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CDC/ATSDR Tribal Advisory Committee Meeting

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CDC/ATSDR Tribal Advisory Committee Meeting, August 2, 2016

Morning Session

Tribal Advisory Committee Business and Tribal Support Unit Updates 

The Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances 

and Disease Registry (ATSDR) designated federal official, senior leaders, and Tribal Advisory 

Committee (TAC) delegates held conversations about committee priorities, strategic 

planning opportunities, and improved engagement strategies. This session provided an 

open format for TAC members to discuss matters of importance and make general inquiries 

of the agency. Discussion focused on the TAC’s expressed desire to come to Atlanta during 

October to hold a discussion session with CDC Director Dr. Tom Frieden to review the TAC

Strategic Priorities document being created for the change in administration. TAC members 

and CDC senior leaders explored opportunities to mitigate concerns over the impact of a 

changing administration. Ideas discussed included the development and implementation of 

a tribal engagement policy across CDC’s centers, institutes, and offices and development of 

a strategic document in the form of an annual agency report that delineates Indian Country 

successes, unmet needs, and budget priorities Additionally, there was robust dialogue about 

strategies to improve the agency’s process for responding to issues raised and 

recommendations made by the TAC. There was consensus that the appropriate response 

document should concretely explain the barriers to action by the by the agency so that TAC 

delegates could have an increased understanding. The ideal response would be trackable 

and filled with substantiating data so that the TAC could statistically analyze its requests and

the resulting actions by the agency . The session concluded with a brief review of the 

improvements made to the Tribal Support website in response to guidance from the TAC 

delegates at the Winter 2016 TAC meeting in February.

Innovative Programmatic Work in Domestic Violence

Beth Turner, director of health promotion services, Indian Health Council, Inc., led a panel of 

experts from a panel of experts from California area tribal organizations discussed 

programmatic work related to intimate partner violence in Native communities. Panel 

participants came from the Strong Hearted Native Women’s Coalition, Inc., La Jolla Band of 

Luiseño Indians Avellaka Program, Southern California Native Women’s Village Kiicha 

Project, and the Native Women’s Resource Center. Panelists shared that, due to the small 

size of many local programs, strategic collaboration has been required for successful 

outcomes. Comprehensive response is achieved through these partnerships, with each 

program taking a lead in its area of expertise, ranging from legal services, 24-hour 

connection to crisis resources, and placement of victims and families in Native-centered 

alternative housing. Panelists explained that the message they share is one of empowering 

Native women and reminding them that they are natural advocates for their children. 

Creative strategies to rethink issues also were shared by the panel, including tribal

implementation of a reversed system that supports the perpetrator, rather than the victim,

in leaving the home. The session concluded with a personal account of domestic violence

highlighting the effectiveness of comprehensive strategies to address victims’ needs. Post-
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session discussions with TAC delegates emphasized the necessity for tribes to face the issue 

within their communities, embracing the use of cultural approaches—such as creation

stories, the roles of Native women and men, the celebration of life, and the celebration of 

children―in addressing domestic violence and other behavioral health issues. 

CDC Budget Updates

Georgia Moore, associate director for policy, Office for State, Tribal, Local and Territorial 

Support, CDC, presented a federal budget update. First, Ms. Moore shared that, in response 

to a TAC request, OSTLTS has launched a new “Budget, Grants, and Funding” section on the 

Tribal Support website (http://www.cdc.gov/tribal/budget.html) to assist tribes with 

needed information. Beginning her budget update, she shared that experts are predicting 

that the fiscal year (FY) 2017 Labor, Health and Human Services, Education and Related 

Agencies (Labor-HHS) appropriations bill, which contains CDC’s budget, will not pass by the 

September 30, 2016 deadline and that a continuing resolution (CR) would be necessary. 

Length of a CR is being debated; some members of Congress want a CR through December 

2016, others through March 2017. Next, Ms. Moore discussed what happens during a CR, 

including that the Office of Management and Budget will use a formula to allocate funding 

to federal agencies to cover the CR period only and that federal agencies under a CR can 

continue activities authorized and conducted in the previous year but cannot start new 

programs unless specified by Congress in the CR. She also provided an overview of the topline Senate and House FY17 budget marks for CDC (e.g., the House mark is $7.8 billion, an 

increase of $605.4 million over CDC’s FY16 program level; the Senate mark is $7.1 billion, a 

decrease of $118.3 million compared to CDC’s FY16 program level). The differences in the 

bills demonstrate areas for negotiation/resolution. She then discussed administration 

transition issues, including potential impact on FY17 appropriations, and development and 

release of the FY18 President’s budget, which is usually released the first Monday in 

February but is often delayed by a change of administration. During the discussion, TAC 

members asked CDC to provide them with information to assist them in engaging more 

substantially and effectively in program and budget/resource planning on tribal health 

issues with CDC (e.g., points of time to engage and mechanisms for engagement). 

