Indian Health Services System Health & Mental Health Services for American Indian/Alaska Natives and Their Elders

1. Indian Health Services System Health & Mental Health Services for American Indian/Alaska Natives and Their Elders University of Oklahoma School of Social Work Master’s Advanced Curriculum Project Supported by

2. Social Work Relevance • Knowledge of Indian Health Services origins • Knowledge of the origins of Tribally administered services • Provide resource for service locators for across tribes and specific to Oklahoma • Knowledge of current service structure that is available to Native Elders in Oklahoma • Focus on Indian Health Service Oklahoma City Service Area that covers the entire state of Oklahoma plus portions of Kansas and Texas-specifically the Tahlequah Service Unit • Knowledge of eligibility issues

3. Origins of Indian Health Services • An agency within the Department of Health and Human Services • Responsibility for providing federal health services to American Indians and Alaska Natives. • The provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution • The IHS is the principal federal health care provider and health advocate for Indian people, • The IHS currently provides health services to approximately 1.5 million American Indians and Alaska Natives who belong to more than 562 federally recognized tribes in 35 states. • All IHS service users will be enrolled members of a Tribal Nation Taken directly from the IHS Website1

4. IHS Service Structure212 Regional Administrative UnitsAcross 35 Reservation States – 1,300,634 BILLINGS BEMIDJI ABERDEEN PORTLAND CALIFORNIA TENNESSEE PHOENIX ALBUQUERQUE TUCSON OKLAHOMA CITY NAVAJO

5. Indian Self-Determination and Education Assistance Act for Service Provision • Public Law 93-638 enacted in 19753 • Allows tribal nations to manage health and mental health services • Typically by assuming program responsibility from Indian Health Service IHS Service Areas are still intact Within service areas there is diversity in terms of whether the programs are tribally administered or still administered by the federal government through IHS Individual tribes can have a combination of tribal and federal administered services.

6. Serves Oklahoma, Kansas, Portions of Texas4 • 11 Service Units2 • Hospitals, Clinics, Health Stations offer health and mental health services3 • Many tribes have chosen to operate their own health services • Urban facilities are Federally Qualified Health Centers • Web address for all IHS Area Offices: • http://www.ihs.gov/FacilitiesServices/AreaOffices/AreaOffices_index.asp • Chickasaw Nation Health System • Choctaw Nation Health Systems Authority • Claremore Service Unit • Clinton Service Unit • Haskell Service Unit • Holton Service Unit • Lawton Service Unit • Northeastern Tribal Health System • Pawnee Service Unit • Tahlequah Service Unit • Wewoka Service Unit

7. Tahlequah Service Unit5 W.W. Hastings Indian Hospital A federally operated Indian Health Service hospital with 126,000 registered patients in 2003 Eufaula Indian Health Center - Eufaula, OKServices Include: General Health Women's Health, Dental Services, Laboratory, Radiology, Pharmacy and Public Health Services 3 Outpatient Clinics within Service Unit Boundary Wilma P. Mankiller Health Center - Stillwell, OKServices Include: Outpatient medical (including pediatrics and internal medicine), Dental, Optometry, Physical Therapy, Pharmacy, Laboratory, Radiology, Nutritional Services, Mammography, Public Health Nursing, WIC, Contract Care, Behavioral Health and translation services in Cherokee. The clinic offers treadmill testing and specialty clinics for diabetic and prenatal patients. Muskogee Health Center - Muskogee, OKServices Include: Outpatient medical; WIC, Laboratory, Pharmacy, Behavioral Health Redbird Smith Health Center - Sallisaw, OKServices Include: Outpatient medical, Dental, Optometry, Radiology, Behavioral health, Public Health Nursing, Pharmacy, Laboratory, Community Nutrition and Contract Care.

8. Recent Changes in Tahlequah Service Area W.W. Hastings Indian Hospital • Previously a federally operated Indian Health Service hospital with 126,000 registered patients in 20035 • As of October 1, 2008 the W.W. Hastings Indian Hospital is now under the administration of the Cherokee Nation as permitted by the Indian Self-Determination and Education Assistance Act6 “Principal Chief Chad Smith holds the ceremonial key to the W.W. Hastings Indian Hospital on Oct. 1 as the tribe takes over the hospital from the Indian Health Service. Also pictured are (from left to right) Melissa Gower, Cherokee Nation Health Services group leader, Muscogee (Creek) Nation Chief A.D. Ellis, acting IHS Area Director Hickory Starr and CN Tribal Councilor Meredith Frailey.” Jami Custer-Cherokee Phoenix http://www.cherokeephoenix.org/3064/Article.aspx

9. Recent Additions to Tahlequah Service Unit THREE RIVERS HEALTH CENTER, MUSKOGEE, OK7 • Purpose To improve care by reducing the burden on the other clinics. Prior to the building of this clinic, there was only a small clinic with female and child patients in Muskogee • Funds Cherokee Nation issued investment grade bonds to pay for the building. The cost of the new clinic was $23 million, with annual operational costs estimated at $17 million. • Patients Open to enrolled members of any tribe • Services A number of different health, mental health services are housed together Cultural Design8 • The building faces east toward the original Cherokee homelands where the Eastern Band of Cherokee still reside. • There are 7 pillars in the front lobby to signify that there are 7 Cherokee Clans • Four front columns were designed similarly to the columns of the early male and female educational seminaries in Tahlequah.

