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TEC News

CTEC Success Story: August 2018

Success Stories, TEC News
Good Health and Wellness in Indian Country

Tiffany Ta, MPH

Within the project year, the California Tribal Epidemiology Center (CTEC) conducted key informant interviews with the CDC Good Health and Wellness in Indian Country (GHWIC) Advancing California Opportunities to Renew Native health Systems (ACORNS) subcontractors. These subcontractors were Tribes, Tribal Health Programs, or Tribal Organizations. The purpose of these interviews were to gather information on how information has been shared with Tribes in their respective area and across other areas.

 

CTEC conducted a total of nine key informant interviews from ACORNS subcontractor program leads.

 

Findings from the key informant interviews indicated that sharing information helped the program leads and community members gather information. Such information included implementation of new programs, sharing of ideas on successes and challenges, and sharing of resources and tools. This sharing of information helped ACORNS subcontractors avoid “reinventing the wheel.” Several recommendations were made by program leads on how improvements could be further made on methods to sharing information to Tribes and across Tribes. The current primary method of communication in sharing information to their community are at meetings, workshops, and conferences. In other words, opportunities for program leads, staff, and/or Tribal community members to gather were considered a success in sharing information within and across other areas. A notable example mentioned from program leads was the 1st Annual 2018 Data, Evaluation, and Grant Writing Training hosted by CTEC last March. Unfortunately, this method of communication did not demonstrate as the most efficient method because meetings, workshops and conferences are held only once or twice a year. In other words, these opportunities to gather and share information are too infrequent.

Key informant interviews revealed concerns that there is a need for more frequent meetings, workshops, or conferences within the program year. More frequent gatherings would further enable them to share information. After conducting these interviews, ACORNS subcontractor program leads and GHWIC staff came to understand the pressing need to gather together in one location more often to share information as well as build relationships with one another. Typically, meetings, workshops, and conferences are held to simply provide health education and training to Tribal communities and staff, but many Tribal Epidemiology Centers (TECs) have yet to realize these meetings are too often the only occasion for them to gather together in one space to connect, build relationships, and share information. Hence, creating opportunities to gather more frequently will foster these connections, further enable the sharing of information, and strengthen relationships with Tribal communities. This is critical for us, as TECs, to truly understand what their needs are, improve overall health, and improve relationships with Tribes in their respective area and across other areas.

As a result of the key informant interviews, GHWIC staff are now aware of the need for more frequent gatherings and will work with program leads to help us develop additional meetings, workshops, and conferences that are efficient and will help Tribes overall. In addition, having these interviews in-person provided GHWIC staff an opportunity to build/strengthen relationships with their program leads. This will help guide future GHWIC work. The significance of this is that program leads are typically members within the Tribal community, having far more knowledge about community needs and can provide invaluable guidance to improvements needed to achieve overall community health and wellness. Lastly, building and strengthening relationships between TECs and Tribal communities will subsequently build trusting relationships that will, in turn, further support them in sharing information within and across other Tribal areas.


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GPTEC Success Story: July 2018

Success Stories, TEC News
Criminalizing Pregnancy in South Dakota

Prepared By: Dr. Jennifer Giroux and Sara Albertson

In South Dakota (SD), maternal substance use disorders during pregnancy are a tribal public health crises. Maternal Child Health (MCH) providers on reservations in SD suggested that 50-75% of pregnant women use a non-prescribed drug. This rate range was confirmed by reports with two tribes that participated in a 2016 CDC EPI AID maternal substance use during pregnancy investigation.

Women who sought help for opioid addiction, learned there were no Medication Assisted Treatment (MAT) options available among Indian Health Service (IHS) facilities in the Great Plains region. There are limited substance use treatment resources in general, and even fewer for pregnant women.

