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FINAL RMTEC_Strategic Plan 2012_20160 Developed by Dr.Akintan Folo FA12.03.2012

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0 August 2012 Publication
1 Executive Summary Dear Colleague: We are pleased to present to you the Rocky Mountain Tribal Epidemiology Center 2012 – 2016 Strategic Plan. The Rocky Mountain Tribal Epidemiology Center developed the strategic plan to fulfill the Indian Health Service Tribal Epidemiology Center core funding epidemiology grant for Montana and Wyoming Tribes. The strategic plan includes all Rocky Mountain Tribal Epidemiology Center goals, objectives, projects and activities which include Surveillance, Capacity Building and Epidemiological Intervention activities. All Montana and Wyoming Tribal Health Departments participate in projects based on Local Tribal Health priorities and all are encouraged to opt-in or opt-out on an annual basis. We welcome all comments and suggestions for continued improvement. We hope the Tribes in this Rocky Mountain Region will find these projects useful in disease surveillance, capacity building and intervention expressing their Public Health Authority. The Rocky Mountain Tribal Epidemiology Center maintains and distributes the Montana and Wyoming Tribal Community Health Profiles as a reference document. For more information how to obtain hard copies, please contact Folorunso Akintan, MD, MPH at fakintan@mtwytlc.com; or (406) 252-2550. Sincerely, Gordon Belcourt, Executive Director Montana Wyoming Tribal Leaders Council _____________________________________________________________ Written by Folorunso (Folo) Akintan MD, MPH Principle Investigator, Rocky Mountain Tribal Epidemiology Center Montana-Wyoming Tribal Leaders Council 175 North 27th Street, Suite 1003 Billings, MT 59101 www.rmtec.org
2 Table of Contents Executive Summary.......................................................................................................................................................1 Table of Contents ..........................................................................................................................................................2 History...........................................................................................................................................................................3 Montana and Wyoming Tribes and Reservations..........................................................................................................4 Public Health Authority.................................................................................................................................................5 Partners..........................................................................................................................................................................5 Healthy People 2020 Overarching Goals.......................................................................................................................8 10 Essential Public Health Services - Objectives ..........................................................................................................9 Specific Goals and Objectives.....................................................................................................................................10 Tribal Health Needs Assessments ...............................................................................................................................11 Rocky Mountain Epidemiology Center Goals............................................................................................................13 Five Project Focus Areas.............................................................................................................................................15 RMTEC PROJECTS ...................................................................................................................................................16 PROJECT ACTIVITIES .............................................................................................................................................19 RMTEC PROJECT ACTIVITY TIMELINE..............................................................................................................20 Strengthening Tribal Public Health Infrastructure for Improved Health Outcomes....................................................22 Emergency Preparedness.............................................................................................................................................24 Health Codes ...............................................................................................................................................................26 Institutional Review Board..........................................................................................................................................28 Infectious Disease/Chronic Disease ............................................................................................................................29 Maternal and Child Health ..........................................................................................................................................33 Obesity Prevention ......................................................................................................................................................35 Cancer Outreach ..........................................................................................................................................................39 Injury & Violence Prevention......................................................................................................................................42 Environmental Health Initiative ..................................................................................................................................44 Developing Community Health Profiles .....................................................................................................................46 Surveillance.................................................................................................................................................................48 Emerging Projects .......................................................................................................................................................50 Other............................................................................................................................................................................50 Evaluation....................................................................................................................................................................53 Performance Measures ................................................................................................................................................58 Growth/Value Performance Measures.........................................................................................................................58
3 History The Rocky Mountain Tribal Epidemiology Center (RMTEC) is a division of the Montana Wyoming Tribal Leaders Council (MTWYTLC). RMTEC started in the fall of 2005 in collaboration with multiple stakeholders. A 5-year cooperative agreement with Indian Health Services (IHS) to support RMTEC was awarded in 2006 and provided the core funding to start RMTEC projects. RMTEC is currently on another IHS 5 year award since 2011. RMTEC serves 10 Tribes on 8 Reservations in Montana and Wyoming - an American Indian (AI) population of approximately 65,000 -120,000 (depending on source of data). All RMTEC projects are developed through a Community Based Participatory Research (CBPR) approach. The RMTEC advisory group includes the Montana - Wyoming Tribal Leader’s Committee on Health and the ten (10) Tribal Health Directors (two in Wyoming and eight in Montana- including the Little Shell Tribe of Montana) and other MTWYTLC/RMTEC stakeholders. RMTEC Stakeholders present or report Community Health Priorities (CHP) to RMTEC for intervention and project development. Tribal Health Directors represent all Tribes and Reservations served by the Billings Area Office – Indian Health Service (BAO-IHS), providing guidance and assistance to RMTEC. RMTEC Vision We contribute to healthy Tribal communities through lasting collaborative partnerships. RMTEC Mission To empower American Indian Tribes in Montana and Wyoming in the development of Public Health services and systems and epidemiological data in order for Tribes to have resources and express their authority in response to Public Health concerns. RMTEC Values  Encourage and Nurture Intellectual Curiosity  High Quality Work  Honest and Open Communication  Integrity  Respect and Trust  Service with Humility  Unity of Purpose RMTEC Believes  We believe in the sovereignty of Tribal Nations.  We believe our purpose is to serve the Tribes in the area of Public Health.  We believe in deferring to Tribal Public Health priorities in the development of all projects.  We believe in open and honest communication that fosters an environment of Respect and Trust.  Be believe in encouraging an environment the nurtures ideas, beliefs, perspectives and cultures.
4 Montana and Wyoming Tribes and Reservations  Assiniboine  Blackfeet  Confederated Salish and Kootenai  Chippewa Cree  Crow  Eastern Shoshone  Gros Ventre  Kootenai  Little Shell  Northern Cheyenne  Northern Arapaho  Sioux  Shoshone Bannock (awaiting legal assimilation)
5 Public Health Authority The MT-WY TLC is acting under a cooperative agreement with the Indian Health Service to operate a Tribal Epidemiology Center, which is authorized by Section 214 (a)(1), Public Law 94- 437, Indian Health Care Improvement Act as amended by P.L. 573. In the conduct of this public health activity, the MT-WY TLC may collect or receive protected health information for the purpose of preventing and controlling disease, injury, or disability, including but not limited to, the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health investigations, and public health interventions for Tribal communities they serve. Further, the Indian Health Service considers this to be a public health activity for which disclosure of protected health information by covered entities is authorized by 45 CFR 164.512(b) of the Privacy Rule. Partners Montana Wyoming Tribal Councils  Northern Arapaho Business Council  Eastern Shoshone Business Council  Blackfeet Tribal Business Council  Chippewa Cree Business Committee  Confederated Salish and Kootenai Tribes  Northern Cheyenne Tribal Council  Crow Tribal Council  Fort Belknap Community Council  Fort Peck Tribal Executive Board  Little Shell Tribe of Chippewa Indians of MT  Fort Hall Business Council Montana Wyoming Tribal Health Departments  Northern Arapaho Tribal Health Department  Eastern Shoshone Tribal Health Department  Blackfeet Tribal Health Department  Chippewa Cree Tribal Health Department  Confederated Salish and Kootenai Tribal Health Department  Crow Tribal Health Department  Northern Cheyenne Tribal Health Department  Fort Belknap Tribal Health Department  Fort Peck Tribal Health Department  Little Shell Tribe of Chippewa Indians of MT  Shoshone-Bannock Tribal Health and Human Services Department
6 State Health Departments  Montana Department of Health and Human Services  Wyoming Department of Health Institutions  Montana State University  University of Montana  Sanford School of Medicine/University of South Dakota  Avera Research Institute  University of West Virginia  University of Nebraska  Pennsylvania State University  WESTAT Agencies  Indian Health Service – Division of Epidemiology & Disease Prevention  Billings Area Indian Health Service  Bureau of Indian Affairs – Rocky Mountain Regional Office  American Public Health Association  National Institute of Health  Centers for Disease Control  National Institute of Child Health/Development  Public Health Accreditation Board  National Association of Local Board of Health  Susan Komen for the Cure – Montana  Native American Management Inc.  Montana Public Health Association  WY All Hazards Steering Committee Cancer Partners: NGOs/Hospitals/Clinics  Montana Comprehensive Cancer Control (MTCCC)  Wyoming Comprehensive Cancer Control Consortium (WCCCC)  Susan G. Komen for the Cure Foundation  Montana American Indian Women’s Health Coalition (MAIWHC)  Montana Cancer Institute Foundation  American Cancer Society (Montana)  Montana Family Planning Clinics  Planned Parenthood
7  St. Vincent Hospital  Benefis Health Care Systems (Sletten)  Northwest Healthcare  Shodair Hospital  St. Peters Hospital  Bozeman Deaconess  Bighorn Valley Health Center  River Stone Public Health Department  Billings Clinic  All 8 Montana/Wyoming Indian Health Service Units  Indian Family Health Clinic  Montana Tobacco Use Prevention Program (MTUPP)  American Indian Tobacco Prevention Specialists  Respecting the Tobacco Way
8 Healthy People 2020 Overarching Goals  General Health Status: Attain high quality, longer lives free of preventable disease, disability, injury, and premature death  Disparities and Inequity: Achieve health equality, eliminate disparities, and improve the health of all groups  Social Determinants of Health: Create social and physical environments that promote good health for all  Health –Related Quality of Life and Well-Being: Promote quality of life, healthy development, and healthy behaviors across all life stages
9 10 Essential Public Health Services - Objectives 1. Monitor health status to identify community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems.
10 Indian Health Service Tribal Epidemiology Center Core Funding Specific Goals and Objectives 1. Assist American Indian/Alaska Native (AI/AN) communities, tribal organizations, and urban Indian Organizations in developing disease surveillance systems and identifying their highest priority health status objectives, based on epidemiologic data. Collect data relating to, and monitor progress made toward meeting, each of the health status objectives of IHS, the AI/AN communities, tribal organizations, and urban Indian communities in the region. Assist and facilitate reporting of nationally notifiable disease conditions to public health authorities in the region. 2. Participate in the development of systems for sharing, improving, and disseminating aggregate health data at a national level for purposes of advocacy for AI/AN communities, Government Performance Results Act (GPRA), HP 2010, and other national-level activities. 3. Collaborate with national HHS programs in the development of standardized surveillance and data monitoring methods and data sets. 4. Support responses to public health emergencies in collaboration with the IHS Epidemiology Program, local, tribal, state, and other Federal health authorities. 5. Develop and implement epidemiologic studies that utilize the principles of community engagement and that have practical application in improving the health status of constituent communities. Studies may require Institutional Review Board approval if human subjects are involved. 6. Develop and implement disease control and prevention programs in cooperation with other public health entities. Make recommendations for targeting of public health services needed by constituents. 7. Ensure the coordination of services and program activities with other similar programs and establish a broad-based council to advise and support the program. Such an advisory council would consist of technical experts in epidemiology and public health, community members, health care providers, and others who could provide overall program direction and guidance. Tribal Epidemiology Centers are Indian Health Service division funded organizations who serve American Indian/Alaska Native Tribal and urban communities by managing public health information systems, investigating diseases of concern, managing disease prevention and control programs, responding to public health emergencies, and coordinating these activities with other public health authorities.
11 Montana and Wyoming Tribal Health Needs Assessments The Montana Wyoming Tribal Leaders Council/Rocky Mountain Tribal Epidemiology Center implemented a Health Needs Assessment with Montana and Wyoming Tribal Health Departments (the health gate keepers of Montana Wyoming Tribes) in 2010. Each Tribal Health Department was encouraged to list the top 3 health priorities of the Tribe/Reservation and let MTWYTLC/RMTEC know how it can be of help over the next five years 2012-2016. These health priorities were taken into consideration by MTWYTLC/RMTEC while developing the project focus areas for the Epidemiology Center for 2012-2016. The following are the top three health priorities by Tribe: Table 1. Montana - Wyoming Tribe Specific Health Priorities Tribe/Reservation Community Top 3 Health Priorities Blackfeet  Community Health Profiles  MT-WY Child/Youth Health Project  Suicide Data Tracking Confederated Salish and Kootenai  Maternal Child Health  Childhood Obesity  Suicide Crow  Childhood Obesity/ Sudden Infant Death Syndrome (SIDS)  Cancer Screenings  Injury/Suicide Rocky Boy  Strengthening Tribal Relations Fort Belknap  Healthy Lifestyles (For all ages)  Obesity Prevention  Elder Care
12 Fort Peck  Mental Health Access  Maternal Child Health  Domestic Violence Northern Cheyenne  Strengthening Current Programs  Collaborate/Build Tribal Programs  Strengthening Reservation Staff Skills and Ability Northern Arapaho  Youth/Adult Alcohol and Drug Abuse  Youth/Adult Suicide  Youth/Adult Mental Health Eastern Shoshone  Diabetes  Substance and Chemical Abuse  Health Promotion /Disease Prevention Little Shell  Childhood Obesity  Stress Reduction  Cancer Screening Shoshone-Bannock Approached MTWYTLC in 2011 (pending legal inclusion) Environmental Health and Cancer as Tribal Leaders Health Priorities Over the past decade, Montana and Wyoming Tribal Leaders have raised concerns about Environmental Health and Health Outcomes of their communities (i.e Cancer). MTWYTLC/RMTEC has been asked to include environmental health as one of its projects over the next 5 years.
13 Rocky Mountain Epidemiology Center Goals 1. Strengthen Individual Tribes’ Public Health Infrastructure and Capacity. 2. Improve Surveillance Data for Health Conditions and Diseases. 3. Provide Data and Technical Assistance to Support Health Promotion, Disease Prevention (HP/DP) Objectives and Behavioral Health Strategies. 4. Implement Pilot Projects and Specific Studies to Address Tribally Identified Health Priorities and Support Tribal Community Based Participatory Epidemiological Studies. 5. Develop Tribal/Urban Indian Community Health Profiles and Tribe Specific Data Collection Initiatives.
