Background on CHS Administration
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What is a CHS Administrator? At first glance, this seems like a simple question with a straightforward answer. Minnesota administrative rules (Minn. R. 4736.0110) make it clear that the community health services (CHS) administrator is a required position for community health board recipients of the Local Public Health Grant funds. Additionally, the administrative rules outline the minimum required qualifications and skills of professionals desiring to fill this role. It is a role that has existed in Minnesota's community health services system since its inception in 1976. Yet, the authorities, responsibilities, and qualifications of this role are poorly understood by many, leading some to question the value of the CHS administrator.
The position of CHS administrator goes back to the first set of administrative rules promulgated for CHS in 1976. In fact, the original rules actually outlined seven "key administrative personnel", including the nursing director; the home health services director; the disease prevention and control director; the emergency medical services director; the health education director; the environmental health services director; and the community health services administrator.
From the beginning, the CHS administrator role was seen as distinct and important. As evidence of this fact, the personnel rules allowed for a single individual to perform one or more of those roles, with the exception of the CHS administrator. It is believed that the use of the term "administrator" was selected so that the importance of the role would be seen as equal to that of the county social services administrators.
The rules were contentious when adopted, with some counties balking at the seven required administrative positions. Some elected officials of the time proclaimed "the Act doomed to immediate failure" on the basis that they would not be able to find or pay for the required highly trained personnel. Yet, the original rules stood for over 10 years before being revisited by the SCHSAC Administrative Rules Subcommittee in 1988.
At this point, the statutory requirements for the other administrative roles were dropped, though not without controversy. Nevertheless, the role of CHS administrator was still seen as important, and the subcommittee agreed that the position's requirements needed to be stronger, with contention as to what "stronger" meant.
A review of historical documents shows that the 1988 changes to CHS administrator requirements were basically an update of the original requirements. It does not appear that they were modeled after other states' requirements, national standards or scientific literature. After input from regional meetings and much deliberation on the part of the subcommittee and SCHSAC, and delay on the part of the Minnesota Department of Health (MDH) due to a change in administration and the loss of key staff, the revised rules were finally adopted on March 19, 1994.
According to expert opinion, in the beginning the role of the CHS administrator was viewed as a full time position, which entailed the following responsibilities:
- Planning (i.e., "CHS planning")
- County commissioner orientation to public health
- Participation in SCHSAC and SCHSAC workgroups
- Engaging local public health staff in population-based public health activities
- Working with MDH
The focus of the job was seen as providing visionary leadership and direction for the community health board, as well as for the statewide system. Many responsibilities on this list represented new concepts for the time, and consequently represented significantly new ways of doing business for community health boards.