### Arizona Department of Health Services Native American Semi-Annual Report July - December 2005

OFFICE OF THE DIRECTOR

Native American Liaison

The Native American Liaiso n participated in the following major activities and

events:

• Attended the Four Corner Public H ealth Bio-terrorism Conference in Durango, Colorado in July 2006.

• Assisted in the hiring process for t he Bureau of Emergency Preparedness and Respo n se (BEP&R) Native Am erican Co ordinator position.

• Assisted the BEP&R in the sponsorship of five Native American Public Health Bio-terrorism Emergency Preparedness and Re sponse Regional training ses s ions held between July-Sept ember in Flagstaff, Hon Dah, Ft. Mojave, Salt River, and Casa Grande.

• Assisted and participated in on-site trips to Navajo and Hopi Indian Reservations by the Governor’s Ad visory Council on Health, Physic a l Fitness & Sports ( G ACHPF&S).

• Assisted and participated in the GACHPF & S Native American Task Force sponsorship of the 1 st Annual Nat i ve American baseball day on October 15th in cooperation wit h Major League Ba seball’s Arizona Fall League.

• Assisted the Indian Health Servic e (IHS) Pathways into Health (PIH) Project by functioning as the Chai rman of the Governance Committee and serving on the PIH Interim Executive Board.

• Attended Nation Indian Health Boar d Cons umer Conference held in downtown Phoenix in October 2006.

• Attended a Mass Vaccination Clinic Bio- terrorism Exercis e sponsored by the Navajo IHS and Navajo Nation in November.

• Represent ed ADHS as a co-sponsor with the Inter Tribal Counc il of Arizona, Inc. in the sponsorship of the 2 nd Annual Ariz ona - American Indian Health Conference in Nov e mber 2006.

• Participated in planning meetings wit h the Commission of Indian Affairs for the 2006 Legislature Indian Nations and Tr ibes Day to be held in January, 2006.

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### DIVISI O N OF PUBLIC HEALTH SERVICES

Office for Children with Special Health Care Needs

The Office for Children with Special Heal th Care Needs (OCSHCN) received a Maternal and Child Health Bureau (MCHB ) Integrated Services Grant in June, 2005, whic h required the creation of a statewide Task F o rce. The Task Force was charged with providing a forum w here stakeholders from governmental and state agencies, local and community leve l providers, and y outh with special health care needs and their families can revi ew activitie s of the various agenc ies and communities, plan needs assessments, and study alternative funding for services.

Several task-specific subcommittees will conduct need s assessments, develop educational resources, and provide input and evaluation for quality improvement activities. These committees include Educat ion, Cultural Com petency, Parents, Youth, Quality Improv ement, and Specialty Services with a focus on Telemedicine.

To help meet the Grant and Office goals, OCSHCN reached out to representatives of Arizona’s Nativ e Am erican community. Roy Teramoto, MD, Indian Health Services/MCHB Regional Consultant, serves on the Task Force and has been instrumental in identi fying potential committee members and partners including John Kittredge, MD, Tucson IHS/MCHB and Diana Hue, MD, Pediatric Consultant for the Navajo Nation. OCSHCN requested representation by the Pima/Salt River Tribe Mesa Sc hool District Liaison for our Education Subcommittee. One of the parent subc ommittee members is from the Hopi Nation and represents their Office of Spec ial Needs. Mark Carroll, MD is the Navajo Nation Teleme dicin e Dire c tor and will be particip a ting in ourSpecial Services Subcommittee.

Through ongoing outreach to educate comm unities about the needs of children and youth with special health care needs, OCSHCN presented information at the request of the Tohono O’odham Tr ibe Division of Special Services Office in Sells, Arizona. These two sessions wer e for educators, community providers and families. The requested topics were an ov erview of OCSHCN an d two programs, Traumatic Brain Injury and the CommunityDevelopme n t Initiative. OCSHCN also presented at and atte nded the Hopi Tribe Office of Special Needs 10 th Annual Specia l Ne eds Day.

During the next six months OCSHCN spec ific planned a c tivities include meetin g with Integrated Services Task Force and subcommittee member s that represent Indian Health Services/MCHB, the Hopi and Salt River Pima – Maricopa Indian Reservations. Another significant activi ty taking plac e over the next few months will be to increase current technical support for the Hopi Office of S pecia l Needs to create a Community Action Team on t heir reservation per their request.