14 Rocky Mountain Epidemiology Center Project Focus Areas, Projects and Project Activities
15 RMTEC Five Project Focus Areas 1. Capacity Building 2. Infections/ Chronic Disease & Public Health Ethics 3. Healthy Lifestyles 4. Environmental Health & Disease Prevention 5. Community Health Profiles & Emerging Projects
16 RMTEC PROJECTS Capacity Building Projects: 1. Strengthening Public Health Capacity 2. Emergency Preparedness Infections/ Chronic Disease & Public Health Ethics Projects: 3. Ethics  Tribal Health Codes  Institutional Review Board – IRB  Infectious Disease Surveillance  Chronic Disease Surveillance Healthy Lifestyles Projects: 4. Maternal and Child Health  Pregnancy Risk Assessment  Sudden Unexpected Infant Death 5. Obesity Prevention  Child Health Measures  Child and Youth Health Project Environmental Health & Disease Prevention Projects: 6. Cancer Outreach and Prevention  Susan Komen  Tobacco Use Prevention 7. Injury and Violence Prevention 8. Environmental Health Initiative Community Health Profiles & Emerging Projects: 9. Data Improvement Projects for Community Health Profile Development/BRFSS  Behavioral Risk Factor Surveillances System –BRFSS  Behavioral Health Data Improvement Project  Chemical Dependence Resource  Child Maltreatment  Infectious Disease Surveillance  Chronic Disease Surveillance 10. Emerging Project based on Community Health Profiles
17 Other:  Annual Trainings 1. Montana Wyoming Native Youth Development Project 2. Project Specific Trainings as Needed 3. Public Health Navigators  Annual Conferences  Technical Support
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19 RMTEC PROJECT ACTIVITIES RMTEC projects are based on three main categories of activities: 1.CAPACITY BUILDING ACTIVITIES 2.SURVEILLANCE ACTIVITIES 3.INTERVENTION ACTIVITIES
20 RMTEC PROJECT ACTIVITY TIMELINE RESULTS &BENEFITS Focus Areas Project Implementation Details Year 1 - Year 5 Activities Results/Benefits A. Capacity Building X Capacity Building Tribal Public Health Empowerment for all Montana and Wyoming Tribes 1. Strengthening Public Health Capacity X Capacity Building 2. Emergency Preparedness X Capacity Building B. Infectious/Chronic Disease & Public Health Ethics X Surveillance/Investigations and Public Health Navigation Maintain a Surveillance System for Diseases. Train Tribal Public Health *Navigators in Sanitation (As Funding Allows); How to Develop Health Codes for their Communities; and How to carry out Outbreak Investigations/Interventions.3. Tribal Ethics X Surveillance C. Healthy Lifestyles X Surveillance/Interventions Maintain a Surveillance System for Healthy Lifestyles; Implement Child Health Measures Project as a surveillance System; Child and Youth Projects as Intervention Projects; and Train Tribal Public Health *Navigators as Perinatal Home Visitors (As Funding Allows), and Maternal Prenatal Care Transporters. 4. Maternal and Child Health X Surveillance/Interventions 5. Obesity Prevention X Surveillance/Interventions D. Environmental Health & Disease Prevention X Surveillance/Interventions Implement an Injury/Violence and Environmental Health Surveillance System with Health Outcomes (i.e. Cancer; Accidents); Maintain Cancer Outreach and Education; Develop Injury and Violence Prevention Interventions. 6. Cancer Prevention and Screening X Surveillance/Interventions “Outreach/Education” 7. Injury and Violence Prevention X Surveillance/Strategic Planning and Interventions 8. Environmental Health X Surveillance/Strategic Planning and Interventions E. Community Health Profiles/BRFSS & Emerging Projects X Surveillance/Report Dissemination Collect, Analyze, Report and Disseminate Tribe Specific Community Health Profiles for all Montana and Wyoming Tribes; Partner with other Tribal Epidemiology Centers to develop National Tribal Community Health Profiles; and Implement the BRFSS Project among Montana and Wyoming American Indian Population. 9. Community Health Profiles/BRFSS X Surveillance/Report Dissemination 10. Emerging Projects based on Community Health Profiles X To Be Determined
21 RMTEC SPECIFIC PROJECTS GOALS OBJECTIVES ACTIVITIES RESULTS & BENEFITS 2012-2016
22 Strengthening Tribal Public Health Infrastructure for Improved Health Outcomes Goal: To systematically increase performance management capacity of the Tribal Health Departments in MT and WY in order to ensure their access to resources needed to express their public health authority. Supplemental Funds from Center for Disease Control and Prevention (CDC) National Public Health Improvement Initiative (NPHII) Grant Objectives for Montana and Wyoming Tribes opting in for the project from 2010 - 2015: 1. Increase efficiencies of Montana and Wyoming Tribal Health Departments’ operations 2. Increase use of evidence –based policies and practices among Montana and Wyoming Tribal Health Departments 3. Increase Montana and Wyoming Tribal Health Departments’ readiness for (applying and achieving) accreditation by the Public Health Accreditation Board (PHAB) Capacity Building Project Activities:  Facilitate the National Public Health Performance Standards -NPHPSP, a local Public Health System Assessments tool and the Mobilizing for Action through Planning and Partnerships (MAPP) tool among all Montana and Wyoming Tribal Health Departments.  Strengthen partnerships among collaborating agencies.  Establish Champion Workgroups (Performance Improvement/Public Health Accreditation Tribal Advisory Board Panel/Task Force) within Montana- Wyoming Tribes.  Host conferences/trainings with incorporated information sessions on public health accreditation and best practices in performance improvement.  Link Tribes with resources and capacity building assistance to address their self- assessed challenges. Supplemental Funds from CDC-NPHII 2010-2015
23 Activities by year/Results and Benefits: In 2011: o Implement the Local Public Health Governance Assessment in the Fort Belknap, Blackfeet and Rocky Boy Health Departments and organize a Departmental Strategic Planning Session with these Tribal Health Departments and their stakeholders. In 2012: o Implement the Local Public Health Governance Assessment in the Fort Peck, Eastern Shoshone and Northern Arapaho Tribal Health Departments and organize a Departmental Strategic Planning Session with these Tribal Health Departments and their stakeholders. o Implement the Mobilizing for Action through Planning and Partnerships (MAPP) in the Fort Belknap, Blackfeet and Rocky Boy Health Departments. In 2013: o Implement the Local Public Health Governance Assessment in the Crow, Northern Cheyenne, Flathead and Little Shell Tribal Health Departments and organize a Departmental Strategic Planning Session with these Tribal Health Departments and their stakeholders. o Implement the Mobilizing for Action through Planning and Partnerships (MAPP) in the Fort Peck, Eastern Shoshone and Northern Arapaho Tribal Health Departments. In 2014: o Implement the Mobilizing for Action through Planning and Partnerships in the Crow, Northern Cheyenne, Flathead and Little Shell Tribal Health Departments. o Implement a training session on Public Health Accreditation for all participating Tribes and develop a resource guide for Public Health Accreditation for all Montana and Wyoming Tribes and Train the Trainer sessions for independent Tribal implementation of NPHPSP among participating Tribes. In 2015: o Prepare at least one of the participating Tribal Health Departments for Public Health Accreditation application. o Implement a training session on Public Health Accreditation for all participating Tribes and develop a resource guide for Public Health Accreditation for all Montana and Wyoming Tribes and Train the Trainer sessions for independent Tribal implementation of NPHPSP among participating Tribes.
24 Emergency Preparedness Goal: To provide Tribal Emergency Preparedness Capacity Building Technical Support to participating Montana and Wyoming Tribes. Objectives for Montana and Wyoming Tribes opting in for the project from 2012 - 2016:  Partner with existing workgroups and agencies to help build the Emergency Preparedness capacity of Montana and Wyoming Tribes. Capacity Building Project Activities:  Strengthen partnerships among collaborating agencies; collaborate with established workgroups within Montana-Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges.  Host conferences/trainings with incorporated information sessions on best practices in performance improvement. Activities/Results and Benefits: Year 1  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes. Year 2  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges. Year 3  Host conferences/trainings with incorporated information sessions on best practices in performance improvement.  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.
25  Link Tribes to resources and capacity building assistance to address their self- assessed challenges. Year 4  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges. Year 5  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges.
26 Health Codes Health Codes: Goal: To “Build Tribal Capacity” to Develop, Modify and Implement Tribal Public Health Codes in order to improve public health practice in Tribal communities in response to community health, emergency preparedness and research concerns. The project will be implemented over the next five years (2012—2016) in 4 phases of objectives: Phase 1: Raising awareness of and improving readiness for Public Health Codes and Regulations; Phase 2: Gathering all relevant existing codes and evaluating their strengths and weaknesses; Phase 3: In consultation with all partners, drafting and developing modernized and highly effective model Tribal Health Codes and Regulations; Phase 4: In collaboration with all partners, ensure effective implementation of the modernized Tribal Health Codes and Regulations. Capacity Building Project A/B/Cs of Activities:  Health Code Development and Implementation Team  Develop Goals and Objectives with Timelines and Strategic Planning on Development and Implementation/Enforcement of Tribal Community Health Code  Develop Health Code “Activities” in order to meet the set Goals and Objectives with Timelines for your Tribal Community Health Code Development and Implementation Project, “Designating Staff/Departments” to each Activity with Timelines Activities/Results and Benefits: Year 1 Phase 1: Raising awareness of and improving readiness for Public Health Codes and Regulations Phase 2: Gathering all relevant existing codes and evaluating their strengths and weaknesses
27 Year 2 Phase 3: In consultation with all partners, drafting and developing modernized and highly effective model Tribal Health Codes and Regulations i. Identify and recruit key stakeholders in the community who will be involved in the development, modification and implementation of Tribal Health Codes ii. Health Code Development and Implementation “Team” meet at least twice a month and develop Health Code Goals and Objectives iii. Health Code Development and Implementation “Team” meet at least twice a month and develop/modify Health Code from Templates and have Strategic Plan meeting on health code implementation Year 3 Phase 3: In consultation with all partners, drafting and developing modernized and highly effective model Tribal Health Codes and Regulations iv. Health Code Development and Implementation “Team” meet at least once with the “Tribal Community” and the “Tribal Council” and Review/approve the Draft Health Code v. Health Code Development and Implementation “Team” meet with the “Tribal Council” to promote the passing and implementation of the FINAL Draft Health Code Year 4/ Year5 Phase 4: In collaboration with all partners, ensure effective implementation of the modernized Tribal Health Codes and Regulations vi. Health Code Development and Implementation “Team” meet with the “Tribal Council” to promote the implementation of the FINAL Draft Health Code vii. Health Code Development and Implementation “Team” meet with the “Tribal Council” to promote the evaluation of the FINAL Draft Health Code being implemented
28 Institutional Review Board Goal: To promote awareness and advance the unique concerns of Tribal nations when any research involves their constituents, ensuring that researchers engage Tribes in an ethical and collaborative manner of process, resulting in mutually beneficial and constructive ethical results -Rocky Mountain Institutional Review Board (RMT-IRB). For more information please go to webpage: http://www.mtwytlc.org/irb/rmtirb-home.html Capacity Building Project Activities:  Collaborate with established IRBs within Montana-Wyoming  Link Tribes to resources and capacity building assistance  Strengthen partnerships among collaborating agencies Activities/Results and Benefits: Year 1  Participate in the Rocky Mountain Institutional Review Board meetings Year 2  Participate in the Rocky Mountain Institutional Review Board meetings  Strengthen partnerships among other Montana and Wyoming Institutional Review Boards Year 3 to Year 5  Participate in the Rocky Mountain Institutional Review Board meetings  Strengthen partnerships among other Montana and Wyoming Institutional Review Boards  Link RMT-IRB to needed resources to successfully implement Tribal IRBs
29 Infectious Disease/Chronic Disease Infectious Disease: Goal: To improve public health practices among communities through sustainable infectious disease prevention and establish an infectious disease surveillance system (database) that will help with tracking notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes. Surveillance/Report Dissemination Project Activities: Objectives for Montana and Wyoming Tribes opting in for the project from 2012 - 2016:  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a notifiable disease and other disease outbreak surveillance system among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes.  Implement at least one Face to Face All Hazards Training/Conference. Surveillance: Public health surveillance is the ongoing, systematic collection, analysis, interpretation and dissemination of data regarding a health related event for use in public health action to reduce morbidity and mortality and to improve health. Attributes of Public Health Surveillance System include:  Simplicity  Data quality  Sensitivity  Acceptability  Flexibility  Predictive value  Representativeness  Timeliness  Stability
30 Activities/Results and Benefits: Year 1  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes. Year 2  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a notifiable disease and other disease outbreak surveillance systems among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes. Year 3 Implement at least one Face to Face All Hazards Training/Conference Goal: To improve the Surveillance Capacity of Montana and Wyoming American Indians in collaboration with all Montana and Wyoming disease surveillance partners, public health authorities and hospitals, in order for Tribes to be prepared and able to respond to all public health hazards (All Hazards).  The Montana Wyoming Tribal All Hazards Advisory Committee will be comprised of the 10 Montana and Wyoming Tribal Health Directors, Health gate keepers for the 8 Reservation Communities in Montana and Wyoming (the Wyoming Wind River reservations has two Tribal Health Directors); All Montana
31 and Wyoming Tribal/IHS Service Unit/Hospital Chief Executive Officers (CEOs) and Public Health Nurses; Representatives from the Montana Department of Health and Human Services MT-DHHS; Representatives from the Wyoming Department of Health WY-DoH; Billings Area Indian Health Service – Chief Medical Officer, Environmental Health Specialist and Indian Health Service Sanitarians, Chief Immunization Nurse Contractor; and MTWYTLC/RMTEC Staff including, RMTEC Acting Director/Senior Epidemiologist; RMTEC Infectious Disease/Emergency Preparedness Epidemiologists, RMTEC Statistician (for data analysis mainly); RMTEC Data Manager and RMTEC Research Assistants.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes. Year 4/Year 5  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes.
32 Chronic Disease Project: Goal: To improve public health practices among communities through sustainable chronic disease prevention and establish a chronic disease surveillance system (database) that will help with tracking chronic diseases among Montana and Wyoming Tribes. Surveillance/Report Dissemination Project Activities: Objectives for Montana and Wyoming Tribes opting in for the project from 2012 - 2016:  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a chronic disease surveillance system among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and reduce chronic diseases among Montana and Wyoming Tribes by seeking intervention funds. Activities/Results and Benefits: Year1  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes. Year2  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a chronic disease surveillance system among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes.
