KNOWLEDGE RESOURCE CENTER

This report should be used as 1) an information reference for COVID related statistics in UIO service areas, 2) a compilation of figures and summary statements that can be used for testimony, publications, or other activities. The seven sections of this report can be shared externally if needed. Figures and summary statements from sections eight through ten can be used but the sections should not be shared. Section 12 should be used as a reference for data sources; the statement can be copied and used as data statements for the content of the report.

New CDC data shows that during March to April in 2020, reported STD cases drastically decreased compared to exactly a year prior. However, during this time period there was also a resurgence in gonorrhea and syphilis cases later in the year, meaning that overall STDs may have actually increased during 2020.

The NIHB has released the Healthy Indian Country Initiative (HICI) Promising Prevention Practices Resource Guide to highlight promising prevention programs within Indian Country. This guide begins the process of identifying, developing, and looking at Tribal community promising prevention practices with the intent to allow other communities to replicate these practices.

This article details the US age-adjusted rates of drug overdose deaths involving methamphetamine. Although addiction outcomes can be improved with sex-specific and culturally tailored prevention and treatment interventions, the extent to which fatalities differ as functions of sex and race and ethnicity has not been analyzed, to our knowledge.

This journal discusses American Indian (AI) adults participation in Alcoholics Anonymous (AA). This study sought out to examine the engagement in AA by urban Southwest AI adult problem drinkers. The study compared three and six-month drinking outcomes of urban S-AI adults by type of meeting attended. They examined the association between frequency of AA attendance and differences between types of meetings attended regressed on the outcomes of proportion abstinent days and drinks per drinking day. Results showed that AA attendance is the model approach and assists urban S-AI adults in reducing their drinking.

A decade before he became the US Surgeon General, Vivek Murthy, MD, published a 2004 study in JAMA about participants in cancer clinical trials. Among other findings, Murthy and his coauthors concluded that from 2000 to 2002, people aged 65 years or older were “strikingly underrepresented” in a set of National Cancer Institute–funded drug trials. Fifteen years later, a JAMA Oncology study suggests that not much has changed for older people with cancer. In fact, things appear to be getting worse.

For the new study, researcher Ethan Ludmir, MD, a radiation oncology resident at MD Anderson Cancer Center in Houston,Texas, and colleagues considered the same cancers as Murthy: breast, colorectal, lung, and prostate—the 4 types that strike and kill the most people every year. But they cast a wider net, looking at all 302 phase 3 randomized, multigroup clinical trials for these cancers that initiated enrollment from 1994 to 2015.

Due to the fact that Asians, Pacific Islanders, and Native Americans are a potentially high-risk group for dietary exposure to methyl mercury through fish consumption, researchers in this study used NHANES data from 1999–2002 to obtain population estimates of blood mercury levels among women of childbearing age classified as belonging to the “other” racial/ethnic group (Asian, Pacific Islander, Native American, and multiracial. Blood mercury levels in this group were compared with those among all other women participants, classified as Mexican American, non-Hispanic black, non-Hispanic white, and “other” Hispanic.

The objective of this article is to help risk assessors and managers step back from paying sole attention to very specific details (e.g., measuring nuances of a single chemical's biochemical action at the molecular level). The authors of the article wanted to stress the importance of the higher service that risk assessment provides, which is to improve everyone's long-term well being and survival.

This article highlights that Lead exposure is still a national concern, and it is possible that Native Americans who live on reservations and pursue traditional lifestyles may be at higher risk through both their unique exposure and their potentially greater sensitivity. A major component of the exposure assessment is the diet. For tribal members, traditional lifestyles that include native foods, medicines, and traditional practices have evolved and proven to be the most healthful over many thousands of years of coexistence with the environment. However, a completely traditional diet may not be fully available for a variety of reasons; so, this study considers the adverse health consequences caused by the loss of healthy native foods and medicines, the contamination of remaining native foods, the inability to practice one’s religion, and the possibly lower quality of the substitute diet.

DISCAIMER: This report should be used as 1) an information reference for COVID related statistics in UIO service areas, 2) a compilation of figures and summary statements that can be used for testimony, publications, or other activities. The seven sections of this report can be copied and shared externally if needed, but please do not share the document as a whole. Figures and summary statements from sections eight through ten can be used but the sections should not be shared. Section 12 should be used as a reference for data sources; this statement can be copied and used as data statements for the entire content of the report.

Findings from a CDC study highlight the importance of counseling pregnant women about their risk for severe COVID-19 illness and the potential risk for preterm birth. "Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status—United States, January 22–October 3, 2020," found that pregnant women with COVID-19 are at increased risk for severe illness, compared with non-pregnant women with COVID-19.

The CDC study, "Birth and Infant Outcomes Following Laboratory-Confirmed SARS-CoV-2 Infection in Pregnancy—SET-NET, 16 Jurisdictions, March 29–October 14, 2020," found that pregnant women with COVID-19 may be at increased risk of having a preterm infant (born before 37 weeks), which may lead to serious health problems for the infant.

This report should be used as 1) an information reference for COVID related statistics in UIO service areas, 2) a compilation of figures and summary statements that can be used for testimony, publications, or other activities. The seven sections of this report can be shared externally if needed. Figures and summary statements from sections eight through ten can be used but the sections should not be shared. Section 12 should be used as a reference for data sources; the statement can be copied and used as data statements for the content of the report.

There has been extensive research on behavioral health disparities in Black, Indigenous, and People of Color (BIPOC) and Lesbian, Gay, Bisexual, Transgender, Queer, and Plus (LGBTQ+) communities. Now, the national movement for racial justice also aims to do the same for Californians.

This concept paper is an attempt to outline policy opportunities and approaches for greater valuation and acceptance of the behavioral health practices BIPOC and LGBTQ+ communities have used for many years to support their behavioral health and wellbeing.

The changes recommended in this paper fall under the jurisdiction of various state authorities, agencies, and local communities.

This report should be used as 1) a information reference for COVID related statistics in UIO service areas, 2) a compilation of figures and summary statements that can be used for testimony, publications or other activities. The seven sections of this report can be shared externally if needed. Figures and summary statements from sections eight through ten can be used but the sections should not be shared. Section 12 should be used as a reference for data sources; the statement can be copied and used as data statements for the content of the report.

This report introduces SDH efforts in the context of an increasing focus on the social determinants in federal health policy, academic research, and emerging care models. It then identifies trends and forces shaping health care and CHCs. The report presents the methods used to study the SDH efforts of CHCs and provides an overview of the patterns observed across the many programs. It concludes with recommendations developed at a national workshop of CHC leaders and other experts to expand and enhance these efforts.

This review paper discusses why community engagement is of increasing importance in children’s enviromental health research, describes models and the continuum of methods that are used and discusses their challenges and benefits. Two case studies, representing different study designs and using different community engagement models and methods, and lessons learned from these cases are described.

As a fundamental component of a comprehensive public health system, environmental health works to advance policies and programs to reduce chemical and other environmental exposures in air, water, soil, and food to protect residents and provide communities with healthier environments. The environmental health playbook lists and details all of this within its guide, along with tips towards working towards creating a more environmental conscious world.

This document helps new and experienced health professionals develop and launch a Tracking Program. It contains specific approaches, methods, and resources that you can use to, learn the history of, and CDC’s approach to, building a sustainable nationwide Tracking Network with national, state, and local components, evaluate your state, city, or other entity’s capacity to launch a tracking network, develop tracking program communications and outreach materials and strategies, and establish a tracking workforce and infrastructure.

To create a movement to put children front and center, CEHN developed A Blueprint for Protecting Children’s Environmental Health: An Urgent Call to Action (Children's Environmental Health Network [CEHN], 2017). W.K. Kellogg is instrumental in offering leadership and funding toward “putting children first” and provided key funding to CEHN for the development of the blueprint as well as putting its recommendations into action.

This revised document was developed by the Illinois Department of Public Health (IDPH) with assistance from the Illinois Childhood Lead Poisoning Elimination Advisory Council for the Illinois Lead Program (Program). The revised guidelines provide the following information, current U.S. Centers for Disease Control (CDC) recommendations, state laws on testing and reporting, case management and follow-up of children and pregnant persons with elevated blood lead levels (EBLLS), medical management of children and pregnant persons with EBLLs, health education and outreach.

The Tribal Public and Environmental Health Think Tank, has created a focus on increasing education and awareness of the unique public and environmental health challenges faced by tribal communities, and achieving improvements to these issues. The six tribal public and environmental health priorities identified by the Think Tank are: 1. Food Sovereignty and Access | 2. Infrastructure and Systems Development | 3. Climate and Health | 4. Resource Extraction | 5. Clean Air | 6. Clean Water

This report should be used as 1) an information reference for COVID related statistics in UIO service areas, 2) a compilation of figures and summary statements that can be used for testimony, publications, or other activities. The seven sections of this report can be shared externally if needed. Figures and summary statements from sections eight through ten can be used but the sections should not be shared. Section 12 should be used as a reference for data sources; the statement can be copied and used as data statements for the content of the report.

This report should be used as 1) an information reference for COVID related statistics in UIO service areas, 2) a compilation of figures and summary statements that can be used for testimony, publications, or other activities. The seven sections of this report can be shared externally if needed. Figures and summary statements from sections eight through ten can be used but the sections should not be shared directly with external partners. Section 12 should be used as a reference for data sources; the statement can be copied and used as data statements for the content of the report.

This educational case study document is one in a series of self-instructional modules designed to increase the primary care provider’s knowledge of hazardous substances in the environment, and to promote the adoption of medical practices that aid in the evaluation and care of potentially exposed patients.

This paper describes the benefits to health centers engaging in research and how to get started. It targets health center senior staff and others who must examine their available capacity and resources in order to commit to engaging in research. It examines reasons for health centers to engage in research that is, health centers participating in or generating their own research projects with or about their targeted population or community.

This tookit was created to serve a resource for American Indian Tribal Nations or other Indigenous Nations developing Institutional Review Boards or other committees responsible for ethical review and monitoring of research on Tribal land.

This is a resource from the CDC, where Dr. Losby provides evaluation technical assistance to National Heart Disease and Stroke Prevention programs and Sodium Reduction in Communities sites.

This forms a simple guide for designing and using program evaluation survey questions.

The Polychlorinated biphenyls (PCBs) manufactured in Anniston, Alabama, from 1929 to 1971 caused significant environmental contamination. The Anniston population remains one of the most highly exposed in the world.

Due to reports of increased diabetes in PCB-exposed populations, this prompted researchers to examine possible associations in Anniston residents.

Due to the fact that human and environmental health continues to be threatened by persistent organic pollutants in the Great Lakes ecosystem, this study decided to explore three major questions in order to provide clarity and solutions surrounding this crisis. 1) Do PCB concentrations vary between largemouth bass (Micropterus salmoides), northern pike (Esox Lucius), smallmouth bass (Micropterus dolomieu), and walleye (Sander vitreus) in west Michigan tributaries of Lake Michigan; 2) Do PCB concentrations vary on a watershed level among Manistee Lake, Muskegon Lake, Pentwater Lake, Tippy Pond, and White Lake; and 3) What are the risk levels associated with fish consumption by members of Little River Band of Ottawa Indians (LRBOI) and sport fishermen for the watersheds and fish species examined?

This study presents results of a study of a heavy metal toxicity cluster of Ayurveda consumers in the United States. This was created in the hopes to be used to inform policy and raise awareness on the expanding use of CAMs in this country.

Given evidence that some herbs may contain high lead content, researchers of this article sought to determine the effect of herbal supplement use on blood lead levels of adult US women and men. Using data from the National Health and Nutrition Examination Survey (NHANES), a representative sample of the civilian non-institutionalized US population, authors of the study investigated the use of herbal supplements that had previously been found to contain high lead content.

This study proposes a conceptual framework for identifying important but unique pathways that risk assessors, public health personnel, and the public can use to adequately incorporate the exposures of minority, low-income, and tribal population groups in risk and health assessments, and to examine how these exposures contribute to health disparities.

Due to the fact that American Indians (AI) have the highest rate of severe physical housing problems in the U.S, and that little information exists about the environmental hazards in AI homes, authors of this paper take on the task of describing challenges that were encountered when recruiting AI for a home-and employment-based environmental health assessments, and highlight major successes, along with proposing recommendations for future indoor environmental health studies.

This article details different ways community organizations often see how the environment impacts the health of their families and neighbors, especially the Native community. In understanding that decisions made upstream impact communities downstream, partnerships become key to lessening or improving the negative health impacts of our natural and built environments. Which is why these partnerships are highlighted within the article along with the decision-making processes to achieve healthier environments for all.

The U.S. Environmental Protection Agency (EPA) has made available to the public an annual compendium of information on locally issued fish advisories and safe eating guidelines. This information is provided to EPA by the states, U.S. territories, Native American tribes, and local governments that issue fish consumption advisories and safe eating guidelines to inform people about the recommended level of consumption for fish caught in local waters. Fish consumption advisories provide advice to limit or avoid eating certain fish due to contamination with chemical pollutants.

In this paper, researchers discuss one potential tool, a set of candidate measures that may be used to track disparities in outcomes, as well as measures that may be used analytically to assess potential causal pathways. Several other reports on health and environmental measures have been produced, including the Environmental Protection Agency’s (EPA) America’s Children and the Environment. However, this paper has a rare focus on measures speciï¬�c to historically disadvantaged populations.

Fish advisories are issued in an effort to protect human health from exposure to contaminants, but Native American communities may suffer unintended health, social, and cultural consequences as a result of warnings against eating local fish. This paper focuses on the Mohawk community of Akwesasne, which lies downstream from a Superfund site, and explores how fish advisories have impacted fish consumption and health.

This report should be used as 1) an information reference for COVID related statistics in UIO service areas, 2) a compilation of figures and summary statements that can be used for testimony, publications, or other activities. The seven sections of this report can be shared externally if needed. Figures and summary statements from sections eight through ten can be used but the sections should not be shared. Section 12 should be used as a reference for data sources; the statement can be copied and used as data statements for the content of the report.

Persistent organic pollutants (POPs), including polychlorinated biphenyls (PCBs) and chlorinated pesticides, have been shown to have many adverse human health effects. These contaminants therefore may pose a risk to Alaska Natives that follow a traditional diet high in marine mammals and fish, in which POPs bioaccumulate, which is why this study examined the levels of PCBs and three pesticides [p, p9-DDE, mirex, and hexachlorobenzene (HCB)] in muscle tissue from nine fish species from several locations around the Aleutian Islands of Alaska.

This document is the testimony made on behalf of the Fond du Lac Band of Lake Superior Chippewa, who testified on FY 2020 appropriations for Indian programs funded through the Interior Department, Indian Health Service, and Environmental Protection Agency. The testimony was submitted to urge Congress to increase, or, at the very least preserve, the federal funding levels for Indians programs that are provided through these federal agencies.

This article explores problems in conventional �sh consumption survey methods used in widely cited tribal �sh consumption reports. The problems arise because of the following: (1) widely cited reports do not clearly state what they intend to do with the data supporting these reports, (2) data collection methods are incongruent with community norms and protocols, (3) data analysis methods omit or obscure the highest consumer subset of the population, (4) lack of understanding or recognition of tribal health co-risk factors, and (5) restrictive policies that do not allow inclusion of tribal values within state or federal actions.

This health profile, produced by the Urban Indian Health Institute (UIHI), provides an overview of the health status of American Indians/Alaska Natives (Al/AN) living in select urban counties. These counties are served by the network of Title V urban Indian health organizations (UIHO) across the country.

Recent research suggests that diabetes, a condition whose incidence is increasing, is associated with exposure to polychlorinated biphenyls (PCBs) and chlorinated pesticides, which is why researchers investigated the potential association between diabetes and serum levels of PCBs, dichlorodiphenyldichloroethylene (DDE), hexachlorobenzene (HCB), and mirex in a cross-sectional study of an adult Native-American (Mohawk) population.

Joanna Burger, PhD, and Michael Gochfeld, MD

This article proposes a framework for identifying important but unique pathways that risk assessors, public health personnel, and the public can use to adequately incorporate the exposures of minority, low-income, and tribal population groups in risk and health assessments, and to exam-ne how these exposures contribute to health disparities.

The FBI has released Missing Person and Unidentified Person Statistics, on Indigenous Persons.

The article explores the treatment for chronic hepatitis C. The virus (HCV) has rapidly evolved to simple, well-tolerated, all-oral regimens of direct-acting antivirals (DAAs). There is few data on the epidemiology of HCV in American Indians/Alaska Natives (AI/ANs), a population disproportionately affected by HCV. The article concluded that there are more steps must be taken to increase access to treatment for this underserved, vulnerable population.

This article discusses the issues with the fact that American Indian and Alaska Native people continue to be disproportionately impacted by the COVID-19 pandemic. And with the emergence of several COVID-19 vaccines, there has been an urgent need for information on the knowledge, attitudes, and beliefs among American Indians and Alaska Natives regarding the vaccines. Urban Indian Health Institute (UIHI) conducted a survey with 1,435 American Indians and Alaska Natives across the United States, with participants representing 318 different tribes across 46 states. The survey asked 49 questions ranging from an individual’s willingness to receive a COVID-19 vaccine to the people they trusted most when making informed decisions.

A new resource from the National Indian Child Welfare Association (NICWA) includes timely information for families encountering the child welfare system with guidance including what to do if a parent is reported for abuse or neglect or if their child is removed from their home.

This study for the CDC reports findings that the COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the United States. Disparities were especially substantial during January–April and generally decreased during May–December however, this was largely because of a greater increase in incidence among White persons, rather than a decline among racial and ethnic minority groups. The largest and most persistent disparities involved Native Hawaiian and Pacific Islander, American Indian or Alaska Native, and Hispanic persons.

This study dives into rates for drug overdose deaths in urban counties. The study found that those involving heroin or cocaine were consistently higher in urban than in rural counties over the entire period. Rates of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) were similar or slightly higher in rural than in urban counties through 2014. However, this pattern changed in 2015 through 2019, with higher rates seen in urban counties than in rural counties.

Culture Forward has a new initiative that has come up with a Strengths and Culture Based Tool to Protect Native Youth from Suicide, this is a new 54-page report with tribally driven, evidence and practice based solutions to prevent Native youth suicide. This report was developed by the Johns Hopkins Center for American Indian Health in partnership with Casey Family Programs, an operating foundation committed to supporting tribes in strengthening tribal nations’ capacity to keep children healthy, safe, and connected with their families, communities and cultures.

This source details the COVID-19 pandemic and the severe effects resulting stay-in-place orders have had on numerous aspects of the lives of Native American and Alaska Native people. It appears that some tribes have the highest infection rate in the US, although more precise details of Native infection rates are unclear because national COVID-19 reports do not identify Native American or Alaska Native people as a distinct demographic group, rather placing them in the “Other” category, making things very difficult to assess.

This resource highlights gender affirming care. Gender affirming care refers to healthcare that affirms a person’s gender identity and allows gender-diverse people to live more authentically. In order to be gender-affirming, providers must create positive and optimistic medical care systems, inclusive clinic environments, and patient support through effective and compassionate social gender transition. Luckily, with the appropriate planning and support, gender-affirming healthcare can be highly successful at all levels of the medical system which this resource provides in detail.

The study explores how many Native people demonstrate resilience when faced with health risks, despite being disproportionately affected by factors that lead to health disparities. Study objectives were to use a resilience framework to identify wellness strategies among American Indian people and to assess health care provider perceptions of American Indian wellness. Participants included 39 American Indian adults who self-reported resilient change and 22 health care providers who served American Indian patients. Results indicated the salience of relationships in demonstrating resilience. Identified challenges and supporters of resilience are discussed.

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Due to the fact that there is limited public health data on urban American Indian/Alaska Native (AI/AN) populations, particularly adolescents. This current study attempted to address gaps by providing descriptive information on experiences of urban AI/AN adolescents across northern, central, and southern California.

Despite their increasing numbers, little is known about the health of American Indians/Alaska Natives living in urban areas. This study examined the health status of American Indian/Alaska Native populations served by 34 federally funded urban Indian health organizations. The studies found health disparities between American Indians/Alaska Natives and the general populations living in selected urban areas and nationwide. The solutions provided were to create improvements in health care access, high-quality data collection, and policy initiatives designed to provide sufficient resources and a more unified vision of the health of urban American Indians/Alaska Natives.

The U.S. Attorney General announced the Department’s Missing and Murdered Indigenous Persons (MMIP) Initiative. They stated that, “American Indian and Alaska Native people suffer from unacceptable and disproportionately high levels of violence, which can have lasting impacts on families and communities.” Therefore, there has been an initiative to not only raise awareness, but also take heed to tribal issues and concerns. As the journal states, "The best solutions to tribal issues come from tribes, and it is our responsibility to listen." It is their hope that the articles serve as a basis for continuing the conversation and advancing this work forward.

This study from the CDC shows that COVID-19 incidence is higher among American Indians/Alaska Natives (AI/ANs) than among non-Hispanic Whites. In 2009, AI/ANs experienced disproportionately high pandemic influenza A(H1N1)–associated mortality. AI/ANs have experienced disproportionate rates of infection and mortality during the COVID-19 pandemic. The excess risk, especially for AI/AN males and persons aged 20–49 years, should be considered when planning and implementing medical countermeasures and other prevention activities.

This source is from The National Resource Center on Native American Aging based at the University of North Dakota. They conducted a survey of Title VI program staff. The 29-question on-line survey addressed various factors related to implementing EBPs. Survey questions focused on greatest needs, familiar programs, funding sources, partnerships, and barriers, among others. 63 respondents completed the survey.

Sixty American Indian, Alaska Native, and Native Hawaiian Elders participated in listening sessions to share their perspectives on aging, health, and what community-based programs can do to support them. These are their responses.

This report highlights the:

*Unique disparities in health care access that AI/AN/NH communities face.

*Diversity of services supported by the Older American Act in AI/AN/NH communities, such as nutrition, transportation, caregiver programs, information and referral, and health promotion.

*Current evidence-base for, availability, and acceptability of health promotion programs in AI/AN/NH communities

*Experience of program administrators in AI/AN/NH communities, and perspectives from elders about what aging well means to them and the extent to which they are aware of and/or have been involved with health promotion and disease prevention programs;

*Results from a survey of Older Americans Act Title VI Directors and Staff, providing information about their experience with health promotion and disease prevention programs, the unique challenges they face in serving their communities, and what resources they think might help; and

*Potential next steps to advance the health and well-being of AI/AN/NH elders.

This source discusses how American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) communities face significant health disparities compared to the general United States population. Specifically, Elders manage a high burden of chronic conditions and report the greatest percentage of falls (34.2%) of all races and ethnicities. In an effort to address these disparities, some organizations serving AI/AN/NH Elders have implemented evidence-based health promotion programs in the community to empower individuals to manage chronic conditions and prevent falls.

The objective of this study was to summarize how racism and, the social determinants of health disproportionately affect rural racial/ethnic minority populations, and provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, along with recommend policy, research, and intervention approaches to reduce these disparities. The results found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival.

This journal article highlights how the COVID-19 pandemic has raised national consciousness about health inequities that disproportionately impact American Indian/Alaska Native (AI/AN) communities, yet urban AI/AN communities continue to remain an issue for health leaders and policymakers. AI/ANs are consistently excluded in local and national health assessments, including recent reports pertaining to COVID-19. Today the majority of AI/ANs live in urban areas, and many cities have strong Urban Indian Health Programs (UIHPs) that provide space for medical care, community gatherings, cultural activities, and traditional healing. However, many of these UIHPs are currently scrambling to meet the needs of their AI/AN service communities during the pandemic.

This report, Urban Diabetes Care & Outcomes Summary Report, Audit Years 2015–2019 (2019 Urban Diabetes Audit), is primarily funded by SDPI and uses data from Urban Indian Health Programs (UIHPs) to highlight strengths and disparities in the health of urban AI/AN patients with diabetes. The data for the 2019 Urban Diabetes Audit was obtained from the annual IHS Diabetes Care and Outcomes Audit (Diabetes Audit). It includes AI/AN patients with diabetes at 30 participating UIHPs from 2015 to 2019. 

Urban Indian Health Institute (UIHI) conducted a survey with 1,435 American Indians and Alaska Natives across the United States, with participants representing 318 different tribes across 46 states. The survey asked 49 questions ranging from an individual’s willingness to receive a COVID-19 vaccine to the people they trusted most when making informed decisions.

On November 2, 2020, this report was posted as an MMWR
Early Release on the MMWR website (https://www.cdc.gov/mmwr).

The National Uniform Data System (UDS) reports provide a “snapshot” of program performance for the reporting calendar year. Data in the National UDS reports are a result of validated data at the individual Urban Indian Organization (UIO) sites.

Oral Statement of Kay Culbertson for the Reauthorization of the Indian Health Care Improvement Act

https://www.ncuih.org/download?publication_id=1641

This publication is from the May issue of an online journal published by the National American Indian and Alaska Native Mental Health Technology Transfer Center.  This issue of the newsletter is on PTSD as the COVID-19 pandemic has actvated PTSD issues in many Natve community members.  The article is based on a session in PTSD and it also discusses Historical trauma. The authors note  there are recordings of five program sessions from a webinar series based on the curriculum, "Native American Veterans: Healing the Returning Warrior."  Ssssion recordings can be found at this link.

The session in the article was titled, Caring for Our Relations:Post-Traumatic Stre s Disorder inIndian Country. The article notes, "PTSD has been described as one of the most serious mental health problems faced by NA/AN populations, and there is general agreement that Native peoples experience high rates of trauma and PTSD."  It disucsses PTSD and co-occurrence with other illnesses, substance use disorder, and rates among AI/AN veterans.  It briefly discusses treatment for PTSD.

The section on histrical trauma links the incidence of PTSD in AI/AN people and the COVID epidemic. It offers insights into elders and the impacts of COVID 19 on urban and rural AI/AN families.  

Center for Native American Youth (CNAY) at The Aspen Institute, released "Native Youth Count: The State of Native Youth 2019,” on November 20.

The Center for Native American Youth (CNAY) at Aspen Institute releases this report annually. The report highlights young leaders who are working hard to create a brighter future for tribal nations, the programs that help them do so, and the policy issues that impact their lives. The report also shares what we’ve learned from community meetings with youth and service providers about the priorities and solutions that matter most. The State of Native Youth report is presented as a resource and roadmap to help decrease barriers and increase opportunity for Native youth.

As noted, the theme of this year’s report is Native Youth Count. CNAY discusses why being counted in the 2020 Census is critical, and they describe the impact of representation on the lives of youth. They share details about some of the people, initiatives, and organizations that help develop today’s youth as well as future generations of young people.  This year’s prompt was: What does citizenship and sense of belonging mean to you? Throughout this year’s report, CNAY highlights the importance of Native youth civic engagement and belonging.   They also feature artwork throughout the report that was submitted as part of the annual Gen-I Creative Native Call for Art.

The objective of this study was to examine recent trends in diagnosed diabetes prevalence for American Indian and Alaska Native (AI/AN) adults aged 18 years and older in the Indian Health Service (IHS) active clinical population.  The study found that diabetes prevalence in AI/AN adults in the IHS active clinical population has decreased significantly since 2013.

After increasing significantly from 2006 to 2013, diabetes prevalence for AI/AN adults in the IHS active clinical population decreased significantly from 2013 to 2017. Prevalence was 14.4% (95% CI 13.9% to 15.0%) in 2006; 15.4% (95% CI 14.8% to 16.0%) in 2013; and 14.6% (95% CI 14.1% to 15.2%) in 2017. Trends for men and women were similar to the overall population, as were those for all age groups. For all geographic regions, prevalence either decreased significantly or leveled off in recent years.

This guide provides a starting point on how to bill a telehealth encounter for eligible practitioners in your practice or your facility. The focus of this guide is primarily on fee-for-service Medicare and an example of one Medicaid program, California, whicg is highlighted in the text using blue MediCal boxes. 

