# Presentation: 715656

## Academic Partnerships with Native American Communities

- Presented by
- Sara L. Young, Montana State University

## American Indian Tribes in the U.S.

- 562 federally recognized American Indian tribes
- Sovereign nation status: conduct government to government relations with other levels of government (federal, state and local)
- Each tribe has its own unique culture, language, practices and economic situations
- Many similarities between some tribes and many differences

- Crow Fair

- Photo source:  http://www.drumhop.com/CrowFair.html

## Crow Tribe of Indians of Montana – the Apsaalooke Nation

- 2 million acres now – the original treaty boundaries included 32 million square acres. Today the reservation is about 60 miles by 40 miles.
- Current tribal enrollment is at 11,500
- The majority of tribal members residing on the reservation receive their medical care at the Indian Health Service facilities on the reservation
- clinics at three sites and one hospital
- Tribal colleges play a significant role in the education of many Native Americans including on the  Crow reservation
- Little Big Horn College chartered in 1980 >enrollment of approximately 250 tribal students
-         >offers associate arts degrees in several areas,
-         >many of students  interested in biomedical and
-           environmental health fields

- http://montanafilm.com/crowres_03.htm

## Montana has 7 reservations 

- Montana has 7 reservations

- http://lewisandclark.state.mt.us/visitres.htm

## U.S. Federal and State Indian Reservations 

- U.S. Federal and State Indian Reservations

-                        http://www.infoplease.com/ipa/A0778676.html

## Tribal Population – 2000 US Census

**Apache96,833**
**Blackfeet85,750**
**Cherokee729,533**
**Cheyenne18,204**
**Chickasaw38,351**
**Choctaw158,774Colville9,393**
**Comanche19,376**
**Chippewa149,669**
**Cree7,734**
**Creek71,310**
**Crow13,394**
**Delaware16,341**
**Houma8,713**
**Iroquois80,822**
**Kiowa12,242**
**Latin American Indian180,940**
**Lumbee57,868**
**Menominee9,840**
**Navajo298,197**
**Osage15,897**
**Ottawa10,677**
**Paiute13,532**
**Pima11,493**
**Potawatomi25,595**

**Pueblo74,085**
**Puget Sound **
**Salish14,631**
**Seminole27,431**
**Shoshone12,026**
**Sioux153,360**
**TohonoO'odham20,087**
**Ute10,385**
**Yakama10,851**
**Yaqui22,412**
**Yuman8,976**
**Other specified American**** Indian tribes357,658**
**American Indian tribe, not specified195,902**
**AlaskaAthabascan18,838**
**Aleut16,978**
**Eskimo54,761**
**Tlingit-Haida22,365**
**Other specified Alaska Native tribes3,973**
**Alaska Native tribe, not specified8,702**
**American Indian or Alaska Native **** tribe, not specified1,056,457**

*Source:* U.S. Census Bureau, Census 2000.

- 1. The numbers by American Indian and Alaska Native tribes do not add up to the total population figure because respondents may have put down more than one tribe. Respondents reporting several tribes are counted several times.
- 2. Total includes American Indian and Alaska Natives alone or in combination with other tribal groups or races. Indian and Alaskan Native population alone in 2000 was **2,475,956.**

## Potential Partners – Tribal Colleges and Universities 

**Institution                            State    Highest Degree Offered**
- BAY MILLS COMMUNITY COLLEGE MI Associate's
- BLACKFEET COMMUNITY COLLEGE MT Associate's
- CANKDESKA CIKANA COMMUNITY COLLEGE ND Associate's
- CHIEF DULL KNIFE COLLEGE MT Associate's
- *COLLEGE OF MENOMINEE NATION WI Associate's
- COMANCHE NATION COLLEGE OK Associate's
- CROWNPOINT INSTITUTE OF TECHNOLOGY NM Associate's
- DINÉ COLLEGE AZ Associate's
- FOND DU LAC TRIBAL AND COMMUNITY COLLEGE MN Bachelor's
- FORT BELKNAP COLLEGE MT Associate's
- FORT BERTHOLD COMMUNITY COLLEGE ND Associate's
- FORT PECK COMMUNITY COLLEGE MT Associate's
- HASKELL INDIAN NATIONS UNIVERSITY KS Bachelor's
- INSTITUTE OF AMERICAN INDIAN AND ALASKA NATIVE
- CULTURE NM Bachelor's
- *KEWEENAW BAY OJIBWA COMMUNITY COLLEGE MI Associate's
- LAC COURTE OREILLES OJIBWA COMMUNITY COLLEGE WI Associate's
- LEECH LAKE TRIBAL COLLEGE MN Associate's