10. Extension of American Indian Health Care Improvement Kaiser Health Disparities Report: A Weekly Look At Race, Ethnicity And Health Politics & Policy | House Subcommittee Passes Bill That Would Extend American Indian Health Care Improvement Act [Nov 08, 2007]       The House Energy and Commerce Health Subcommittee on Wednesday voted to approve legislation (HR 1328) that would extend the Indian Health Care Improvement Act through fiscal year 2017, CQ Today reports. The bill is intended to improve health care for American Indians and Alaska Natives. The bill, approved by voice vote, includes an amendment that would clarify that American Indian Health programs must meet state requirements before they can receive state Medicaid funding. Republican members said they intend to propose other amendments when the bill is introduced to the full committee. Potential amendments could include proof-of-citizenship rules for American Indians and provisions addressing American Indians who reside in urban areas (Lubbes/Nylen, CQ Today, 11/7). The bill failed to win passage because funding could not be found (National Indian Health Board, September 28, 2008)

11. Social Work Implications Eligibility • Based on elder’s tribal enrollment • Must have evidence of tribal citizenship to use tribal services and HIS • If an elder belongs to one tribe, but lives in another tribe’s jurisdiction they may be able to receive local services within the other tribe’s jurisdiction Client may have to apply for citizenship • Citizenship requirements vary by tribe, must contact individual tribes to determine if client meets criteria for tribal citizenship and has documentation necessary • Some tribal nations have a long waiting period for the processing of tribal enrollment applications; don’t delay seeking services waiting for tribal enrollment, but seek other local, state, federal services Tribal elders are still eligible for local and state sponsored services • Present local and state level service options that are available Services are diverse across the Oklahoma service units • Contact each clinic, health center, hospital for elder services, resources Advocacy • Increase services for Native Americans due to persisting disparities in health and mental health within the elder population and across all ages.

12. How to Find Services for Tribal Elders General Services for Elders: Physical and Mental Health Services: Oklahoma City Area Federal/Tribal/Urban 2008 Directory of Services 8 page directory that is available to view and/or print http://www.ihs.gov/FacilitiesServices/AreaOffices/oklahoma/OCAIHSDirectory_2008.pdf The directory lists federally sponsored, tribally administered, and urban programs (not elder specific)

13. How to Find Services for Tribal Elders • Older Americans Act Native American Programs • http://www.olderindians.org/ • Resource Directory • Links to Native American Elders Resource Centers • Title VI Directors • Highlights a financial education program for Native women

14. Native Elder Service Locator Sponsored by the National Resource Center on Native American Aging, University of North Dakota Services Listed Within the Elder Services Locator that will vary by tribe and urban area: Native Elder Service Locator http://ruralhealth.und.edu/projects/nrcnaa/ On left hand side, Click on Service Locator, it will take you to a map of the United States, You can highlight a state and it will list the number of service centers within that state. If you click on a state it will take you to a map of the state that will then have services by tribe You can use a pull down menu above the map to select the services you want that will then take you to a state map color coded by the number of services available within that state. If you click on the state then it will list services by tribe • Adult Day Care • Assisted Living • Caregiver Programs • Case Management • Congregate Meals • Elder Abuse Prevention Programs • Emergency Response Systems • Employment Services • Financial Assistance • Government Assisted Housing • Home-Delivered Meals • Home Health Services • Home Modification • Home Repair Information and Referral/Assistance • Legal Assistance • Nursing Facilities • Personal Care • Respite Care • Retirement Communities • Senior Center Programs • Shared Housing • Telephone Reassurance • Transportation • Volunteer Services

15. References 1) Indian Health Service. (no date). Indian Health Service introduction.Washington DC: Department of Health and Human Services. Retrieved October 15, 2008 from http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/IHSintro.asp 2) Indian Health Service. (no date). Area offices and facilities. Washington DC: Department of Health and Human Services. Retrieved October 15, 2008 from http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/IHSintro.asp • Nelson, S.H., McCoy, G.F., Stetter, M., & Vanderwagen, W.C. (1992). An overview of mental health services for American Indians and Alaska Natives in the 1990s. Hospital and Community Psychiatry, 43(3), 257-261. • Indian Health Service. (no date).Oklahoma City area Indian Health Services. Washington DC: Department of Health and Human Services. Retrieved October 15, 2008 from http://www.ihs.gov/FacilitiesServices/AreaOffices/oklahoma/index.cfm • Indian Health Service. (no date). Tahlequah service unit. Washington DC: Department of Health and Human Services. Retrieved October 15, 2008 from http://www.ihs.gov/FacilitiesServices/AreaOffices/oklahoma/index.cfm?module=tahlequah • Custer, J. (2008). IHS hands keys over to CN. Cherokee Phoenix. Retrieved http://www.cherokeephoenix.org/3064/Article.aspx • Purtell, K. (2008,February 07). Cherokee Nation dedicates health center. Muskogee Phoenix. Retrieved http://www.muskogeephoenix.com/local/local_story_038231847.html • Custer, J. (2008). Tribe dedicates Three Rivers Health Center. Cherokee Phoenix. Retrieved http://www.cherokeephoenix.org/News/News.aspx?StoryID=2708