Most of the descriptions and definitions are from the Centers for Medicare and Medicaid Services (CMS). Managed care plans, private payers and employer-based plans generally follow these rules though not every time, so coders and others should always check with the plan. This billing resource is only provided as a guide and should not be considered legal advice.

(For more detailed information on California billing, please visit the California Telehealth Resource Center’s website at www.caltrc.org.

Since 1990, the scientific literature has expanded greatly on the determinants and processes of smoking cessation, informing the development of interventions that promote cessation and help smokers quit.  Of all groups measured, the prevalence of past-year quit attempts and interest in quitting smoking was lowest among AI/ANs 18 or older. The prevalence of key indicators of cessation—quit attempts, advice to quit from a health professional, and access to cessation therapies—varies across populations, with lower prevalence among vulnerable subgroups like AI/ANs.  Further, of all groups measured, the prevalence of past-year quit attempts and interest in quitting smoking was lowest among AI/ANs 18 or older.

Health care providers who serve AI/AN populations may be a vital linchpin for efforts to improve tobacco cessation among AI/ANs.  

The Center for Connected Health Policy has released a new guide for successfully setting up and maintaining billing for telehealth services. The guide covers fee-for-service Medicare and Medicaid billing for live-video, store-and-forward, econsult, remote monitoring and mobile forms of telehealth.  

This study provides new national incidence and cost estimates for NAS in 2016....

"The overall incidence rate of NAS was 6.7 per 1000 in-hospital births in 2016 (Table 1); rates were highest among American Indian/Alaska Native individuals (15.9 per 1000)"

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This scan looks at promising practices being developed and implemented by tribes around the country, the resource and infrastructure challenges they face, as well as the opportunities afforded by cultural resilience and sovereignty. While the current scan was compiled from publicly available information on the internet, annual updates will incorporate other sources of information, and become a more comprehensive living document that will help guide tribal community members, tribal and organizational leaders, and healthcare professionals who are at the forefront of opioid epidemic.

ACEs are a serious public health problem with far-reaching consequences across the lifespan. They are also preventable. The strategies outlined here, drawn from the CDC Technical Packages to Prevent Violence, are intended to change norms, environments, and behaviors in ways that can prevent ACEs from happening in the first place as well as to lessen the immediate and long-term harms of ACEs. To maximize impact, these strategies and approaches are intended to be used in combination as part of a comprehensive effort to help ensure that all children have safe, stable, nurturing relationships and environments in which to thrive and achieve lifelong health and success. The hope is that multiple sectors, such as public health, health care, education, public safety, justice, social services, and business will use this information as a guide and join CDC in efforts to prevent ACEs.

Adverse Childhood Experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years) such as experiencing violence, abuse, or neglect; witnessing violence in the home; and having a family member attempt or die by suicide Also included are aspects of the child’s environment that can undermine their sense of safety, stability, and bonding such as growing up in a household with substance misuse, mental health problems, or instability due to parental separation or incarceration of a parent, sibling or other member of the household.  An estimated 62% of adults surveyed across 23 states reported that they had experienced one ACE during childhood and nearly one-quarter reported that they had experienced three or more ACEs.  ACEs can have negative, lasting effects on health, wellbeing, and opportunity. These exposures can disrupt healthy brain development, affect social development, compromise immune systems, and can lead to substance misuse and other unhealthy coping behaviors.

ACEs and their associated harms are preventable. Creating and sustaining safe, stable, nurturing relationships and environments for all children and families can prevent ACEs and help all children reach their full health and life potential. The evidence tells us that ACEs can be prevented by:

• Strengthening economic supports for families

• Promoting social norms that protect against violence and adversity

• Ensuring a strong start for children and paving the way for them to reach their full potential

• Teaching skills to help parents and youth handle stress, manage emotions, and tackle everyday challenges

• Connecting youth to caring adults and activities

• Intervening to lessen immediate and long-term harms

This publication conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. A total of 3421 articles were encountered. Nine categories of protective factors positively associated with health and social outcomes, including current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. 

This publication conducted a systematic literature review to assess the conceptualization, application, and measurement of resilience in American Indian and Alaska Native (AIAN) health promotion.

American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racialethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.

This publication conducted a systematic literature review to assess the conceptualization, application, and measurement of resilience in American Indian and Alaska Native (AIAN) health promotion.

OBJECTIVE: This study wanted to see how social support (SS) affects the odds of suicide attempts among American Indian/Alaska Native (AI/AN) youth in New Mexico and is modified by school location and metropolitan status. METHODS: The study used a multiple logistic regression for complex design was used to produce the adjusted odds of suicide attempt by SS using the New Mexico Youth Risk and Resiliency Survey (NM-YRRS) for 2011 (n = 2,730), 2013 (n = 3,171), and 2015 (n = 2,604) while adjusting for age, grade, gender, and maternal education level.

In 2010, 5.2 million people, about 1.7% of the United States population, identified as
American Indian and Alaska Native (AI/AN), either alone or in combination with one or more other races. Out of this total, 2.9 million people identified as American Indian and Alaska Native alone, 0.9% of the U.S. population.1 There are 567 federally recognized Tribes in the U.S., yet the majority of Americans remain unaware of tribal public and environmental health concerns. American Indian and Alaska Native people have long experienced poorer health compared to other Americans. It is alarming to realize that American Indians and Alaska Natives live on average 4.4 years less than other Americans. They also experience higher rates of premature death compared to other Americans from diabetes, chronic liver disease, intentional self-harm and suicide, and chronic lower respiratory diseases.

Tribal Public and Environmental Health Think Tank

Since the group’s inception in 2011, the Tribal Public and Environmental Health Think Tank
has worked to promote the voice of tribal communities across the country as a strategy to
raise awareness about and achieve improvements in the unique environmental health, and
more recently public health, challenges faced by tribal communities.

Understanding the social and cultural contexts for why American Indian and Alaska Native peoples suffer from some of the highest disparity rates for public and environmental health is key in grappling with resulting tribal public and environmental health issues. The Think Tank therefore identified the following six public and environmental health priorities to continue to bring visibility to:

1. Food Sovereignty and Access

2. Infrastructure and Systems Development

3. Climate and Health

4. Resource Extraction

5. Clean Air

6. Clean Water

The Think Tank, with support from CDC and APHA, has identified strategies and products to produce over the next three years. The intention of these next steps is to promote the voice of Tribes across the country and raise awareness of the issues that disproportionately impact the health of American Indians and Alaska Natives. The Think Tank’s goals include:

ï‚· Advance principles of sovereignty through education

ï‚· Provide outreach and technical support to Tribes

ï‚· Promote the need for data equity among Native populations

ï‚· Engage with partners to broaden its impact

Testimony of Professor Sarah Deer:

...a citizen of the Muscogee(Creek) Nation and currently hold the position of Professor at the University of Kansas and serve as theChief Justice of the Prairie Island Indian Community Court of Appeals. Today I am testifying in my personal capacity.
My testimony today will focus on our knowledge in terms of the high numbers of MMIW based on open source reporting (media reports and family accounts). I will offer some theories about the causes of this high rate of MMIW. Finally, I will suggest how this committee, and Congress generally, can improve lawenforcement’s response to this crisis.

STATISTICS: WHAT WE KNOW

First, it is critical to understand that this crisis has deep roots in the historical mistreatment of Nativepeople throughout the history of the United States. Native women and girls have been disappearingsince 1492, when Europeans kidnapped Native people for shipment back to Europe. Targeted killing ofNative women is also not a recent phenomenon. This history of oppression makes it difficult to achieve buy-in from marginalized communities who have been victims of oppression at the hands of the federal government for centuries.

When crafting solutions, we have to be ready to accept that there will be no “quick fix” to this problem.This crisis has been several hundred years in the making and will require sustained, multi-year, multifaceted efforts to understand and address the problem.

Currently, there is no formal government-funded national database that carefully and deliberately tracks cases of MMIW. Fortunately, a Native-owned and -operated non-profit organization known as the Sovereign Bodies Institute (SBI) has been working tirelessly since 2015 to gather as much data as possible using open source reporting and input from family members of MMIW. I share this data with the permission of the Sovereign Bodies Institute (SBI):
Because this database has largely been built by hand, the data likely only represents a fraction of the true numbers. The SBI database currently tracks the following types of MMIW cases:
ï‚· Missing
ï‚· Murdered (both solved and unsolved)
ï‚· Suspicious deaths
ï‚· Deaths in custody (jail/prison/hospital)
ï‚· Jane Does (unidentified human remains thought to be Native women)

The Trafficking Victim Protection Act of 2000 (TVPA) signaled a comprehensive campaign by the United States (US) government to address the scourge of human trafficking in the US and abroad. The US rhetoric about sex trafficking suggests that the problem originates in foreign countries and/or is recent problem. Neither claim is correct.

This article details the historical and legal context of sex trafficking from its origin among the colonial predecessors of the US and documents the commercial trafficking of Native women over several centuries. Native women have experienced generations of enslavement, exploitation, exportation, and relocation. Human trafficking is not just a problem of poor, underdeveloped nations but an ongoing issue in the US and Canada that ties into the growth of the sex industry in these nations, where Native women are significantly overrepresented.

The authors propose reinvigorating and extending the traditional social
history beyond its narrow range of risk behaviors to enable clinicians to address
negative health outcomes imposed by social determinants of health. In
this Perspective, they outline a novel, practical medical vulnerability assessment
questionnaire that operationalizes for clinical practice the social science
concept of “structural vulnerability.”

A structural vulnerability assessment tool designed to highlight the pathways
through which specific local hierarchies and broader sets of power relationships
exacerbate individual patients’ health problems is presented to help clinicians
identify patients likely to benefit from additional multidisciplinary health and
social services. To illustrate how the tool could be implemented in time- and
resource-limited settings (e.g., emergency department), the authors contrast two
cases of structurally vulnerable patients with differing outcomes.

Operationalizing structural vulnerability in clinical practice and introducing it in medical educationcan help health care practitioners think more clearly, critically, and practically
about the ways social structures make people sick. Use of the assessment tool
could promote “structural competency,” a potential new medical education
priority, to improve understanding of how social conditions and practical logistics
undermine the capacities of patients to access health care, adhere to treatment,
and modify lifestyles successfully. Adoption of a structural vulnerability
framework in health care could also justify the mobilization of resources
inside and outside clinical settings to improve a patient’s immediate access to
care and long-term health outcomes.  Ultimately, the concept may orient
health care providers toward policy leadership to reduce health disparities
and foster health equity.

In October 2017, the National Academy for State Health Policy (NASHP) convened state health officials representing 10 state accountable health models to discuss strategies for using accountable health structures to promote population health. Participants also discussed strategies to assess these structures’ impact on health, determine their return on investment, and develop sustainable funding approaches.

To improve population health and health equity, states are working across Medicaid, public health, and other agencies to develop accountable health structures. State accountable health models — both currently operating and those in development — fall along a continuum. All of them promote healthy communities through community partnerships, but some contract with Medicaid agencies to provide health care services directly to individual Medicaid beneficiaries, while others focus only on community-based interventions.

• Accountable health structures are community-based entities that invest in, or are accountable for, population health improvement.
• State accountable health entities can take a range of forms. Some — such as Health Equity Zones — focus only on community-based interventions, while others — such as accountable care and coordinated care organizations — contract with Medicaid to provide direct clinical care.

This brief highlights policy levers, performance measurement strategies, and sustainable financing options that states can use to support accountable health structures.

The authors aim is twofold. First, they highlight the historical and ongoing contributions of Native Americans to Chicago. In pursuit of this goal, the authors draw upon the work of local scholars and organizations focused on Native American history, community organizing, and development throughout the city. The authors second aim in this report is to document the many ways that racial inequity affects Native Americans in Chicago today. Here, they draw on their strengths as a policy institute located within a public research university to analyze a range of data that helps us capture the current challenges facing Native American Chicagoans.

Jasmine Gurneau, Manager of Native American and Indigenous Initiatives at Northwestern University, focuses on the complexity of determining who “counts” as Native American. Gurneau highlights the various entities, (such as the U.S. government and tribal nations) that have sought to define the criteria for tribal membership and the implications of such decisions. She also discusses the methodological quandaries raised when conducting research on Native peoples.

The authors recognize that their offices and homes are built in areas originally inhabited by Native Americans from multiple tribes, including the Potawatomi, Odawa, Sauk, Ojibwe, Illinois, Kickapoo (Kiikaapoi), Miami (Myaamia), Mascouten, Wea, Delaware, Winnebago, Menominee, and Mesquakie. Throughout this report, the authors seek to honor this history by making visible the contemporary challenges facing Chicago’s Native American population.

Background: A variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions.

Discussion: We convened a panel of experts from American Indian and Alaska Native communities, substance abuse treatment programs serving these communities, and researchers to discuss and analyze these controversies in preparation for a national study of American Indian and Alaska Native substance abuse services. While the panel identified programs that are using evidence-based treatments, members still voiced concerns about the cultural appropriateness of many evidence-based treatments as well as the lack of guidance on how to adapt them for use with American Indians and Alaska Natives. The panel concluded that the efforts of federal and state policymakers to promote the use of evidence-based treatments are further complicating an already-contentious debate within American Indian and Alaska Native communities on how to provide effective substance abuse services. This external pressure to utilize evidence-based treatments is particularly problematic given American Indian and Alaska Native communities’ concerns about protecting their sovereign status.

Summary: Broadening this conversation beyond its primary focus on the use of evidence-based treatments to other salient issues such as building the necessary research evidence (including incorporating American Indian and Alaska Native cultural values into clinical practice) and developing the human and infrastructural resources to support the use of this evidence may be far more effective for advancing efforts to improve substance abuse services for American Indian and Alaska Native communities.

The National Action Alliance for Suicide Prevention is the public-private partnership working to advance the National Strategy for Suicide Prevention and make suicide prevention a national priority. The Substance Abuse and Mental Health Services Administration provides funding to EDC to operate and manage the Secretariat for the Action Alliance which was launched in 2010.

Transforming communities to prevent suicide is one of three priority areas currently championed by the National Action Alliance for Suicide Prevention (Action Alliance), the public-private partnership that supports implementation of the National Strategy.** This priority area focuses on providing guidance to states and communities to support the implementation of community-based suicide prevention efforts. The need for this guidance was identified in a recent review of progress towards achievement of the National Strategy, conducted by an Action Alliance advisory group. Findings from the implementation review indicated that states and communities would benefit from a “full range of comprehensive, coordinated, and effective suicide prevention efforts across all relevant settings and populations.”

In May 2016, the Action Alliance created the Transforming Communities Priority Work Group to identify ways to help communities implement effective suicide prevention programs (see participant list in Appendix 7).  This paper presents the results of their work. It describes the information sources reviewed (see appendices for detailed descriptions) and presents a set of seven key elements for comprehensive community-based suicide prevention derived from the review process.

Based on this review, the work group identified seven key elements for the implementation of comprehensive community-based suicide prevention efforts:

1. Unity—Attainment and maintenance of broad-based momentum around a
shared vision
2. Planning—Use of a strategic planning process that lays out stakeholder roles
and intended outcomes
3. Integration—Use of multiple, integrated suicide prevention strategies
4. Fit—Alignment of activities with context, culture, and readiness
5. Communication—Clear, open, and consistent communication
6. Data—Use of surveillance and evaluation data to guide action, assess progress,
and make changes
7. Sustainability—A focus on long-lasting change

Importance  Health equity is an often-cited goal of public health, included among the 4 overarching goals of the Department of Health and Human Services’ Healthy People 2020. Yet it is difficult to find summary assessments of national progress toward this goal.

Question  Has health equity improved or worsened during the past 25 years in the United States among working-aged adults?

Findings  Using data from more than 5.4 million respondents to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, this study found that from 1993 to 2017, the black-white gap showed significant improvement. However, measures of health equity and health justice declined over time, and income disparities worsened.

Meaning  Meaningful progress on health equity in the United States will require greater effort, new approaches, or both.

Risk assessment determines pathways, and exposures that lead to poor
health. For exposures that fall disproportionately on urban low-income communities,
minorities, and Native Americans, these pathways are often more common than in the general population. Although risk assessors often evaluate these pathways on an ad hoc basis, a more formal way of addressing these nonstandard
pathways is needed to adequately inform public health policy.

A conceptual model is presented for evaluating nonstandard, unique, or excessive
exposures, particularly for environmental justice communities that have an exposure matrix of inhalation, dermal, ingestion, and injection. Risk assessment can be improved by including nonstandard and unique exposure pathways as described in this conceptual model.

This report’s in-depth inquiry looks at an array of challenges, successes, and innovative ways that AI/AN communities are engaging the sensitive topic of suicide data collection with an understanding of the uniqueness of each American Indian and Alaska Native community. It is our hope that we have captured a unique and foundational base of information that can be useful in the conceptualization, design, and implementation of current and future suicide data collection, prevention, and evaluation efforts.

This report briefly summarizes findings and recommendations from SPRC’s exploration of suicide surveillance among AI/AN communities across the country. Each section describes challenges, provides strategies, lists resources, and highlights community examples as available.

One of the roles of SPRC is to provide technical assistance to Garrett Lee Smith grantees, including support for suicide data surveillance and monitoring systems, by identifying resources, strategies, and success stories that can help grantees overcome common barriers and implement effective prevention programs. State and tribal Garrett Lee Smith grantees are required to demonstrate their impact in reducing suicide deaths and attempts in the populations they 8 SUICIDE SURVEILLANCE STRATEGIES FOR AMERICAN INDIAN AND ALASKA NATIVE COMMUNITIES are working with. Tribal Garrett Lee Smith grantees include federally recognized tribes, tribal organizations (as defined in the Indian Self-Determination and Education Assistance Act), Alaska Native entities, and urban Indian organizations (as defined in the Indian Health Care Improvement Act) that are actively involved in the development and continuation of a tribal youth suicide early intervention and prevention strategy

The majority of American Indian and Alaska Native people now live in urban communities due to a variety of reasons for migration, from forced relocation due to 1950s federal relocation and termination policies, to current barriers to obtaining quality educational, employment, and housing opportunities on tribal lands. Because of this, urban American Indian and Alaska Native people experience MMIWG-related violence in two ways—through losses experienced by extended family and community ties on reservations, in villages, and in urban communities themselves. Though there are critical issues regarding jurisdiction of MMIWG cases on reservation and village lands, lack of prosecution, lack of proper data collection, prejudice, and institutional racism are factors that also occur in urban areas.

In this study, UIHI sought to demonstrate the ways in which these issues also impact urban MMIWG cases, highlighting the results of a deeply fawed institutional system rooted in colonial relationships that marginalize and disenfranchise people of color and remains complicit in violence targeting American Indian and Alaska Native women and girls.  UIHI identifed 506 unique cases of missing and murdered American Indian and Alaska Native women and girls across the 71 selected cities—128 (25%) were missing persons cases, 280 (56%) were murder cases, and 98 (19%) had an unknown status.

• Approximately 75% of the cases UIHI identifed had no tribal afliation listed.
• Sixty-six out of 506 MMIWG cases that UIHI identifed were tied to domestic and sexual violence.
• The youngest victim was a baby less than one year old.
• The oldest victim was an elder who was 83 years old.

The states with the highest number of cases are as follows: New Mexico (78), Washington (71), Arizona (54), Alaska (52), Montana (41), California (40), Nebraska (33), Utah (24), Minnesota (20), and Oklahoma (18).

This report provides a summary of
current knowledge and research on the
quality and reliability of death rates by
race and Hispanic origin in official
mortality statistics of the United States
produced by the National Center for
Health Statistics (NCHS). It also
provides a quantitative assessment of
bias in death rates by race and
Hispanic origin. It identifies areas for
targeted research.  

For the white population and the black
population, published death rates are
overstated in official publications by an
estimated 1.0 percent and 5.0 percent,
respectively, resulting principally from
undercounts of these population groups
in the census. Death rates for the other
minority groups are understated in
official publications approximately as
follows: American Indians, 21 percent;
Asian or Pacific Islanders, 11 percent;
and Hispanics, 2 percent. These
estimates do not take into account
differential misreporting of age among
the race/ethnic groups.

The purpose of this study was to identify whether positive relationships with adults at home, school, and in the community are protective for suicide among American Indian/Alaska Native, Hispanic, and Anglo adolescents. Using data from the New Mexico version of the 2015 Centers for Disease Control and Prevention Youth Risk Behavior Survey, we found that positive relationships with adults affected past-year suicide attempts differently in youth from the 3 groups. The final multivariable model for American Indian/Alaska Native youth included only positive relationships with adults in the home. Among Hispanic and Anglo youth, adults in the home and also in the community were protective.

A 2-day public workshop on estimating the prevalence of human trafficking in the United
States was held by the Committee on National Statistics in collaboration with the Committee on Population April 8-9, 2019. The workshop explored current and innovative sampling methods, technological approaches, and analytical strategies for estimating the prevalence of sex and labor trafficking in vulnerable populations.

The workshop, sponsored by the Office on Women’s Health at the Department of Health and Human Services (HHS), brought together statisticians, survey methodologists, researchers, public health practitioners, and other experts who work closely with human trafficking data or with the survivors of trafficking. Dorothy Fink Deputy Assistant Secretary for Women’s Health and the Director of the Office on Women’s Health at HHS) called the issue a bipartisan congressional priority, and she highlighted the passing of the Trafficking Victims’ Protection Act (2017) and the Put Trafficking Victims First Act (2019) as necessary steps toward developing methodologies to assess the prevalence of human trafficking.

The workshop was designed to illustrate and discuss what is known,
what is currently being done, and what needs to be done to identify and
reduce suicide risk among people with serious mental illness. Richard McKeon, chief of the Suicide Prevention Branch in the Centerfor Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA), briefly spoke about why SAMHSA supported the workshop. Suicide rates have increased significantly in the United States
in recent years, he observed. A recent report from the Centers for Disease
Control and Prevention (CDC) showed that suicide had increased in 49
of 50 states between 1999 and 2016, and in half the states examined the
increase was greater than 30 percent

The workshop presentations and moderated discussions will examine opportunities
to prevent suicide among people with serious mental illness (SMI), including,
at minimum, bipolar disorder, major depression, schizophrenia, and borderline
personality disorder, as well as mood, anxiety, or other disorders that result in
significant functional impairment.

The workshop will:

• Highlight the patterns of mortality by suicide among people with SMI,
• Consider the implications of the relationship between SMI and suicide,
and
• Examine interventions that can reduce the high risk of suicide in this
population.

The workshop will also consider ways to:
• Improve and implement early interventions,
• Improve access to care among vulnerable populations with SMI, and
• Effectively target interventions to specific populations with unique needs.

The workshop consisted of six plenary panel presentations, a breakout
session on the second day, and opportunities to report back from the
breakout sessions and comment on the major themes and messages that
emerged from the workshop.

About 22 percent of American Indians/Alaska Natives (AI/ANs) reside on reservations or other trust lands, which contain unique governments, histories, traditions, communities, languages, and behavioral health challenges. In general, there is a lack of nationally representative data on the substance use and mental health of AI/ANs residing on and off tribal lands. This report provides methodological information on how to obtain estimates of behavioral health outcomes for populations living on and off tribal lands and provides some initial estimates form data collected bewtween 2005 and 2014

Combined 2005 to 2014 National Survey on Drug Use and Health (NSDUH) data included about 31,900 self-identified U.S.-born AI/AN adolescents and adults aged 12 or older residing on (n = 5,400) or off (n = 26,500) tribal lands.

This study found significant differences in the mental health and substance use of the U.S.-born AI/AN population by tribal land residential status, which forms the foundation for future efforts to understand differences in the behavioral health landscape of U.S.-born AI/ANs residing on and off tribal lands. This study examined the differences in behavioral health outcomes by tribal land residential status for the nation based on a large nationally representative sample. However, although these data are nationally representative, the estimates in this report may not be representative of any specific U.S.-born AI/AN tribe or village.

For many of the behavioral health topics analyzed, U.S.-born AI/AN adults and adolescents residing on tribal lands were equally or less likely than U.S.-born AI/AN adults and adolescents residing off tribal lands to experience the behavioral health challenges.  Among U.S.-born AI/AN adolescents, past year major depressive episode was less likely among those residing on tribal lands compared with those living off tribal lands

Alcohol misuse contributes to 88,000 deaths in the United States each year; 1 in 10 deaths among working adults are due to alcohol misuse. In addition, in 2014 there were 47,055 drug overdose deaths including 28,647 people who died from a drug overdose involving some type of opioid, including prescription pain relievers and heroin—more than in any previous year on record.

In 2015, 66.7 million people in the United States reported binge drinking in the past month and 27.1 million people were current users of illicit drugs or misused prescription drugs.  Even though the United States spends more than any other country on health care, it ranks 27^th in life expectancy, which has plateaued or decreased for some segments of the population at a time when life expectancy continues to increase in other developed countries—and the difference is largely due to substance misuse and associated physical and mental health problems  

Individual chapters in the Report review the science associated with the major substance use, misuse, and disorder issues for specific topics. Tobacco, also an addictive substance, is mentioned only briefly, because problems associated with tobacco use and nicotine addiction have been covered extensively in other Surgeon General's Reports.  Because of the broad audience and the practical emphasis, the Report is intentionally selective rather than exhaustive, emphasizing findings that have the potential for the greatest public health impact and the greatest potential for action.

Misclassification of race in medical andmortality records has long been documented as an issue in American Indian/Alaska Native data. Yet, little has been shared in a cohesive narrative which outlines why misclassification of American Indian/Alaska Native identity occurs. The purpose of this paper is to provide a summary of the current state of the science in racial misclassification among American Indians and Alaska Natives.We also provide a historical context on the importance of this problem and describe the ongoing political processes that both affect racial misclassification and contribute to the context of American Indian and Alaska Native identity.

Researchers and policy makers must be careful not to link socially constructed categoriesdirectly to genetics, given our global history of a racialized science. Despite efforts undertaken to transcend discrimination brought about by socially constructed categories of race, we all are shaped by our society wherein race and ethnicity organize our perceptions, relations, and behaviors. We must be aware of our biases to guard against reproducing the same mistakes. This starts with understanding the difference between race and ethnicity, and using the terminology appropriately. Authors strongly recommend the science community advocate for appropriate use of terminology, to better inform policy makers, accurately identify health disparities, and improve efforts to advocate for resources from funding sources. No other racial or ethnic group in the US must undergo documented scrutiny to “prove” their identity.

Racial misclassification
of infant deaths among American
Indians has been widely acknowledged
and reported in studies in California
and Montana, Oklahoma, and Washington.
 When birth and death files were
linked, the number of deaths for American
Indian infants increased from 20% to
150%, depending on the study.  

The objectives of this study were to
determine the extent of racial misclassification
in mortality reported for American
Indian infants and children in California,
provide more accurate data adjusted for
misclassification errors, and ascertain
counties with the highest levels of racial
misclassification in order to improve
reporting.  

We identified four times as many
American Indian infants and children as
had been reported on state death certificates.  On the
basis of the matched records, we found
that the number of deaths among American
Indian children was 4.1 times greater
than that reported on death certificates. 

Misclassification at time of death
was more likely if the child resided in the
more urbanized counties outside of the
Indian Health Service delivery areas   Deaths due to injuries were less
likely to be misclassified than deaths due
to other causes. Deaths occurring outside
of the hospital are likely to be investigated,
which may have led to greater
accuracy. Overall rates of misclassification
may be higher in California because
of the heterogeneity of the population and
the large number of American Indians
with Hispanic surnames.

To our knowledge, the extent to which
American Indian injury rates are underestimated
owing to racial misclassification is
unknown.
To examine this question, we conducted
a study that linked the Oregon Injury
Registry with a patient registration file
of American Indian Oregon residents registered
with the Indian Health Service
(IHS). In addition, we examined selected
risk factors that might be associated with
the likelihood of discordant racial classification
between the two data sets. 

