 |
For the
Phoenix Area Indian Health Service
| PROJECT
STAFF: |
John Lewis, Executive
Director
Alberta Tippeconnic, Assistant Director
Alida Montiel, Health Systems Analyst
Vacant, Health Project Specialist
Melva Zerkoune, Registered Dietician
Bette Hartsfield, Health Administrative Assistant |
| PROJECT
PERIOD: |
May 1, 2003 thru
April 30, 2004 |
| FUNDING
SOURCE: |
Phoenix Area Indian
Health Service |
PURPOSE:
To provide the necessary staff support to facilitate
an open and objective forum to address American Indian health care
risks, policy issues and Indian health budgetary concerns by operating
the Tribal Health Steering Committee consisting of tribal leaders
from Indian tribes in Arizona, Nevada and Utah. The Area Director
of the Phoenix Area Indian Health Service, the Area Director of
the Tucson Area Indian Health Service and a representative of the
Phoenix Area Bureau of Indian Affairs also serve on the committee.
WORKING GROUPS:
The Steering Committee provides area-wide coordination
for tribal leaders to advise the Phoenix Area Indian Health Service.
ITCA personnel provide research assistance, coordinate meetings
and disseminate information to tribal governments in the region
of Arizona, Nevada and Utah. The Steering Committee has established
four regionally based working groups comprised of tribal health
personnel to assist in their efforts. These are:
- Tribal Health Directors Working Group
- Desert Visions Youth Wellness Center Tribal
Coordinating Committee
- Strategic Health Planning Working Group
- Diabetes Data Enhancement Working Group
- Phoenix Area Tribal Health Research Technical
Committee (Tribal IRB for the Phoenix Indian Medical Center)
American
Indian Health Issues
The project through the mechanism of the Tribal Health Steering
Committee and the tribal health related working groups identifies
and clarifies Indian health issues. During the project period, the
Steering Committee also provided input and guided tribal consultation
efforts on the issue areas requested by the Phoenix Area IHS or
the Indian Health Service Headquarters. Some of the issue areas
include:
- FY 2003, FY 2004 and FY 2005 budget formulation
process for Indian Health Service and Tribal government health
care delivery programs and priority health concerns including
treatment and prevention of diabetes, substance abuse, mental
illness, injury, elder health, cancer, access to adequate and
appropriate services and increasing funding to address infrastructure
needs.
- Special Diabetes Program
for Indians (SDPI) including input by the Phoenix Area representative
to the Tribal Leaders Diabetes Committee (TLDC), the area wide
Diabetes Working Group and the Diabetes Data Enhancement Working
Group. Recent Phoenix Area tribal consultation sessions on national
and regional funding distribution took place on April 11, 2003,
September 16, 2003 and November 25, 2003. Tribal recommendations
were submitted to Don Davis, Director of the Phoenix Area IHS,
TLDC and Dr. Charles Grim, Director of IHS.
- The Indian Health
Care Improvement Act of 2003 reauthorization legislation-S.556
was introduced in the U.S. Senate by Senator Bill Nighthorse Campbell
on March 6, 2003 and introduced in the House of Representatives
as H.R. 2440 by Representative Don Young (R-Alaska) along with
53 other sponsors on June 11, 2003. The Senate Committee on Indian
Affairs held hearings on the bill in April and July 2003. The
National Indian Health Board staff provides assistance to the
National Public Law 94-437 Steering Committee activated in 1999
to provide overall tribal direction and advisement to IHS as well
as provide information to the various Congressional committees
who have oversight responsibility for reauthorization.
The Steering Committee provides a forum for participation to improve
American Indian health status through efforts at the state, regional
and at the national level. ITCA Staff assist by developing analysis
and informing tribal governments about progress made to address
priority issues identified by the Tribes. Collaboration among the
Tribes helps facilitate meaningful discussion at the local tribal
level, with federal and state agency officials and Congressional
members and staff.
Facilitation of Federal/Tribal Consultation Policies
The project created a forum for the implementation of federal/tribal
consultation policies as directed by the following:
- Presidential Memorandum
of April 29, 1994 - "Government to Government Relations with
Native American Tribal Governments"
- Executive Order of May 14, 1998 - "Consultation
and Coordination with Indian Tribal Governments."
