approval. Introduction Members & guests did an introduction. ARC Report- Presession Guidelines 8:43 AM. Motion to ANTHC, NSHC, Linda Curda  Includes syllabus, skills check list, student work book, instructor handbook, job description provisionally approve BBAHC, KANA, Maniilaq presession materials for  5 corporations (and others invited) to use utilize materials, report back to ARC regarding any to provide feedback to demonstration project with suggested revisions. ARC chair by August ‘08 ARC Report- expectation of feedback Continued Clinical Evaluation Form from regional organizations  Being used in field and during preceptorships, not a required document. utilizing materials to ARC. nd  Discussion to include addition of line for other items such as GPRA indicators, JCAHO, 2 George Drinkwater. Medicaid. Recommend changing “Additional Comments” section to “Regional Additions”. Unanimous approval. Preceptorship Skills Checklist 9:01 Motion approved to ARC Dec meeting will accept Clinical Evaluation review preceptorship  Form revised 1st time in 10 years, changes to be in line with ’06 CHAM including: changes to Form with change to instructions to ensure instructions – “certified” to “credentialed”; “lab” manufacturers instructions; 5 unique patient “Regional Additions”, reference to clinical eval. types: Acute, Chronic, Return visit, Well Child, Prenatal. Question if Subcut is an acceptable George Drinkwater. 2nd Form. New abbreviation and several typos/formatting changes. Steve Gage. Unanimous preceptorship skill Page 1 of 6 A A C H A P D A P P R O V E D 9 / 1 9 / 2 0 0 8 Medical standing orders added to ’06 CHAM approval. checklist to be mailed to  Adult immunization, Tdap & Nebulizers. You can contact NSHC for information/sample of 9:25 Motion to approve each CHAPD with clinical these MSOs. Preceptorship skills evaluation form and letter of introduction for use Emergency PEF checklist to include suggested edits from these and timeline of  Members of ARC report emergency PEF has not been implemented in most of their regions. discussions, George implementation. Training Centers are teaching the use of this document. Request regional health organizations Drinkwater. 2nd Steve work to implement this form. Gage. Unanimous CHA/P role in filling medisets approval.  Reviewed current CHAM language page M-16. 1. function should be performed by family member. 2. Health aides are prohibited by law to fill medisets. Gary Givens, lead pharmacist for ANMC has reviewed federal law and has found nothing prohibiting CHA/Ps from filling medisets. Language in CHAM was based on state law. Language in CHAM will need to be Training centers to bring changed. Still caution this role being another addition/expectation of the CHA/P. training needs Statewide training needs tool tool/process to next meeting.  Recommend this tool be resurrected, sessions are going unfilled. If regional health corporations can convey actual training needs the training centers can better plan to meet needs. TABE test-electronic  Can be taken through electronic means but cost prohibitive for individual organizations to do this on an individual basis. Researching how this could be offered from a central location. Curriculum updating/revision process  Dr. Golnick data from organizations will be reviewing assessment, frequency of assessment and MD assessment to determine if current curriculum is teaching to the right needs/with the right amount of time dedicated to each topic. Ask CHAPD to provide Convocation direction on what is Planning efforts have begun. Anyone wanting to help is invited. CHAPD have suggested distance expected with distance delivered education be on agenda. Other topics to include PEF review process and clinical delivered topic. evaluation form. University Academic Updates provided on: Liaison Report- 1. Students completing Certificates and Associate of Applied Science degrees in 2007 and 2008 Linda Curda 2. MEDEX NW PA admission process 3. Fall audio conference course related to CHA/Ps’ AAS degree 4. Student Course Tracking Guide

RAC Report- RAC Membership RAC Membership Dan Thomas  Leif Albertson is resigning his position at Y-K. He filled the RAC position of Field Rep. Need 11:00 Motion to approve CHAPD recommendation for replacement. Elsie Dexter to fill vacant Site Review for ANTHC CHAP Training Center- Field rep. position to RAC, Herman Geffe. 2nd Bill  The team consisted of Dan Thomas as Team Leader, Bill Schreiner as Co-Leader, John Schriener. Unanimous Everson (SEARHC), Helena Bock, and George Drinkwater. approval.  Review of distance ed. portion by D. Thomas, G. Drinkwater. Did not pass review-Summary ANTHC CHAP Training written separately from rest of training center review. Center Site Review- CHA Education Program Evaluation Checklist Motion to approve RAC  Review newly established instructions recommendation that ANTHC Training Center be recertified. Amendment to Page 2 of 6 A A C H A P D A P P R O V E D 9 / 1 9 / 2 0 0 8 motion to include findings of distance ed review including a recommendation that before further distance education classes are taught, there will be additional review of that material, Steve Gage. 2nd Jud Brenteson. Unanimous approval. CHA Education Program Evaluation Checklist- Motion to approve CHA Education Checklist with newly submitted instructions, Bill Schriener. 2nd George Drinkwater. Behavioral Health Update Update-  January CHAPCB approved as first read, with grammatical edits, next review in June Kathleen Graves  Goal to start submitting applications in October  Will grandfather existing BHAs