The Oregon Injury Registry is a population-
based surveillance system for injuries
resulting either in death or in hospital
admission for at least 1 calendar day.  The Portland Area
IHS maintains a computer file of Oregon
residents who have registered for services
with it. To examine how inconsistent racial
classification between the two data sets
affected estimated injury rates among
American Indians, we calculated age-adjusted
rates of injury using three methods.

This report presents the findings of an updated study of the validity of race and Hispanic-origin reporting on death certificates in the United States, and its impact on race- and Hispanic origin-specific death rates.
Methods
The latest version of the National Longitudinal Mortality Study (NLMS) was used to evaluate the classification of race and Hispanic origin on death certificates for deaths occurring in 1999–2011 to decedents in NLMS. To evaluate change over time, these results were compared with those of a study based on an earlier version of NLMS that evaluated the quality of race and ethnicity classification on death certificates for 1979–1989 and 1990–1998. NLMS consists of a series of annual Current Population Survey files (1973 and 1978–2011) and a sample of the 1980 decennial census linked to death certificates for 1979–2011. Pooled 2009–2011 vital statistics mortality data and 2010 decennial census population data were used to estimate and compare observed and corrected race- and Hispanic origin-specific death rates.
Results
Race and ethnicity reporting on death certificates continued to be highly accurate for both white and black populations during the 1999–2011 period. Misclassification remained high at 40% for the American Indian or Alaska Native (AIAN) population. It improved, from 5% to 3%, for the Hispanic population, and from 7% to 3% for the Asian or Pacific Islander (API) population. Decedent characteristics such as place of residence and nativity affected the quality of reporting on the death certificate. Effects of misclassification on death rates were large for the AIAN population but not significant for the Hispanic or API populations.

American Indians (AI) have the highest rate of severe physical housing problems
in the U.S. (3.9%). Little information exists about the environmental hazards in AI homes.
The purposes of this paper are to discuss challenges that were encountered when recruiting AI for a home-and employment-based environmental health assessments, highlight major successes, and propose recommendations for future indoor environmental health studies.
The Center for American Indian Community Health (CAICH) and Children’s Mercy
Hospital’s Center for Environmental Health and Allergy and Immunology Research Lab
collaborated to provide educational sessions and healthy home assessments for AI. Through educational trainings, more than 240 AI were trained on the primary causes of health problems in homes. A total of 72 homes and places of employment were assessed by AI environmental health specialists. The top three categories with the most concerns observed in the homes/places of employment were allergens/dust (98%), safety/injury (89%) and chemical exposure (82%). While some information on smoking inside the home was collected, these numbers may have been underreported due to stigma. This was CAICH’s first endeavor in environmental health and although challenges arose, many more successes were achieved.

Suicide is a significant health disparity among
Alaska Native youth, which is linked to cultural disruptions brought about by colonialism and historical
trauma. Many Indigenous suicide prevention efforts
center on revitalizing and connecting youth to their
culture to promote mental health and resilience. A
common cultural approach to improve psychosocial
outcomes is youth culture camps, but there has been
little evaluation research to test this association.
Here, we conduct a pilot evaluation of a 5-day culture camp developed in two remote regions of Alaska.
The camps bring together Alaska Native youth from
villages in these regions to take part in subsistence
activities, develop new relationships, develop life
skills, and learn traditional knowledge and values.
This pilot evaluation of the culture camps uses a
quantitative pre/post design to examine the outcomes of self-esteem, emotional states, belongingness, mattering to others, and coping skills among
participants. Results indicate that culture camps can
significantly increase positive mood, feelings of
belongingness, and perceived coping of participants.
Culture camps are a common suicide prevention
effort in Indigenous circumpolar communities, and
although limited in scope and design, this pilot
evaluation offers some evidence to support culture
camps as a health promotion intervention that can
reduce suicide risk.

Misclassification of race in medical and mortality records has long been documented as an issue in American Indian/Alaska Native data. Yet, little has been shared in a cohesive narrative which outlines why misclassification of American Indian/Alaska Native identity occurs. The purpose of this paper is to provide a summary of the current state of the science in racial misclassification among American Indians and Alaska Natives. We also provide a historical context on the importance of this problem and describe the ongoing political processes that both affect racial misclassification and contribute to the context of American Indian and Alaska Native identity.

View PDF

Needs Assessment of the Urban Indian Health Program and the Communities It Serves

A power point from Helena Indian Alliance on their Medication Assisted Treatment program.   Given by Tara Wells, APRN (MAT PROVIDER) Amy Nelson, RN, BSN (MAT COORDINATOR) and Jason McNees, CBHPSS

Dear Speaker Ryan:

On behalf of the National Indian Health Board, the National Congress of American Indians, and the National Council of Urban Indian Health, are writing to ask for your support for a long-term reauthorization of the Special Diabetes Program for Indians (SDPI), which expires on March 31, 2018. It would be a tragedy for this highly effective and popular program to expire for the first time since its creation due to Congressional inaction. Therefore, we request that the Congressional leadership include a long-term SDPI reauthorization in the next moving legislative vehicle, including the February 2018 Continuing Resolution or budget agreement.

Download full letter.

Request from Acting IHS Director for NCUIH and its Members to participate in the development of the 2018-2022 Strategic Plan by providing comments. It includes the Federal Register announcement as an enclosure.

Download

There are some resources available to AI/AN communities for human trafficking and more are in development.

American Indians experience morbidity and mortality from injury at a rate exceeding that for any other race in the United States' and specifically in the state of Oregon. It is possible that even the reported rates are underestimates of the true burden of injuries among American
Indians because of racial misclassification in vital records and morbidity registries.

I am writing to initiate an Urban Confer on establishing a standard methodology to allocate program increases to the Urban Indian Health budget line.

This paper examines what is known about suicide clusters within American Indian and Alaska Native (AI/AN) populations and uses that information to provide recommendations for stakeholders working to prevent and contain suicide clusters within AI/AN communities.

Within philanthropy there is a surge of interest in racial equity, accompanied by new support for Native-led organizing and social change organizations. This encouraging uptick runs counter to a long pattern of philanthropic neglect and under-investment in the infrastructure of Native American organizations and institutions. Nonetheless, questions abound. Is this new philanthropic interest in racial equity episodic? And will it translate into long-term and significant support for Native-led social change organizations to make Native American communities matter and thrive? 

The Integration Edge provides the latest tips and stories of how organizations are implementing primary and behavioral health care integration. A regularly updated resource from the SAMHSA-HRSA Center for Integrated Health Solutions for you and your team to get tips and examples of how organizations like yours implement integrated primary and behavioral health care.

REQUEST: We request that Congressman X weigh in with leadership and insist that long-term renewal of the Special Diabetes Program for Indians (SDPI) is contained in the next Continuing resolution or Budget Caps Agreement.

The Special Diabetes Program has been operating on short-term extensions since September 30. Current authorization is until March 31, 2018.

Treaty Health Services for Urban “Tribal” Members
Indian Health Services - Tribal Health Programs - Urban Program:
42 Urban Indian Health Programs Nationally – Impact on FY18 budget
Increase from 35 last year (7 NIAAA programs added to Title V)
20% program increase without equal increase in funding

The NCUIH mission is to support its membership in the development of quality, accessible, and culturally competent healthcare programs for American Indians and Alaska Natives living in urban communities by serving as a resource center providing advocacy, education, technical assistance, training, and leadership.

In 2016, about half (51%) of serious violent crimes, including rape or sexual assault, robbery, and aggravated assault, were reported to police (figure 1).1 In comparison, 42% of all violent crimes and 36% of property crimes were reported to police.

On behalf of the National Council of Urban Indian Health (NCUIH), which represents over forty urban Indian health programs (UIHPs) across the nation, I urge you not to support the Graham-Cassidy-Heller-Johnson measure to repeal and replace the Affordable Care Act (ACA) until the measure is reformed to ensure it is consistent with the federal government’s Trust Responsibility to provide American Indian/Alaska Native (AI/AN) people with health care. This obligation has been reaffirmed, repeatedly, by all three branches of the federal government, one which cannot be passed on to the states, and one which follows AI/AN people off of reservations and into urban areas.

WHEREAS, the National Indian Health Board (NIHB), established in 1972, serving all Federally recognized American Indian/Alaska Native (AI/AN) Tribal governments by advocating for the improvement of health care delivery to AI/ANs, as well as upholding the Federal government’s trust responsibility to AI/AN Tribal governments, does hereby establish and submit the following resolution

This manual describes the annual Uniform Data System (UDS) reporting requirements for all health centers that receive federal award funds (“grantees”) under the Health Center Program authorized by section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b) (“section 330”), as amended (including sections 330(e), (g), (h), and (i)), as well as Health Center Program look-alikes (“look-alikes”). Look-alikes do not receive federal funding under section 330 of the PHS Act. However, they must meet the Health Center Program requirements for designation under the program (42 U.S.C. 1395x(aa)(4)(A)(ii) and 42 U.S.C. 1396d(l)(2)(B)(ii)). Certain health centers funded under the Health Resources and Service Administration’s (HRSAs) Bureau of Health Workforce (BHW) also are required to complete annual UDS reporting.

Dear Chairman Alexander and Ranking Member Murray:

On behalf of the National Council of Urban Indian Health (NCUIH), which represents over forty urban Indian health care programs (UIHPs) across the nation which provide high-quality, culturally-competent care to urban Indians, who constitute more than 70% of the nation’s American Indian/Alaska Native (AI/AN) people, I urge the Health, Education, Workforce, and Pensions (HELP) Committee to expeditiously mark up and promote passage of legislation to reauthorize the Special Diabetes Program for Indians (SDPI)--particularly S. 747, a bill introduced by Senator Tom Udall (D-NM), which would extend the program for 7 years through 2024, at no increase in cost other than taking into account health care inflation.

Objectives. To estimate obesity and overweight prevalence in American Indian and Alaska Native (AI/AN) children across genders, ages, and geographic regions in the Indian Health Service active clinical population.

Methods. We obtained data from the Indian Health Service National Data Warehouse. At least 184 000 AI/AN children aged 2 to 19 years had body mass index data for each year studied, 2006 to 2015. We calculated body mass index percentiles with the 2000 Centers for Disease Control and Prevention growth charts.

Use this guide to Using Mental Health and Substance Use Disorder Services, with the Roadmap to Better Care and a Healthier You to understand how to use your
coverage to improve your mental and physical health. This guide adds to the 8 steps of the Roadmap to give important information about behavioral health.

What is the federal government’s trust responsibility for Indian health care?

Under law, tribal governments are treated as “domestic dependent nations”—similar to states in terms of sovereignty but with a trust obligation from the federal government. The federal government is considered to be the trustee with responsibility for the 567 federally-recognized tribes.

The trust responsibility means that the government has a fiduciary duty to act in the best interest of Tribes and American Indians / Native Alaskans (AI/AN). That responsibility is not restricted to the borders of reservations, and it includes issues related to health care.

This community health profile provides an overview of the health status of AI/ANs living in select urban counties served by the network of Subchapter IV UIHPs across the country. This document presents data specific to demographics, social determinants of health, mortality, sexually transmitted diseases, maternal and child health, substance use, and mental health.

In recent years, the Department of Veterans Affairs (VA) health care system has mounted a response to HCV that should be the envy of any health system, public or private. On the other hand, the Indian Health Service (IHS), an agency that serves American Indians and Alaska Natives, is struggling to meet the needs of its patients with HCV.

The Association of American Indian Physicians’ (AAIP) Healthy Active Native Communities project is working toward increasing access to and impact of obesity prevention projects in
American Indian and Alaska Native (AI/AN) communities. 

On June 26, the Indian Health Service (IHS) initiated listening sessions related to the Resource and Patient Management System (RPMS) Electronic Health Record (EHR). Several Tribes have requested additional sessions, so we have added two listening sessions to seek further input and recommendations from American Indian and Alaska Native Tribes, Tribal Organizations, and Urban Indian Organizations, on how best to modernize and improve our EHR.

I am writing to invite you to join the Indian Health Service (IHS) for a meeting to confer on the distribution of the fiscal year (FY) 2017 Urban Indian Health budget increase, in accordance with IHS policy on Conferring with Urban Indian Organizations (UIOs). The balance of funds available for distribution for FY 2017 is $1,137,000.

Purpose: With a sample of American Indian adults, we estimated the prevalence of adult caregiving, assessed the demographic and cultural profile of caregivers, and examined the association between cultural factors and being a caregiver. This is the first such study conducted with American Indians.

Design and Methods: Data came from a crosssectional study of 5,207 American Indian adults residing on 2 closely related Lakota Sioux reservations in the Northern Plains and one American Indian community in the Southwest. Cultural factors included measures of cultural identity and traditional healing practices. 

The terms 'quality-of-life', 'wellbeing' and 'happiness' denote different meanings; sometimes they are used as an umbrella term for all of value, and the other times to denote special merits.

This paper is about the specific meanings of the terms. It proposes a classification based on two bi-partitions; between life 'chances' and life 'results', and between 'outer' and 'inner' qualities. Together these dichotomies imply four qualities of life: 1) livability of the environment, 2) life-ability of the individual, 3) external utility of life and 4) inner appreciation of life.

This fourfold matrix is applied in three ways: firstly to place related notions and alternative classifications, secondly to explore substantive meanings in various measures for quality of life and thirdly to find out whether quality-of-life can be measured comprehensively. This last question is answered in the negative. Current sum-scores make little sense. The most inclusive summary measure is still how long and happily people live.

This study identified prevalence of dis­abilities, employment, and rehabilitation needs of four eastern tribal members. Chi-square tests were conducted to compare females to their male counterparts. Females were more likely to experience arthritis and orthopedic challenges; males to experience substance abuse. No gender difference in employment rate was found.

Native Americans are reported to have many health problems and a significant need for more health education and mental health services. This paper is part of a five-year research project funded by the National Institute on Disability and Rehabilitation Research (NIDRR) that addresses the health, disability and service needs of Native Americans in eastern tribes. The Mashantucket Pequot Tribal Nation (MPTN) is the lead grantee representing three Native American tribes in the state of Connecticut and one Native American tribe in Rhode Island that are building capacity to improve the quality and utility of research related to Native Americans with disabilities. The Participatory Action Research model with a community-based approach was used to facilitate collaboration among the participating tribes. Native American research technicians conducted individual interviews with members of their tribes. Demographics, prevalence of disabilities, and various factors associated with health and mental health are presented.

My name is Ashley Tuomi. I am an enrolled member of the Confederated Tribes of Grand Ronde of Oregon, the CEO of American Indian Health and Family Services of Southeast Michigan, and the President of the National Council of Urban Indian Health. On behalf of 43 clinics and programs located in 21 states, I am grateful for this opportunity to once again testify before the Appropriations Subcommittee.

This document is intended as a brief overview of documentation of tribal codes for consistent registration of eligible Urban Indians in RPMS and Non-RPMS systems by urban Indian organizations.

Good morning my name is Ashley Tuomi, I am an enrolled member of the Confederated Tribes of Grand Ronde of Oregon and I am the Chief Executive Officer of the American Indian Health and Family Services of Southeastern Michigan, Inc., and the President Elect of the National Council of Urban Indian Health. On behalf of the 34 Urban Indian Health clinics and programs, which are located in 21 states, I am grateful for this opportunity to testify before the Appropriations Subcommittee.

I am writing to provide updates on several important Indian Health Service (IHS) behavioral health initiatives. 

Good afternoon my name is Donna Keeler, I am enrolled member of the Eastern Shoshone Tribe from the Wind River reservation in Wyoming, and I am the Executive Director of the South Dakota Urban Indian Health Clinics, and the President of the National Council of Urban Indian health. On behalf of the 37 Urban Indian Health clinics and programs, which are located in 21 states and have 43 individual sites, I am grateful to the Chairman for this opportunity to testify before the Appropriations Subcommittee.

The population of American Indians and Alaska Natives (AIAN) in the USA, which comprise about 5 million individuals, have worse health outcomes than other Americans. 

This letter is being sent to your organization to inform you that the Office of Urban Indian Health Programs would like to provide an administrative supplement to your program.

I am writing to provide an update on efforts by the Indian Health Service (IHS) to combat the opioid epidemic facing American Indian and Alaska Native (AI/AN) communities.

I am writing to update you on systems enhancements related to the use of electronic prescriptions for controlled substances (EPCS). The Indian Health Service (IHS) has developed a plan and project schedule to bring the Resource and Patient Management System (RPMS) Electronic Health Record (EHR) into compliance with Drug Enforcement Administration (DEA) EPCS requirements. We anticipate software development and testing to occur over the summer of 2017, with the release of the software for implementation by the end of this calendar year.

The aim of this exploratory study, which was informed by ethnographic principles, was to better understand the intergenerational transmission of historical trauma among urban American Indians/Alaska Natives (AI/ANs) in culturally specific sobriety maintenance programs. The results of the study were organized into 3 overarching categories, which included 10 themes that emerged contextually in relation to participants’ lived experience of historical and associated traumas, substance abuse, and current involvement in a culturally specific sobriety maintenance program.

In a significant decision, the U.S. District Court for South Dakota in Rosebud Sioux Tribe v. United States, et al., 3-16-CV-03038-RAL, recently held that the Tribe's claim that the IHS violated the Federal trust responsibility to provide Indian health care was sufficient to survive a motion to dismiss.

Since 2005, the National Indian Education Study (NIES) has provided educators, policymakers, and the public with information about the educational experiences and the academic performance of fourth- and eighth-grade American Indian and Alaska Native (AI/AN) students in the United States.

I am committed to ensuring transparency and accountability at the Indian Health Service (IHS). To that end, I want to address a subject I've received many questions about: the perception that the IHS is returning a significant amount of unused money to the United States Treasury each year.

This is inresponse to your letter dated April 27, 2015, to the Drug Enforcement Administration (DEA). On behalf ofindian Health Service (IHS), and pursuant to Title 21, C_ode of Federal Regulations, Section 1307.03 (21 C.F.R. § 1307.03) you requested an exception to the conditions of 21 C.F .R. Part 1311, Subpart C. Specifically, you requô€€¨sted an exception to 21 C.F .R. § § 1311.115, 1311.120(b )(9), (b )(13), (b )(23), (b )(25), 1311.150, l 311.215(b ), and 1311.300 because IHS anticipates completion of software development, testing, certification, and release to bring IRS' s Resource and Patient Management System Electronic Health Record (RPMS/EHR) into conformity with the Interim Final Rule (IFR) titled, Electronic Prescriptions for Controlled Substances by December 2018. This IRF became effective June 1, 2010.

As an obstetric resident I once took care of a young Native American woman who had been transported by helicopter from a remote rural community because she had been assaulted by her intoxicated partner. She was early in her third trimester, and the damage to her face and extremi-ties was dramatic but not life threatening. However, the trauma to her abdomen resulted in a fracture of the femur of her unborn 28-week-old female fetus. Our team recognized that while we could successfully get her safely through her pregnancy, the real challenges she and her daughter faced would come upon her return home. For American Indian people, context matters and is a key determinant of health and mortality. We need to examine what’s really killing our children across a spectrum of health indicators, and public health needs to intervene at all levels.

I am pleased to share an update on the status of the exemption of certain Indian Health Service (IHS) positions from the Federal civilian hiring freeze as provided by the Office of Management and Budget's (0MB) guidance memoranda (M-17-171 and M-17-182) for implementing the Presidential Memoranda Regarding the Hiring Freeze. 

SDPI should be have a long-term reauthorization of at least $200 million September 30, 2017, so that these programs can continue to eradicate diabetes and communities can access culturally appropriate diabetes care.

On behalf of the National Council of Urban Indian Health (NCUIH), which represents urban Indian health care organizations across the nation, I thank you for your service and congratulate you on becoming the agency’s acting chief medical officer.

On behalf of the National Council of Urban Indian Health (NCUIH), which represents urban Indian health care programs (UIHPs) across the nation that serve the 70% of American Indians and Alaskan Natives (AI/AN) who live in urban environs, we urge your Administration to exempt the Indian Health Service (IHS) from the federal hiring freeze imposed pursuant to your January 23 memorandum.

On behalf of the National Council of Urban Indian Health (NCUIH), which represents urban Indian health care organizations across the nation, I thank you for your service and congratulate you on becoming the agency’s OCPS acting director.

On behalf of the National Council of Urban Indian Health (NCUIH), which represents urban Indian health care organizations across the nation, I thank you for your service and congratulate you on becoming the agency’s acting chief of staff.

IHS Response Letter to NCUIH regarding the request for  IHS's Commitment to Expanding Access to Oral Health Care Services in Indian Country.

X

This Memorandum of Understanding (“MOU”) is by and between the National Council of Urban Indian Health, hereinafter referred to as NCUIH” and the Association of American Indian Physicians, hereinafter referred to as “AAIP” both of which are hereinafter referred to as “organization” or collectively as “organizations”. This MOU coveys the commitment of the organization to work together for the purpose of achieving various aims and objectives in relation to mutual collaboration in future opportunities to improve the health of American Indian/Alaska Native communitie

Too often, the lives of Native American youth are understood through a narrow media lens
that focuses almost exclusively on disparities and the challenges that face them, and very little on solutions. This leaves the public feeling that the barriers in front of Native youth are intractable — their situation, hopeless.

This could not be further from the truth. Native youth are accomplishing incredible things together across the country every day. They are drawing strength from their cultures to help revive their languages, improve their peers’ outcomes in schools, improve their communities’ health by bringing back traditional foods, and reach out and give hope to other youth when hope is hard to find.

In July 2016, 30 leaders and workers of Urban Indigenous Organizations (UIO) from across the United States gathered together in Denver, Colorado. This meeting was an innovative collaborative event where attendees discussed the priorities and barriers of advancing the work in their respective arenas. The gathering was hosted and made possible by First Nations Development Institute, with further support from the National Urban Indian Family Coalition, the Kresge Foundation and the Comcast Foundation. After two days the attendees had identified shared themes and trends and where the most powerful leverage points for positive change may be.

Dear Mr. Bermudez Del Villar :
I am writing to initiate an urban confer through Monday, December 5, to request rapid input on the Indian Health Service's (IHS) Office of Urban Indian Health Programs (OUIHP) draft Strategic Plan - Strategic Planning for Urban Indian Health Programs. I have enclosed a copy of the draft Strategic Plan for your review. The 2016 Consolidated Appropriations Act (Act) directed the IHS to develop a strategic plan for urban Indian health programs in consultation with urban Indians and the National Academy of Public Administration.

This Memorandum of Understanding ("MOU") is by and between the National Council of Urban Indian Health ("NCUIH") and the National Center for American Indians with Disabilities ("NCAID") for the purpose of achieving various aims and objectives in relation to mutual collaboration in future opportunities.

Preventing and Responding to Suicide Clusters in American Indian and Alaska Native (AI/AN) Communities

Honorable Chairman and Committee Members, my name is Georgiana Ignace, President of the National Council of Urban Indian Health (NCUIH). I am a member of the Menominee Tribe and serve on the board of the Gerald L. Ignace Indian Health Center, Inc., which provides health care services to the Milwaukee urban Indian community. On behalf of NCUIH, and its 34 member programs, I would like to express our appreciation for this opportunity to testify before your Committee on urban Indian health issues.

Origin of the “Confer” Requirement – An Agreement Reached with NCUIH and
the Title V Programs. As originally drafted by the Senate Committee on Indian Affairs,
the Indian Health Care Improvement Act reauthorization legislation provided for the
Secretary of Health and Human Services to “consult” (not “confer”) with both tribes and
“urban Indian organizations.” Late in the process, a regional inter-tribal organization
became involved and had, as one of its major concerns, an objection to the application of
the term “consult” with regard to NCUIH and its members. The conflict escalated as
NCUIH felt that it was vital to NCUIH and its membership that they have an elevated
status in IHS deliberations about matters that affect the urban Indian community. The
Senate Committee on Indian Affairs convened several meetings to seek a resolution of
this conflict.

The “Definitions of Indian” in the Affordable Care Act (ACA) are not consistent with the definitions already used by the Indian Health Service (IHS), Medicaid and the Children’s Health Insurance Plan (CHIP) for services provided to American Indians and Alaska Natives (AI/ANs). The ACA definitions, which currently require that a person is a member of a federally recognized Tribe or an Alaska Native Claims Settlement Act (ANCSA) corporation, are narrower than those used by IHS, Medicaid and CHIP, thereby leaving out a sizeable population of AI/ANs that the ACA was intended to benefit and protect.

REQUEST: Enact legislation that would streamline the Definition of Indian in the Affordable Care Act (ACA) to conform with definitions used by IHS and the Centers for Medicare & Medicaid Services. For Senators, Co-sponsor S. 2114, introduced by Senator Lisa Murkowski (R-AK) which would provide a legislative fix to Definition of Indian in the Affordable Care Act.

American Indian and Alaska Native (AI/AN) youth experience trauma at higher rates than other youth in the U.S. population. In fact, according to a report by the Indian Country Child Trauma Center (BigFoot et al., 2008), Native youth are 2.5 times more likely to experience trauma compared to their non-Native peers. A recent report from the Attorney General’s Advisory Committee on AI/AN Children Exposed to Violence noted that AI/AN juveniles experience posttraumatic stress disorder (PTSD) at a rate of 22 percent, the same rate as veterans returning from Iraq and Afghanistan, and triple the rate of the general population (Dorgan et al. 2014; Robin et al. 1996).

American Indian and Alaska Native (AI/AN) youth experience trauma at higher rates than other youth in the U.S. population. In fact, according to a report by the Indian Country Child Trauma Center (BigFoot et al., 2008), Native youth are 2.5 times more likely to experience trauma compared to their non-Native peers. A recent report from the Attorney General’s Advisory Committee on AI/AN Children Exposed to Violence noted that AI/AN juveniles experience posttraumatic stress disorder (PTSD) at a rate of 22 percent, the same rate as veterans returning from Iraq and Afghanistan, and triple the rate of the general population (Dorgan et al. 2014; Robin et al. 1996).

Infograph

Infograph on PrEP 101

I am writing to confer on effective evaluation data for Urban Indian health programs (UIHPs) that are funded by the Indian Health Service (IHS) under Title V of the Indian Health Care Improvement Act (IHCIA). During several meetings over the past 2 years, I have heard that some programs are concerned that the data and evaluation requirements for Title V UIHPs are difficult to meet for some programs and do not accurately reflect the range of programs and services of UIHPs. For example, while certain clinical measures may be routine for UIHPs with ambulatory clinics, they may be difficult to meet by UIHPs that only provide limited clinical services or outreach and referral services.

The Methamphetamine and Suicide Prevention Initiative is critical for American Indian and Alaska Natives due to substantially alarming rates of suicide and methamphetamine abuse in Indian Country. Since, September 2009, the MSPI efforts to serve American Indian and Alaska Native communities successfully contributed to over 9,400 individuals entering treatment for methamphetamine abuse. Additionally, over 12,000 substance abuse and mental health encounters were conducted via tele-health. Furthermore, desperate calls for individuals trained in suicide crisis response were answered with 13,150 professionals and community members undergoing such trainings. Lastly, more than 528,000 encounters with youth were provided as part of evidence-based and practice-based prevention activities.

The Indian Health Service (IHS or ‘‘the Agency’’) is issuing this Notice to implement the final Policy for conferring with Urban Indian Organizations (UIOs). In March 2010,the Indian Health Care Improvement Act (IHCIA) was reauthorized and amended as part of the Patient Protection and Affordable Care Act, Public Law 111–148, as amended by the Health Care and Education Reconciliation Act (together, the Affordable Care Act), Public Law 111–152. One of the changes made to the IHCIA was to create a new requirement that the IHS ‘‘confer’’ with UIOs, to the maximum extent practicable, in carrying out the IHCIA.

