# Presentation: 125607

## Center for Native American TeleHeath and TeleEducation  

**Jay H. Shore, MD, MPH**
**University of Colorado Health Sciences Center**
**Division of American Indian and Alaska Native Programs**

**Notes:**
Hello my name is Jay Shore. And I am here to talk about the Center for Native American TeleHealth and TeleEducation, otherwise known as CNATT.   CNATT at University of Colorado Health Sciences Center in Denver 

**Division of American Indian and Alaska Native Programs**

**Notes:**
-START BIG GO SMALL
-MISSION
-RUN THROUGH CENTERS
This slide gives you a general organizational overview of the Division of American Indian and Alaska Native Programs.  
We traffic in ancroynms and abrevations.
The Division is a part of the department of psych at UCHSC.  It is headed by Dr. Spero Manson, and it is currently composed of 7 national centers.
The general mission of the Division is to promote the health and well being of American Indians and Alaska Natives through research, training, education, and information dissementaion.
CNATT is one of the 7 centers in the division, the others are the NCAIANMHR, the Native Elder Health Care Resource Center, Native Elder Research Center, Healthy Nations Intiative, Circles of Care, Native Elder Health Disparities Research.

## MISSION

**CNATT organizes and focuses technological resources for Native American health from an array of telecommunication services at  UCHSC that offer education, clinical care, and training.  **
**CNATT also monitors impact assessment of these telecommunications services.**

**Notes:**
-SPECIFIC MISSION, ORGANIZATION OF TECHNOLOGY
-MONITOR IMPACT
The specific mission of CNATT is to organize and focus technological resources for Native American health from and array of telecommunication services at UCHSC that offer education, clinical care, and training.

The other major purpose of CNATT is to monitor the impact of these services to find out which of these are most effective in fulling CNATT’s mission

## Components

**Indian Telehealth Network**
**consult/liaison services**
**distant learning programs**
**linkage and communication with communities**
**Web-based Services for the Division**
**information dissemination **
**archive retrieval **

**Notes:**
-TWO MAJOR COMPENTS
-OUTLINE DUTIES
-OUTLINE TALK
The Two major components of CNATT are the Indian Telehealth Network and the Web-based services for the division of American Indian and Alaska Native Programs.

The Indian Telehealth network provides, consultation/liaison services, distant learning programs, and linkage and communications with our partners in Native communities.

The Web-base services for the the Division focus on information dissemination and archive retrieval.

## DAIANP Partnerships in TeleHealth and TeleEducation 

**Seattle Indian Health Board**

**Wind River Mental Health Clinic**

**PineRidge** **Community School**

**Rosebud Veterans’ Center**

**Sinte Gleska University, Mission**

**Providence Health Care Anchorage, AK**

**University of Colorado Health Sciences Center**

**Veterans Administration Medical Center**

***DAIANP Partnerships in TeleHealth and TeleEducation***

**Children’s Hospital**

**Chinle Vet Center Chinle, AZ**

**Notes:**
-MAP OF PARTNERS
-GENERAL DESCRIPTION OF PARTNERS
-DIFFERENT STAGES OF DEVELOPMENT
Here is a map of  showing the Indian TeleHealth Network, and the Division’s partner’s in the Network.
The Network consists of 3 partners within Denver, the UC, the denver VA, and children’s hospital, and 7 partners around the western united states.
The community sites right now are all in different stages of development, it terms of both the connections, and the services provided.  
The stages that they range from are communities where we have the connection, technology in place, and are currently running programs, to other sites where we are still negotiating partnerships and trying to get the hardware in place.

## Indian TeleHealth Network

**7 partner sites throughout the Western United States**
**Linked with ISDN lines of at least 1/4 T (384K)**
**PicTel 2000 Video Conferencing Unit**
**Real-time live interactive teleconferenc-ing**

**Notes:**
-LINKAGE
-SEGWAY TO PROGRAM DESCRIPTIONS
As mentioned on the previous slide there are 7 partner sites across the western US ranging from sd to alaska

Linked from denver to these sites with ISDN lines, with at least 1/4T capability.(which is are minimal transimission requirement.)

