# Quick Guide to Title III-Title VI Nutrition Collaboration

This document is intended to provide suggested steps to State Units on Aging (SUA), Area Agencies on Aging (AAA) and local nutrition providers on ways that Title III and Title VI nutrition service providers can work together to achieve the goals of the Older Americans Act (OAA). The OAA has specific requirements for both state plans and the AAA plans to detail how they are working together with the Title VI programs in their states/service areas if applicable.

The Administration for Community Living (ACL) encourages states and AAAs to ensure services are reaching older adults in greatest social need, including individuals who are Indigenous and Native American. This quick guide has suggestions for starting and maintaining a collaboration with Title VI programs in your state, AAA, or local areas.  

For more information on Title III-Title VI collaboration, check out the full study on collaboration, funded by ACL in 2020.

Suggested actions are divided into categories of Planning, Implementing and Maintaining a collaborative relationship. Collaboration is an important step in:

· Learning about current programs funded under Title III and Title VI serving your area.

· Attaining greater efficiency and less delay in providing needed services.

· Minimizing duplication of services, which leads to more persons being served.

· Gaining more community support.

## Planning for a collaboration

· Recognize tribal sovereignty. Tribal sovereignty is the inherent right of federally recognized tribes to self-govern.  At the state level, this means the tribe (variously called tribes, nations, bands, pueblos, communities, and Native villages) is interacting with the state on a government-to-government basis. Federally acknowledged tribes are sovereign governments that exercise direct jurisdiction over their members and territory and, under some circumstances, over other citizens as well. Tribal governments provide a wide array of governmental services to their members including lawmaking, tribal police and court systems, health and education services, and possibly much more. A state generally does not have legal authority over tribal governments and tribal members when they are inside the tribe's territory, i.e., lands designated as the tribe's reservation or trust lands.

· Understand that each tribe can have its own rules and regulations, so recognize that no two tribes are alike.

· Identify the contact person for the tribe and the Title VI programs.  A list of tribal leaders can be found at the  Department of Indian Affairs website. The Older Indians website also has a listing of tribal leaders as well as Title VI directors. To locate agencies that provide Title VI services, visit the Aging, Independence, and Disability (AGID) map for information on grantee organizations.

· Set up a ‘meet and greet’ with tribal leaders. You don’t necessarily have to talk detailed plans at the first few meetings. Remember that it’s okay to admit that you are unsure of cultural practices and ask for guidance. If your agency has established relationships with groups that work with tribes, you may want to ask for an introduction to the tribal leaders.

· Incorporate cultural competency practices into your organization (see resource section for detailed ideas including those listed below).

· Implement policies that include assessments of your organizational and staff’s cultural competency and specific training for Indian nations, tribes, pueblos, or Native villages.

· Seek out providers of cultural equity or cultural competency trainings.

· Practice diverse hiring.

· As you begin the planning for a collaboration, find out what differences exist between the Title VI (tribal) and Title III (non-tribal) nutrition programs. For example, get an understanding of how state and tribal practices differ, and what practices are common between both. This will take some meetings with tribal leaders and/or their nutrition program managers. You may want to set up a time to visit tribal meal sites or kitchens and ask questions of the site manager and nutrition provider.

· Review what your SUA has included in their state plan. The OAA states, “The state plan shall provide an assurance that the State agency will coordinate programs under this title and programs under Title VI, if applicable, or state-specific information” (Sec. 307 (a)(21)(A)).

· AAAs also must provide information in their plans about coordination with tribes when applicable. “Area Agencies on Aging...to the maximum extent practicable, coordinate the services the agency provides under this title with services provided under Title VI” (Sec. 306(a)(11)(B)).

· Once you have reviewed the current plans and activities that the state plan and AAA plans have for working with the tribes, create a crosswalk of policies, actions, and activities related to nutrition programs to see where the groups are similar and/or different. This makes a great conversation starter when meeting with tribal elders to propose collaboration.

· Review the different models of collaboration that ACL reported in a recent study.

· Any level of collaboration is good, but make sure your organization can follow through on what it commits to. In general, the four levels (discussed below) build on each other, from least complex and involved (cooperation) to most complex and involved (service integration).

## Implementing collaboration

· Decide which tribes you want to work with. Consider the following:

· Greatest need:  Tribes that have large wait lists for services, elders who are not receiving services, have high poverty levels or a high incidence of chronic disease should be approached first for a collaboration.  If you are working with a tribal organization that represents multiple tribes, ask them which tribe or tribes have the greatest need.

· Existing partnership: If the tribe is already working with a non-nutrition program in your SUA or AAA, such as Title III-D programs, the existing partnership can be expanded into nutrition programs.

· Assistance from other community agencies. If other community agencies are partnering with a tribe to provide nutrition services assistance, you may want to partner with a tribe that does not already have community support.

· Readiness to partner:  During your ‘meet and greet’ and subsequent meetings, determine how ‘ready’ the tribe is to partner. If the tribe seems reluctant to partner, don’t give up on the idea of collaborating. Partnering with another tribe first may help you to gain credibility and trust with other tribes.  

· Ensure sustainable communication channels

· Add the Title VI Director or other appropriate tribal aging program staff to your newsletter or other distribution lists. Do this for all tribes in your service area.

· Ensure your state, AAAs, and local service providers maintain updated lists of tribal contacts. Reference the links listed above periodically to keep the contact info up to date.