This Division provides no Indian- or tribal-specific provisions or protections. However, Indian people would enjoy the same benefits - or suffer the same penalties (e.g., tax penalties) that apply to the general population, with no recognition of the US trust responsibility for Indian health. In addition, there is no language to guarantee that Indian health care providers would be assured admission to provider networks. In fact, the licensing provision included in this Division would actually exclude Indian health care providers from participation in public plan. The omission of specific Indian language in this Division prompted the development of Rahall amendment package.

AMENDMENT IN THE NATURE OF A SUBSTITUTE TO H.R. 3200 OFFERED BY MR. WAXMAN OF CALIFORNIA

In the summer of 2006 the Board of Directors and Staff of the National Council on Urban Indian Health (NCUIH) met in a retreat to review the previous strategic planning efforts of the organization and to prepare a revised five year (2006-2011) strategic plan.  In order to maintain a strategic focus within its current operating environment NCUIH will be monitoring this strategic plan at each of its meetings. Efforts are also underway to identify opportunities later in the 2006/2007 and 2007/2008 fiscal years to enable the organization to engage in an intensive strategic planning process.

The National Congress of American Indians Resolution #SAC-06-071

Title: Opposing the Presidents Request to Eliminate the urban Indian Health Programs

The 2010 Census will shape the next decade for Indian country. Not only does the Census count define the tribal voice in Congress but it seriously affects funding and other opportunities for tribal people. The future of Indian Country is dependent upon an accurate count to allow for economic growth and improvement in services for native people. Unless US Census strategically targets the urban American Indian/Alaska Native population, the count will be incomplete. The devastating effects of this will permeate beyond the urban setting and affect tribal people living in all areas of the country. It is the position of the National Council of Urban Indian Health that failure to strategically target the urban Indian population will ultimately result in even more significant disparities in health and is committed to a complete and accurate count of all American Indians and Alaska Natives.

Although the Urban Indian Health Program (UIHP) constitutes only 1% of the Indian Health Service budget, it provides an important link in the circle of health services that connects the reservation Indian population and the Urban Indian population (between which there is an ongoing mixing and movement). Removing Urban Indians from the IHCIA would also be a complete financial debacle for Tribal Programs nation-wide. This proved to be the case with the closing of the IHS operated urban facility in Albuquerque in 2005. Urban Indians were forced to return to reservations to obtain medical care, consuming the scarce resources available in the already overburdened Tribal facilities. The end result of the closing of this urban facility was indeed financial chaos for a series of Tribes; especially if we consider that- according to the 2000 Census- 67 % of Americans identifying themselves as of American Indian or Alaska Native heritage live in urban areas.

On behalf of all the Urban Indian Health Programs, I would like to extend my warmest thanks for your essential testimony today at the Committee on Natural Resources hearing on the reauthorization of the Indian Health Care Improvement Act.

The American health care system has undergone revolutionary changes in the last two decades. Unfortunately these changes are not reflected on the American Indian/Alaska Native health care system, above all because the Indian Health Care Improvement Act (IHCIA) has escaped reauthorization for thirteen years. Thus, the improvements in technology and methods of health care that have swept through the American medical landscape have rendered Native American health services outdated.

In a coordinated effort NCUIH, NIHB, NCAI and several tribal consultants met with more than fourteen Republican members of the Energy and Commerce Committee last week to discuss the possible reauthorization of IHCIA. The meetings served as a platform for discussing the means necessary to bring Native American health care into the 21st Century.

The National Council of Urban Indian Health thanks the Senate Committee on Indian Affairs for seeking the views and suggestion from all of Indian Country on the redrafting of the Indian Health Care Improvement Act. Some have referred to the Indian health delivery system has broken, but it would be better to refer to the system as starved. Many of the vital elements of health delivery in Indian Country are unable to function properly due to either significant lack of resources or the inability to utilize those resources in ways that modern health care require. Health care reform can only go so far in moving Indian health care forward without the necessary increases in funding to support the programs and opportunities contained in H.R. 2708 and the Committees concept paper. That said this concept paper presents the desperately needed modernizations to the Indian health system.

As an ever evolving entity, Indian Country was formed with many sovereign nations and communities within the United States; its geographically and culturally varied nature created multiple governmental dynamics through the years. Thus a series of different development initiatives evolved into a complex political, legal and cultural system. A system that was heavily influenced by the US Governments decisions and funding. The strength of its cultural values, as well as the deeply entrenched life principles, however, made Indian Country evolve different than what the US Government had planned. American Indians did not blend into the melting pot-- not even in the most pressing economic and social situations. Moreover, Indians did not remain constrained to reservation lands. Forced and voluntary mass migration on Indian people to urban and semi-urban settings took place in the last forty years. This has resulted in an expansion of Indian presence beyond tribal lands and, in fact, Urban Indian communities are the perfect synthesis of both the proof of how strong Indian Identity is (regardless of location and circumstances); and also a proof that the Indian paradigm needs to evolve at the same pace as its population.

Following months of political stalemate, the Ryan White Care Act (RWCA) was reauthorized by the Senate last week. While the passing of the bill bodes well for all individuals infected with HIV/AIDS, the news of the reauthorization was also widely lauded by Indian Country. For the first time in the history of RWCA, provisions guaranteeing treatment for Native Americans are included.

Today the Senate Committee on Indian Affairs approved S.1790, the Indian Health Care Improvement Act Extension and Reauthorization of 2009 and S.1635, 7th Generation Promise: Indian Youth Suicide Prevention Act of 2009 by unanimous voice vote. The committee will report the two bills as amended out from the committee. Chairman Byron Dorgan accepted en bloc: Dorgan managers amendment; Udall/Cantwell Facilities list/ADF amendment; and Murkowski amendments pertaining to sanitation facilities and definition clarifications. The committee also voted and approved two additional amendments: the first from Senator Tester on three additional Title V provisions, and the second from Senator Franken will create a permanent position to coordinate HIV/AIDs prevention and treatment as well as to provide additional technical assistance to Indian health care providers.

The conference report provided $4.1 billion for the service, $451 million (13%)more than regular FY 2009excluding funds received in the stimuluswhich is equal to the House bill. When the stimulus funds are taken into account, the measure provides $29 million less than the current level. Within that total, $3.7 billion is for health services, $395 million for health facilities, and $43,139,000 for the Urban Indian Health Program.

President Obama signed into law the American Recovery and Reinvestment Act of 2009 this past Tuesday after several weeks of intense debate and work in Congress. NCUIH, working with NIHB and NCAI worked to ensure that key provisions from Title II of the Indian Health Care Improvement Act and critical appropriations for Indian health care were included in the bill. Although NCUIH was unsuccessful in obtaining the 20 million for Urban Indian health facilities renovation and construction in the ARRA, we were successful in securing several key changes to the Social Security Act with regard to Medicaid, Medicare and SCHIP.  NCUIH is still in the process of fully analyzing the bill and the new health provisions that it has introduced. Many of the new provisions regarding health care deliveryparticularly the provisions regarding health information technology and comparative effectiveness researchhave the potential to drastically change health policy and health care delivery. NCUIH will be preparing an in depth analysis of these provisions and the potential impact that they could have upon Urban Indian Health Program clinics and programs in the upcoming weeks. NCUIH will also be working with other health organizations to ensure that as the Department of Health and Human Services implements these changes, Urban Indian health concerns are heard.

submission form for publications to be added to the knowledge resource center

On behalf of the National Council of Urban Indian Health (NCUIH), I am writing to ask for your assistance in overcoming some last minute concerns raised by Senator Enzi that have the potential to block passage of the Indian Health Care Improvement Act (S. 1200).  We believe that the Senators concerns are largely based on misinformation and ask that you write the Senator in support of the bill as it is written without further damaging amendments.  By standing together, Indian Country has greatly advanced this critical legislation.  We urge you to stand with the urban Indian health programs, which provide services to your tribal members when they are in the cities we serve, so that those who would divide us and seek to kill this vital legislation are finally defeated themselves.     

Urban Indian Communities nation-wide are thrilled to know that we have your support, empathy and understanding in our quest to restore and dignify healthcare access for Native Americans living in urban settings. For such reason, we would like to hereby officially request your presence as a speaker in our Annual Conference on September the 18th, 2007-- here in Washington, D.C.  This event will also be a unique opportunity for us thank you for being our champion in Urban Indian Health issues.

Objective: To compare rates of motor vehicle crash (MVC) fatalities among different race/ethnic groups in urban and rural Arizona.  

This article explores patterns of morbidity and comorbidity and their ability to predict functional disability among American Indian elders, using data from a sample of urban, rural off-reservation, and reservation Great Lakes American Indians age 55 and older.

Modifications to the Chairmans Mark

DAmericas Healthy Futures Act of 2009

September 22, 2009

Modifications to the Chairmans Mark,

Title IHealth Care Coverage

Prepared by Ed Fox

July 7, 1999 minutes work group 3 Finance for Title IV of the Indian Health Care Improvement Act

Primary Objective: To determine the incidence and epidemiology of emergency department (ED)-attended mild traumatic brain injury (mTBI)in the US.

The Indian Health Service (IHS), Division of Behavioral Health welcomes you to the Methamphetamine and Suicide Prevention Initiative (MSPI).

The (MSPI) is a nationally-coordinated demonstration program, focusing on providing much needed funding for methamphetamine and suicide prevention and treatment to Indian Country. This initiative promotes the development of evidence-based and practice-based models that represent culturally appropriate treatment approaches from a community-driven context.

The MSPI is comprised of 124 Federal, Tribal, and Urban Programs that proposed new and enhanced methods of addressing methamphetamine and suicide crises.

Mental health needs of Native American youth in the Oregon juvenile justice system are compared to those of Euro-American youth.  The comparison is between 109 Euro-American youth and 22 Native American youth drawn from two samples of youth adjudicated to community service and incarcerated.  The youth completed a mental health history and indices of mental health and health status.

This report presents the design, implementation, and results of a 1992 mental health needs assessment of Tucson's urban American Indians.  The study was conducted under the auspices of the Traditional Indian Alliance (TIA) of Greater Tucson, Inc.  TIA is a community-based, non-profit corporation committed to addressing the health and social welfare issues of Tucson's American Indians. 

Memorandum between UIHO's and the Robert Wood Johnson Foundation

This memorandum of understanding (MOU) is entered into between the National Native American AIDS Prevention Center (NNAAPC) - hereafter referred to as NNAAPC - and National Council on Urban Indian Health - hereafter referred to as NCUIH -  in order to enhance, advocate and strengthen Health and HIV prevention provided to American Indian and Native Alaskan. Through this MOU, NNAAPC will collaborate when appropriate with NCUIH.

This Memorandum of Cooperative Agreement is entered into between the National Congress of American Indians, hereafter referred to as NCAI, and the National Council of Urban Indian Health, hereafter referred to as NCUIH.

As set forth by this agreement, a cooperative relationship is hereby established between NCAI and NCUIH while recognizing the independent and autonomous authorities of each entity. The major purpose of this agreement is to facilitate shared efforts to promote health care for all Indian people and to cooperate by providing services, technical help and outreach  to each other in areas of  common interest.

Memorandum Kauffman & Associates may-8-2000

Itinerary for Fayetteville, NC update on other site visits

Legislative Goal for the Special Diabetes Program for Indians Congress established the Special Diabetes Program for Indians (SDPI) in 1997 and the program was reauthorized in 2002, for five years at $150 million per year. The SDPI is a grant program administered by the Indian Health Service (IHS) and grants are awarded to IHS service units, Tribes and Tribal organizations, and urban Indian clinics to provide diabetes prevention and treatment programs. The SDPI is set to expire in 2008.

Medicare Prescription Drug Legislation Summary Talking Points

Discount drug care

Traditional Medicare

Low-income seniors

New Medicare Advantage

Health Savings Accounts for all Alaskan

Presentation on Meaningful Use, and the Electronic Health record Program. Presentation was held at the 2011 Annual Leadership Conference, presented by Merriah Gille

Letter from Byron Dorgan to tribal leaders stating his and the SCIA steadfast support and dedication to IHCIA being passed.

 As we begin the next century, I believe it is important to reaffirm the Federal Government's commitment to providing health services to American Indian and Alaska Native AI/AN people.

Proof of this commitment is the dedication of the Indian Health Service (IHS) to its mission of ensuring that health care services are available and accessible to all eligible AI/AN people. The IHS and tribes share a unique partnership in carrying out this mission, whether the local program is operated directly by the IHS or by tribal governments through the Indian Self-Determination and Education Assistance Act (ISDEAA), Public Law (P.L.) 93-638, as amended.

As the President of the National Council of Urban Indian Health (NCUIH), and on behalf of the 36 urban Indian health clinics serving over 150,000 patients annually, I write to request your support for H.R. 1328, the Indian Health Care Improvement Act (IHCIA). In February the Senate passed S.1200, the Senate version of the IHCIA, by an overwhelming veto-proof vote of 83-10. This vote gives us the opportunity for the enactment of a reauthorization bill this Session, but only with your support. On June 6th all three Committees of jurisdiction: Energy and Commerce, Ways and Means, and the Natural Resources announced that they have completed all consideration of the bill. IHCIA is ready for the floor of the House. We ask you stand up for all American Indians and Alaska Natives and support this bill.

We write to implore you to support H.R. 1328, the bill to reauthorize the Indian Health Care Improvement Act (IHCIA), and to urge that this bill move through the House on a bi-partisan basis.  Members of both parties and all of Indian Country have labored for ten years to craft this measure and the time to pass it is now.  The IHCIA was enacted in 1976 to address the deplorable health conditions in Indian Country and was last reauthorized in 1992, more than sixteen years ago.  With passage of the Senate bill, S. 1200, by an overwhelming vote of 83-10, Indian Country finally sees the opportunity for enactment of a reauthorization bill this Session.  As of June 6, 2008, all three House Committees of jurisdiction, Natural Resources, Energy & Commerce, and Ways & Means have completed consideration of the bill.   The bill is ready for final action in the House.

Letter from various Senators expressing concern over lack of support for prevenative measures for HIV/ AIDS for American Indians

Urban Indian Health Organizations are not only a source of unique and culturally appropriate health care for the urban Indian population they also serve as a critical cultural link for urban Indians struggling for identity. They are  also an indispensable partner in providing services to families in their local communities across the country. Far from duplicating the health services offered by CHCs, Urban Indian Health Organizations have a proven track record of providing quality care  and targeted outreach to vulnerable American Indians and Alaska Natives living in urban areas. Losing Title V would undermine the Urban Indian Health Organizations ability to retain its high quality and culturally appropriate services to the wildly underserved while at the same time weakening the local public health safety net.  

Letter to Speaker of the House Nancy Pelosi from Eli Grayson President of the California Muscogee (Creek) Association thanking for the support of Indian Health Care Improvement Act (IHCIA)

I am writing to express my strong support of Dr. Yvette Roubideaux for the position of Director of Indian Health Services (IHS). I express individual support but also extend support on behalf of the National Council of Urban Indian Health, our 36 member programs and the 150,000 patients that our programs serve annually. We feel that Dr. Roubideaux not only has the experience and passion to be a dynamic Director, but that she is also deeply innovative at a time where innovation and the ability to think creatively are desperately needed. As health care reform moves forward all American Indians and Alaska Natives, particularly those living in urban centers, need a Director at IHS that is able to fully exploit the opportunities opening at this time. The Indian Health Service must be flexible at this time. Dr. Roubideaux is a person who understands the need to re-imagine not just what the Indian Health Service is currently doing, but what it could be doing.

Engaging Young Minds and Sustaining Youth in Prevention Programs Powerpoint Presentation from Friendship House Association of San Francisco 

Kauffman & Associates Slides, Suicide Among American Indian/Alaskan Native Youth


Trauma in AI/AN Communities
Consequences of Trauma
Individual Risk Factors.......

1. Evidence-based Practices for Effective Case Management (Behavioral Health)
2. Department of Defense and Veterans Affairs Joint Suicide Prevention Conference (Behavioral Health, Outreach)
3. 29th Annual "Protecting Our Children" American Indian Conference (Youth Services, Behavioral Health)
4. Native H.O.P.E. (Helping Our People Endure) Training (Behavioral Health)
5. Nike Premieres Air Native N7 Walking Shoe

This issue of the Information Dose includes:
1) An article from CMS regarding Billing for the H1N1 Vaccine (Billing staff).
2) An announcement for the American Indian/Alaska Native Health Policy Conference in  Albuquerque on October 22-23 (Executive Director)
3) An announcement for a September 14th conference call Information Sharing from HHS on H1N1. (Medical and Other: Public Health)

In This Issue

• Methamphetamine Presentations from UCLA
• Meth 360 Information Kit
• Project Venture: Evaluation of an Experiential, Culturally Based Approach to Substance Abuse Prevention with American Indian Youth
• National Indian Youth Leadership Project Gallup, NM
• Oklahoma Methamphetamine Prevention Toolkit
• National Congress of American Indians Partnership for a Drug-Free America, Meth Awareness Campaign for Indian Country, Meth Focus Group Analysis

In This Issue:

• 7thAnnual Phoenix Area Integrated Behavioral Health Conference (Behavioral Health Staff)
• Native Health Database (All Staff)
• Warrior Spirit 2010 Indigenous Psychology Conference (Behavior Health Staff)
• National Children's Mental Health Awareness Day 2010 (Behavior Health Staff)
• The National Institute on Drug Abuse (NIDA) Conference (Behavior Health Staff)
• Census 2010 Are you up for the "Take 10" challenge? (Community Outreach Staff)

In this issue

1.                   Public Safety in Indian Country Press Release (Executive Director)

2.                   Article-Challenges for Native American Victims of Domestic Violence (Executive Director, Behavioral Health, Medical)

3.                   National Children's Health Insurance Summit--Strategies for Increasing Enrollment and Retention (Executive Director, Finance Department)

4.                   Tribal Leadership Conference (Executive Director)

5.                   Request for Public Comment: The National Plan for Action (All Staff)

6.                   2010 Summer Fellowship Program (Research Department)

OBJECTIVES: To evaluate how frequently older and high-risk adults received vaccinations for influenza and pneumococcal infection and to identify patient characteristics associated with adherence to published recommendations.

Background: Breast cancer is the second leading cause of cancer death among American Indian women. Southwestern American Indian women are more likely to have distant spread of the disease, and 5-year survival from breast cancer is poor in comparison to U.S. whites. Mortality from breat cancer could be reduced by more than 30% in American Indian women if current recommendations for screening were followed.

This Indian Health Service-sponsored rountable meeting provided a forum for Indian women, health providers, elected tribal leaders, and researchers to: 1) identify the major health problems of Indian women; 2) identify strategies to address these issues; 3) develop recommendations for comprehensive Indian women's health programs.

Indian Self-Determination and Education Assistance Act of 1975 (Full Text)

INDIAN HEALTH SERVICE OFFICE OF URBAN INDIAN HEALTH PROGRAMS 2006-2011 STRATEGIC PLAN (DRAFT- NOVEMBER 7, 2006)

The purpose of this document, the ninth note in this series, is to clarify the concepts of urban and rural and other geographic entities as they relate to the IHS and the American Indian and Alaska Native population

Indian Health Services Office of Information and Technology PowerPoint Presentation on EHR (electronic health records), incentive programs, and measuring effectiveness.

The Indian Health Service (IHS), part of HHS, provides or arranges health care services, including HIV/AIDS treatment, to eligible American Indians and Alaska Natives. It provided or arranged services for a projected 1.5 million American Indians and Alaska Natives in fiscal year 2007, across 12 federally designated areas that cover all or part of 35 states. Services are provided through IHS-funded facilities, including those operated by IHS, those operated by tribes, and Urban Indian Health Program (UIHP) facilities or through contracts with outside providers. Our prior work found gaps in the health care services IHS provided for American Indians and Alaska Natives that, in some cases, hindered American Indians and Alaska Natives from obtaining needed services. In addition to IHS, American Indians and Alaska Natives with HIV/AIDS may also receive care through other sources depending on their access to private health insurance; their eligibility for other federal health care programs, such as Medicare and Medicaid; or their eligibility for services provided by entities because access to HIV/AIDS prevention services can affect the number of American Indians and Alaska Natives who have the disease and there may be variation in the availability of treatment services, you asked us to examine IHSs efforts related to HIV/AIDS. Specifically, we examined the extent to which IHS provides (1) HIV/AIDS prevention services and (2) HIV/AIDS treatment services. We also examined (3) what other HIV/AIDS-related initiatives IHS has undertaken.

The goal of this initiative is to develop a process for the IHS to effectively and efficiently address chronic conditions. A strategic plan will be developed using a model for chronic illness care created from the experience of the IHS Division of Diabetes Treatment and Prevention, the Chronic Care Model, the WHO Innovative Care for Chronic Conditions Framework, and the Institute of Healthcare Improvement. These models and experience suggest that our approach to chronic conditions can be improved by creating a health care system that is practical, supportive, population -based, and evidence-based. The system should promote an interactive relationship between informed, motivated patients and a healthcare team that is prepared and proactive. The Chronic Care Model has been successfully applied to a variety of chronic illnesses, health care settings, and target populations.

Summary of Indian Health Care Improvement Reauthorization and Extension Action of 2009

The primary focus of the National Council of Urban Indian Health is advocating for the health and well-being of American Indians and Alaska Natives living in urban centers. We believe that health care reform is critical to ensuring all Indian people have access to affordable care and all medically necessary health care services. To that end we strongly encourage the Senate to follow Senator Dorgans lead and include S. 1790, the Indian Health Care Improvement Act, to the final Senate bill for national health care reform. We join the National Congress of American Indians (NCAI), the National Indian Health Board (NIHB), and the National Steering Council (NSC) in their request for your support of Senator Dorgans bill. Including IHCIA will ensure that national health care reform addresses the unique health care needs of Indian people. It has been 10 years since this important piece of legislation has been reauthorized. This is the best opportunity to pass this critical piece of legislation for Indian people and the only chance this Congress.

The United States has a longstanding trust responsibility to provide health care services to American Indians and Alaska Natives. This responsibility is carried out by the Secretary of the United States Department of Health and Human Services through the IHS. Since its passage in 1976 the IHCIA has provided the programmatic and legal framework for carrying out the federal governments trust responsibility for Indian health. The IHCIA is the law under which health care is administered to American Indians and Alaska Natives.

Originally created in 1976 as an acknowledgement of low-health status ranking disparities in comparison to the general population, the Indian Health Care Improvement Act has been reauthorized three times with the mandate to implement the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging maximum participation of Indians in such Programs.

Provisions for Restoration: Although the urban Indian health programs have lost a number of provisions over the years, the National Council of Urban Indian Health is only advocating for the return of 3 provisions and the creation of one new provision authorizing the appropriation of funds for HIT for Urban Indian Organizations. These provisions would all be included in Title V of the Indian Health Care Improvement Act and would not impact Tribal appropriations as all appropriations for Urban Indian Organizations must come through authorizing language in Title V. Outlined below are the provisions that NCUIH respectfully asks that National Steering Committee recommend for re-inclusion in the Indian Health Care Improvement Act.

Thank you for the work you and others have done on developing H.R. 3962. We appreciate your efforts to address the problems facing our nations health care system and move forward on the passage of real health care reform legislation that will provide Americans with quality, affordable health coverage and care.

The primary focus of the National Council of Urban Indian Health is advocating for the health and well-being of American Indians and Alaska Natives living in urban centers. We believe that health care reform is critical to ensuring all Indian people have access to affordable care and all medically necessary health care services. To that end we are delighted that the House has included H.R. 2708, the Indian Health Care Improvement Act, in H.R. 3962. We join the National Congress of American Indians (NCAI), the National Indian Health Board (NIHB), and the National Steering Council (NSC) in their request for your continued support of Representative Pallones bill in H.R. 2708. Including IHCIA will ensure that national health care reform addresses the unique health care needs of Indian people. It has been 10 years since this important piece of legislation has been reauthorized. This is the best opportunity to pass this critical piece of legislation for Indian people and the only chance this Congress.

HHS Staff Analysis of S.212

In considering amendments to programs such as Medicare, Medicaid and SCHIP, it is important to be mindful of the fundamental differences between them and the public health programs such as IHS. Public health programs generally have limited funds, but broad discretion as to how those funds may be used. Medicare, medicaid and SCHIP, on the other hand, guarantee payment of covered services  for covered individuals, but limit both the type benefits and the categories  of individuals for whom those benefits are available.

The use of primary health care services by urban American Indians and their health problems were compared with national and regional data compiled by the Indian Health Service, Bureau of the Census, Office of Technology Assessment, and the National Center for Health Statistics.  A survey of medical records was conducted at urban Indian health clinics, one located in Oklahoma City, OK, and the other in Wichita, KS.  Health records of 500 patients from each clinic were reviewed.

Representative Rahalls amendment package will provide that the necessary provisions to protect and preserve the Indian health system. These include: ensuring that Indian people will not be penalized for utilizing the I/T/U system, protecting health benefits provided to Indian people by their tribes from retroactive taxation, and provisions strengthening Indian health providers ability to seek third party reimbursement for services provided to Indian people. The Rahall amendment package will provide much needed modernizations to the Indian health delivery system as well as further developing Indian Countrys ability to conduct its own research through the development and strengthening of Indian epidemiology centers. The Rahall amendment package also allows tribes and tribal organizations to provide desperately needed health services to their people such as long term care services, home and community-based health services, and assisted living services. These are health services that most Americans take for granted but many American Indians and Alaska Natives are unable to access. The Rahall amendment package would address this inequality.

Health Insurance Reform and the Indian Health Care Improvement Act - It Passed... Celebrate!

Presented at the 2010 NCUIH Annual Leadership Conference 

This document is a preliminary analysis of the Patient Protection and Affordable Care Act (PPACA) and the Indian Health Care Improvement Act, and what the provisions will mean for Urban Indian Health Programs.

Research has found that the amount charged for health care can be a determining factor for whether or not individuals seek necessary health care services. With health care costs at an all-time high, more families are finding that health care no longer fits in their budgets.

Due to the structure of the Indian Health Care Improvement Act separate definitions for Indians who live on the reservations or near their tribal homes (Indians) and Indians who live off the reservations (Urban Indians) were necessary despite the fact that the distinction is largely legal and academic rather than reflecting and actual distinction. However, under the previous Administration, Executive branch agencies such as DHHS began actively interpreting any law that did not specifically include urban Indians or urban Indian organizations to exclude the urban Indian community. This causes particular problems with regard to third party billing, conferring with agencies on issues impacting urban Indian health, and fully developing the urban Indian health program. The automatic assumption when interpreting IHCIA that urban Indians are excluded if not explicitly included is a long running issue and not one easily solved on the administrative level. Given this interpretive rubric used by the Executive branch for interpreting federal Indian law, it is particularly important to specifically include urban Indians in any statement of federal policy or Congressional intent as the absence of urban Indians will be interpreted as a specific intent to exclude.

For expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect to the Indian Health Service, $3,657,618,000, together with payments received during the fiscal year pursuant to 42 U.S.C. 238(b) and 238b for services furnished by the Indian Health Service: Provided, That funds made available to tribes and tribal organizations through contracts, grant agreements, or any other agreements or compacts authorized by the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), shall be deemed to be obligated at the time of the grant or contract award and thereafter shall remain available to the tribe or tribal organization without fiscal year limitation:

FY 2011 Tribal Budget Recommendations to the U.S. Department of Health and Human Services

Standing on Principles:

A New Era in Tribal Government Relations

Presented by: Darryl Red Eagle, Co Chair Ft. Peck Assiniboine and Sioux Tribes

Gaiashkibos, Co Chair
Lac Courte Oreilles Band of Lake Superior Chippewa Indians

Reducing the spiraling costs of health care is a priority for Indian Country. Astronomical medical inflation rates, the expense of providing services in extremely rural communities, along with an increasing Indian population and limited competitive pricing have all tremendously hindered tribes and IHSs abilities to provide health care to Indian people. Often times, the only option is to require strict adherence to a medical priority system. These covered services are meant to be used for emergency and specialty medical services not offered onsite. However, due to severe under-funding, they are generally used for emergency care the treatment of life threatening conditions. Medical needs falling outside the priority system are not funded. This means that life-and-limb saving measures are selected by necessity over such things as health promotion and disease prevention. The results of this have been devastating in Indian Country. A paradigm shift, allowing tribes to focus on early intervention and prevention would significantly reduce the human and financial costs of health care delivery in Indian Country.

