Community Health Program


The community health program acts as a patient liaison. Duties include:

  • Health education
  • Home visits
  • Medication set-up
  • Monthly health screenings
  • Patient care, monitoring, and case management
  • Transports
  • Wound checks and dressing

The community health representative program also plans and facilitates a yearly health fair for tribal members and the community.

CHR Program Policy

In the following paragraphs is the Indian Health Services standard federal policies and procedures for the Community Health Representative Program and the Quapaw Tribal Policies and procedures approved by the Quapaw Tribe Business Committee and administrator.

Standards and Practice - The following standards and practice shall serve as the minimum applicable to a tribe's SOW. Additional standards and practice may be developed and approved by the tribal governing body serving the community, in accordance with accepted health practices.

CHR Mission Statement: To provide quality outreach health care services and health promotion/disease prevention services to American Indians and Alaska Natives within their communities through the use of well-trained CHR's as mandated by Section 107 of P.L. 100-713, dated November 23, 1988.

Program Goal and Objectives


The CHR Program was implemented to improve the health knowledge, attitudes and practices of Indian people by promoting, supporting, and assisting the IHS in delivering a total health care program. The efforts of CHR program staff have produced an American Indian and Alaska Native health service delivery system, which provides for follow-up and continued contact with the health care delivery system at the community level, thereby meeting the most basic needs of the American Indian and Alaska Native population.

The goal of the CHR Program is to address health care needs through the provision of community-oriented primary care services, including traditional Native concepts in multiple' settings, utilizing community-based, well-trained, medically-guided health care workers.


  • Provide curative, preventive, and rehabilitative services in those areas of health care in which services would not otherwise be available to the American Indian and Alaska Native people.
  • Provide home health care services.
  • Provide transportation within the local community to/from an IHS or tribal hospital or clinic for routine, non-emergency problems, to a patient without other means of transportation, when necessary.
  • Act as a liaison/advocate for the communities served by Federal, State, and local agencies. The liaison/advocate motivates and assists the agencies by clarifying the role of Native traditions, value systems, and cultural beliefs, to meet the health care needs of the communities, thereby reducing the potential for conflict and misunderstanding regarding the health conditions of American Indian and Alaska native people.
  • Interpret languages, if necessary, when the community-based language and the language used by other health care providers differ.
  • Facilitate communications between community members and health care' providers, thereby enhancing accessibility and acceptability of health care facilities. The CHRs assist IHS and non-IHS health agencies to design and/or redesign services to ensure greater responsiveness to the needs of American and Alaska Native communities.
  • Provide and retain community-based health care providers to meet reservation and community health care needs as part of their community's health care system and to ensure that program training and performance meet established national standards, as specified in the Indian Health Manual, Indian Self-Determination Memorandum (ISDM), 81-4, and Section 107 of P.L. 100-713, dated November 23, 1988.
  • Develop annual program plans which address specific community health care needs.
  • Assess community health care resources, both IHS and non-IHS, and to facilitate appropriate utilization of those resources.
  • Ensure availability of appropriate IHS medical guidance to CHR Programs.
  • Ensure compliance with the requirements of a CHR data collection plan.
  • Provide and/or assist in demonstrations, conduct training sessions and community meetings in the areas of safety, nutrition/dietetics, environmental health, and in other areas of health concerns.
  • Provide health care education and facilitate understanding by using the Native language when appropriate, thereby fostering greater cross-cultural understanding.
  • Provide extensive health promotion/disease prevention information and instruction in self-help services that address chronic health problems.

