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including triage and request for medical evacuation (Harrison, 1965). The Community Health Aide Program has expanded significantly over time. It is funded by Congress and operates under federal law. As such, community health aides were not subject to the health licensing authorities of states. 2.4

Creation of the DHAT Program Under the leadership of the IHS Alaska Area Dental Director, Jeanine Tucker, the Alaska

Area applied for a grant from the IHS Clinical and Preventive Support Center.3 The $1.3 million, 5-year grant awarded in 2000 was to be used as seed money for developing dental providers under the aegis of the Community Health Aide Program. Ron Nagel, who had workforce development experience from his dental assignments in the Western Pacific, was hired to staff the grant. The University of Kentucky, which had several dentists who had been active in developing alternative workforce models in international settings, was contracted to assist in curriculum development. Those who were active in developing the concept of the program were not particularly wedded to a specific provider model at this time. “The idea was just to explore which models might work and continue to refine them,” recalls Nagel. Much of what was evolving in the early part of the decade was still iterative. At this point, Nagel was responsible for writing the proposed draft of federal standards under which the program, with its multiple levels, would operate. These standards included training and education requirements, modes of supervision, competencies, and scope of practice. These standards would need to be approved by the Community Health Aide Program Certification Board. Nagel developed “the requirements for the federal standards for each of…four or five different models,” and then embarked on a 2-year consensus-building process with tribal organizations, dental directors, members of the certification board, and other stakeholders to agree upon the standards. At this time, others who supported the concept of the program, such as Mary Williard, a dentist from Bethel, assisted Nagel in writing and revising these standards. With considerable assistance from private legal counsel retained by ANTHC, Myra Munson, an expert in Native and health law, they transformed their work into language that could be adopted and approved by the certification board. With the creation of the Community Health Aide Program in 1968, the Community Health Aide Program Certification Board was established under the authority of the Indian Heath Care Improvement Act and the Snyder Act. As the standards and procedures now state, the Community Health Aide Program Certification Board “sets standards for the community health 3

Interview with Ron Nagel, April 14, 2010.