- Executive Order of November
6, 2000 - "Consultation and Coordination with Tribal Governments"
Activities increased with discussion on budget and policy matters
with several federal agencies under the US Department of Health
and Human Services (DHHS), most notably the Center for Medicare
and Medicaid Services (CMS), Administration for Children, Youth
and Families (ACYF) and the Indian Health Service (IHS).
For the first time the Centers for Disease Control and Prevention
(CDC) requested that ITCA coordinate a tribal consultation session
for Phoenix Area Tribes. It was held on July 17, 2002 in Phoenix,
Arizona. Tribal governments from throughout the region participated.
ITCA staff developed 17 briefing papers on various tribal health
concerns for this meeting. CDC reported in September 2003 that the
results include a revised tribal consultation plan and national
and regional efforts to improve American Indian health.
During 2003 the US Department of Health and Human Services (DHHS)
also held regional consultation sessions and a one-day national
meeting for Tribes to address their concerns on the department's
health and human services budget. The Region IX consultation for
Tribes in California, Nevada and Arizona was held in July 2003.
ITCA staff developed 20 briefing papers for this meeting. The national
DHHS budget meeting was held in August 2003.
Indian Health Budget Formulation and Consultation
The Tribal Health Steering Committee for the Phoenix Area IHS serves
as the Phoenix Area IHS/Tribal/Urban Budget Formulation Team. The
Executive Director of Native American Community Health Services,
Inc. of Phoenix and the Phoenix Area IHS Director are members of
the Area budget formulation team. The Committee provides oversight
to the budget formulation and consultation process for the Phoenix
Area IHS. ITCA staff provides analysis on the IHS budget and meeting
coordination so that tribal leaders may participate in an open and
objective forum to discuss the development of the IHS budget. The
Area consultation on the fiscal year 2005 IHS Budget Formulation
was held on April 22, 2003. The national IHS budget session was
held in August 2003.
ITCA staff distributes
information to the Tribes in Utah, Nevada and Arizona regarding
federal budget approval and policy development for Indian health
programs throughout the congressional appropriations process. ITCA
staff support includes coordinating and conducting meetings with
the budget formulation team and tribal government representatives
of the Inter Tribal Council of Nevada, the Inter Tribal Council
of Utah and the Inter Tribal Council of Arizona and the Phoenix
Area IHS.
Comprehensive
Phoenix Area Health Care Strategic Planning
Planning for the renovation and new facility construction for the
Phoenix Indian Medical Center (PIMC) and needed services and facilities
at all IHS and tribal health care operating units in the Phoenix
Area is a central topic of discussion by the Tribes. The Phoenix
Area IHS initiated a process to continue planning and coordinating
with Tribes on the issues. Tribal leadership indicated that coordination
efforts are needed to guide the planning of health service delivery,
including needed changes to medical service delivery at PIMC and
specialty services at the field clinics.
One outcome
of the intensive regional planning effort is the development of
a Comprehensive Regional Health System Strategic Plan and a 10-year
Health Services Master Plan for the Phoenix Area to identify facilities
and health services needs. Tribal leaders and tribal health officials
have maintained oversight throughout the three-year comprehensive
planning initiative. Tribes will also have an opportunity to decide
important strategies and priorities to fully achieve implementation
of the plan.
Desert Visions Youth Wellness Treatment Center
Work was done by a Tribal Coordinating Committee to monitor and
advise IHS regarding the youth inpatient treatment center in Sacaton,
Arizona and a satellite center to be built in Gardnerville, Nevada.
In address the successful operation of the inpatient facility, the
Coordinating Committee provides a tribal voice to policy issues
impacting treatment and aftercare of youth in the Phoenix and Tucson
Area. Tribes were active participants in efforts by Desert Visions
to obtain accreditation by JCAHO. This was first accomplished in
2000 and it is completed annually. Tribal leaders, IHS and tribal
health officials also serve on the governing body of Desert Visions
and they meet on a quarterly basis.