2Office of H ealth Sy st ems Devel opment A Native American Community Developm ent Program was created under the Office of Health Systems Developmen t; Ms . Kim Russell started as Program Manager on December 12, 2005. The Nati ve American Community Developm ent Program’s overall goal is to improve the development and accessibility of pri m ary health care for Native Americans thr oughout Arizona by worki ng in collaboration with the 21 tribal natio ns, 3 urban centers, and 3 IHS Area offices. Ms. Russell’s tasks include resource development, advo c acy, training, technical assistance, outreach, assessment, coalit ion building, community de velopment and planning. Currently, initial vis i ts to the tribal communities are being conducted to introduce program services and to become familiar with the current services the tribal health care systems deliver. For additio nal information, Kim Russell can be contacted at 602-542-1292 The Primary Care Program, offeri ng basic health care services to low income persons without health insurance in Arizona, awarded 20 contracts July 1, 2005. Most of these clinics s e rve Native American people. Three are particularly noteworthy: Native American CHC assi sts the Urban Indian Popu lation in Phoen ix; Canyonlands CHC serves the Navajo communities of Chilch i nbeto a nd Kaibeto as well as in Page, AZ; and No rthern Apache County Sp ecial Healt h care District is providing care in St. Mic haels and Sanders. These contracts are in place for a year and are expected to be renewed July 1, 2006. For additional information, Gordon Jensen can be contacted at 602-542-1243 The Center for Minority Heal th (CMH), in partnership with the Center for Health Equality in Tucson, will be convening a gr oup of public health professionals from all over the state to be a part of the Health Disparit ies Section of the Arizona Public Hea l th Association. The CMH will ens ure that public hea lth representatives from the tr ibes and urban Indians are invited and participate in a process to develop a statewide agenda to address health disparities for all groups. This meeting will take place in early April, a date has not been set. For additional information, Suncerria Tillis can be contacted at 602-542-2909 The Community Development program, in pa rtnership with the St. L u ke's Health Initiatives and Arizona Health Facilities Author ity, was able to offer a mini grant to the Gila River Health Care Corp orati on (GRHCC), HuHuKam Memorial Hos p ital to support a Breast Cancer Needs Assessm ent Survey to understand why Native American Women have such a high rate of non-compliance wit h keepin g their scheduled mammogram appointm ents. Technical Assistance was provided by the ADHS Offices of Health Syst ems De velopment and the Office of Chronic Diseas e Prevention and Nutrition Serv ices. The GRHCC Managed Care team wants to organize a Health Fair fo r women and the Community Development Program will continu e to connect them to appropriate resources. For additiona l information, Ramnish Mandrelle can be contacted at 602-542-2902 The Health Care Shortage Designations Program submitted applicat ions to the HRSA – Shortage Designation Branch to se cure Health Professional Shortage

3Area Re-Designations (HPSA) of the Navajo and Hop i Nations. For additio nal information, Colleen McGregor ca n be contacted at 602-542-2904.

Office of C h ronic Disease Prevention and Nutrition Services (OCDPNS)

The Cardiovascular Disease (CVD) Program has established the Core Advis o ry Team (CAT). There are several wo rkgroups, each chaired by 2 or more indiv i duals. The CVD program invited Dr . Ja mes Galloway to co-chair the health disparities committee with a distinct focus on the Native American issues related to cardiovascular disease.

The Nutrition and Phy s ical Activit y Progr am provided s ponsorship for the Live Long, Live Strong! youth summer camp . Native American youth from the Colorad o Indian Rese rvation participated in skill-bu ild in g sessions that increased hand-eye c oordination, maintained conc entration, and increased self-esteem, while incor porating the Mohave language and native crafts. This activity was provided through the Colorado River I ndian Tribe Recreation Department. For additional information, Rena Van Fl eet can be contacted at 928-669-1350.

