final rmtec_strategic plan 2012_20160 developed by dr.akintan folo fa12.03.2012

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August 2012 Publication

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Executive Summary

Dear Colleague:

We are pleased to present to you the Rocky Mountain Tribal Epidemiology Center 2012 – 2016 Strategic Plan.

The Rocky Mountain Tribal Epidemiology Center developed the strategic plan to fulfill the Indian Health Service

Tribal Epidemiology Center core funding epidemiology grant for Montana and Wyoming Tribes. The strategic plan

includes all Rocky Mountain Tribal Epidemiology Center goals, objectives, projects and activities which include

Surveillance, Capacity Building and Epidemiological Intervention activities.

All Montana and Wyoming Tribal Health Departments participate in projects based on Local Tribal Health priorities

and all are encouraged to opt-in or opt-out on an annual basis.

We welcome all comments and suggestions for continued improvement. We hope the Tribes in this Rocky Mountain

Region will find these projects useful in disease surveillance, capacity building and intervention expressing their

Public Health Authority.

The Rocky Mountain Tribal Epidemiology Center maintains and distributes the Montana and Wyoming Tribal

Community Health Profiles as a reference document. For more information how to obtain hard copies, please

contact Folorunso Akintan, MD, MPH at [email protected]; or (406) 252-2550.

Sincerely,

Gordon Belcourt,

Executive Director

Montana Wyoming Tribal Leaders Council

_____________________________________________________________

Written by

Folorunso (Folo) Akintan MD, MPH

Principle Investigator, Rocky Mountain Tribal Epidemiology Center

Montana-Wyoming Tribal Leaders Council

175 North 27th

Street, Suite 1003

Billings, MT 59101

www.rmtec.org

mailto:[email protected]

http://www.rmtec.org/

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Table of Contents Executive Summary ....................................................................................................................................................... 1

Table of Contents .......................................................................................................................................................... 2

History ........................................................................................................................................................................... 3

Montana and Wyoming Tribes and Reservations .......................................................................................................... 4

Public Health Authority ................................................................................................................................................. 5

Partners .......................................................................................................................................................................... 5

Healthy People 2020 Overarching Goals....................................................................................................................... 8

10 Essential Public Health Services - Objectives .......................................................................................................... 9

Specific Goals and Objectives ..................................................................................................................................... 10

Tribal Health Needs Assessments ............................................................................................................................... 11

Rocky Mountain Epidemiology Center Goals ............................................................................................................ 13

Five Project Focus Areas ............................................................................................................................................. 15

RMTEC PROJECTS ................................................................................................................................................... 16

PROJECT ACTIVITIES ............................................................................................................................................. 19

RMTEC PROJECT ACTIVITY TIMELINE .............................................................................................................. 20

Strengthening Tribal Public Health Infrastructure for Improved Health Outcomes .................................................... 22

Emergency Preparedness ............................................................................................................................................. 24

Health Codes ............................................................................................................................................................... 26

Institutional Review Board .......................................................................................................................................... 28

Infectious Disease/Chronic Disease ............................................................................................................................ 29

Maternal and Child Health .......................................................................................................................................... 33

Obesity Prevention ...................................................................................................................................................... 35

Cancer Outreach .......................................................................................................................................................... 39

Injury & Violence Prevention ...................................................................................................................................... 42

Environmental Health Initiative .................................................................................................................................. 44

Developing Community Health Profiles ..................................................................................................................... 46

Surveillance ................................................................................................................................................................. 48

Emerging Projects ....................................................................................................................................................... 50

Other ............................................................................................................................................................................ 50

Evaluation .................................................................................................................................................................... 53

Performance Measures ................................................................................................................................................ 58

Growth/Value Performance Measures ......................................................................................................................... 58

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History

The Rocky Mountain Tribal Epidemiology Center (RMTEC) is a division of the Montana

Wyoming Tribal Leaders Council (MTWYTLC). RMTEC started in the fall of 2005 in

collaboration with multiple stakeholders. A 5-year cooperative agreement with Indian Health

Services (IHS) to support RMTEC was awarded in 2006 and provided the core funding to start

RMTEC projects. RMTEC is currently on another IHS 5 year award since 2011.

RMTEC serves 10 Tribes on 8 Reservations in Montana and Wyoming - an American Indian

(AI) population of approximately 65,000 -120,000 (depending on source of data). All RMTEC

projects are developed through a Community Based Participatory Research (CBPR) approach.

The RMTEC advisory group includes the Montana - Wyoming Tribal Leader’s Committee on

Health and the ten (10) Tribal Health Directors (two in Wyoming and eight in Montana-

including the Little Shell Tribe of Montana) and other MTWYTLC/RMTEC stakeholders.

RMTEC Stakeholders present or report Community Health Priorities (CHP) to RMTEC for

intervention and project development. Tribal Health Directors represent all Tribes and

Reservations served by the Billings Area Office – Indian Health Service (BAO-IHS), providing

guidance and assistance to RMTEC.

RMTEC Vision

We contribute to healthy Tribal communities through lasting collaborative partnerships.

RMTEC Mission

To empower American Indian Tribes in Montana and Wyoming in the development of Public

Health services and systems and epidemiological data in order for Tribes to have resources and

express their authority in response to Public Health concerns.

RMTEC Values

Encourage and Nurture Intellectual Curiosity

High Quality Work

Honest and Open Communication

Integrity

Respect and Trust

Service with Humility

Unity of Purpose

RMTEC Believes

We believe in the sovereignty of Tribal Nations.

We believe our purpose is to serve the Tribes in the area of Public Health.

We believe in deferring to Tribal Public Health priorities in the development of all

projects.

We believe in open and honest communication that fosters an environment of Respect

and Trust.

Be believe in encouraging an environment the nurtures ideas, beliefs, perspectives and

cultures.

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Montana and Wyoming Tribes and Reservations

Assiniboine

Blackfeet

Confederated Salish and Kootenai

Chippewa Cree

Crow

Eastern Shoshone

Gros Ventre

Kootenai

Little Shell

Northern Cheyenne

Northern Arapaho

Sioux

Shoshone Bannock (awaiting legal assimilation)

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Public Health Authority

The MT-WY TLC is acting under a cooperative agreement with the Indian Health Service to

operate a Tribal Epidemiology Center, which is authorized by Section 214 (a)(1), Public Law 94-

437, Indian Health Care Improvement Act as amended by P.L. 573. In the conduct of this public

health activity, the MT-WY TLC may collect or receive protected health information for the

purpose of preventing and controlling disease, injury, or disability, including but not limited to,

the reporting of disease, injury, vital events such as birth or death, and the conduct of public

health surveillance, public health investigations, and public health interventions for Tribal

communities they serve. Further, the Indian Health Service considers this to be a public health

activity for which disclosure of protected health information by covered entities is authorized by

45 CFR 164.512(b) of the Privacy Rule.

Partners

Montana Wyoming Tribal Councils Northern Arapaho Business Council

Eastern Shoshone Business Council

Blackfeet Tribal Business Council

Chippewa Cree Business Committee

Confederated Salish and Kootenai Tribes

Northern Cheyenne Tribal Council

Crow Tribal Council

Fort Belknap Community Council

Fort Peck Tribal Executive Board

Little Shell Tribe of Chippewa Indians of MT

Fort Hall Business Council

Montana Wyoming Tribal Health Departments Northern Arapaho Tribal Health Department

Eastern Shoshone Tribal Health Department

Blackfeet Tribal Health Department

Chippewa Cree Tribal Health Department

Confederated Salish and Kootenai Tribal Health Department

Crow Tribal Health Department

Northern Cheyenne Tribal Health Department

Fort Belknap Tribal Health Department

Fort Peck Tribal Health Department

Little Shell Tribe of Chippewa Indians of MT

Shoshone-Bannock Tribal Health and Human Services Department

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State Health Departments Montana Department of Health and Human Services

Wyoming Department of Health

Institutions Montana State University

University of Montana

Sanford School of Medicine/University of South Dakota

Avera Research Institute

University of West Virginia

University of Nebraska

Pennsylvania State University

WESTAT

Agencies Indian Health Service – Division of Epidemiology & Disease Prevention

Billings Area Indian Health Service

Bureau of Indian Affairs – Rocky Mountain Regional Office

American Public Health Association

National Institute of Health

Centers for Disease Control

National Institute of Child Health/Development

Public Health Accreditation Board

National Association of Local Board of Health

Susan Komen for the Cure – Montana

Native American Management Inc.