Maternal Child Health providers anecdotally reported that women who tested positive or who were at risk of testing positive tended to avoid prenatal care out of fear of losing their children or legal prosecution. Women seeking assistance with Substance Use Disorders (SUD) face additional barriers in SD. Health care providers are required to report her to authorities or risk being charged with a misdemeanor. 1

South Dakota Codified Law 26-8A-2, states that physicians are mandatory reporters of child abuse and neglect, and in South Dakota, prenatal exposure to controlled substances or alcohol is considered child abuse. South Dakota child-welfare statues consider substance use during pregnancy to be child abuse and grounds for civil commitment (SDCL 34-20A-63). South Dakota Codified Law 22-42-5.1 classifies ingestion of a non-prescribed controlled substance as a felony. A positive urine drug screen is used as evidence for prosecution of 22-42-5.1. South Dakota law enforcement has used forced catheterization and entering treatment facilities to take a photo of patient’s positive drug urine screen as evidence for prosecution, enforcement officials are protected from being prosecuted for these acts under SDCL 22-42-5.1. 2, 3, 4

State laws shuttle pregnant women needing or wanting help for their SUD into the criminal system. Data supports that these laws are disproportionately applied to American Indian women. Evidence from the South Dakota Women’s Prison (SDWP) from July 2018, demonstrates that out of the 564 women in custody, 52% (295) of them were American Indian. 5, 6 Nearly 64% (361) of the women were incarcerated due to drug related offenses. 7 Of the 64% of women in prison on drug charges, 132 of them, or 37% were prosecuted under South Dakota Codified Law (SDCL) 22-42-5.1. 8

In Pennington County, South Dakota, American Indians Comprise 10% of the population, but 52% of inmates. 9

Pennington County ranks top three in the nation for both incarcerating women, predominantly AI mothers, and for recidivism rates. 10 To address this high rate of incarceration and recidivism the criminal justice system has received numerous grants for diversion, interventions, and reentry programs. These grants did not initially network with Tribes and Tribal organizations to integrate Lakota Culture into the programs, or deliver critical education and training on the perpetuation of historical trauma and the impacts of institutionalized racism.

From a public health perspective, upstream substance use education and prevention interventions are critical to reduce the costly and limited downstream treatment services and law enforcement repercussions. Currently there are no substance use education requirements for an individual to graduate from high school in SD. Teachers are not required to have training or knowledge of SUD. Evidence based substance use prevention programs exist with interventions targeting critical development years, but State funds are not allocated towards these prevention services.

 

GPTEC is taking a multi-prong approach to the Tribal Maternal Substance Use Disorder During Pregnancy crisis:

 

Policy Work

  • Address need to adapt SD mandatory reporting laws of pregnant women with substance use disorders

Media

Upstream

  • Participate in American Indian Youth Substance Abuse Prevention Coalition.
  • Host Subject Matter Expert, Dr. Annette Bosworth, to speak on Brains of Addiction
  • Develop and conduct survey of substance abuse disorder education and prevention and Harm Reduction education in reservation schools.
  • Host Subject Matter Expert, Dr. Annette Bosworth to speak on Brains of Addiction
  • Mental Health First Aid Instructors – 8 hours
  • Presentations on Resiliency, Toxic Stress, ACEs and Historical Trauma- 2 hours

At the falls

  • Survey of tribal treatment program services
  • Collaborated with NWPIHB to complete a People Who Inject Drugs qualitative research project on local needs
  • Provide GPTEC leadership in the 2016 CDC EPI AID on maternal substance use during pregnancy investigation

Downstream – Breaking the cycle of Intergenerational Trauma

We recognized a need for Tribal involvement in the emerging criminal justice system’s new programs, and the need for support from the criminal justice system to adapt SD state laws that are serving as barriers to women who have SUDs and are pregnant. Shifting resources to cost effective upstream prevention and education programs requires community and elected official’s buy-in. Tribal and Criminal Justice System collaborations were unlikely relationships that first needed to be forged. It was out of this need for relationships and partnerships that the idea of our symposium was born. On July 10th, 2018, we held our symposium titled “Exploring the Intersection of Criminal Justice, Lakota Culture and Behavioral Health”.

1 South Dakota Legislative Research Council. (2017). South Dakota Codified Law. Accessed at: http://sdlegislature.gov/Statutes/Codified_Laws/DisplayStatute.aspx?Type=Statute&Statute=22-42-5.1

2 Ibid.

3 South Dakota Cops Indulged ‘Sadistic Desires’ Forcing Catheters into Men, ACLU Lawsuit Says. (2017). Accessed at: https://www.usnews.com/news/national-news/articles/2017-07-07/south-dakota-cops-indulged-sadistic-desires-forcing-catheters-into-men-aclu-lawsuit-says

4 Rapid City Journal. (2016). Woman sues Pennington County authorities for alleged violation of her civil rights. Accessed at: http://rapidcityjournal.com/news/local/article_e136dc0b-47c3-508a-9f9c-3c1d5354af30.html