**Institution                          State     Highest Degree Offered**
- LITTLE BIG HORN COLLEGE MT Associate's
- LITTLE PRIEST TRIBAL COLLEGE NE Associate's
- NEBRASKA INDIAN COMMUNITY COLLEGE NE Associate's
- NORTHWEST INDIAN COLLEGE WA Associate's
- OGLALA LAKOTA COLLEGE SD Master's
- SAGINAW CHIPPEWA TRIBAL COLLEGE MI Associate's
- SALISH KOOTENAI COLLEGE MT Bachelor's
- SINTE GLESKA UNIVERSITY SD Master's
- SISSETON WAHPETON COLLEGE SD Associate's
- SITTING BULL COLLEGE ND Bachelor's
- SOUTHWESTERN INDIAN POLYTECHNIC INSTITUTE NM Associate's
- STONE CHILD COLLEGE MT Associate's
- TOHONO O'ODHAM COMMUNITY COLLEGE AZ Associate's
- TURTLE MOUNTAIN COMMUNITY COLLEGE ND Bachelor's
- UNITED TRIBES TECHNICAL COLLEGE ND Associate's
- WHITE EARTH TRIBAL AND COMMUNITY COLLEGE MN Associate's
- *WIND RIVER TRIBAL COLLEGE WY Associate's
- *Indicates a tribal college is seeking formal accreditation candidacy status

- Source:  http://www.aihec.org

## Tribal College and University (TCU) Demographic Information:

-  **34 tribal colleges in 13 states**
**  ****8 TCUs offer baccalaureate programs; 2 offer**
**       ****master’s degree programs and all offer**
**      ****associate degree programs.**
**27,000+ academic students annually; tens of**
**      ****thousands more through community outreach**
**80% of the students are enrolled in federally**
**      ****recognized tribes**
**67% Female**
**59% Full-time**

**Tribal College and University **
**Student Demographics:**

- Source:  http://www.aihec.org

## Many tribal nations are facing serious health disparities

- Life expectancy that is 2.4 years less than the U.S, all races population (74.5 vs 76.9 years)
- Higher infant mortality (8.5 per 1,000 live births compared to 6.8 per 1,000 for the U.S. all races population)
- Higher death rates from tuberculosis (600% higher) alcoholism (510% higher) motor vehicle crashes (229% higher) diabetes (189% higher) unintentional injuries (152% higher) homicide (61% higher) and suicide (62% higher).

- Source:  “Facts on Indian Health Disparities” Indian Health Service, January 2006

- _[Aberdeen Area](http://www.nihb.org/staticpages/index.php?page=200403301344375598#aberdeen#aberdeen)__ _
- _[Alaska Area](http://www.nihb.org/staticpages/index.php?page=200403301344375598#alaska#alaska)__ _
- _[Albuquerque Area](http://www.nihb.org/staticpages/index.php?page=200403301344375598#albuquerque#albuquerque)__ _
- _[Billings Area](http://www.nihb.org/staticpages/index.php?page=200403301344375598#billings#billings)__ _
- _[California Area](http://www.nihb.org/staticpages/index.php?page=200403301344375598#california#california)__ _

- _[Nashville Area](http://www.nihb.org/staticpages/index.php?page=200403301344375598#nashville#nashville)__ _
- _[Navajo Area](http://www.nihb.org/staticpages/index.php?page=200403301344375598#navajo#navajo)__ _
- Oklahoma Area
- Phoenix Area
- Portland Area

- Source:  http://www.nihb.org/index.php

- (According

- According to the Indian Health Service, 55% of American Indians and Alaska Natives living in the U.S. rely on the I.H.S. to provide access to health care services in 49 hospitals and nearly 600 other facilities operated by the I.H.S., tribes, and Alaska Native corporations or purchased from private providers.