Montana Public Health Association

WY All Hazards Steering Committee

Cancer Partners: NGOs/Hospitals/Clinics Montana Comprehensive Cancer Control (MTCCC)

Wyoming Comprehensive Cancer Control Consortium (WCCCC)

Susan G. Komen for the Cure Foundation

Montana American Indian Women’s Health Coalition (MAIWHC)

Montana Cancer Institute Foundation

American Cancer Society (Montana)

Montana Family Planning Clinics

Planned Parenthood

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St. Vincent Hospital

Benefis Health Care Systems (Sletten)

Northwest Healthcare

Shodair Hospital

St. Peters Hospital

Bozeman Deaconess

Bighorn Valley Health Center

River Stone Public Health Department

Billings Clinic

All 8 Montana/Wyoming Indian Health Service Units

Indian Family Health Clinic

Montana Tobacco Use Prevention Program (MTUPP)

American Indian Tobacco Prevention Specialists

Respecting the Tobacco Way

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Healthy People 2020 Overarching Goals

General Health Status: Attain high quality, longer lives free

of preventable disease, disability, injury, and premature death

Disparities and Inequity: Achieve health equality, eliminate

disparities, and improve the health of all groups

Social Determinants of Health: Create social and physical

environments that promote good health for all

Health –Related Quality of Life and Well-Being: Promote

quality of life, healthy development, and healthy behaviors

across all life stages

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10 Essential Public Health Services - Objectives

1. Monitor health status to identify community health problems.

2. Diagnose and investigate health problems and health hazards in the

community.

3. Inform, educate, and empower people about health issues.

4. Mobilize community partnerships to identify and solve health

problems.

5. Develop policies and plans that support individual and community

health efforts.

6. Enforce laws and regulations that protect health and ensure safety.

7. Link people to needed personal health services and assure the

provision of health care when otherwise unavailable.

8. Assure a competent public and personal health care workforce.

9. Evaluate effectiveness, accessibility and quality of personal and

population-based health services.

10. Research for new insights and innovative solutions to health

problems.

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Indian Health Service Tribal Epidemiology Center Core Funding

Specific Goals and Objectives

1. Assist American Indian/Alaska Native (AI/AN) communities, tribal

organizations, and urban Indian Organizations in developing disease surveillance

systems and identifying their highest priority health status objectives, based on

epidemiologic data. Collect data relating to, and monitor progress made toward

meeting, each of the health status objectives of IHS, the AI/AN communities,

tribal organizations, and urban Indian communities in the region. Assist and

facilitate reporting of nationally notifiable disease conditions to public health

authorities in the region.

2. Participate in the development of systems for sharing, improving, and

disseminating aggregate health data at a national level for purposes of advocacy

for AI/AN communities, Government Performance Results Act (GPRA), HP

2010, and other national-level activities.

3. Collaborate with national HHS programs in the development of standardized

surveillance and data monitoring methods and data sets.

4. Support responses to public health emergencies in collaboration with the IHS

Epidemiology Program, local, tribal, state, and other Federal health authorities.

5. Develop and implement epidemiologic studies that utilize the principles of

community engagement and that have practical application in improving the

health status of constituent communities. Studies may require Institutional Review

Board approval if human subjects are involved.

6. Develop and implement disease control and prevention programs in cooperation

with other public health entities. Make recommendations for targeting of public

health services needed by constituents.

7. Ensure the coordination of services and program activities with other similar

programs and establish a broad-based council to advise and support the program.

Such an advisory council would consist of technical experts in epidemiology and

public health, community members, health care providers, and others who could

provide overall program direction and guidance.

Tribal Epidemiology Centers are Indian Health Service division funded organizations

who serve American Indian/Alaska Native Tribal and urban communities by managing

public health information systems, investigating diseases of concern, managing disease

prevention and control programs, responding to public health emergencies, and

coordinating these activities with other public health authorities.

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Montana and Wyoming

Tribal Health Needs Assessments

The Montana Wyoming Tribal Leaders Council/Rocky Mountain Tribal Epidemiology

Center implemented a Health Needs Assessment with Montana and Wyoming Tribal

Health Departments (the health gate keepers of Montana Wyoming Tribes) in 2010.

Each Tribal Health Department was encouraged to list the top 3 health priorities of the

Tribe/Reservation and let MTWYTLC/RMTEC know how it can be of help over the next

five years 2012-2016. These health priorities were taken into consideration by

MTWYTLC/RMTEC while developing the project focus areas for the Epidemiology

Center for 2012-2016. The following are the top three health priorities by Tribe:

Table 1. Montana - Wyoming Tribe Specific Health Priorities

Tribe/Reservation Community Top 3 Health Priorities

Blackfeet Community Health Profiles

MT-WY Child/Youth Health Project

Suicide Data Tracking

Confederated Salish and Kootenai Maternal Child Health

Childhood Obesity

Suicide

Crow Childhood Obesity/ Sudden Infant

Death Syndrome (SIDS)

Cancer Screenings

Injury/Suicide

Rocky Boy Strengthening Tribal Relations

Fort Belknap Healthy Lifestyles (For all ages)

Obesity Prevention

Elder Care

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Fort Peck Mental Health Access

Maternal Child Health

Domestic Violence

Northern Cheyenne Strengthening Current Programs

Collaborate/Build Tribal Programs

Strengthening Reservation Staff

Skills and Ability

Northern Arapaho Youth/Adult Alcohol and Drug

Abuse

Youth/Adult Suicide

Youth/Adult Mental Health

Eastern Shoshone Diabetes

Substance and Chemical Abuse

Health Promotion /Disease

Prevention

Little Shell Childhood Obesity

Stress Reduction

Cancer Screening

Shoshone-Bannock Approached MTWYTLC in 2011 (pending

legal inclusion)

Environmental Health and Cancer as Tribal Leaders Health Priorities

Over the past decade, Montana and Wyoming Tribal Leaders have raised concerns about

Environmental Health and Health Outcomes of their communities (i.e Cancer).

MTWYTLC/RMTEC has been asked to include environmental health as one of its projects

over the next 5 years.

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Rocky Mountain Epidemiology Center Goals

1. Strengthen Individual Tribes’ Public Health Infrastructure and Capacity.

2. Improve Surveillance Data for Health Conditions and Diseases.

3. Provide Data and Technical Assistance to Support Health Promotion, Disease

Prevention (HP/DP) Objectives and Behavioral Health Strategies.

4. Implement Pilot Projects and Specific Studies to Address Tribally Identified Health

Priorities and Support Tribal Community Based Participatory Epidemiological

Studies.

5. Develop Tribal/Urban Indian Community Health Profiles and Tribe Specific Data

Collection Initiatives.

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Rocky Mountain Epidemiology Center

Project Focus Areas, Projects

and

Project Activities

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RMTEC

Five Project Focus Areas

1. Capacity Building

2. Infections/ Chronic Disease & Public Health Ethics

3. Healthy Lifestyles

4. Environmental Health & Disease Prevention

5. Community Health Profiles & Emerging Projects

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RMTEC PROJECTS

Capacity Building Projects:

1. Strengthening Public Health Capacity

2. Emergency Preparedness

Infections/ Chronic Disease & Public Health Ethics Projects:

3. Ethics

Tribal Health Codes

Institutional Review Board – IRB

Infectious Disease Surveillance

Chronic Disease Surveillance

Healthy Lifestyles Projects:

4. Maternal and Child Health

Pregnancy Risk Assessment

Sudden Unexpected Infant Death

5. Obesity Prevention

Child Health Measures

Child and Youth Health Project

Environmental Health & Disease Prevention Projects:

6. Cancer Outreach and Prevention

Susan Komen

Tobacco Use Prevention

7. Injury and Violence Prevention

8. Environmental Health Initiative

Community Health Profiles & Emerging Projects:

9. Data Improvement Projects for Community Health Profile Development/BRFSS

Behavioral Risk Factor Surveillances System –BRFSS

Behavioral Health Data Improvement Project

Chemical Dependence Resource

Child Maltreatment

Infectious Disease Surveillance

Chronic Disease Surveillance

10. Emerging Project based on Community Health Profiles

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Other:

Annual Trainings

1. Montana Wyoming Native Youth Development Project

2. Project Specific Trainings as Needed

3. Public Health Navigators

Annual Conferences

Technical Support

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RMTEC

PROJECT ACTIVITIES

RMTEC projects are based on three main categories of activities:

1. CAPACITY BUILDING ACTIVITIES

2. SURVEILLANCE ACTIVITIES

3. INTERVENTION ACTIVITIES

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RMTEC PROJECT ACTIVITY TIMELINE RESULTS &BENEFITS

Focus

Areas

Project

Implementation Details

Year 1 -

Year 5 Activities Results/Benefits A. Capacity Building X Capacity Building

Tribal Public Health

Empowerment for all Montana

and Wyoming Tribes

1. Strengthening Public

Health Capacity X Capacity Building

2. Emergency Preparedness X Capacity Building

B. Infectious/Chronic Disease & Public

Health Ethics X

Surveillance/Investigations

and Public Health

Navigation

Maintain a Surveillance

System for Diseases. Train

Tribal Public Health

*Navigators in Sanitation (As

Funding Allows); How to

Develop Health Codes for

their Communities; and How

to carry out Outbreak

Investigations/Interventions. 3. Tribal Ethics X Surveillance

C. Healthy Lifestyles X Surveillance/Interventions Maintain a Surveillance

System for Healthy Lifestyles;

Implement Child Health

Measures Project as a

surveillance System; Child and

Youth Projects as Intervention

Projects; and Train Tribal

Public Health *Navigators as

Perinatal Home Visitors (As

Funding Allows), and

Maternal Prenatal Care

Transporters.

4. Maternal and Child Health X Surveillance/Interventions

5. Obesity Prevention X Surveillance/Interventions

D. Environmental Health & Disease

Prevention X Surveillance/Interventions Implement an Injury/Violence

and Environmental Health

Surveillance System with

Health Outcomes (i.e. Cancer;

Accidents); Maintain Cancer

Outreach and Education;

Develop Injury and Violence

Prevention Interventions.

6. Cancer Prevention and

Screening X

Surveillance/Interventions

“Outreach/Education”

7. Injury and Violence

Prevention X

Surveillance/Strategic

Planning and Interventions

8. Environmental Health X

Surveillance/Strategic

Planning and Interventions

E. Community Health Profiles/BRFSS &

Emerging Projects X

Surveillance/Report

Dissemination

Collect, Analyze, Report and

Disseminate Tribe Specific

Community Health Profiles for

all Montana and Wyoming

Tribes; Partner with other

Tribal Epidemiology Centers

to develop National Tribal

Community Health Profiles;

and Implement the BRFSS

Project among Montana and

Wyoming American Indian

Population.

9. Community Health

Profiles/BRFSS X

Surveillance/Report

Dissemination

10. Emerging Projects based

on Community Health

Profiles X To Be Determined

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RMTEC

SPECIFIC PROJECTS

GOALS OBJECTIVES ACTIVITIES

RESULTS & BENEFITS

2012-2016

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Strengthening Tribal Public Health Infrastructure for Improved Health Outcomes

Goal: To systematically increase performance management capacity of the Tribal Health

Departments in MT and WY in order to ensure their access to resources needed to express

their public health authority.

Supplemental Funds from Center for Disease Control and Prevention (CDC) National

Public Health Improvement Initiative (NPHII) Grant

Objectives for Montana and Wyoming Tribes opting in for the project from 2010 -

2015:

1. Increase efficiencies of Montana and Wyoming Tribal Health Departments’

operations

2. Increase use of evidence –based policies and practices among Montana and

Wyoming Tribal Health Departments

3. Increase Montana and Wyoming Tribal Health Departments’ readiness for

(applying and achieving) accreditation by the Public Health Accreditation Board

(PHAB)

Capacity Building Project Activities:

Facilitate the National Public Health Performance Standards -NPHPSP, a local

Public Health System Assessments tool and the Mobilizing for Action through

Planning and Partnerships (MAPP) tool among all Montana and Wyoming Tribal

Health Departments.

Strengthen partnerships among collaborating agencies.

Establish Champion Workgroups (Performance Improvement/Public Health

Accreditation Tribal Advisory Board Panel/Task Force) within Montana-

Wyoming Tribes.

Host conferences/trainings with incorporated information sessions on public

health accreditation and best practices in performance improvement.

Link Tribes with resources and capacity building assistance to address their self-

assessed challenges.

Supplemental Funds from CDC-NPHII 2010-2015

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Activities by year/Results and Benefits:

In 2011: o Implement the Local Public Health Governance Assessment in the Fort Belknap,

Blackfeet and Rocky Boy Health Departments and organize a Departmental

Strategic Planning Session with these Tribal Health Departments and their

stakeholders.

In 2012: o Implement the Local Public Health Governance Assessment in the Fort Peck,

Eastern Shoshone and Northern Arapaho Tribal Health Departments and organize

a Departmental Strategic Planning Session with these Tribal Health Departments

and their stakeholders.

o Implement the Mobilizing for Action through Planning and Partnerships (MAPP)

in the Fort Belknap, Blackfeet and Rocky Boy Health Departments.

In 2013:

o Implement the Local Public Health Governance Assessment in the Crow,

Northern Cheyenne, Flathead and Little Shell Tribal Health Departments and

organize a Departmental Strategic Planning Session with these Tribal Health

Departments and their stakeholders.

o Implement the Mobilizing for Action through Planning and Partnerships (MAPP)

in the Fort Peck, Eastern Shoshone and Northern Arapaho Tribal Health

Departments.

In 2014:

o Implement the Mobilizing for Action through Planning and Partnerships in the

Crow, Northern Cheyenne, Flathead and Little Shell Tribal Health Departments.

o Implement a training session on Public Health Accreditation for all participating

Tribes and develop a resource guide for Public Health Accreditation for all

Montana and Wyoming Tribes and Train the Trainer sessions for independent

Tribal implementation of NPHPSP among participating Tribes.

In 2015:

o Prepare at least one of the participating Tribal Health Departments for Public

Health Accreditation application.

o Implement a training session on Public Health Accreditation for all participating

Tribes and develop a resource guide for Public Health Accreditation for all

Montana and Wyoming Tribes and Train the Trainer sessions for independent

Tribal implementation of NPHPSP among participating Tribes.

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Emergency Preparedness

Goal: To provide Tribal Emergency Preparedness Capacity Building Technical Support

to participating Montana and Wyoming Tribes.

Objectives for Montana and Wyoming Tribes opting in for the project from 2012 - 2016:

Partner with existing workgroups and agencies to help build the Emergency

Preparedness capacity of Montana and Wyoming Tribes.


Strengthen partnerships among collaborating agencies; collaborate with

established workgroups within Montana-Wyoming Tribes.

Link Tribes to resources and capacity building assistance to address their self-


Host conferences/trainings with incorporated information sessions on best

practices in performance improvement.

Activities/Results and Benefits:

Year 1

Strengthen partnerships among collaborating agencies by attending Region 8

Meetings.

Collaborate with established workgroups within Montana-Wyoming Tribes by

attending Bureau of Indian Affairs (BIA) meetings with Montana and Wyoming

Tribes.

Year 2


Meetings.



Tribes.



Year 3

Host conferences/trainings with incorporated information sessions on best

practices in performance improvement.


Meetings.



Tribes.

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Year 4


Meetings.



Tribes.



Year 5


Meetings.



Tribes.



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Health Codes

Health Codes:

Goal: To “Build Tribal Capacity” to Develop, Modify and Implement Tribal Public

Health Codes in order to improve public health practice in Tribal communities in

response to community health, emergency preparedness and research concerns.

The project will be implemented over the next five years (2012—2016) in 4 phases of

objectives:

Phase 1: Raising awareness of and improving readiness for Public Health Codes and

Regulations;

Phase 2: Gathering all relevant existing codes and evaluating their strengths and

weaknesses;

Phase 3: In consultation with all partners, drafting and developing modernized and

highly effective model Tribal Health Codes and Regulations;

Phase 4: In collaboration with all partners, ensure effective implementation of the

modernized Tribal Health Codes and Regulations.