Statewide Services Jeannie Greene Productions Video Jeannie Greene CHAM Orientation DVD- Report-  Has footage, waiting for script Productions Video- Review older version of Torie Heart CHAM Orientation DVD Start with 2-3 minute orientation videos- funding/program executive team to draft  90 Min. Done. Waiting to talk with all funders prior to printing and distribution description, if any funding script for new DVD. CHAP Forum left over consider 10 minute CHAP Forum-  19 THOs represented recruitment/program Recommendations and  In the past, it was contracted out; maybe look into doing that again to lighten the work-load for description. planning will be on the Torie Heart and her office. Sept. meeting agenda.  Would like to get more skilled sessions on the agenda for next year. One topic that should be put on is getting CHA/Ps ready for the Joint Commission reviews.  For any CHAP Directors that attended this year’s Forum, they should meet with the Executive Team for feedback on how it was this year. Statewide Services  The hotel cost was about $12k. $6k was spent on products given to the attendees (tote bags, t- Report- shirts, pens, etc.). Another $4k was spent on travel for CHAA members and one speaker. Continued  Would like the roles clearly defined on whom is responsible/director for the CHAP Forum, and see what is needed to make it more effective and stream-lined. Community Health Aide/Community Health Practitioner/Dental Health Aide Week  Have statewide services funding to purchase items for CHA/Ps in recognition of the programs’ 40 year anniversary. Recognition and 2008 AACHAPD Shining Star Award Winners Support Committee- Experienced CHA/P- Sue Evanoff, BBAHC- Pilot Point. Jud Brenteson New Motivated CHA- Adolf Paul, YKHC- Kipnuk. Outstanding Accomplishments in the Community- Jennifer Kalmakoff, BBAHC- Chignik. In Memoriam- Martha Kayouktuk, NSHC- Little Diomede; Arlene Saccheus, NSHC- Elim; Eddie Page 3 of 6 A A C H A P D A P P R O V E D 9 / 1 9 / 2 0 0 8 Clay Slayton, BBHAC- Itinerant; Augusta Kvasnikoff, Chugachmiut- Port Graham.

 Will be purchasing a trophy for Jennifer Kalmakoff; she had received a certificate.  Winners also received flowers. ETT/Certification Tribal Health Directors requested that CHAP Certification Board remove Standard 2.20.200 AACHAPD do not typically C. Stordahl to draft letter Discussion-  Certification Board is requesting response from AACHAPD and Clinical Directors. recommend changes to the from AACHAPD in AACHAPD CHAPCB standards without preparation for consultation of the tribal certification board programs. request to review topic CHAPCB- Feedback After 10 years of existence what recommendations do AACHAPD have for CHAPCB? C. Stordahl to draft letter from AACHAPD  Medical director is the only seat with term limits. from AACHAPD to Cert Board for consideration  Roles/Relation of ARC & RAC to Certification Board  Membership/composition  Application- original signatures. Explore electronic process/accept fax copies February Draft Page 7- last sentence, Training Center reports- UAF is not eligible for any of that money. Steve Gage moves to Edits will be done to the Meeting Minutes Voted to spend $30k-$40k on CHAM Revision- it was voted on, but is unclear what it will be used accept the draft minutes draft and then sent out to for. The money was to be used as “seed” money for future editions of the CHAM. Needs to be clear with changes. Shirley all CHAP Directors. that this money is not available at this time. Thornton seconds the motion. All in favor. Motion passes. March March teleconference minutes are approved as-is. Steve Gage moves to Teleconference accept the March Meeting Minutes Teleconference draft minutes. George Drinkwater seconds the motion. All in favor. Motion passes.

