Preparing for accreditation: supporting tribes

1. Aleena Hernandez, Red Star Innovations Tim Gilbert, Yellowhawk Tribal Health Center Preparing for accreditation: supporting tribes

2. PREPARING FOR ACCREDITATION: SUPPORTING TRIBES National Network Of Public Health Institutes – Open Forum June 19, 2012 Aleena M. Hernandez, MPH, Red Star Innovations

3. Overview • Inter Tribal Council of Arizona and Red Star partnership • Background information • Strategies for Tribal accreditation preparation • Outcomes and lessons learned

4. Inter Tribal Council of Arizona • To be the voice of the member Tribes in bringing about Indian involvement and self-determination • Founded in 1975 • Membership includes highest elected official among 20 of 22 Tribes in Arizona • 10 Major programs, 30 projects and 70 staff • Tribal Epidemiology Center serves 43 Tribes in Arizona, Utah and Nevada

5. Red Star Innovations • To strengthen infrastructure and performance of Tribal health departments, organizations and programs to improve community wellness through purposeful planning, action and leadership • Provide culturally and contextually relevant and information, resources, tools and assistance to: • Prepare Tribes for public health accreditation • Develop and evaluate programs and practices that improve the health • Provide 10 Essential Public Health Services.

6. ITCA/Red Star Partnership • Identify and describe Tribal research review and approval protocols in Arizona • Cultural adaption of an evidence-based intervention to prevent HIV/AIDS among Native American women • Tribal Consultation – policy development • Other program assessments, trainings and facilitation

7. Background • National Indian Health Board/Public Health Accreditation Board partnership since 2009 • Exploring Tribal Public Health Accreditation • Tribal Think Tank • Tribal Standards Development • National call for Tribal input on the standards • Evaluation of the beta test

8. Emerging Themes • Educate and inform Tribal Health Departments about public health accreditation and its benefits • Provide culturally appropriate accreditation readiness technical assistance, tools, and training • Convene Tribal, State and Local Health Departments, and other partners to communicate and coordinate accreditation readiness efforts

9. Objectives • Assess interest and readiness to pursue accreditation • Increase awareness about accreditation • Develop a tribally specific community health assessment framework • Increase opportunities for Tribal, state and local stakeholders to communicate and coordinate

10. Baseline Assessment • 33 percent response rate (64% AZ, 14% UT, 22% NV) • 57 percent had heard about accreditation, but knew very little about it • 29 percent were familiar and had reviewed some material • 14 percent had never heard of accreditation

11. Readiness Assessment • Eligibility – documentation of legal authority to provide public health services • Accreditation Prerequisites • Community Health Assessment • Community Health Improvement Plan • Strategic Plan • Interest in accreditation • Interest in training about accreditation

12. Readiness Findings • 31 percent did not have the eligibility documentation • 36 percent had conducted a CHA within last 5 years; 21 percent more than 5 years ago • 36 percent had conducted a CHIP within last 5 years; 14 percent more than 5 years ago • 86 percent used CHA results to develop the CHIP • 36 percent had conducted a strategic plan within the last 3 years

13. Interest in Accreditation • 71 percent very interested; 21 percent interested • All but one were very likely to attend a training if offered • 71 percent indicated that travel support would increase their likelihood of attending

14. Indian Health Service Phoenix Area

15. Accreditation Trainings • Accreditation Workshop Series – Team approach • Introduction to Accreditation • Self-Assessment based on standards/measures • 3 Prerequisites • 8 Tribes attended 1st training; 6 Tribes attended 2nd; 10 Tribes attended 3rd • Evaluations indicated increased interest and knowledge about the steps required

16. Other Training Outcomes • Tribal team size often increased • Increased interest in funding to support accreditation • Increased interest in information, networking and technical assistance to prepare • Trainings created momentum and energy • When’s the next training???

17. Accreditation Roundtable • 7 Tribes, AZ State Performance Improvement Manager, Epidemiologist, Tribal Liaison, IHS Area Office; ITCA leadership • Brief overview of accreditation followed by facilitated discussion: • What mechanisms already exist to facilitate statewide coordination and collaboration? • How can statewide coordination and collaboration among Tribal, state and local health departments improve? • Share recommendations and/or strategies to address these improvement needs?

18. Key Outcomes: Roundtable What exists to support coordination: • ITCA Epidemiology Center provides connects between Tribes and State; MOU with Tribes • Statewide collaboration on infectious disease and emergency response • State support – Tribal liaison; Tribal consultation • IHS communicated support to the Tribes

19. Key Outcomes: Roundtable Opportunities for improvement: • Recognition and respect for Tribal sovereignty by state and federal governments • IT systems need to improve; data sharing • Accreditation is an opportunity to improve statewide coordination and collaboration • Facilitate better relationships

20. Key Outcomes: Roundtable Strategies: • Further exploration on the role of IHS • Data is a priority – need to find ways to facilitate greater data sharing • ADHS representatives expressed interest in working with the Tribes – NPHII grantee • Seek additional funding to support Tribal readiness and preparation for accreditation

21. Community Health Assessment • Conducted a literature review of existing models • Identified key themes based on the common steps of a CHA as identified by NACCHO: • Develop an assessment plan • Engage the community • Define the population • Identify community health indicators • Collect data • Analyze data • Identify health priorities • Report Results

22. Tribal Specific Recommendations • Provide guidance on the role of Tribal governance recognizing that each Tribe has its own protocols • Address the importance of community and individual protections when collecting data. • Provide guidance on data sources and methods that are relevant to Tribes. • Address the issues around the quality of data (e.g. limited availability, outdated, lack of specificity) • Provide recommendations on how to collect relevant and high priority data

23. Thank You Inter Tribal Council of Arizona Red Star Innovations Patrick McMullen, PhD Aleena M. Hernandez, MPH (602) 258-4822 (520) 407-630 patrick.mcmullen@itcaonline.comaleenamh@redstar1.org