The Behavioral Health Aide Program

Historically, Alaska Native villages had unique traditional roles, with well respected persons functioning as counselors, advisors, and helpers. Today, throughout Alaska, THOs employ Behavioral Health Aide/Practitioners (BHA/Ps) as village-based behavioral health providers. They provide a wide range of community outreach, case management, screening, and intervention services related to individual, family, and community behavioral health and wellness. BHA/Ps:

• Are typically recruited from their local communities. The local cultural knowledge they have is helpful in their work. However, BHA/Ps are sometimes hired from outside their communities or from outside Alaska.
• Are paid and supervised by a local THO. BHA/Ps also receive field training and ongoing support from their local THO.
• Must have knowledge and skills to respond to any situation; some have acquired specialized skills as well.
• Are trained to develop specific knowledge and skills based on community needs, cultural strengths, and evidenced-based practice.
• Must understand unique community histories, values, social and environmental changes, cultural beliefs and traditions, resources, strengths, and stressors.
• Must complete specific requirements to become certified and provide services as a BHA-I, BHA-II, BHA-III, or Behavioral Health Practitioner. All levels of BHA are supervised by either a licensed behavioral health clinician or a master’s-level behavioral health professional. The Community Health Aide Program Certification Board (CHAPCB), the governing body for all certified health aides, has more information on certification levels and requirements.

BHA/Ps strengthen their communities as local resources for people struggling with difficult problems such as:

• Substance abuse and sobriety.
• Mental health issues.
• Family issues.
• Suicide.
• Self-harm.
• Domestic violence.
• Child abuse.
• Depression, anxiety, and stress.
• Aggression.
• Grief.
• Learning and developmental issues.

BHA/Ps can provide services under two models: the Community Behavioral Health Clinic (CBHC) model and the State Plan Amendment (SPA) model. For more information, see a thorough overview of these models in Chapter B-8: Documentation, theBHA Superbill for a detailed list of services BHA/Ps can provide under the SPA model, and the Service Definitions for definitions of each item on the superbill.

BHA/Ps help their communities in many ways, such as:

• Prevention and wellness activities that help individuals and communities to identify health-related concerns, connect with resources, stay healthy, and even protect against potential problems.
• Awareness and health promotion activities that teach about the dangers associated with certain behaviors while encouraging people to make healthy choices.
• Cultural linkages that help clients understand differences between local cultural practices and non-local ways. This can include translating medical or behavioral health procedures or drawing upon culturally protective strengths (for example, engaging in subsistence activities with clients).
• Early intervention services, including screening, to help treat conditions before they become worse.
• Health education to teach clients and the community about problems and ways to be healthier.
• Case management and referral services that support coordination with other providers.
• Assessment activities to gather client information so that the behavioral health team can develop the best plan to help the client.
• Outreach activities that help people access services.
• Counseling, listening to, and supporting clients to help them solve their problems.
• Advocacy between a client and their other health care providers to make sure the client receives the best services.
• Traditional healing assistance, connections to traditional healing practices, and referrals to tribal doctors and traditional healers.
• Drawing upon their own cultures and values to provide services.

Under the direction of the Tribal Health Directors, ANTHC used the Community Health Aide Program (CHAP) as a model to develop a certification program for a workforce of BHA/Ps. A partnership was formed between the CHAP Certification Board and the Behavioral Health Academic Review Committee (BHARC) to amend the existing Standards and Procedures to include details of the BHA/P certification requirements. This includes information about the BHA/P scope of practice and training requirements for each level of BHA/P certification.

Under the authority of the CHAPCB, the BHA program:

• Provides a structure to support village-based behavioral health workers.
• Develops capacity for village-based behavioral health services.
• Engages local community members who understand their villages and local culture to provide services.

Mission: To promote behavioral health and wellness in Alaska Native people by training and educating village-based counselors.

Values: The BHA program values the emotional, physical, spiritual, social, and cultural wellbeing of individuals, their families, and the communities where they live.

Goals:

• Develop a competent workforce to provide culturally relevant behavioral health care in Alaska Native communities throughout the state.
• Promote the integration of BHA/P services into the primary care setting and other community-based services.
• Create resources that can be used to enhance training and services for BHA/Ps.
• Recognize the knowledge and skills of BHA/Ps through certification by the Community Health Aide Program Certification Board (CHAPCB).
• Encourage the sustainability of regional behavioral health programs through third-party reimbursement of BHA/P services.

Professional certification is a way to recognize a provider’s educational qualifications and experience and to ensure competency in the knowledge and skills needed to practice. Essential concepts and skills include both technical (behavioral health) and cultural (Native ways of knowing) skills. BHA/Ps are strongly encouraged to become certified.

An uncertified person may perform services of a certified BHA/P under the following circumstances:

• As part of training for certification.
• As part of a clinical practicum.
• To satisfy work experience requirements.
• After the application for certification has been submitted (pending certification).

BHA/Ps seeking certification must be employed by the IHS, a tribe, or a THO that operates a community health aide program. BHA/Ps are certified for practice under the authority of the federal CHAPCB. The CHAPCB was created in 1998 to oversee certification of CHA/Ps and CHA/P Training Centers. The board has since added certification for more specialized service providers, including DHATs and BHA/Ps.

BHA/P training is varied. BHA Trainees may complete the BHA/P specialized training courses or complete a course of study determined by the Board to be equivalent.

Certification is required before a BHA/P’s services can be billed to third-party payers such as Medicaid. The BHA/P model includes four different levels of certification that require the BHA to complete specific courses and practice activities and to demonstrate certain knowledge, skills, and abilities related to the BHA scope of practice. All BHA/Ps are supervised by a master's-level clinician.

• BHA-I (certified) can conduct screening and initial intake services, provide case management, crisis management, and psychosocial rehabilitation services, and coordinate and facilitate community education and prevention events.
• BHA-II (certified) can conduct substance use assessments and provide substance use treatment and rehabilitative services.
• BHA-III (certified) can provide substance use assessments, treatment planning, and rehabilitative services for clients with co-occuring disorders. They have also developed skills in quality assurance case reviews.
• BH Practitioner (certified) can provide counseling services to clients, mentor BHA-I, II, and III, and take on team leadership roles within their organization's BHA program.

Complete BHA/P requirements are provided in the certification Standards and Procedures, which are available on the CHAPCB website.

Certification must be renewed every two years. Forty contact hours ofContinuing Education (CE)courses are required for recertification, including:

• Ethics and Consent.
• Confidentiality and Privacy.
• Cross-cultural Communication and Understanding.
• Other courses related to BHA/P knowledge, skills, and scope of practice.

Behavioral Health Aide (BHA)andBehavioral Health Aide/Practitioner (BHA/P)are titles used to describe village-based behavioral health workers in rural Alaska. In the BHAM, the acronym BHA/P will generally be used, but any reference to BHA/P or BHA applies to all levels unless stated otherwise. Other titles used by THOs around the state include:

• Family Service Worker (FSW).
• Village-Based Counselor (VBC).
• Wellness Counselor.
• Community Family Service Worker.
• Village Counselor.
• Prevention Specialist.
• Chemical Dependency Counselor.
• Traditional Counselor.
• Counselor Technician.
• Behavioral Health Clinician.

These scenarios offer a general idea of the types of activities that might fill a typical BHA/P’s day. Actual BHA/P duties will depend on certification, training, and the policies and procedures of the employing organization.