Letter from California Consortium of Urban Indian Health to Dr. Charles Grim of the Indian Health Service about Eligibility Requirements

Oral Presentation of Ms. Kay Culbertson, President of NCUIH

Tribal/HHS/White House Meeting December 6, 2002

Introduction

Department of Health and Human Service Representatives , Tribal Representatives and Indian Organization Representatives:

Good morning, I am Kay Culbertson, President of the Urban Indian Health (NCUIH). I am also the Executive Director of the Denver Indian Health and Family Services in Denver Colorado. 

This issue brief presents key findings on the relationship between EBPs and systems of care from Case Studies of System Implementation. Strategies critical to implementing EBPs within systems of care are also presented.

Oregon Legislative Commission on Indian Affairs

Letter of consequenses and issues pertaining to propsed budget cuts to UIHP programs in FY 06-07

Senator Wyden congratulating President Obama on elections, and offering support for Health care Reform

Letter from Senator Reid to NCUIH, expressing his ongoing support for IHCIA

Robert McSwain Director of Indian Health Services to Tribal Leaders to inform of the allocation of funds by the Consolidated Appropriations Act of 2008

While there are abundant data on Medicaid, these tend to avoid making value judgments. This report therefore seeks to fill the existing gap. We feel that it is not enough to say this is the way things are; instead, we should assess and say this is the way things should be. Almost 20 years ago, the Public Citizen Health Research Group published a report on Medicaid, Poor Medicine for Poor People, ranking state Medicaid programs. The current report seeks to update that report. But because programmatic mandates have changed and states now have considerably more latitude in how they run their programs, the indicators are different, as are the sources of data. As a result, there is greater variety among states, as well as greater differences within states.

Each state program has been evaluated in terms of four categories: eligibility, scope of services, quality of care, and reimbursement. These were in turn measured by 55 indicators, and the resulting scores were weighted according to the relative value given to each category by experts. The ranking system gives a state a score for each category as well as an overall score.

The National Council of Urban Indian Health developed a comprehensive transition plan for the first 100 days of the Obama Administration addressing problems and issues confronting American Indians and Alaska Natives living in Urban Centers. NCUIH fully supports the goals and plans of Indian Country, but wants to ensure that the specific needs of the urban communities are addressed during this critical time. For the sake of clarity NCUIH has identified its top three concerns for the Centers for Medicare and Medicaid Services Transition Team:

The Medicaid Commission was established by charter by the Honorable Michael O. Leavitt, Secretary of the United States Department of Health and Human Services, in May 2005. The commission charge is defined as follows:

a) The Commission shall report to the Secretary, for his consideration and submission to Congress, by September 1, 2005, their recommendations on options to achieve $10 billion in scorable Medicaid savings over 5 years while at the same time make progress toward meaningful longer-term program changes to better serve beneficiaries.

b) By December 31, 2006, the Commission shall submit to the Secretary a report making longer-term recommendations on the future of the Medicaid program that ensure the long-term sustainability of the program. They shall develop proposals that address the following issues:

1) Eligibility, benefits design, and delivery;

2) Expanding the number of people covered with quality care while recognizing budget constraints;

3) Long term care;

4) Quality of care, choice and beneficiary satisfaction;

5) Program administration; and

6) Other topics that the Secretary may submit to the Commission.

Our amendment would delay through March 2009 recently proposed regulatory action by the Centers for Medicare and Medicaid Services (CMS).  This particular regulation drastically cuts Medicaid funding for case management and targeted case management (TCM) services that currently assist Medicaid-eligible adults and children with complex situations -- including beneficiaries with disabilities, mental illness and children in foster care -- access much-needed medical, social, educational and other services.

2010 Handout CMS Federally Qualified health Centers (FQHC) and Tribal and Urban Indian Health Programs 

Statutory citation, Services,  Eligible entity, Tribal and urban facility eligibility etc.

Overview of Medicaid & Indian Health Program Aug 31, 2005 

three part publication, Mim Dixon & Kris Locke, Medicaid Roundtable

P52, P53 & P54

Overview of Medicaid & Indian Health Programs

Mim Dixon & Kris Locke

Medicaid Roundtable Aug 31, 2005 (slides)

2008 Annual Report to the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds.

ARRA Protections for Indians in Medicaid & Chip 2010 (slides)

Center for Medicare & Medicaid Services (Slides) April -7-2010

CMS Tribal Consultation presentation

Summary of Medicare benefits, coverage options, rights and protections, and answers to the most frequently asked questions about Medicare.

The Congress has generally assigned this responsibility to the Indian Health Service (IHS), an agency of the Department of Health and Human Services (HHS).  It funds IHS through direct appropriations and, since 1976, through authority for IHS and tribes and tribal organizations that carry out IHS programs under the Indian Self-Determination and Education Assistance Act, as amended (ISDEAA), to bill Medicaid and Medicare, as well as other third-party payors. Because the responsibility is Federal, Congress also authorized 100 percent Federal Medical Assistance Percentage (FMAP) for States that reimburse for services provided through IHS and tribal facilities.  Thus, the Centers for Medicare & Medicaid Services (CMS) has become a partner to IHS in fulfilling the Federal responsibility, albeit often a reluctant one. 

The item concerns the federal matching funds made available to states by the American Recovery and Reinvestment Act of 2009 (ARRA) to incentivize the adoption of meaningful use-certified EHR technology.  Final regulations have been promulgated by CMS, and this letter will provide further guidance on these utilizing these matching funds.

The purpose of this roundtable was to identify options to increase Medicaid managed care participation by Indian health programs.  These include programs operated directly by IHS, programs operated by tribes under the Indian Self-Determination Act, and urban Indian programs under Title V of the Indian Health Care Improvement Act.

The National Council of Urban Indian Health developed a comprehensive transition plan for the first 100 days of the Obama Administration addressing problems and issues confronting American Indians and Alaska Natives living in Urban Centers. NCUIH fully supports the goals and plans of Indian Country, but wants to ensure that the specific needs of the urban communities are addressed during this critical time. For the sake of clarity NCUIH has identified its top three concerns for the Centers for Medicare and Medicaid Services Transition Team:

On January 8th, 2009 NCUIH organized a Urban Indian CMS working group to identify issues and potential solutions involving Medicaid, Medicare and SCHIP. This working group will work to develop NCUIH positions on proposed legislation, policy statements to both Congress and the Transition team, as well as help formulate the NCUIH positions on health care reform measures that impact or otherwise affect CMS policies, procedures, and regulations. Jamie Bartgis and Danielle Delaney will staff this group and help develop and disseminate necessary information.

National Governors Association Proposals for Medicaid Aug, 2005

by Andy Schneider, Medicaid Policy, LLC

The Centers for Medicare & Medicaid Services (CMS) is updating its policy regarding the circumstances in which 100 percent federal funding would be available for services furnished to Medicaid-eligible American Indian and Alaska Native (AI/AN) individuals through facilities of the Indian Health Service (IHS) or Tribes. The intent of this policy change, which would apply to all states, would be to improve access to care for AI/AN Medicaid beneficiaries. This paper describes the policy options under consideration and seeks feedback from states, Tribes, and other stakeholders.

On February 23, 2009, the President announced to State Governors the release of more than $15 billion in increased FMAP funding. This $15 billion represents the first two quarters of the increased FMAP funding provided under ARRA. Funds have been deposited in special Treasury accounts so that States, the District of Columbia, and the Territories can start drawing down those funds. States must meet Medicaid eligibility requirements outlined in the law to receive the new funding, and may only claim for appropriate expenditures. CMS is working with the States to ensure that they meet the eligibility requirements in order to access the increased Medicaid funding.

Patient Protection and Affordable Care Act:What’s in it? What’s next?

Presentation by Carol Barbero for National Council on Urban Indian Health Washington, D.C. January 12, 2011

This is the Senate released bill of S.2526 the Indian Health Care Improvement Act to revise and extend. Pages 51-100

Section 201 of the Indian Health Care Improvement Act (IHCIA) amends sections 1911 and 1880 of the Social Security Act. The proposed amendments would allow Indian Health Programs and Urban Indian Health Programs to directly bill Medicaid and Medicare for providing services or items to Indian patients. Due to an unfortunate understanding of the UIHPs third party bill capacity, Urban Indian Organizations have been removed from this provision. The general argument for removing UIOs from this provision is that UIOs already have authority to bill Medicaid and Medicare through the FQHC and RHC provisions. This argument is incorrect on a number of grounds.

The American Medical Student Association (AMSA) is pleased to endorse the House Tri-Committee health care reform legislation HR 3200, supporting effective and robust reform. AMSA is the oldest and largest organization of physicians-in-training in the United States, and the international representative organization of American medical students through the International Federation of Medical Student Associations (IFMSA). AMSA represents over 62,000 medical, pre-medical, resident and physicians members.

As future physicians, we see throughout our training the lack of access and affordability our patients must face. All too often, our patients are left without needed medical care, including preventative care, life-saving therapies, and other medical interventions. This is why AMSA recognizes as one of its key Strategic Priorities: Quality, Affordable Health Care for All.

United States Senate version of the Indian Health Care Improvement Act (IHCIA) Amendments of 2008 

Department of Health & Human Services 1997

Medicaid 101 A Brief Introduction

The National Council of Urban Indian Health (NCUIH) enthusiastically supports the Joint Indigenous Summer Research Institute —a unique project which aims at increasing the understanding of the social variables of health among indigenous populations and stimulating research in this generally understudied field. NCUIH is the primary organization working to secure the short and the long-term healthcare needs of urban Indians, who constitute more than fifty percent of today's American Indian/Alaska Native population. In our experience, one of the major obstacles to successful Native American representation at the political level—and thus to securing a healthy Indian Country for many years to come—is the lack of research and knowledge of the many health issues affecting this country’s indigenous population. The Joint Indigenous Summer Research Institute would therefore serve as an important step to bridge the gap between health needs and information sharing.

On behalf of the National Congress of American Indian, the National Indian Health Board and the National Council of Urban Indian Health, we thank you for including the many amendments addressing the unique nature of Indian health care delivery into The Affordable Health Choices Act. Our organizations strive to advance the level and quality of health care that are offered to Indian people through services provided by the Indian Health Service, programs operated directly by Tribal Governments and Urban Indian health organizations. We greatly appreciate all of your hard work to address Indian Country’s need for national health care reform.

The Urban Indian Health Program (Title V) within the Indian Health Service is facing elimination in the FY 2008 Budget.

The elimination proposed is based on the Administration’s claim that the medical services offered by the Urban Indian Health Program are a duplication of services already provided by Community Health Centers. However, the Urban Indian Health Program is the only culturally sensitive medical and behavioral health provider to American Indians and Alaska Natives who reside in urban areas. A fact which has been acknowledged by the National Association of Community Health Centers, Inc. who indicated last year that Community Health Centers have neither the means nor the capacity to take on the significant urban Indian patient load, should Title V be zeroed out. 

The fundamental goal of the Express Lane Agency language is to reduce barriers for enrollment into critical programs such as Medicaid for American Indians and Alaska Natives (AI/ANs). AI/ANs suffer from disproportionately high poverty rates.  Based on the 2000 Census, 25.7 percent of AI/ANs live in poverty in comparison with 12.4% of the general U.S. population. Additionally, in the recently released Census report on health insurance coverage, 31.7 percent of AI/ANs are reported to be uninsured based on a 3-year average (2006-2008).  Despite this high rate of poverty and lack of insurance, AI/ANs are severely under-enrolled in Medicaid and CHIP. The consistent under-enrollment in Medicaid and CHIP has been a topic of frequent discussion in Tribal consultation, testimony to Congress, and policy debates. The reasons for this under-enrollment are numerous and Indian health care providers are uniquely situated to overcome these obstacles.

1. 29th Annual "Protecting Our Children" National American Indian Conference on Child Abuse and Neglect
2.Spirit of EAGLES 8th National Conference:“Changing Patterns of Cancer in Native Communities: Strength through Tradition and Science”
3. Association of American Indian Physicians (AIIP) 39th Annual Meeting & National Health Conference
4. Building Domestic Violence Health Care Responses in Indian Country: A Promising Practices Report
5. Child Abuse Identification and Reporting Course is presented by Continuum Services

1. SAMHSA Children's Mental Health Awareness Day
2. CDC's Health Disparities and Inequalities Report
3. Rosetta Stone Helps Revitalize Inupiaq Language
4. Native Language Documentation Workshop to be Held in Washington, DC
5. Meeting on Indigenous Child Health March 4-5 in Vancouver
6. White House Office of National Drug Control Releases New Data on Prescription Use

Incorporating Urban Indigenous Health into the Mainstream Health Systems:New Zealand and the United States: two different approaches two different results

Prepared for the: New York Academy of Medicine’s Ninth International Conference on Urban Health

New York, NY. October 27-29, 2010

Alejandro Bermudez-Del-Villar, M.A.1, Development & Technology Director
Jason Alexander Stiener, M.S. Legislative Fellow1 National Council of Urban Indian Health

Note Publication is listed in KRC in parts TA95 - TA110 

Introduction, Background, Historical Trauma, Diversity among AI/AN Communities, Urban Community Demographics etc.

American Indian & Alaskan Native FY 2002 Needs-Based Budget Narrative Justification

Part 1 of 2

Introduction/Background

The IHS. Tribal, and Urban Indian Health Programs (I, T, Us) are at a critical point and have  concluded that it will take additional appropriations to achieve parity with the rest of America. This Needs-Based Budget was formulated using a partnership-consultative process.

Congratulatory Letter to South Dakota Urban Indian Health, to serve as delegate to represent NCUIH on Tribal Human Services Workgroup

NCUIH Board of Directors Teleconference Minutes oct-6-1999

Includes Draft

NCUIH Board of Directors Meeting September 3, 2002

Kay Culbertson, President

NCUIH Board of Directors Meeting Minutes

Packet: Minutes from March 8 & 11, April 16 2003

Board of Directors Meeting Minutes 3/10/00

NCUIH Board of Directors Meeting Minutes Feb-11-2003

NCUIH Board of Directors Meeting Minutes May-1-1999

NCUIH Board of Directors Meeting Minutes 2-8-06

NCUIH 98-99 Board of Directors Progress Report

Board Meeting Minutes Sept-13-1999
K. Culbertson, President 1999

NCUIH's 2012 Audit

NCUIH's 2011 Audit

NCUIH Annual Report 2002 (Growing Forward)

NCUIH Board Minutes from 10-25-1999

Overview: In this section we will look at indigenous perspectives and traditions in relationships to cultural values and how that may influence in the way native persons approaches leadership in their communities and responds to the outside world. These descriptions may appear to be tribal or community specific in nature but in reality have cross-cultural similarities. These descriptions can offer the reader a perspective of common values keeping in mind the differences among indigenous people. It is also important to be aware that many of these values while have been romanticized resulting in stereotyping natives as being passive and/or noble savages. In the reality of native life, these values and rules of conduct are the unspoken code of ethics that are part of their daily living as individuals and community.

Tribal leaders concur with Chairman Baucus's proposal to augment funding for the Indian health system, and concur with his observation that "IHS desperately needs additional funding. It is impossible to keep America's promise to provide care to Native Americans and Alaska Natives with the current level of IHS funding."

Health Insurance Reform and the Indian Health Care Improvement Act-- Review and Breakdown for Urban Indians by NCUIH

The Senate bill is the most comprehensive in terms of what Indian Country was able to get in health reform. The tri-organizations (NCAI, NIHB, NCUIH) were successful in their advocacy for the key provisions Indian Country identified as major priorities. The chart below highlights only the major Indian specific provisions of the Senate HCR bill. These are provisions directly impacting urban Indian patients or urban Indian organizations.  Highlighted sections are those provisions that were identified as priorities by Urban Indian Organizations. This chart does not include those provisions which have obvious impact on I/T/U providers (regulation of health insurance, closing the donut hole, etc) but only those provisions that directly reference Indian patients or Indian health providers.

HCAN strongly supports the provisions in the draft bill that make health insurance and health care services more affordable. In particular, premium assistance, reduced cost-sharing, and application of an out-of-pocket cap are central to making health care accessible to low-income individuals and families. Also, we commend you for your leadership in extending assistance in purchasing health insurance to working families who have seen health costs increase four times faster than wages.

Health Care for America Now (HCAN) appreciates the opportunity to comment on the draft House tri-committee health care reform legislation that is designed to address the critical health care issues that have plagued the American health care system for far too long. HCAN is a national grassroots movement powered by 30 million people and more than 1,000 organizations working to win a guarantee of quality, affordable health care we all can count on. The draft legislation put forward by your committees shows that we can achieve the Presidents goal of quality, affordable health care for all this year.

Is an ounce of prevention still worth a pound of cure? With chronic disease accounting for nearly three-quarters of all health care costs, and a substantial part of that chronic disease burden being caused by smoking, diet and alcohol abuse, the age-old maxim would suggest that spending money on interventions to reduce these serious public health threats should reduce what the nation spends on health care.

Health Care for America Now campaign membership list

Health Human Services Secretarys Tribal Consultation Policy Revision Workgroup

Workgroup Members Contact Information

List of Tribal Delegates and Alternates Updated: 7/13/2010

On behalf of the National Council of Urban Indian Health, its 36 member organizations and the 150,000 urban individual Indian patients that our member health programs serve annually, I would like to thank the Senate Committee on Indian Affairs for the opportunity to provide written testimony addressing the FY 2009 budget elimination of the Urban Indian Health Program within the Indian Health Services. The National Council of Urban Indian Health opposes, with the strongest possible terms, the elimination of the funding for the Urban Indian Health Program in FY 2009 and urges the Senate Committee to strongly support the restoration and, indeed, support a 14% budget increase to address nearly a decade of funding shortfalls. Once again the President has proposed to eliminate the Urban Indian Health Programs in his FY09 Budget. This is the third year in a row that he has attempted to zero out this program despite Congress overwhelmingly rejecting this proposition in both the FY07 and FY08 budgets.  The Senate Appropriations Committee has traditionally taken its leads from this Committee and had, in the past two years, restored funding for the Urban Indian Health Program, going so far as to include sharp report language directed at the Administration.

President's FY 2009 Annual Budget summarized by tables

The Administration has once again zeroed out the Urban Indian Health Program. The President has also made deep cuts throughout the DHHS budget, including reductions in IHS overall budget level. Therefore, this year we intend to make a concerted effort to affect what is referred to as the 302(b) budget formulation process whereby Congress determines the overall budget limit that appropriators must work with for that fiscal years budget. As we learned last year the amount set in the line item is determined by the overall level of funds available to appropriators. It is NCUIHs intent to start working with Congressional staff early to ensure that the 302(b) appropriations level set for the Native health care system as a whole is at the appropriate level to start addressing the very serious discrepancies facing Indian Country. This year we will have a tiered advocacy plan to address each phase of the budget and appropriations process to effectively impact each part of the process and thus, hopefully, will reach our target number of 40 million this year. We expect there to be three main tiers to the budget process:

American Indian/Alaska Native & Native Hawaiian Housing Appropriations Chart

The Urban Indian Health Program provides $35 million of funding for the nearly 75% of Indians living away from their native tribal land in Americas urban centers. During the 2/28/08 House Energy & Commerce Committee hearing on the FY09 HHS Budget Request, Rep. Wilson (R-NM) expressed her support for Indian health, including the Urban Indian Health Program.  Wilson asked several questions of Secretary Leavitt about his plan to end the program and serve urban Indians through community health centers.  Wilson stated:  community health centers do not have the capacity to serve this increased volume of patients and the Department of Health has put forward no plan to make sure these patients are cared for. Wilson asked the Department to provide justification for eliminating the program, and asked Secretary Leavitt to show that shifting all patients to community health centers would save money while providing comparable access and quality of care.

The FY 2009 Budget requests $4.3 billion for the Indian Health Service (IHS). The request prioritizes the provision of health care services, maintaining them at the FY 2008 level. The total request for IHS includes a $21 million reduction in construction costs due to the completion of project stages funded in FY 2008. IHS provides health services for the growing population of eligible American Indians and Alaska Natives to reduce health disparities through preventive health services, primary care, and the expanded use of information technology in partnership with Tribes.

Good Morning. I am Robert McSwain, Acting Director of the Indian Health Service. Today I am accompanied by Dr. Richard Olson, Acting Director of the Office of Clinical and Preventive Services, Mr. Gary Hartz, Director, Environmental Health and Engineering, and Mr. Richard Turman, Deputy Assistant Secretary for Budget, Department of Health and Human Services. We are pleased to have the opportunity to testify on the President's FY 2009 budget request for the Indian Health Service. The IHS provides health services to nearly 1.9 million American Indians and Alaska Natives. In carrying out this responsibility, the IHS maintains a unique relationship with more than 560 sovereign Tribal governments that represent this service population in some of the most remote and harsh environments within the United States as well as in modern metropolitan locations such as Anchorage and Phoenix. These relationships and the geographic diversity offer extraordinary opportunities and challenges to managing and delivering health services.

Department of Health and Human Services FY 2009 Budget proposed by the President

As we enter this New Year, our economy retains a solid foundation despite some challenges, revenues have reached record levels, and we have reduced the Federal deficit by $250 billion since 2004. Thanks to the hard work of the American people and spending discipline in Washington, we are now on a path to balance the budget by 2012. Our formula for achieving a balanced budget is simple: create the conditions for economic growth, keep taxes low, and spend taxpayer dollars wisely or not at all. As Commander in Chief, my highest priority is the security of the American people. So my Budget invests substantial resources to protect the United States from those who would do us harm. Continuing our Nations efforts to combat terrorism around the globe, my Budget provides our men and women in uniform the tools they need to succeed in Afghanistan and Iraq, and it furnishes the resources needed for our civilians to help those nations achieve economic and political stabilization. My Budget also strengthens our overseas diplomatic capabilities and development efforts, advances our political and economic interests abroad, and improves the lives of people around the world.

Testimony of the National Council of Urban Indian Health Presented by Moke Eaglefeathers Board President National Council of Urban Indian Health On the President’s Fiscal Year 2008 (FY08) Budget Elimination of the Urban Indian Health Program February 15, 2007

FY2013 HHS Tribal Budget Consultation Testimony of Dr. Patrick Rock, President of the National Council of Urban Indian Health Testimony on The Urban Indian Health Program Line Item March 2nd-4th, 2011

For FY 2011, the National Indian Council on Aging recommends support for three initiatives: Nutrition and Supportive Services to Indian Tribes and Native Hawaiian Organizations, Tribal capacity building to support elder access to services, and protection of vulnerable Indian elders.

Priority 1: Title VI, Aging Grants to Indian Tribes and Native Hawaiian Organizations, including Part C, Native American Caregiver Support Program and training for Title VI service providers from funds other than those appropriated for Title VI programs.

We have another tough year ahead for Urban Indian Health. NCUIH is again anticipating the Urban Indian Health line item in the IHS budget to be zeroed out. We are ready to employ the political capital we have gained from last years congressional renouncement of the proposed budget, and have been busy planning for and producing materials that will be key in our advocacy efforts this year. We are better situated then in years past and we will again achieve success. Following are highlights of our advocacy plan. This will be an evolving and changing plan as conditions require. NCUIH is in a position to anticipate needs and assist Congress to move through the budget process this year.

The Online Performance Appendix is one of several documents that fulfill the Department of Health and Human Services (HHS) performance planning and reporting requirements. HHS achieves full compliance with the Government Performance and Results Act of 1993 and Office of Management and Budget Circulars A-11 and A-136 through HHS agencies FY 2009 Congressional Justifications and Online Performance Appendices, the Agency Financial Report and the HHS Performance Highlights.

Indian Health Service Budget FY 2009 President's Request (Dollars in Thousands)

FY 2007 Inflation & Additional Medical Inflation options (breakout)

FY 2004 PART Ratings 30 HHS Programs

(SLIDES)

FY 2003 National  Alcohol Substance Abuse Distribution Formula

As recomended by the IHS Alcohol & Substance Abuse Work  Group

Proposed distribution formula, Propsed methodology by area, Proposed methodology (operating unit within area)

Written testimony addressing the FY 2009 budget for the Urban Indian Health Program (UIHP). While the FY 2007 budget proposal argued that Urban Indian Health Program medical services are a duplication of services already provided by Community Health Centers (CHC), the FY 2008 budget cut states that "urban Indians can receive health care through a wide variety of Federal, State, and local providers." However, contrary to the assertions made in the President's FY 2008 budget, urban Indian health programs do not duplicate the functions of CHCs nor does Federal, State or local providers have the capacity, means or cultural understanding to take on the sizable urban Indian patient load. Rather, they serve a unique, non-duplicative and culturally specific purpose within the large urban Indian communities. 

2007 UDS: Recent changes to the Uniform Data System prevent accurate and complete reporting of American Indian/Alaska Native populations. As a result, they are excluded from health disparities studies, trends, technical assistance and funding opportunities.

Health and Human Services HHS Annual Budget Consultation Session PowerPoint Presentation about Federal Trust Responsibilities

Each year, the Indian Health Service (IHS) budget is developed using a budget formulation process that involves IHS direct operated programs, tribally-operated programs, and Urban Indian health programs, commonly referred to as the I/T/U. Representatives from each of the 12 IHS Areas serve on the I/T/U budget work team to discuss their health and budget priorities and develop funding recommendations. The work team, along with IHS headquarters and national organizations, come together to develop consensus on the IHS budget priorities for that year, and to present their recommendations before the Department of Health & Human Services (HHS). In previous years, tribal representatives were allowed to make budget presentations to the Office of Management and Budget (OMB)—however despite repeated requests by the IHS budget formulation work group—this has not happened for the past seven years.

Letter responding to request for the Senate Indian Affairs Committee's views and estimates on the President's Fiscal Year 2009 budget request for Indian programs. 

U. S. DEPARTMENT OF HEALTH & HUMAN SERVICES, 10th ANNUAL NATIONAL HHS TRIBAL BUDGET and POLICY CONSULTATION SESSION

Hubert H. Humphrey Building,  Washington, DC

Introduction.  On behalf of the National Council of Urban Indian Health, its 34 member programs and the 120,000 Native patients that our members serve annually; I would like to thank you for this opportunity to provide written testimony addressing the FY 2007 and FY 2008 budget for the Urban Indian Health Program (UIHP) within the Indian Health Service.

               In the strongest possible terms, NCUIH opposes the zeroing out of funding for the Urban Indian Health Program in FY 2007, which is a clear mistake that could presumably set a precedent and be repeated in the FY 2008 proposed budget.  If adopted, this proposal would lead to the complete collapse of many urban Indian health centers and greatly constrain the efficiency and work of those that could survive such a cut. Contrary to the assertions made in the Presidents FY 2007 Budget, urban Indian health centers do not duplicate the functions of other programs but rather serve a unique, non-duplicable and culturally-specific purpose within the large urban Indian communities. The fact that there are other health services available in urban areas is already reflected in how IHS funding is distributed, with urban Indian programs receiving only 32 million dollars in FY 2006, despite 2000 census data that showed nearly 70% of Americans identifying themselves as of American Indian or Alaska Native heritage, live in urban areas.

fundraising board training 

This document constitutes a framework of a plan for consideration by the Bipartisan Six. The policies outlined here represent many of the policies discussed with Finance Committee members and described in previous options papers. In addition, the policies also reflect the groups conversations and the groups work throughout the summer, including throughout the August recess. Chairman Baucus proposes this framework for consideration and response by the next meeting scheduled for Tuesday, September 8, 2009.