**Notes:**
The Area Health Boards serve as the communication link between the NIHB and the tribes. Area Health Boards advise in the development of positions on health policy, planning, and program design. They gather information and review public opinion and proposals. In areas without an Area Health Board, the NIHB representative communicates policy information and concerns to the tribes in that area.

## NCAI – National Congress of American Indians

**Cowlitz Indian Tribe** [Northwest]**John Barnett** (Chairman)Tel: (360) 577-8140Fax: (360) 577-7432P.O. Box 2547Longview, WA 98632-8594Website: www.cowlitz.org**Coyote **
**Valley Band of Pomo Indians** [Pacific]**John Feliz, Jr.** (Chairman)Tel: (707) 485-8723Fax: (707) 485-1247P.O. Box 39Redwood Valley, CA 95470Website: www.coyotevalleycasino.com
**Craig Community Association (IRA)** [Alaska]**A. Millie Stevens** (President)Tel: (907) 826-3996Fax: (907) 826-3997P.O. Box 828Craig, AK 99921
**Crooked Creek Traditional Council** [Alaska]**Johnny John** (President)Tel: (907) 432-2201Fax: (907) 432-2200P.O. Box 69Crooked Creek, AK 99575
**Crow Creek Sioux Tribe** [Great Plains]**Lester Thompson, Jr.** (Chairman)Tel: (605) 245-2221Fax: (605) 245-2470P.O. Box 50Fort Thompson, SD 57339
**Crow Nation **[Rocky Mountain]**Carl E. Venne** (Chairman)Tel: (406) 638-3715Fax: (406) 638-3773P.O. Box 159Crow Agency, MT 59022

- NCAI’s webpage gives a list of the contact information for over 250 member tribes – this is just a sample of some of the tribes listed.
- In many cases, a tribal resolution approving the research project will be required prior to gaining approval from an IRB of a regional I.H.S. office.

- Source:  http://www.ncai.org/Tribal_Governments.119.0.html?&no_cache=1&print=1

- Tribal Governments

## Urban Indians

- Clusters of Native Americans living in urban areas that have their own inter-tribal communities with
- 31 urban Indian clinics or other healthcare facilities are funded through the I.H.S. with minimal funding
- Usually have Native American boards that are another source of potential partnerships
- More Native Americans actually reside “off the reservation”
- Urban Indians are harder to find and generally include groups of many different tribes.
- Their community population may or may not maintain close ties to their extended families, tribes and cultural ways.

**Notes:**
Throughout the U.S. there are a number of clusters of Native Americans living in urban areas that have their own inter-tribal communities with urban Indian clinics or other healthcare facilities governed by Native American boards that are another source of potential partnerships. More Native Americans actually reside “off the reservation” than live on but they are a little harder to find and generally include groups of many different tribes.  Their community population may or may not maintain close ties to their extended families, tribes and cultural ways.

## IRB’s

- Many tribes and/or tribal colleges have developed or are in the process of developing their own IRBs which researchers need to work with for projects involving tribal members or tribal data
- When a tribe or tribal college does not have an IRB in place researchers generally are required to go through the IRB process with the area office of the Indian Health Service
- If the research will involve working with any data, patients, staff or facilities of the I.H.S., researchers need to seek approval from both the tribal IRB and the I.H.S. IRB

**Notes:**
Human Research Participant Protection in the Indian Health Service 
All human participant research conducted in IHS facilities or with IHS staff or resources must be approved by an IHS Institutional Review Board (IRB). This also includes all research in Tribally managed or Urban facilities. This is because all such facilities fall under the IHS federal-wide assurance (FWA00008894). This FWA is the IHS Director’s assurance to the DHHS Office for Human Research Protections (OHRP) that all research conducted under his/her purview will follow Title 45, Code of Federal Regulations part 46 (45 CFR 46), the Belmont Report, and the instructions of the IHS IRB(s) with jurisdiction. The sole exception to this is that urban or Tribally managed facilities may obtain their own independent FWA with OHRP. In that case, the Tribe may use an IHS IRB or any other IRB of it’s own choosing. The IHS encourages (and will assist) Tribally managed health programs engaging in research to obtain independent FWAs.
All IHS approved research conducted in facilities serving specific Tribes must first have obtained the formal, written approval of the appropriate Tribal government(s). This approval must be submitted with the original application to the IHS IRB. Evidence of support from the facility’s Chief Executive Officer (CEO) must also be provided, to document that the project will not use IHS resources in a manner that would adversely impact on the health care provided at the facility. Presentations or publications based on research approved by the IHS IRB(s) must also be approved by the same IRB(s) or by the Area Publication Review Committee (in areas that have such a committee but not a full IRB, see here). Applications for publication/presentation approval with findings about specific Tribes must be accompanied by approval from the relevant Tribal government(s), even if the Tribes are not named in the manuscript. 

