The Rocky Mountain Tribal Leaders Council is a Tribal organization that serves more than 100,000 American Indians (AIs) in the States of Montana, Wyoming, Shoshone Bannock of Idaho, and the Piikani Nation of Canada. The RMTLC is dedicated to improving the health, economic development, and education for Tribes and their members through a variety of programs, policy recommendations, and Tribal Leaders meetings. Since 2005, the RMTLC has housed the Rocky Mountain Tribal Epidemiology Center (RMTEC), which serves AIs in Montana and Wyoming (Billings Area). As one of twelve Tribal Epidemiology Centers (TECs), the RMTEC works in partnership with local, area Tribes to improve the health and well-being of their Tribal community members by offering culturally competent approaches to reduce health disparities AI populations face.

Each year, the Rocky Mountain Tribal Leaders Council (RMTLC) hosts an annual conference in Billings, Montana for Tribal Health Departments, Directors, Tribal Councils, Urban Organizations, public health professionals, relatives, partners, Indigenous Advocates, and others who serve American Indians (AI) in Montana and Wyoming. As a regional Tribal Public Health event, this year’s theme was Strengthening Indigenous Well-Being: A New Era in Tribal Public Health, August 14-15, 2024. A variety of topics and sessions featured Tribal Public Health professionals, the sharing of Tribal best practices, and Indigenous-led wellness activities. Our region continues to celebrate our resiliency, our culture, and strengthen AI Health Equity. This year, RMTLC was pleased to offer several pre-conference sessions focused on building capacity and strengthening collaborations. Through conversations, partnerships, and working groups with Tribes, the RMTEC organized a one-day workshop titled, Indigenous Data Warriors Training (IDWT), on August 13, 2024.

 

Valuing our region’s diverse workforce that serve our Tribal Nations, the IDWT had more than 50 attendees, in-person and virtually. The following topics covered were:
 

• Fundamentals of Epidemiology
• Fundamentals of Descriptive Statistics
• Hot Topics: Data Decolonization and Reducing Racial Misclassification
• How to Manage a Dataset (Data Management 101)
• Fundamentals of Data Visualization
• What Does Data Mean to you? Indigenous Data Sovereignty

 

All attendees were provided with course materials and supplies. In addition, attendees were provided with the option for Continuing Education Units (CEUs). Attendees were also provided opportunities to reinforce concepts learned through interactive activities and networked with fellow regional data warriors. Understanding that travel expenses may be limited, the RMTEC offered travel scholarships to attendees along with the opportunity to attend the full conference.

Besides regional attendees, the IDWT event had individuals from Arizona, Nebraska, and Minnesota register. One IDWT attendee mentioned, “This training was appropriate for beginner/intermediate levels of understanding. A lot of ground covered, and they were able to answer my questions. I can tell they are passionate about this.” Another IDWT attendee stated, “The delivery of information was engaging and left me feeling empowered with my ability to manage data.” “I liked that other TECs joined in. It shows collaboration.” As a thank you to the attendees for taking time, the RMTEC provide attendees with Indigenous Data Warriors power banks.

For future trainings, many IDWT attendees would like a second training that builds off the skills learned and hands-on practice to build a dashboard. The IDWT was a months long process to identify foundational data training topics and to identify presenters/speakers. Rather than seek assistance externally, the RMTEC reached out to fellow TECs to share their expertise with our attendees. Those who work with AI/AN data, understand the data challenges such as—data access, representation in data, and the importance of data sovereignty. We appreciated the presenters/speakers for taking the time and effort to carefully develop course materials that have laid a foundation for our data warriors. The skills learned through this training have increased an attendee’s understanding about data, where to locate data, and how to interpret data. The skills that will be useful for developing Tribal data initiatives. Data is medicine. Data empowers Indigenous people to make change.