The network uses the PICTEL 2000 Videoconferencing Unit, there is at least one unit at each site in the network, and this provides us with live real-time interactive teleconferencing.

So that’s a general description of CNATT’s hardware, I now will discuss some examples of the “software” , or some of the programs we are working on through the network.

## Post-traumatic Stress Disorder TeleHealth Service

**Rosebud Sioux, Veteran’s Center**
**CNATT**
**Denver Veterans Administration Medical Center**
**VA Readjustment Counseling Services**

**Notes:**
-PTSD SERVICE
-PARTNERS
-COMPONENTS
The first program is Post-traumatic Stress Disorder TeleHealth Services.  This is the program I am most involved in.  This involves working with the Rosebud Sioux, Veteran’s to provide telehealth services for their veterans.  
The other entities currently involved are the Denver VA, VA Readjustment Counseling Services, and hopefully in the next month we will be approaching the Rosebud IHS unit, and getting their involvement and input as well.

The services consist of three components, education, med management, and crisis intervention.

## PTSD TeleHealth Service

**One weekly, 1-hour psychoeductional course (ongoing)**
**6 classes per course**
**offered quarterly**
**wives, partners and family of veterans**

**Notes:**
-PSYCHOEDUCTIONAL 
Currently have a one hour psychoeducational series development in conjuction with the denver VA, for wives partners and family of veterans.  This has just begun this spring, and we have had a couple trial sessions, that were received very well by the RVC.  The plan is to now start a full 6 class course.

## PTSD TeleHealth Service

**Two weekly, 2-hour medication management clinics weekly for Rosebud Sioux military veterans suffering from PTSD (Summer 2001)**
**Two weekly, 2-hour acute crisis clinics weekly for Rosebud Sioux military veterans and family members (Summer 2001)**

**Notes:**
-MED CLINIC
-CRISIS CLINIC
-STAGE OF DEVELOPMENT
In addition to the educational class, currently working on beginning medication management clinic for Rosebud Veterans as well as an acute ciris clinic weekly for rosebud Veterans and their families.
Currently in the missed of sorting out a whole host of issues to get this up and running, including confedeitialty, record keeping, cooridation with the VA, possibily the HIS, to provide in person services as neccary. 

## PTSD TeleHealth Service

**One Weekly, 1-hour continuing medical education course on PTSD monthly for Indian Health Service, tribal, and Readjustment Counseling Service providers (Summer 2001)**

**Notes:**
-DEVELOPMENT OF CME
The final component of this service is a one hour monthly CME course, to provide education to local personall and providers about issues affecting Indian Veterans.  This will include the HIS, the Veteran Center, as well as tribal personall.

## Slide 11

**Notes:**
-INTRODUCE
-DESCRIBE
-MODULES
Another Information that CNATT has been involved in is Wounded Spirits Ailing Hearts: PTSD and the Legacy of War.

What this is an educational series that includes a video and a manual that educate about PTSD in American Indian Combat Veterans.
There are four different versions of this Video and manual 
One for the veteran
One for family/community
One for mental health providers
One for medical providers
This has been widely dispriputed to all VA s around the country, as well as to Veterans Centers.

## Child/Adolescent Behavioral TeleHealth Service

**K-12 boarding school on Pine Ridge Indian Reservation**
**Oglala Community School**
**Indian Health Service**
**Bureau of Indian Affairs**

**Notes:**
-CHILD/ADOLESCENT SERVICE
-PARTNERS
Another example of Network activities is our Child/Adolescent Behavioral Telehealth services.  The players in this project are the boarding school on Pine Ridge, Oglala Community school, the indian health service, as well as the BIA.