33 Year 3 to Year 5  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and reduce chronic diseases among Montana and Wyoming Tribes by seeking intervention funds. Maternal and Child Health Sudden Infant Death: RMTEC has a contract with Native American Management Services (NAMS), Inc to implement “Healthy Native Babies”, a Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) project, among American Indians (AI) in Montana and Wyoming. “Healthy Native Babies” is a risk reduction SIDS prevention message aimed at high risk populations among AI in Montana and Wyoming. Supplemental Funds from Native American Management Services -NAMS Contract Surveillance/Intervention Project Activities: Implement the Native American Management Services, Inc Contract from 2009-2012 or as long as it lasts. Activities/Results and Benefits (Based on Contract): Year 1 to Year 5  Participate in Healthy Native Babies Workgroup meetings.  Disseminate Healthy Native Babies Risk Reduction Materials to constituents.  Implement Train the Trainer trainings among Montana and Wyoming Tribes and other Tribes in U.S (i.e Parenting Skills Training). Supplemental Funds from NAMS/NICHD 2009-2012
34 Pregnancy Risk Assessment: Goal: To implement an American Indian Pregnancy Risk Assessment Monitoring System (PRAMS) Survey (a Maternal Health Behaviors Survey). PRAMS is a Replication Pilot study with Reservations opting in. This study explores innovative techniques to ensure adequate American Indian response rates and data quality. Surveillance/Intervention Project Activities: Objectives for Montana and Wyoming Tribes “opting in” for the project from 2012 - 2016:  Collaborate with the Wyoming Department of Health –WY OH to over-sample American Indians effectively during the implementation of Wyoming PRAMS.  Collaborate with the Montana Department of Health and Human Services MT DHHS (when funded) to over-sample American Indians effectively during the implementation of Montana PRAMS.  Participate in the data analysis, reporting and dissemination of results from implemented PRAMS by the state of Montana (when funded) and Wyoming, and report results to Montana and Wyoming Tribes  Offer technical support to Tribes in Montana and Wyoming to implement and seek funding for interventions for their Maternal and Child Health population. Activities/Results and Benefits: Year 1/Year 2  Collaborative partnerships built with the Wyoming Department of Health –WY DoH, and an over-sampling of American Indians effectively during the implementation of Wyoming PRAMS.  Collaborative partnerships with the Montana Department of Health and Human Services MT DHHS, and an over-sampling of American Indians effectively during the implementation of Montana PRAMS. Year 3 to Year 5  Participation in the data analysis, reporting and dissemination of results from implemented PRAMS by the state of Montana and Wyoming, with reports and information disseminated to Montana and Wyoming Tribes
35 Obesity Prevention Child Health Measures (CHM): Goal: To help inform participating Tribes on health measures associated with the risks for childhood obesity, diabetes, and heart disease among participating Tribes’ children. Screening children in kindergarten through high school with the following measurements: BMI, Blood Pressure, Acanthosis presence, and Asthma diagnosis. Trained Tribal field workers who volunteer to help with the project (measurements) from participating Reservations perform these tasks. Surveillance/Intervention Project Activities: There are ten (10) STEPS to follow annually and Child Health Measures is divided into eight (8) STATIONS. Step 1: School Participation and Student Information Step 2: Community Information Step 3: Parent Consent Process and Child Assent Process Step 4: Child Health Measures  Station 1: Child Assent/Parent Consent and Measurement Sheet…  Station 2: Blood Pressure and Pulse Station (Pulse is optional)  Station 3: Weigh Measurement  Station 4: Height Measurement  Station 5: Waist Circumference Measurement  Station 6: Hip Circumference Measurement  Station 7: Acanthosis Measurements  Station 8: Question Answering Station Step 5: Referral Process Step 6: Incident Report/Data storage, transfer, analysis and report dissemination process Step 7: Report Cards Step 8: Data Storage, Transfer, Analysis and Report Dissemination Process Step 10: Data Requests Step 9: Attend the Annual Child Health Measures Training Supplemental Funds from IHS/CYP 2010-2012
36 Activities/Results and Benefits: Year1 to Year 5  Annual Measures: The ten (10) STEPS above will be implemented by local Child Health Measures teams on each participating Reservation annually.  Annual Follow–ups: Each year, parents will be notified of their child’s measurement status via a “Child Health Measurement Report Card”. If the measurement screening identifies a child with potential abnormal measures, their parent will also be notified via a letter to encourage the parent and child to follow up with a local health care provider.  Annual Intervention Funding: The information collected is used to inform the Tribal Leaders on Child Health Measures trends in their community. This helps leaders identify ways to prevent childhood obesity and its’ complications among children living in Montana and Wyoming Reservations. The CHM measurement cumulative data will also be used to apply for intervention funds. Montana Wyoming Native Child & Youth Project (CYP): Goal: To promote the body, mind and spiritual well-being of Montana and Wyoming American Indian School age children and youth, ages 5 to 19 years by refurbishing safe and accessible play places for children in the reservation communities, while encouraging healthy traditional foods and culturally appropriate emotional well-being and social skills development. Supplemental Funds from Indian Health Service (IHS) Child and Youth Project (CYP) Surveillance/Intervention Project Activities:  Mobilize the community to assist in refurbishing already existing Reservation recreational facilities, making them child friendly and safe for play.  Assist with salary funds, trainings and certification of nominated Tribal Staff Recreation Guides/Aids.  Assist with accessing and promoting age-appropriate healthy traditional foods.
37 Activities/Results and Benefits: Year 1 (FY 10) Project Type Tribes Tribe 1 Play Place Refurbishment/Recreation Guide Wind River - Northern Arapaho Tribe 2 Play Place Refurbishment/Recreation Guide Wind River – Eastern Shoshone Tribal Consultants Tribal Physical Education Specialist/Nutritionist/Traditional Games Consultants Project Evaluator Year 2 (FY 11) Project Type Tribes Tribe 3 Play Place Refurbishment/Recreation Guide Northern Cheyenne Tribe 4 Play Place Refurbishment/Recreation Guide Blackfeet Tribe 1 Recreation Guide Wind River - Northern Arapaho Tribe 2 Recreation Guide Wind River – Eastern Shoshone Tribal Consultants Tribal Physical Education Specialist/Nutritionist/Traditional Games Year 3 (FY 12) Project Type Tribes Tribe 5 Play Place Refurbishment/Recreation Guide Fort Peck Tribe 1 Recreation Guide Wind River - Northern Arapaho Tribe 2 Recreation Guide Wind River – Eastern Shoshone Tribe 3 Recreation Guide Northern Cheyenne Tribe 4 Recreation Guide Blackfeet Consultants Project Evaluator Tribal Consultants Tribal Physical Education Specialist/Nutritionist/Traditional Games Year4/Year5 **Supplemental Funding Ending June 2013: due to lack of resources from funding agency
38 Child Health Measures/Montana Wyoming Native Child & Youth Project Logic Model
39 Cancer Outreach Cancer Outreach Project: Goal: The Cancer Outreach Project will increase cancer outreach to American Indians by educating, encouraging early cancer screening/diagnosis, and offering survivorship coaching for Montana and Wyoming American Indians in collaboration with Montana/Wyoming Cancer Stakeholders. Surveillance/Intervention Project Activities:  Education: o Distributing education materials o Train the Trainer Activities o Organization of Cancer Summit with other Montana/Wyoming Cancer Stakeholders  Outreach: o Offering links to resources o Serving as a resource for access to quality cancer continuum of care o Organization of Cancer Summit with other Montana/Wyoming Cancer Stakeholders Project Activities: Year 1 to Year 2  Distribution of education materials  Serving as a resource for access to quality cancer continuum of care  Offering links to resources Year 3 to Year 5  Train the Trainer Activities  Organization of Cancer Summit with other Montana/Wyoming Cancer Stakeholders  Distribution of education materials  Serving as a resource for access to quality cancer continuum of care  Offering link to resources Susan G. Komen for the Cure: Goal: The Breast Cancer Outreach Project will increase the survival rate of American Indians with breast cancer through education, encouraging early screening, diagnosis, and offering survivorship coaching; distributing education materials and serving as a resource for access to quality cancer continuum of care for Montana AIs in collaboration with Montana Cancer Stakeholders. **Supplemental Funding Ended Sept 30, 2012
40 Surveillance/Intervention Project Activities/Results and Benefits:
41 Tobacco Use Prevention: Goal: To engage Montana and Wyoming Tribal Youth to become agents of Social Change for Culturally-Relevant Tobacco Control. Surveillance/Intervention Project Activities:  Partner with Montana and Wyoming Tobacco Prevention Stakeholders to track Tobacco use on Montana and Wyoming Reservations using secondary data (i.e Youth Risk Behavioral Surveillance System -YRBS and Behavioral Risk Factor Surveillance System -BRFSS)  Partner with Montana and Wyoming Tobacco Prevention Stakeholders to intervene and reduce Tobacco use among Montana and Wyoming Tribes by seeking intervention funds for social marketing. Activities/Results and Benefits: Year 1/Year2  Partnerships with Montana and Wyoming Tobacco Prevention Stakeholders to track Tobacco use on Montana and Wyoming Reservations using secondary data (i.e Youth Risk Behavioral Surveillance System -YRBS and Behavioral Risk Factor Surveillance System -BRFSS)  Develop and Disseminate YRBS Tobacco Use Fact Sheets  Develop and Disseminate BRFSS Tobacco Use Fact Sheets Year 3 to Year 5  Partnerships with Montana and Wyoming Tobacco Prevention Stakeholders to intervene and reduce Tobacco use among Montana and Wyoming Tribes by seeking intervention funds for social marketing.  Engaged youth in the development of Tobacco Use Prevention Social Marketing Champaign Materials  Engaged youth in the dissemination of Tobacco Use Prevention Social Marketing Champaign Materials BASED ON FUNDING AND ON AN OPT-IN/OPT-OUT BASIS
42 Injury & Violence Prevention Goal: To collect, analyze and report intentional and un-intentional injury data in order for Tribal communities to understand the injury status of their community; and To develop a comprehensive strategic plan in collaboration with all Montana and Wyoming injury stakeholders to be implemented in the Billings Indian Health Service Area, in order to reduce the adverse effect of injury among Montana and Wyoming Reservations. Surveillance/Strategic Planning/Intervention Project Activities:  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to track injury and violence on Montana and Wyoming Reservations.  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to develop a comprehensive Strategic Plan for injury and violence prevention on Montana and Wyoming Reservations.  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to intervene and reduce injury and violence among Montana and Wyoming Tribes by seeking intervention funds. Activities/Results and Benefits: Year 1 to Year 3  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to track injury and violence on Montana and Wyoming Reservations.  Collaborate with Tribal Health Departments on intentional/un-intentional injury and violence prevention data. o Identification of “Injury Prevention Best Practice/Promising Projects” among American Indians in Montana and Wyoming and in US.  Collaborate with Billings Area Indian Health Service to track intentional/un- intentional injury and violence data. o Identification of “Injury Prevention Best Practice/Promising Projects” among American Indians in Montana and Wyoming and in US. o Manuscript Development: “Intentional and Un-intentional Injury among American Indians in Montana and Wyoming”.  Collaborate with West Virginia University to study the risk indicators of
43 suicide among Montana and Wyoming Youth o Manuscript Development: “A Study on Suicide Risk Indicators among American Indian Montana Youth”. o Manuscript Development: “Life expectancy deficits in Montana American Indians”.  Implement Promising Practices including Suicide data tracking project: A suicide data improvement project (AS FUNDING ALLOWS) o RMTEC collaborates with Tribal Health Departments to implement suicide data tracking project as a promising practice. The purpose of the project is: • To understand suicide and suicide attempts on the Reservations; • To demonstrate the process of increasing the scope of data collection on suicidal behaviors of eligible American Indian (AI) residents, on Reservations of interest; • To generate more complete data on suicidal attempts, in order to improve prevention, treatment and decrease attempts and fatalities of suicides on the Reservations. Both conventional and non-conventional methods were allowed in obtaining more complete data on suicide attempts and completions. Implementation of the project involved collaboration between IHS mental health professionals and Tribal mental health outreach workers.  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to develop a comprehensive Strategic Plan for injury and violence prevention on Montana and Wyoming Reservations  Collaborate with the Montana Wyoming Tribal Leader Council’s Strategic Prevention Framework Tribal Incentive Grant (SPF-TIG), also known as the Rocky Mountain Tribal Wellness Initiative (RMTWI).  Collaborate with the Montana Wyoming Tribal Leader Council’s Planting Seeds of Hope (PSOH), a youth suicide prevention project.  Collaborate with Billings Area Indian Health Service’s Injury Prevention program to strategize on a comprehensive Montana and Wyoming Tribal injury and violence prevention Strategic Plan . Year 4/Year 5  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to intervene and reduce injury and violence among Montana and Wyoming Tribes by seeking intervention funds.  Collaborate with the Centers for Disease Control and Prevention (CDC) project –”Indian Health Service (IHS) collaboration for injury-related issues with the Tribal Epidemiology Centers”.
44 Environmental Health Initiative Goal: The goal of the initiative is to provide a systematic assessment of environmental risks; a framework for long-term surveillance of environmental health indicators; develop environmental health policies and remediations; and build Tribal environmental health capacity. Surveillance/Strategic Planning/Intervention Project Activities: Phases of Objectives: Phase 1: Assessment: The systematic assessment of environmental risk indicators and associated health outcomes at suspected high-risk areas identified by Tribes; conducting community impact assessment/surveillance studies and strategizing on solutions based on the findings of the assessments and surveillance. Phase 2: Surveillance: Establishment of a framework for long-term surveillance of environmental health indicators in order to establish baseline characteristics and “direct” policy initiatives. Phase 3: Remediation Measures/Emergency Preparedness Policy Initiatives: Follow-up and implementation of recommendations for remediation measures, policy initiatives, and legislative efforts based on the strategic plans in phase 1 and 2. Activities/Results and Benefits: Year1/Year2 Phase 1: Assessment: Systematic assessment of environmental risk indicators and associated health outcomes at suspected high-risk areas identified by Tribes; conducting community impact assessment/surveillance studies and strategizing on solutions based on the findings of the assessments and surveillance. These are immediate/urgent needs for assessments and are the initial steps in the MTWYTLC/RMTEC Environmental Health Initiative. There is high risk for adverse health outcomes identified by RMTEC in collaboration with the Tribes, will be reported back to the Tribes at local “Community Meetings” and a full report written and submitted to the Tribal Leaders. Remedies will be sought by the Tribes in collaboration with MTWYTLC/RMTEC.
45 Phase 1 Activities are Comprise of Seven (7) Main Steps: 1. MTWYTLC/RMTEC site visit to the community and the high risk area identified by the Reservation Community as environmental high risk area 2. Community Readiness Tests 3. Develop Community Impact Assessment Tools and Surveillance Studies Protocol 4. Resolutions, Letters of Support and or Memorandum of Agreement/Understanding (MOA/MOU) 5. Institution Review Board (IRB) Approval 6. Implement the Community Impact Assessment on participating Reservation sites 7. Strategizing on solutions based on findings of the assessments and surveillance; and recommend remediation measures to be shared/disseminated to participating Reservation Communities Year 3-Year 5 Phase 2: Surveillance: Establishment of a framework for long-term surveillance of environmental health indicators in order to establish baseline characteristics and “direct” policy initiatives. The surveillance will be based on Tribe-specific strategic plans, drafted in collaboration with Tribes. This phase will also include training and capacity building for emergency preparedness, based on needs. Phase 2 Activities are Comprise of Three (3) Main Steps: 1. Assessment of existing Surveillance resources available to the Tribal Environmental Departments/Programs 2. Tribal Environmental Departments/Programs “Readiness Tests” 3. Systematic data collection, analysis, easy to understand reporting (to Tribal Communities and Leaders), dissemination of report and strategic planning Phase 3: Remediation Measures/Emergency Preparedness Policy Initiatives: Follow-up and implementation of recommendations for remediation measures, policy initiatives, and legislative efforts based on the strategic plans in phase 1 and 2. Exploration of funding opportunities to sustain surveillance and follow-up on recommended activities depending on the outcomes of Phases 1 and 2. Phase 3 Activities are Comprise of Three (3) Main Steps: 1. Assessment of strategic plans in phase 1 and 2 2. Tribal Community, Tribal Leader and Tribal Environmental Departments/Programs “Readiness Tests” 3. Systematic development of remediation measures, policy initiatives, and legislative efforts based on the strategic plans in phase 1 and 2.
