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National Indian Health Board Exploring Tribal Public Health Accreditation Aleena M. Hernandez, MPH Red Star Innovations, LLC September 15, 2010.

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Presentation on theme: "National Indian Health Board Exploring Tribal Public Health Accreditation Aleena M. Hernandez, MPH Red Star Innovations, LLC September 15, 2010."— Presentation transcript:

1 National Indian Health Board Exploring Tribal Public Health Accreditation Aleena M. Hernandez, MPH Red Star Innovations, LLC September 15, 2010

2 Overview Historical Basis of Indian Health Tribal Management of Health Programs NIHB’s Exploring Tribal Public Health Accreditation project PHAB/NIHB Tribal Think Tank Recommendations Next Steps

3 Promises to Keep: Public Health Policy for American Indians and Alaska Natives in the 21 st Century Dixon M, Roubideaux Y American Public Health Association, 2001

4 American Indians and Alaska Natives 564 Federally-recognized Tribes in 35 States 1 Sovereign Nations Distinct culture, language and traditions Live on trust land and in urban areas Economic Diversity Tribal Membership 1 Indian Health Service Website

5 2000 Census AI/AN alone2.5 million (0.9%) AI/AN in combination with 1.6 million one or more other races Total AI/AN 4.1 million (1.5%) Reported a specific tribal affiliation74% IHS Service Population1.5 million

6 Historical Basis of Indian Health Pre-Contact/Tradition Medicine Impact of European Settlement Constitution/Supreme Court/Treaties/Legislation - Sovereignty - Federal Trust Responsibility - Government to Government Relationship

7 Significant Policy/Legislation Affecting Indian Health  1800’s – Responsibility of the War Department  Indian Removal  Indian Removal Act of 1830  1836 – Medical services for land cessions  1849 - BIA/Department of Interior  Dawes Act – General Allotment Act 1887  Reservation land divided into allotments  Ban on traditional practices  Introduction of boarding schools

8 Significant Policy/Legislation Affecting Indian Health  Indian Reorganization Act 1934  Termination Program of the 1950’s  The Transfer Act of 1954 – Transferred health services from the BIA to PHS  1955 - Indian Health Service established

9 Indian Health Service  Under the US Department of Health and Human Services  Comprehensive, primary health care system and some public health services Only agency to provide direct medical care  Trust Responsibility: Members of federally recognized tribes  Divided into 12 Service Areas


11 Per Capita Health Expenditures Indian Health Service (2005)$2,130 Bureau of Prisons (2005 estimate)$3,986 In California and New Mexico over $4000 Veterans Administration (2002)$4,653 US General Population (2003)$5,670 Department of Health and Human Services,, Source published January

12 Tribal Management of Health Programs The Indian Self-Determination and Educational Assistance Act 1975 P.L. 93-638 Tribes can manage their health programs - Title I: CONTRACT part or all of the services - Title V: COMPACT entire health programs - Funding issues: shares, contract support costs

13 Putting Tribal Public Health Into Context for Accreditation  Direct service and 638 (contract/compact) tribes  Geographic location (IHS Area, Rural/Urban)  Landbase versus non-landbase tribes, checkerboard  Single tribe applicant versus consortium of tribes  Health Department Size  Level of Public Health Activity  Multi-jurisdictional overlap and relations

14 National Indian Health Board Exploring Tribal Public Health Accreditation

15 Exploring Tribal Public Health Accreditation  National Indian Health Board involvement  Grant: Robert Wood Johnson Foundation 2008  Purpose: to assess the feasibility of the promotion of voluntary public health accreditation and public health standards in Indian Country

16 Exploring Tribal Public Health Accreditation  Objectives of NIHB Project:  Establish an Advisory Panel  Review past accreditation efforts in Indian country  Explore/Discuss the potential for voluntary public health accreditation in Indian country  Benefits, challenges, barriers, ideas…  Gather recommendations from Indian country  Process, resources needed, potential partnerships  Produce a Strategic Plan

17 Call for Input Results  Positive response to concept of public health accreditation – broader than just health services  Interest in tribes having a leadership role  Opportunity to recognize the excellence in public health across Indian Country  Challenges include the diversity of public health delivery in Indian country, time, capacity and cost to seek accreditation, multiple entities involved

18 Strategic Plan Recommendations  Provide ongoing education/awareness to Tribes  Provide training, Technical Assistance, preparation, and readiness assessments relevant to tribal context  Consider Tribal version of Standards and Measures  Explore PHAB’s role in strengthening relationships among tribal, local, and state HDs  Convene regional roundtables  Facilitate a “Tribal Think Tank” to address relations

19 Public Health Accreditation Board National Indian Health Board Tribal Think Tank December 16, 2009 Tucson, Arizona

20 TRIBAL THINK TANK 17 Participants Representing  Tribal Beta Test Sites  NIHB Tribal Public Health Accreditation Advisory Board Members  Tribal Health Directors/Administrators  PHAB Staff/Board Members  RWJF

