Chapter C4 – Article 10. Training Programs, Facilities and Training Staff

Sec. C4.10.010. Certification.

The Board shall issue a CHA/P Training Center certificate to a training center which:

1. applies on a form provided by the Board; and
2. adopts and adheres to requirements of sections C4.10.020 [training facilities] through C4.10.110 [CHA/P training center self-evaluation].

Sec. C4.10.020. Training Facilities.

A CHA/P Training Center facility must provide classroom, e-classroom, and clinical environments that are conducive to a positive learning experience for faculty and community health aide trainees by ensuring that:

1. traditional classrooms have appropriate space and privacy. An environmental health review of the facility must be performed and on file. Specific consideration and evaluation in the areas of safety, adequacy of space, air quality, lighting, heating, and storage and disposal of hazardous waste must be documented; and
2. e-classrooms have appropriate policies on Internet safety and privacy, appropriate language, emergency procedures for Internet outages, and recommendations on lighting, noise, and an ergonomic environment.

Sec. C4.10.030. Training Staff.

1. Qualifications and Roles.
   1. Director/Instructor of Record. The following standards apply to the CHA/P Training Center Director/Instructor of Record:
      1. The CHA/P Training Center Director/Instructor of Record should be an individual with a combination of education, research, work, and/or life experience which are relevant to providing leadership in a CHA/P Training Center Program.
      2. In recognition of the diverse role of the CHA/P Training Center Director/Instructor of Record, it is preferred that the Director or Instructor of Record have a background in health and education and be able to administrate, serve in a statewide liaison role, hold the mission of the statewide program, and provide program direction, development, and leadership.
      3. The Instructor of Record must at a minimum be a state licensed advanced practice provider who will assume responsibilities for course development, evaluation and revision, clinical site development and evaluation, and evaluation of students and instructors.
   2. CHA/P Training Center instructors must consist of a majority of full-time equivalent advanced practice provider or physician instructors who are employees of the federal government or licensed by the State of Alaska. Additional instructors should be certified or licensed and have formal training in the knowledge and skills that they are teaching, including CHPs with current CHP credential, CHAPCB certification, and EMT certification. All instructors will be monitored to assure compliance with the CHA/P Curriculum and competence in subject being taught. Instructors teaching CHA curriculum via eLearning must demonstrate competency in e-teaching by experience, completed coursework, or other approved measure.
   3. Clinical Instructor. Clinical instructors must be advanced practice provider or physicians who are employees of the federal government or licensed by the State of Alaska. Certain patient encounter, exams, or procedures may be taught by other persons who have appropriate experience or certification (e.g. well child visits and return prenatal visits by a public health nurse; surrogate body system exams by a CHP). These encounters must be periodically reviewed by an experienced advanced practice provider or physician trainer as part of the training center quality assurance program. The majority of clinical experiences for a student must be taught by an advanced practice provider or physician trainer.
   4. Medical Advisor. The CHA/P Training Center Medical Advisor must be a physician employed by the federal government or licensed by the State of Alaska who is practicing primary care and is currently working with community health aides or practitioners. The Medical Advisor should have prior experience with the CHA/P program. The Medical Advisor’s classroom instruction and clinical preceptorship will comply with the CHA/P Curriculum and statewide goals of the Community Health Aide Program. The Medical Advisor will participate in quality assurance/continuing quality improvement efforts, serve as a resource and be available for consultation and regular meetings.

Sec. C4.10.040.  Hospital/Clinic Affiliation.

1. A CHA/P Training Center must be affiliated with the Alaska Native Medical Center or a hospital or clinic accredited by The Joint Commission (formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)) or licensed by the State of Alaska. Exception can be made in a clinic facility for which The Joint Commission accreditation or state licensing is not available.
2. Hospital/Clinic Commitment. A CHA/P Training Center must have the support of hospital/clinic and/or corporation administration to provide on-going access to clinical training for CHA/Ps. A letter of support should be updated with each new clinical director and hospital or clinical administrator or corporation Board.

Sec. C4.10.050. Volume, Hours and Distribution of Patient Encounters.

Clinical hours will be scheduled in compliance with the CHA/P Curriculum. For each trainee a CHA/P Training Center’s documentation of volume, hours and distribution of patient encounters must meet the requirements of this section.