Nutrition and Diabetes Prevention
The Diabetes Nutrition Coordinator provides technical assistance
to the tribal diabetes programs in Arizona, Nevada and Utah. This
includes advisement in such areas as diabetes prevention, nutrition,
physical activity, program development and evaluation. The coordinator
shall work with the IHS/Tribal Nutritionists of the Phoenix Area
to survey training needs and developing two area wide training sessions.
The Coordinator will communicate with Tribes regarding trainings,
conferences, meetings, and recent news related to nutrition and
diabetes.
Diabetes Data Enhancement
A multi year project has resulted in the completion of diabetes
data studies conducted by the ITCA Epidemiology Center to assess
the strengths and weaknesses of the existing diabetes data, as well
as comparability study of diabetes data collected by IHS Service
Units in the Phoenix Area. The project resulted in recommendations
to improve the IHS RPMS and the ability of Tribes to develop local
surveillance systems and access to the existing data. The establishment
of the Diabetes Data Enhancement Working Group resulted in greater
tribal oversight and direction to the project. This led to the assessment
of tribal data sources and methods were outlined to improve access
and analysis of data so that Tribes can better plan, manage and
evaluate their SDPI programs. At the present time ITCA is advocating
for continued tribal involvement in the development of model Tribal/IHS
Data Sharing Agreements and other data enhancement practices. The
working group had indicated that instituting best practices in diabetes
data management should result in a direct benefit to the Tribes.
The Phoenix Area recently redesigned their diabetes date improvement
efforts and placed emphasis on assessing capacity at the local service
units and facilitating regional trainings on the RPMS packages.
ITCA has recommended tribal oversight to this project by maintaining
the tribal work group.
Tribal Health Research Technical Committee
ITCA provides staff support to the Tribal Health Research Technical
Committee. It serves as the official tribal review board to assess
the merits to proposed research, evaluation projects or patient
surveys involving patients of the Phoenix Indian Medical Center
(PIMC).Proposals to be reviewed also include biomedical, clinical
and behavioral health human subject research projects. Evaluation,
policy analysis and health services research projects coordinated
with the Medical Center are sometimes evaluated.
ISSUES IDENTIFIED:
- The need
for tribal consultation and intensive discussion on tribal health
care needs and health disparities as identified by the Tribes
in the IHS budget formulation and Congressional appropriations.
- The need
to address tribal concerns by monitoring, providing tribal input
on State and National health, welfare and Social Security Act
reform and other national policy issues that impact discretionary
funding.
- The need
to facilitate IHS/Tribal/Urban Indian recommendations pertaining
to restructuring and new management directives placed on the Indian
Health Service at the national and Area level.
- The need
to provide information and coordination assistance to the Tribes
to implement federal agency tribal consultation policies as directed
by the Presidential Executive Orders.
- The need
to address issues such as determination of contract support cost
policy and funding availability in the implementation of P.L.
103-435, the Indian Self-determination and Education Assistance
Act of 1994, as amended (P.L.93-638)
- The need
to provide information and coordination assistance to facilitate
tribal recommendations for the reauthorization of PL 102-572,
the Indian Health Care Improvement Act of 1976.
- The need
to coordinate service delivery and expand needed health care services
throughout the Phoenix Area Indian Health Service, including PIMC,
all IHS Service Units and tribal health care programs. Plus the
need to answer any questions and resolve issues surrounding the
new facility construction and renovation project at PIMC as the
proposal goes forward in the IHS budget approval process in FY
2004 and beyond.
- The need
to continue to provide information to Tribes to develop policies
and procedures for involuntary commitment for impatient psychiatric
hospitalization of Indian people who reside on-reservation and
the provision of aftercare mental health services.
- The need
to address distribution of state health resources to tribal governments
and expanding behavioral health services authorized under Title
XIX Medicaid and Title XXI State Children's Health Insurance Program.
- The need
to expand alcohol substance abuse treatment and aftercare services
by establishing the satellite unit in Nevada and provide staff
support to the Desert Visions Youth Wellness Treatment Center
Tribal Coordinating Committee.
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The need to improve nutritional health in tribal communities especially
to prevent diabetes and diabetes complications.
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