46 Developing Community Health Profiles Behavioral Health Data Improvement Project: Goal: To assess the needs of the Tribal Chemical Dependency program staff in collecting, entering and extracting data on the services provided using the Indian Health Service -IHS BH software and the AccuCare system by performing a needs assessment. Surveillance/Report Dissemination Project Activities: Activities/Results and Benefits Year 1 to Year 5:  Inform, educate, and empower chemical dependency program staff about importance of data entry in order to identify behavioral health issues; and mobilize community partnerships to reduce behavioral health problems.  Data training will be offered based on funding and recommendations from the needs assessment in order for data to be collected, reporting and used by the Tribal Government and Tribal Health Department to improve the quality of client services.  Research for insights and innovative solutions to Behavioral Health problems Data Improvement Projects BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS
47 Chemical Dependency Resource Assessments: Goal: To collect, analyze and report data from Chemical Dependency Programs/Centers on the Reservations and urban areas in Montana and Wyoming. This project provides the Tribes a standardized information system as a basis for comparison for longitudinal evaluation of resources available to clients over the years in Chemical Dependency Centers serving Montana and Wyoming Tribes. Surveillance/Report Dissemination Project Activities: Activities/Results and Benefits Year 1 to Year 5:  Inform, educate, and empower chemical dependence program staff on the resources available and the resources needed to implement a successful Chemical Dependency program  Mobilize community partnerships to research new insights and innovative solutions to chemical dependency program resource and sustainability problems Child Maltreatment: Goal: To work with the Bureau of Indian Affairs -BIA to identify specific risk factors associated with child maltreatment among American Indian (AI) children in MT and WY. Surveillance/Report Dissemination Project Activities:  Promote the use of a more specific analyzable database/surveillance system which includes risk factors for child maltreatment in collaboration with BIA.  Develop and Disseminates reports on Child Maltreatment with recommended sustainable solutions for Montana and Wyoming Tribes Year 1/Year 2  Develop a Memorandum of Understanding (MOU) for data sharing and analysis of the data generated by the developed BIA Child Maltreatment database Year 3 to Year 5  Generate periodic reports from the database on Child Maltreatment with recommended sustainable solutions for Montana and Wyoming Tribes  Disseminate the Child Maltreatment periodic reports to Participating Montana and Wyoming Tribes via BIA
48 Surveillance Goal: To implement BRFSS, increasing response rates for American Indian Population in Montana and Wyoming, following the Center for Disease Control and Prevention - CDC BRFSS survey protocol with data comparable to state and national BRFSS data. Montana Wyoming Tribal BRFSS Project Advisory Committee: The Montana Wyoming Tribal BRFSS Project Advisory Committee will comprise of the 10 Montana and Wyoming Tribal Health Directors, Health gate keepers for the 8 Reservation Communities in Montana and Wyoming; The Montana Department of Health and Human Services MT-DHHS BRFSS Coordinator and the Wyoming Department of Health WY-DoH BRFSS Coordinator; the University of Nebraska (Institutional contractors implementing the surveys on behalf of RMTEC) designee; and RMTEC Staff. Surveillance/Report Dissemination Project Activities: Montana Wyoming Tribal BRFSS Project Advisory Committee will discuss: 1. Tribal BRFSS awareness among RMTEC Tribal Advisory Committee including the Tribal Health Directors, Tribal Leaders and Montana and Wyoming Tribes 2. Tribal BRFSS Community Readiness test for Montana and Wyoming Reservation Communities 3. Tribal BRFSS implementation Methodology and Protocol for participating Montana and Wyoming Tribes 4. Tribal BRFSS Feasibility Study on participating Montana and Wyoming Reservation Communities 5. Tribal BRFSS Long Term Oversampling Methodology among Montana and Wyoming state BRFSS samples Behavioral Health Risk Factor Surveillance System (BRFSS) Project: See Above for Infectious Disease/Chronic Disease Surveillance
49 Activities/Results and Benefits Year 1 to Year 5: RMTEC 2011-2016 BRFSS Project Five Year Schedule for the BRFSS Project Implementation Details Year 1 Year 2 Year 3 Year 4 Year 5 Meet with RMTEC Tribal Advisory Committee including the Tribal Health Directors and Tribal Leaders X X Review of the BRFSS project with Tribal support in form of Letters X X Develop a protocol for conducting the BRFSS approved by the Montana Wyoming Tribal BRFSS Project Advisory Committee and participating Reservation Communities X X Develop a sampling method and recruitment strategy approved by the Montana Wyoming Tribal BRFSS Project Advisory Committee and participating Reservation Communities X X Obtain Tribal IRB and University of Nebraska IRB Approval X Develop a training protocol for interviewers for the BRFSS with the University of Nebraska X Develop a database to enter BRFSS data in partnership with the University of Nebraska X Implement the BRFSS Survey; Data Collection; in partnership with the University of Nebraska X Analyze data; Develop Reports; Develop a report dissemination plan that includes a project overview, dissemination goals, targeted audiences and key messages X X Evaluated the Project/ Lessons Learned –BRFSS in Indian Country X
50 Emerging Projects Other Capacity Building Project Activities: Technical Support (Ongoing)  Offer Technical support for all RMTEC and other Tribe specific projects upon request and as needed to Montana and Wyoming Tribes. Annual Conference  Participate in the planning and implementation of the Annual Montana Wyoming Tribal Leaders Council’s Health Conference. Annual Capacity Building Training  Participate in the planning and implementation of Annual Capacity building Training as needed or upon request by Montana or Wyoming Tribe.  Montana Wyoming Native Youth Development Project  Project Specific Trainings as Needed  Public Health Navigators Technical Support/Trainings/Annual Conference: Emerging Projects: These will be based on current Montana and Wyoming Tribal Community Health Profiles and emerging health needs and priorities (for example - Men’s Wellness - Pending Funding) BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS
51 Montana Wyoming Native Youth Development Project: Goal: To encourage Individual Intern Capacity Building Capacity Building Project Activities:  An opportunity to work on prevention projects of public health concern on Reservations  An opportunity to earn credit units and/or do a practicum/earn a certificate This is a paid Internship job opportunity (Stipends will depend on funding and prior qualifications of the intern) Activities/Results and Benefits Year 1 to Year 5: One youth will be chosen from a Montana or Wyoming Tribe each year with the Tribes rotating over the next 10 years. Summary: There are two components of the Montana Wyoming Youth Development Project: 1) Youth Data/Health Skills Development and 2) Summer Youth Development Camp Youth Data/Health Skills Development The Youth Data Skills Development Project is a youth development focused project that entails mentoring at least one youth with an associate/bachelors degree from a Montana or Wyoming Tribe annually as an Epidemiology/Health Education/Peer Education Intern at the Rocky Mountain Tribal Epidemiology Center (RMTEC). The youth is employed as a Research Assistant and assists with RMTEC projects. Summer Youth Development Camp The purpose of the “Summer Youth Development Camp” for Middle and High School age group is to:  Empower youth to handle life situations;  Increase knowledge of public health epidemiology fundamentals;  Increase public health and epidemiology literacy;  Increase ability to create positive norms;  Propose a plan for advancing the health of youth on their Reservations;  Decrease dropout rates and increase interest in the Public Health and Sciences. Each youth is awarded a certificate of participation at the end of the Summer Camp. Summer Camp implementation is dependent on funding.
52 Public Health Navigators: Public Health Navigators will provide culturally appropriate and community relationship- appropriate Public Health information; social support; and Community Public Health advocacy to their Reservation Communities and will be directly under the supervision of the Tribal Health Directors as a Tribal contractor working on RMTEC projects with the Tribal Health Departments. RMTEC will have contracts with all 10 Tribal Health Departments in Montana and Wyoming for the salary of a Public Health Navigator in order to be able to implement projects successfully at the Reservation Community Level. Each Public Health Navigator’s immediate supervisor will be the Tribal Health Director of the Reservation Tribal Health Department. A Public Health Navigator job will include, but is not limited to, implementing RMTEC projects among participating Tribal Health departments as needed. Each Tribal Health Department will determine what duties/trainings their Public Health Navigator will have depending on Tribal Health Department needs and the RMTEC projects opted in by Tribal Health Department. RMTEC will organize an annual Training for the Public Health Navigators in the following topic areas based on Tribal Health Department Needs:  Community Assessments/Survey Implementation  Maternal and Child Health Navigation/Train the Trainer Parenting Classes  Health Codes Implementation  Outbreak Investigation – Organized by RMTEC for action by Tribal Health Department  Public Health Preparedness  Other Topics as needed BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS NOTE A Public Health Navigator is NOT an IHS Sanitarian:  Public Health Navigators do not have environmental Health Degrees or Environmental Health Inspection or investigation duties or educational background (i.e Vector control, food inspection, water/sewage system inspection)  Public Health Navigators are Trusted Community Members trained by RMTEC to carry out RMTEC projects on the Reservations under direct supervision of Tribal Health Directors
53 Rocky Mountain Tribal Epidemiology Center Evaluation Measures of Progress Healthy People 2020 10 Essential Public Health Services Indian Health Service RMTEC Project Goals RMTEC Project Project Measure of Progress Social Determinants of Health: Create social and physical environments that promote good health for all Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts Ensure the coordination of services and program activities with other similar programs and establish a broad- based council to advise and support the program. Support responses to public health emergences in collaboration with the IHS Epidemiology Program, local, Strengthen Individual Tribes’ Public Health Infrastructure and Capacity Capacity Building Projects: 1. Strengthening Public Health Capacity 2. Emergency Preparedness Other:  Annual Trainings o Montana Wyoming Native Youth Development Project o Project Specific Trainings as Needed Tribal Public Health Capacity:  Measure of Public Health Performance Improvement of Montana and Wyoming Tribes * (Measure: NPHPSP)  Measure of Emergency Preparedness Performance Improvement (Measure: NPHPSP) Workforce Development:  Number of Tribal Public Health Workforce Improved
54 Assure a competent public and personal health care workforce tribal, state, and other Federal health authorities. o Public Health Navigators  Annual Conferences  Technical Support General Health Status: Attain high quality, longer lives free of preventable disease, disability, injury, and premature death Monitor health status to identify community health problems Diagnose and investigate health problems and health hazards in the community Enforce laws and regulations that protect health and ensure safety Assist in developing disease surveillance systems and identifying their highest priority health status objectives, based on epidemiologic data. Collect data relating to, and monitor progress made toward meeting, each of the health status objectives Assist and facilitate reporting of nationally notifiable disease conditions to public health authorities in the region. Improve Surveillance Data for Health Conditions and Diseases Infections/ Chronic Disease & Public Health Ethics Projects: 3. Ethics  Tribal Health Codes  Institutional Review Board –IRB  Infectious Disease Surveillance  Chronic Disease Surveillance Ethics:  Measure of Number of Tribal Policy Development Encouraged  Measure of support for IRB and number of meetings participated in Infectious/Chronic Disease:  Development of an Infectious Disease and Chronic Disease Surveillance System Protocol in collaboration with other Montana and Wyoming Agencies Health Related Quality of Life and Well- Being: Promote quality of life, Research for new insights and innovative solutions to health problems Develop and implement epidemiologic studies that utilize the principles of Implement Pilot Projects and Specific Studies to Address Tribally Healthy Lifestyles Projects: 4. Maternal and Child Health a. Pregnancy Risk Assessment Maternal and Child Health:  Number of Studies on Maternal and Child Health Needs Implemented/Reported
55 healthy development, and healthy behaviors across all life stages community engagement and that have practical application in improving the health status of constituent communities. Identified Health Priorities and Support Tribal Community Based Participatory Epidemiological Research b. Sudden Unexpected Infant Death 5. Obesity Prevention a. Child Health Measures b. Child and Youth Health Project  Number of Trainings on Capacity Building for Parenting Skills Obesity Prevention:  Measure of improved Health Measure, Reducing Obesity **(Measure: Child Health Measures)  Number and Type of Interventions Implemented Emerging Projects: Developing New and Innovative Projects for Tribe Self Sustaining Prevention/Intervention Projects based on Tribal Community Health Profiles in Collaboration with Montana and Wyoming Tribes Disparities and Inequity: Achieve health equality, eliminate disparities, and improve the health of all groups Inform, educate, and empower people about health issues Link people to needed personal health services and assure the provision of health care when otherwise unavailable Develop and implement disease control and prevention programs in cooperation with other public health entities. Make recommendations for targeting of public health services needed by constituents. Provide Data and Technical Assistance to Support Health Promotion, Disease Prevention (HP/DP) Objectives and Behavioral Health Strategies Environmental Health & Disease Prevention Projects: 6. Cancer Outreach and Prevention a. Susan Komen b. Tobacco Use Prevention 7. Injury and Violence Prevention Cancer Outreach:  Number of Target Population Reached  Measure of collaboration with other Cancer Stakeholder Agencies/Organizations Injury/Violence Prevention:  Development of an Injury and Violence Prevention Strategic Plan in collaboration with other Montana and Wyoming
56 8. Environmental Health Initiative Agencies (Measure: Strategic Plan Developed)  Development of an Injury/Violence Prevention Surveillance System Protocol in collaboration with other Montana and Wyoming Agencies  Measure of collaboration with other Injury and violence Stakeholder Agencies/Organizations Environmental Health Initiative:  Measure of progress based on the three phases of the initiative: -1) Needs Assessment -2) Surveillance -3) Remediation Emerging Projects: -Developing New Innovative and Tribe Self Sustaining -Prevention/Intervention Projects based on Tribal Community Health Profiles in Collaboration with Montana and Wyoming Tribes Disparities and Inequity: Achieve health equality, eliminate Evaluate effectiveness, accessibility and quality of personal and Participate in the development of systems for sharing, improving, and disseminating Develop Tribal/Urban Indian Community Health Profiles Community Health Profiles & Emerging Projects: 9. Data Improvement Projects for Community Health Profile Development/BRFSS Community Health Profiles:  Developing and Disseminating Annual Community Health
57 disparities, and improve the health of all groups population- based health services aggregate health data at a national level for purposes of advocacy for AI/AN communities, Collaborate with national HHS programs in the development of standardized surveillance and data monitoring methods and data sets. and Tribe Specific Data Collection Initiatives a. Behavioral Risk Factor Surveillances System – BRFSS b. Behavioral Health Data Improvement Project c. Chemical Dependence Resource d. Child Maltreatment e. Infectious Disease Surveillance f. Chronic Disease Surveillance 10. Emerging Project based on Community Health Profiles Fact Sheets  Developing and Disseminating 5 year Community Healthy Profiles (every 5 years)  Implementing Data Improvement Projects with Montana and Wyoming Tribes, Building their Data Capacity  Developing Surveillance Systems for Behavioral Health, infectious Disease and Chronic Disease (Measure: Number of Fact Sheets and 5 Year Community Health Profiles Developed and Disseminated; and Number of Surveillance Systems Developed/Implemented) Emerging Projects:  Developing New Innovative and Tribe Self Sustaining Prevention/Intervention Projects based on Tribal Community Health Profiles in Collaboration with Montana and Wyoming Tribes * (Measure: National Public Health Performance Standards Program Assessment -NPHPSP) ** (Measure: Child Health Measures Project Data)
58 Performance Measures Process Evaluation RMTEC Semi-Annual Report RMTEC Annual Report Short term (annual) / Long term (completion of project) Outcome Measures RMTEC Project Summary Report Impact National Public Health Performance Standards Program’s Local Public Health Governance Performance Assessment Instrument Growth/Value Performance Measures 1. Number of Collaborations, Stakeholders and Partners (Including Universities, Public Health Agencies and other Public Health Institutions) 2. Number of Professional Staff/Administrative Staff 3. Number of Scientific Publications Written and or Presented 4. RMTEC Website 5. RMTEC Web-based Data Warehouse (Password Protected Individual Tribe Data Warehouse) 6. Number of Grants Written 7. Number of Funded Grants (Sustainability) 8. RMTEC Combined Budget 9. Number of Successfully Completed Projects during the Funding Period 10. RMTEC Stakeholder Value Assessment
59

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FINAL RMTEC_Strategic Plan 2012_20160 Developed by Dr.Akintan Folo FA12.03.2012

