Improving the lives of 10 million older adults by 2020

Strategies to Engage Tribal

Elders in Evidence-Based

Programs

May 23, 2017

Presenters: Cynthia LaCounte

Melody Coleman

Becky Bendixen

Fostering Tribal RelationsCynthia LaCounte, Director, Office for American Indians,

Alaskan Natives and Native Hawaiians

May 23, 2017

Let’s start by changing how you think a bit:

Let’s talk about any context of building a relationship.

It begins with courting and building a friendship… then progresses to hanging out together or dating… then sometimes marriage or a deepening, lasting friendship… and finally growing old together with the satisfaction of a lifetime of work, accomplishments and happy thoughts.

That’s what I’m going to discuss here today. It’s way past time that States and other entities work with Tribes build a lasting lucrative relationship.

Overview

• Coordinating in Indian Country? How do I begin?

• How should the initial contact be made?

• Am I clear about what I can offer?

• Am I willing to listen to their ideas?

• Am I willing to consider that my methods might need to be changed to work with this special population?

• Am I willing to stay for the long haul and make a difference?

• Am I willing to listen and work hard more than talking, while still offering my expertise?

Overview, cont.

• If not. Don’t start.

Coordinating in Indian Country? Where do I begin?

• The tribal population for our elders 60+ are included in the State population.

• Familiarize yourself with the targeting factors in the OAA.

• Title VI participation or casinos do not replace a state’s obligation to provide services to tribal members both on reservations and in urban areas.

• Work with your policy makers to assure that your state is meeting their obligation to serve American Indians.

Coordinating in Indian Country? How do I begin?

• Become familiar with the Tribes in your area…read…attend events…and learn about their issues.

• Introduce yourself to the Tribal Senior Services Director to learn about the senior program. Invite that person to your office, and request to see their facility and to meet some of their seniors.

• Maintain that relationship. Include the tribes in training events, in Board meetings, ask them to do presentations about their program.

• Find out what is needed and how you can help.

How should the initial contact be made?

• Normally the first point of contact is through the highest elected official’s office (Tribal Chairman, Tribal President, Governor, Chief…).

• Request to come onto tribal land and bring “x” services to tribal members.

• Offer to send written information.

• Offer a face-to-face meeting.

• Ask who to work with further.

• Promise to maintain frequent contact with the leader’s office…AND DO IT!!!

How should the initial contact be made?

• Making your life easier!!!• Contacting Leadership is essential. Their knowledge and

blessing of your involvement is absolutely critical.• At the same time you may also want to contact the Aging

Programs Director to make the same introduction, provide the same information, alert them that you have notified tribal leadership and have/have not had a response. They can assist to elevate your request.

• Talk about your good idea that you think would work in Indian Country…and be willing to keep your mind open to find those ways to help change the program to be culturally relevant.

Coordination in Indian Country

• Follow-up

• Patience

• Follow-up

• Patience

• Follow-through

• Patience

• Now you’re bought in!!!!

Next steps:

• Am I clear about what I can offer?

• Am I willing to help them see if it meets their needs?

• Am I willing to listen to their ideas?

• Am I willing to help them find a way to make the service culturally appropriate, and actually “give it to them” to do that?

• Am I willing to try to understand why those cultural differences matter?

• Am I willing to continue offering guidance and expertise?

Promising Prevention Practices in Indian Country

• Tribes have identified concerns with “traditional” evidence-based programs and the evidence-based approach since it was first identified.

• The Oregon DHHS identified those concerns as:

– Model programs are not always adaptable in Indian Communities

– Developer training & fidelity testing are often alien processes, and not always available to Tribes.

– Loss of familiar and accepted practices/programs can be traumatic for the Tribe

Promising Prevention Practices in Indian Country, cont.

• Cost is prohibitive.

• Mandate is in conflict with principles of sovereignty, consultation and government-to-government relations.

Caroline Cruz (OR DHHS) Comparison between science & culture

Scientific Validated: Cultural Validated:__________

Transparency – evidence? Does practice have longevity in Replication? historical tribal history?