Independent Tribal IRBs
An increasing number of Tribes are forming their own IRBs (below) under 45 CFR 46. Research projects at IHS direct care facilities serving a Tribal Nation that has its own IRB must have the approval of both the Tribal IRB and the IHS IRB. Projects at facilities managed by Tribal Nations with their own IRB and FWA require approval of only the Tribal IRB. Protocols approved by Tribal Research Review Committees that do not meet the formal requirements of 45 CFR 46 for an IRB should also be forward to the IHS IRB for approval. A formal letter of approval from the Tribal Research Committee or IRB is required for consideration by an IHS IRB. This generally takes the place of the Council Resolution or approval letter from an authorized Tribal Health Official that would ordinarily be required. Tribal IRBs that serve a dual role as both a Tribal IRB and an IHS Area Office IRB (Such as the Navajo Nation’s IRB) are listed under “IHS IRBs.”

## So how do we develop partnerships?

- Respect, collegiality, trust, equality, communication, commitment, sincere interest in working with the tribe, development of a minimal level of understanding about the tribe’s history prior to making contact if possible
**“****The rule is to talk to tribes before the pencil hits the paper, not when the document is ready to be signed in ink.” **Reno Charette, Coord. of Indian Affairs for the  State of Montana

## Is CBPR the only way, the best way?

- Community based participatory research approaches are not the only way to establish academic partnerships with Native American communities but CBPR does provide a good approach to building a trust relationship with individual community groups or tribes.

## Messengers for Health

- A community-based participatory research project between Dr. Suzanne Christopher, a faculty member at Montana State University, and the Crow Nation that began 5 years ago to increase the participation of Crow women in cervical cancer screening and has now expanded to cover a broader area of addressing health disparities. The project is funded by the American Cancer Society.

## Montana Consortium for Community- Based Research in Native American Health

- Established as a result of many requests from community groups within the Crow Nation, community groups in other Montana reservations and faculty from both the Montana State University and University of Montana campuses for more partnerships to conduct collaborative research between the universities and Native communities.

## Center for Native Health PartnershipsMontana State University-Bozeman

- Linking Native American community partners, university partners and other research partners to develop CBPR projects to address health disparities affecting Native American communities
- 25 planning grants and pilot projects throughout Montana’s seven reservations  and urban Indian centers over a 5 year period
- Have developed MOA’s with 3 of tribes to collaborate on Community Organizers funded through the center to assist the tribal health dept’s in developing the tribe’s own health research agendas; others are in progress

## How do academic partnerships develop when the reservations are so far from the university and urban Native communities are not always easy to locate ?

- Working with universities that have Native American Studies departments and can provide information on Native communities in the region
- Identifying I.H.S. regions with health disparities that fall into research areas of interest to you  and making contacts through either the I.H.S. Area Office, the Area Tribal Health Board or the tribal health board
- Establishing a collaboration with an investigator who has already developed a positive working relationship with Native communities and/or TCUs.

## Native American Health Disparities

- Need for research to address the broad range of health disparities impacting Native American people.
- Tribes are requiring a more significant role in research on or about their tribal members.
- Tribes recognize the need to partner with academic researchers to overcome the health disparities.

**Notes:**
The research needs to address specific health disparities affecting Native communities is broad and there are many potential research partnerships that can be established if you have the time to build a relationship within the tribe whether it be with the governing body, the tribal health board, the tribal college of a small interest group within the tribe.
Many tribes prioritize highly the need to improve the overall health of their tribal members and are willing and interested in collaborating with research partners with the expertise to assist them but most tribes are no longer willing to quietly sit back and watch research conducted on or about their people; they want an active and decision-making role in what will be researched, how it will be conducted and what happens to the data collected and analyzed.

## Thank you for your interest in fostering collaborations with a diverse population impacted by health disparities.