Indigenous Data Warriors Training

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In June 2024, National Coordinating Center for TECPHI (NCC) staff members participated in a Digital Storytelling workshop. This workshop was offered to staff at the Alaska Native Tribal Health Consortium (ANTHC), the parent organization of the Alaska Native EpiCenter and the NCC, as part of a partnership between ANTHC and Creative Narrations.

Participants in this workshop honed their skills in telling personal health stories via video. Hearing directly from individuals, hearing their voices, their values, their perspective of relevant health problems and their solutions can help us better understand fighting chronic disease within the world of Tribal communities.

Stories serve an important role in NCC national evaluation: to highlight program success, emphasize indigenous core values and knowledge, show the reach and impact of the NCC and TECPHI, and to connect grantees who are working on the various public health strategies across Tribal health organizations.

View Mishelle’s digital story here: https://www.youtube.com/watch?v=jUBabuDQ2MU

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The Northwest Tribal Epidemiology Center (NWTEC), housed within the Northwest Portland Area Indian Health Board (NPAIHB), is preparing to launch Beta testing of the Northwest Tribal Data Hub application (Data Hub) to an initial cohort of Northwest Tribes during the summer of 2024. This milestone will signify the culmination of three and a half years of planning, learning, and developing the foundational infrastructure of the Data Hub. As we near this milestone, NWTEC’s Data Hub team reflects on the successes and lessons learned from this developmental phase of the platform.

What is the Northwest Tribal Data Hub?

At its core, the Northwest Tribal Data Hub seeks to connect Northwest Tribal Nations with their data. When fully developed, the Data Hub will provide Tribes in Idaho, Oregon, and Washington with secure, direct, and easy access to public health data on topics such as demographics, cancer, substance use and overdose, leading causes of death, and other public health issues within their Tribal areas. The Data Hub utilizes data obtained from state and federal agencies, including vital records, disease registries, and health surveys. When possible, the data have been improved for Tribal communities by correcting the misclassification of AI/AN people. Tribes will access the Data Hub through a secure login and can view, interact with, and download data through visual and interactive dashboards. Each Tribe will be able to view key public health indicators for their Tribal service area, state, and the Northwest region.

Building NWTEC’s Data and Tribal Engagement Infrastructure

The Data Hub represents a significant investment in modernizing NWTEC’s data and information technology infrastructure. The initial planning phase included defining our goals and outcomes for the Data Hub, assessing the feasibility of its development, and engaging four Tribes in a proof of concept to test the underlying technology and gauge interest in further development. As part of that planning phase, the Amazon Web Services (AWS) cloud environment emerged as the best platform to host the Data Hub. The first, foundational step of the development phase was to design, build, and test the Data Hub’s security to ensure confidential data are protected and accessible through the data pipeline. With platform’s security developed and tested, NWTEC’s data assets were migrated to a database and formatted to support the analysis and visualization of public health indicators. The data visualization tool, QuickSight, is used to develop interactive dashboards that report key indicators on Northwest Tribes’ priority health issues. The first dashboard to be launched addresses one of the Northwest Tribes’ highest priority issues – drug overdoses.

 

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The COVID-19 pandemic underscored many strengths of the Alaska Tribal Health System (ATHS) and the Alaska Native Tribal Health Consortium (ANTHC), however it also brought to light opportunities for improvement in Tribal public health infrastructure throughout the state and emphasized the need for ANTHC and the ATHS to be better prepared for future public health emergencies.

Supported by TECPHI funding from the Centers for Disease Control and Prevention, the Alaska Native Epidemiology Center (ANEC) contributed to ANTHC’s efforts to invest purposefully in infrastructure to improve public health and strengthen its capacity. Using Tribal public health assessments, ANEC staff worked throughout FY23 and FY24 to evaluate the ATHS’s capacity to deliver the essential public health services and inform ANTHC’s efforts to align its public health initiatives with its strategic direction.

