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Authors: Barney DD, Barney, DD
Publication Year: 1994
Last Updated: 2010-01-21 08:14:08
Journal: American Indian and Alaska Native Mental Health Research - Monograph Series
Keywords: Community Mental Health Services/ut [Utilization]; Cross-Sectional Studies; Female; Geriatric Assessment; Health Services Needs and Demand/Trends; Male; Mental Disorders/Epidemiology; Middle Age; Rural Population/Statistical & Numerical Data; Urban Population/Statistical & Numerical Data

Short Abstract: This study uses the Anderson and Newman conceptual framework to identify need as well as enabling and predisposing factors for mental health service use in a national sample of reservation and urban American Indian and Alaska Native elders.

Abstract: American Indian and Alaska Native elders are an important at-risk population in need of mental health services, yet little is known about the factors that influence Indian/Native elders to actually seek mental health services. This study uses the Anderson and Newman conceptual framework to identify need as well as enabling and predisposing factors for mental health service use in a national sample of reservation and urban American Indian and Alaska Native elders. Results indicate that self-perceived need is the strongest predictor of mental health service use for elders living on reservations. However, for Indian/Native elders in urban areas, degree of mental impairment is most likely to predict use of mental health services. For both groups of elders, enabling variables, such as total income, level of education and access to medical insurance, were the least important in influencing whether or not an elder elected to use mental health services.

Source: Link to Original Article.
Funding:
Code: 3088
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Authors: Indian Health Service
Publication Year: 1991
Last Updated: 2010-01-21 08:14:08
Journal: Indian Health Service Division of Program Statistics
Keywords: Case Study; Family Characteristics; Family Health; Intergenerational Relations; Stress Disorders; Post-Traumatic

Short Abstract: The purpose of this study is to describe the dysfunctional behaviors in a specific urban American Indian family in the northeastern United States in order to discern whatever relationships that may exist between those behaviors and secondary post-traumatic stress.

Abstract: The purpose of this study is to describe the dysfunctional behaviors in a specific urban American Indian family in the northeastern United States in order to discern whatever relationships that may exist between those behaviors and secondary post-traumatic stress. The focus of this study is a large extended American Indian family living in the urban northeast. The family is comprised of 72 members and spans 5 generations. The family moved to its present location in the mid-1970's. The members left the reservation to escape economic hardship, but maintain close ties to the reservation. The family members maintain their first language, engage in traditional ceremonial activities, and frequently gather together to celebrate traditional holidays. The data for the case study was collected by means of an in-depth questionnaire The four different areas investigated through the use of the questionnaire am the physiologic, self-concept, role function and interdependence. Experts in the fields of public health planning, the Indian Health Service, medical social work and family therapy assisted the researcher. The researcher ultimately describes the family as chaotic and barely surviving. Assessment in the psycho-social modes reveals alienation from the community, deviant behavior, abuse, depression, suicide and trauma. The extended family structure serves as the major instrument for transmitting cultural attributes and conserving family patterns. In other words, the family that is the source of strength and stability is also the source of spiraling negative behavior patterns. The study produced data indicating that many of the family members experienced trauma as a result of separation from their family. The design of the study did not allow for direct correlation between stress trauma and leaving the reservation. Further research would be required to substantiate the relationship between separation of the family from the tribe and secondary PM. The author recognizes that a single family profile is insufficient to generalize causal relationships, or even clearly establish patterns of trans-generational behavior. However, the current family profile is typical of many American Indian families and thus demonstrates the need for further investigation of the inter-generational effects of secondary post-traumatic stress

Source:
Funding:
Code: 3109
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Authors: Steele R.  
Publication Year: 1975
Last Updated: 2010-01-21 08:14:08
Journal: Indian Health Service, Staff Office of Planning, Evaluation, and Research
Keywords: Indian Health Service; Medicaid; Medicare; public health services; American Indian/Alaska Natives; collection costs; net revenues; potential revenues; third-party reimbursements; patient load/outpatient; health status; rural/urban population

Short Abstract: Indian Health Service (IHS), a component of the Health Service Administration, Public Health Service, is the principal provider of medical care and public health services to nearly one-half million American Indians and Alaska Natives.  In the fiscal year 1975, Congress appropriated some $230 million for IHS personal health services, an amount believed to fall short of need by $70 million.  The objective is to close this gap with alternative funding, such as Medicare and Medicaid.  Macro Systems, Inc. (MSI) was contracted to analyze and forecast collection procedures, recapture costs, net revenues realized, and other issues raised by the implementation of a collection program. 