Role of a CHR

  • Visiting clients in the home and referring people in need of care to the proper facility.
  • Explaining the available health programs, the health policies and procedures that the community members must abide by when seeking health care.
  • Organize community health promotion and disease prevention events and facilitate the learning. Events can include.
    • Immunizations
    • Safety in the home
    • Use of machinery/automotive vehicles
    • Medication/ Drug storage
    • Proper sanitation and maintenance of the community/personal buildings and grounds
    • Educate people of the health hazards of behaviors such as:
    • Alcohol use
    • Tobacco use
    • Poor eating habits
    • Poor hygiene
  • Offer transportation to health promotion facilities for those in need.
  • Enter diagnostic patient-specific data into official patient medical record through the use of the CHR component of the Resource and Patient Management System (RPMS).
  • Arrange for police/ambulance transport in accident or emergency situations. Responsibilities
  • Attend staff meetings
  • Maintain standards and Ethics.
  • Report to the service unit director the overall impact and effectiveness of the program.
  • Advocate for the health needs of the community and programs to the service unit director.


The SOW (Scope of Work) is a mutually agreed upon a document that specifies the responsibilities of a tribal entity to the government for a specified amount of funds.

A. The CHR Program SOL Matrix shall be used to indicate Workload objectives

(percentages) of the contractor, and shall include the number of full-time/part- time CHRs by job title and IHS/CHR dollar amounts.

B. Workload percentages shall be negotiated by each tribal contractor and shall indicate the total program workload.

C. All CHR services shall be community-based.

D. If transportation is to be provided; it shall be within the local community to/from an IHS or tribal hospital or clinic for routine, non-emergency problems, to a patient without other means of transportation when necessary. A tribally developed transportation policy shall be in place.

Indian Health Manual Community Health Representative Policy

Indian Health Manual Part 3, Chapter 16, Community Health Representatives - The Community Health Representatives (CHR) Program is an Indian Health Service (IHS) funded, tribally contracted/granted and directed program of well-trained, community-based, health care providers, who provide health promotion and disease prevention services in their communities.

Quapaw Tribe Policy and Procedure for CHR Program

  • Medicine pick up, delivery, ordering and set up.
  • Patient/Client must give at least 24-hour notice for pickup of any medicine. NO EXCEPTIONS
  • The CHR will only make one (1) trip per day to pick up medicine. This is put into effect to cut expense and free up time slots for other duties. Daily medicine runs will take place between 10:00 am and 12:00 pm.
  • The CHR cannot pick up any drug that requires a picture ID to be presented. This includes, but not limited to scheduled narcotic prescriptions.
  • The CHR cannot pick up a paper prescription from doctors office to delivery to a pharmacy. This includes but not limited to scheduled narcotics. This also requires a photo ID and signature.
  • Please be courteous and inform the CHR if you have made other arrangements to have medicines picked up after you have contacted CHR to schedule a medicine pick up.
  • The CHR cannot deliver medicines that have initially been picked up by someone other than the CHR. Meds will only be delivered if they have been picked up at the pharmacy by the CHR.
  • If the CHR orders your prescriptions on a monthly basis, please give 5-7 days' notice so it can be put on the schedule. (This allows for delays such as weekends, and holidays to be avoided.) *Transports and Doctors' Appointments
  • Transportation is available to MEDICAL appointments only. This includes medical, dental, vision, etc. This is a first come first serve basis.
  • Please do not make appointments for a long distance transport (Tulsa, Tahlequah, and Claremore) before 9:00 am or after 1:30 pm.
  • Please be ready at the designated pick up time that has been agreed upon by CHR and patient/client.
  • Please be courteous and notify the CHR of any cancellations for transports and appointments as soon as possible. This will make time available for others to be transported if necessary.
  • It is the patient/clients responsibility to confirm transport and appointments with doctors' offices and the CHR.
  • The patient/client is responsible for scheduling, rescheduling, and canceling their appointments. Please consult with the CHR for "open" scheduling days before making an appointment if you require transport.
  • The CHR is not allowed to do any transport when tribal offices are closed due to weather or hazards which make being on the roads a danger to the patient/clients and the CHR. The patient/client will be responsible for canceling/rescheduling their appointment. Tribal office closures occur when Quapaw Schools cancel due to weather conditions, unless otherwise posted.

Please be advised that these policy and procedures have been approved by the Indian Health Services and the Quapaw Tribe of Oklahoma Business Committee, Tribal Administrator, and at any time the policy and procedures may be amended.