  • 2. 1 Executive Summary Dear Colleague: We are pleased to present to you the Rocky Mountain Tribal Epidemiology Center 2012 – 2016 Strategic Plan. The Rocky Mountain Tribal Epidemiology Center developed the strategic plan to fulfill the Indian Health Service Tribal Epidemiology Center core funding epidemiology grant for Montana and Wyoming Tribes. The strategic plan includes all Rocky Mountain Tribal Epidemiology Center goals, objectives, projects and activities which include Surveillance, Capacity Building and Epidemiological Intervention activities. All Montana and Wyoming Tribal Health Departments participate in projects based on Local Tribal Health priorities and all are encouraged to opt-in or opt-out on an annual basis. We welcome all comments and suggestions for continued improvement. We hope the Tribes in this Rocky Mountain Region will find these projects useful in disease surveillance, capacity building and intervention expressing their Public Health Authority. The Rocky Mountain Tribal Epidemiology Center maintains and distributes the Montana and Wyoming Tribal Community Health Profiles as a reference document. For more information how to obtain hard copies, please contact Folorunso Akintan, MD, MPH at fakintan@mtwytlc.com; or (406) 252-2550. Sincerely, Gordon Belcourt, Executive Director Montana Wyoming Tribal Leaders Council _____________________________________________________________ Written by Folorunso (Folo) Akintan MD, MPH Principle Investigator, Rocky Mountain Tribal Epidemiology Center Montana-Wyoming Tribal Leaders Council 175 North 27th Street, Suite 1003 Billings, MT 59101 www.rmtec.org
  • 3. 2 Table of Contents Executive Summary.......................................................................................................................................................1 Table of Contents ..........................................................................................................................................................2 History...........................................................................................................................................................................3 Montana and Wyoming Tribes and Reservations..........................................................................................................4 Public Health Authority.................................................................................................................................................5 Partners..........................................................................................................................................................................5 Healthy People 2020 Overarching Goals.......................................................................................................................8 10 Essential Public Health Services - Objectives ..........................................................................................................9 Specific Goals and Objectives.....................................................................................................................................10 Tribal Health Needs Assessments ...............................................................................................................................11 Rocky Mountain Epidemiology Center Goals............................................................................................................13 Five Project Focus Areas.............................................................................................................................................15 RMTEC PROJECTS ...................................................................................................................................................16 PROJECT ACTIVITIES .............................................................................................................................................19 RMTEC PROJECT ACTIVITY TIMELINE..............................................................................................................20 Strengthening Tribal Public Health Infrastructure for Improved Health Outcomes....................................................22 Emergency Preparedness.............................................................................................................................................24 Health Codes ...............................................................................................................................................................26 Institutional Review Board..........................................................................................................................................28 Infectious Disease/Chronic Disease ............................................................................................................................29 Maternal and Child Health ..........................................................................................................................................33 Obesity Prevention ......................................................................................................................................................35 Cancer Outreach ..........................................................................................................................................................39 Injury & Violence Prevention......................................................................................................................................42 Environmental Health Initiative ..................................................................................................................................44 Developing Community Health Profiles .....................................................................................................................46 Surveillance.................................................................................................................................................................48 Emerging Projects .......................................................................................................................................................50 Other............................................................................................................................................................................50 Evaluation....................................................................................................................................................................53 Performance Measures ................................................................................................................................................58 Growth/Value Performance Measures.........................................................................................................................58
  • 4. 3 History The Rocky Mountain Tribal Epidemiology Center (RMTEC) is a division of the Montana Wyoming Tribal Leaders Council (MTWYTLC). RMTEC started in the fall of 2005 in collaboration with multiple stakeholders. A 5-year cooperative agreement with Indian Health Services (IHS) to support RMTEC was awarded in 2006 and provided the core funding to start RMTEC projects. RMTEC is currently on another IHS 5 year award since 2011. RMTEC serves 10 Tribes on 8 Reservations in Montana and Wyoming - an American Indian (AI) population of approximately 65,000 -120,000 (depending on source of data). All RMTEC projects are developed through a Community Based Participatory Research (CBPR) approach. The RMTEC advisory group includes the Montana - Wyoming Tribal Leader’s Committee on Health and the ten (10) Tribal Health Directors (two in Wyoming and eight in Montana- including the Little Shell Tribe of Montana) and other MTWYTLC/RMTEC stakeholders. RMTEC Stakeholders present or report Community Health Priorities (CHP) to RMTEC for intervention and project development. Tribal Health Directors represent all Tribes and Reservations served by the Billings Area Office – Indian Health Service (BAO-IHS), providing guidance and assistance to RMTEC. RMTEC Vision We contribute to healthy Tribal communities through lasting collaborative partnerships. RMTEC Mission To empower American Indian Tribes in Montana and Wyoming in the development of Public Health services and systems and epidemiological data in order for Tribes to have resources and express their authority in response to Public Health concerns. RMTEC Values  Encourage and Nurture Intellectual Curiosity  High Quality Work  Honest and Open Communication  Integrity  Respect and Trust  Service with Humility  Unity of Purpose RMTEC Believes  We believe in the sovereignty of Tribal Nations.  We believe our purpose is to serve the Tribes in the area of Public Health.  We believe in deferring to Tribal Public Health priorities in the development of all projects.  We believe in open and honest communication that fosters an environment of Respect and Trust.  Be believe in encouraging an environment the nurtures ideas, beliefs, perspectives and cultures.
  • 5. 4 Montana and Wyoming Tribes and Reservations  Assiniboine  Blackfeet  Confederated Salish and Kootenai  Chippewa Cree  Crow  Eastern Shoshone  Gros Ventre  Kootenai  Little Shell  Northern Cheyenne  Northern Arapaho  Sioux  Shoshone Bannock (awaiting legal assimilation)
  • 6. 5 Public Health Authority The MT-WY TLC is acting under a cooperative agreement with the Indian Health Service to operate a Tribal Epidemiology Center, which is authorized by Section 214 (a)(1), Public Law 94- 437, Indian Health Care Improvement Act as amended by P.L. 573. In the conduct of this public health activity, the MT-WY TLC may collect or receive protected health information for the purpose of preventing and controlling disease, injury, or disability, including but not limited to, the reporting of disease, injury, vital events such as birth or death, and the conduct of public health surveillance, public health investigations, and public health interventions for Tribal communities they serve. Further, the Indian Health Service considers this to be a public health activity for which disclosure of protected health information by covered entities is authorized by 45 CFR 164.512(b) of the Privacy Rule. Partners Montana Wyoming Tribal Councils  Northern Arapaho Business Council  Eastern Shoshone Business Council  Blackfeet Tribal Business Council  Chippewa Cree Business Committee  Confederated Salish and Kootenai Tribes  Northern Cheyenne Tribal Council  Crow Tribal Council  Fort Belknap Community Council  Fort Peck Tribal Executive Board  Little Shell Tribe of Chippewa Indians of MT  Fort Hall Business Council Montana Wyoming Tribal Health Departments  Northern Arapaho Tribal Health Department  Eastern Shoshone Tribal Health Department  Blackfeet Tribal Health Department  Chippewa Cree Tribal Health Department  Confederated Salish and Kootenai Tribal Health Department  Crow Tribal Health Department  Northern Cheyenne Tribal Health Department  Fort Belknap Tribal Health Department  Fort Peck Tribal Health Department  Little Shell Tribe of Chippewa Indians of MT  Shoshone-Bannock Tribal Health and Human Services Department
  • 7. 6 State Health Departments  Montana Department of Health and Human Services  Wyoming Department of Health Institutions  Montana State University  University of Montana  Sanford School of Medicine/University of South Dakota  Avera Research Institute  University of West Virginia  University of Nebraska  Pennsylvania State University  WESTAT Agencies  Indian Health Service – Division of Epidemiology & Disease Prevention  Billings Area Indian Health Service  Bureau of Indian Affairs – Rocky Mountain Regional Office  American Public Health Association  National Institute of Health  Centers for Disease Control  National Institute of Child Health/Development  Public Health Accreditation Board  National Association of Local Board of Health  Susan Komen for the Cure – Montana  Native American Management Inc.  Montana Public Health Association  WY All Hazards Steering Committee Cancer Partners: NGOs/Hospitals/Clinics  Montana Comprehensive Cancer Control (MTCCC)  Wyoming Comprehensive Cancer Control Consortium (WCCCC)  Susan G. Komen for the Cure Foundation  Montana American Indian Women’s Health Coalition (MAIWHC)  Montana Cancer Institute Foundation  American Cancer Society (Montana)  Montana Family Planning Clinics  Planned Parenthood
  • 8. 7  St. Vincent Hospital  Benefis Health Care Systems (Sletten)  Northwest Healthcare  Shodair Hospital  St. Peters Hospital  Bozeman Deaconess  Bighorn Valley Health Center  River Stone Public Health Department  Billings Clinic  All 8 Montana/Wyoming Indian Health Service Units  Indian Family Health Clinic  Montana Tobacco Use Prevention Program (MTUPP)  American Indian Tobacco Prevention Specialists  Respecting the Tobacco Way
  • 9. 8 Healthy People 2020 Overarching Goals  General Health Status: Attain high quality, longer lives free of preventable disease, disability, injury, and premature death  Disparities and Inequity: Achieve health equality, eliminate disparities, and improve the health of all groups  Social Determinants of Health: Create social and physical environments that promote good health for all  Health –Related Quality of Life and Well-Being: Promote quality of life, healthy development, and healthy behaviors across all life stages
  • 10. 9 10 Essential Public Health Services - Objectives 1. Monitor health status to identify community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Assure a competent public and personal health care workforce. 9. Evaluate effectiveness, accessibility and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems.
  • 11. 10 Indian Health Service Tribal Epidemiology Center Core Funding Specific Goals and Objectives 1. Assist American Indian/Alaska Native (AI/AN) communities, tribal organizations, and urban Indian Organizations in developing disease surveillance systems and identifying their highest priority health status objectives, based on epidemiologic data. Collect data relating to, and monitor progress made toward meeting, each of the health status objectives of IHS, the AI/AN communities, tribal organizations, and urban Indian communities in the region. Assist and facilitate reporting of nationally notifiable disease conditions to public health authorities in the region. 2. Participate in the development of systems for sharing, improving, and disseminating aggregate health data at a national level for purposes of advocacy for AI/AN communities, Government Performance Results Act (GPRA), HP 2010, and other national-level activities. 3. Collaborate with national HHS programs in the development of standardized surveillance and data monitoring methods and data sets. 4. Support responses to public health emergencies in collaboration with the IHS Epidemiology Program, local, tribal, state, and other Federal health authorities. 5. Develop and implement epidemiologic studies that utilize the principles of community engagement and that have practical application in improving the health status of constituent communities. Studies may require Institutional Review Board approval if human subjects are involved. 6. Develop and implement disease control and prevention programs in cooperation with other public health entities. Make recommendations for targeting of public health services needed by constituents. 7. Ensure the coordination of services and program activities with other similar programs and establish a broad-based council to advise and support the program. Such an advisory council would consist of technical experts in epidemiology and public health, community members, health care providers, and others who could provide overall program direction and guidance. Tribal Epidemiology Centers are Indian Health Service division funded organizations who serve American Indian/Alaska Native Tribal and urban communities by managing public health information systems, investigating diseases of concern, managing disease prevention and control programs, responding to public health emergencies, and coordinating these activities with other public health authorities.
  • 12. 11 Montana and Wyoming Tribal Health Needs Assessments The Montana Wyoming Tribal Leaders Council/Rocky Mountain Tribal Epidemiology Center implemented a Health Needs Assessment with Montana and Wyoming Tribal Health Departments (the health gate keepers of Montana Wyoming Tribes) in 2010. Each Tribal Health Department was encouraged to list the top 3 health priorities of the Tribe/Reservation and let MTWYTLC/RMTEC know how it can be of help over the next five years 2012-2016. These health priorities were taken into consideration by MTWYTLC/RMTEC while developing the project focus areas for the Epidemiology Center for 2012-2016. The following are the top three health priorities by Tribe: Table 1. Montana - Wyoming Tribe Specific Health Priorities Tribe/Reservation Community Top 3 Health Priorities Blackfeet  Community Health Profiles  MT-WY Child/Youth Health Project  Suicide Data Tracking Confederated Salish and Kootenai  Maternal Child Health  Childhood Obesity  Suicide Crow  Childhood Obesity/ Sudden Infant Death Syndrome (SIDS)  Cancer Screenings  Injury/Suicide Rocky Boy  Strengthening Tribal Relations Fort Belknap  Healthy Lifestyles (For all ages)  Obesity Prevention  Elder Care
  • 13. 12 Fort Peck  Mental Health Access  Maternal Child Health  Domestic Violence Northern Cheyenne  Strengthening Current Programs  Collaborate/Build Tribal Programs  Strengthening Reservation Staff Skills and Ability Northern Arapaho  Youth/Adult Alcohol and Drug Abuse  Youth/Adult Suicide  Youth/Adult Mental Health Eastern Shoshone  Diabetes  Substance and Chemical Abuse  Health Promotion /Disease Prevention Little Shell  Childhood Obesity  Stress Reduction  Cancer Screening Shoshone-Bannock Approached MTWYTLC in 2011 (pending legal inclusion) Environmental Health and Cancer as Tribal Leaders Health Priorities Over the past decade, Montana and Wyoming Tribal Leaders have raised concerns about Environmental Health and Health Outcomes of their communities (i.e Cancer). MTWYTLC/RMTEC has been asked to include environmental health as one of its projects over the next 5 years.
  • 14. 13 Rocky Mountain Epidemiology Center Goals 1. Strengthen Individual Tribes’ Public Health Infrastructure and Capacity. 2. Improve Surveillance Data for Health Conditions and Diseases. 3. Provide Data and Technical Assistance to Support Health Promotion, Disease Prevention (HP/DP) Objectives and Behavioral Health Strategies. 4. Implement Pilot Projects and Specific Studies to Address Tribally Identified Health Priorities and Support Tribal Community Based Participatory Epidemiological Studies. 5. Develop Tribal/Urban Indian Community Health Profiles and Tribe Specific Data Collection Initiatives.
