Utah Navajo Health System, Inc.

1. Utah Navajo Health System, Inc. Meeting the Healthcare Needs of the Navajo People

2. Utah Navajo Health System, Inc. UNHS HISTORY & GROWTH Donna Singer, RDMS & CEO UNHS was incorporated and began management of the Montezuma Creek Clinic on January 1, 2000. The community has since been involved in its progression, and has insured the success of UNHS. UNHS now operates four Federally Qualified 330e Community Health Centers (CHC) and the Blue Mountain Hospital (Critical Access).

3. Utah Navajo Health System, Inc. UNHS GROWTH As a private, non-profit 501 (c)(3) corporation, UNHS provides medical, dental, and behavioral health services, and is directed by a Navajo Board of Directors representative of all communities in which our clinics are located. Melinda Farley Treasurer–TeecNosPos Robert Whitehorse Vice Chair - Aneth Lorrissa Jackson Secretary - Oljato Gloria Begaye Blanding Wilfred Jones Board Chair - Red Mesa Jamie Harvey Aneth Edward Tapaha Red Mesa Harriet Lansing Aneth Kenneth Miles Navajo Mountain Cassandra Beletso Mexican Water

4. Utah Navajo Health System, Inc. UNHS GROWTH Goal 1: UNHS wants to bring excellent quality healthcare to local communities in the Utah Strip and increase patient access to care. Goal 2:To teach and train Navajos to fully understand the daily operating functionalities of the facilities while offering quality patient care. Goal 3: To expand levels of service increasing access to specialty services locally. Goal 4: Expand access thru assumptions of other local health care facilities to coordinate and collaborate in improving healthcare.

5. Utah Navajo Health System, Inc. UNHS GROWTH

6. UNHS – Where Our Patients Come From

7. Utah Navajo Health System, Inc. UNHS GROWTH

8. Utah Navajo Health System, Inc. UNHS HISTORY & GROWTH Fig. 1. As UNHS becomes more accessible and improves the quality of health services, the number of patients seen has increased dramatically. 133,325

9. Utah Navajo Health System, Inc. UNHS Accomplishments 2012 • Accreditation by Joint Commission and Patient Centered Medical Home certification • Blue Mountain Hospital Joint Commission Accreditation • Clinical Pharmacy services for UNHS patients • Behavioral Health Program expansion • Tomosynthesis Mammography Units • Patient Navigation Program • Case Management • Information Technology • Patient Transportation program expansion • EMS Services • Navasew Building lease • Financial support for UNHS employees and local students for higher education • Board approval for acquisition of Dental facility and expansion of dental services to Blanding community

10. Utah Navajo Health System, Inc. UNHS GROWTH • Blue Mountain Hospital (BMH) is managed by UNHS and a collaborative effort and is intended to make hospital services and renal dialysis more accessible to communities located in the Utah portion of the Navajo Reservation. • Located in Blanding, Utah, Blue Mountain Hospital is a private, nonprofit corporation developed and owned by the Ute Tribe and UNHS.

11. Utah Navajo Health System, Inc. UNHS GROWTH • Challenges

12. Utah Navajo Health System, Inc. UNHS GROWTH • Goals

13. Utah Navajo Health System, Inc. • Behavioral Health Department

14. Utah Navajo Health System, Inc. Behavioral Health Value Statement:UNHS is customer focused, responsive, respectful, honest and committed to excellence through teamwork in delivering healthcare. Current Staff: Stephen Hiatt, MS APRN Nicole Olsen, CMHC Roselyn Maryboy, LCSW Jessica Stubbs, LMFT Rex Harvey Sr., PSS

15. Utah Navajo Health System, Inc. Behavioral Health Services Offered:1. Depression/ Sadness2. Anxiety/ Fear3. Grief4. Alcohol or Drug Abuse5. Emotional Problems6. Thoughts of Death7. Anger8. Stress9. Co- Dependency10. Medication Evaluation11. Evaluation for Inpatient treatment for Life Threatening problems12. Court Ordered Services13. Etc.