As a result of the information gained in these assessments, ANTHC identified areas for which an immediate was response was possible including funding additional positions in Emergency Preparedness, establishing Tribal public health infrastructure sub-award funding opportunities, creating a Research Advisory Network, and strengthening partnerships and networking relationships with partners such as the State of Alaska. Additional work continues on these assessments, and the results continue to provide valuable insights for the Alaska Native EpiCenter, the ANTHC Division of Community Health Services, and the organization as a whole.

Maria Caruso presents on Tribal Public Health Assessment processes and results and the 2023 EpiCenter Scientific Advisory Council.

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The Inter Tribal Council of Arizona, Inc. (ITCA) Tribal Epidemiology Center Public Health Infrastructure (TECPHI) Team holds Public Health Working Group (PHWG) Meetings to provide a gathering space for collaboration among Tribal public health programs. Through a strategic planning meeting held in March 2023, the TECPHI Team established 3 main goals for the working group meeting series:

1. Provide a collaborative public space to enhance relationships,
2. Promote and improve awareness of Tribal Epidemiology Center services, and
3. Provide public health/health data training and education at no cost.

To date, the TECPHI Team has hosted 4 PHWG meetings during this 5-year funding cycle, with attendees from Tribal organizations in Arizona, Nevada, and Utah, along with presenters traveling from across the country to provide trainings or present on various public health programs. The TECPHI Team is currently planning the 5th PHWG meeting, which will be held on June 4, 2024 on the topic of Substance Use and Overdose Prevention.

 

The first PHWG meeting of the series was held virtually. It has since shifted to in-person meetings after receiving feedback that participants preferred an in-person format.

 

During the course of the 4 PHWG meetings that have been held, the gathering has expanded from a 4-hour virtual meeting to a full-day (or 2-day) in-person meeting. Additionally, due to the success of the first two PHWG meetings held in Year 1, the TECPHI Team has moved forward with offering the meetings every quarter in Year 2. Speakers have included Tribal health program leadership and staff, medical providers, the Arizona Department of Health Services, and our fellow colleagues from other Tribal Epidemiology Centers. These presenters provided information about their programs or gave trainings pertaining to the meeting topics.

Through these presentations and breakout discussions, attendees have been able to share information, opportunities, and resources with each other. Of note, the most recent PHWG meeting on Maternal and Child Health enabled participants to provide invaluable information and recommendations for updates to an Arizona Tribal Maternal and Child Health Needs Assessment that the TECPHI Team is currently working on.

PHWG Meeting attendance has increased from 20 to 43 people (see tables for more information), many of whom have been returning attendees. The most recent working group meeting had so many registrants that the number of attendees had to be limited due to conference room capacity. Meeting participants provide helpful feedback and insight to the TECPHI Team via evaluation surveys after each meeting. The surveys include questions about the format and content of the meetings to improve future gatherings and ensure they are useful to our Tribal public health partners. To date, the TECPHI Team has received 80 survey responses across the 4 meetings, enabling them to integrate participant feedback into their planning and implementation. For example, when asked if the meeting provided a collaborative environment for discussion, 73% of survey respondents strongly agreed, 27% agreed, and 0% were neutral, disagreed, or strongly disagreed.

Additionally, the TECPHI PHWG Meetings series has strengthened the relationships and partnerships between the TECPHI Team and other ITCA Departments, including the Social Media Manager, Assistant Director, Maternal Health Innovation Department, and Health and Human Services Department. The PHWG meetings have also enabled the TECPHI Team to connect with and collaborate with other TECs around the country, including the Northwest Portland Area Indian Health Board, Southern Plains Tribal Health Board, and the Albuquerque Area Southwest Tribal Epidemiology Center.

The TECPHI Team has found that the PHWG meeting series has greatly expanded opportunities for collaboration with our public health partners. Overall, the PHWG meetings have been successful in providing an environment for discussion, collaboration, sharing information, and building relationships between the ITCA TECPHI Team, Tribal health programs, ITCA departments, Tribal Epidemiology Centers, and other public health partners.

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