The Arizona Diabetes Prev ention and Control Program (DPCP) assisted with planning the agenda and topics for the 2 nd Annual Arizona - American Indian Health Conference , and provided general diabetes information and financial support. DPCP and Nutrition and Physica l Activity started discussion with Native Health (Native American Community Health Center, Inc.) to collaborate on diabetes pr evention and management through a networking group that represents several Native American agencie s in Arizona. On September 14-15, 2005 the Inter Tribal Council of Arizona s ponsored a conference called “Steps to Nourish the Cycle of Life” in St. George, UT. Participant s were Native Americans from several tribes in Arizona, Nevada and Utah. Two speakers were from ADHS Office of Chronic Disease and Nutrition Services. Magda Ciocazan, Manager, DPCP, was part of a panel presenting on “State Diabetes Programs Working with Tribes” and also hosted an exhibit

. Sue Ze van, nutritionist for the A DHS Arizo na Nutrition Network, gave presentations on “Healthy Menu Planning” and “Elderly Nutrition”.

The Arizona Nutrition Network sponsored a two day training program with the theme of C u lturally Appropr iate Nutrition Edu c ation for Arizona Indian Tribes on the White Mountain Apache Res e rvation. Approxim ately 100 people attended from both urban and rural areas of Arizona. Four tribes presented information on their native foods, including harv e sting and preparation with samples of some of the foods. There were also two presentat ions on working with Native Americans. Throughout the summer of 2005, the Arizona Nutrition Network also provided training and equipment to do demonstr ations about healthy foods, including samples and recipes of foods which are available at reasonable prices. Seven agencies from throughout the state received equipment and training.

4The Steps to a Healthier Arizona (STEPS) continued to work with the Tohono O’odham Nation to assist in getting progr am activities under way. Highlights include the participation of adult and adoles c ent community members in a series of focus groups conducted in October 2005 to gather relevant healt h and cultural information to be utilized for the Steps heal t h marketing campaig n . In addition, the Tohono O’odham Nation Steps program staff has been participating in various conferences and trainings coordinated and sponsored in part by ADHS. These activ i ties suppor t the Tohono O’odham Nation's work in the community and schools and include the 8t h Annual Nat i onal Communi ty Health Workers/ Promotores Conference; the 6th Annual Border Health Information For Action Conferenc e; a Southern Arizona Walk able Communities Workshop; and CDC School Health Index training. A jo int presentation on community and school based programs was also given by Franc es Kaplan, MPH and Michael Bitric k, Tohono O’odham Nation Department of Heal th (TODHS), at the 2nd Annual Arizona - American Indian Health C onference in November 2005. The presentation focused on community and school-based programs. The TODHS and their local Steps program are in t he process of preparing to conduct the Behavioral Risk Factor Surveillance S ystem (BRFSS) s u rvey in the SpringSummer 2006. ADHS and CDC provided technical as sistance to TODHS to adapt the BRFSS to best fit with the Nation’s cultural, programmatic and

resources concerns.

The Well Woman Health Check Progr am is working with the CDC and contractors to increase the recrui tment of Native American Women into the program. At quarterly meetings, c ontractors have been educated on many issues related to Native American wom en, including hea lth status, health beliefs, and access -to-care issues. All cont ractors, along with member of the Comprehensive Canc er Control Coalit ion and several ADHS employees, will attend a training presented by the Nati onal Indian Women’s Health Resource Center, Inc., entitled “Working Effectiv ely with American Indians: A Cultural Competenc y Training” in January 2006.

The Arizona WIC Program has been work ing closely with the Navajo Nation and Inter Tribal Counc il of Arizona, Inc. WI C Programs to finaliz e our Arizona St ate Nutrition Action Plan. The plan is designed to encourage partnerships and collaborativ e interventions between nut rition assistance programs and other groups (e.g., Arizona Department of Educ ation), which promote healthy eating and healthy weight. Our next join meeti ng will be Febr uary 15, 2006, where all participants will d i scus s their successes in implementing their portion of the plan.

Office of Oral Health

Regarding the San Carlos Apache Tribe WI C Program, the Inter Tribal Counc il of Arizona, Inc. Dental Support Center trai ned a Tribal member of the San Carlos Apache Tribe as a dental health educator. She works out of t he WIC Program in San Carlos and also provides service to the community of Bylas on Tuesdays.

5The funding ($12,000) was contracted to t he Inter Tribal Counc il of Arizona, Inc, who sub-contracted the funding to the San Carlos Apache Tribe WIC Program. The Dental Health Educator provided or al health educ ational materials, oral hygiene ins t ructions (OHI), diet and f eeding practice information, and prevention supplies to clients of the San Carlos WIC Program. Fluorid e varnish was applied to high-risk children enrolled in the WI C Program every 3 months. 1089 clients received oral health educational material s, oral hygiene in struction, diet and feeding practice information and preventi on supplies. 655 applic ations of fluoride varnish wer e applied to children. The San Carlos Dental Health Educator also attended two community health fairs where she set up a dental health education booth. In addition, the San Carlos Dental Health Educ ator wrot e an article in the local news paper about fluoride varnis h and information on preventing Early Childhood Caries.

