Table 1 COPE intervention additional components, Navajo Nation, United States, 2010–2014

Home visits by CHRs without established frequency.

“COPE clients” receive home visits at least monthly and tracked as high-risk client.

Each CHR prepares his/her own health education materials resulting in inconsistent health coaching.

CHRs deliver standardized coaching materials that have been vetted by local providers and ensure goal setting at each session.

Vital signs monitored inconsistently, CHRs lack oximeters, multiple size blood pressure cuffs, or glucometer training / supplies.

Vital signs monitored; all CHRs equipped with oximeters, multiple size blood pressure cuffs, glucometer training / supplies.

CHRs receive training on health topics when available.

Monthly training sessions to CHRs on health topics taught by local providers to build CHR-provider relationship.

CHRs do not receive training on motivational interviewing, self-care, goal setting.

CHRs receive training on motivational interviewing, self-care, goal setting delivered by Navajo-speaking trainers.

Not competency assessments of CHR or trainer knowledge / proficiency.

Competency assessments administered at each training to assess CHR and trainer knowledge / proficiency.

CHR supervisors receive training when available.

CHR supervisors receive monthly trainings in team building, supervision and leadership, quality improvement, and wellness / self-care.

CHRs work with Public Health Nurses to evaluate clients together and establish care plans; however, CHRs rarely coordinate care with other healthcare providers.

Increased bi-directional communication and care coordination through planning conjunct meetings, orientation of new clinical staff, provider-led CHR trainings, joint home visits, and conjunct case management.

No access to Electronic Health Records for CHRs.

CHRs are able to gain access to Electronic Health Records to document home visits and obtain client information.

Patients rarely referred by providers to CHRs; primarily identified by CHRs themselves.

COPE helped to increase the awareness of the CHR program with presentations in hospitals. Referral system established and increased referrals by providers to CHR Program.