5 South Dakota Department of Corrections. (2018). Adult Population. Accessed at: https://doc.sd.gov/documents/AdultPopulationJune2018.pdf

6 South Dakota Department of Corrections. (2018). Adult Inmates by Race/Ethnicity. Accessed at: https://doc.sd.gov/documents/InmatesbyRaceEthnicityJuly22018.pdf

7 South Dakota Department of Corrections. (2018). Adult Crimes Breakdown. Accessed at: https://doc.sd.gov/documents/AdultCrimeBreakdownJune2018.pdf

8 Ibid.

9 Pennington County Sheriff’s Office. (2017). Pennington County Sheriff’s Office 2017 Report. Accessed at: https://www.pennco.org/index.asp?SEC=E6CD5DAE-1428-4E43-BFEE-C303509D5320&Type=B_BASIC

10 The Pew Charitable Trusts. (2013). South Dakota’s 2013 Criminal Justice Initiative. Public Safety Performance Project. Accessed at: http://psia.sd.gov/PDFs/SouthDakotaBrief.pdf


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RMTEC Success Story: March 2018

Success Stories, TEC News
Partnerships with the Rocky Mountain Tribal Leaders Council, Epidemiology Center (RMTEC)

Over the past year, the Rocky Mountain Tribal Leaders Council, Epidemiology Center (RMTEC) has been working with the Montana Department of Health and Human Services (DPHHS) and the Wyoming Department of Health (WDH) to better address specific American Indian/Alaska Native (AI/AN) heath concerns in Montana and Wyoming, respectfully. This initiative arose following the development of two new Memoranda of Understanding: one between RMTEC and DPHHS and the other between RMTEC and WDH.

 

A Memorandum of Understanding (MOU) is a type of cooperative agreement between two parties over a mutual sentiment.

 

It has language on collaborative efforts and other rules of engagement for partnership to better serve the Tribal Communities in both states. It also offered a more comprehensive replacement to the Data Sharing Agreements RMTEC had in the past. The new Memoranda between RMTEC and each state health department focused more broadly on the individual partnerships themselves rather than single projects. This capacity-building approach emphasizes ways that the partnerships can work jointly to address multiple tribal public health issues. Each state health department brainstormed with RMTLEC to consider the prominent tribal public health concerns in their respective state and the joint initiatives that best spoke to each tribal public health concern. The resulting Memoranda documented initiatives that both parties agreed upon and outlined the parameters of the partnership, including providing technical assistance when needed and establishing channels of communication. The Rocky Mountain Tribal Leaders Council, Epidemiology Center is looking forward to a renewed partnership with each state health department and hopes to identify even more approaches for better serving the tribes in Montana and Wyoming.

 

Montana DPHHS
 


 
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Wyoming Department of Health

The Opioid Crisis Impact on Native American Communities

TEC News
AASTEC recently produced and disseminated a new fact sheet on the impact of the opioid crisis among Native American communities. Key findings demonstrate that overdose deaths due to any type of opioid use have been on the rise among Native Americans since 2000.

 

The current opioid-related overdose death rate for Native Americans nationwide is 13.7 deaths per 100,000 population, which exceeds the national rate of 13.1 per 100,000.

 

The opioid overdose death rate among Native American males significantly exceeds the rate among Native American females (10.0 per 100,000 vs. 7.0 per 100,000). Among youth, more than 1 in 10 Native American high school students in New Mexico (11%) used a prescription pain medication without a doctor’s order in the past 30 days, and high school students who used a prescription pain medication also used heroin in the past 30 days (22%).

The fact sheet concludes with strategies that can be adopted at the individual, family and community level to reduce the harmful impact of opioids.

2018 Tribal Youth Health Policy Fellowship

TEC News

Description: The National Indian Health Board’s second cohort of Fellows will consist of 12 Native youth from around the country to engage throughout the year in Indian health policy and programming efforts. The Fellows will engage in Indian health policy solutions, tell their personal story, and advocate for changes in the healthcare and public health systems important to their Tribal communities.

The Fellowship provides youth with key opportunities for relationship- and skills-building that allows them to return home feeling empowered, connected to other Native youth, and well equipped to be the next generation of advocates for Indian health.

Deadline: April 6, 2018

Apply Here