1. 1. Session I. Ten encounters under the following conditions: the trainee will be the primary provider in at least four patient encounters with particular emphasis on the patient problems delineated in the CHA/P Curriculum, as outlined below, and at least six additional encounters with the trainee as an active participant.
   2. Session II. Ten encounters under the following conditions: the trainee will be the primary provider in at least four patient encounters with particular emphasis on patient problems delineated in the CHA/P Curriculum, as outlined below and at least six additional encounters with the trainee as active participant.
   3. Session III. Ten encounters under the following conditions: the trainee will be the primary provider in at least six patient encounters with particular emphasis on the patient problems delineated in the CHA/P Curriculum, as outlined below, and at least four additional encounters with the trainee as active participant.
   4. Session IV. Fourteen encounters under the following conditions: the trainee will be the primary provider in at least ten patient encounters with particular emphasis on the patient problems delineated in the CHA/P Curriculum, as outlined below, and at least four additional encounters with the trainee as active participant.
2. Primary Provider. Under subsection (a) [volume, hours and distribution of patient encounters; encounters] of this section, the primary provider must perform the history and examination, and depending on the complexity of the encounter and the skill and confidence level of the trainee, determine the assessment and plan in conjunction with the instructor.
3. Active Participant. Under this section, the active participant performs part of the patient encounter with direction or guidance of the instructor.
4. Distribution of Clinical Hours. The distribution of clinical hours must be available in the following kinds of patient encounters:
   

   Session I.
   Encounter Type	Hours
   Acute care	12
   Lab	1
   Respiratory	1
   Ear	1
   Digestive system	1
   Screening exam	1
   Sick child	8
   Total Hours	25

   Session II.
   Encounter Type	Hours
   Acute care	16
   Lab	1
   Prenatal	2
   Mental Illness	4
   Sick child	8
   Total Hours	31

   Session III.
   Encounter Type	Hours
   Prenatal	8
   Newborn	1
   Sick child	4
   Postpartum (fundus exam)	0.5
   Well child	8
   STI male and female	4
   Total Hours	25.5

   *Note: if no new postpartum patient is available, a RAC-approved model may be substituted.

   Session IV.
   Encounter Type	Hours
   Acute care	12
   STI male and female	4
   Prenatal	4
   Sick child	4
   Well child	4
   Newborn	1
   Chronic disease	4
   Total Hours	33

Sec. C4.10.060. Trainees Selection Process.

1. Qualifications for Trainees and Application Process. The CHA/P Training Center will have a policy for selection of trainees. The selection process will include requiring applicants for trainee slots to file a completed statewide application form recommended no less than four weeks prior to the start of the training session, unless extraordinary circumstances are present. The policy for selection must include requirements that the training applicants have no less than sixth grade math and reading skills and that they have completed presession, unless the applicant satisfies one of the exceptions to these requirements adopted under section C4.10.060(c) [trainees selection process; exceptions].
2. Statewide Priorities. The CHA/P Training Center must adhere to statewide placement priorities for training applicants for a limited number of training slots.
3. The CHA/P Training Center must have exception policies. Policies must be written to incorporate individual hardship cases, including emergency training needs in communities where there are no trained personnel and in situations where community health aides or practitioners have no access to field site courses (presession and ETT). Exception policies must also include arrangements for applicants with prior medical training, such as registered nurses, National Guard Corpsman, etc.

Sec. C4.10.070. Trainee Services.

1. Counseling and Health Services. The CHA/P Training Center must have a system for onsite or online initial individual counseling for trainees, which may include assigning faculty members for this purpose. Referral for confidential counseling by mental health professionals must be available to trainees. A system to provide acute care and emergency health services must also be provided.
2. Academic Advising. A CHA/P Training Center must provide an onsite or online system for trainee academic advising, documentation of formative and summative evaluations, and advising pertinent to the role of the community health aide and practitioner and certification.
3. A system of recording trainee attrition data including the causes and timing of attrition during training must be in place.
4. Housing, Meals, and Transportation. Housing, meals and transportation should be available, affordable, and conveniently located to face-to-face or traditional trainees.
5. Internet Connectivity. A workstation with Internet connectivity must be accessible as an alternate to an eLearning student’s own Internet service.

Sec. C4.10.080. Community Health Aide Curriculum and Teaching Guidelines.