Tobacco Education and Preven tion Program

There are monthly ongoing progr am activi ties (on/off reservations) with our Native American contractors including com m unity education, youth coalitio n groups, school interv ention, cessation (Phoenix/Tucso n), and collaboration meetings with county health depar tments, pr ovider training/presentation, public services announcements, and events. Fo r information, please contact: Beau Cordova (ADHS-TEPP) (520) 770-3109. Highlighted activities of the major collaborativ e efforts are as follows:

Ongoing Activities:

(Off Reservation) Monthly collaborati on meetings with Phoenix Indian Medical Center (PIMC) and ITCA. Monthly meeti ngs with Native Visions Coalition, meetings with Native Health, PIMC, and ITCA. Monthly collaborat ion meetings with Black Hills Center for Indian Health (CDC funded for Navajo Nation), Navajo County, Apache Count y, Coconino Count y, Native American for Community Action (NACA), and ITCA. Monthly Amer ican Indian Youth Conference Planning meetings with ITCA, Hualapai Tribe, H opi Tribe, Native Health, NACA, Tucson Indian Cent er, Inc. (TIC), Salt RiverPima Maricopa Indian Community (SRPMIC), and Colorado River Indian Tribes (CRIT).

(On/Off Reservation): Quarterly C o mmunity Advisory T o bacco Co alitio n Meeting with ITCA, Gila River Indian Community, Hopi Tribe, Hualapai Tribe, Pascua Yaqui Tribe, SRP-MIC, CRIT, White Mountain Apache T r ibe (WMA T), KaibabPaiute Trib e (KBPT), NACA, Native Health , TIC, I.H.S., and Black Hills Cente rfor American Indian Healt h

.

Activities for Past SixMonths:

(Off Reservation) Staff attended 3 rd Annual Hualapai Yo uth Conference in Phoenix wit h Arizona T r ibes and ITCA in July . Staff attended National Native

6Tobacco Conference in Portland, OR with US Tribes, Urban Indian Health Centers, US State Health Departments, and Indian Health Services in August. Staff attended Best of the West Coalit ion for Tobacco Free Arizona Conferenc e in Phoenix in September. In Novem ber staff attended Great American Smoke Out at PIM C with Native Health and 2 nd Annual Arizona - American Indian Hea l th Conferenc e in Phoenix.

(On Reservation) In Oc tober staff attended Red Ribbo n Week with the Hualapai Tribe, Hopi Tribe, WMAT , SRP-MIC, PYT, and KBPT.

Planned Ac tivities fo r Next Six Months:

(Off Reservation) In February staff will participate in the Tucson Indian Hea l th Event with the TIC, P Y T, Tohon o O’odham Nation, I.H .S., AHCCCS, DES, ADHS, and UA Colleg e of Public Health . In July staff will participate in the Tobacco and Health Youth Conf erence wit h ITCA and tribal/urban Indian health

center contractors.

Office of Women’s and Children’s Health

Regarding the Rape Prevention and Educ ation Program (funded by Centers for Diseas e Control), Ama Doo Alch ini Bigh an, Inc. (ADABI) in Chinle r e ceives funding to provide rape prevention and educ ation (RPEP) services on the Navajo Reservation. ADABI is active in presenting rape prevention and education by providing prev ention activities for schools, businesses, social service providers and others throughout the area. Additionally, they also disseminat e information via community boot hs. For additiona l information, C a rol Hensell can be contac ted at 602-542-7343.

