Tribal Leaders Diabetes Committee

OrientationUpdated 8/23/16

CONGRATULATIONS!on your recent appointment to be a Primary or Alternate

Representative on the Tribal Leaders Diabetes

Committee (TLDC).

IHS Principal Deputy Director, Mary Smith

Tribal leaders meet with Congresswoman, Jaime Herrera Beutler [WA-3]

Tribal Leaders Diabetes Committee attending quarterly meeting (September 2015) with former IHS Principal Deputy Director, Mr. Robert McSwain

DDTP (Division of Diabetes Treatment and Prevention)

• IHS Headquarters Division• Within the Office of Clinical and Preventive Services

• IHS “National Diabetes Program” started in late 1970s

• Administers the SDPI grant program in collaboration with Division of Grants Management (DGM)

• Closely follows diabetes science and translates it to diabetes clinicians and I/T/U programs nationwide• Training and technical assistance to clinicians, educators, and grantees

• Provides tools: Best Practices, Standards of Care, algorithms

• Website: www.diabetes.ihs.gov

• Diabetes Data• National and Area diabetes prevalence estimates

• Annual Diabetes Care and Outcomes Audit• Data collection and feedback to sites on diabetes care

• Non-profit, non-governmental organization established by Tribes in 1972

• Serve all 567 Federally recognized Tribes

• NIHB has a cooperative agreement with IHS to provide logistical support to the TLDC and

technical assistance, education and outreach to Tribal leaders, Indian organizations and

others.

Mission Statement:

One Voice affirming and empowering American Indian and Alaska Native Peoples to protect and improve health and reduce health disparities.

Diabetes in Indian Country

2.1 timeshigher

Likelihood of American Indian and Alaska Native adults to

have diagnosed diabetes compared with non-Hispanic

whites (15.9% vs. 7.6%; 2010-2012).

Source: Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in

the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services;

2014.http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

1.8 times

higher

Incidence rate of kidney failure due to diabetes

in American Indians and Alaska Natives compared

with the overall U.S. population (278.5 vs. 152.4

per million; 2013).

Source: Table A.3.1. U.S. Renal Data System, USRDS 2015 Annual Data Report: Atlas of Chronic

Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health,

National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2015.

http://www.usrds.org/adr.aspx

2.3 timeshigher

People with diagnosed diabetes, on average, have

medical expenditures that are approximately 2.3 times

higher than what expenditures would be in the

absence of diabetes.Source: Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in

the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

41% increase

The estimated total economic cost of diagnosed

diabetes in 2012 is $245 billion, a 41% increase

from the previous estimate of $174 billion (in

2007 dollars).

Source: *American Diabetes Association, Economic Costs of Diabetes in the US in 2012. Diabetes Care March 6,

2013. http://care.diabetesjournals.org/content/early/2013/03/05/dc12-2625.full.pdf+html

1.5+ timeshigher

Adults with diabetes have heart disease death rates

about 1.7 times higher than adults without

diabetes.

Source: Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden

in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

The hospitalization rates for stroke are 1.5 times higheramong adults with diabetes.

Source: Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its

Burden in the United States, 2014. Atlanta, GA: U.S. Department of Health and Human Services; 2014.http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

SDPI Overview• Began in 1998

• Since 2004 and through FY2015, SDPI funded 3 major components: • Community-Directed grant program

• Diabetes Prevention (DP)/Healthy Heart (HH) Initiative programs

• Set-asides• Urban Indian Health Programs

• Data Infrastructure

• CDC Native Diabetes Wellness Program (discontinued in FY2015)

• FY 2016 + will be Community-Directed programs

Since SDPI Programs Began:

48% Decrease in incidence of ESRD

• End-stage renal disease due to diabetes declined more than any other racial groups between 2000-2013.*

Youth Programming(1997-2010)

• 73% increase in primary prevention activities**

• 56% increase in weight management activities**

Healthier Lifestyles(1997-2010)

• 72% increase in community walking & running programs**

*U.S. Renal Data System. Table A.3.1. USRDS 2015 Annual Data Report http://www.usrds.org/adr.aspx

** IHS Special Diabetes Program for Indians. 2011 Report to Congress: Making Progress Toward a Healthier Future

SDPI FUNDING AMOUNT AND DURATION OF FUNDING IS DECIDED BY CONGRESS, NOT IHS.

SDPI Interventions (FY 2016 Grants)

Component Funding Amt # IHS, Tribal,

programsWhat does it fund?

