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Clarifying the picture: Data Collection In Indian Country

Clarifying the picture: Data Collection In Indian Country. Terry Batliner dds , mba Cherokee nation of oklahoma Joaquin gallegos Jicarilla apache nation/pueblo of santa ana. Need for Relevant Information.

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Clarifying the picture: Data Collection In Indian Country

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  1. Clarifying the picture:Data Collection In Indian Country Terry Batliner dds, mba Cherokee nation of oklahoma Joaquin gallegos Jicarilla apache nation/pueblo of santaana

  2. Need for Relevant Information • The last full Indian Health Service (IHS) report on dental needs was published in 1999 • Most reports aggregate data across regions or tribal groups and is not tribal-specific • Certain oral health issues, such as oral lesions, are often not reported

  3. Havasupai Tribe v. Arizona State University Board of Regents • 1990 – Blood Samples • Diabetes ≠ Schizophrenia, Inbreeding, Bering Strait Theory • 2003 – Discovery of misuse • 22 published journal articles without tribe’s knowledge • 2010 – Settlement Courtesy of Sierra Club

  4. An assessment of oral health on the pine ridge Indian reservation • 2010 • A comprehensive report on the oral health of the Oglala Lakota was needed • Convenience sample of 292 participants • One hygienist was fluent in the Lakota language Courtesy of Joaquin Gallegos

  5. Results • 90% of participants had at least one decayed tooth • -Children had on average two decayed primary teeth and two decayed permanent teeth • -Adults had on average five decayed teeth • 1 in 10 adults had 16 or fewer teeth • 68% of adults had evidence of periodontal disease • 10% of males had roughened or corrugated oral muscosa • Prevalence and severity of periodontal disease and decay was worse in the Oglala population than the 1999 IHS user population

  6. Policy Outcomes • Delta Dental of South Dakota subsequently added 24 registered dental hygienists to health system to treat American Indians • Supported by $3.4 million award from Centers for Medicare & Medicaid Services

  7. Oral health barriers • The population of approximately 40,000people is serviced by only 9dentists, a ratio of 22 dentists per 100,000 people • By contrast, the state of Connecticut has 66 dentists per 100,000 people

  8. New Mexico Tribal Oral health Disparities Assessment Courtesy of Santo Domingo Pueblo

  9. New Mexico Tribal Oral health Disparities Assessment • Need for a representative sample – Pueblos are small tribes • The Santo Domingo Indian Reservation is home to approximately 6,000 people (5th largest Pueblo) • Santo Domingo did not have tribal-specific oral health status data • Previous lack of cultural respect for Pueblo by Universities – an opportunity to form a sustainable partnership Courtesy of Ysleta Del Sur Pueblo

  10. Tradition Courtesy of First Nations Development Institute

  11. State of Health System • In the spring of 2012 Santo Domingo Pueblo utilized the Indian Self-Determination and Education Assistance Act (Public Law 93: 638) • Historically, tribal members received health care from the Santa Fe IHS Service Unit, which is also tasked with serving 8 other Pueblos Courtesy of Kauffman & Associates

  12. Recruitment • Need for a random sample • Participants were recruited from housing structures which were chosen by random number assignment from satellite images of the community provided by tribal authorities Courtesy of Santo Domingo Office of Planning

  13. Community Involvement • Community Health Representative (CHR) Program • Communal good – project benefits the whole Tribe • <10 refusal to participate Courtesy of Kauffman & Associates

  14. Working Amidst Community Issues • “Two people are accused of murder following the deaths of two young children in just a month” • 1) Grandmother of 17 month old boy: “second-degree murder and felony child abuse and neglect” • 2) Boyfriend of Mother’s 10 month old boy: “first-degree murder and felony child abuse and neglect” • - “significant head trauma to the child with a blunt object” • - “causing serious bodily injury to the child, mistreatment, exposing the child to extreme conditions and threatening the child with harm” • -Rapid City Journal

  15. Comparison To NHANES • Untreated dental caries and dental restoration were most prevalent in the 20-44 age range, 69.9% and 88.2% respectively • Prevalence of untreated dental caries was significantly and substantially higher in the Santo Domingo Pueblo participants, 58.8% compared to 21.5% • The prevalence of sealants on permanent teeth among 5 to 19 year olds was significantly higher in the Santo Domingo participants, 56.5% compared to 27.2% Courtesy of Kauffman & Associates Courtesy of Kauffman & Associates

  16. Impact • The Kewa Health Corporation and Santo Domingo Health Center now have tribal-specific and accurate data for health planning, intervention measures, and program development • Data can be used to advance House Bill 17 in the New Mexico State Legislature to improve access to care in Indian Country Courtesy of Kauffman & Associates

  17. Impact • Affordable Care Act - Medicaid Rollout- Tribal consultation • Interaction with New Mexico State Health Department

  18. IMPACT • Presented at: • U.S. Senate Committee on Indian Affairs • Native American Affairs – The White House • 2013 NCAI Executive Council Winter Session Courtesy of Michael Woestehoff, NIGA

  19. Lack of Resources • Chronic underfunding • -Least funded Federal Program (less spent per capita than Medicaid, Medicare, Veteran, and Prisoner patients) • 2013 sequester • - only federal health and safety-net program facing cuts • -$204.9 million (Health Services) (FY 13 alone) • -$23.3 million (Health Facilities) (FY 13 alone) • Difficulty recruiting Dentists to practice Indian Country • According to IHS Division of Oral Health: • - IHS dentists reported treating 28 percent of the patients who needed care, which is 5 percent more than they serviced in the 1990s (American Dental Association 2013) Courtesy of IHS

  20. American Indian and Alaska Native children between the ages of 2 and 4 have the highest rate of decay in the United States—five times the national average… • -U.S. Department of Health and Human Services

  21. Native Solution: DHATS • Most studied health professional in the history of oral medicine! • Providers with cultural awareness and understanding of community needs • Provide routine care – overburdened Dentists can now prioritize complex cases Saving health systems money Creating a new educational field for AI AN students Improved pediatric care (760 hours treating children) Alleviate burden IHS faces Courtesy of ANTHC

  22. DHATS Expanded access to 40,000 Alaska Natives… Courtesy of ARCUS Courtesy of Joaquin Gallegos They Can Expand Access to the American Indian population

  23. Dental Therapy is one pathwayleading to healthy living. Courtesy of Kauffman & Associates Courtesy of University of Colorado

  24. Gordon Belcourt “If I thought it was hopeless, I wouldn’t be here. I know what it means to have to have half of your heart ripped out. It’s created a whole sense of urgency and awareness to me.”

  25. Courtesy of University of Colorado

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