Regarding the Family Viol ence and Prevention Services/Rural Safe Home Network (funded by Dept. of Health and Human Services Administration on Children an d Families) , Ama Doo Alchini Big han, Inc. (ADABI) in Chinle receiv es funding to provide domestic violence serv ices on the Navajo Reservation. ADABI is active in the domestic violence ta sk force, provides temporary emergency shelter through its safe home network, cr isis counseling, case management and a 24-hour crisis line; provides prev ention ac tiv i ties for schools, businesses, social service providers and others throughout the area. For addition al inf o rmation, J Ann Pope can be contac ted at 602-542-7341

Regarding, Community Health Contract ors (funded by Maternal Child Health Block Grant):

• Inter Tribal Counc il of Arizona, Inc. (ITCA) has a child car seat program and adult motor vehicle safety prac tices regarding seat belt use for pregnant women. ITCA distributes child car safety seats to certified technicians that, in turn, distribute the car seat with car seat safety education to any of the 19 tribes that request them. The tribe receiving the seats submits a list of i n stallation s completed/distributed to the ITCA

7coordinator(Marianne Johnson, 602-307-150 9.) During this time period, 2,059 car seats were distributed to several of the tribes, 20 advertisements demonstrating safe seat best use for pregnant women were publis hed in various tribal new spapers/magazines (Au-Authm Action News, Ariz ona Native Scene Newspaper, Fort Apache Scout News paper, 2005 Nativ e American Recognition Days Publication, Apache Gold Magazine, to name a few). Four Public Service Announcements have been aired and ten new car seat te chnic i ans have been trained and certified to serve the 19 tribes. Du ring the past six months, thousands of brochures addressing child car safety s eats using pictur es of local tribal children have been dis t ributed along with those demonstrating the proper use of adult seat belt placement for pregnant women. Lar ge, professional posters on these same two topics have also been distributed to the tribes that request them and are often found in the various WIC offices. A child passenger safety conference is sc heduled for year 2006 and is planned on being held in conjunction with a 4-day Child Passenger Safety S eat Training to help increase the numberof certified technic i ans throughout the various 19 tribal communities by at least 10. Twenty additional newspaper ads are planned for 2006 and 2,500 additional car seats to be distributed. The brochures and pos ters will continue to be printed and distributed as has been done in the past.

• Apache County has a child car s eat program and adoles cent motor vehicle safety program. Through the I ndian Health Ser v ices Envir onmental Health Division at Fort Defiance, the Northern Native American population is served. This population is als o served every time a Native American comes into the Apache County office and requests child car seat services. Services are also provided to Navajo County through a sub-contract which also inc l udes assistance to those co mmunity members of Native American ethnicity. During the past year, 33 child car seats with education have been distributed to parents/caregi vers at Fort Defiance.

• Pinal County has a child car seat program and adolescent motor vehicle safety program. The hi gh school s t udents at the VHM Alternative School in Sacaton receive a yearly presentati on on “Survival 101 – Staying Alive”. This class teaches the importance of car seat belt sa fety and the dangers of alcohol use while operating a motor vehicle through an interactive/ educational presentation. This contract or also provides car seats, forms, incentives and educat ional materials to the Gila River Polic e Department and the Gila River Fire Department. The two agenc i es provide education on and distribution of child car safety seats to parents/caregivers within their tribe.

• Mohave County has a child car seat pr ogram. This contractor assists with car seat events on the Hualapai Indi an Reservation in Peach Springs in collaboration with the I ndian Healt h Service H ealth Center. Mohave County provides car seats and certifi ed technicians to assist with the education and installation of the car seats and also teaches the importance of using adult seat belts.

8• Coconino County has child car seat program. Annual child safety seat classes are scheduled for the Havasupai Res e rvation. The trip is coordinated with the Arizona Departm ent of Public Saf e ty which helic opters the seats and teaching equi pment to the community which is located at the bottom of the Grand Canyon. Services are also provided in Page, with Navajo Reservation resi dents participating. Coconino County administers a Governor’s Office ofHighway Safety CAPP (Children Are Priceless Program) in nort hern Arizona. Many of the participants are from the nearby reservations. For informat ion contact: Patty Rhodes/Karen Kuhfuss, 364-1400

Office of Infecti ous Disease Services

In the Vector-borne and Zoonotic Diseases (VBZD) Section:

• In 2005, ADHS’ VBZ D staff participated wit h CDC, IHS, Whiteriver Apache and San Carlos Apac he Tribes in controlling an outbreak of Rocky Mountain spotted fever (RMSF) i n t he White Mountains area. ADHSVBZD print ed/provided educational ma terials (over 10,000 fliers and 2,500 calendars/coloring books for kids), provided tick collars and sprays for dogs (over 4,000), provided pesticides (360 bags of permethrin granules) for tick control around homes, and st aff assisted in the field with conducting tick trapping/risk assessment s and putting tick collars on dogs. These efforts were funded through t he $50,000 from the Health Crisis Fund approved by the Governor earlier in the year for thi s purpose. (NOTE: most of the assistance in the field occurred in May)

• ADHS-VBZ D staffs have worked with tribes and IHS programs throughout Arizona on West Nile virus surveillanc e and vector control. The program provided s u rveillance equipment, training, mosquito speciation and testing support, and larvicidal products.