Capacity Building Project A/B/Cs of Activities:

Health Code Development and Implementation Team

Develop Goals and Objectives with Timelines and Strategic Planning on

Development and Implementation/Enforcement of Tribal Community Health

Code

Develop Health Code “Activities” in order to meet the set Goals and Objectives

with Timelines for your Tribal Community Health Code Development and

Implementation Project, “Designating Staff/Departments” to each Activity with

Timelines


Year 1

Phase 1: Raising awareness of and improving readiness for Public Health Codes and

Regulations

Phase 2: Gathering all relevant existing codes and evaluating their strengths and

weaknesses

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Year 2


highly effective model Tribal Health Codes and Regulations

i. Identify and recruit key stakeholders in the community who will be involved in the

development, modification and implementation of Tribal Health Codes

ii. Health Code Development and Implementation “Team” meet at least twice a

month and develop Health Code Goals and Objectives

iii. Health Code Development and Implementation “Team” meet at least twice a

month and develop/modify Health Code from Templates and have Strategic Plan

meeting on health code implementation

Year 3


highly effective model Tribal Health Codes and Regulations

iv. Health Code Development and Implementation “Team” meet at least once with

the “Tribal Community” and the “Tribal Council” and Review/approve the Draft

Health Code

v. Health Code Development and Implementation “Team” meet with the “Tribal

Council” to promote the passing and implementation of the FINAL Draft Health

Code

Year 4/ Year5

Phase 4: In collaboration with all partners, ensure effective implementation of the

modernized Tribal Health Codes and Regulations

vi. Health Code Development and Implementation “Team” meet with the “Tribal

Council” to promote the implementation of the FINAL Draft Health Code

vii. Health Code Development and Implementation “Team” meet with the “Tribal

Council” to promote the evaluation of the FINAL Draft Health Code being

implemented

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Institutional Review Board

Goal: To promote awareness and advance the unique concerns of Tribal nations when

any research involves their constituents, ensuring that researchers engage Tribes in an

ethical and collaborative manner of process, resulting in mutually beneficial and

constructive ethical results -Rocky Mountain Institutional Review Board (RMT-IRB).

For more information please go to webpage:

http://www.mtwytlc.org/irb/rmtirb-home.html


Collaborate with established IRBs within Montana-Wyoming

Link Tribes to resources and capacity building assistance

Strengthen partnerships among collaborating agencies


Year 1

Participate in the Rocky Mountain Institutional Review Board meetings

Year 2


Strengthen partnerships among other Montana and Wyoming Institutional Review

Boards

Year 3 to Year 5


Strengthen partnerships among other Montana and Wyoming Institutional Review

Boards

Link RMT-IRB to needed resources to successfully implement Tribal IRBs

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Infectious Disease/Chronic Disease

Infectious Disease:

Goal: To improve public health practices among communities through sustainable

infectious disease prevention and establish an infectious disease surveillance system

(database) that will help with tracking notifiable diseases and other disease outbreaks

among Montana and Wyoming Tribes.

Surveillance/Report Dissemination Project Activities:


Partner with Billings Area Indian Health Service, Montana Department of Health

and Human Services -MT DHHS, Wyoming Department of Health -WY DoH and

other Health agencies to track notifiable diseases and other disease outbreaks




other Health agencies to develop a notifiable disease and other disease outbreak

surveillance system among Montana and Wyoming Tribes.



other Health agencies to intervene and curtail notifiable disease and other

disease outbreaks among Montana and Wyoming Tribes.

Implement at least one Face to Face All Hazards Training/Conference.

Surveillance: Public health surveillance is the ongoing, systematic collection, analysis,

interpretation and dissemination of data regarding a health related event for use in public

health action to reduce morbidity and mortality and to improve health.

Attributes of Public Health Surveillance System include:

Simplicity

Data quality

Sensitivity

Acceptability

Flexibility

Predictive value

Representativeness

Timeliness

Stability

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Year 1

Partnerships with Billings Area Indian Health Service, Montana Department of

Health and Human Services -MT DHHS, Wyoming Department of Health -WY

DoH and other Health agencies to track notifiable diseases and other disease

outbreaks among Montana and Wyoming Tribes.



DoH and other Health agencies to intervene and curtail notifiable disease and

other disease outbreaks among Montana and Wyoming Tribes.

Year 2



DoH and other Health agencies to develop a notifiable disease and other disease

outbreak surveillance systems among Montana and Wyoming Tribes.



DoH and other Health agencies to track notifiable diseases and other disease




DoH and other Health agencies to intervene and curtail notifiable disease and

other disease outbreaks among Montana and Wyoming Tribes.

Year 3

Implement at least one Face to Face All Hazards Training/Conference

Goal: To improve the Surveillance Capacity of Montana and Wyoming American

Indians in collaboration with all Montana and Wyoming disease surveillance partners,

public health authorities and hospitals, in order for Tribes to be prepared and able to

respond to all public health hazards (All Hazards).

The Montana Wyoming Tribal All Hazards Advisory Committee will be

comprised of the 10 Montana and Wyoming Tribal Health Directors, Health gate

keepers for the 8 Reservation Communities in Montana and Wyoming (the

Wyoming Wind River reservations has two Tribal Health Directors); All Montana

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and Wyoming Tribal/IHS Service Unit/Hospital Chief Executive Officers (CEOs)

and Public Health Nurses; Representatives from the Montana Department of

Health and Human Services MT-DHHS; Representatives from the Wyoming

Department of Health WY-DoH; Billings Area Indian Health Service – Chief

Medical Officer, Environmental Health Specialist and Indian Health Service

Sanitarians, Chief Immunization Nurse Contractor; and MTWYTLC/RMTEC

Staff including, RMTEC Acting Director/Senior Epidemiologist; RMTEC

Infectious Disease/Emergency Preparedness Epidemiologists, RMTEC

Statistician (for data analysis mainly); RMTEC Data Manager and RMTEC

Research Assistants.







other Health agencies to intervene and curtail notifiable disease and other disease


Year 4/Year 5







other Health agencies to intervene and curtail notifiable disease and other disease


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Chronic Disease Project:

Goal: To improve public health practices among communities through sustainable

chronic disease prevention and establish a chronic disease surveillance system (database)

that will help with tracking chronic diseases among Montana and Wyoming Tribes.





other Health agencies to track chronic diseases among Montana and Wyoming

Tribes.



other Health agencies to develop a chronic disease surveillance system among

Montana and Wyoming Tribes.



other Health agencies to intervene and reduce chronic diseases among Montana

and Wyoming Tribes by seeking intervention funds.


Year1



DoH and other Health agencies to track chronic diseases among Montana and

Wyoming Tribes.

Year2



DoH and other Health agencies to develop a chronic disease surveillance system





Wyoming Tribes.

33

Year 3 to Year 5




Wyoming Tribes.



DoH and other Health agencies to intervene and reduce chronic diseases among

Montana and Wyoming Tribes by seeking intervention funds.

Maternal and Child Health

Sudden Infant Death:

RMTEC has a contract with Native American Management Services (NAMS), Inc to

implement “Healthy Native Babies”, a Eunice Kennedy Shriver National Institute of

Child Health and Human Development (NICHD) project, among American Indians (AI)

in Montana and Wyoming. “Healthy Native Babies” is a risk reduction SIDS prevention

message aimed at high risk populations among AI in Montana and Wyoming.

Supplemental Funds from Native American Management Services -NAMS Contract

Surveillance/Intervention Project Activities:

Implement the Native American Management Services, Inc Contract from 2009-2012 or

as long as it lasts.

Activities/Results and Benefits (Based on Contract):

Year 1 to Year 5

Participate in Healthy Native Babies Workgroup meetings.

Disseminate Healthy Native Babies Risk Reduction Materials to constituents.

Implement Train the Trainer trainings among Montana and Wyoming Tribes and

other Tribes in U.S (i.e Parenting Skills Training).