16. Utah Navajo Health System, Inc. Behavioral Health Family Counseling (Clinical/ Traditional Prospectives) 1. Marital Conflicts 2. Family Problems 3. Domestic Violence 4. Alcohol/ Drug Abuse

17. Utah Navajo Health System, Inc. Behavioral Health Counseling for Children and Teenagers (Clinical/ Traditional Prospectives) 1. Relationship Problems 2. Parenting 3. Drugs and Alcohol 4. Depression 5. Anxiety 6. Physical/ Sexual Abuse

18. Utah Navajo Health System, Inc. Behavioral Health Group Counseling (Clinical/ Traditional) • Healthy Relationships/ Substance Abuse Education 2. Domestic Violence 2. Parenting Skills 3. Parent Support Group 4. Peer Support Group with Chronic illness diabetes

19. Utah Navajo Health System, Inc. Behavioral Health Other Services • Referral to other agencies when needed. • Consultation services to agencies, including Medical Facilities, Schools, Law Enforcement, Social Services, Substance Abuse programs and other that may need our assistance. 3. Educational services to organizations. 4. All services meet the needs of our community members in both languages, English and Dine Language.

20. Utah Navajo Health System, Inc. • Meth & Suicide Prevention Initiative

21. Utah Navajo Health System, Inc. The Methamphetamine and Suicide Prevention Initiative (MSPI) was implemented as an initiative to combat violent and gang-related crime in Native American Country UNHS Behavioral Health Staff continue to work hard each year to provide interventions, assistance, awareness, classes and outreach programs that inspire and educate our community members. Positive programs include our youth organization, Native Youth Designs, and the annual Venture Utah Summer Camp

22. Utah Navajo Health System, Inc. MSPI The department was created to: - Provide education & increase community involvement in prevention goals - Reduce methamphetamine abuse • Reduce suicidal ideations and activity MSPI Goals • Enhance community awareness, collaboration, and response to drugs and suicidal related activities • Increase number of youth participating in educational and therapeutic groups.

23. Utah Navajo Health System, Inc. MSPI Find healing and promoting constructive behavior through science and culture based teachings that encourage balance and self-awareness. Learning to celebrate self and cope with life’s challenges “Trust yourself, create the kind of self that you will be happy to live with all your life. Make the most of yourself by fanning the tiny, inner sparks of possibility into flames of achievement.”

24. Utah Navajo Health System, Inc. Venture Utah Summer Camp a two week, soft nature experience designed to put at-risk-youth in touch with the nature world, accomplished counselors, native artists, native traditions, including food & youth counselors who have also been at risk and have overcome personal obstacles to be able to mentor the process of creating resilience & personal accountability with their peers. • St. Christopher’s Mission at Bluff, UT • At risk youth are served by a large group of experienced licensed counselors, therapists and medical personnel (also Alternative Therapist)

25. Utah Navajo Health System, Inc. Venture Utah Summer Camp Physical activities include: kayaking, swimming, hiking, horseback riding, volleyball, bear dancing, dancing, ballroom dancing lessons, service projects such as planting & clearing. Regular counseling from licensed clinical social workers, medical workers, native traditions, personal power practitioners, holistic health workers, music therapist & team building exercises.

26. Utah Navajo Health System, Inc. Venture Utah Summer Camp Activities include: Native Arts, Navajo basket making, rug weaving, beading, gourd painting and flute making. Other traditions are also explored such as sheep shearing, the butchering of a goat, and the process of preparing the animal to eat along with traditional bread, ash bread, and fry bread.

27. Utah Navajo Health System, Inc. HUMAN RESOURCES A. Byron Clarke, J.D.

28. Utah Navajo Health System, Inc.

29. Utah Navajo Health System, Inc. UNHS Employees Goals and Compliance

30. Upward Mobility: On-the-Job training and advancement UNHS employees can request school scholarships in exchange for service commitment. To date, UNHS has paid over $211,000.00 to employee Education Costs