• In 2006, ADHS’ VBZ D staff will continue to work with tribes and IHS in monitoring and mitigating the RMSF thr eat in the White Mountain Region (as resources allo w). Additio nally , VBZD an d CDC staffs are working with humane societies, animal control progr ams, etc. in ex panding the RMSF surveillanc e effort beyond the reservations through an ongoing ca nine serologic study. The program staff will a l so co ntinue the West Nile virus partnership s with tribes and IHS in 2006 for purposes o f surveillan c e and disease control.

In the TB C ontrol Program:

• The TB Control Program provided financ ial support to two tribal health departments through supplement al Inter governmental Agreements (IGAs) for TB control and prevention activities, inclu d ing dis eas e surveilla n c e, education and the provision of directly observed therapy.

• The program co-sponsored the 11th Annual TB/HIV Four Corners Conferenc e, which was held on October27 -28 in Durango, Colorado.

9Conferenc e attendees included TB, ST D and HIV staff from tribes and IHS.

• On December 15, the ADHS De puty TB Controller presented "Fundamentals of Clinical / Medical TB : Update and TB Control" to the public healt h nurses of the Navajo Nation and Navajo Indian Health Service.

• The program coordinated monthly TB case conference calls with the Phoenix Indian Medic a l Center, tri bal TB Control Programs, and county health departments for the purposes of coordinatin g Native American TB patient tracking and care acro ss jurisdictional boundaries.

• The program provided food voucher inc entiv es to local health department TB Control Programs, i n cluding tr ibal TB Control Programs. These vouchers were made available to TB patients to encourage compliance with taking their medicine.

• In 2006, the program will c ontinue supportin g specific tribes through IGAs. Additio nally , the program will co-sponsorwith other Four-corner states the 12th Annual TB/HIV Four Corners C onference 2006, which will tak e place in Flagstaff in October. The program will als o co-sponsor with the Arizona Department of Corrections a statewi de TB Conference on April 5, 2006 for correctional facilities a nd public health depar tments. All tribal healt h departments and Indian Health Services regional offices will be invit ed. Finally, the program will continu e coor dinatin g Native A m erican TB case conference calls and provision of food vouchers depending upon availability.

In the STD Control Program:

• The program staff provided and/ or fa cilitated the provis ion of staff and equipment for the Navajo Nation Health Fair s held in both Fort Defiance and Tuba City.

• The program hosted CDC’s Adv a nced STD Intervention s training and worked wit h the IHS and Navajo Nation to successfully encourage attendance of Navajo Nation Communi ty Health Repr esentatives

.

• The program provided assistance for HIV Partner Counseling and Referral Services training of nurses at the White River IHS Hospital to address intervention in a cluster of HIV cases.

• The program arranged supervisory training at the Maricopa County Department of Health for one staff member of the Navajo Nation HIV Prevention Program.

• Program staff worked with staff of the Inter Tribal Counc il of Arizona and the IHS on the planning of a Phoeni x Area STD/HIV Conference to be held in Phoenix in January 2006.

• Dr. Melanie Taylor, the STD Program ’s Medical Epidemiologist made presentations at the G ila River and the Whiter iver Reservation’s IHS hospitals to over 45 physicians, clinic nurses and public health nurs e s. These presentations, offering CEUs for attendance, covered medical

10diagnosis, treatment and follow-up of STDs, as well as providing Arizona STD morbidity data.

• In 2006, the program will work with Native American communities and the Arizona Family Planning Counc il to expand chlamydia screening in Native American communities . The STD Progr am will also continue to provide presentations to medical staff at IHS and tribal medical facilities and to increase contact with all Arizona Nati ve American Tribal communitie s

. In the Hepatitis C Program:

• The program trained 21 persons in t he Gila River India n Community on Hepatitis C training.

