Tribal Epidemiology Centers: HHS Actions Needed to Enhance Data Access

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Authors: United States Government Accountability Office

Publication Year: 2022

Last Updated: March 2022

Journal:

Keywords: Covid-19; Data Collection; IHS

 

Short Abstract: Among the 12 tribal epidemiology centers (TEC), which are public health entities serving American Indian and Alaska Native (AI/AN) communities across the U.S., access to epidemiological data varied.

 

Abstract: Among the 12 tribal epidemiology centers (TEC), which are public health entities serving American Indian and Alaska Native (AI/AN) communities across the U.S., access to epidemiological data varied. Federal law authorizes TECs' access to data from the Department of Health and Human Services (HHS), including data from HHS's Centers for Disease Control and Prevention (CDC) and Indian Health Service (IHS), for a variety of public health purposes. However, according to TEC officials, access to non-public HHS data, such as CDC data on positive COVID-19 tests or IHS data on patient diagnosis codes, varied among TECs. TEC officials also described challenges accessing some CDC and IHS data, such as the inability to access certain CDC data on infectious diseases and other conditions. TECs used available epidemiological data to monitor the spread of COVID-19 and to conduct other analyses that support public health decision-making in AI/AN communities. However, TEC officials told GAO that their access to data influences the analyses they are able to conduct, and that a lack of access can limit their ability to provide AI/AN communities with meaningful information needed for decision-making.

 

Source: Link to Original Article.

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Source: https://www.gao.gov/products/gao-22-104698

Type of Resource: Best Practices Newsletter

Cultural Dynamics, Substance Use, and Resilience Among American Indian/Alaska Native Emerging Adults in Urban Areas

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Authors: Ryan A. Brown et al.

Publication Year: 2022

Last Updated:

Journal: Adversity and Resilience Science

Keywords: Substance Use; Emerging Adulthood; Cultural Identity; Intervention Development; Qualitative

 

Short Abstract: Identity development during emerging adulthood helps lay down the structure of values, social bonds, and decision-making patterns that help determine adult outcomes, including patterns of substance use. Managing cultural identity may pose unique challenges for American Indian/Alaska Native (AI/AN) emerging adults in “urban” areas (away from tribal lands or reservations), who are relatively isolated from social and cultural connections.

 

Abstract: Identity development during emerging adulthood helps lay down the structure of values, social bonds, and decision-making patterns that help determine adult outcomes, including patterns of substance use. Managing cultural identity may pose unique challenges for American Indian/Alaska Native (AI/AN) emerging adults in “urban” areas (away from tribal lands or reservations), who are relatively isolated from social and cultural connections. This isolation is in turn a product of cultural genocide and oppression, both historically and in the present day. This paper uses qualitative data from 13 focus groups with urban AI/AN emerging adults, parents, and providers to explore how cultural dynamics are related to substance use outcomes for urban AI/AN emerging adults. We found that cultural isolation as well as ongoing discrimination presents challenges to negotiating cultural identity, and that the AI/AN social and cultural context sometimes presented risk exposures and pathways for substance use. However, we also found that culture provided a source of strength and resilience for urban AI/AN emerging adults, and that specific cultural values and traditions — such as mindfulness, connection to nature, and a deep historical and cosmological perspective — offer “binding pathways” for positive behavioral health. We conclude with two suggestions for substance use prevention and intervention for this population: (1) incorporate these “binding pathways” for health and resilience explicitly into intervention materials; (2) emphasize and celebrate emerging adulthood itself as a sacred cultural transition.

 

Source: Link to Original Article.

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Source: https://link.springer.com/article/10.1007/s42844-022-00058-w

Type of Resource: Peer-reviewed scientific article

“Do You Live in a Teepee? Do You Have Running Water?” The Harrowing Experiences of American Indians in North Carolina’s Urban K‑12 Schools

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Authors: Brittany D. Hunt et al.