## Child/Adolescent Behavioral TeleHealth Service

**Continuing education for local staff on child/adolescent mental health issues by child psychiatrist from UCHSC (ongoing)**
**Two weekly, 2-hour clinics staffed by child/adolescent psychiatrists and psychologists **

**Notes:**
-CME
-EXPANSION CLINICS
This involves cme for the local staff on child/adolescent mental health issues by a child psychiatrist from UCHSC, this has been going on for the past year.

The next step in the expansion of this project will be to provide telehealth clinics for children at the school/boarding home.

## Geriatric/Geropsychiatric TeleHealth Service

**Mary Conrad Long-Term Care Center, Anchorage, Alaska**
**Owned by Cook Inlet Native Regional Corporation (90 beds)**
**UCHSC, Center on Aging**
**Providence Health Care of Alaska**

**Notes:**
-GERO SERVICE
-PARTNERS
Another example of a CNATT services, are the Geriatric/Geropsychiatric Teleheath Service.  This involves the mary-conrad lTC faciculty in anchorage alaska, which is owned and operated by the Cook Inlet Native Regional Corporation. Other partners are the UCHSC, center on Aging as well as providence health care of Alaska.

## Geriatric/Geropsychiatric TeleHealth Service

**Two weekly, 2-hour geriatric/geropsychiatric clinics **
**Staffed by Geriatric fellows from the Center on Aging and by DAIANP faculty (begins Summer 2001)**

**Notes:**
-STAFFING/ROLE OF CLINICS
This summer we will start geriatric/geropsychiatric consultation clinics to this facility and this will be staffed by fellows in geriatric medicine on the center on aging as well as DAIANP staff.

## World Wide Web Services of DAIANP

**Established in 1996 to offer information dissemination and archive retrieval**
**Currently 5 total sites**
**www.uchsc.edu/ai**

**Notes:**
-WWW, MISSION
-5 SITES
-ADDRESS
The second major role of CNATT is to administer the WWW sites of the Division, which offer information dissemination and archive retrieval.  
The first of the website was established in 1996.
There are currently 5 total web sites.
The home address is www.uchsc.edu/ai

**Notes:**
-OULTINE OF 5 SITES
-DESCRIPTIONS
-FUNCTIONS
Here are the 5 sites taken off the main web page.
1)Circles of Care-which is a support program for Native Communities that are developing programs for kids with SED.
2)Healthy Nations Initiative-this is funded by robert wood johnson  to help native communities reduce harm caused by substance abuse through community based programs.
3)National Center for American Indian and Alaska Native Mental Health Research
4)Native Elder  Health Care Resource Center- focused on helping increase culturally competent care for Native Elders.
5)Native Elder Research Center

These websites span a host of activities, but some of the typical items you will find on these web pages are links to other relevent web pages, resource directories, directories of personall, example programs, contacts, educational models, online reference lists, libaries, funding opportunities, ongoing research, access to data bases, and it goes on and on.

## Exit Survey of Web Site

**Exit survey of site use October, 1999 through September, 2000 **
**71% of inquires by individuals, programs or organizations that are either Native American or serve this population**
**Every state represented, 19 countries**
**65% originated from rural areas.**

**Notes:**
-EXIT SURVEY
-RESULTS
An exit survey of the site use spanning a year time period showed, that 
71% of inquires came by  either individuals, programs, or organizations that are either Native American or serve Native American Populations.  
Inquires from everystate, and 19 different countries.
65% of inquires originated from rural areas.

## Exit Survey of Web Site

**Reasons for visiting the Division’s WWW sites**
**81% educational and training materials**
**76% examples of relevant programs**
**71% cultural issues in health care**
**68% info on policy and planning**
**63% health status and related problems**
**59% past and current research**

**Notes:**
-EXIT SURVEY RESULTS
Reasons given in exit survey for visiting the web site.
-81% educational and training materials
-76% examples of relevant programs
-71% cultural issues in health care
-68% info on policy and planning
-63% health status and related problems
-59% past and current research

## Slide 20

**Notes:**
-BREAKDOWN OF VISITS
-REFERENCE AND VISITS
This graph is a breakdown to the Native Elder Health Care Resource Center Web Site hits, and where on the website people where visiting.