• In 2006, the program will increas e STD Awareness in Tribal Communities through participation in the Region al STD Co nference. Judy Norton will present The ABC's of Hepatitis s e ssi on on 1 / 25/06. The program w ill a l so conduct a Hepatitis C training class for Indian Health Service and PIMC staff.

DIVISION OF BEHAVIORAL HEALT H SE RVICE S

Division of Behaviora l Health Services (DBHS)

Methamphetamine First Responder Training: DBHS provided the first of three planned technical assistance sessions to the Colorado River Indian Community in Parker during October 2005. The wor kshop was collaboratively planned by CRIT Behavioral Health, Social Services and local law enforcement and focused on community-wide planning to address methamphetamine.

Methamphetamine Initiative: DBHS provided funding in October to the Gila River Indian Com m unity and three RBHAs to develop and launch a specialized outpatient treatment program for adults with methamphetamine use disorders. Gila River is establishing on-reservation spec ialized counseling services beginning in December. Cenpatico establish ed a contract with a Native American consultant to develop c u lturally appropr iate treatment programming with the San Carlos Apache Tribe and hired a spec ialized methamphet amine treatment provider to conduct three 2-day trainings for all provid ers and interested tribes during Nov e mber. Value Options and CP SA will develop expedited referral linkages and specializ ed methamphetami ne treatments for adults in the Pima county detoxification center and in Mari copa County drug courts. Both linkages serve a considerable number of urban Nativ e Americans.

New/Unobligated Funds: DBHS conducts routine financ ial monitoring of RBHA and TRBHA contractors to identify funds that could be re-directed for greater efficiency. In addition, AD HS met with the Governor’s Tribal Liaison and the Governor’s Budget Director to finalize an appropriations request for the FY 2007 state budget that would include up to $1.1M in General Funds to develop

11additional methamphetamine tr eatment centers in rura l regions of the state including s e rvices for tribal communiti es. Funds would be adminis tered by the ADHS.

Governor’s Office Anti-Meth Init iative: DBHS participated in two methamphetamine planning efforts launched by the Governor’s Office, including an initiativ e to develop and support communi ty and tribal anti-drug coalitions to address methamphetamine at the local lev e l.

Native American Suic ide Coa litio n Re treat: Planning for the semi-annual Coalition retreat began in early Dece mber. The retreat, scheduled for March 2006, will include a strategic planning sess ion featuring Dr. Teresa LaFromboise from Stanford Univers i ty. Dr. LaFromboise is the author of the Zuni Life Skills Development curriculum, a SAMH SA-endors ed evidenc e based practice for suicide prevention among native youth.

Child-Adolescent State Incentive Grant: ADHS/DBHS hosted the federal site visit for the grant in December. Gila River TRBHA, a grantee participant, participated in interviews with the site visit team on strengthening s e rvices for children us ing culturally acceptable approaches.

Northern Arizona- Nav ajo Nation Coll aborative: Northern Arizona Behavioral Health Aut hority (NARBHA) held two collabor ative meetings wit h tribal entities in northern Arizona in October and December . The focus of the meetings is providing technical as sistance to strengt hen local servic e delivery on reservation lands.

The Bureau of Contract Compliance rec ently hired Ms. Julia Ysaguirre, as a Contract Complianc e Administrator, to work exc l usiv ely with Tribal Regional Behavioral Health Aut horities (TRBHAs). In her role, Ms. Ysaguirre serves as the point of contact for the Gila River Indian Community and the Pascua Yaqui Tribe, who currently maintain signed intergov ernmental agreements (IGA) with the Division for the adminis tration, planning, coordi nation and monitoring of behavioral health services. The TRBHAs serve tribal members residing in eac h Tribe’s respective geographical service de liv ery area. The IGAs provide Title XIX (Medicaid) and Title XXI (KidsCare) funding and require s the TRBHAs to administer a managed care behavioral hea lth delivery system of care that provides services that ar e individual and family centered. Ms. Ysaguirre provides technical assistance to the TRBHAs and assists the TRBHAs in their program operations to ensure tribal communi ty members have access to care and services are culturally relevant. She also coordinates internally to foster cooperation and coordinat ion wit hin the Division and as sists with the oversight of contractual performance of the TRBHAs. The Divis ion recently completed an administrative review of TRBHA financia l and operational syst ems, as required by AHCCCS, and Ms. Ysaguirre will coordi nate the communicatio n s regarding

12final outcomes and any required correct ive actions. Ms. Ysaguirre may be reached at 602-364-4739 or by email at ysaguij@azdhs.gov

Arizona State Hospital

Arizona St ate Hospital, located in C entral Phoenix emplo ys about 900 people, with operations 24 hours a day . Generally, the Hospital is divided into four populations : Forensics, Civil, Adolescent s, and Sexually Violent Persons. The Arizona St ate Hospital is a public ly f unded long-term hospital that provides services for those suffering from a severe mental illnes s, as well as people with a history of sexuallyviolent crimes.