Community-Directed

Diabetes Grant

Program

$130.2 million/yr 272 Interventions that address local

community priorities using diabetes

best practices

Examples:

Medical care

Access to meds

Self-monitoring supplies

Education and medical nutrition therapy

Nutrition, physical activity and weight mgmnt programs

Risk-reduction programs for youth

SDPI Set Asides (FY2016)

Component Funding Amt # IHS, Tribal

programs

What does it fund?

• Urban Indian

Health Programs $8.5 million 29

Community –Directed Programs

• Data

Infrastructure

Improvement $5.2

million

$2.6mNational

OIT: RPMS EHR, Diabetes

Management System, iCare,

Diabetes Audit, web conferencing

platform

$2m12 Areas Area identified priorities that

support data programs

$600kDDTP Org and analyzing diabetes audit,

calculating AI/AN stats

SDPI Program SupportComponent Funding Amt # IHS, Tribal,

Urban

programs

What does it fund?

Program Support $6.1 million IHS Division of

Diabetes

Treatment and

Prevention

All aspects of administration of

SDPI, including TLDC support,

Coordination of the Annual

Diabetes Care and Outcomes

Audit, GrantSolutions, Multiple

Source Contracts, Division of

Grants Management.

Balanced Budget Act of 1997: Established SDPI at $30m per year.

Consolidated Appropriations Act of 2001: Added $70m per year to SDPI in 2001-2002, $100m in 2003.

House Resolution 5738: Funded SDPI 2004-2008 at $150m per year.

House Resolution 6331: Reauthorized SDPI through 2011 at $150m per year.

Public Health Service Act 23 42: Extended SDPI activities through 2009 at $150m per year.

The Medicare Access and CHIP Reauthorization Act of 2015: SDPI extended at $150 million per year through September 2017.

House Resolution 4994: Extended SDPI through 2013 at $150m per year.

SDPI Legislative History

http://www.ihs.gov/MedicalPrograms/Diabetes/HomeDocs/Resources/FactSheets/2012/Fact_sheet_LegisHis_508c.pdf

Tribal Leaders Diabetes Committee

Participants at the September 2015 In-person meeting, Washington DC

Now what?

Your past and present fellow TLDC members have worked hard to put together an overview of what it means to be a Tribal Leader on the TLDC. Please refer to the following slides for basic information on the background and infrastructure of the TLDC.

Contact information for TLDC members, IHS and National Indian Health Board Staff can be found at the end of the slides if you have any questions. Thank you for committing your time and efforts to the important work of the TLDC!

IHS Tribal Advisory Committees

• Direct Service Tribes Advisory Committee (DSTAC)

• Tribal Leaders Diabetes Committee (TLDC)

• National Tribal Advisory Committee on Behavioral Health (NTACBH)

• Tribal Self-Governance Advisory Committee (TSGAC)

• IHS Information Systems Advisory Committee (ISAC)

http://www.ihs.gov/tribalconsultation/committees/

Guiding Documents• TLDC Charter (2007)

http://www.ihs.gov/IHM/index.cfm?module=dsp_ihm_circ_main&circ=ihm_circ_0703

• TLDC Strategic Planhttp://www.nihb.org/sdpi/tldc_member_portal.php

Charter

• Background & history

• Mission & vision statements

• Committee objectives

• Membership and voting rules

• Meeting procedures and purpose

Charter: Background• The SDPI was created by Congress as part of the Balanced

Budget Act of 1997, Public Law 105-33

• The TLDC was created by the Director of IHS in 1998

• TLDC recommends to the IHS Director a process for distributing SDPI funds

• TLDC provides IHS and Tribal leadership with an ongoing forum to discuss all matters related to diabetes and the impact of other chronic diseases on AI/AN communities

Charter: Mission & VisionVISION STATEMENT

The TLDC will empower AI/AN people to live free of diabetes and related chronic diseases through promotion of healthy lifestyles while preserving culture, traditions, and values through Tribal

leadership.

MISSION STATEMENT

The TLDC will make recommendations to establish broad-based policy and advocacy priorities for diabetes and related chronic disease

activities to the Director, IHS.

Charter: TLDC ObjectivesA. Make recommendations and provide advice on policy and

advocacy issues concerning diabetes and related chronic diseases;

B. Provide advice and guidance to ensure the incorporation of appropriate culture, traditions, and values in program development, research, and community-based activities;

C. Provide broad-based guidance and assistance in defining how other Federal agencies and organizations, States, Tribal epidemiology centers, institutions of higher learning, and private health organizations can play a role in addressing diabetes and related chronic diseases; and

D. Serve as a Tribal advisory committee to the Centers for Disease Control and Prevention's Native Diabetes Wellness Program.