  • 15. 14 Rocky Mountain Epidemiology Center Project Focus Areas, Projects and Project Activities
  • 16. 15 RMTEC Five Project Focus Areas 1. Capacity Building 2. Infections/ Chronic Disease & Public Health Ethics 3. Healthy Lifestyles 4. Environmental Health & Disease Prevention 5. Community Health Profiles & Emerging Projects
  • 17. 16 RMTEC PROJECTS Capacity Building Projects: 1. Strengthening Public Health Capacity 2. Emergency Preparedness Infections/ Chronic Disease & Public Health Ethics Projects: 3. Ethics  Tribal Health Codes  Institutional Review Board – IRB  Infectious Disease Surveillance  Chronic Disease Surveillance Healthy Lifestyles Projects: 4. Maternal and Child Health  Pregnancy Risk Assessment  Sudden Unexpected Infant Death 5. Obesity Prevention  Child Health Measures  Child and Youth Health Project Environmental Health & Disease Prevention Projects: 6. Cancer Outreach and Prevention  Susan Komen  Tobacco Use Prevention 7. Injury and Violence Prevention 8. Environmental Health Initiative Community Health Profiles & Emerging Projects: 9. Data Improvement Projects for Community Health Profile Development/BRFSS  Behavioral Risk Factor Surveillances System –BRFSS  Behavioral Health Data Improvement Project  Chemical Dependence Resource  Child Maltreatment  Infectious Disease Surveillance  Chronic Disease Surveillance 10. Emerging Project based on Community Health Profiles
  • 18. 17 Other:  Annual Trainings 1. Montana Wyoming Native Youth Development Project 2. Project Specific Trainings as Needed 3. Public Health Navigators  Annual Conferences  Technical Support
  • 19. 18
  • 20. 19 RMTEC PROJECT ACTIVITIES RMTEC projects are based on three main categories of activities: 1.CAPACITY BUILDING ACTIVITIES 2.SURVEILLANCE ACTIVITIES 3.INTERVENTION ACTIVITIES
  • 21. 20 RMTEC PROJECT ACTIVITY TIMELINE RESULTS &BENEFITS Focus Areas Project Implementation Details Year 1 - Year 5 Activities Results/Benefits A. Capacity Building X Capacity Building Tribal Public Health Empowerment for all Montana and Wyoming Tribes 1. Strengthening Public Health Capacity X Capacity Building 2. Emergency Preparedness X Capacity Building B. Infectious/Chronic Disease & Public Health Ethics X Surveillance/Investigations and Public Health Navigation Maintain a Surveillance System for Diseases. Train Tribal Public Health *Navigators in Sanitation (As Funding Allows); How to Develop Health Codes for their Communities; and How to carry out Outbreak Investigations/Interventions.3. Tribal Ethics X Surveillance C. Healthy Lifestyles X Surveillance/Interventions Maintain a Surveillance System for Healthy Lifestyles; Implement Child Health Measures Project as a surveillance System; Child and Youth Projects as Intervention Projects; and Train Tribal Public Health *Navigators as Perinatal Home Visitors (As Funding Allows), and Maternal Prenatal Care Transporters. 4. Maternal and Child Health X Surveillance/Interventions 5. Obesity Prevention X Surveillance/Interventions D. Environmental Health & Disease Prevention X Surveillance/Interventions Implement an Injury/Violence and Environmental Health Surveillance System with Health Outcomes (i.e. Cancer; Accidents); Maintain Cancer Outreach and Education; Develop Injury and Violence Prevention Interventions. 6. Cancer Prevention and Screening X Surveillance/Interventions “Outreach/Education” 7. Injury and Violence Prevention X Surveillance/Strategic Planning and Interventions 8. Environmental Health X Surveillance/Strategic Planning and Interventions E. Community Health Profiles/BRFSS & Emerging Projects X Surveillance/Report Dissemination Collect, Analyze, Report and Disseminate Tribe Specific Community Health Profiles for all Montana and Wyoming Tribes; Partner with other Tribal Epidemiology Centers to develop National Tribal Community Health Profiles; and Implement the BRFSS Project among Montana and Wyoming American Indian Population. 9. Community Health Profiles/BRFSS X Surveillance/Report Dissemination 10. Emerging Projects based on Community Health Profiles X To Be Determined
  • 22. 21 RMTEC SPECIFIC PROJECTS GOALS OBJECTIVES ACTIVITIES RESULTS & BENEFITS 2012-2016
  • 23. 22 Strengthening Tribal Public Health Infrastructure for Improved Health Outcomes Goal: To systematically increase performance management capacity of the Tribal Health Departments in MT and WY in order to ensure their access to resources needed to express their public health authority. Supplemental Funds from Center for Disease Control and Prevention (CDC) National Public Health Improvement Initiative (NPHII) Grant Objectives for Montana and Wyoming Tribes opting in for the project from 2010 - 2015: 1. Increase efficiencies of Montana and Wyoming Tribal Health Departments’ operations 2. Increase use of evidence –based policies and practices among Montana and Wyoming Tribal Health Departments 3. Increase Montana and Wyoming Tribal Health Departments’ readiness for (applying and achieving) accreditation by the Public Health Accreditation Board (PHAB) Capacity Building Project Activities:  Facilitate the National Public Health Performance Standards -NPHPSP, a local Public Health System Assessments tool and the Mobilizing for Action through Planning and Partnerships (MAPP) tool among all Montana and Wyoming Tribal Health Departments.  Strengthen partnerships among collaborating agencies.  Establish Champion Workgroups (Performance Improvement/Public Health Accreditation Tribal Advisory Board Panel/Task Force) within Montana- Wyoming Tribes.  Host conferences/trainings with incorporated information sessions on public health accreditation and best practices in performance improvement.  Link Tribes with resources and capacity building assistance to address their self- assessed challenges. Supplemental Funds from CDC-NPHII 2010-2015
  • 24. 23 Activities by year/Results and Benefits: In 2011: o Implement the Local Public Health Governance Assessment in the Fort Belknap, Blackfeet and Rocky Boy Health Departments and organize a Departmental Strategic Planning Session with these Tribal Health Departments and their stakeholders. In 2012: o Implement the Local Public Health Governance Assessment in the Fort Peck, Eastern Shoshone and Northern Arapaho Tribal Health Departments and organize a Departmental Strategic Planning Session with these Tribal Health Departments and their stakeholders. o Implement the Mobilizing for Action through Planning and Partnerships (MAPP) in the Fort Belknap, Blackfeet and Rocky Boy Health Departments. In 2013: o Implement the Local Public Health Governance Assessment in the Crow, Northern Cheyenne, Flathead and Little Shell Tribal Health Departments and organize a Departmental Strategic Planning Session with these Tribal Health Departments and their stakeholders. o Implement the Mobilizing for Action through Planning and Partnerships (MAPP) in the Fort Peck, Eastern Shoshone and Northern Arapaho Tribal Health Departments. In 2014: o Implement the Mobilizing for Action through Planning and Partnerships in the Crow, Northern Cheyenne, Flathead and Little Shell Tribal Health Departments. o Implement a training session on Public Health Accreditation for all participating Tribes and develop a resource guide for Public Health Accreditation for all Montana and Wyoming Tribes and Train the Trainer sessions for independent Tribal implementation of NPHPSP among participating Tribes. In 2015: o Prepare at least one of the participating Tribal Health Departments for Public Health Accreditation application. o Implement a training session on Public Health Accreditation for all participating Tribes and develop a resource guide for Public Health Accreditation for all Montana and Wyoming Tribes and Train the Trainer sessions for independent Tribal implementation of NPHPSP among participating Tribes.
  • 25. 24 Emergency Preparedness Goal: To provide Tribal Emergency Preparedness Capacity Building Technical Support to participating Montana and Wyoming Tribes. Objectives for Montana and Wyoming Tribes opting in for the project from 2012 - 2016:  Partner with existing workgroups and agencies to help build the Emergency Preparedness capacity of Montana and Wyoming Tribes. Capacity Building Project Activities:  Strengthen partnerships among collaborating agencies; collaborate with established workgroups within Montana-Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges.  Host conferences/trainings with incorporated information sessions on best practices in performance improvement. Activities/Results and Benefits: Year 1  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes. Year 2  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges. Year 3  Host conferences/trainings with incorporated information sessions on best practices in performance improvement.  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.
  • 26. 25  Link Tribes to resources and capacity building assistance to address their self- assessed challenges. Year 4  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges. Year 5  Strengthen partnerships among collaborating agencies by attending Region 8 Meetings.  Collaborate with established workgroups within Montana-Wyoming Tribes by attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming Tribes.  Link Tribes to resources and capacity building assistance to address their self- assessed challenges.
  • 27. 26 Health Codes Health Codes: Goal: To “Build Tribal Capacity” to Develop, Modify and Implement Tribal Public Health Codes in order to improve public health practice in Tribal communities in response to community health, emergency preparedness and research concerns. The project will be implemented over the next five years (2012—2016) in 4 phases of objectives: Phase 1: Raising awareness of and improving readiness for Public Health Codes and Regulations; Phase 2: Gathering all relevant existing codes and evaluating their strengths and weaknesses; Phase 3: In consultation with all partners, drafting and developing modernized and highly effective model Tribal Health Codes and Regulations; Phase 4: In collaboration with all partners, ensure effective implementation of the modernized Tribal Health Codes and Regulations. Capacity Building Project A/B/Cs of Activities:  Health Code Development and Implementation Team  Develop Goals and Objectives with Timelines and Strategic Planning on Development and Implementation/Enforcement of Tribal Community Health Code  Develop Health Code “Activities” in order to meet the set Goals and Objectives with Timelines for your Tribal Community Health Code Development and Implementation Project, “Designating Staff/Departments” to each Activity with Timelines Activities/Results and Benefits: Year 1 Phase 1: Raising awareness of and improving readiness for Public Health Codes and Regulations Phase 2: Gathering all relevant existing codes and evaluating their strengths and weaknesses
  • 28. 27 Year 2 Phase 3: In consultation with all partners, drafting and developing modernized and highly effective model Tribal Health Codes and Regulations i. Identify and recruit key stakeholders in the community who will be involved in the development, modification and implementation of Tribal Health Codes ii. Health Code Development and Implementation “Team” meet at least twice a month and develop Health Code Goals and Objectives iii. Health Code Development and Implementation “Team” meet at least twice a month and develop/modify Health Code from Templates and have Strategic Plan meeting on health code implementation Year 3 Phase 3: In consultation with all partners, drafting and developing modernized and highly effective model Tribal Health Codes and Regulations iv. Health Code Development and Implementation “Team” meet at least once with the “Tribal Community” and the “Tribal Council” and Review/approve the Draft Health Code v. Health Code Development and Implementation “Team” meet with the “Tribal Council” to promote the passing and implementation of the FINAL Draft Health Code Year 4/ Year5 Phase 4: In collaboration with all partners, ensure effective implementation of the modernized Tribal Health Codes and Regulations vi. Health Code Development and Implementation “Team” meet with the “Tribal Council” to promote the implementation of the FINAL Draft Health Code vii. Health Code Development and Implementation “Team” meet with the “Tribal Council” to promote the evaluation of the FINAL Draft Health Code being implemented
  • 29. 28 Institutional Review Board Goal: To promote awareness and advance the unique concerns of Tribal nations when any research involves their constituents, ensuring that researchers engage Tribes in an ethical and collaborative manner of process, resulting in mutually beneficial and constructive ethical results -Rocky Mountain Institutional Review Board (RMT-IRB). For more information please go to webpage: http://www.mtwytlc.org/irb/rmtirb-home.html Capacity Building Project Activities:  Collaborate with established IRBs within Montana-Wyoming  Link Tribes to resources and capacity building assistance  Strengthen partnerships among collaborating agencies Activities/Results and Benefits: Year 1  Participate in the Rocky Mountain Institutional Review Board meetings Year 2  Participate in the Rocky Mountain Institutional Review Board meetings  Strengthen partnerships among other Montana and Wyoming Institutional Review Boards Year 3 to Year 5  Participate in the Rocky Mountain Institutional Review Board meetings  Strengthen partnerships among other Montana and Wyoming Institutional Review Boards  Link RMT-IRB to needed resources to successfully implement Tribal IRBs
  • 30. 29 Infectious Disease/Chronic Disease Infectious Disease: Goal: To improve public health practices among communities through sustainable infectious disease prevention and establish an infectious disease surveillance system (database) that will help with tracking notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes. Surveillance/Report Dissemination Project Activities: Objectives for Montana and Wyoming Tribes opting in for the project from 2012 - 2016:  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a notifiable disease and other disease outbreak surveillance system among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes.  Implement at least one Face to Face All Hazards Training/Conference. Surveillance: Public health surveillance is the ongoing, systematic collection, analysis, interpretation and dissemination of data regarding a health related event for use in public health action to reduce morbidity and mortality and to improve health. Attributes of Public Health Surveillance System include:  Simplicity  Data quality  Sensitivity  Acceptability  Flexibility  Predictive value  Representativeness  Timeliness  Stability
  • 31. 30 Activities/Results and Benefits: Year 1  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes. Year 2  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a notifiable disease and other disease outbreak surveillance systems among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes. Year 3 Implement at least one Face to Face All Hazards Training/Conference Goal: To improve the Surveillance Capacity of Montana and Wyoming American Indians in collaboration with all Montana and Wyoming disease surveillance partners, public health authorities and hospitals, in order for Tribes to be prepared and able to respond to all public health hazards (All Hazards).  The Montana Wyoming Tribal All Hazards Advisory Committee will be comprised of the 10 Montana and Wyoming Tribal Health Directors, Health gate keepers for the 8 Reservation Communities in Montana and Wyoming (the Wyoming Wind River reservations has two Tribal Health Directors); All Montana
  • 32. 31 and Wyoming Tribal/IHS Service Unit/Hospital Chief Executive Officers (CEOs) and Public Health Nurses; Representatives from the Montana Department of Health and Human Services MT-DHHS; Representatives from the Wyoming Department of Health WY-DoH; Billings Area Indian Health Service – Chief Medical Officer, Environmental Health Specialist and Indian Health Service Sanitarians, Chief Immunization Nurse Contractor; and MTWYTLC/RMTEC Staff including, RMTEC Acting Director/Senior Epidemiologist; RMTEC Infectious Disease/Emergency Preparedness Epidemiologists, RMTEC Statistician (for data analysis mainly); RMTEC Data Manager and RMTEC Research Assistants.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes. Year 4/Year 5  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track notifiable diseases and other disease outbreaks among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and curtail notifiable disease and other disease outbreaks among Montana and Wyoming Tribes.
  • 33. 32 Chronic Disease Project: Goal: To improve public health practices among communities through sustainable chronic disease prevention and establish a chronic disease surveillance system (database) that will help with tracking chronic diseases among Montana and Wyoming Tribes. Surveillance/Report Dissemination Project Activities: Objectives for Montana and Wyoming Tribes opting in for the project from 2012 - 2016:  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a chronic disease surveillance system among Montana and Wyoming Tribes.  Partner with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and reduce chronic diseases among Montana and Wyoming Tribes by seeking intervention funds. Activities/Results and Benefits: Year1  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes. Year2  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to develop a chronic disease surveillance system among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes.