· Establish processes to refer clients between AAAs/service providers and tribal organizations and share information. The process should be thoroughly explained to all staff involved.

· Include Title VI grantee staff representatives and/or Title VI service recipients on your organization’s advisory boards.

## Maintaining collaboration

· Have a consistent point of contact to streamline communication and build relationships.

· Meetings can be helpful to brainstorm solutions or work on events together.

· Check-ins will help build trust. Call or email periodically even when there is no business or programming to discuss.

· Regularly share organizational goals and plans with each other. When there are changes of leadership in any organization, priorities can also change. Make sure that your organization is clear in your commitment to continue to work together.

· Reach out for help. Other State Units on Aging, AAAs, local service providers, and/or ACL Regional staff can support collaboration efforts and provide assistance.

· Don’t give up. Remember that collaboration can take time. 

## Resources

· **Working with Tribal Nations** is a free online training developed by the National Indian Health Board. The training is designed for state, federal, and other non-Native stakeholders to learn to work collaboratively and effectively with American Indian and Alaska Native Tribes and Tribal systems. The training offers background on Indigenous people's contact with Europeans, how the colonial experience has impacted the health and well-being of Tribal populations, and best practices for successful engagement with Tribal governments.

· **Older Indians** is the website home of ACL’s Title VI program. The site provides news, information for grantees, a map of Title VI directors, and archived trainings for the Tribal aging network.

· **ACL Diversity Toolkit** provides a starting point for conversations regarding how to better serve diverse populations of older adults. It includes assessments and information on identifying resources, designing services, and program evaluation. 

· **Native Elder Service Locator** from the National Resource Center on Native American Aging is useful for locating services, resources, and data available by area.

· **Services for Native Americans (OAA Title VI)** is an ACL webpage that outlines the history of the OAA Title VI programs and services, its purpose, evaluation updates, funding history, resources and more.

· **The National Resource Center on Native American Aging, University of North Dakota******has been funded by AoA since 1994. A culturally sensitive staff and national steering committee govern the resource center, which provides education, training, technical assistance, and research. It also assists in developing community-based solutions to improve the quality of life and the delivery of related support services to the Native elderly population. A major project of this Resource Center has been the development of an elderly needs assessment tool to assist tribes in planning for elder care services.

· **National Resource Center for Alaska Native Elders**. In 2003, AoA funded the National Resource Center for Alaska Native Elders at the University of Alaska-Anchorage to: 

· Empower Native communities to incorporate traditional and contemporary health practices that have the potential to effectively support and treat elders within community health care systems.

· Provide technical information to promote culturally sensitive and functionally appropriate services to maintain social well-being.

· Provide an arena for discussions about the increasing problems of elder abuse to help Native communities in developing their own plans to reduce and control occurrences.

· **The National Resource Center for Native Hawaiian Elders** was established in 2006 under a grant from AoA to the University of Hawaii School of Social Work. With the nation’s largest enrollment of Native Hawaiian students, the University of Hawaii has as its mission the development and transmission of knowledge for the betterment of all Native Hawaiians. The National Resource Center seeks to continue this commitment with a focus on improving the well-being of Native Hawaiian elders by forging stronger collaborative relationships among the University and Native Hawaiian and gerontology communities.

## 4 Models of Collaboration

**Cooperation, Coordination, Partnership and Service Integration**

**Cultural Competency & Tribal Sovereignty: Foundational to Successful Collaboration**

### Cooperation

· Referrals of clients between organizations

· Information sharing

· What this looks like in real life:

· Alu Like, Inc. (Title VI grantee) and the Hawai’i County Office of Aging (Title III grantee) refer clients to each other based on the needs of elders as well as the services offered by the other organization.

### Coordination

· One-time or occasional joint events

· Regular joint meetings

· What this looks like in real life:

· Northwest Regional Council (Title III grantee) hosts a booth with information on their services at Nooksack (Title VI grantee) tribal functions.

· Kodiak Area Native Association (Title VI grantee) and Senior Citizens of Kodiak (Title III grantee) are both part of the Human Services Coalition that meets quarterly to discuss social services on Kodiak island.

### Partnership

· Shared funding

· Consistent or many joint events

· Shared resources

· Regular advising

· What this looks like in real life:

· Kodiak Area Native Association (Title VI grantee) receives supplemental Title III funding from Senior Citizens of Kodiak (Title III grantee) to support congregate meals and in-home meal delivery.

· The Standing Rock Sioux Tribe (Title VI grantee) and North Dakota ASD (Title III grantee) both advise each other on a number of topics. For instance, the director of the Standing Rock Sioux Tribe provides advice on Native cultural norms, while North Dakota ASD staff provide advice on OAA services and reporting requirements.

### Service Integration

· Continuous communication

· Multiple layers of collaboration at the leadership & staff level

· Development of new programs or services together

· What this looks like in real life:

· The directors of the Wyandotte Nation (Title VI grantee) and Grand Gateway AAA (Title III grantee) regularly communicate to share any issues that arise. The director of Grand Gateway AAA has encouraged all of her staff, regardless of their level, to be involved in collaboration efforts.

· Alu Like, Inc. (Title VI grantee) and Hawai’i County Office of Aging (Title III grantee) worked with the state’s two other AAAs, the SUA, and the Self- Management Resource Center to develop the Healthy Aging Partnership.

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