KAREN:  And so the AAS degree, is that something required for health aides or --

LINDA:  No.  The training for health aides is -- and just to sort of review that a little bit, when an individual is hired, they start on the job, and depending on the corporation -- and again, I have 25 years of history, so in the early years, people often sort of worked without much training. 

Today the system is such that they start on the job, and we try to integrate them into training as soon as possible.  And that training includes a Pre-Session 1 package of information that is delivered by the health corporation that gives them the basic information on use of the Community Health Aide Manual, history and exam, vital signs, so that they can start in the role. 

Then they go to a training center and they take Session 1, and that's a four-week session.  And the current training centers in the state, there's the Anchorage Training Center through the Alaska Native Tribal Health Consortium; the Bethel Training Center, which is through YKHC, Yukon Kuskokwim Health Corporation; through Nome, and that's the Norton Sound Health Corporation; and then in Sitka, through the Southeast Area Health Corporation.  We have four basic training centers. 

And the students -- it's a remarkable program.  You get hired and on the job before your education.  So we try to complement the program with not only basic training, but through each of the health corporations, and there's 26 entities.  When I started, there were 12, but the health corporations have divided, villages have split off and formed their own administrative unit. 

KAREN:  I didn't know that. 

LINDA:  Uh-hum.  So we had 12 in the original division of the state, for profit and nonprofit, it was a division of 12. 

KAREN:  Right. 

LINDA:  And now my understanding and this could have changed as we're speaking but I believe there's 26 administrative, whether they call themselves health corporations or some other title, but responsible for the delivery of health care in their region, or often now it's -- it can be single village entities. 

And so the corporations employ supervisor instructors, sometimes called coordinator instructors, who work with the health aides in the village to either teach new skills, but more often it's in the reinforcement of the skills and basic training. 

So an individual comes for Session 1, four weeks long, then they go back to the village.  And one of the field staff will go out for a village visit and look at reinforcing and developing sort of the skill that they've learned in basic training, then they return to a training center, and it's Session 2, the same pattern again. 

They are required to complete 200 hours and a certain number of patient encounters to look at sort of rounding out their educational process in the village.  And then they come back to Sessions 1, 2, 3 and 4, so it's a total of four sessions and 15 weeks spread over about two years, with the field component between.
 
And once they finish that, they do a preceptorship, which is a process where they work with a midlevel practitioner, their village doc, and I think of it as sort of a final polishing.  It's an opportunity to see a lot of patients and see what piece of the puzzle skills that they may have not gotten. 

And just to remind everyone that the Health Aide Program is remarkable in that when you think of health care and you think of an individual, health aides are taking care of all aspects.  Emergency care, acute care, chronic and preventative services. 

And so the scope of theirs is very, very, very, very broad.  It goes way out.  And the depth of which their skills depends on that component. 

With time and experience, they are able to do a lot of additional -- with advanced training, say, women's health care, they may do additional skills there, or in well child and immunizations.  The training component and the field piece sort of work together. 

And once they complete the preceptorship they attend, through their corporation usually -- and again, the state is so different -- but usually then they take a statewide certification that has both a written and a clinical component.  And all of this, then, is fed through the certification board, which was created in 1998, to look at the continued certification of health aides.