Standardization to be reliably Practices that are culturally

replicated. relevant, appropriate & designed in the Indian Way.

Replication – more than once Replication, development, & implementation the Indian way can be adapted per tribe and culturally replicated.

Caroline Cruz (OR DHHS) Comparison between science & culture

Scientific Validated: Cultural Validated:__________Research – accumulated Meet tribal principles -- Experts

knowledge that should be in AI/AN communities are the published. Elders. They provide the basis

for understanding what works &why in tribal communities. Theseteachings have been the basis forhealthy communities for manycenturies.

Outcomes to show that they can Outcomes in Indian Country – Do peoplehelp consumers to reach goals continue coming & bring others? Do you & outcomes related to risk factors. hear about it in the community? This is

` the program story. It can be documented,tracked & changed over time.

Caroline Cruz (OR DHHS) Comparison between science & culture

Scientific Validated: Cultural Validated:__________

Fidelity – scale used to verify Our elders within our

that intervention community, our teachers,

is implemented in a manner & the “3 elder women test”

consistent with the treatment is our fidelity scale. The

model – or the research that Elders are our gauge for

that produced the practice. how we are doing.

The scale has been shown to

be reliable & valid.

It could be a possible solution.

What if….we could design a Practice Based Evidence Program

to focus on the negative impacts of historical trauma…and

have tribal elders re-building & strengthening our

communities?

A Challenge & Ask from Indian Country

What if that program had as its “center pole” the elders?

What if branching out from that we had suicide prevention for our youth….alcohol/drug abuse prevention…early pregnancy intervention…language & cultural retention…mentoring young veterans as they return home…encourage/tutoring with school…members helping other members…and all guided by elders? Think creatively of all the branches that could come off that center pole…all to rebuild our people and our communities and all involving the elders to once again elevate their status as the experts in our communities?

Summary

For more information about ACL Title VI:

U.S. Department of Health and Human Services, Administration for Community Living,

Washington DC 20201

Phone: 202-795-7380 Email: cynthia.lacounte@acl.hhs.gov Web: www.acl.gov or

www.olderindians.aoa.gov

Wisdom Warriors:Living Wise, Living Strong

Melody ColemanBecky Bendixen

Northwest Regional Council

Why is this important?

What is CDSMP?

What is the program?

Indian lands were exchanged for treaty

promises, most of which have not been

upheld

A Disparate Culture

Years of poverty, poor medical care and loss have left tribes in a vulnerable position

• Cardiovascular Disease unheard of 40 years ago!

• Infant mortality +33%• Accidental death +38%• Diabetes death +54%• Cirrhosis death +126%• Alcohol death +178%• Diabetes unheard of in

1900!

Chronic Disease Rates

What is Chronic Disease Self-Management?

Developed by researchers at Stanford University Patient Education Research Center

Began in 1991Six weeks; 2½ hours per weekListening and activities including

problem solving and action planningGoal is to promote an “I CAN”

attitude in participants

What Does CDSMP Do?

What is the Content?

Camas (traditional food & medicine)

What is the content?

Stinging Nettle – Nutritious spring green

Self-Management Model

Traditional Model Self-Management Model

Tools Used for CDSMP

Hibulb Cultural Center (picture taken with permission)

Who Teaches?

Relaxing Nature Picture

Outcomes

•Numerous changes, all positive!•Appear to work for the long run…

Tribal people get their information from a

number of sources—usually word of mouth.

Keeping the Ball Rolling

Wisdom Warriors

Living Wise, Living Strong.

New Beginnings

Honoring Tribal Sovereignty

Health Checks

Self Care

Exercise

Spiritual/Cultural

Intergenerational Activities

Biannually or annually….

Questions?

For additional information contact:

Becky Bendixen orMelody ColemanNorthwest Regional Council600 Lakeway Drive, Suite 100Bellingham, WA 98225(360) 676-6749