Supplemental Funds from NAMS/NICHD 2009-2012

34

Pregnancy Risk Assessment:

Goal: To implement an American Indian Pregnancy Risk Assessment Monitoring System

(PRAMS) Survey (a Maternal Health Behaviors Survey). PRAMS is a Replication Pilot

study with Reservations opting in. This study explores innovative techniques to ensure

adequate American Indian response rates and data quality.


Objectives for Montana and Wyoming Tribes “opting in” for the project from 2012 -

2016:

Collaborate with the Wyoming Department of Health –WY OH to over-sample

American Indians effectively during the implementation of Wyoming PRAMS.

Collaborate with the Montana Department of Health and Human Services MT

DHHS (when funded) to over-sample American Indians effectively during the

implementation of Montana PRAMS.

Participate in the data analysis, reporting and dissemination of results from

implemented PRAMS by the state of Montana (when funded) and Wyoming, and

report results to Montana and Wyoming Tribes

Offer technical support to Tribes in Montana and Wyoming to implement and

seek funding for interventions for their Maternal and Child Health population.


Year 1/Year 2

Collaborative partnerships built with the Wyoming Department of Health –WY

DoH, and an over-sampling of American Indians effectively during the

implementation of Wyoming PRAMS.

Collaborative partnerships with the Montana Department of Health and Human

Services MT DHHS, and an over-sampling of American Indians effectively

during the implementation of Montana PRAMS.

Year 3 to Year 5

Participation in the data analysis, reporting and dissemination of results from

implemented PRAMS by the state of Montana and Wyoming, with reports and

information disseminated to Montana and Wyoming Tribes

35

Obesity Prevention

Child Health Measures (CHM):

Goal: To help inform participating Tribes on health measures associated with the risks

for childhood obesity, diabetes, and heart disease among participating Tribes’ children.

Screening children in kindergarten through high school with the following measurements:

BMI, Blood Pressure, Acanthosis presence, and Asthma diagnosis. Trained Tribal field

workers who volunteer to help with the project (measurements) from participating

Reservations perform these tasks.

Surveillance/Intervention Project Activities: There are ten (10) STEPS to follow annually and Child Health Measures is divided into

eight (8) STATIONS.

Step 1: School Participation and Student Information

Step 2: Community Information

Step 3: Parent Consent Process and Child Assent Process

Step 4: Child Health Measures

Station 1: Child Assent/Parent Consent and Measurement Sheet…

Station 2: Blood Pressure and Pulse Station (Pulse is optional)

Station 3: Weigh Measurement

Station 4: Height Measurement

Station 5: Waist Circumference Measurement

Station 6: Hip Circumference Measurement

Station 7: Acanthosis Measurements

Station 8: Question Answering Station

Step 5: Referral Process

Step 6: Incident Report/Data storage, transfer, analysis and report dissemination process

Step 7: Report Cards

Step 8: Data Storage, Transfer, Analysis and Report Dissemination Process

Step 10: Data Requests

Step 9: Attend the Annual Child Health Measures Training

Supplemental Funds from IHS/CYP 2010-2012

36


Year1 to Year 5

Annual Measures: The ten (10) STEPS above will be implemented by local

Child Health Measures teams on each participating Reservation annually.

Annual Follow–ups: Each year, parents will be notified of their child’s

measurement status via a “Child Health Measurement Report Card”. If the

measurement screening identifies a child with potential abnormal measures, their

parent will also be notified via a letter to encourage the parent and child to follow

up with a local health care provider.

Annual Intervention Funding: The information collected is used to inform the

Tribal Leaders on Child Health Measures trends in their community. This helps

leaders identify ways to prevent childhood obesity and its’ complications among

children living in Montana and Wyoming Reservations. The CHM measurement

cumulative data will also be used to apply for intervention funds.

Montana Wyoming Native Child & Youth Project (CYP):

Goal: To promote the body, mind and spiritual well-being of Montana and Wyoming

American Indian School age children and youth, ages 5 to 19 years by refurbishing safe

and accessible play places for children in the reservation communities, while encouraging

healthy traditional foods and culturally appropriate emotional well-being and social skills

development.

Supplemental Funds from Indian Health Service (IHS) Child and Youth Project (CYP)


Mobilize the community to assist in refurbishing already existing Reservation

recreational facilities, making them child friendly and safe for play.

Assist with salary funds, trainings and certification of nominated Tribal Staff

Recreation Guides/Aids.

Assist with accessing and promoting age-appropriate healthy traditional foods.

37


Year 1

(FY 10) Project Type Tribes

Tribe 1 Play Place Refurbishment/Recreation Guide

Wind River - Northern

Arapaho

Tribe 2 Play Place Refurbishment/Recreation Guide

Wind River – Eastern

Shoshone

Tribal

Consultants

Tribal Physical Education

Specialist/Nutritionist/Traditional Games

Consultants Project Evaluator

Year 2


Tribe 3 Play Place Refurbishment/Recreation Guide Northern Cheyenne

Tribe 4 Play Place Refurbishment/Recreation Guide Blackfeet

Tribe 1 Recreation Guide


Arapaho



Shoshone

Tribal

Consultants



Year 3


Tribe 5 Play Place Refurbishment/Recreation Guide Fort Peck



Arapaho



Shoshone

Tribe 3 Recreation Guide Northern Cheyenne

Tribe 4 Recreation Guide Blackfeet

Consultants Project Evaluator

Tribal

Consultants



Year4/Year5

**Supplemental Funding Ending June 2013: due to lack of resources from funding

agency

38

Child Health Measures/Montana Wyoming Native Child & Youth Project Logic Model

39

Cancer Outreach

Cancer Outreach Project:

Goal: The Cancer Outreach Project will increase cancer outreach to American Indians by

educating, encouraging early cancer screening/diagnosis, and offering survivorship

coaching for Montana and Wyoming American Indians in collaboration with

Montana/Wyoming Cancer Stakeholders.


Education:

o Distributing education materials

o Train the Trainer Activities

o Organization of Cancer Summit with other Montana/Wyoming Cancer

Stakeholders

Outreach:

o Offering links to resources

o Serving as a resource for access to quality cancer continuum of care

o Organization of Cancer Summit with other Montana/Wyoming Cancer

Stakeholders

Project Activities:

Year 1 to Year 2

Distribution of education materials

Serving as a resource for access to quality cancer continuum of care

Offering links to resources

Year 3 to Year 5

Train the Trainer Activities

Organization of Cancer Summit with other Montana/Wyoming Cancer

Stakeholders

Distribution of education materials

Serving as a resource for access to quality cancer continuum of care

Offering link to resources

Susan G. Komen for the Cure:

Goal: The Breast Cancer Outreach Project will increase the survival rate of American

Indians with breast cancer through education, encouraging early screening, diagnosis, and

offering survivorship coaching; distributing education materials and serving as a resource

for access to quality cancer continuum of care for Montana AIs in collaboration with

Montana Cancer Stakeholders. **Supplemental Funding Ended Sept 30, 2012

40

Surveillance/Intervention Project Activities/Results and Benefits:

41

Tobacco Use Prevention:

Goal: To engage Montana and Wyoming Tribal Youth to become agents of Social

Change for Culturally-Relevant Tobacco Control.


Partner with Montana and Wyoming Tobacco Prevention Stakeholders to track

Tobacco use on Montana and Wyoming Reservations using secondary data (i.e

Youth Risk Behavioral Surveillance System -YRBS and Behavioral Risk Factor

Surveillance System -BRFSS)

Partner with Montana and Wyoming Tobacco Prevention Stakeholders to

intervene and reduce Tobacco use among Montana and Wyoming Tribes by

seeking intervention funds for social marketing.


Year 1/Year2

Partnerships with Montana and Wyoming Tobacco Prevention Stakeholders to

track Tobacco use on Montana and Wyoming Reservations using secondary data

(i.e Youth Risk Behavioral Surveillance System -YRBS and Behavioral Risk

Factor Surveillance System -BRFSS)

Develop and Disseminate YRBS Tobacco Use Fact Sheets

Develop and Disseminate BRFSS Tobacco Use Fact Sheets

Year 3 to Year 5

Partnerships with Montana and Wyoming Tobacco Prevention Stakeholders to

intervene and reduce Tobacco use among Montana and Wyoming Tribes by

seeking intervention funds for social marketing.