This is not a final product, should not be construed as a Chairmans Mark and does not include everything that might be in a Mark. Members may suggest individual modifications or offer whole or partial counters to specific provisions. As discussed, suggestions to reduce the cost of the package are welcome. If, however, a modification will increase the cost of the package, then the member making that suggestion should offer offsets to keep the package budget neutral

This article looks at functional assessment in the elderly and tools to measure functional ability.  Functional assessment has been shown to be important in predicting mortality, hospitalization, and health care cost.

Background:  In this commentary, we describe culturally specific cancer support and education programs that have been successfully adapted for use with both urban and reservation-based California Indian communities.

This is the audio and video from a training seminar held August 12, 2010 by the National Association of Community Health Centers, FQHC's: Requirements and Opportunities.

The PDF slides from a training seminar held August 12, 2010.  This training session tells how to become a Federally Qualified Health Center.

This study investigated correlations among physical fitness, dietary intakes, activity levels, and body mass index (BMI) for 155 urban Native American youth, ages 5 to 18 years.  Heights, weights, skinfold measurements, activity level, balance times, and dietary intakes were assessed.

PowerPoint Presentation about the Financial Sustainability of Native American Systems of Care at the 22nd Annual RTC Conference in Tampa, FLA. March 2009

Final National Report on the Major Policy Issues and Consensus Recommendations from the I/T/U Regional Consultation Meetings, IHCIA

(starting Point for National Steering Committee Recommendations 1999)

State recognition is an alternative tribal status to formal federal recognition.30 Much like federal recognition, it operates as a means for states to acknowledge the longstanding existence of tribes within their borders and to establish a government-to-government relationship to coordinate and communicate with tribes. State recognition is also a prerequisite to certain federal and state benefits meant to foster and preserve indigenous communities and to facilitate mutually beneficial relationships following centuries of conflict.31 While state recognition offers several benefits, the powers granted through state recognition are quite limited. State-recognized tribes do not generally have the same immunities from state law that federal tribes enjoy.32 Instead, they are endowed only with those sovereign characteristics recognized by that state’s laws, legislative resolutions, administrative regulations and other documents that collectively define the government-to-government relationship.

Navajo Nation, Federal Spending: A Practical Understanding of the Federal Budget

What is Federal Budget, Legislation, Budget and Appropriations Process, NNWO Recomendations.

This article examines the use of supplemental food programs by two Native American populations and assesses some of the heath and cultural impacts of these programs. A cross-sectional survey of 80 American Indian families, 40 families residing on the Round Valley Indian Reservation and 40 in Sacramento, California was conducted to determine access, use, and appropriateness of supplemental feeding programs.

This report acquaints readers with the concept of family-driven care for children who have emotional and behavioral disturbances. From this context, the authors provide information about evidence-based practices that are effective interventions to help the children and their families. This information will help families, educators, and mental health service providers plan effective interventions for the children in their care.

The objective of this study was to examine hepatitis A vaccination coverage rates among children living in states with different vaccination recommendations and to examine individual characteristics associated with vaccination.

Goal
To discuss strategies and tools for guiding boards through executive transitions

Youtube Video: https://youtu.be/dU1HjpHtPLU?list=PL04IxqLfZOqN0fHbzKATy5ZAn9vjjy9zq

This document is a summary of the Western Nevada Health Delivery Study.  The geographic area addressed by this study is known as the Schurz Service Unit of the Phoenix Area Indian Health Service (IHS).  The target population (12 tribes) consists of the Indians residing within this area.  Three main purposes of this study were to: 1) assess the total health care needs of the Indians in western Nevada; 2) set area-wide goals aimed at satisfying those needs; and 3) develop a phased strategy for moving from the present situation to the desired improvements.

The Administration is committed to reauthorizing and improving the Indian Health Service (IHS) and to increasing the availability of high-quality health care to eligible American Indians and Alaska Natives. The Administration appreciates that the Senate bill includes certain provisions that maximize the Health and Human Services Secretarys flexibility and strengthen his authority in the administration of the IHS. Such provisions will allow the Secretary, in consultation with Tribes, to prioritize those services and programs that best address the needs of American Indians and Alaska Natives. However, the Administration has serious concerns with numerous provisions in S. 1200 including an expansion of Davis-Bacon Act prevailing wage requirements that would violate a longstanding Administration policy. If this provision is included in the final bill presented to the President, his senior advisors would recommend he veto the bill.

Updated yearly based on latest vital events data. Component categories may not sum to other published totals due to minor rounding errors of estimates prepared for counties split between IHS Service Units and/or Area Offices.

Objective: To compare weight-related concerns and behaviors across ethnicity/race among a population-based sample of adolescent boys and girls.

Objectives:  We examined the correlates of having ever had sexual intercourse among American Indians ages 13 to 18 years in Minnesota.

Age-adjusted mortality from cancer is steadily increasing among Native Americans, raising concern about environmental causes.  Toxic waste dumps, mining activities, paper mills, military activities, agricultural chemicals, and urban pollution are common sources of carcinogen exposure on reservations and among the urban poor.  Despite documented hazards, we do not see a pattern of cancer excess that might result if Native Americans were exposed to these carcinogens more than other Americans.  Abuse of tobacco can be shown to be the most important contributor to cancer mortality among Native Americans.  

In order to reap the benefits brought about by the passage of the Affordable Care Act, clinics and health programs across the US have to accommodate a series of new requirements to keep their financial structure up and running. That is not the case for Urban Indian Health Programs (UIHPs). These programs--serving a marginalized population within an already vulnerable community-- will have to learn and re-engineer their core finances system in order to survive and grow. UHPs creation and evolution respond to a promise never fulfilled; and that got them locked into a dependency cycle that is not compatible with the pervasive Third Party Billing (TPB) system; therefore not sustainable in current times.  UIHPs are a critical component of the Indian health system given their unique culturally customized healthcare and community services in urban settings across the US. There is hope, however, if the right approach is taken.

Amendment offered by Congressman Rahall in the Nature of a Substitute to Congressman Waxman amendment to H.R. 3200 "Definition of Indian"

Meaningful Use of Electronic Health Records presentation by Donna Keeler of the South Dakota Urban Indian Health Center at the NCUIH 2011 annual leadership conference

The purpose of this study was to evaluate the efficacy of a community-based exercise course applied to a group of American Indians (AI) who, because of physician recommendation and/or self-motivation, desired to increase their physical activity.

This document presents examples of effective financing strategies for seven key areas related to the development of comprehensive and strategic financing plans for systems of care. It is intended as a companion to the Self-Assessment and Planning Guide: Developing a Comprehensive Financing Plan.

This special issue of American Indian and Alaska Native Mental Health Research presents a series of papers which describe the results of mental health needs assessments performed by four urban American Indian organizations.

Executive Director Job Description for distribution

Introduction letter of Paul Dioguardi to tribal leaders and discussion about ARRA

The worsening recession is causing pain across the country, especially for the millions of women and families who already were struggling to make ends meet. The Obama Administration and House and Senate leaders have developed a strong plan for economic recovery to preserve and create jobs, help people through tough times, protect vital public services, and invest in our nations future. The Conference Agreement on the American Recovery and Reinvestment Act includes a number of measures that are especially important for women and their families.

Estimating Effect on Federal Direct Spending and Revenues of Titles II-V of the American Recovery and Reinvestment Act of 2009, Senate Finance Committee, Chairman's Mark (January 23, 2009)

As millions of people have lost their jobs, millions have lost their health insurance. Those that remain covered are paying more for less. And unrelenting health care costs are burdening business, state governments, and our economy. The American Reinvestment and Recovery Act will prevent health coverage loss and stabilize the system. It will make key investments now that will lower health spending in the long run. It is part of the Presidents commitment to make health care affordable for all Americans.

Powerpoint presentation from SF Friendship House Youth Program

The committee of conference on the disagreeing votes of the two Houses on the amendment of the Senate to the bill (H.R. 1) "making slpplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for the fiscal year ending September 30, 2009, and for other purposes", having met, after full and free conference, have agreed to recommend and do recommend to their respective Houses as follows

Making supplemental appropriations for job preservation and creation, infrastructure investment, energy efficiency and science, assistance to the unemployed, and State and local fiscal stabilization, for the fiscal year ending September 30, 2009, and for other purposes.

Amendments to ARRA offered by Mr. Oliver of Massachusetts

UIHP Infrastructure Projects: The National Council of Urban Indian Health has identified six ready to build infrastructure projects and five renovation and acquisition projects. Details of these projects can be found in the appendixes. These projects are facilities development projects designed to accommodate increased patient load and services. All of these projects are construction ready with finalized, or near to finalized, architectural plans and appropriate permits. These projects were stalled due to the economic crisis and failure to secure additional lines of necessary credit.

The Earthstar Project, located in St. Paul, MN, is an urban Indian mental health organization that reaches out into the community through various projects.

The major purpose of this study was to extend our understanding by comparing the drinking-related expectancies of three groups of Native Americans: problem drinkers, nonproblem drinkers and recovered alcoholics.

Purpose and Design or Urban Indian Health Programs (Draft of working document)

The purpose of this initiative is to increase the role of health care providers in recognizing and responding to the issue of domestic violence.

This report describes a domestic violence program in an urban Indian health center. The failure of office-based interventions and the importance of developing interventions that are sensitive to the needs of this population are discussed.  Successful interventions including home visits and a domestic violence group that incorporated American Indian traditions and values are presented.

The purpose of this publication is to provide a resource and reference to assist in the formulation of culturally acceptable cancer prevention and control research projects or programs. Information in this publication may be of assistance to health care providers, tribal health planners, health educators, public health nutritionists, community health representatives, and health professionals working with American Indian and Alaska Native (AI/AN) populations.

Objective: To determine geographic variation in urban American Indian & Alaska Native (AI/AN) rates of infant mortality, low birth weight, prenatal care use, and maternal-child health care service availability.

Objectives: To better understand the prevalence of asthma among American Indian and Alaska Native (AI/AN) children and to explore the contribution of locale to asthma symptoms and diagnostic assignment, the authors surveyed AI/AN middle school students, comparing responses from metropolitan Tacoma, Washington (metro WA) and a non-metropolitan area of Alaska (non-metro AK).

A leading cause of morbidity and mortality among Native Americans, cancer is largely preventable through lifestyle habits.  Ranked high among those habits is a diet low in fat and high in fiber, fruits, and vegetables.  Because Native Americans are not included in national nutritional monitoring systems, limited data exist on the cancer-related dietary habits of this population.  To bridge this gap, this study measured the eating patterns of Native American youths in the northeastern United States.

OBJECTIVE: We summarized data from a study of Alaska Native women living in predominantly urban communities to assess the quality of their dietary intakes and compare to current US dietary recommendations.

A cross sectional survey was conducted of American Indian women ages 18 years and older and residing in Minneapolis to assess dietary and physical activity practices.

Diabetes WorkGroup Meeting Minutes July 28-29, 2004

Diabetes Workgroup Conference Call Minutes 11-05-04

In 2006 the National Council of Urban Indian Health led an initiative to implement changes to the urban diabetes data collection process.  The change was made for the purpose of unifying the data for collective diabetes reporting.  Its main goal was to ensure that all organizations that receive or will receive Special Diabetes Program for Indians funding will submit their diabetes audit to not only the Indian Health Service but also to the Urban Indian Health Institute.  The decision was made to better ensure excellence in reporting and to establish a standardized set of diabetes data, and the data derived from these outcomes would be used to further enhance the diabetes program and allow the Urban Indian Health Organizations to be better educated on the technical aspects of diabetes management, including:

Studies of the medical conditions of, and the quality of health care received by, older AI/ANs in urban, non-reservation settings are very rare. Most studies of diabetes or its care among AI/ANs have been conducted in communities served by the Indian Health Service or tribal health programs, and none have focused on older persons not living on or near reservations. Older AI/ANs are among the fastest growing populations in the United States, and 41% of AI/AN elders now live in urban areas, and do not receive direct health care from the Indian Health Service or tribal health programs.  Several urban Indian health programs were developed in the 1970s in recognition of the unmet healthcare needs of AI/ANs, many of whom relocated to urban areas in the 1950s, as the result of formal federal policy. However, little is known about the quality of care provided by these urban programs.

Since previous work has suggested that the quality of diabetes care for older persons may vary by race, or by socioeconomic status, the purpose of this study was to assess the quality of diabetes care among older AI/ANs in a low-income, urban, primary care setting. In addition, factors associated with performance of quality of care indicators were assessed.

To assess the prevalence of, and quality of care for, diabetes mellius among the understudied, yet growing, population of older, urban American Indians and Alaska Natives

DHHS/IHS Budget Submission 2004

Frequency in Distribution of Identified Area Health and other Problems

DHHS Statement of Charles W. Grim, D.D.S, Director IHS

Before the Senate Committee on Indian Affairs of the United States Senate over sight hearing on the Presidents FY 2008 Budget Request for the IHS Feb 15, 2007

Statement of  Michel E. Lincoln, Deputy Director, Office of the Director of Indian Health Service before the Senate Committee on Indian Affairs, February 23rd, 2000

The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry (A TSDR) released their Tribal Consultation Policy on October 18, 2005. The policy establishes standards to guide us in working effectively with tribes and tribal organizations and will help ensure increased tribal access to CDC programs and resources. The poJicy also outlines several venues for tribal consultation and information exchange with CDC staff and leadership that maximize both tribal and CDC staff participation. We believe that tribal partnerships will be strengthened through increased opportunities for tribal input into CDC's decision-making processes. One key venue for information exchange is the CDC Tribal Consultation Advisory Committee (TCAC). I am excited to reach out to you at this time as we begin the process of identifying TCAC members.

Greetings from the Department of Health and Human Services. Enclosed, please find our 2008 Tribal Consultation Report, developed in accordance with the HHS Tribal Consultation Policy. The report details a wide array of tribal consultation activities by HHS, its agencies and regional offices, during fiscal year 2008.

I especially want to highlight some of the Department's 2008 accomplishments, including the Tribal Emergency Preparedness Initiative, the CDC and ACF National Tribal Consultation Sessions, and the Assistant Secretary for Resources and Technology's enhanced Grants Forecast website.

This letter is one of a series that provides guidance on the implementation of the American Recovery and Reinvestment Act of 2009 (Recovery Act), Public Law 111-5. Section 5006 of the Recovery Act provides protections for Indians in Medicaid and the Children's Health Insurance Program (CHIP). The amendments made by this section were effective on July 1, 2009. This letter provides a brief overview to assist States with implementation of these new provisions for Indians in your programs. Section 5006 of the Recovery Act provides certain premium and cost-sharing protections under Medicaid and exemption for certain Indian-specific property from consideration in determining Medicaid eligibility and from Medicaid estate recovery. It also provides certain Medicaid managed care protections for Indian health programs and Indian beneficiaries and establishes new requirements for consultation on Medicaid and CHIP with Indian health programs. The new provisions are described in greater detail below.

I am pleased to provide you the enclosed copy of the Department of Health and Human Services' (HHS) "Policy on Consultation with American Indian and Alaska Native Tribes and Indian Organizations," Which was issued on August 7, 1997. -we are proud of the relationship between our Department and the Native American Community and hope that this new policy will further strengthen that relationship. 

As you may know, President Clinton issued an Executive Memorandum to federal departments and agencies entitled, "Government-toGovernment Relations with Native American Tribal Governments." The President's Memorandum reaffirmed the unique relationship between the  U.S. government and tribal governments and directed each federal department and agency to honor this relationship by consulting with tribal governments before taking actions that affect them.

Dear State Medicaid Director:

This is one in a series of letters regarding American Indian & Alaskan Native Health policy issues and the medicaid program and the state childrens health insurance program, This letter adresses the request of Federally recognized tribes to more activley participate in the Planning  and development of medicaid and SCHIP waiver proposals and waiver renewals.

NCUIH testimony by Mr. D.J. Lott, President to U.S Department of Health and Human Services Fifth Annual Tribal Budget Consultation  Meeting on 2005 Budget May 6, 2003

DHHS/IHS

Budget Formulation and Presentation Branch Division of Financial Management

FY2006 Budget Formulation

40 Developmental Assets® for Middle Childhood (ages 8-12)

Search Institute® has identified the following building blocks of healthy development—known as Developmental Assets®—that help young people grow up healthy, caring, and responsible.

40 Developmental Assets® for Adolescents (ages 12-18)

Search Institute® has identified the following building blocks of healthy development—known as Developmental Assets®—that help young people grow up healthy, caring, and responsible.

40 Developmental Assets® for Children Grades K–3 (ages 5-9)

Search Institute® has identified the following building blocks of healthy development—known as Developmental Assets®—that help young people grow up healthy, caring, and responsible.

Job description for Development Specialist

The Office of the National Coordinator for Health Information Technology (ONC) today issued a final rule to establish a temporary certification program for electronic health record (EHR) technology. The temporary certification program establishes processes that organizations will need to follow in order to be authorized by the National Coordinator to test and certify EHR technology.

The Development Dispatch is NCUIH's monthly newsletter on the social, economic, and technological issues that Urban Indian Health Programs face in their day-to-day operations.

Development Dispatch latest edition 6-24-10 

Affordable Care Act (ACA) $3 million in funding is available for award in FY 2010

Few if any Native American/Alaska Native (NA/AN) people have been included in highly active antiretroviral therapy (HAART) treatment trials or epidemiologic studies, leaving little data on which to be assured of the efficacy of HAART in this unique population. This study aims to evaluate the impact of HAART and review determinants of survival in a cohort of NA/AN persons receiving treatment for HIV in a real life clinical setting. A retrospective chart review of 235 HIV-infected Native Americans receiving services at an urban medical center operated by the Indian Health Service from January 1, 1981 through June 30, 2004 was conducted, providing 782.7 person-years of follow-up. The main outcome measures were time from study entry and from incident AIDS diagnosis to death. Death rates fell from 18.4 (13.3–25.4) per 100 person-years in the period prior to 1998 to 6.4 (4.6–8.8) per 100 person-years in the years 1998–2004, (RR 0.35, p  0.0001). Factors associated with the greatest reduction in risk of death from time of study entry were current use of HAART, HR 0.13 (0.06–0.30, p  0.001), and CD4 count 200 at entry, HR 0.16 (0.08–0.35, p  0.001). Current use of HAART was the strongest predictor of survival from time of AIDS diagnosis, HR 0.11 (0.05–0.25, p  0.001). The use of HAART therapy and CD4 count were primary predictors of survival. Earlier diagnosis and access to effective medical treatment will be key factors in reducing disparities in health brought about by HIV infection in Native American/Alaska Native communities.

Proposals included in this document would ensure that the insurance market functions effectively. Reforms proposed for the individual and small group markets would ensure a competitive insurance market in which plans compete on price and quality rather than on their ability to segment risk and discriminate against individuals with pre-existing health conditions. Proposals contemplated in this document would also make purchasing health insurance coverage easier and more understandable by establishing a gateway or marketplace where American consumers could easily compare and purchase the coverage that best fits their needs.

Portland, OR Tribal leaders criticized the Bush Administration for its last minute objections to S. 1057, a bill to reauthorize the Indian Health Care Improvement Act (IHCIA) at the National Congress of American Indians (NCAI) annual conference in Sacramento,. The Senate bill was cleared for passage last month by the Senate Committees on Indian Affairs (SCIA) and Health, Education, Labor, and Pensions (HELP). Two weeks ago the bill was hot-lined for passage with amendments from the Finance and HELP Committees. Hot-lining is a legislative procedure in which a bill is circulated to all Senate members with a 72 hour window to raise objections; if no Senator objects, the bill passes by unanimous consent.

This proposed rule would revise and consolidate the criteria and processes for designating medically underserved populations (MUPs) and health professional shortage areas (HPSAs), designations that are used in a wide variety of Federal government programs. These revisions are intended to improve the way underserved areas and populations are designated, by incorporating up-to-date measures of health status and access barriers, eliminating inconsistencies and duplication of effort between the two existing processes. These revisions are intended to reduce the effort and data burden on States and communities by simplifying and automating the designation process as much as possible while maximizing the use of technology. No changes are proposed at this time with respect to the criteria for designating dental and mental health HPSAs. Podiatric, vision care, pharmacy, and veterinary care HPSAs, which are no longer in use, would be abolished under the rules proposed below

Congress annually considers 13 or more appropriations measures, which provide funding for numerous activities, for example, national defense, education, homeland security, and crime. These measures also fund general government operations such as the administration of federal agencies. Congress has developed certain rules and practices for the consideration of appropriations measures, referred to as the congressional appropriations process. This report discusses the following aspects of this process:

• Annual appropriations cycle;
• Spending ceilings for appropriations associated with the annual budget resolution; and
• Prohibitions against certain language in appropriations measures that violate separation of the authorization and appropriation functions into separate measures.

Many Organizational components of the Department of Health and Human Services (HHS) support research on the health needs of American Indians and Alaska Natives (AI/AN) but to date there has been few formal avenues through which the Department gathers tribal input on the research needs and priorities of the tribes. While the Department and its divisions and staff divisions (OPDIVS/STAFFDIVS) have tribal consultation policies in place, regularly scheduled consultation meetings tend to focus on more immediate service delivery and financing issues. AI/AN)research priorities do not receive regular or in-depth considerations at most consultations. Moreover, none of the departmental components have AI/AN groups to provide advice specifically on health research matters. In addition, no active organization within the Department is charged with coordinating and optimizing AI/AN research.

This is the Handbook for the 10th Annual Department of Health and Human Services Tribal Budget Consultation Session that took place in the Hubert H. Humphrey Building in Washington DC March 12th-13th

DHHS Testimony of John J. Callahan
July 26, 2000

Assistant Secretary for Management and Budget, before the Senate Committee of Indian Affairs.
Hearing on S.2526

The purpose of the survey was to gather data from Denver American Indian adults and adolescents as well as service providers in the Denver area who work, to one degree or the other, with members of the American Indian community.  These data were to provide a general ideaof the breadth of mental health and other associated problems among the Denver American Indian population.

Dena Ned, former Executive Director for the Salt Lake Walk-In Center (2003-2007), was one of only two Urban Indians having the opportunity to participate in the 2007 John Hopkins Summer Indigenous Research. As such, Ms. Ned was representing and bringing in the perspective of Indian communities living in urban settings when it comes to health issues. The latter was especially important given that the 2007 session focused on the Social Determinacy of Health in Indigenous Populations.  NCUIH had the chance to speak with her about what the program meant for her and what she took from this unique experience.

RPMS presentation by South Dakota Urban Indian Health at the NCUIH annual leadership conference

Accurate and timely information is essential for understanding and improving the health of all Americans. This is especially important for the American Indians and Alaska Natives (AI/AN) residing in urban areas who receive their health services through a network of urban Indian health organizations (UIHOs). This community driven health care network is successful at addressing many of the health needs because it tailors health care delivery to the unique needs of the urban Indian population.

As the nation engages in fervent debate about the future of health care, the need for data to inform the process for organizations that serve urban AI/AN is needed. But unlike the rest of the American health care system, the diversity across the urban Indian health landscape demands a thorough assessment and defined strategy to move toward Health Information Technology (HIT) that will meet the requirements outlined by health care reform.

In the last decade, the United States has increasingly focused on the reduction and elimination of health disparities in racial and ethnic minority groups. Somewhat neglected in these efforts have been mental health disparities for American Indians.2 American Indians remain in a precarious position as an underserved community with limited culturally competent resources to address their mental health and substance-abuse needs.3 The lack of resources continues to prevail despite emerging data that indicate that American Indian disparities in mental health and behavioral health occur at alarming rates, ·which calls for the need for interventions and attention for public mental health, medical and educational resources.

December 6, 2002

White House, Tribal Leaders, Meeting  (The White House) FY 2003 IHS Budget Analysis

Intro:

Tribal leadders requested a brief summary of budget issues for thier meeting today, December 6, 2002, with White House and Department of Health and Human Services staff based on the 13th Annual Northwest Portland  Area Indian Health Board analysis of the Indian Health Service Budget.

Dear Colleague Letter from Various Senators to the Subcommittee on Interior Committee on Appropriations expressing their support for fiscal year 2007 funding for the Urban Indian Health Programs

We are writing to express our support for FY2008 funding of the Urban Indian Health Programs (UIHPs) and to request that funding be restored to the FY2006 enacted level of $32.7 million dollars.  The Presidents budget proposal eliminates funding for 34 urban Indian non-profit organizations providing health care services at 41 sites throughout the U.S. for 430,000 eligible Indian users.

The number one issue with substance abuse on Native-American reservation lands has been and continues to be

alcohol, but there seems there may be a shift in the illegal drug of choice among young people on The Mountain, including "Anglo" communities and The White Mountain Apache Reservation

Database of Universities with Native American Programs

In a community-based sample of urban American Indian and Alaska Native adults, 25 lesbian, gay, bisexual, and two-spirit participants were compared with 154 heterosexual participants with respect to sociodemographic characteristics, Native, cultural participation, trauma, physical and mental health, and substance abuse.

This study examined the perceptions and views of urban American Indian parents regarding foster care and American Indian family issues.  Findings highligh four themes: (1) discouragement from working with the current foster care system, (2) the role of culture in caregiving, (3) differing definitions of family and relatedness, and (4) the effects of historical pain due to past family disruption.  These themes are used to formulate guidelines for the development of an American Indian foster care and child welfare program.

This paper explores the social and cultural context of remission from alcohol problems in an urban American Indian community. Using the discourse of interviews conducted with 48 self-defined problem drinkers, 13 of whom had abstained from alcohol for at least a year prior to the interview, it explores the ways in which alcohol problems have been understood and dealt with by these Indian men and women.

This article will examine HIV/AIDS and substance abuse prevention for urban Native youth in Oakland, California.  it will highligh the Native American Health Center's Youth Services programs.  These programs incorporate solutions based on a traditional value system rooted in Native culture and consisting of youth empowerment, leadership training, prevention activities, traditional cultural activities and wellness and life skills education. 

Social workers need to appreciate the traditions and beliefs of clients from different cultures to provide effective services.  The succes of one hospital clinic in serving American Indians in Boston demonstrated how this appreciation can be translated into programs that are relevant to a particular population or targeted group.

This study investigated the interrelationships among cultural identity, explanatory style, and depression in Navajo adolescents.

Cultural Competency Guidelines & Suggested Output and Outcome Measures


1. Organization ensures that clients/ consumers receive effective, understandable, and respectful services that are provided in a manner compatible with their cultural beliefs and practices, preferred language, physical ability and gender.

This issue brief presents cross-site patterns of system implementation. These patterns emerged from the analysis of locally identified implementation factors that stakeholders considered critical to system of care development. This overview was prepared by Research and Training Center for Children's Mental Health investigators Sharon Hodges, Nathaniel Israel, Kathleen Ferreira, & Jessica Mazza

This paper is a review of federal reimbursement for Indian health care services and a proposal for establishing the Qualified Indian Health Program to aid in maximizing reimbursement to Indian health programs.

This monograph shares results of interviews conducted with personnel from selected organizations and focuses on key practices that were reported to increase accessibility of mental health services for underserved populations. It includes a description of each of the target populations served by the participating study sites, as well as information about the history and context of, and general service delivery information for each organization.

Letter from Two-Spirit Council of Wichita to Governor Sebelius re: President Bush fy 07 budget eliminating UIHP funding. 

Letter from Laura Sisulak to Senator Smith of the Committee of Indian Affairs re: Presidents FY 07 eliminating UIHP

Letter from Representative John Spratt, Ranking Democrat to Chairman Nussle of the House Budget Committee regarding President Bush's FY 2007 Budget which eliminates funding for the Urban Indian Health programs. 

National Congress of American Indians (NCAI) Resolution #SAC-06-071 Opposing President Request to Eliminate the Urban Indian Health Programs

Letter from First Nations Community HealthSource (FNCH) to Senator Jeff Bingaman of New Mexico regarding President Bush's FY 07 budget request that strips the Urban Indian Health Program Funding.

Correspondence Supporting UIHP, State of Arizona office of the Governor - to President Bush regarding his proposed FY 07 budget eliminating the UIHP line item.