21 Tribal Think Tank Objectives Based on NIHB Advisory Board Recommendations:  Identify and discuss strategies to ensure ongoing Tribal input into the accreditation process  Identify strategies for PHAB to strengthen Tribal/State relations in accreditation  Explore the adaptation of the PHAB Public Health Accreditation Standards and Measures to create a Tribal version

22 Strategies: Involving Tribes  Convene local, regional and national meetings  Provide outreach and education to tribes  Hire/contract individuals with experience in tribal public health systems (culturally competence)  Identify opportunities for communication and collaboration among tribal, local and state health department

23 Accreditation Incentives  Potential to identify model Tribal Public Health Systems  Opportunity to strengthen tribal public health infrastructure  Improve the quality of care  Build credibility and  Strengthens a tribe’s ability to advocate for health Cost Issues – funding is needed to support tribal infrastructure development, technical assistance, and capacity building.

24 Tribe/State Relations  Government to Government relationship  Overlapping Jurisdictions  Responsibility and Authority  Federal transfer of responsibility and funding for public health functions to states

25 Tribal Consultation  1994 – Bill Clinton introduced Tribal Consultation Policy  Facilitates formal government to government relations  Requires federal executive departments and agencies to consult with tribes prior to making decisions that would affect them  November 2009, President Barack Obama convened all tribal leaders in Tribal Consultation

26 Strategies: Tribe/State Relations  Conduct regional/national roundtables with tribal, local, and state health departments  Use the Beta Test to develop a “Model Partnership for Accreditation”  Provide education about tribal public health systems to local and state health departments  Utilize the accreditation process/documents to encourage coordination and collaboration among tribal, local and state health departments

27 Next Steps – In Progress  Conduct outreach to tribes at the regional and national level  Convene tribal, local and state health departments to dialogue about partnership and accreditation  Utilize input from the Tribal Beta Test Sites to identify lessons learned and to inform future work  Develop tribal version of the Standards, Measures and documentation

28 PHAB – Tribal Standards Workgroup  Conducted a call for Workgroup volunteers in July  People with knowledge and understanding of Tribal Public Health Systems  Workgroup volunteers selected in August  Includes members of original Standards and Measures Workgroup  1 st Workgroup meeting to be held in conjunction with NIHB Annual Consumer Conference  Scheduled to be completed in March 2011

29 2010 NIHB Tribal Public Health Profile  Assess readiness for public health accreditation  Provide a baseline to measure growth and change in tribal public health capacity  Prioritize development and resource allocations  Advocate for resources and policy on behalf of Tribes and public health  Identify technical assistance and quality improvement needs

30 Tribal Standards Workgroup Tribal Representatives  Michael Allison, MPH  Donald Vesper, REHS,MPH  Loren Sekayumptewa, MSW  Debra Smith, RN, PHN, MSN  JT Petherick, JD, MPH  Annette James, RN  Gary Quinn, MSW  Glenda Davis Standards Development WG  Jane Smilie  Barbara Worgess, MPH  Steve Ronk, MPH  Torney Smith, MSHE

31 Profile Participants Tribal Health Organizations  Tribal Health Departments  Indian Health Service Units (Hospitals, clinics, and satellites)  Indian Health Boards or Intertribal Councils with Tribal Epidemiology Centers  Urban Indian Health Centers

32 Profile Highlights: Assessment  44% conducted community health assessment in the past 3 years  47% of Tribal Health Departments; 46% percent of IHS Facilities: 60% Area Indian Health Boards and 74 % of Urban Indian Health Centers have data sharing agreements with state health departments  66% evaluate public health activities and/or services

33 Profile Highlights: Policy Development  Regulatory activities are provided primarily by the Tribal Health Departments or IHS in tribal communities  Less than 40% receive funding from their state health agency through the CDC public health preparedness cooperative agreement.  Over 40% have a research policy or ordinance for reviewing and approving health research.

34 Profile Highlights: Assurance  59 % serve populations that travel 50 miles or more to access their services  83% help enroll eligible individuals into public benefit programs, such as Medicaid/Medicare.  Collaborative relationships with other Tribal Health Organizations were most frequently rated effective or highly effective

35 Profile in Summary  Tribes are providing a wide range of public health activities across domains  Further exploration is needed to understand:  Tribal public health performance  Readiness for public health accreditation  Technical assistance and quality improvement needs 

36 RWJF – PHSSR Grant 2010  RWJF Grant: Public Health Systems and Services Research  Partnership with Nat’l Opinion Research Center (NORC)  Enhance data analysis and conduct initial comparison to state and local health departments  Gather additional qualitative data  Recommend future data collection enhancements to produce a profile for harmonization with State and Local Profiles (ASTHO and NACCHO)

37 Thank You Aimee Centivany, MPH National Indian Health Board Aleena M. Hernandez, MPH Red Star Innovations, LLC

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