All patients are served through asse ssment and treatment planning processes that are patient and family centered, are clinically sound and build upon the identified strengths and needs of the patient, and are cult urally and linguistically appropriate and responsive to the individual needs of the patient. All patient care services are provided by qualified and co mpetent staff and are intended to meet the needs of the patient to achieve the highest level of functioning possible for the patient, so that he/she can achieve disc harge, community reintegration, rehabilitation and recovery of his/ her behavioral health and well-being.

The patient ’s inpatient clinic al treatment team consists of a qualified psychiatrist (treatment team leader ), fa mily practice physician or certified physician assist ant, registered nurse and mental health program specialist, social worker, rehabilitation professional, nutritionist, any involved family/guardian or other patient representative, community tr eatment provider representatives , and representatives of any other involv ed agencies or departments. The Hospital’s Interdisciplinary Clin ic al Team assesses each patient upon admiss i on to the Hospita l

.

The acuity of the patient’s symptoms and c ondition, and legal status at the time of admission, provide the interdisc i pl inary clinical team with guidanc e in determining the least rest rictive and most appropria te treatment methods and interventio ns to be utilized with the pat ient follo wing ad mission to meet the patient’s identifi ed treatment needs.

Within 24 hours of an admission, psychia tric, medical, and nursing assessments are completed. Following admission, the Interdisciplinar y Clin ical T eam meets with the patient to consider the initial assessments of the patie nt and to identify the patient’s initial treatment needs for se rvices during the hospitalization. The clin ical tea m develops an initial treatment plan that is utilized for up to 10 days following admission, until the Master I ndividualize d Treatment and Discharge Plan is dev eloped and implemented. P sychosocial, rehabilitation, and other assessments as needed, are completed wit hin 10 days of the admission.

13Fifteen Native American patients were tr eated in 2005, nine were males and six were females. Six of the fifteen were tr eated by Serious Mental Illness status.

DIVISION OF LICENSING SERVICES

Medical Facilit ies

Gila River Healthcare Cor poration has two dialys is facilities located on the reservation located in Sacaton and Laveen. The Corporation was provided

extens ive technical as sistance to meet the federal ESRD regulations to be certified as an ESRD Medicare provider. Since these two facilities are located on the reservation they are not required to be state licensed. Sage Memorial Hospita l ha s a facility located in S anders, AZ which is n o t located on the reservation, however, it provides servic es to the Native American population. The facility was given technica l as sistance on services provided an d there is no licens ing requirement for providin g only dental services.

Long Term Care

The White Mountain Apache Tribe wants to build a nursing home outside of a traditional nursing home. There has been discussion re: oversight/regulations and wheth e r they will meet federal requi rements. The tribe may apply for an exemption. Gila River Annual Sur v ey (Medicare) conducted on December 6, 2005.

Assisted Living:

Assisted Living has had inquiries and been meeting with Navajoland Nursing Home Inc, with regards to an assisted liv ing facility in Chinle on the Navajo reservation. There is an active applic at ion, Their building is built and sitting empty, since architecture (Special Licens i ng) is waiting for some documentation. The Office of Assisted Living and Specia l Licensure have been wor k ing diligently to help them get up and running. Assist ed Living has also met with the White Mountain Apache Nation concerning an assi sted living facility adjacent to the hospital in White Rive r . Assisted Livi n g has met with an unaffiliated group of Native Americans from Blue Gap which is north and west of Chinle and on the Navajo Re servation.

Special Licensing:

Special Lic ensing ass i sted Sage Memorial Ho spital with the architectural aspect of the licensing requir e ments.

14Child Care:

No activities with Native Americ an tribes within last six months.

Behavioral Health:

No activities with Native American tribes within last six months. Planned Activities - The Behavioral Health Program will be conducting surveys with two Native American tribes within next six months.

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