Engaged youth in the development of Tobacco Use Prevention

Social Marketing Champaign Materials

Engaged youth in the dissemination of Tobacco Use Prevention

Social Marketing Champaign Materials

BASED ON FUNDING AND ON AN OPT-IN/OPT-OUT BASIS

42

Injury & Violence Prevention

Goal:

To collect, analyze and report intentional and un-intentional injury data in order for

Tribal communities to understand the injury status of their community; and

To develop a comprehensive strategic plan in collaboration with all Montana and

Wyoming injury stakeholders to be implemented in the Billings Indian Health Service

Area, in order to reduce the adverse effect of injury among Montana and Wyoming

Reservations.

Surveillance/Strategic Planning/Intervention Project Activities:

Partner with Montana and Wyoming Injury and Violence Prevention Stakeholders to

track injury and violence on Montana and Wyoming Reservations.


develop a comprehensive Strategic Plan for injury and violence prevention on

Montana and Wyoming Reservations.


intervene and reduce injury and violence among Montana and Wyoming Tribes by

seeking intervention funds.


Year 1 to Year 3

Partner with Montana and Wyoming Injury and Violence Prevention

Stakeholders to track injury and violence on Montana and Wyoming

Reservations.

Collaborate with Tribal Health Departments on intentional/un-intentional

injury and violence prevention data.

o Identification of “Injury Prevention Best Practice/Promising

Projects” among American Indians in Montana and Wyoming

and in US.

Collaborate with Billings Area Indian Health Service to track intentional/un-

intentional injury and violence data.

o Identification of “Injury Prevention Best Practice/Promising

Projects” among American Indians in Montana and Wyoming

and in US.

o Manuscript Development: “Intentional and Un-intentional

Injury among American Indians in Montana and Wyoming”.

Collaborate with West Virginia University to study the risk indicators of

43

suicide among Montana and Wyoming Youth

o Manuscript Development: “A Study on Suicide Risk Indicators

among American Indian Montana Youth”.

o Manuscript Development: “Life expectancy deficits in Montana

American Indians”.

Implement Promising Practices including Suicide data tracking project: A

suicide data improvement project (AS FUNDING ALLOWS)

o RMTEC collaborates with Tribal Health Departments to

implement suicide data tracking project as a promising practice.

The purpose of the project is:

• To understand suicide and suicide attempts on the Reservations;

• To demonstrate the process of increasing the scope of data collection on suicidal

behaviors of eligible American Indian (AI) residents, on Reservations of interest;

• To generate more complete data on suicidal attempts, in order to improve

prevention, treatment and decrease attempts and fatalities of suicides on the

Reservations.

Both conventional and non-conventional methods were allowed in obtaining more

complete data on suicide attempts and completions. Implementation of the project

involved collaboration between IHS mental health professionals and Tribal mental health

outreach workers.


develop a comprehensive Strategic Plan for injury and violence prevention on

Montana and Wyoming Reservations

Collaborate with the Montana Wyoming Tribal Leader Council’s Strategic

Prevention Framework Tribal Incentive Grant (SPF-TIG), also known as the

Rocky Mountain Tribal Wellness Initiative (RMTWI).

Collaborate with the Montana Wyoming Tribal Leader Council’s Planting

Seeds of Hope (PSOH), a youth suicide prevention project.

Collaborate with Billings Area Indian Health Service’s Injury Prevention

program to strategize on a comprehensive Montana and Wyoming Tribal

injury and violence prevention Strategic Plan .

Year 4/Year 5


intervene and reduce injury and violence among Montana and Wyoming Tribes by

seeking intervention funds.

Collaborate with the Centers for Disease Control and Prevention (CDC)

project –”Indian Health Service (IHS) collaboration for injury-related issues

with the Tribal Epidemiology Centers”.

44

Environmental Health Initiative

Goal: The goal of the initiative is to provide a systematic assessment of environmental

risks; a framework for long-term surveillance of environmental health indicators; develop

environmental health policies and remediations; and build Tribal environmental health

capacity.

Surveillance/Strategic Planning/Intervention Project Activities:

Phases of Objectives:

Phase 1:

Assessment: The systematic assessment of environmental risk indicators and associated

health outcomes at suspected high-risk areas identified by Tribes; conducting community

impact assessment/surveillance studies and strategizing on solutions based on the

findings of the assessments and surveillance.

Phase 2:

Surveillance: Establishment of a framework for long-term surveillance of environmental

health indicators in order to establish baseline characteristics and “direct” policy

initiatives.

Phase 3:

Remediation Measures/Emergency Preparedness Policy Initiatives: Follow-up and

implementation of recommendations for remediation measures, policy initiatives, and

legislative efforts based on the strategic plans in phase 1 and 2.


Year1/Year2

Phase 1:

Assessment: Systematic assessment of environmental risk indicators and associated

health outcomes at suspected high-risk areas identified by Tribes; conducting community

impact assessment/surveillance studies and strategizing on solutions based on the

findings of the assessments and surveillance.

These are immediate/urgent needs for assessments and are the initial steps in the

MTWYTLC/RMTEC Environmental Health Initiative. There is high risk for adverse

health outcomes identified by RMTEC in collaboration with the Tribes, will be reported

back to the Tribes at local “Community Meetings” and a full report written and submitted

to the Tribal Leaders. Remedies will be sought by the Tribes in collaboration with

MTWYTLC/RMTEC.

45

Phase 1 Activities are Comprise of Seven (7) Main Steps:

1. MTWYTLC/RMTEC site visit to the community and the high risk area identified

by the Reservation Community as environmental high risk area

2. Community Readiness Tests

3. Develop Community Impact Assessment Tools and Surveillance Studies Protocol

4. Resolutions, Letters of Support and or Memorandum of

Agreement/Understanding (MOA/MOU)

5. Institution Review Board (IRB) Approval

6. Implement the Community Impact Assessment on participating Reservation sites

7. Strategizing on solutions based on findings of the assessments and surveillance;

and recommend remediation measures to be shared/disseminated to participating

Reservation Communities

Year 3-Year 5

Phase 2:

Surveillance: Establishment of a framework for long-term surveillance of environmental

health indicators in order to establish baseline characteristics and “direct” policy

initiatives.

The surveillance will be based on Tribe-specific strategic plans, drafted in collaboration

with Tribes. This phase will also include training and capacity building for emergency

preparedness, based on needs.

Phase 2 Activities are Comprise of Three (3) Main Steps:

1. Assessment of existing Surveillance resources available to the Tribal

Environmental Departments/Programs

2. Tribal Environmental Departments/Programs “Readiness Tests”

3. Systematic data collection, analysis, easy to understand reporting (to Tribal

Communities and Leaders), dissemination of report and strategic planning

Phase 3:

Remediation Measures/Emergency Preparedness Policy Initiatives: Follow-up and

implementation of recommendations for remediation measures, policy initiatives, and


Exploration of funding opportunities to sustain surveillance and follow-up on

recommended activities depending on the outcomes of Phases 1 and 2.

Phase 3 Activities are Comprise of Three (3) Main Steps:

1. Assessment of strategic plans in phase 1 and 2

2. Tribal Community, Tribal Leader and Tribal Environmental

Departments/Programs “Readiness Tests”

3. Systematic development of remediation measures, policy initiatives, and


46

Developing Community Health Profiles

Behavioral Health Data Improvement Project:

Goal: To assess the needs of the Tribal Chemical Dependency program staff in

collecting, entering and extracting data on the services provided using the Indian Health

Service -IHS BH software and the AccuCare system by performing a needs assessment.


Activities/Results and Benefits Year 1 to Year 5:

Inform, educate, and empower chemical dependency program staff about

importance of data entry in order to identify behavioral health issues; and

mobilize community partnerships to reduce behavioral health problems.

Data training will be offered based on funding and recommendations from the

needs assessment in order for data to be collected, reporting and used by the

Tribal Government and Tribal Health Department to improve the quality of client

services.

Research for insights and innovative solutions to Behavioral Health problems

Data Improvement Projects

BASED ON FUNDING AND ON OPT-IN/OPT-OUT BASIS

47

Chemical Dependency Resource Assessments:

Goal: To collect, analyze and report data from Chemical Dependency Programs/Centers

on the Reservations and urban areas in Montana and Wyoming.