Round Robin Reports Tanana Chiefs Conference  Currently recruiting for a couple of CIs and 12 or so CHA/Ps.  TCC has a management team for health services, and 9 people represent 30 health programs.  Pushing forward with AAA accreditation for health aide clinics. Kodiak Area Native Association  CHAP division assumed administrative supervision over the BHAs.  A new person will be starting as the director of Community Health Services. She has a Round Robin behavioral health background. She will start on June 16th. Reports-  KANA is creating a safety officer position and that person will manage BHAs, DHAs, and Continued CHA/Ps.  Jud will be transitioning to another position. He will maintain some administrative oversight over the CHA/Ps and do some safety officer duties as well. Unsure if he will be attending the September AACHAPD meeting. Council of Athabascan Tribal Governments  Opened a new clinic in Fort Yukon. Some of CATG’s clinics will be getting broadband upgrades. Maniilaq Association  Herman Geffe will be with Maniilaq until July 28th, and then will be going back to school. Chugachmiut

of 6 A A C H A P D A P P R O V E D 9 / 1 9 / 2 0 0 8  All CHA/P positions are filled. Currently interviewing some physicians based in Seward. New mid-level providers will take on SI duties.  This summer they will be building a new clinic in Nanwalek. The building is coming from North Slope Borough. Eastern Aleutian Tribes  Chris Devlin, Executive Director, will be moving on this September. Patty Lunduska (sp) may transition into his position. Norton Sound Health Corporation  Now have 3 DHAs in Savoonga and St. Michael.  NSHC hasn’t had a director in over a year; they will be posting an ad for it soon. They are also recruiting for CHA/Ps and training instructors. SEARHC  They are currently looking at how electronic medical records will incur a lot of training and transitions.  Going to the Joint Commission and getting accreditation for the clinics this year.  There will be Preceptorships this summer. Yukon Kuskokwim Health Corporation  Currently using new method of recruiting in Bethel; also have openings for mid-level providers and one for a CI.  Starting a new program called “Well Child Wednesday”. For a long time CHAs were trained to do well-child checks, but were not doing them as often as should. They will now be using a Xerox program to expedite the paperwork and tracking by clinic and by health aide. Wednesday was chosen because it is the least busy day of the work-week. Also are now making sure that the health aides include teenagers in well-child checks.  Starting chronic and diabetes long-term-care programs. May also be starting elder-care program based on the “Well Child Wednesday” model.  YKHC wants to support instructors to do an exchange program with other training centers.  Looking into outsourcing a triage-line service based in the continental US. Will be discussing it with legal personnel and researching how it has worked for other organizations that use them.  They had purchased mail-lists for Washington, Colorado and Alaska, and sent out a pamphlet to recruit. They will also be getting a nationwide 800 number, and an email address will be put on future brochures. Human Resources will put something on Career Builders website as well.

Round Robin Bristol Bay Area Health Corporation Reports-  As with national patient safety goals, elders are part of the focus with fall prevention. Continued  Sharon Peabody was hired to do a system-wide audit and there will be changes based on the data collected.  Have nine new clinics, finding that fuel cost is higher than other clinics. Looking at getting portable generators.  A poster related to after-hours calls is being finished. It will be sent out and posted in all the clinics in the region. Much of the data for it has come out of the CHAM.  For patients on Coumadin therapy, there is a new machine that they can use and it will assist them. Mt. Sanford Tribal Consortium

of 6 A A C H A P D A P P R O V E D 9 / 1 9 / 2 0 0 8  Copper River will be building a public transportation system.  Now have a Health Network.

Strategic Planning- Group had worked on an assignment on Retention. Crystal Stordahl Retention  Teach people who actually receive complaints how to investigate them. Also, board should be responding to it. Should they be dealing with it? And if so, how should they respond.  Educate the patient by following up the day after regarding any inappropriate call.  Skills in CHA/Ps- how to respond and how to say “no”.  Working to get itinerant coverage to give full-time workers a break.  Create and establish training component on how to teach CHA/Ps more in-depth triage.  Establishing a triage answering-line that is familiar with the program and CHA/Ps. Adjourn Motion to adjourn meeting by George Drinkwater. Motion seconded by Bill Schriener. All in favor. Motion passes. 12:15 PM.

Documents distributed at the meeting include the following (items with * are permanent attachments with the meeting minutes): 1. Meeting Agenda 2. Pre-Session Guidelines* 3. Clinical Evaluation Tool 4. CHA Education Program Evaluation Checklist 5. ARC Report to AACHAPD* 6. RAC Report to AACHAPD* 7. EMS Report to AACHAPD* 8. Strategic Planning 2008* 9. February Meeting Minutes (Approved 5/16/2008)* 10. Draft May Meeting Minutes 11. Dental Health Aide Update* 12. AACHAPD Report to Tribal Caucus 3/27/2008* 13. Training Center Reports* 14. AACHAPD Resource List 3/12/2008 15. 2008 CHAP Events Calendar 16. AACHAPD March Teleconference Meeting Minutes* 17. Legislative Priorities 2008* These documents are available along with the CHAP Resource List and CHAP Events Calendar. Please contact Tamaree Kawagley (Office Assistant, CHAP Statewide Services, M-F 9 am to 1 pm) if you need copies. Phone: (907) 729-4492 Fax: (907) 729-3629 Email: t d k a w a g l e y @ a n m c . o r g