Abstract: Indian Health Service (IHS), a component of the Health Service Administration, Public Health Service, is the principal provider of medical care and public health services to nearly one-half million American Indians and Alaska Natives. In the fiscal year 1975, Congress appropriated some $230 million for IHS personal health services, an amount believed to fall short of need by $70 million. The objective is to close this gap with alternative funding, such as Medicare and Medicaid. Macro Systems, Inc. (MSI) was contracted to analyze and forecast collection procedures, recapture costs, net revenues realized, and other issues raised by the implementation of a collection program. MSI examined potential revenues, projected costs of capturing these revenues, and the non-financial ramifications of implementing and planning to collect third-party reimbursements. The study was conducted over a period of seven months, beginning in July 1974. It was carried out in three phases: 1) initial estimates of potential revenues available from Medicare and Medicaid; 2) extensive fieldwork in all Area Offices and 18 Service Units; and 3) data analysis and report writing. The fieldwork was conducted for three months in every area office and 18 Service Units. A representative mix was chosen with respect to size and type of facility, average daily patient load, outpatient visit capacity, health status of target population, rural/urban nature of the environment, and political posture of the Tribes within the Service Unit. Comprehensive interview guides were developed for the Area Offices, Services Units, and Medicaid agencies. Examples of all interview schedules, questionnaires, and projections, are contained in this report. IHS had little information about the true income distribution of the target population because income has never been a criterion for determining patient eligibility for IHS services. Where such data gaps occurred, MSI used inferential measures and often subjective judgment, to construct reasonable estimates. MSI found that contract care by IHS would be unaffected by the pending legislation, but that some opportunities do exist to offset current contract care costs more effectively, even without legislation. Sources other than Medicare and Medicaid were considered, but were found to be much less significant except in a few localized situations. With respect to Medicare reimbursements for direct patient care and field health, MSI found that potential revenues are quite limited, principally because relatively few people in the target population are eligible for Hospital Insurance Benefits unless they pay a premium of $512.40 a year. The analysis indicated that gross Medicare collections would average less than 2% of direct patient care expenditures for the IHS system as a whole. This is equivalent to potential gross revenues of slightly less than $1.5 million. Although this is not large enough to justify a program to collect both Medicare and Medicaid reimbursements alone, there is no reason why these potential revenues should not be pursued as part of a larger effort to collect both Medicare and Medicaid reimbursements. Medicaid reimbursement is much more complex because it is administered by state plans that vary from state to state. MSI projects gross Medicaid collections ranging from 12% or $15 million to 19% or $22 million. There are significant costs that must be expended to collect such revenues. A more sophisticated accounting system, incorporating a claims processing system, will have to be developed for IHS as a whole. The implementation of such a program in 73 Service Units would entail nonrecurring costs of about $800,000 before collection begins and recurring costs of personnel of about $4.5 million. Finally, there are the non-financial issues of termination and Native management of the system. The issue of termination arises from the perception held by some of the target population that the Federal government is more trustworthy than any state or county government and any hint of a delegation of responsibility by the Federal government will eventually lead to termination of the coverage. Native management is an issue because there is reliance on the Federal government and simultaneous mistrust and desire to be independent of it. Conclusions: The study reviews five (of many) alternatives in terms of initial investment, cumulative five-year net revenues, and five-year return on investment. The five alternatives range from 73 Service Units to 7 Service units with net revenues from $26 million to $56 million. The choice among these alternatives depends on the relative importance attached to maximizing net revenues as compared to minimizing initial investment. Non-financial considerations, such as termination and delegation, may also influence the decision strongly.

Source:
Funding:
Code: 3121
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Authors: Hatton DC
Publication Year: 1994
Last Updated: 2010-01-21 08:14:08
Journal: Western Journal of Nursing Research
Keywords: Age Factors; Aged; Aged, 80 and over; Attitude to Health; Female; Health Behavior; Male; Middle Age; Nursing Methodology Research; Self Care; Urban Population 

Short Abstract: The purpose of the present investigation was to explore the phenomenon of health among urbanized  members of older American Indians.  More specifically, the study focused on how these individuals perceived their health and how they managed their health problems.

Abstract: There is a dearth of empirically based accounts dealing with health from the perspective of older American Indians. Some have even referred to these individuals as a "forgotten population." The purpose of the present investigation was to explore the phenomenon of health among urbanized members of this vulnerable population. More specifically, the study focused on how these individuals perceived their health and how they managed their health problems. Using the grounded theory method, discoveries indicated that these older adults constructed their ideas of health by observing signs of illness, incorporating the ideas of others, and evaluating getting around. Moreover, their health ideas often reflected a biomedical perspective. The data analysis also revealed factors in the historical and contemporary context that had salient consequences for these individuals' health beliefs and practices. Research implications include future studies of the complex factors that have consequences for health beliefs and practices, as well as a critical examination of the underlying social conditions that relate to health among these older American Indians.

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