by Robert G. McSwain Acting Director Indian Health Service Tribal Self-Governance Conference

1. Indian Healthcare Initiatives by Robert G. McSwain Acting Director Indian Health Service Tribal Self-Governance Conference 20 Years of Self-Governance: Celebrating Excellence April 27 - May 1, 2008

2. INDIAN HEALTH SERVICE MISSION The IHS Mission, in partnership with American Indian and Alaska Native people, is to raise their physical, mental, social, and spiritual health to the highest level possible.

3. Tribal Self-Governance • The concept of self-governance is a vital part of the IHS mission. • Currently, there are 73 compacts and 94 funding agreements, representing 323 Tribes. • Approximately one-third of the total IHS budget, or over $1 billion, is transferred to Self-Governance Tribes.

4. Self-Governance Focus • Innovation and Collaboration • Education and Outreach • Title V Implementation • Better Business • Tribal Consultation

5. Tribal Consultation • A vital part of the IHS mission • The IHS remains committed to tribal consultation at all levels • HHS participation in the tribal consultation process continues to grow

6. Director’s Initiatives HEALTH PROMOTION & DISEASE PREVENTION CHRONIC CARE BEHAVIORAL HEALTH http://www.ihs.gov/NonMedicalPrograms/DirInitiatives

7. Tribal Self Governance: bringing innovative ideas and approaches to addressing health disparities and supporting IHS initiatives for Indian people

8. Health Promotion and Disease Prevention (HP/DP) Initiative Goal Create healthier American Indian and Alaska Native communities by developing, coordinating, implementing, and disseminating effective health promotion and chronic disease prevention programs through collaboration with key stakeholders and by building on individual, family, and community strengths and assets.

9. HP/DP Efforts • Selection of 16 teams to participate in the FY 2008 Healthy Native Communities Fellowship program. • Continuation of 13 HP/DP grantees focusing on behavioral risk factors. • Partnering with NIH to expand the Honoring the Gift of Heart Health program to five I/T/U sites. • Expanding the Protecting You/Protecting Me alcohol prevention program to two additional sites.

10. Restoring Balance - Community Owned Wellness guidebook Physical Activity Kit: Lifespan Approaches HP/DP RESOURCES

11. IHS and Prevention Effective prevention programs: • Require the input of the American Indian and Alaska Native people • Build on the strengths and assets of Indian people, families, and communities

12. Behavioral Health Initiative Objectives Some important objectives of the IHS Behavioral Health Initiative include: • Meth abuse prevention/intervention • Suicide prevention • Child/family protection programs • Information Management improvements

13. Integration of Behavioral Health into Primary Care • Only one out of five patients referred from primary care to behavioral health actually make an appointment. • It’s been shown that co-locating behavioral health with primary care increases the successful referral rate to 80%. • It’s also been shown that untreated mental illness has a powerful negative affect on chronic physical illness.

14. Prevention and Behavioral Health • Suicide Prevention • Suicide rates are from 1.5 to 3 times higher for American Indians and Alaska Natives. • Suicide is the second leading cause of death for Native youth ages 15 – 24 yrs.

15. Mental Health Begins Early Researchers supported by the National Institute of Mental Health have found that: • 50% all lifetime cases of mental illness begin by age 14; • 75% of cases have begun by age 24; • Untreated mental disorders can lead to more severe illnesses, and to the development of co-occurring mental illnesses.

16. Prevention and Behavioral Health Alcohol/Substance Abuse • AI/ANs are about 1.5 times more likely to abuse alcohol or use illicit drugs. • AI/ANs have the highest rate of tobacco abuse of any group in the U.S.

17. Alcohol Screening and Brief Intervention Program • Takes advantage of the “teachable moment” when an injury patient presents at a facility as a result of possible intoxication or drug abuse. • Considered the largest “rural targeted injury-alcohol intervention” to date.  • Being implemented system-wide in all IHS and tribal hospitals. • 17 Train-the-Trainer conferences held so far. • The ASBI program will be introduced in IHS/tribal primary care and behavioral health clinics.

18. Federal Support • Congress appropriated $14 million to address substance abuse/suicide prevention in Indian Country. • A new “Behavioral Health Advisory Committee” made up of tribal leaders from each Area will be formed. • One of its first tasks will be to make recommendations regarding the use of the $14 million.

19. The Chronic Care Initiative • The future of the Indian Health System will be shaped by our ability to: • Address the challenge of chronic conditions • Improve care in a patient-centered focus so that improvements apply across conditions and settings • Coordinate care across all members of the care team • IHS will reflect a culture of excellence, innovation, and improvement • Leaders need to be knowledgeable, supportive, and clear away obstacles

20. Chronic Care Collaborative Pilot Sites The eight federal pilot sites are: • Gallup Indian Medical Center • Albuquerque Service Unit • Warm Springs Service Unit • Chinle Comprehensive Health Care Center • Wind River Service Unit • Sells Service Unit • Whiteriver Service Unit • Rapid City Service Unit • The five Tribal sites are: • Indian Health Council, Inc. • Cherokee Nation Health Services • The Choctaw Health Center • Eastern Aleutian Tribes  • Forest County Potawatomi Health & • Wellness Center • And the Urban program: • The Gerald L. Ignace Indian Health Center 

21. The Care Model • The Patient is at the center of our Care Model, which is focused on the importance of the relationship between the patient and the health care team. • The “Community” is also an important asset in our health care system.

22. Partnering with the Institute for Healthcare Improvement • The IHI provides a network of expertise and knowledge to improve health care worldwide. • The IHI is working with IHS on implementing and evaluating the Chronic Care Initiative.

23. Traumatic Injuries • Traumatic injuries are a continuing major problem in Indian Country. • Indian mortality rates for unintentional injuries and motor vehicle crashes are up to 3 times the rates for the general population. • We need to work towards improving our trauma care capabilities and injury prevention programs and resources.

24. Traditional Healing • We continue to encourage and explore ways to incorporate traditional healing practices into the Director’s Initiatives.   • We’ve held nine HIV Regional Behavioral Health training sessions that included a Traditional Healer as a part of the faculty. • A Traditionalist Summit is being held this summer.

25. IHS Partnerships • Tribal Organizations such as NIHB, NCAI, NCUIH, etc. • Within HHS: CDC, SAMHSA, NIH, ANA, ACF/Head Start, AHRQ • Other federal agencies such as VHA • Institute for Healthcare Improvement • Harvard University • University of New Mexico • Johns Hopkins • MAYO Clinic • NIKE • Mothers Against Drunk Driving (MADD) • International Collaborations, such as with Health Canada

26. IHS is working together with our tribal, urban, federal, state, and private organization partners to eliminate health disparities among American Indian and Alaska Native people.