Publication Year: 2020

Last Updated:

Journal: The Urban Review

Keywords: Cultural Sensitivity and Appropriateness; Race; Students; Urban Education; Racism; Tokenism

 

Short Abstract: American governmental policy toward Native American people and nations has long taken an exterminatory approach. The relocation era sought to remove American Indian people from reservations and tribal communities into cities to assimilate them into dominant society.

 

Abstract: American governmental policy toward Native American people and nations has long taken an exterminatory approach. The relocation era sought to remove American Indian people from reservations and tribal communities into cities to assimilate them into dominant society. The cities were marketed as beacons of economic and academic opportunity, but their realities bore different fruit including unemployment, poor living conditions, and segregated and low-performing schools. Though schools are often depicted as mechanisms of social and economic mobility, for Native children, the continued extermination of their histories, languages, cultures continue to be obstacles to their success. These obstacles are particularly harmful for Natives living in urban areas away from their tribal communities. This study of nine American Indian people from various tribes in North Carolina gathers their stories of trauma and triumph as they navigated urban public K-12 schools. Several themes emerged including the racism endured in school, lack of American Indian representation in curriculum, teachers, and peers, being tokenized as the only American Indian student, and stories of resistance and resilience despite anti-Indian circumstances.

 

Source: Link to Original Article.

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Source: https://www.researchgate.net/publication/339761711_Do_You_Live_in_a_Teepee_Do_You_Have_Running_Water_The_Harrowing_Experiences_of_American_Indians_in_North_Carolina%27s_Urban_K-12_Schools

Type of Resource: Peer-reviewed scientific article

An Interview Project with Native American People: A Community-Based Study to Identify Actionable Steps to Reduce Health Disparities

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Authors: J. Leston, C. Crisp, C. Lee, E. Rink

Publication Year: 2019

Last Updated:

Journal:

Keywords: Data Collection; Health Disparities; HIV/AIDS; Mental and Behavioral Health; Programmatic Initiatives; Injection Drug Use; Community-Based Participatory Research (CBPR)

 

Short Abstract: Objectives: The primary objective of this study was to work with tribal communities to define and develop their own healthcare services and strategies for positive change regarding injection drug use, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) infection. The secondary objective of this study was to incorporate community capacity building strategies to develop and sustain programming and resources to optimize tribal communities’ responsiveness to reduce health disparities.

 

Abstract: Objectives: The primary objective of this study was to work with tribal communities to define and develop their own healthcare services and strategies for positive change regarding injection drug use, human immunodeficiency virus (HIV), and hepatitis C virus (HCV) infection. The secondary objective of this study was to incorporate community capacity building strategies to develop and sustain programming and resources to optimize tribal communities’ responsiveness to reduce health disparities. Study design: Semi-structured qualitative interviews. Methods: Interviews were guided by community-based participatory research (CBPR) principles to create programs, projects, and policy recommendations meaningful to American Indian and Alaska Native (AI/AN) people. Results: The study generated a formative understanding of the context of AI/AN people who inject drugs (PWID) in three distinct AI/AN communities as well as developed local capacity for future programming, projects, and policy. Conclusions: This study confirms CBPR methods should be part of an iterative cycle to inform policy and programs. CBPR has helped strengthen local research capacity and has formed ongoing relationships between study investigators, local liaisons, and the community that will be essential for next phases of program design and policy implementation. This cycle of CBPR could be replicated in other tribal communities to bring awareness of the opioid epidemic and its effects and to prioritize local indigenous and community-led responses.

 

Source: Link to Original Article.

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Source: https://www.sciencedirect.com/science/article/pii/S0033350618303767?via%3Dihub

Type of Resource: Best Practices Newsletter

Suffering like a Broken Toy: Social, Psychological, and Cultural Impacts for Urban American Indians with Chronic Pain

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Authors: Elise AG Duwe

Publication Year: 2019

Last Updated:

Journal: International Journal of Indigenous Health

Keywords: Chronic Pain; Illness Experience; Invisibility; Psychological Peace; Warrior Strength

 

Short Abstract: This paper will explore the difficult conversations and places of tension in the lived experience of chronic pain for urban American Indians from a larger study discerning relationships between chronic pain and colonization.