## Slide 21

**Notes:**
-HITS PER YEAR
This slide shows for NEHCRC the number of hits per year.  As you can see it has increase signicantly since the first year, more than tripling in the number of hits.

That’s an overview of our web activities.

## The Nighthorse Campbell Native Health Building

**50,000 square foot facility at the new UCHSC Fitzsimons Campus, to be completed Summer 2002.**
**DAIANP**
**TeleHealth/TeleEducation Programs of UCHSC**
**Public Psychiatry **

**Notes:**
-BUILDING
-MOVE
-PROGRAMS
-DESCRIPTION
-CULTURAL INCORPORATION
A final exiting project involving CNATT and the Division is the The Nighthorse Campell Native Health Buildings.

The University of Colorado is undergoing on of the biggest expansion/moves in the history of a medical center.  UC is moving from its current location to the decamissioned Fitzsimons Army Base 6 miles to the east of its current location.

Currently under construction is the Ben Nighthorse Campbell Building which will be completed by next summer.  It will house the Division of American Indian and Alaska Native Programs, TeleHealth and TeleEducation programs of  UCHSC, as well as the public psychiatry programs.

In addition to the program office and support space necessary to house these three programs, space in the new facility will include a rotunda - great hall for ceremonial and program events; a large demonstration training room with capacity to seat 100; a multi media production laboratory and studios; and a CD production area.
Aspects important to Native American Culture have been incoorpated into this unique building.

## Slide 23

**Notes:**
-OVERVIEW OF NEW CAMPUS
Here is a overview of the New Fitzsimmons campus and where the Native American/TeleHealth building will be located.

## Slide 24

**Notes:**
-CIRCLE
The design of both the interior and exterior space celebrates the Native American belief that the 'circle' represents the dwelling place created by the Great Spirit for all people. As a result, circles play a major role in the architecture of the new facility. Circular forms are repeated to form the interior rotunda, the exterior plaza area and the large training room. A fragment of a circle is even used to define the overall shape of the entire building.

## Slide 25

**Notes:**
-AXIS
-EAST ENTRY
-TIPI
Since the earth-sky orientation is an important part of the Native American culture, even the primary public spaces are oriented in a special fashion toward the axis lines of the winter and summer solstices. The overall building form reflects similarity to a grassland butte found in this region of Colorado. The building entry, facing to the east, exposes the building's rotunda to the exterior and also aligns with the sun's solstice

## Slide 26

**Notes:**
-ALTERNATIVE VIEW OF TIPI
A fragmented tipi form is used for the rotunda and reflects the influences of these local nations in the building design

## Slide 27

## Slide 28

**Notes:**
-EARTH-SKY
-ARTWORK
-EXICITING
Battered walls with pole like structures will open up each of the three floors in the building and reflect in the floors and skylight earth and sky locations. The rotunda skylight will become a nighttime feature emitting light while defining the building and its entry. Additionally, in many Native American ceremonies, a connection with the earth is required. This will be accommodated in the new building with an opening in the rotunda floor exposing an area of earth.
Native American art will be incorporated throughout the building interior and exterior. 

## Conclusions

**The CNATT programs are directly relevant to the culturally informed diagnosis, epidemiology, treatment, and prevention of physical, alcohol, drug, and mental health problems that commonly occur among American Indians and Alaska Natives.  **
**The CNATT programs offer an important model for utilizing telehealth to improve services for under-served populations.**

**Notes:**
-MISSION
-MODEL
As above.

## Acknowledgements

**Staff affiliated with UCHSC working with CNATT**
**Spero M. Manson, PhD, Head, DAIANP**
**Doug K. Novins, MD, Director, Circles of Care**
**Candace Fleming, PhD, DAIANP**
**Martin Reite, MD, DVAMC**
**Special thanks to the Community Partners and Community Field Staff working in partnership with CNATT and the DAIANP**

**Notes:**
-STAFF
-COMMUNITY