  • 34. 33 Year 3 to Year 5  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to track chronic diseases among Montana and Wyoming Tribes.  Partnerships with Billings Area Indian Health Service, Montana Department of Health and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and other Health agencies to intervene and reduce chronic diseases among Montana and Wyoming Tribes by seeking intervention funds. Maternal and Child Health Sudden Infant Death: RMTEC has a contract with Native American Management Services (NAMS), Inc to implement “Healthy Native Babies”, a Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) project, among American Indians (AI) in Montana and Wyoming. “Healthy Native Babies” is a risk reduction SIDS prevention message aimed at high risk populations among AI in Montana and Wyoming. Supplemental Funds from Native American Management Services -NAMS Contract Surveillance/Intervention Project Activities: Implement the Native American Management Services, Inc Contract from 2009-2012 or as long as it lasts. Activities/Results and Benefits (Based on Contract): Year 1 to Year 5  Participate in Healthy Native Babies Workgroup meetings.  Disseminate Healthy Native Babies Risk Reduction Materials to constituents.  Implement Train the Trainer trainings among Montana and Wyoming Tribes and other Tribes in U.S (i.e Parenting Skills Training). Supplemental Funds from NAMS/NICHD 2009-2012
  • 35. 34 Pregnancy Risk Assessment: Goal: To implement an American Indian Pregnancy Risk Assessment Monitoring System (PRAMS) Survey (a Maternal Health Behaviors Survey). PRAMS is a Replication Pilot study with Reservations opting in. This study explores innovative techniques to ensure adequate American Indian response rates and data quality. Surveillance/Intervention Project Activities: Objectives for Montana and Wyoming Tribes “opting in” for the project from 2012 - 2016:  Collaborate with the Wyoming Department of Health –WY OH to over-sample American Indians effectively during the implementation of Wyoming PRAMS.  Collaborate with the Montana Department of Health and Human Services MT DHHS (when funded) to over-sample American Indians effectively during the implementation of Montana PRAMS.  Participate in the data analysis, reporting and dissemination of results from implemented PRAMS by the state of Montana (when funded) and Wyoming, and report results to Montana and Wyoming Tribes  Offer technical support to Tribes in Montana and Wyoming to implement and seek funding for interventions for their Maternal and Child Health population. Activities/Results and Benefits: Year 1/Year 2  Collaborative partnerships built with the Wyoming Department of Health –WY DoH, and an over-sampling of American Indians effectively during the implementation of Wyoming PRAMS.  Collaborative partnerships with the Montana Department of Health and Human Services MT DHHS, and an over-sampling of American Indians effectively during the implementation of Montana PRAMS. Year 3 to Year 5  Participation in the data analysis, reporting and dissemination of results from implemented PRAMS by the state of Montana and Wyoming, with reports and information disseminated to Montana and Wyoming Tribes
  • 36. 35 Obesity Prevention Child Health Measures (CHM): Goal: To help inform participating Tribes on health measures associated with the risks for childhood obesity, diabetes, and heart disease among participating Tribes’ children. Screening children in kindergarten through high school with the following measurements: BMI, Blood Pressure, Acanthosis presence, and Asthma diagnosis. Trained Tribal field workers who volunteer to help with the project (measurements) from participating Reservations perform these tasks. Surveillance/Intervention Project Activities: There are ten (10) STEPS to follow annually and Child Health Measures is divided into eight (8) STATIONS. Step 1: School Participation and Student Information Step 2: Community Information Step 3: Parent Consent Process and Child Assent Process Step 4: Child Health Measures  Station 1: Child Assent/Parent Consent and Measurement Sheet…  Station 2: Blood Pressure and Pulse Station (Pulse is optional)  Station 3: Weigh Measurement  Station 4: Height Measurement  Station 5: Waist Circumference Measurement  Station 6: Hip Circumference Measurement  Station 7: Acanthosis Measurements  Station 8: Question Answering Station Step 5: Referral Process Step 6: Incident Report/Data storage, transfer, analysis and report dissemination process Step 7: Report Cards Step 8: Data Storage, Transfer, Analysis and Report Dissemination Process Step 10: Data Requests Step 9: Attend the Annual Child Health Measures Training Supplemental Funds from IHS/CYP 2010-2012
  • 37. 36 Activities/Results and Benefits: Year1 to Year 5  Annual Measures: The ten (10) STEPS above will be implemented by local Child Health Measures teams on each participating Reservation annually.  Annual Follow–ups: Each year, parents will be notified of their child’s measurement status via a “Child Health Measurement Report Card”. If the measurement screening identifies a child with potential abnormal measures, their parent will also be notified via a letter to encourage the parent and child to follow up with a local health care provider.  Annual Intervention Funding: The information collected is used to inform the Tribal Leaders on Child Health Measures trends in their community. This helps leaders identify ways to prevent childhood obesity and its’ complications among children living in Montana and Wyoming Reservations. The CHM measurement cumulative data will also be used to apply for intervention funds. Montana Wyoming Native Child & Youth Project (CYP): Goal: To promote the body, mind and spiritual well-being of Montana and Wyoming American Indian School age children and youth, ages 5 to 19 years by refurbishing safe and accessible play places for children in the reservation communities, while encouraging healthy traditional foods and culturally appropriate emotional well-being and social skills development. Supplemental Funds from Indian Health Service (IHS) Child and Youth Project (CYP) Surveillance/Intervention Project Activities:  Mobilize the community to assist in refurbishing already existing Reservation recreational facilities, making them child friendly and safe for play.  Assist with salary funds, trainings and certification of nominated Tribal Staff Recreation Guides/Aids.  Assist with accessing and promoting age-appropriate healthy traditional foods.
  • 38. 37 Activities/Results and Benefits: Year 1 (FY 10) Project Type Tribes Tribe 1 Play Place Refurbishment/Recreation Guide Wind River - Northern Arapaho Tribe 2 Play Place Refurbishment/Recreation Guide Wind River – Eastern Shoshone Tribal Consultants Tribal Physical Education Specialist/Nutritionist/Traditional Games Consultants Project Evaluator Year 2 (FY 11) Project Type Tribes Tribe 3 Play Place Refurbishment/Recreation Guide Northern Cheyenne Tribe 4 Play Place Refurbishment/Recreation Guide Blackfeet Tribe 1 Recreation Guide Wind River - Northern Arapaho Tribe 2 Recreation Guide Wind River – Eastern Shoshone Tribal Consultants Tribal Physical Education Specialist/Nutritionist/Traditional Games Year 3 (FY 12) Project Type Tribes Tribe 5 Play Place Refurbishment/Recreation Guide Fort Peck Tribe 1 Recreation Guide Wind River - Northern Arapaho Tribe 2 Recreation Guide Wind River – Eastern Shoshone Tribe 3 Recreation Guide Northern Cheyenne Tribe 4 Recreation Guide Blackfeet Consultants Project Evaluator Tribal Consultants Tribal Physical Education Specialist/Nutritionist/Traditional Games Year4/Year5 **Supplemental Funding Ending June 2013: due to lack of resources from funding agency
  • 39. 38 Child Health Measures/Montana Wyoming Native Child & Youth Project Logic Model
  • 40. 39 Cancer Outreach Cancer Outreach Project: Goal: The Cancer Outreach Project will increase cancer outreach to American Indians by educating, encouraging early cancer screening/diagnosis, and offering survivorship coaching for Montana and Wyoming American Indians in collaboration with Montana/Wyoming Cancer Stakeholders. Surveillance/Intervention Project Activities:  Education: o Distributing education materials o Train the Trainer Activities o Organization of Cancer Summit with other Montana/Wyoming Cancer Stakeholders  Outreach: o Offering links to resources o Serving as a resource for access to quality cancer continuum of care o Organization of Cancer Summit with other Montana/Wyoming Cancer Stakeholders Project Activities: Year 1 to Year 2  Distribution of education materials  Serving as a resource for access to quality cancer continuum of care  Offering links to resources Year 3 to Year 5  Train the Trainer Activities  Organization of Cancer Summit with other Montana/Wyoming Cancer Stakeholders  Distribution of education materials  Serving as a resource for access to quality cancer continuum of care  Offering link to resources Susan G. Komen for the Cure: Goal: The Breast Cancer Outreach Project will increase the survival rate of American Indians with breast cancer through education, encouraging early screening, diagnosis, and offering survivorship coaching; distributing education materials and serving as a resource for access to quality cancer continuum of care for Montana AIs in collaboration with Montana Cancer Stakeholders. **Supplemental Funding Ended Sept 30, 2012
  • 42. 41 Tobacco Use Prevention: Goal: To engage Montana and Wyoming Tribal Youth to become agents of Social Change for Culturally-Relevant Tobacco Control. Surveillance/Intervention Project Activities:  Partner with Montana and Wyoming Tobacco Prevention Stakeholders to track Tobacco use on Montana and Wyoming Reservations using secondary data (i.e Youth Risk Behavioral Surveillance System -YRBS and Behavioral Risk Factor Surveillance System -BRFSS)  Partner with Montana and Wyoming Tobacco Prevention Stakeholders to intervene and reduce Tobacco use among Montana and Wyoming Tribes by seeking intervention funds for social marketing. Activities/Results and Benefits: Year 1/Year2  Partnerships with Montana and Wyoming Tobacco Prevention Stakeholders to track Tobacco use on Montana and Wyoming Reservations using secondary data (i.e Youth Risk Behavioral Surveillance System -YRBS and Behavioral Risk Factor Surveillance System -BRFSS)  Develop and Disseminate YRBS Tobacco Use Fact Sheets  Develop and Disseminate BRFSS Tobacco Use Fact Sheets Year 3 to Year 5  Partnerships with Montana and Wyoming Tobacco Prevention Stakeholders to intervene and reduce Tobacco use among Montana and Wyoming Tribes by seeking intervention funds for social marketing.  Engaged youth in the development of Tobacco Use Prevention Social Marketing Champaign Materials  Engaged youth in the dissemination of Tobacco Use Prevention Social Marketing Champaign Materials BASED ON FUNDING AND ON AN OPT-IN/OPT-OUT BASIS
  • 43. 42 Injury & Violence Prevention Goal: To collect, analyze and report intentional and un-intentional injury data in order for Tribal communities to understand the injury status of their community; and To develop a comprehensive strategic plan in collaboration with all Montana and Wyoming injury stakeholders to be implemented in the Billings Indian Health Service Area, in order to reduce the adverse effect of injury among Montana and Wyoming Reservations. Surveillance/Strategic Planning/Intervention Project Activities:  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to track injury and violence on Montana and Wyoming Reservations.  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to develop a comprehensive Strategic Plan for injury and violence prevention on Montana and Wyoming Reservations.  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to intervene and reduce injury and violence among Montana and Wyoming Tribes by seeking intervention funds. Activities/Results and Benefits: Year 1 to Year 3  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to track injury and violence on Montana and Wyoming Reservations.  Collaborate with Tribal Health Departments on intentional/un-intentional injury and violence prevention data. o Identification of “Injury Prevention Best Practice/Promising Projects” among American Indians in Montana and Wyoming and in US.  Collaborate with Billings Area Indian Health Service to track intentional/un- intentional injury and violence data. o Identification of “Injury Prevention Best Practice/Promising Projects” among American Indians in Montana and Wyoming and in US. o Manuscript Development: “Intentional and Un-intentional Injury among American Indians in Montana and Wyoming”.  Collaborate with West Virginia University to study the risk indicators of
  • 44. 43 suicide among Montana and Wyoming Youth o Manuscript Development: “A Study on Suicide Risk Indicators among American Indian Montana Youth”. o Manuscript Development: “Life expectancy deficits in Montana American Indians”.  Implement Promising Practices including Suicide data tracking project: A suicide data improvement project (AS FUNDING ALLOWS) o RMTEC collaborates with Tribal Health Departments to implement suicide data tracking project as a promising practice. The purpose of the project is: • To understand suicide and suicide attempts on the Reservations; • To demonstrate the process of increasing the scope of data collection on suicidal behaviors of eligible American Indian (AI) residents, on Reservations of interest; • To generate more complete data on suicidal attempts, in order to improve prevention, treatment and decrease attempts and fatalities of suicides on the Reservations. Both conventional and non-conventional methods were allowed in obtaining more complete data on suicide attempts and completions. Implementation of the project involved collaboration between IHS mental health professionals and Tribal mental health outreach workers.  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to develop a comprehensive Strategic Plan for injury and violence prevention on Montana and Wyoming Reservations  Collaborate with the Montana Wyoming Tribal Leader Council’s Strategic Prevention Framework Tribal Incentive Grant (SPF-TIG), also known as the Rocky Mountain Tribal Wellness Initiative (RMTWI).  Collaborate with the Montana Wyoming Tribal Leader Council’s Planting Seeds of Hope (PSOH), a youth suicide prevention project.  Collaborate with Billings Area Indian Health Service’s Injury Prevention program to strategize on a comprehensive Montana and Wyoming Tribal injury and violence prevention Strategic Plan . Year 4/Year 5  Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to intervene and reduce injury and violence among Montana and Wyoming Tribes by seeking intervention funds.  Collaborate with the Centers for Disease Control and Prevention (CDC) project –”Indian Health Service (IHS) collaboration for injury-related issues with the Tribal Epidemiology Centers”.
  • 45. 44 Environmental Health Initiative Goal: The goal of the initiative is to provide a systematic assessment of environmental risks; a framework for long-term surveillance of environmental health indicators; develop environmental health policies and remediations; and build Tribal environmental health capacity. Surveillance/Strategic Planning/Intervention Project Activities: Phases of Objectives: Phase 1: Assessment: The systematic assessment of environmental risk indicators and associated health outcomes at suspected high-risk areas identified by Tribes; conducting community impact assessment/surveillance studies and strategizing on solutions based on the findings of the assessments and surveillance. Phase 2: Surveillance: Establishment of a framework for long-term surveillance of environmental health indicators in order to establish baseline characteristics and “direct” policy initiatives. Phase 3: Remediation Measures/Emergency Preparedness Policy Initiatives: Follow-up and implementation of recommendations for remediation measures, policy initiatives, and legislative efforts based on the strategic plans in phase 1 and 2. Activities/Results and Benefits: Year1/Year2 Phase 1: Assessment: Systematic assessment of environmental risk indicators and associated health outcomes at suspected high-risk areas identified by Tribes; conducting community impact assessment/surveillance studies and strategizing on solutions based on the findings of the assessments and surveillance. These are immediate/urgent needs for assessments and are the initial steps in the MTWYTLC/RMTEC Environmental Health Initiative. There is high risk for adverse health outcomes identified by RMTEC in collaboration with the Tribes, will be reported back to the Tribes at local “Community Meetings” and a full report written and submitted to the Tribal Leaders. Remedies will be sought by the Tribes in collaboration with MTWYTLC/RMTEC.
  • 46. 45 Phase 1 Activities are Comprise of Seven (7) Main Steps: 1. MTWYTLC/RMTEC site visit to the community and the high risk area identified by the Reservation Community as environmental high risk area 2. Community Readiness Tests 3. Develop Community Impact Assessment Tools and Surveillance Studies Protocol 4. Resolutions, Letters of Support and or Memorandum of Agreement/Understanding (MOA/MOU) 5. Institution Review Board (IRB) Approval 6. Implement the Community Impact Assessment on participating Reservation sites 7. Strategizing on solutions based on findings of the assessments and surveillance; and recommend remediation measures to be shared/disseminated to participating Reservation Communities Year 3-Year 5 Phase 2: Surveillance: Establishment of a framework for long-term surveillance of environmental health indicators in order to establish baseline characteristics and “direct” policy initiatives. The surveillance will be based on Tribe-specific strategic plans, drafted in collaboration with Tribes. This phase will also include training and capacity building for emergency preparedness, based on needs. Phase 2 Activities are Comprise of Three (3) Main Steps: 1. Assessment of existing Surveillance resources available to the Tribal Environmental Departments/Programs 2. Tribal Environmental Departments/Programs “Readiness Tests” 3. Systematic data collection, analysis, easy to understand reporting (to Tribal Communities and Leaders), dissemination of report and strategic planning Phase 3: Remediation Measures/Emergency Preparedness Policy Initiatives: Follow-up and implementation of recommendations for remediation measures, policy initiatives, and legislative efforts based on the strategic plans in phase 1 and 2. Exploration of funding opportunities to sustain surveillance and follow-up on recommended activities depending on the outcomes of Phases 1 and 2. Phase 3 Activities are Comprise of Three (3) Main Steps: 1. Assessment of strategic plans in phase 1 and 2 2. Tribal Community, Tribal Leader and Tribal Environmental Departments/Programs “Readiness Tests” 3. Systematic development of remediation measures, policy initiatives, and legislative efforts based on the strategic plans in phase 1 and 2.