 

Abstract: This paper will explore the difficult conversations and places of tension in the lived experience of chronic pain for urban American Indians from a larger study discerning relationships between chronic pain and colonization. A concurrent transformative mixed methods design with in-depth interviews and a survey was used for the larger study. This paper concerns only the qualitative data. Forty self-identified American Indian adults living in Indiana, Chicago, and Tulsa who reported pain for greater than three months provided their chronic pain illness experiences for this paper. The paper uses three data-derived themes to encompass the broad reaching social, psychological, and cultural suffering inherent in coping with chronic pain: invisibility, psychological peace, and warrior strength. American Indian chronic pain sufferers in this study struggle with the multiplicative invisibility of both their chronic pain and their native identity. The invisibility leads to passing as white in environments hostile to people of color. It also results in family disconnection, loneliness, and isolation. In order to survive socially-mediated assaults, American Indian chronic pain sufferers keep their psyche at peace through stress management, cultural engagement, and non-negativity. They also call upon warrior strength—their understanding that American Indians as peoples have always survived bolsters their individual strength to push through the pain. They seek to function without further debility and to maintain their economic, spiritual, social, and physical wellness. Ultimately the participants in this research tell a profound, critical, and world-changing story that requires attention in overcoming barriers to full thriving with chronic pain.

 

Source: Link to Original Article.

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Source: https://jps.library.utoronto.ca/index.php/ijih/article/view/31707/25292

Type of Resource: Peer-reviewed scientific article

Integrating Professional and Indigenous Therapies: An Urban American Indian Narrative Clinical Case Study

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Authors: Dennis C. Wendt and Joseph P. Gone

Publication Year: 2016

Last Updated:

Journal: Counseling Psychology

Keywords: Cultural Sensitivity and Appropriateness; Ethnicity; Mental and Behavioral Health; Race; Psychotherapy; Spirituality; Religion; Qualitative; Multiculturalism

 

Short Abstract: We present a narrative case study of an urban American Indian male college student who integrated Indigenous and professional therapies during an acute period of stress, loss, and depression.

 

Abstract: We present a narrative case study of an urban American Indian male college student who integrated Indigenous and professional therapies during an acute period of stress, loss, and depression. The first published case of an American Indian in an urban context, this article expands on previous clinical cases by focusing on the perspective of the client relative to his own conceptions of help-seeking behaviors. Based on qualitative analysis of five audio-recorded interviews, this case utilizes an innovative methodology to portray four approaches to healing (medication, counseling, bonding, and spirituality), which contribute to holistic well-being. Implications for counseling psychologists include being aware of how some American Indian clients may (a) view professional treatment dynamics through a Native cultural lens (e.g., seeing ideal communication as a “rhythm”); (b) utilize an expanded range of therapeutic agents; (c) resist medication for cultural and spiritual reasons; and (d) refrain from discussing spiritual matters with professionals.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007066/

Type of Resource: Peer-reviewed scientific article

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention

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Authors: Rachel L. Burrage, Joseph P. Gone, and Sandra L. Momper

Publication Year: 2016

Last Updated:

Journal: American Journal of Community Psychology

Keywords: Cultural Sensitivity and Appropriateness; Mental and Behavioral Health; Suicide and Suicide Prevention; Youth; Prevention; Informal Supports

 

Short Abstract: American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources.

 

Abstract: American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre-existing interview data from 15 self-identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community’s knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.

 

Source: Link to Original Article.

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Source: https://deepblue.lib.umich.edu/bitstream/handle/2027.42/134173/ajcp12080.pdf?sequence=1

Type of Resource: Peer-reviewed scientific article

Urban-Indigenous Therapeutic Landscapes: A Case Study of an Urban American Indian Health Organization

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Authors: Dennis C. Wendt and Joseph P. Gone

Publication Year: 2012

Last Updated:

Journal: Health & Place

Keywords: Cultural Sensitivity and Appropriateness; Health Disparities; Therapeutic Landscapes

 

Short Abstract: We engage and extend the concept of therapeutic landscapes through a case study at an urban American Indian health organization in the Midwestern United States.