Dear Mr. President:

I am writing to express my deep concern over the proposed Fiscal Year 2007 elimination of urban Indian Health Program funding, which is based on the assumption that urban Indians will be able to seek medical services through Community Health Centers (CHCs).

Series of Letters to the United States Congressional Budget Committee requesting continued funding for the Urban Indian Health Program.

Letter from Spokane Tribe of Indians to Northwest Portland Indian Health Board re: improved funding for IHS

Dear Representative Rehberg:

As Governor of the State of Montana, I have opened the doors of state government to Montana's tribal nations. Although I have noteworthy accomplishments during my first year as Governor, there is still much more to do including quality education, economic development, and above all access to health care.

Correspondence, Tribal President, Joseph P. Mike (Village of Kotlik) - Senator Stevens, Washington DC

Dear senator Stevens;

We would like to express our concern over the opposition to fund and preserve the Urban Indian Health Programs across the country. I understand that a series of rumors based on pieces of misinformation have been circulating  in  congress. Such rumors are devastating to the existence of Urban Indian Health Programs

This introduction to the evaluation component of the Circles of Care initiative includes background on the nature of the initiative, Center for Mental Health Services support for developing systems of care for youth with emotional disturbances, and an overview of the systems of care approach.

We are writing in support of the Health Equity and Accountability Act of 2009 and its inclusion in the final health reform legislation. As you and your colleagues continue to work on health reform legislation, the undersigned coalitions, groups, and organizations urge you to strengthen the commitment to addressing health inequities and make certain that health and health care disparities reduction and elimination is prioritized. 

Congressional Hearings Official Transcripts March 30, 2006

House Appropriations Subcommittee on the Interior, Environment and Related Agencies Holds Hearing on FY2007 Appropriations: Native American Issues

Congressional Transcripts, Congressional Hearings

April 2nd, 2008

House Appropriations Subcommittee on Interior, Environment and Related Agencies holds hearing on the Fiscal 2009 Budget for IHS

The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary analysis of the Chairmans mark for the Americas Healthy Future Act of 2009, incorporating the amendments that have been adopted to date by the Committee on Finance. That analysis reflects the specifications posted on the committees Web site on October 2, 2009, corrections posted on October 5, and additional clarifications provided by the staff of the committee through October 6. CBO and JCTs analysis is preliminary in large part because the Chairmans mark, as amended, has not yet been embodied in legislative language. 

Goal: Determine a definition for the Indian Health Care Improvement Act (IHCIA)

Board of Directors Teleconference Meeting Minutes 10-25-1999 (Partially signed with mark-up)

Board of Directors Meeting Minutes 10-25-99

H.R. 5613 would extend existing moratoria on certain regulatory actions taken by the Centers for Medicare & Medicaid Services (CMS) with regard to the Medicaid program. Those actions are related to payments for services furnished by public providers, for graduate medical education, for school-based administration and transportation services, and for rehabilitation services. In addition, the bill would impose new moratoria on Medicaid regulations involving targeted case-management services and provider taxes and on a proposed regulation involving outpatient hospital services. The bill would appropriate $5 million to study the effects of these regulations on the Medicaid program.

We are writing to call your attention to the Special Diabetes Program, which is demonstrating real returns on a modest federal investment and has tremendous potential not only to reduce health care costs, but also to dramatically improve the lives of nearly 26 million Americans living with diabetes. We thank you for your past support of the program and hope that you will continue to ensure that investments are made in this critical program.

U.S. Congress House of Representatives invitation to Beverly Russel, NCUIH Executive Director, to a special hearing on Eliminating Health Disparities that will be held April 3rd, 2002.

Confidentiality Diagram "HIPAA Organized Health Care Delivery System"

National Council of Urban Indian Health 2011 Annual Leadership Conference Agenda (draft) 

NCUIH's 2010 Annual Conference Agenda in Washington DC.

1999 Compilation of the Social Security Laws

Comparison of the Senate Version of Indian Health Care Improvement Reauthorization and Extension Action of 2009 with Current Law and 2nd Report on Recommendations from the NSC

Overweight and obesity affect almost half of all reservation-based Native American youth. One causative factor may be low levels of physical activity. The purpose of this study was to compare Native American physical activity in adolescents living on reservations to their urban dwelling counterparts. 

Community Health Aide Program (CHAP) services are a sustainable, effective, and culturally acceptable method for delivering health care. This unique progra1n has demonstrated adaptability to advances in medicine and the evolving health needs of the population, and it does so at comparatively low cost. The total combined program expenses of $55M provide 270,000 emergency and primary health visits annually to approximately 50,000 Alaska Natives at a cost of approximately $1,100 annually per patient ($5 5M/50,000).

 Today over 550 Community Health Aides/Community Health Practitioners (CHA/Ps) are employed by 27 tribal health organizations in 1 78 rural communities. CHA/Ps are the patients' first contact within the network of health professionals in the Alaska Tribal Health System.

A learning community comprised of leaders, professional and paraprofessional staff of Urban Indian Health Programs addressing a variety of health and wellness topics for urban Indian populations. The Community of Learning is coordinated by the National Council of Urban Indian Health to provide information, training, tools, peer support, resources and updates on funding opportunities to support Native health, wellness, treatment, and recovery support initiatives within urban communities.

On February 4, 2008, the President issued his Budget of the United States Government for Fiscal Year 2009. Indian housing programs are lodged in the Department of Housing and Urban Development (HUD), the Department of the Interior Bureau of Indian Affairs (BIA), the Department of Veterans Affairs, the United States Department of Agriculture and the Department of Labor. The Presidents Budget Request keeps pace with last years funding levels for many programs; however, as has happened for the last few years, programs such as Interiors BIA Housing Improvement Program (HIP) and NAIHC are zeroed out. The Administration describes HIP as duplicative to HUDs NAHASDA programs. NAIHC is viewed as an earmark in the fiscal reform movement sweeping across Washington DC now.

Indian health programs by increasing the base funding for the Indian Health Service but roughly $700 million in the outline of the Presidents FY2010 budget. These actions, when taken together with President Obamas outreach to Tribal and Urban Indian communities during the election season, signal a deep ideological shift in the Executive Branch towards being more responsive to Native American issues and concerns. The Obama Administration has thus far proven to be interested in increasing IHS funding, reviewing problematic regulations, and in general has been responsive to both Tribal and Urban Indian concerns. Having a responsive, engaged President provides new opportunities for Urban Indian health programs and clinics that have been absent for the past eight yearsnew opportunities  that will require innovative and creative thinking.

I am writing on the behalf of the National Council of Urban Indian Health (NCUIH), our 36 member programs and the 150,000 patients that our programs serve annually. NCUIH works to raise the health status of all American Indians and Alaska Natives living in urban centers. As the primary organization dedicated to urban Indian issues, we have been participating in the UN forum on Indigenous People and been working with other indigenous groups from other countries to find innovative solutions to our peoples needs. We feel that with the new Administration there is a great opportunity for the United States to become a world leader on protecting the freedoms, health, and wellbeing of indigenous peoples everywhere. I respectfully request that you guide the Department of Sate to focus upon issues impacting indigenous people. As you know, there are over 600 federally-recognized Tribes in the United States and over one million American Indians and Alaska Natives living across the country. As the Obama Administration reaffirms the federal governments commitment to fulfill its trust responsibilities to American Indians and Alaska Natives, I respectfully request that you take leadership in directing the State Department to address Indigenous issues.

The hottest topic in Washington right now besides the FY2010 Budget is health care reform and the multitude of health care reform proposals floating around Washington. President Obama announced that major health care reform will be his chief priority for his first year in office. Senator Baucus has also announced that he intends to introduce and move a major reform package through Congress by the end of June. Various groups representing consumers, insurance companies, business interests, consumer groups, health care providers, and minority organizations have all put forward their policy statements on health care reform. If Native Americans are going to be heard during this time, the national Indian organizations must also produce policy statements.

This report outlines how essential it is that we pursue improvements in health care quality and efficiency at the same time as we pursue universal coverage, said Dr. James Mongan, Commission Chair and CEO of Partners Health System. We can not and should not hold either of these facets of reform hostage while we wait for the other to happen

The Interior and the Environment bill provides for the environmental and conservation needs of Americas people and its natural resources. The key investments made in this bill will ensure that Americas water and air will be cleaner, its pristine natural landscapes and historic structures more protected, wildfires will be appropriately managed, and visitors to its national parks, refuges and forests will experience, for the first time in years, improved levels of service. The bill also honors our obligations to Native American communities, making investments into better education and healthcare. It works to improve the quality of drinking water throughout the country by restoring funding to the Clean Water Revolving Fund. And it renews our nations support for the arts and humanities.

This is a practical resource for medical providers who are confronted with basic cultural challenges presented by Native American patients living with or at risk for HIV infection.

The purpose of this series of articles is to encourage Indian Health Service, tribal, and urban program providers to view the Congressionally required Government Performance and Results Act (GPRA) clinical performance activity as an opportunity to improve patient care.

(publication has no date, loaded 2012)

The Indian Health Service (IHS) has established a long and successful history of addressing acute, infectious diseases. Today, a new epidemiological challenge faces the Indian Health system: Chronic Illness. The IHS has recognized that the future health of American Indian and Alaskan Native  communities depends on how effectively the the Indian Health System addresses chronic conditions, such as diabetes, cardiovascular disease and various cancers.

Goal
 To discuss key characteristics common to highly effective boards

The objectives of this study were to ascertain the extent of, and health-related characteristics associated with, travel to reservations in a low-income, urban American Indian and Alaska Native (AI/AN) population.

Changing The Borders of the Federal Trust Obligation, Urban Indian Healthcare Crisis. This publication introduces readers to the Urban Indian population starting with the BIA relocation program -through- present day issues regarding access to healthcare, definition of Indian, gaps in the IHS health care system.

Report: 6/4/2001

Canges in Title V Current and Submitted Leg. Health Services for Urban Indians

There are 2.4 million American Indians living within the territorial boundaries of the United States, according to the 2000Census. Although a full picture is less than clear and statistics vary from tribe to tribe, there are challenges that exist across

Indian country. Median wages for both American Indian men and women are below the national average. Many tribes have poverty rates above the national average. The poverty rate for Cherokee is 18.1 percent, for Chippewa, 23.7 percent, and for Navajo, 37 percent, based on the 2000 Census. The Associated Press reported in July that the results of a Freedom of Information Act request show that the Navajo Nation lost $9.2 million a year in Head Start funding due to broken playground equipment, heaters, and a host of other problems.

I am very pleased to present to the Subcommittee recommendations for the 2009 Interior and Environment Appropriations. These recommendations are the product of a very deliberate and bi-partisan process. Our subcommittee held 20 separate hearings on the Presidents budget with more than 200 witnesses. These witnesses included agency officials, Members of Congress, more than 100 tribal leaders and many other public witnesses. The recommendations in this bill, especially those related to Native Americans Programs, flow directly from these hearings. Mr. Tiahart and I have also discussed this bill many times since the hearings concluded on April 9th, and the Majority and Minority Committee staff have spent scores of hours working as a team putting the Members recommendations into todays proposal.

CDC/ATSDR FY 05

Breakdown,

Award no., Project title, Grantee name, CIO Approved budget etc.

Note: Doc. P134 - P144 related CDC Info

CDC/ATSDR Tribal Consultation  Policy Questions & Answers

What is the Tribal Consultation Policy?

Why did the CDC/ ATSDR establish a Tribal Consultation Policy?

How will Tribal Partnerships be strengthned through this policy?

note: Documents P134 -P144 related, CDC handouts, informative info.

Center for Disease Control and prevention efforts in self-directed violence Surveillance


Health Disparities in Suicidal Behavior Among Adolescents

CDC, Objectives, The Public Health  Approach to Prevention, Public Health Surveillance, Why do we need Injury Surveillance Systems?........

CDC/ATSDR (draft) Tribal Consultation Policy Summary of Operating  Procedures & Reporting Requirments

note: Doc. P134 - P144 related, Informative info from CDC

CDC/ATSDR Tribal Consultation Policy (outline of Policy)

Purpose, Abbreviations, Acronyms, Definitions, Philosophy, Introduction, Background, Policy, Responsibilities, Procedures, ATSDR supp. Information, Additional Resources, References

note: Doc. P134-P144 related, CDC handouts, Informative

CDC Announcments on Tribal Consultation Policy

New policy seeks to strengthen CDC efforts to improve health and well being of American Indian & Alaska Native people.

CDC/ATSDR

Tribal Consultation Tribal Policy Update  (Slides)

CDC ATSDR has developed a new policy regarding Tribal Consultation. The purpose of this Policy is to provide  guidance for working effectively with American Indian & Alaskan Native  (AI/AN) Communities and organization and enhancing (AI/AN access CDC/ATSDR programs.

note: Doc. P134 - P144 related topics, handouts from CDC

Objectives. Little information exists regarding the causes of visual impairement and the most common eye problems in American Indians/Alaska Natives. Methods. We randomly sampled American Indians/Alaska natives older than 40 years from 3 tribes within the Northwest region.

Native Americans, the smallest racial minority in the United States, comprise the fastest growing ethnic group and have a myriad of social and health problems.  Women play an important role in health care practices and decision making in this community because many tribes are matrilineal.  Practice, education, and research strategies should include identification of beliefs and practices specific to the clan or tribe because there is wide varience in values, lifestyles, and taboos from tribe to tribe.

This Roundtable Conference focused on financial provisions contained in the Clinton Administration's national health care reform package.  Discussions centered on how these provisions would impact approximately 1.3 million American Indians and Alaska Natives (AI/ANs) who currently receive health care from the Indian Health Service.

Cancer survival among American Indians is worse than among other races in some regions of the United States, but has been studied among American Indians in Washington state. Our purpose was to evaluate cancer survival among American Indians included in the Seattle-Puget Sound Cancer Registry. 

PURPOSE: The health issues which have historically faced American Indians are related to infectious disease, but today many chronic diseases play a large role in the health status of this special population. For example, existing data indicate that American Indians have the poorest cancer survival of any group in the U.S. (34% vs. 50% for U.S. Whites). Regular participation in cancer screening and lifestyle factors such as smoking, diet, and alcohol have been found to significantly contribute to cancer risk. However, available information about these behaviors is sparse and suffers from limitations. The purpose of this study was to assess the prevalence of cancer risk behaviors and provider recommendation for cancer screening among urban American Indian women.

This report presents data on cancer patterns among AI/ANs residing in Idaho, Oregon, and Washington. We examined data from the area’s three state cancer registries to describe a range of cancer measures from 1996-2007. Tribal leaders provided insights on cancer experiences within their communities, cancer care issues, and the role of traditional lifestyles.

Very little is known about breat carcinoma risk factors for American Indian/Alaska Native (AI/AN) women undergoing screening.  The Gail model has been a useful tool for predicting the risk of breast carcinoma in several populations.  It has not been applied systematically to AI/AN women.

The case for reform is strong. The U.S. is the only developed country that does not guarantee health coverage for all its citizens, with 46 million uninsured and another 25 million underinsured. As a result, families are struggling to keep up with out-of-pocket costs for medical care. American businesses are straining to absorb rising health care costs while staying competitive at home and around the world. Despite high levels of spending on health care, research documents poor quality of care received by patients in the U.S. Studies show, for example, that adults receive recommended care for many illnesses only 55 percent of the time. Children fare even worse.

National Health Reform policy Document with recommendations from California Rural Indian Health Board (CRIHB)

NCUIH Bylaws Committee Meeting packet Feb-3-2000

Contents part 2b of 3

Articles 9-15

page 32

Written Consent of Directors Adopting Bylaws

Certification Page 32

NCUIH Bylaws Committee Meeting Packet Feb-3-2000

Contents: Article 1-7

The project examined data available on American Indian cancer patients in clinic records, identified cancer screenings currently being conducted, and implemented a trial use of a neoplasm record form to report cases to the Wisconsin Cancer Reporting System, the states cancer registry.

California Health Care Foundation: Health Currents

Publication, Urban Indian Children Left Out of Public Inssurance Programs May 20, 2002

NCUIH Audit Report, Fiscal Year Dec-2003 & 02

Ego & Company, P.C. Certified Public Accountants

NCUIH Board of Directors Policy Manual (March-2003)

Packet Contents: Policy, Procedures, Forms

Note Publication is listed within the KRC in parts TA95 - TA110. Historical Trauma, Diversity among AI/AN Communities, Urban Community Demographics etc.

Welcome/Introductions
Overview of session
Key questions
Definitions
Characteristics of an effective team
Characteristics of an effective team meeting
Moving from a group to a team
The five dysfunctions of a team
Resources
Evaluate This Session

For the past three years running the Bush Administration has sought to eliminate the Urban Indian Health Program from the IHS budget. This is a small, but vital program in the larger health care system for Native American peoples. The National Council of Urban Indian Health has successfully advocated for the restoration of the UIHP in the FY2007 and FY2008 budgets passed by Congress. We are delighted to have found staunch friends in Congress on both sides of the aisle. We hope that once again Congress will reject the Administration’s attempt to zero out the UIHP. 

Finding disparities in the health status and outcomes for Native Americans, the Commission explored the causes for those disparities. Consequently, the Commission report assesses whether the Indian Health Service (IHS), and the Centers for Medicare and Medicaid Services (CMS) are improving the delivery of health services and the overall health status of Native Americans. In essence, this report evaluates the Native American Health Care system.

Briefing Paper on H.R. 2440, Congressman Don Young
The Indian Health Care Improvement Act of 2003

On March 14th, the House Resources Committee held a hearing on H.R. 1328 with mark-up conducted on April 25th. Linda Holt, NPAIHB Chairperson, provided testimony before the Committee. The Resources Committee favorably reported H.R. 1328 out of committee with a commitment from Chairman Rahall to work with the National Steering Committee and Representative Inslee on health facilities construction language that continues to be a concern for Northwest Tribes. Rep. Inslee did offer an amendment to revise facilities construction language at Section 301; however after the Chairman and other members committed to continue to work on this issue until a favorable outcome is reached, Rep. Inslee then withdrew the amendment. The bills sponsor, Rep. Pallone, who also serves as the Chair of the Energy and Commerces Health Committee, has convened a hearing on the bill on June 7, 2007.

Brief Summary of Major Changes Proposed to the Indian Health Care Improvement Act by the National Steering Committee
  

Background: Breast cancer incidence and survival varies by race and ethnicity. There are limited data regarding breast cancer in Native American women. Methods: A retrospective chart review was performed of 139 women diagnosed with breast cancer and treated at Phoenix Indian Medical Center in Phoenix, AZ between January 1, 1982 and December 31, 2003.

This study investigated body-image perceptions among Native American youth.

NCUIH Board Meeting Oct-12-1999
This Document shows a special session meeting to discuss Bill s 1507
Decision to draft resolution to oppose bill

Roles and Responsibilities of Non-Profit Board and Board Members workbook 

NCUIH board of Directors Meeting Teleconference Jan-4-2000

Bismarck Tribune May 16, 2001

35% of Indian women Nicotine users.

Outcomes: To describe perinatal outcomes and maternal characteristics among American Indian/Alaska Native (AI/AN) women with diabetes in pregnancy.

A letter in response to the request for reviews of the Department of Health & Human Services (DHHS) S.212, the " Indian Health Care Improvement Act Reauthorization of 2001". S212 would expand coverage for the delivery of health care services to American Indians and Alaska Natives and make a number of other changes to the Indian Health Care Improvement Act (IHCIA)  and in related provisions of the Social Security Act. 

From HHS - to - Committee on Indian Affairs

Despite largely successful efforts by the chronically underfunded Indian Health Service and by tribally managed andurban Indian health centers to provide high-quality health services, the system is strained nearly to the breaking point by poverty and ill health.  This article includes related statistics and quotes from those involved in the system.

This study addresses the impact of assessment method (interviewer-administered questionnaire vs. selfadministered questionnaire) and interviewers’ demographic characteristics (gender, ethnicity, and residency) on responses to alcohol and tobacco questions. The study population included 1,522 men and women aged 45 to 74 from the Dakota Center of the Strong Heart Study (SHS), a multicenter study of cardiovascular disease in American Indians. Assessment method effects were greater for alcohol than tobacco but did not differ by interviewer characteristics.

Background: The biopsychosocial model has been a cornerstone for the training of family physicians; however, little is known about the use of this model in community practice.  This study, conducted in an urban Native American health center, examined the application of the biopsychosocial model by an experienced family physician (Dr M).

Background: Little is known about beverage preference, especially among understudied urban minority populations.  Also, most studies do not differentiate between beer and malt liquor or among wine, wine coolers, and fortified wine.  This articles examines whether ethnicity or drinking frequency are associated with beverage choice, considering six types of alcoholic beverages: beer, wine, spirits, malt liquor, fortified wine, and wine coolers.

A mixture of commitment, cultural sensitivity, and community involvement ca lead to success in Indian health care diabetes intervention programs.  Meeting the demand for consumer and patient-focused nutrition education, registered dietitians (RDs) serving Indian Health Service, tribal, and urban programs are developing methods to address specific need of American Indian and Alaska Native communities.

The provision of health care to American Indian and Alaska Native (AI/AN) people in Indian Country and urban areas has become increasingly complex. Health care delivery systems are expected to be more flexible even though health care dollars are becoming scarce. To justify national funding and maintain a high quality of health care, baseline measures must be established.

The purpose of this study was to gather information from both HHS program officials and tribal representatives on their perspectives on various program and regulatory barriers to American Indian, Alaska Native, and other Native American (AI/AN/NA) tribes and communities accessing HHS discretionary grants, identify for HHS the most significant barriers to grants access for American Indians, Alaska Natives and Native Americans (AI/AN/NA), and consider strategies for improving access. Lessons learned about reducing barriers to funding in other recent HHS initiatives targeting special populations were also reviewed to inform the study.

NCUIH, Co-OperativeAgreement with IHS Health Advocacy Grant, 2 year Extension 1999-2000

Families with a parent, child, or youth who is lesbian, gay, bisexual, transgender, questioning, intersex, two-spirit (LGBTQI2-S) or transitioning navigate varying levels of acceptance and support when accessing and utilizing needed services within the mental health system. A new monograph offers a public health approach for communities to meet the needs of these families.

Based upon Senate Report No. 100-165 and Conference Report No. 100-498 of FY 1988, the Committe on Approprations requested that the Indian Health Service (IHS) conduct an assessment of the needs of urban Indian residing in the State of Arizona.

The Periodontal Disease Research Center at the State University of New York at Buffalo has studied two sets of subjects--those with a high prevalence of diabetes (the Pima Indians) and an urban populations in Erie County, New York--to determine factors that put a patient at risk for periodontal disease.

The purpose of this report is to present findings on the health status and health needs of American Indians and Alaska Natives (AI/ANs) in six urban areas not currently served by urban Indian health programs funded by the Indian Health Service (IHS).

One of the most important responsibilities of a board is to evaluate the performance of the chief executive and quality of the board/chief executive relationship. This critical partnership is where governance and management come together; where professional growth and development is encouraged, and where boards both support and hold accountable the chief executive.

When detainees are screened during admission for suicide risk, their culture may make a difference in the outcome of the assessment. For any group of people, culture – or way of life - is the prism through which group members see the world and respond to it. Culture shapes people's view of concepts like trust and authority, and can even affect their perceptions of physical and mental health. With the help of researchers, the administrator of a jail in the Northern Plains area of the United States found out the power of culture in identifying suicide risk. The rate of suicidal behavior at this facility was high, and the administrator called in the researchers to try to find the reason.

The TeenPEACE Project, which is a violence intervention model within the Peace Mentors Program, caters to teens that have either experienced, witnessed or perpetrated violence in relationships. The program has been in operation for four years and had, by its first year, served 180 teens.

American Indians are more likely than other Americans to suffer from arthritis joint pain, a leading cause of disability in the United States. This article discusses cultural interpretations of pain and theirimpact on treatment decisions.

OBJECTIVE: To describe beliefs and self-care strategies of American Indians with chronic arthritis join pain.

This article describes the intricate challenges of bringing mental health services to isolated, guarded urban HIV-positive Native Americans suffering from chronic trauma-related illnesses and imbalances, depression, anxiety, substance abuse, thought disorders and trauma-based characterological disorders.

PowerPoint presentation describing the protections offered by the American Recovery and Reinvestment Act of 2009

Dear Senators Harkin and Spector,

We are writing to express our support for a $300,000 earmark in the fiscal year 2003 Senate Labor, Health and Human Services, and Educations Appropriations bill for the Seattle Indian Health Board's Family practice Physician Residency Training Program, which prepares physicians to serve American Indian and Alaskan Native  communities.

The purpose of this study was to identify and characterize any association between prior injury and/or alcohol use contacts with the Indian Health Service (IHS) and subsequent alcohol-related injury death that may suggest opportunities for mitigation.

This study evaulated the health care situation for American Indians and Alaska Natives (AI/ANs) in urban areas.

The purpose of this study was to obtain information on the oral health status, treatment needs, and cost of treatment for Head Start children in Alaska.

There is little information on the lead levels of Indian children nationally.  In the late 1990s members of the Chippewa and Cree tribes living on the Rocky Boy Reservation near Box Elder, Montana, were concerned about environmental pollution and how it might be affecting the health of their children. 

When Native people arrive at the doctors office, they come bearing the effects of discrimination and dispossession, which take a physical and mental toll. As a result, Native people in the United States bear an excess burden of disease, dying younger and often living sicker than members of other groups.

Yet Native people* often cannot get quality health care when they need it, despite the responsibility of the United States government to provide for Native peoples health care. The infrastructure serving Native health needs is chronically underfunded, out-of-date, and understaffed. Native people have extremely high rates of uninsurance, and when they do make it into the clinic or hospital they often receive substandard care and biased treatment.

This storybook shares the experiences of Native people struggling to get health care they need. The contributors provide personal accounts of their efforts to be treated with respect by practitioners, as well as their fight to improve the health and wellbeing of their communities.

American Recovery and Reinvestment Act of 2009, HR. 1, (ARRA), (Full Text)

The American Medical Student Association (AMSA) is pleased to endorse HR 3200 addressing much needed change in our current healthcare system. AMSA is the oldest and largest organization of physicians-in-training in the United States, with over 62,000 medical, pre-medical, resident and physician members.

As future physicians, we see throughout our training the lack of access and affordability our patients must face. All too often, our patients are left without needed medical care, including preventative care, life-saving therapies, and other medical interventions. AMSA recognizes as one of its key Strategic Priorities: Quality, Affordable Health Care for All, as well as necessary Health Care Equity.

There is often confusion regarding urban/rural population statistics because of the difficulties in defining these geographic terms.  This article attempts to clarify the concepts of uran and rural, metropolitan areas, and other geographic terms as they relate to IHS and the American Indian and Alaska native population.

In this study, the Indian Health Service (IHS) and Administration on Aging (AoA) pursued the following objectives: 1) to assess the current health status and health care needs of Amerian Indian elders; 2) to assess the status of services currently provided to American Indian elders under Titles III and VI of the Older Americans Act; 3) to identify areas where significant gaps in documentation prevent the clear assessment of the the status of American Indian elders.

AI/AN Fy 2001 Needs Based Budget charts

The purpose of this study was to examine the extent to which role conflict, life satisfaction, self-esteem, instrumentality, expressiveness, age and education predicts ambulatory depression among a community based sample of urban American Indian working women.

A team of researchers used social learning theory, research data, and focus groups to design a cervical cancer screening program. The major component of the program was the adaptation of a culturally acceptable mode of communication called Talking Circles. The American Indian Talking Circle project used the Talking Circle format, coupled with traditional Indian stories, as a vehicle to provide cancer education and to improve adherence to cancer screening. Eight American Indian clinics were randomly assigned into intervention and control sites.

