CCHSC Rep speaks to the group

July 13 and 14, 2003 may prove to be historic days for Community Health Representatives. On those two days, key representatives from Aboriginal health organizations, government, and educational institutions met in the community of Kahnawake, Quebec for a long-awaited roundtable discussion organized by the National Indian and Inuit Community Health Representatives Organization (NIICHRO) on ‘Standards and Accreditation for Community Health Representatives’.

These talks are long overdue: since 1965, CHRs have played an important role in improving health care, education and promotion in First Nations and Inuit communities. Since that time, they have been working within a broad scope of duties and are expected to possess a wide range of skills and knowledge. Remarkably, they have moved forward and refined their work, all in the absence of nationally accredited training.

Brought together for the roundtable discussions were the
following government and non-governmental organizations:

-National Indian and Inuit Community Health
Representatives Organization (NIICHRO)
-Mohawk College
-Portage College
-First Nations and Inuit Health Branch (FNIHB)
-Aboriginal Nurses Association of Canada (ANAC)
-Canadian Council on Health Services Accreditation
-Yellowquill College
-Health Canada – Primary Health Care Division
-National Aboriginal Health Organization (NAHO)
-Community Health Associates of British Columbia
-Indian and Northern Affairs
-Human Resources Development Canada (via
telephone conference call)

In light of the roundtable discussions, this article discusses why there is a need for CHRs to work with national occupational standards, the types of training that are currently available for CHRs, a listing of some of the benefits to both the CHR and community, and a brief framework of the process involved.

Karen McCulla addresses the group

What are national occupational standards?

In a nutshell, these describe the skills and knowledge needed to perform competently in the workplace. They help guide employers and funding agencies to design, deliver and evaluate relevant and quality training of the employee.

Why are national occupational standards for Community Health Representatives needed?

One of the major reasons is that the role of the CHR has changed dramatically over time. Originally, when the Community Health Representative program was initiated in 1962, their main job responsibilities included assisting health professionals by translating medical instructions to primarily Aboriginal-language-speaking clients, accompanying health professionals on home visits, and acting as the main health workers between visits from health professionals. Currently, CHRs perform a variety of diverse tasks that vary from community to community and from region to region. Increasingly, they are playing a major role as community health developers by providing health promotion, education and prevention services. They also participate in the planning and implementation of community health programs and play a greater role in mental health care and counseling than they did in the past. Lastly, in northern, remote and isolated communities, CHRs are often called upon to carry out clinical or physical assessments and provide some treatment services and emergency care such as First Aid, CPR, drug dispensing, and midwifery.

Due to these changing roles, the scope of the CHRs’ duties has become unclear and increasingly misunderstood. All of this points to a need for developing occupational standards for CHRs to help increase their effectiveness in the community. Also, occupational standards are essential in developing accredited training programs, since the issues of occupational standards and training go hand-in-hand.

Types of training available for CHRs:
By 1998, several provinces and territories had already developed certificate/diploma programs specifically designed for CHRs. However, when the content of training is examined in each region, there are inconsistencies in the level and availability of training for CHRs. The variety of training available is: training without a certificate or diploma, basic training upon request, accredited diploma program, and certificate programs that entail both course work and a practicum. It is important to note that for adequate and relevant training to be developed, it must be based on the duties performed by the CHR.

Mohawk College Reps

Who will benefit from national occupational standards?

It would be a no-loss situation if CHRs worked within national occupational standards. Both CHRs and communities will reap benefits that are too many to specify in this article. Therefore, just a few are mentioned. First and foremost, the Community Health Representatives will be able to:

-Have clarification of their scope of duties, supervision, accountability and definition of a more realistic workload;
-Access accredited training that is recognized on a national level;
-Upgrade their skills in the context of a global market that emphasizes
competitiveness and highly skilled labor;
-Have increased access to and eligibility for training funds;
-Become protected by liability insurance against the potential legal proceedings that may be issued against them;
-Have formal recognition as health professionals by community, leadership and other health professionals.

On the other hand, Native communities will benefit as well: up-to-date and pertinent training for CHRs will improve the health status and living conditions of First Nations and Inuit peoples through more effective health promotion and education, as well as more efficient assessment, treatment and emergency care in those communities where these are part of CHRs’ duties. Communities will benefit by:

-Having trained CHRs specialized in areas such as environmental health, maternal health, prenatal care, diabetes education, and HIV/AIDS awareness and prevention to meet the community’s ever-changing needs;
-The provision of culturally appropriate and holistic health care through a more effective and efficient integrated health team that
recognizes the value of the CHR’s role, duties and training;
-Increased recruitment and retention of Aboriginal people in health professions;
-The creation of a new group of professional Aboriginal workers (CHRs currently make up the largest category of employed Aboriginal health workers);
-The reduction of health care costs through more effective health prevention and increased employee productivity.

The process involved:
Putting national occupational standards into place is a complex matter. It will take the right combination of government, Aboriginal health organizations, educational institutions and Community Health
Representatives who adequately represent all of the diverse regions across Canada. As well, it will take time to effectively work through the various stages involved. Normally, the process of standardizing
occupations is divided into five phases. Briefly, these are:
a) Phase 1: Planning the process
b) Phase 2: Producing National Occupational Standards
c) Phase 3: Establishing an Approved Training Program
d) Phase 4: Certification and Accreditation
e) Phase 5: Maintenance, Monitoring and Renewal

In conclusion, the health status of First Nations and Inuit peoples is still not on par with that of most other Canadians and there continues to be a critical need for improved access to and delivery of a wide range of health care services. Since CHRs play a central role in delivering these health care services, it is necessary to ensure that all CHRs have a solid foundation of knowledge and skills required to enable them to effectively and competently carry out these activities. As the Royal Commission on Aboriginal Peoples has stated,

“Improved training for CHRs will improve the health status and living conditions of First Nations and Inuit peoples through more effective health promotion and education, as well as more efficient assessment, treatment services and emergency care in communities where these are part of CHRs’ duties.”

In Touch Magazine will keep its readers posted on the development of national occupational standards for Community Health Representatives.