This project provides the Tribes a standardized information system as a basis for

comparison for longitudinal evaluation of resources available to clients over the years in

Chemical Dependency Centers serving Montana and Wyoming Tribes.



Inform, educate, and empower chemical dependence program staff on the

resources available and the resources needed to implement a successful Chemical

Dependency program

Mobilize community partnerships to research new insights and innovative

solutions to chemical dependency program resource and sustainability problems

Child Maltreatment:

Goal: To work with the Bureau of Indian Affairs -BIA to identify specific risk factors

associated with child maltreatment among American Indian (AI) children in MT and

WY.


Promote the use of a more specific analyzable database/surveillance system which

includes risk factors for child maltreatment in collaboration with BIA.

Develop and Disseminates reports on Child Maltreatment with recommended

sustainable solutions for Montana and Wyoming Tribes

Year 1/Year 2

Develop a Memorandum of Understanding (MOU) for data sharing and analysis

of the data generated by the developed BIA Child Maltreatment database

Year 3 to Year 5

Generate periodic reports from the database on Child Maltreatment with

recommended sustainable solutions for Montana and Wyoming Tribes

Disseminate the Child Maltreatment periodic reports to Participating Montana and

Wyoming Tribes via BIA

48

Surveillance

Goal: To implement BRFSS, increasing response rates for American Indian Population

in Montana and Wyoming, following the Center for Disease Control and Prevention -

CDC BRFSS survey protocol with data comparable to state and national BRFSS data.

Montana Wyoming Tribal BRFSS Project Advisory Committee:

The Montana Wyoming Tribal BRFSS Project Advisory Committee will comprise of the

10 Montana and Wyoming Tribal Health Directors, Health gate keepers for the 8

Reservation Communities in Montana and Wyoming; The Montana Department of

Health and Human Services MT-DHHS BRFSS Coordinator and the Wyoming

Department of Health WY-DoH BRFSS Coordinator; the University of Nebraska

(Institutional contractors implementing the surveys on behalf of RMTEC) designee; and

RMTEC Staff.


Montana Wyoming Tribal BRFSS Project Advisory Committee will discuss:

1. Tribal BRFSS awareness among RMTEC Tribal Advisory Committee including

the Tribal Health Directors, Tribal Leaders and Montana and Wyoming Tribes

2. Tribal BRFSS Community Readiness test for Montana and Wyoming Reservation

Communities

3. Tribal BRFSS implementation Methodology and Protocol for participating

Montana and Wyoming Tribes

4. Tribal BRFSS Feasibility Study on participating Montana and Wyoming

Reservation Communities

5. Tribal BRFSS Long Term Oversampling Methodology among Montana and

Wyoming state BRFSS samples

Behavioral Health Risk Factor Surveillance System

(BRFSS) Project:

See Above for Infectious Disease/Chronic Disease Surveillance

49


RMTEC 2011-2016 BRFSS Project Five Year Schedule for the BRFSS

Project Implementation Details

Year

1

Year

2

Year

3

Year

4

Year

5

Meet with RMTEC Tribal Advisory Committee

including the Tribal Health Directors and Tribal

Leaders X X

Review of the BRFSS project with Tribal support

in form of Letters X X

Develop a protocol for conducting the BRFSS

approved by the Montana Wyoming Tribal

BRFSS Project Advisory Committee and

participating Reservation Communities X X

Develop a sampling method and recruitment

strategy approved by the Montana Wyoming

Tribal BRFSS Project Advisory Committee and

participating Reservation Communities X X

Obtain Tribal IRB and University of Nebraska

IRB Approval X

Develop a training protocol for interviewers for

the BRFSS with the University of Nebraska X

Develop a database to enter BRFSS data in

partnership with the University of Nebraska X

Implement the BRFSS Survey; Data Collection; in

partnership with the University of Nebraska X

Analyze data; Develop Reports; Develop a report

dissemination plan that includes a project

overview, dissemination goals, targeted audiences

and key messages X X

Evaluated the Project/ Lessons Learned –BRFSS

in Indian Country X

50

Emerging Projects

Other


Technical Support (Ongoing)

Offer Technical support for all RMTEC and other Tribe specific projects upon

request and as needed to Montana and Wyoming Tribes.

Annual Conference

Participate in the planning and implementation of the Annual Montana Wyoming

Tribal Leaders Council’s Health Conference.

Annual Capacity Building Training

Participate in the planning and implementation of Annual Capacity building

Training as needed or upon request by Montana or Wyoming Tribe.

Montana Wyoming Native Youth Development Project

Project Specific Trainings as Needed

Public Health Navigators

Technical Support/Trainings/Annual Conference:

Emerging Projects:

These will be based on current Montana and Wyoming Tribal Community Health Profiles

and emerging health needs and priorities (for example - Men’s Wellness - Pending

Funding)



51

Montana Wyoming Native Youth Development Project:

Goal: To encourage Individual Intern Capacity Building


An opportunity to work on prevention projects of public health concern on

Reservations

An opportunity to earn credit units and/or do a practicum/earn a certificate

This is a paid Internship job opportunity

(Stipends will depend on funding and prior qualifications of the intern)


One youth will be chosen from a Montana or Wyoming Tribe each year with the Tribes

rotating over the next 10 years.

Summary: There are two components of the Montana Wyoming Youth Development

Project: 1) Youth Data/Health Skills Development and 2) Summer Youth Development

Camp

Youth Data/Health Skills Development

The Youth Data Skills Development Project is a youth development focused project that

entails mentoring at least one youth with an associate/bachelors degree from a Montana

or Wyoming Tribe annually as an Epidemiology/Health Education/Peer Education Intern

at the Rocky Mountain Tribal Epidemiology Center (RMTEC). The youth is employed as

a Research Assistant and assists with RMTEC projects.

Summer Youth Development Camp

The purpose of the “Summer Youth Development Camp” for Middle and High School

age group is to:

Empower youth to handle life situations;

Increase knowledge of public health epidemiology fundamentals;

Increase public health and epidemiology literacy;

Increase ability to create positive norms;

Propose a plan for advancing the health of youth on their Reservations;

Decrease dropout rates and increase interest in the Public Health and Sciences.

Each youth is awarded a certificate of participation at the end of the Summer Camp.

Summer Camp implementation is dependent on funding.

52

Public Health Navigators:

Public Health Navigators will provide culturally appropriate and community relationship-

appropriate Public Health information; social support; and Community Public Health

advocacy to their Reservation Communities and will be directly under the supervision of

the Tribal Health Directors as a Tribal contractor working on RMTEC projects with

the Tribal Health Departments.

RMTEC will have contracts with all 10 Tribal Health Departments in Montana and

Wyoming for the salary of a Public Health Navigator in order to be able to implement

projects successfully at the Reservation Community Level. Each Public Health

Navigator’s immediate supervisor will be the Tribal Health Director of the Reservation

Tribal Health Department.

A Public Health Navigator job will include, but is not limited to, implementing RMTEC

projects among participating Tribal Health departments as needed. Each Tribal Health

Department will determine what duties/trainings their Public Health Navigator will

have depending on Tribal Health Department needs and the RMTEC projects opted

in by Tribal Health Department.

RMTEC will organize an annual Training for the Public Health Navigators in the

following topic areas based on Tribal Health Department Needs:

Community Assessments/Survey Implementation

Maternal and Child Health Navigation/Train the Trainer Parenting Classes

Health Codes Implementation

Outbreak Investigation – Organized by RMTEC for action by Tribal

Health Department

Public Health Preparedness

Other Topics as needed


NOTE

A Public Health Navigator is NOT an IHS Sanitarian:

Public Health Navigators do not have environmental Health Degrees or

Environmental Health Inspection or investigation duties or educational

background (i.e Vector control, food inspection, water/sewage system inspection)

Public Health Navigators are Trusted Community Members trained by RMTEC

to carry out RMTEC projects on the Reservations under direct supervision of

Tribal Health Directors

53

Rocky Mountain Tribal Epidemiology Center

Evaluation Measures of Progress

Healthy

People

2020

10

Essential

Public

Health

Services

Indian

Health

Service

RMTEC

Project

Goals

RMTEC Project Project Measure of

Progress

Social

Determinants

of Health:

Create social

and physical

environments

that promote

good health for

all

Mobilize

community

partnerships to

identify and

solve health

problems

Develop

policies and

plans that

support

individual and

community

health efforts

Ensure the

coordination of

services and

program activities

with other similar

programs and

establish a broad-

based council to

advise and support

the program.