Letter to Senator Dorgan from the American Indian Heritage Support Center, Thanking him for the support of the Indian Health Care Improvement Act. 03-29-07

Minnesota's urban and rural Indian communities today face a similiar set of complex and daunting health problems.  No one overriding issue exists, nor does an overall solution.  While staff shortages, a dire lack of Indian health professionals, and inadequate financial resources play a role, poverty, racism, lifestyle, alcoholism, and cultural change and conflict all further complicate health problems for Indian people.

American Indian Health Care Association (mark-up) Evaluation of Potential Site Locations for New urban Indian Health Care Programs

September 30, 1989

"My people are in pain and are suffering from meth," Kathleen Wesley-Kitcheyan told the U.S. Senate Committee on Indian Affairs. The chairwoman of the San Carlos Apache Tribe, a community of 13,000 in Arizona said methamphetamine is "shattering families, endangering children and threatening the tribe's spiritual and cultural lives." It was impossible for her to get through her testimony without breaking into tears.

Racial and ethnic health disparities undermine our communities and our health care system. Our infographic shows some of the more prevalent health disparities that afflict American Indians & Alaska Natives in the United States (compared to non-Hispanic whites). 

Survey and Spreadsheet of all Amendments to H.R.1328 offered by Representative Pallone  11/07/07 as amended by Health Subcommittee of Energy and Commerce Committee. 

As part of its trust responsibility to Indian tribes, the Federal Government has the obligation to provide health care to Indian people. It is the mission of the Indian Health Service (IHS) to carry out this obligation primarily through the Indian Health Care Improvement Act (IHCIA). But since the IHS is funded at little more than 50% of need, the IHS has never been able to supply even the most basic package of benefits to Indian people. H.R. 3200, would make sweeping changes that will profoundly affect health care access and delivery. Tribal leaders seek to assure that the unique Indian health care delivery system through which some 1.9 million  American Indians and Alaska Natives receive their care is both protected from harm and is strengthened through this legislative process. 

One of the major battles that Urban Indian Health Program has had to fight under the previous Administration revolved around the Congressional intent to fund and maintain the Urban Indian Health Program. While Congress was explicit in its intent to maintain the program in the FY2007, FY2008, and FY2009 Budget Appropriations Acts, the underlying argument that it is not the federals responsibility, and should not be the federal governments policy to provide health care to Indians off the reservation, is still very much alive.

Amendment in the Nature of a substitute intended to be proposed by Mr. Dorgan-- This act may be cited as the "Indian Health Care Improvement Act Amendments of 2008"

To rescind funds appropriated by the Consolidated Appropriations Act, 2008, for the City of Berkeley, California, and any entities located in such city, and to provide that such funds shall be transferred to the Operation and Maintenance, Marine Corps account of the Department of Defense for the purposes of recruiting

Amendment #4038 to S.1200 Indian Health Care Improvement Act (Vitter) -child victims of sexual abuse

Amendment no.4066 to Amendment 3899 for Senate Bill S.1200 the Indian Health Care Improvement Act (IHCIA)

To amend Title XVIII of the Social Security Act to provide for a limitation on the charges for contract health services provided to Indians by Medicare providers

(Brownback) To acknowledge the long history of depredations and ill-conceived policies by the Federal Government regarding Indian Tribes and to offer an apology to all Native Peoples on behalf of the United States

(Bingaman) Limitation of Contract Health Services Provided to Indians by Suppliers 

(Vitter) #3985 - Application of FECA to Indian Tribes - Treatment of Tribes as Corporations

(Vitter) Limitation Relating to Abortion - No federal funds may be used to "provide any abortion" or "to provide, or pay any administration costs of, any health benefits coverage that includes coverage for abortion

(Smith-Otters) Consultation and Conferring 

(Barrasso) IHCIA evaluation report on recommendations in coordinating healthcare 

Low-Income Home Energy Assistance Program

AMENDMENT TO THE AMENDMENT IN THE NATURE OF A SUBSTITUTE TO H.R. 3200

1 (14) INDIAN.The term Indian has the meaning given such term in section 4 of the Indian Health Care Improvement Act (24 U.S.C. 1603).

(15) INDIAN HEALTH CARE PROVIDER.The term Indian health care provider means a health care program operated by the Indian Health Service, an Indian tribe, tribal organization, or urban Indian organization as such terms are defined in section 4 of the Indian Health Care Improvement Act (2510 U.S.C. 1603).

To amend Title IV to conform to the Medicare, Medicaid, and State's Children Health Initiative Program (SCHIP) Indian Health Care Improvement Act of 2006

Amendment to Senate Bill S.1200 the Indian Health care Improvement Act--On page 139, strike lines 5-9 and insert the following: (III) May include such health care facilities, and such renovation or expansion needs of any health care facility, as the Service may identify; and on page 143, strike lines 15-17 and insert the following: Wellness centers, and staff quarters, and the renovation and expansion........

To amend titles XVIII, XIX, and XXI of the Social Security Act to Improve health care provided to Indians under the Medicare, Medicaid, and State Childrens Health Insurance Programs, and for other purposes.

Amendment to Senate Bill S.1200 the Indian Health Care Improvement Act--Amendment No.4073 that was included into Amendment 3899--Indian Tribes Operating Class III Gaming Activities--This Act and the Amendments made by this Act shall not apply to any tribe carrying out Class III gaming activity (as defined in section 4 of the Indian Gaming Regulatory Act (25U.S.C.2703)

Amendment to the Senate Bill S.1200--The Indian Health care Improvement Act--(None of the Funds made available to carry out this Act may be used to carry out any anti-firearm program, gun buy-back program, or program that discourage or stigmatize the private ownership of firearms for collecting, hunting, or self-defense purposes.) Proposed by Senator DeMint

Amendment No.4038 to the Indian Health Care Improvement Act S.1200

On page 294, Strike lines 11-15 and insert the following. Programs involving treatment for victims of Sexual Abuse who are Indian Children or Children in an Indian Household

Amendment No. 3893-- Brownback Apology
Amendment 3894--Bingamen Amendment to Social Security for American Indians
Amendment No. 3896--Vitter No funds in this amendment can be used to provide any abortion; or to provide, or pay any administrative cost of, any health benefits coverage that includes coverage of an abortion
Amendment No.3897--Smith -Otters-- Strike Subsection (f) of section 301 of the Indian Health Care Improvement Act (as amended by section 101) and insert the following: (f) Developement of Innovative Approaches--The Secretary shall; consult and cooperate with Indian Tribes and Tribal Organizations, and confer with Urban Indian Organizations, in developing innovative approaches to address all or part of the total unmet need for construction of Health Facilities, that may include the establishment of an area distribution fund in which a portion of health facility construction funding could be devoted to all service areas;

Mr. Waxman of California submitted amendments to H.R. 3200, the "America's Affordable Health Care Choices Act of 2009"

Objective: To describe the pattern of alcohol consumption by older urban American Indians in Los Angeles, California, in 1987-89.

This paper introduces an ongoing ten-year prospective longitudinal study of alcohol abuse, drug abuse, and mental health status in a community sample of urban American Indian asolescents and women.

The purpose of this report is to describe the particular health needs of the American Indian population of Albuquerque, NM and based on those needs to establish a health care plan as a step toward self-determination

Letter: Anita Cordova (Albuquerque Health Care for the Homeless) to John McCain, Senate Committee on Indian Affairs

Dear Chairman McCain, Senator Dorgan and Members of the Committee,

President Bush has opposed the elimination of the entire Urban Indian Health Program (UIHP) from the Indian Health Services FY07 budget in the department of health and human services (DHHS).

Albuquerque Area Indian Health Board, Inc. 

Resolution 06-03, to support the Albuquerque Indian Community in addressing the federal 2007 budget cuts to Urban Indian Health Funding.

Alaska- Distraught over the suicides of their friends, teens from Southwest Alaska fought back tears as they pleaded with parents to connect with children. They blamed the deaths on family abuse, bullying, alcoholism and other problems.

Suicide rates in Alaska Native elders are studied to further explore cultural factors in elderly suicide. Data for the 1960s and 1970s are reviewed, and new data on Alaska Native suicide rates are presented for the 10-year period of 1985 through 1994. In many areas throughout the world, suicide rates are highest for the elderly. During the Alaska'' oil boom," suicide rates more than tripled for the general population but decreased to zero for Alaska Native elders. Cultural teachings from the society's elders were more important during this time of cultural upheaval. During the study period, the cultural changes dissipated, and suicide rates for Alaska Native elders, although lower than those of White Alaskans, increased. This provides further evidence that suicide rates for elders can by influenced by social factors-both to raise and to lower rates.

Amendment to the Indian Health Care Improvement Act of 2009 submitted by Senator Franken for S.1790 attached by unanimous voiced vote.

NCUIH 2011 Annual Leadership Conference Agenda

Poor outcomes in education and economics are closely tied to poor outcomes in health. Like the disparities in education, disparities in health persist from the beginning of life onwards. The black infant mortality rate is more than twice as high as that for white infants. The following statistics give some illustration of other grave health concerns that disproportionately affect African Americans.

2002 Cover Letter and Application for Advocacy Demonstration Grant 2002-2005 IHS

Discusses critical financing structures and strategies to support systems of care for children, adolescents and their families, and examines how financing mechanisms operate separately and collectively to achieve this goal.

Although HIV/AIDS prevention has presented challenges over the past 25 years, prevention does work. To be most effective, however, prevention must be specific to the culture and the nature of the community. Building the capacity of a community for prevention efforts is not an easy process. If capacity is to be sustained, it must be practical and utilize the resources that already exist in the community. Attitudes vary across communities; resources vary, political climates are constantly varied and changing. Communities are fluid-always changing, adapting, growing. They are ready for different things at different times. This article presents a model that has experienced a high level of success in building community capacity for effective prevention/intervention for HIV/AIDS and offers case studies for review. 

A study of whether adolescent vegetarians were more likely than nonvegetarian peers to meet the dietary recommendations of the Healthy People 2010 objectives and to examine differences in other nutrients between these 2 groups.

position description

In 1990, at the Third International Gathering of Native gay, lesbian and bisexual people held in Winnipeg, cultural teachers shared language and information that resulted in the widely accepted term Two Spirit, which many people embraced as an alternative to berdache and gay. The community recognized that some males are balanced by feminine identities, and some females are balanced by strong masculine characteristics, in keeping with many Native traditions. As the communities have reconstituted pieces of our histories, it also became clear that quite often the partners (spouses) of Two Spirit persons dont identify as gay/lesbian/bi or Two Spirit-, which is also consistent with cultural traditions. The rebirth of pride in these identities began to grow, at the same time that the epidemic of HIV began to appear with devastating results among Native people.

Debate on how to fix the U.S. health care system has reached a crescendo recently, with a host of proposals directly aimed at addressing the nearly 47 million Americans struggling without health insurance coverage and the millions more left underinsured due to changes in employer coverage plans.1 Presidential candidates, along with Members of Congress and health care experts, have put forth varying solutions to the one crisis on which there is little dispute— the lack of affordable health insurance coverage for too many Americans. But expanding health care coverage without addressing the need to provide access to quality preventive and primary care services answers only part of the health care equation. Even if universal coverage becomes a reality in the next decade, there persists the larger problem of the scarcity, and even in some communities the total absence, of preventive and primary health care services. Our research has found 56 million Americans of all income levels, race and ethnicity, and insurance status have inadequate access to a primary care physician due to shortages of these physicians in their communities.

Diabetes Mellitus is the most frequently identified health problem in the Aberdeen Area IHS/Tribal budget formulation consultations for FY 2009-10, and has been among the top five health priorities for budget formulations for the past ten years. Type II diabetes occurs at dramatically higher rates in American Indians and Alaska Natives (AI/AN) than in the general U.S. population.  The prevalence of Diabetes in the Active User Population of the Aberdeen Area increased by 3.5% (6114 patients) over the baseline GPRA Year 2000 based on data extracted via the Clinical Reporting System (CRS).  Among all age groups, the highest increase in diabetes prevalence has occurred among AI/AN  adolescents aged 1519 years, with a 106% increase from 1990 to 2001. (Interim Report to Congress, Special Diabetes Program For Indians, IHS National Diabetes Program, December 2004).

1)      Lawmakers take on Bill to create Health-Reform Authority
2)      Medicare to play big role in Health Care Overhaul
3)      Lawmakers Debate Tax on Health Benefits
4)      New Analysis Democrats Consider Bypassing GOP on Health Care Plan
5)      Senate Finance Committee Votes 15-8 to Endorse Sebelius as HHS Secretary

The American Psychological Association's (APA) newly released report, Stress in America™: Our Health at Risk, paints a troubling picture of the impact stress has on the health of the country, especially caregivers and people livingwith a chronic illness such as obesity or depression.The Stress in America survey, which was conducted online by Harris Interactive on behalf of AP A among 1,226 U.S. residents in August and September, showed that many Americans consistently report high levels of stress (22 percent reported extreme stress, an 8, 9 or 10 on a 10-point scale where 1 is little or no stress and 10 is a great deal of stress). While reported average stress levels have dipped slightly since the last survey (5.2 on a 10-point scale vs. 5.4 in 2010) many Americans continue to report that their stress has actually increased over time (39 percent report their stress has increasedover the past year and 44 percent say their stress has increased over the past 5 years). Yet stress levels exceed people's owndefinition of what is healthy, with the mean rating for stress of 5.2 on a 10-point scale- 1.6 points higher than the stresslevel Americans reported as healthy.

The current report (1) summarizes findings from previous studies of early (pre-kindergarten) child development for AIAN youth, (2) briefly reviews national child development research efforts and their relevance to this target group, and (3) proposes a course of study within the Early Childhood Longitudinal Study framework (ECLS-ECLS-B 9-month restricted use data file and electronic code book, 2004) that addresses some of the noted research gaps for AIAN child development.

This report examines federal funding of programs intended to assist Native Americans at the U.S. Department of Interior, U.S. Department of Health and Human Services, U.S. Department of Housing and Urban Development, U.S. Department of Justice, U.S. Department of Education, and U.S. Department of Agriculture.

Objectives. Despite their increasing numbers, little is known about the health of American Indians/Alaska Natives living in urban areas. We examined the health status of American Indian/Alaska Native populations served by 34 federally funded urban Indian health organizations. Methods. We analyzed US census data and vital statistics data for the period 1990 to 2000. Results. Disparities were revealed in socioeconomic, maternal and child health, and mortality indicators between American Indians/Alaska Natives and the general populations in

Our primary goal was to assess the health status of the urban AIAN population served by UIHOs. As mentioned, this information is critical if these organizations are to demonstrate the effectiveness and impact of their services.

The Native American Health Center has implemented a holistic system of care in the San Francisco Bay Area as a result of a multiyear strategic planning process that included a needs assessment based on the community-readiness model. The strategic plan links substance abuse, mental health, HIV/AIDS, and social services in a holistic approach congruent with Native American values and traditions. The plan also links prevention with treatment in a continuum of care. Based on a collaboration of Native American nonprofit community-based organizations and public agencies, the plan has resulted in bringing significant resources to the community.

The patterns of alcohol consumption, family history of alcoholism, and lifetime and current diagnoses of substance dependence were determined in a sample of American Indians (n = 105) living in Denver. Subjects were recruited through flyers, posters, and advertisements placed in local newspapers, the Denver Indian Center, and Denver Indian Health and Family Services. Subjects were interviewed regarding their education, employment, past and present drug and alcohol use (including frequency/quantity, beverage type, and pattern of intake) and family history of alcoholism.

In order to better/properly address the healthcare needs of the urban Indian population from a policy oriented perspective, it is necessary to identify the status of health in the community. This can be done either by carrying out actual health study programs of the population or by accessing and interpreting published scientific studies and research papers, which is the purpose of the Knowledge Map. Thus by gaining an understanding of the knowledge available as well as the gaps in our knowledge there can be a renewed focus on the actual research needed to further identify and address the healthcare needs of the population.

A comparison of two native American Navigator formats: face-to-face and telephone. Dignan MB, Burhansstipanov L, Hariton J, Harjo L, Rattler T, Lee R, Mason M.Cancer Control. 2005 Nov;12 Suppl 2:28-33.PMID: 16327748 [PubMed - in process]

Samples of target and control American Indian children in the Southwest United States are compared for child abuse/neglect and family alcohol abuse. Alcohol abuse is present in virtually all families that abuse/neglect children. However, alcohol abuse exists exclusive of the association with child abusefneglect. The study demonstrates that alcohol abuse is a necessary, but not sufficient, condition for child abuse/neglect.buse. 

This report provides a portrait of the American Indian and Alaska Native population in the United States and discusses that population’s distribution at the national level and at lower levels of geography. 1 It is part of a series that analyzes population and housing data collected from the 2010 Census.2010 Alaskan Native & American indian Population 

National Steering Committee 1999
Lists: "In Consultation with", "Negotiated Rule Making / Regulations"
Title's, I, II, III, IV, V, VII, VIII  

Testimony of D’Shane Barnett, Executive Director National Council of Urban Indian Health House Interior Appropriations Subcommittee’s Native American Witness Day April 12th-13th, 2011

2011 Conference registration form

Please review the enclosed letters of support written to our South Dakota Congressional Delegation for the Indian Health Care Improvement Act, Urban Indian Health, and the United Sioux Tribes Employment Assistance Program. We are pleased to offer our help to the National Council of Urban Indian Health.

In compliance with the HHS Consultation Policy, this is the eighth HHS Tribal Consultation Report developed by the U.S. Department of Health and Human Services. The report is a combined effort by the Department to highlight the progress we have made with Tribal issues and activities. This report provides an overview of consultation and other Tribal activities conducted by HHS during fiscal year 2008and is organized to provide a response to the issues HHS hears about most from Tribes and tribal leaders.

On behalf of NCUIH, I would like to express our appreciation for this opportunity to address the Committee on the FY 2004 President's Budget Request and its impact on the off reservation Indian population

According the 2000 United States Census, over 60% of American Indians and Alaska Natives currently live in urban centers. However, the division between an urban Indian and a non-urban Indians is a fundamentally false dichotomy. 

Good Health and Wellness in Indian Country is a 5-year, $13 million/year initiative that started in fiscal year 2014. The program enlists tribes and tribal organizations as change agents to improve the individual and community health of American Indians and Alaska Natives.

 Eleven tribes work on a combination of effective community-chosen and culturally adapted strategies. These strategies aim to reduce commercial tobacco use and exposure, improve nutrition and physical activity, increase support for breastfeeding, increase health literacy, and strengthen team-based care and community-clinical links.

Awardees customize effective approaches for their communities to create sustainable programs, broaden community and cross-sector partnerships, and demonstrate health improvements.

Eleven tribal organizations provide leadership, technical assistance, training, and resources to tribes and villages in their Indian Health Service (IHS) administrative areas to initiate program activities that will lead to improvements in health.

Older American Indians and Alaska Natives (AI/ANs) constitute a population that will grow substantially over the next 30 years. Such growth follows an increase over the previous decade that is nearly three times more than other races. Numbers of AI/ANs ages 65 and over will triple, and the oldest cohort (ages 85 and over) is projected to increase more than sevenfold by 2050. The socioeconomic and health coverage disparities that have historically characterized their lives remain, to a large extent, unresolved. This report outlines the demographics of this growing cohort and concludes with recommendations for coordinating programmatic resources to better serve it.

Definition of an Urban indian as of Indian Health Care Improvement Act of 2003

IHCIA 1999 Discussion Draft

The U.S. Entitlement Programs, Entitlement Programs, Medicare, Medicaid, Childrens Health insurance Program..............

This is the handbook that accompanied attendees at the 12th Annual HHS Tribal Budget and Policy Consultation Session

This is the handbook that accompanied attendees at the 12th Annual HHS Tribal Budget and Policy Consultation Session

To amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes.

Senator Dorgan's Amendments to the Indian Health Care Improvement Act S.1790

The Indian Health Care Improvement Act Amendments of 2009

An Act To amend title XXI of the Social Security Act to extend and improve the Childrens Health Insurance Program, and for other purposes.

This Act may be cited as the Childrens Health Insurance Program Reauthorization Act of 2009.

H.R.3962: Affordable Health Care for America Act’

Amendment to S.1790 The Indian Health Care Improvement Act for a Director of HIV/AIDS Prevention and Treatment 

To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.

This Act may be cited as the Americas Healthy Future Act of 2009.

To establish an Indian youth telemental health demonstration project, to enhance the provision of mental health care services to Indian youth, to encourage Indian tribes, tribal organizations, and other mental health care providers serving residents of Indian country to obtain the services of predoctoral psychology and psychiatry interns, and for other purposes.

To amend the Indian Health Care Improvement Act to revise and extend that Act. Indian Health Care Improvement Act Amendments of 2008

This Act may be cited as the Indian Health Care Improvement Act Amendments of 2008

To amend the Indian Health Care Improvement Act to revise and extend that Act for the year of 2007 by the U.S. House of Representatives

Indian Health Care Improvement Act of 2009 Pages 1-216

H.R. 2764 - An Act: Making appropriations for the Department of State, foreign operations, and related programs for the fiscal year ending September 30, 2008, and for other purposes.

This memorandum analyzes Title V of S. 556 (108th Congress) for those provisions which are non-controversial and for those which have raised issues. Only three sections of Title V of the Indian Health Care Improvement Act (S. 556, 108th Congress) have raised significant inquiry on the part of either the Bush Administration or of Congress: Section 512, Treatment Of Certain Demonstration Projects Section 515, Federal Tort Claims Act Coverage and Section 517, Use of Federal Property and Supplies. 

H.R. 403 106th Congress 1st Session

To elevate the position of Director of the Indian Health Service within the Department of Health and human Services to Assistant Secretary of Indian Health, and for other purposes.

107th Congress 1st Session S. 212

To Amend the Indian Health Care Improvement Act to revise and extend such Act.
(a) Short Title.-This Act may be cited as the "Indian Health Care Improvement Act Reauthorization of 2001"

This is the Senate released bill of S.2526 the Indian Health Care Improvement Act to revise and extend. Pages 1-341

This is the Senate released bill of S.2526 the Indian Health Care Improvement Act to revise and extend. Pages 251-300

This is the Senate released bill of S.2526 the Indian Health Care Improvement Act to revise and extend. Pages 201-250

This is the Senate released bill of S.2526 the Indian Health Care Improvement Act to revise and extend. Pages 151-200

This is the Senate released bill of S.2526 the Indian Health Care Improvement Act to revise and extend. Pages 101-150

This is the Senate released bill of S.2526 the Indian Health Care Improvement Act to revise and extend, and an amendment to the social security act. Pages 1-50

106th Congress 1st Session S.406

To amend the Indian Health Care Improvement Act to make Permanent the Demonstration program that allows for direct billing of medicare, medicaid, and other third party payors, and to expand the eligibility under such program to other tribes and tribal organizations.

Action Alert for Health Care Reform H.R. 3200 America

Kathleen Sebelius, former Governor of Kansas, was the last of President Obamas nominees to be confirmed. 

Urban Indian Health Funding Fully Restored in FY 2009 with Modest Increase

The 111th Congress & the Obama Administration

End of Session Review (2008) What passed, what didn’t, and what must be revisited in the 111th Congress.

American Indians and Alaska Natives are more likely to have certain health problems than whites. And they are more likely to get sicker and die from them too. Finding and treating these problems early can make a huge difference. Thanks to the Affordable care Act, most health insurance must cover preventive services for free, which can lead to better health and a longer life.

This report provides a portrait of the American Indian and Alaska Native population in the United States and discusses that population’s distribution at the national level and at lower levels of geography. 1 It is part of a series that analyzes population and housing data collected from the 2010 Census.

Facts on culturally competent services:

• Many Native Americans are reluctant to go to health care providers who are unfamiliar with and insensitive to Native cultures because they often feel unable to describe their health needs to strangers outside their own culture.
• Frequently, mainstream providers misunderstand or misinterpret the reticence and stoicism of some Indians.  Provide a vast array of services that are essential for health.
• Urban Indian programs not only enjoy the confidence of their clients, but also play a vital role in educating other health care providers in the community to the unique needs and cultural conditions of the urban Indian population.
• Reconnecting AI/AN people to their culture is central to restoring health.

National Steering Committee document (for Review and Comment) on Title V Health Services of the Reauthorization of the Indian Health Care Improvment Actm P.L. 94-437 (9/21/99)

C/O Kauffman & Associates
(Marked up)

Preliminary Discussion Draft for the Presedential Executive Order 1998 Re: Consultation & Coordination With Indian Tribal Governments

reference, Doc # P76 final order

Effective communication with patients and their family members forms the foundation of a therapeutic relationship.  This is particularly important when the occupational therapist, other health professionals, and the patient are from different cultural backgrounds.  This paper describes once aspect of the finding of a ethnographic study of chronic diabetes among the Navajo (referred to here as Dine).

Overview of Medicaid & Indian Health Programs Aug 31, 2005

Three part publication, Mim Dixon & Kris Locke, Medicaid Roundtable (slides)

P52, P53 & P54

Written Statement of Robert Hall, President of NCUIH, to the Committee on Energy and Commerce Subcommittee on Health H.R. 293 (June 27,2001) "Elevation of the Position of the IHS Director to the Assistant Secretary for Indian Health"

This monograph aims to increase awareness of the impact of culture on the availability of mental health services with the goal of improving services for culturally/racially diverse families in ways that reduce mental health disparities. The monograph is second in a series outlining successful strategies for increasing access, availability, and utilization of services at the organizational and direct service levels. Availability strategies were identified through interviews conducted with personnel from 12 organizations that met study criteria.

Letter to Speaker Boehner, and Minority Leader Nancy Pelosi regarding bipartisan support from congress for the reauthorization of the Special Diabetes Program and the Special Diabetes Program for Indians.

Testimony of NIHB presented to the Senate Committee on Indian Affairs by Kathy Kitcheyan, Chairwoman-San Carlos Apache Tribe & Board Member

Regarding: Presidents Fiscal Year 2007 Budget for American Indian & Alaskan Native Health Programs Feb 14, 2006

Submission to DHHS Second Budget Formulation  Consultation 4/10/2000

NCUIH Spring Conference May 2006 "Renewing our Commitment to Urban Indian Health" Agenda

NCUIH Presentation to the Department of Health & Human Services Second Budget Consultation Meeting

April 10, 2000

NCUIH Leadership Conference March 1999 Summary of Proceedings (draft) part 2

2 part publication p50 & p51

NCUIH Leadership Conference March 1999 Summary of Proceedings (received draft) part 1 of 2

2 part publication P50 & P51

NCUIH Annual Program Progress & Financial Status Report

Sept-1998-Aug-1999

reference: B116 for second half of report

NCUIH Board of Directors Meeting Agenda March-10-2000

Packet: reference B112,B113, B114

NCUIH Board of Directors Annual Program Progress Report & Financial Status Report 1999 (Part 2)

Reference: B115 for first half of publication 

Letter from Kay Culbertson, President of NCUIH, to Julia Davis, President of NIHB, in regards to the "alternative language" directed to the National Steering Committee that changes programs status from "Oklahoma Demonstrative Projects" as mentioned in S.212 

NCUIH 2002 Fall Leadership Conference Sept 20-22, 2002 Agenda

Table of Contents:

Opportunities Under Obama Administration

e-Urban Indians?

US Census

Inauguration Experience by an Urban Indian

Needs Assessment

Baltimore Clinic

Portland Area Indian Health Service, Phoenix area Tribal Health Priorities, Oklahoma Area Priorities, Tucson Area Indian Health service

FY 2007 Budget Recommendation Charts, IHS Program services, Program Increases

Note: Publication In two parts (P178a, P178 B)

IHS 2003 Planned Contruction Budget

IHS Health Facilities Program Status Repoprt, Back log of Essential Maintenance, Alterations & Repairs, Estimated cost of Sanitation Deficiencies etc.

To implement the Federal responsibility for the care and education of the Indian people by improving the services and facilities of Federal Indian health programs and encouraging maximum participation of Indians in such programs, and for other purposes.