Charter: Membership13 Voting Members

12 Tribal Representatives from the 12 IHS areas

• Selected by the respective IHS Area Director in consultation with Area Tribes:

• One Tribal leader member, defined as an elected or duly-appointed official of a Federally Recognized Tribe from each area

• One Tribal leader alternate from each IHS Area

1 Federal Appointee

• Appointed by the IHS Director

• Alternate appointed by the IHS Director

Charter: Advisors• Provides advice and input in an advisory capacity at the

request of the co-chairs

Charter: Membership• If the primary member is unable to attend a meeting, the alternate should be

notified

• If no alternate, the primary shall identify an acting member to attend on behalf of the IHS Area. The acting member must be an appointed or elected Tribal Leader and a letter from the Area Director must be sent to DDTP prior to the meeting for the member to vote.

• If a primary member misses 2 consecutive meetings, TLDC will notify the IHS Area Director and request a replacement

• No term limits

Charter: Leadership

Tribal Co-chair elected by TLDC members representing

the 12 IHS Areas

Ann Bullock, MD, TLDC Federal Co-ChairDivision of Diabetes Treatment & Prevention

Federal Co-chair

Connie Barker, Chickasaw Nation Dr. Ann Bullock, IHS DDTP

Charter: MeetingsQuarterly Meetings*:

•Dates & locations determined [with input of] the TLDC

Quorum:

•7 Representatives

• IHS Federal Co-chair

*Note: meetings may not always happen quarterly; depends on what needs to be discussed

Strategic Plan

• Voted on by TLDC July 8, 2011

• Approved by IHS Dir. Dec. 12, 2012

• Sets priorities and goals for TLDC

• Created 4 workgroups around 4 goals

• Housed on the TLDC portalhttp://www.nihb.org/sdpi/tldc_member_portal.php

Strategic Plan: WorkgroupsWorkgroup Goal Schedule

SDPIEnsure long-term viability of SDPI and planning

for future growth

Last Monday of the month @

3:00pm ETTribal Consultation

Facilitate effective consultations with IHS

Director and Tribal communities

Education &

Awareness

Educate all stakeholders about diabetes and

how it impacts AI/ANs and for increasing the

visibility of the TLDC and the importance of its

work

First Weds of the month @

3:00pm ET

Organizational

Capacity

Ensure that the TLDC will have the capacity to

fulfill its mission

Strategic Plan: Workgroups• Members serve on 1 but no more than 2 workgroups

• Each workgroup has a chair

• Priorities are set in the Strategic Plan

• Action plan will be set each year within each workgroup

• Monthly teleconferences

• Organizational Capacity and Education and Awareness workgroups meet

together

• SDPI and Tribal Consultation workgroups meet together

• Quarterly reports distributed to full TLDC

NIHB Deliverables

• Logistical support for TLDC meetings (planning, agendas, handouts, badges, notes, etc.)

• Facilitate TLDC outreach at national health conferences

• Facilitate Workgroup conference calls

• Process travel reimbursement requests for TLDC members

• Develop, update, house SDPI Resource Center on NIHB website

• Communicate SDPI-related information and policy analysis to key stakeholders (including TLDC members)

Role: NIHB Deliverables

• Hosts annual SDPI poster session at NIHB PH Summit

• Creates opportunities for TLDC members to educate on SDPI

Karrie JosephPublic Health Programs Manager

910 Pennsylvania Ave. SEWashington DC, 20003Phone: (202) 507-4079

kjoseph@nihb.org

Public Health Project Coordinator910 Pennsylvania Ave. SE

Washington DC, 20003Phone : (202) 507-4083mcastagne@nihb.org

Stacy BohlenExecutive Director

910 Pennsylvania Ave. SEWashington DC, 20003Phone : (202) 507-4070

sbohlen@nihb.org

NIHB

VACANT

Caitrin McCarron ShuyDirector of congressional Relations

910 Pennsylvania Ave. SEWashington DC, 20003Phone: (202) 507-4070

cshuy@nihb.org

Michelle CastagneCongressional Relations Associate

910 Pennsylvania Avenue, SEWashington, DC 20003

202-507-4083mcastagne@nihb.org

NIHB

Role:Indian Health Service (IHS) Director

• Conducts nationwide Tribal Consultation on SDPI

• Holds quarterly meetings with TLDC to inform decisions on the treatment and prevention of diabetes and other chronic diseases