Support responses

to public health

emergences in

collaboration with

the IHS

Epidemiology

Program, local,

Strengthen

Individual

Tribes’ Public

Health

Infrastructure

and Capacity

Capacity Building Projects:

1. Strengthening Public Health

Capacity

2. Emergency Preparedness

Other:

Annual Trainings

o Montana Wyoming

Native Youth

Development Project

o Project Specific

Trainings as Needed

Tribal Public Health Capacity:

Measure of Public Health

Performance Improvement of


* (Measure: NPHPSP)

Measure of Emergency

Preparedness Performance

Improvement (Measure:

NPHPSP)

Workforce Development:

Number of Tribal Public Health

Workforce Improved

54

Assure a

competent

public and

personal health

care workforce

tribal, state, and

other Federal health

authorities. o Public Health

Navigators

Annual Conferences

Technical Support

General Health

Status: Attain

high quality,

longer lives free

of preventable

disease,

disability,

injury, and

premature death

Monitor health

status to identify

community

health problems

Diagnose and

investigate

health problems

and health

hazards in the

community

Enforce laws

and regulations

that protect

health and

ensure safety

Assist in developing

disease surveillance

systems and

identifying their

highest priority

health status

objectives, based on

epidemiologic data.

Collect data relating

to, and monitor

progress made

toward meeting,

each of the health

status objectives

Assist and facilitate

reporting of

nationally notifiable

disease conditions

to public health

authorities in the

region.

Improve

Surveillance

Data for Health

Conditions and

Diseases

Infections/ Chronic Disease & Public

Health Ethics Projects:

3. Ethics

Tribal Health Codes

Institutional Review

Board –IRB

Infectious Disease

Surveillance

Chronic Disease

Surveillance

Ethics:

Measure of Number of Tribal

Policy Development

Encouraged

Measure of support for IRB and

number of meetings participated

in

Infectious/Chronic Disease:

Development of an Infectious

Disease and Chronic Disease

Surveillance System Protocol in

collaboration with other

Montana and Wyoming

Agencies

Health Related

Quality of Life

and Well-

Being: Promote

quality of life,

Research for

new insights

and innovative

solutions to

health problems

Develop and

implement

epidemiologic

studies that utilize

the principles of

Implement Pilot

Projects and

Specific Studies

to Address

Tribally

Healthy Lifestyles Projects:

4. Maternal and Child Health

a. Pregnancy Risk

Assessment

Maternal and Child Health:

Number of Studies on Maternal

and Child Health Needs

Implemented/Reported

55

healthy

development,

and healthy

behaviors across

all life stages

community

engagement and

that have practical

application in

improving the

health status of

constituent

communities.

Identified Health

Priorities and

Support Tribal

Community

Based

Participatory

Epidemiological

Research

b. Sudden Unexpected

Infant Death

5. Obesity Prevention

a. Child Health Measures

b. Child and Youth

Health Project

Number of Trainings on Capacity

Building for Parenting Skills

Obesity Prevention:

Measure of improved Health

Measure, Reducing Obesity

**(Measure: Child Health

Measures)

Number and Type of

Interventions Implemented

Emerging Projects:

Developing New and Innovative

Projects for Tribe Self Sustaining

Prevention/Intervention Projects based

on Tribal Community Health Profiles

in Collaboration with Montana and

Wyoming Tribes

Disparities and

Inequity: Achieve health

equality,

eliminate

disparities, and

improve the

health of all

groups

Inform, educate,

and empower

people about

health issues

Link people to

needed personal

health services

and assure the

provision of

health care

when otherwise

unavailable

Develop and

implement disease

control and

prevention

programs in

cooperation with

other public health

entities. Make

recommendations

for targeting of

public health

services needed by

constituents.

Provide Data and

Technical

Assistance to

Support Health

Promotion,

Disease

Prevention

(HP/DP)

Objectives and

Behavioral

Health Strategies

Environmental Health & Disease

Prevention Projects:

6. Cancer Outreach and

Prevention

a. Susan Komen

b. Tobacco Use

Prevention

7. Injury and Violence Prevention

Cancer Outreach:

Number of Target Population

Reached

Measure of collaboration with

other Cancer Stakeholder

Agencies/Organizations

Injury/Violence Prevention:

Development of an Injury and

Violence Prevention Strategic

Plan in collaboration with other

Montana and Wyoming

56

8. Environmental Health Initiative

Agencies

(Measure: Strategic Plan

Developed)

Development of an

Injury/Violence Prevention

Surveillance System Protocol in

collaboration with other Montana

and Wyoming Agencies

Measure of collaboration with

other Injury and violence

Stakeholder

Agencies/Organizations

Environmental Health

Initiative:

Measure of progress based on

the three phases of the initiative:

-1) Needs Assessment

-2) Surveillance

-3) Remediation

Emerging Projects:

-Developing New Innovative and Tribe

Self Sustaining

-Prevention/Intervention Projects

based on Tribal Community Health

Profiles in Collaboration with


Disparities and

Inequity: Achieve health

equality,

eliminate

Evaluate

effectiveness,

accessibility and

quality of

personal and

Participate in the

development of

systems for sharing,

improving, and

disseminating

Develop

Tribal/Urban

Indian

Community

Health Profiles

Community Health Profiles &

Emerging Projects:

9. Data Improvement Projects for

Community Health Profile

Development/BRFSS

Community Health Profiles:

Developing and Disseminating

Annual Community Health

57

disparities, and

improve the

health of all

groups

population-

based health

services

aggregate health

data at a national

level for purposes of

advocacy for AI/AN

communities,

Collaborate with

national HHS

programs in the

development of

standardized

surveillance and

data monitoring

methods and data

sets.

and Tribe

Specific Data

Collection

Initiatives

a. Behavioral Risk Factor

Surveillances System –

BRFSS

b. Behavioral Health

Data Improvement

Project

c. Chemical Dependence

Resource

d. Child Maltreatment

e. Infectious Disease

Surveillance

f. Chronic Disease

Surveillance

10. Emerging Project based on

Community Health Profiles

Fact Sheets

Developing and Disseminating

5 year Community Healthy

Profiles (every 5 years)

Implementing Data

Improvement Projects with

Montana and Wyoming Tribes,

Building their Data Capacity

Developing Surveillance

Systems for Behavioral Health,

infectious Disease and Chronic

Disease

(Measure: Number of Fact Sheets

and 5 Year Community Health

Profiles Developed and

Disseminated; and Number of

Surveillance Systems

Developed/Implemented)

Emerging Projects:

Developing New Innovative and

Tribe Self Sustaining

Prevention/Intervention

Projects based on Tribal

Community Health Profiles in

Collaboration with Montana and

Wyoming Tribes

* (Measure: National Public Health Performance Standards Program Assessment -NPHPSP)

** (Measure: Child Health Measures Project Data)

58

Performance Measures

Process Evaluation

RMTEC Semi-Annual Report

RMTEC Annual Report

Short term (annual) / Long term (completion of project) Outcome Measures

RMTEC Project Summary Report

Impact

National Public Health Performance Standards Program’s Local Public Health

Governance Performance Assessment Instrument

Growth/Value Performance Measures

1. Number of Collaborations, Stakeholders and Partners (Including Universities, Public

Health Agencies and other Public Health Institutions)

2. Number of Professional Staff/Administrative Staff

3. Number of Scientific Publications Written and or Presented

4. RMTEC Website

5. RMTEC Web-based Data Warehouse (Password Protected Individual Tribe Data

Warehouse)

6. Number of Grants Written

7. Number of Funded Grants (Sustainability)

8. RMTEC Combined Budget

9. Number of Successfully Completed Projects during the Funding Period

10. RMTEC Stakeholder Value Assessment

final rmtec_strategic plan 2012_20160 developed by dr.akintan folo fa12.03.2012

Documents