 

Abstract: We engage and extend the concept of therapeutic landscapes through a case study at an urban American Indian health organization in the Midwestern United States. This case affords insights at the unique confluence of indigeneity and urbanization, prompting us to coin the construct ‘‘urban indigenous therapeutic landscapes’’ to characterize such sites. These landscapes warrant urgent attention in light of increasing urbanization and health disparities among indigenous peoples internationally. On the basis of thematic content analysis, three themes were identified from 17 open-ended interviews with American Indian community members. Specifically, respondents viewed the health organization as (a) a vital place to be among other American Indians and connected to Native culture, (b) a place where one feels at home and welcome, and (c) a place in which health services are delivered in an especially intimate and hospitable manner. Significant challenges and tensions were also communicated, in terms of unique intersections of health care and indigeneity. Results are interpreted in terms of urban Indian health organizations as urban-indigenous therapeutic landscapes.

 

Source: Link to Original Article.

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Source: http://gonetowar.com/wp-content/uploads/2013/11/TxLandscapes.pdf

Type of Resource: Peer-reviewed scientific article

Adaptation of a Smoking Cessation and Prevention Website for Urban American Indian/Alaska Native Youth

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Authors: Maile Taualii

Publication Year: 2010

Last Updated:

Journal: Journal of Cancer Education

Keywords: Cultural Sensitivity and Appropriateness; Tobacco Use (non-traditional); Youth; eHealth Intervention

 

Short Abstract: Tobacco use among American Indian youth is a disproportionately significant problem. We adapted and modified an existing web-based and youth-focused tobacco control program to make it appropriate for young urban American Indian/Alaska Natives (AI/ANs).

 

Abstract: Tobacco use among American Indian youth is a disproportionately significant problem. We adapted and modified an existing web-based and youth-focused tobacco control program to make it appropriate for young urban American Indian/Alaska Natives (AI/ANs). The results of the focus group indicate that AI/AN youth were very receptive to the use of a web-based Zine-style intervention tool. They wanted the look and feel of the website to be more oriented toward their cultural images. Future research should examine if successful programs for reducing non-ceremonial tobacco use among urban AI/AN youth can keep young irregular smokers from becoming adult smokers.

 

Source: Link to Original Article.

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Source: https://link.springer.com/article/10.1007/s13187-009-0004-2

Type of Resource: Peer-reviewed scientific article

An Urban American Indian Health Clinic’s Response to a Community Needs Assessment

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Authors: Mary Kate Dennis, MSW, PhD, Sandra L. Momper, MSW, PhD, and the Circles of Care Project Team

Publication Year: 2016

Last Updated:

Journal: American Indian and Alaska Native Mental Health Research Journal

Keywords: Cultural Sensitivity and Appropriateness

 

Short Abstract: Utilizing community-based methods, we assessed the behavioral and physical health needs of a Detroit metropolitan Indian health clinic.

 

Abstract: Utilizing community-based methods, we assessed the behavioral and physical health needs of a Detroit metropolitan Indian health clinic. The project goal was to identify health service needs for urban American Indians/Alaska Natives and develop the infrastructure for culturally competent and integrative behavioral and physical health care. We conducted 38 semi-structured interviews and 12 focus groups with service providers and community members. Interview and focus group data indicated a need for 1) more culturally competent services and providers, 2) more specialized health services, and 3) more transportation options. We then report on the Indian health clinic's and community's accomplishments in response to the needs assessment.

 

Source: Link to Original Article.

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Source: https://coloradosph.cuanschutz.edu/docs/librariesprovider205/journal_files/vol23/23_5_2016_15_dennis.pdf?sfvrsn=6fdbe0b9_2

Type of Resource: Peer-reviewed scientific article