  • 47. 46 Developing Community Health Profiles Behavioral Health Data Improvement Project: Goal: To assess the needs of the Tribal Chemical Dependency program staff in collecting, entering and extracting data on the services provided using the Indian Health Service -IHS BH software and the AccuCare system by performing a needs assessment. Surveillance/Report Dissemination Project Activities: Activities/Results and Benefits Year 1 to Year 5:  Inform, educate, and empower chemical dependency program staff about importance of data entry in order to identify behavioral health issues; and mobilize community partnerships to reduce behavioral health problems.  Data training will be offered based on funding and recommendations from the needs assessment in order for data to be collected, reporting and used by the Tribal Government and Tribal Health Department to improve the quality of client services.  Research for insights and innovative solutions to Behavioral Health problems Data Improvement Projects BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS
  • 48. 47 Chemical Dependency Resource Assessments: Goal: To collect, analyze and report data from Chemical Dependency Programs/Centers on the Reservations and urban areas in Montana and Wyoming. This project provides the Tribes a standardized information system as a basis for comparison for longitudinal evaluation of resources available to clients over the years in Chemical Dependency Centers serving Montana and Wyoming Tribes. Surveillance/Report Dissemination Project Activities: Activities/Results and Benefits Year 1 to Year 5:  Inform, educate, and empower chemical dependence program staff on the resources available and the resources needed to implement a successful Chemical Dependency program  Mobilize community partnerships to research new insights and innovative solutions to chemical dependency program resource and sustainability problems Child Maltreatment: Goal: To work with the Bureau of Indian Affairs -BIA to identify specific risk factors associated with child maltreatment among American Indian (AI) children in MT and WY. Surveillance/Report Dissemination Project Activities:  Promote the use of a more specific analyzable database/surveillance system which includes risk factors for child maltreatment in collaboration with BIA.  Develop and Disseminates reports on Child Maltreatment with recommended sustainable solutions for Montana and Wyoming Tribes Year 1/Year 2  Develop a Memorandum of Understanding (MOU) for data sharing and analysis of the data generated by the developed BIA Child Maltreatment database Year 3 to Year 5  Generate periodic reports from the database on Child Maltreatment with recommended sustainable solutions for Montana and Wyoming Tribes  Disseminate the Child Maltreatment periodic reports to Participating Montana and Wyoming Tribes via BIA
  • 49. 48 Surveillance Goal: To implement BRFSS, increasing response rates for American Indian Population in Montana and Wyoming, following the Center for Disease Control and Prevention - CDC BRFSS survey protocol with data comparable to state and national BRFSS data. Montana Wyoming Tribal BRFSS Project Advisory Committee: The Montana Wyoming Tribal BRFSS Project Advisory Committee will comprise of the 10 Montana and Wyoming Tribal Health Directors, Health gate keepers for the 8 Reservation Communities in Montana and Wyoming; The Montana Department of Health and Human Services MT-DHHS BRFSS Coordinator and the Wyoming Department of Health WY-DoH BRFSS Coordinator; the University of Nebraska (Institutional contractors implementing the surveys on behalf of RMTEC) designee; and RMTEC Staff. Surveillance/Report Dissemination Project Activities: Montana Wyoming Tribal BRFSS Project Advisory Committee will discuss: 1. Tribal BRFSS awareness among RMTEC Tribal Advisory Committee including the Tribal Health Directors, Tribal Leaders and Montana and Wyoming Tribes 2. Tribal BRFSS Community Readiness test for Montana and Wyoming Reservation Communities 3. Tribal BRFSS implementation Methodology and Protocol for participating Montana and Wyoming Tribes 4. Tribal BRFSS Feasibility Study on participating Montana and Wyoming Reservation Communities 5. Tribal BRFSS Long Term Oversampling Methodology among Montana and Wyoming state BRFSS samples Behavioral Health Risk Factor Surveillance System (BRFSS) Project: See Above for Infectious Disease/Chronic Disease Surveillance
  • 50. 49 Activities/Results and Benefits Year 1 to Year 5: RMTEC 2011-2016 BRFSS Project Five Year Schedule for the BRFSS Project Implementation Details Year 1 Year 2 Year 3 Year 4 Year 5 Meet with RMTEC Tribal Advisory Committee including the Tribal Health Directors and Tribal Leaders X X Review of the BRFSS project with Tribal support in form of Letters X X Develop a protocol for conducting the BRFSS approved by the Montana Wyoming Tribal BRFSS Project Advisory Committee and participating Reservation Communities X X Develop a sampling method and recruitment strategy approved by the Montana Wyoming Tribal BRFSS Project Advisory Committee and participating Reservation Communities X X Obtain Tribal IRB and University of Nebraska IRB Approval X Develop a training protocol for interviewers for the BRFSS with the University of Nebraska X Develop a database to enter BRFSS data in partnership with the University of Nebraska X Implement the BRFSS Survey; Data Collection; in partnership with the University of Nebraska X Analyze data; Develop Reports; Develop a report dissemination plan that includes a project overview, dissemination goals, targeted audiences and key messages X X Evaluated the Project/ Lessons Learned –BRFSS in Indian Country X
  • 51. 50 Emerging Projects Other Capacity Building Project Activities: Technical Support (Ongoing)  Offer Technical support for all RMTEC and other Tribe specific projects upon request and as needed to Montana and Wyoming Tribes. Annual Conference  Participate in the planning and implementation of the Annual Montana Wyoming Tribal Leaders Council’s Health Conference. Annual Capacity Building Training  Participate in the planning and implementation of Annual Capacity building Training as needed or upon request by Montana or Wyoming Tribe.  Montana Wyoming Native Youth Development Project  Project Specific Trainings as Needed  Public Health Navigators Technical Support/Trainings/Annual Conference: Emerging Projects: These will be based on current Montana and Wyoming Tribal Community Health Profiles and emerging health needs and priorities (for example - Men’s Wellness - Pending Funding) BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS
  • 52. 51 Montana Wyoming Native Youth Development Project: Goal: To encourage Individual Intern Capacity Building Capacity Building Project Activities:  An opportunity to work on prevention projects of public health concern on Reservations  An opportunity to earn credit units and/or do a practicum/earn a certificate This is a paid Internship job opportunity (Stipends will depend on funding and prior qualifications of the intern) Activities/Results and Benefits Year 1 to Year 5: One youth will be chosen from a Montana or Wyoming Tribe each year with the Tribes rotating over the next 10 years. Summary: There are two components of the Montana Wyoming Youth Development Project: 1) Youth Data/Health Skills Development and 2) Summer Youth Development Camp Youth Data/Health Skills Development The Youth Data Skills Development Project is a youth development focused project that entails mentoring at least one youth with an associate/bachelors degree from a Montana or Wyoming Tribe annually as an Epidemiology/Health Education/Peer Education Intern at the Rocky Mountain Tribal Epidemiology Center (RMTEC). The youth is employed as a Research Assistant and assists with RMTEC projects. Summer Youth Development Camp The purpose of the “Summer Youth Development Camp” for Middle and High School age group is to:  Empower youth to handle life situations;  Increase knowledge of public health epidemiology fundamentals;  Increase public health and epidemiology literacy;  Increase ability to create positive norms;  Propose a plan for advancing the health of youth on their Reservations;  Decrease dropout rates and increase interest in the Public Health and Sciences. Each youth is awarded a certificate of participation at the end of the Summer Camp. Summer Camp implementation is dependent on funding.
  • 53. 52 Public Health Navigators: Public Health Navigators will provide culturally appropriate and community relationship- appropriate Public Health information; social support; and Community Public Health advocacy to their Reservation Communities and will be directly under the supervision of the Tribal Health Directors as a Tribal contractor working on RMTEC projects with the Tribal Health Departments. RMTEC will have contracts with all 10 Tribal Health Departments in Montana and Wyoming for the salary of a Public Health Navigator in order to be able to implement projects successfully at the Reservation Community Level. Each Public Health Navigator’s immediate supervisor will be the Tribal Health Director of the Reservation Tribal Health Department. A Public Health Navigator job will include, but is not limited to, implementing RMTEC projects among participating Tribal Health departments as needed. Each Tribal Health Department will determine what duties/trainings their Public Health Navigator will have depending on Tribal Health Department needs and the RMTEC projects opted in by Tribal Health Department. RMTEC will organize an annual Training for the Public Health Navigators in the following topic areas based on Tribal Health Department Needs:  Community Assessments/Survey Implementation  Maternal and Child Health Navigation/Train the Trainer Parenting Classes  Health Codes Implementation  Outbreak Investigation – Organized by RMTEC for action by Tribal Health Department  Public Health Preparedness  Other Topics as needed BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS NOTE A Public Health Navigator is NOT an IHS Sanitarian:  Public Health Navigators do not have environmental Health Degrees or Environmental Health Inspection or investigation duties or educational background (i.e Vector control, food inspection, water/sewage system inspection)  Public Health Navigators are Trusted Community Members trained by RMTEC to carry out RMTEC projects on the Reservations under direct supervision of Tribal Health Directors
  • 54. 53 Rocky Mountain Tribal Epidemiology Center Evaluation Measures of Progress Healthy People 2020 10 Essential Public Health Services Indian Health Service RMTEC Project Goals RMTEC Project Project Measure of Progress Social Determinants of Health: Create social and physical environments that promote good health for all Mobilize community partnerships to identify and solve health problems Develop policies and plans that support individual and community health efforts Ensure the coordination of services and program activities with other similar programs and establish a broad- based council to advise and support the program. Support responses to public health emergences in collaboration with the IHS Epidemiology Program, local, Strengthen Individual Tribes’ Public Health Infrastructure and Capacity Capacity Building Projects: 1. Strengthening Public Health Capacity 2. Emergency Preparedness Other:  Annual Trainings o Montana Wyoming Native Youth Development Project o Project Specific Trainings as Needed Tribal Public Health Capacity:  Measure of Public Health Performance Improvement of Montana and Wyoming Tribes * (Measure: NPHPSP)  Measure of Emergency Preparedness Performance Improvement (Measure: NPHPSP) Workforce Development:  Number of Tribal Public Health Workforce Improved
  • 55. 54 Assure a competent public and personal health care workforce tribal, state, and other Federal health authorities. o Public Health Navigators  Annual Conferences  Technical Support General Health Status: Attain high quality, longer lives free of preventable disease, disability, injury, and premature death Monitor health status to identify community health problems Diagnose and investigate health problems and health hazards in the community Enforce laws and regulations that protect health and ensure safety Assist in developing disease surveillance systems and identifying their highest priority health status objectives, based on epidemiologic data. Collect data relating to, and monitor progress made toward meeting, each of the health status objectives Assist and facilitate reporting of nationally notifiable disease conditions to public health authorities in the region. Improve Surveillance Data for Health Conditions and Diseases Infections/ Chronic Disease & Public Health Ethics Projects: 3. Ethics  Tribal Health Codes  Institutional Review Board –IRB  Infectious Disease Surveillance  Chronic Disease Surveillance Ethics:  Measure of Number of Tribal Policy Development Encouraged  Measure of support for IRB and number of meetings participated in Infectious/Chronic Disease:  Development of an Infectious Disease and Chronic Disease Surveillance System Protocol in collaboration with other Montana and Wyoming Agencies Health Related Quality of Life and Well- Being: Promote quality of life, Research for new insights and innovative solutions to health problems Develop and implement epidemiologic studies that utilize the principles of Implement Pilot Projects and Specific Studies to Address Tribally Healthy Lifestyles Projects: 4. Maternal and Child Health a. Pregnancy Risk Assessment Maternal and Child Health:  Number of Studies on Maternal and Child Health Needs Implemented/Reported
  • 56. 55 healthy development, and healthy behaviors across all life stages community engagement and that have practical application in improving the health status of constituent communities. Identified Health Priorities and Support Tribal Community Based Participatory Epidemiological Research b. Sudden Unexpected Infant Death 5. Obesity Prevention a. Child Health Measures b. Child and Youth Health Project  Number of Trainings on Capacity Building for Parenting Skills Obesity Prevention:  Measure of improved Health Measure, Reducing Obesity **(Measure: Child Health Measures)  Number and Type of Interventions Implemented Emerging Projects: Developing New and Innovative Projects for Tribe Self Sustaining Prevention/Intervention Projects based on Tribal Community Health Profiles in Collaboration with Montana and Wyoming Tribes Disparities and Inequity: Achieve health equality, eliminate disparities, and improve the health of all groups Inform, educate, and empower people about health issues Link people to needed personal health services and assure the provision of health care when otherwise unavailable Develop and implement disease control and prevention programs in cooperation with other public health entities. Make recommendations for targeting of public health services needed by constituents. Provide Data and Technical Assistance to Support Health Promotion, Disease Prevention (HP/DP) Objectives and Behavioral Health Strategies Environmental Health & Disease Prevention Projects: 6. Cancer Outreach and Prevention a. Susan Komen b. Tobacco Use Prevention 7. Injury and Violence Prevention Cancer Outreach:  Number of Target Population Reached  Measure of collaboration with other Cancer Stakeholder Agencies/Organizations Injury/Violence Prevention:  Development of an Injury and Violence Prevention Strategic Plan in collaboration with other Montana and Wyoming
  • 57. 56 8. Environmental Health Initiative Agencies (Measure: Strategic Plan Developed)  Development of an Injury/Violence Prevention Surveillance System Protocol in collaboration with other Montana and Wyoming Agencies  Measure of collaboration with other Injury and violence Stakeholder Agencies/Organizations Environmental Health Initiative:  Measure of progress based on the three phases of the initiative: -1) Needs Assessment -2) Surveillance -3) Remediation Emerging Projects: -Developing New Innovative and Tribe Self Sustaining -Prevention/Intervention Projects based on Tribal Community Health Profiles in Collaboration with Montana and Wyoming Tribes Disparities and Inequity: Achieve health equality, eliminate Evaluate effectiveness, accessibility and quality of personal and Participate in the development of systems for sharing, improving, and disseminating Develop Tribal/Urban Indian Community Health Profiles Community Health Profiles & Emerging Projects: 9. Data Improvement Projects for Community Health Profile Development/BRFSS Community Health Profiles:  Developing and Disseminating Annual Community Health
  • 58. 57 disparities, and improve the health of all groups population- based health services aggregate health data at a national level for purposes of advocacy for AI/AN communities, Collaborate with national HHS programs in the development of standardized surveillance and data monitoring methods and data sets. and Tribe Specific Data Collection Initiatives a. Behavioral Risk Factor Surveillances System – BRFSS b. Behavioral Health Data Improvement Project c. Chemical Dependence Resource d. Child Maltreatment e. Infectious Disease Surveillance f. Chronic Disease Surveillance 10. Emerging Project based on Community Health Profiles Fact Sheets  Developing and Disseminating 5 year Community Healthy Profiles (every 5 years)  Implementing Data Improvement Projects with Montana and Wyoming Tribes, Building their Data Capacity  Developing Surveillance Systems for Behavioral Health, infectious Disease and Chronic Disease (Measure: Number of Fact Sheets and 5 Year Community Health Profiles Developed and Disseminated; and Number of Surveillance Systems Developed/Implemented) Emerging Projects:  Developing New Innovative and Tribe Self Sustaining Prevention/Intervention Projects based on Tribal Community Health Profiles in Collaboration with Montana and Wyoming Tribes * (Measure: National Public Health Performance Standards Program Assessment -NPHPSP) ** (Measure: Child Health Measures Project Data)
  • 59. 58 Performance Measures Process Evaluation RMTEC Semi-Annual Report RMTEC Annual Report Short term (annual) / Long term (completion of project) Outcome Measures RMTEC Project Summary Report Impact National Public Health Performance Standards Program’s Local Public Health Governance Performance Assessment Instrument Growth/Value Performance Measures 1. Number of Collaborations, Stakeholders and Partners (Including Universities, Public Health Agencies and other Public Health Institutions) 2. Number of Professional Staff/Administrative Staff 3. Number of Scientific Publications Written and or Presented 4. RMTEC Website 5. RMTEC Web-based Data Warehouse (Password Protected Individual Tribe Data Warehouse) 6. Number of Grants Written 7. Number of Funded Grants (Sustainability) 8. RMTEC Combined Budget 9. Number of Successfully Completed Projects during the Funding Period 10. RMTEC Stakeholder Value Assessment
  • 60. 59