• Makes final decisions regarding SDPI funding

Role:IHS Division of Diabetes Treatment and Prevention (DDTP)

• Administers the SDPI program & supports grant programs in using best practices

• Closely follows diabetes science and translates it to diabetes clinicians and I/T/U programs nationwide

• Provides clinical data through Diabetes Care & Outcomes Audit

• 1 voting member on TLDC (Federal Co-Chair)

• Keeps the IHS Director up-to-date on TLDC issues, decisions, recommendations and concerns

Role:IHS Area Diabetes Consultants (ADC)

• Serve as project officers for SDPI Community-Directed grants

• Provide diabetes training & resources

• Disseminate latest scientific findings on treatment & prevention

• Can inform you of your Area’s wants/needs – your BEST resource for connecting with your Areas!

• As outlined in the Strategic Plan, ADCs are encouraged to serve on one workgroup and participate in conference calls between TLDC meetings

• There is 1 ADC per IHS Area

ADCs

Click here to view the ADC directoryhttp://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=peopleADCDirectory

ADCs

Click here to view the ADC directoryhttp://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=peopleADCDirectory

Navajo Area

Jill Moses, MD, MPHPO Drawer PHChinle, AZ 86503Phone: (928) 675-7188

ADCs

Click here to view the ADC directoryhttp://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=peopleADCDirectory

Stephen "Miles" Rudd, MD, FAAFPCAPT, USPHS1414 NW Northrup St., Ste 800Portland, OR 97209Phone: (503) 414-5555

Daniel Marino, MD7900 South J Stock RdTucson, AZ 85746Phone: (520) 295-2406

Responsibilities: PRIMARY TLDC Members

• Act as 1 of 12 voting members – Vote on behalf their Area on consultation questions

• Attend TLDC meetings

• Notify your Area alternate if unable to attend

• Must not miss scheduled meeting on two consecutive occasions

• Participate in up to 2 workgroups

• Schedule permitting, attend national conferences and meetings on behalf of TLDC

• Discuss with Area SDPI grantees to understand needs

• Submit for travel reimbursement

Responsibilities: ALTERNATE

TLDC Members

• If requested by Primary, attend TLDC meetings

•Participate in up to 2 workgroups

•Discuss with Area SDPI grantees to understand needs

Travel Procedures1. NIHB will pre-arrange flight & hotel reservations for

Primary members or Alternates if they are representing the Primary at the meeting.

OR2. The Primary’s Tribe can arrange

travel and submit for reimbursement• Click here full travel policy.

http://www.nihb.org/sdpi/tldc_member_portal.php

Good Practices (as recommended by other TLDC members)

Recommended Practices• Participate in Area meetings

• Take notes during TLDC meetings

• Participate in Consultation process

• Be active in your chosen workgroup

• Communicate with SDPI grantees, ADCs and others in your Area

• Submit travel reimbursement documentation to NIHB within 30 days of travel

Meeting Etiquette• Be on time

• Be respectful

• Primary members sit at the table

• Every voting member has a right to be heard & voice their opinions

Online Member Portal

Documents (meeting minutes, agendas, contact information, etc.) can be found on the online TLDC

Member Portal:

http://www.nihb.org/sdpi/tldc_member_portal.php

Password: #SDPI2015

AbbreviationsAcronym Title

C-D Community Directed Grants

DDTP Division of Diabetes Treatment and Prevention

DP Diabetes Prevention Initiative

HH Healthy Heart Initiative

IHS Indian Health Service

I/T/U IHS/Tribal/Urban

NIHB National Indian Health Board

SDPI Special Diabetes Program for Indians

TLDC Tribal Leaders Diabetes Committee

Resources• IHS Division of Diabetes Treatment and Prevention

• http://www.ihs.gov/MedicalPrograms/Diabetes/index.cfm?module=home

• National Indian Health Board SDPI Resource Website• http://www.nihb.org/sdpi/index.php

• Centers for Disease Control and Prevention Diabetes Atlas• http://www.cdc.gov/diabetes/atlas/countydata/atlas.html

• American Diabetes Association: Awakening the Spirit • http://www.diabetes.org/in-my-community/awareness-programs/american-

indian-programs/awakening-the-spirit.html