31. Utah Navajo Health System, Inc. UNHS Employees Departmental Percentages

32. Utah Navajo Health System, Inc. UNHS Employees Departmental Numbers Total Employees: 217, 73.5% Native American

33. Utah Navajo Health System, Inc. UNHS Employees

34. Utah Navajo Health System, Inc. UNHS Employees

35. Utah Navajo Health System, Inc. UNHS Employees Investing in Employees – Local Economic Impact • Every Full-time employee is eligible for benefits – • 5% gross income to retirement 403b • Full Premiums for Health Insurance • Eye and Dental coverage • Salaries aligned with the • -National Association of Community Health Centers Survey • 2,000+ similarly situated clinics • -State, Regional, & Market Demand • PTO, Vacation, Bereavement, CME, Bonuses • Largest private employer in San Juan County

36. Utah Navajo Health System, Inc. UNHS Employees UNHS Hiring Practices are governed by the NPEA, EEOC & Title VII, ULC, FLSA, ADA, ICPFVP, FMLA, VPA, ADEA, USERRA Credentialing Standards established by HRSA and JCAHO

37. Utah Navajo Health System, Inc. UNHS Employees 2012 &2013 Interns and Training sessions Local education system collaboration Whitehorse High School & Elementary Monument Valley High School & Elementary Navajo Mountain High School San Juan High School & Elementary College of Eastern Utah University of Utah Other Universities

38. Utah Navajo Health System, Inc. ACCREDITATION

39. Utah Navajo Health System, Inc. UNHS is Joint Commission Accredited Survey Completed August 2013

40. Utah Navajo Health System, Inc. JC Mission Statement "The mission of The Joint Commission is to continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations."

41. Utah Navajo Health System, Inc. JC Background History: • Founded in 1951 • Nonprofit organization • Establish standards to address a facility’s level of performance in areas such as patient rights, patient treatment, and infection control.

42. Utah Navajo Health System, Inc. Purpose: Assure standards of care Benefits of Joint Commission accreditation and certification • Strengthens community confidence in the quality and safety of care, treatment and services • Provides a competitive edge in the marketplace • Improves risk management and risk reduction • Provides education on good practices to improve business operations • Provides professional advice and counsel, enhancing staff education • Recognized by select insurers and other third parties • Fulfills regulatory requirements for UNHS

43. Utah Navajo Health System, Inc. Joint Commission Function: • Conducts onsite evaluations of facilities “Accreditation Surveys” • Issues a certificate of accreditation valid for 3 years • Also provides ‘unannounced surveys’ to encourage a system of continuous quality improvement rather than preparation focused specifically on a site visit

44. Utah Navajo Health System, Inc. JA Requirements Include: • 2 Patient Identifiers • “Time Outs” • Read Back of Orders • Do not Use Lists • Reporting of Problems • Look Alike/ Sound Alike Drugs • Complete List of Medications

45. Utah Navajo Health System, Inc. Patient Centered Care A Better Approach

46. Utah Navajo Health System, Inc. PCMH Have You Ever Been Confused While Getting Healthcare? • You Didn’t Know What Your Medications Were For? • You Didn’t Know What the Next Steps Were to Get You Healthier? • Felt as Though Your Provider was Telling You What to Do? Felt as Though You Didn’t Have any Say? • Wished Someone Would “Hold Your Hand” Through the Process?

47. Utah Navajo Health System, Inc. PCMH What is the PCMH? A PCMH puts patients at the center of the health care system, and provides primary care that is “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.” (American Academy of Pediatrics)

48. Utah Navajo Health System, Inc. PCMH Principles Joint Principles of the PCMH • Personal Physician (Empanelment) • Physician Directed Medical Practice (Team Approach with Patient at its Center) • Whole Person Orientation (Many support services: Clinical pharmacy, Nutrition, Specialty Services, Preventive Screenings, Dental, Behavioral Health, etc.)

49. Utah Navajo Health System, Inc. PCMH Joint Principles of the PCMH • Care is Coordinated and Integrated • (Many support services: Patient Navigation, Referral Specialists, Chronic Care Team) • Quality and Safety are Hallmarks • (Data supported patient care: Electronic Health Records, Population Based Care) • Enhanced Access • (Extended hours and weekends, 24/7 access to clinical advice, 24/7 access to the patients medical record)

50. Utah Navajo Health System, Inc. PATIENT Navigation & CASE MANAGEMENT Road Map to Best Practice in Health Care