California Rural Indian Health Board, Inc. (CRIHB), Community Health Aide Program, (TPI) - California is home to the largest American Indian and Alaska Native (AIAN) population in the United States, with 109 federally recognized Tribes – more than any other region. The California Rural Indian Health Board (CRIHB) is a nonprofit, Tribal‑governed 501(c)(3) organization that represents a network of Tribal Health Programs (THP) sanctioned by over 70 federally recognized California tribes, serving AIAN communities statewide. CRIHB’s overall goal is to improve the health and social conditions of Native communities by providing advocacy, resources, training, and policy leadership that strengthen Tribal sovereignty and culturally grounded, comprehensive health care. California Tribal communities continue to face persistent barriers to accessing timely, culturally grounded, and community-based health care services. These barriers are exacerbated by an ongoing shortage of health care workers. California THPs struggle to recruit and retain a skilled medical, behavioral health, and dental workforce. Rural communities often have limited amenities and resources available to attract providers and their families to serve the area. Growing providers from rural communities has been challenging due to a lack of accessible training pathways for Tribal community members to enter the health workforce. The Community Health Aide Program (CHAP) is a Tribally driven, community-based workforce model that expands access to care and reduces gaps in the health care system by creating accessible pathways for tribal community members to become culturally responsive health care providers for their own communities. This proven model has significantly improved access to care in Alaska, the Northwest, and other areas. Through two Tribal Assessment and Planning grants, CRIHB has laid a strong foundation for CHAP implementation by engaging Tribal leadership, convening advisory bodies, conducting focus groups, and producing actionable reports to guide the next phases of work. With this groundwork established, CRIHB is well-positioned to proceed with the next phase of CHAP implementation in California. Despite clear need and strong Tribal enthusiasm for CHAP, California Tribes currently lack the infrastructure required to support comprehensive education, certification, and long‑term employment of CHAP providers. Tribal leaders, clinics, and the CHAP advisory board across California have identified the need for coordinated support to address these key needs and ensure that CHAP implementation is responsive to the unique needs and priorities of California Tribes. Without targeted planning and infrastructure development, Tribal communities will continue to face inequities in access to care and missed opportunities to build a sustainable, culturally grounded health care workforce. CRIHB proposes to implement a Tribal Planning Implementation (TPI) to support the development of CHAP infrastructure across California. This project, California ACB and engagement, provides direct implementation support, leads policy and reimbursement advocacy, establishes a California ACB, and builds partnerships to develop CHAP education programs within the state. Through these coordinated efforts, CRIHB will increase implementation readiness, reduce inequities in CHAP adoption, and lay the foundation for a sustainable, tribally driven health care workforce model tailored to the needs of California Tribes.