1. Duration of Training and Attendance. The length of training sessions I, II, III, and IV are based on the competencies as stated in sections: C2.20.110 [CHA I competencies], C2.20.210 [CHA II competencies], C2.20.310 [CHA III competencies], and C2.20.410 [CHA IV competencies].
   1. The CHA/P Training Center must establish and enforce an attendance policy, which assures that each training participant fully satisfies all conditions of the training.
2. Class Size. The size of classes must allow for faculty/trainee ratios under section C4.10.080(c) [CHA curriculum and teaching guidelines; faculty/trainee ratio], and otherwise be determined by the number of exam rooms available for clinical experience, the size of the classroom for onsite didactic instruction, course content, past trends identified in the particular class, and the CHA/P Curriculum requirements for lab skills instruction.
3. Faculty/Trainee Ratio. Due to the short, intensive nature of CHA/P courses, faculty/trainee ratios for clinical instruction during patient encounters, in which the trainee is the primary provider, as defined in section C4.10.050(b), must be done on a one-to-one basis. For all other clinical instructions the following faculty/trainee ratios for clinical instruction may not be exceeded:
   1. Sessions I and II: one to one;
   2. Sessions III and IV: one to two, depending on the independence of the trainees.
4. Classroom and Clinical Instruction. The intent in instruction for each session is to integrate the CHA/P Curriculum, the CHAM, and the training and skill of the community health aide or practitioner, with consideration to the “Role of the Community Health Aide/Practitioner.”
   1. The CHA/P Curriculum objectives must be followed as a minimum standard.
   2. The CHAM must be used as a reference book for teaching community health aides and practitioners, as a minimum standard.
   3. The instructional materials for faculty must consist of the CHA/P Curriculum course objectives and lesson plans. Instructional materials must be updated every three years. Additionally, eLearning classes externally linked content not created by the CHA/P instructor must be checked for accuracy prior to every session.
   4. Learning objectives and course expectations must be clearly defined for each trainee.

Sec. C4.10.090. Field Training.

1. The CHA/P Training Center staff must evaluate each trainee at the end of each training-center portion of a session and prepare a packet of Field Training Requirements for session completion.
2. Completion of the Field Training Requirements is the responsibility of the employing Tribal Health Organization.
3. CHA/P Training Center staff must review the Field Training Requirements for completion, before accepting a CHA into the next session.

Sec. C4.10.100. CHA/P Training Center Administration and Records.

1. Educational Program Philosophy. A CHA/P Training Center must have on file a mission statement that reflects the statewide nature of the program and the goals and objectives of the program, which must include quality healthcare, competency based instruction, emphasis on clinical instruction and skills, emphasis on a positive learning environment, and respect for the unique needs of the adult learner.
2. Job Descriptions. Job descriptions for each of the training staff which reflect these roles and responsibilities must be on file.
3. Orientation of New Staff. Each CHA/P Training Center must have in place a written orientation procedure for new employees which will minimally include the CHA/P Training Center’s mission, goals, and objectives; the CHA/P Curriculum; the methods of instruction and function of the statewide Community Health Aide Program; cultural diversity; the role of the CHA/P; and the CHA/P certification process.
4. Faculty Turnover. In order to maintain the quality of instruction, the Board must be notified if during any twelve-month period 50 percent of the instructor staff of a CHA/P Training Center resigns and whenever a CHA/P Training Center Director resigns. Documentation of new employee orientation, peer review and student evaluation and examination must be available for review for each new instructor.
5. Commitment of Administration. A CHA/P Training Center must have a memorandum of agreement updated with each new CHA/P Training Center administrative agency to document on-going support of staffing positions and program needs.
6. Secretarial Support. A CHA/P Training Center should have administrative and secretarial support sufficient to assure timely and smooth functioning of the program.
7. CHA/P Training Center Files. A CHA/P Training Center must have on file for review: CHA/P Curriculum outlines, learning objectives/lesson plans, session quizzes/exams, CHA/P evaluation records, application forms, student training files, quality assurance/continuous quality improvement files and a training plan for employees. A CHA/P Training Center must adopt and enforce policies regarding retention of CHA/P Training Center files and conditions under which transfer of files may occur. The retention schedule policy must be consistent with a schedule approved by the Board. The file transfer policy must require that a record be retained identifying the files that were transferred and to whom.
8. CHA/P Training Center Office Space. A CHA/P Training Center should have offices available for instructors which provide an environment that is conducive to high productivity of its faculty in preparation for instruction.
9. Faculty Continuing Education. A CHA/P Training Center must have a policy on faculty continuing education both in the educational and medical fields. A plan should be developed annually to meet the policy goals.

Sec. C4.10.110. CHA/P Training Center Self-Evaluation.

1. CHA/P Training Center. A CHA/P Training Center must have a policy on quality assurance (QA)/continuous quality improvement (CQI). This policy must include:
   1. documentation of post-session meetings for staff evaluation of training sessions and quarterly program reviews;
   2. evaluation of CHA clinical encounters;
   3. Patient Encounter Form (PEF) evaluation for quality and appropriateness of patient care as delineated by the CHAM;
   4. weekly evaluation of the CHA in a learner role;
   5. a summary evaluation of the CHA;
   6. CHA evaluations of training sessions and individual instructors; and
   7. faculty peer review of didactic and clinical instruction.
2. QA/CQI. The QA/CQI process must be in effect, documenting that evaluation tools are in use, trends are identified, and the continuous quality improvement process is being implemented to address and modify those identified trends.