Afternoon Session

Highlighting CDC Workforce Resources for Indian Country

Del Yazzie, director, Navajo Nation Tribal Epidemiology Center, introduced the panel. The 

panel’s objective was to highlight the organic genesis of a partnership between tribes and 

CDC to address a specific health concern―hantavirus. Mr. Yazzie explained how the Tribal 

Epidemiology Center functions in identifying public health concerns within the tribe and 

that the role it plays is making recommendations to tribal leaders for possible engagements 

with CDC. Co-panelist Dr. Pierre Rollin, deputy branch chief, Viral Special Pathogens Branch,

Division of High-Consequence Pathogens and Pathology, CDC, gave background information 

about hantavirus prevention and hantavirus pulmonary syndrome identification and disease 

management. Craig Manning, health communications specialist, Viral Special Pathogens 

Branch, Division of High-Consequence Pathogens and Pathology, CDC, described the 

collaborative’s development, which hinged on a clear understanding of the Navajo Nation’s 

need. Once the need was delineated, the agency was able to partner strategically with the 
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Navajo Nation in a robust response. Mr. Manning described the resulting outputs from the 

partnership, which included an update of hantavirus messaging in the Navajo language, a 

live question-and-answer radio call-in show, and deployment of a CDC official to update the 

Navajo Nation surveillance/tracking systems for hantavirus cases. A post-panel discussion 

highlighted the success of clearly identifying the requests and communicating in-depth with 

the agency on activities or actions required to meet the expressed need. Once the need was 

defined, it was fairly easy to determine and then develop the appropriate outreach. Postpanel discussions with the TAC were filled with praise for the speed and efficiency of this

response collaboration.

Reducing Opioid Dependence and Overdose in Indian Country

The panel consisted of staff from the Indian Health Council, Inc., and included Dr. Daniel 

Calac, chief medical officer, Dr. Elaine Davidson, family medicine physician and coordinator 

for the chronic pain management program, and Mr. Tony Luna, project coordinator on the 

opioid drug take back program. Dr. Calac introduced the Indian Health Council’s 

multidisciplinary approach to addressing opioid use and abuse in the community. Dr. 

Davidson described the evolution of the center’s current chronic pain management 

program, demonstrating how the program has advanced and expanded based on evidence 

collected over a 10-year period. She carefully outlined the lessons learned that 

strengthened the program’s effectiveness. Mr. Luna described the Indian Health Service’s 

Pill Take Back program and explained that the program’s goal is to look at doing community 

interventions, creating convenient options for community members to reduce the 

availability of non-prescribed pain medications. Both the research and community outreach 

aspects of the Pill Take Back program were reviewed. Program tools to support community 

outreach were shared, and use of a pill lock box was demonstrated for the TAC. 

Collaboration in addressing opioid abuse prevention was a consistent theme from the 

panelists. Building partnerships in the clinic, as well as in the community, was emphasized as 

a key feature of a prevention strategy to address opioid abuse. After the presentation, 

panelists held a question-and-answer session with TAC delegates, responding to inquiries 

regarding uses of Narcan, alternative modalities for addressing chronic pain, and the pill 

lock boxes. Dr. Roderick McClure, director, National Center for Injury Prevention and 

Control, Office of Noncommunicable Diseases, Injury and Environmental Health, CDC, 

informed the TAC about the agency’s current programming for prescription drug overdose. 

Discussion also centered on the need to advance the Department of Health and Human 

Services’ response to the opioid epidemic with an interagency partnership to tackle this 

complex issue. The session concluded with a general agreement that the issue is 

multifaceted and will require a strategic, cross-agency response to generate impactful and 

long-term change. 

Underage Drinking Prevention 

Dr. Roland Moore, center director and senior research scientist, Pacific Institute for 

Research and Evaluation, introduced the topic of underage drinking, focusing on a statistical 

analysis conducted to assess the problem of underage drinking in adolescents receiving 

services at the Indian Health Council, Inc. Dr. David Gilder, senior staff scientist, Department 

of Molecular and Cellular Neuroscience, The Scripps Research Institute, shared results of a
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study conducted within the program to compare motivational interviewing with

psychoeducational trials on affecting behaviors. For both strategies, improvement in 

behavior was observed, although the motivational interviewing technique was slightly 

superior. Jennifer Geisler, RN, research coordinator, Preventing Underage Drinking Project, 

Indian Health Council, Inc., shared the community outreach that has been conducted to 

prevent underage drinking. She highlighted the Reward and Reminder program, which 

thanks establishments that card minors and sends reminders to those that don’t. These 

operations have been highly successful, with a demonstrated 100% compliance rate, up 

from 60% when they were initially implemented. After the presentation, discussions among 

panelists and TAC delegates emphasized the importance of collaborating with youth to 

identify the access points where they obtain alcohol and working strategically to mitigate 

these access points. The program has been re-funded for an additional 5 years and is 

exploring creating a manual of its strategies that could then be used to replicate the 

interventions and identifying opportunities to expand to other issues, including marijuana 

use among Native American youth.

Jennifer S. Irving’s Fireside Chat with Dr. Frieden

John Auerbach, acting director, Office for State, Tribal, Local and Territorial Support, and 

associate director for policy, CDC, introduced a 10-minute video featuring CDC Director Tom 

Frieden, MD in a discussion with Jennifer S. Irving, MPH, Director of Regional Equity, 

Thunder Valley Community Development. In the video, Dr. Frieden addressed a range of 

topics, including a brief look back at the agency’s successes during his time as director. He 

expressed pride over the success of the Public Health Associate Program and how this 

program is now one of several at the agency that are directly improving tribal public health 

capacity. He also took a moment to look ahead to the future and to ways programs such as 

Good Health and Wellness in Indian Country are expanding how the agency works with 

tribes. He addressed the state of the Zika virus and how the emergency response effort has 

been one of the agency’s most successful responses, with regard to the level of proactive 

outreach and communication with tribal leaders. Dr. Frieden closed with an apology that he 

was not able to join the meeting in person and emphasized that he would be briefed 

extensively on the topics discussed. A transcript of the video is available on request. The 

video concluded the first day, and the TAC meeting was adjourned.

CDC/ATSDR Tribal Advisory Committee Meeting, August 2, 2016

Morning Session

CDC Office of the Director Updates

Dr. Ursula Bauer, designated federal official, CDC/ATSDR TAC, and director, National Center 

for Chronic Disease Prevention and Health Promotion, CDC, stated that she would share the 

update time allotted for this section with her colleagues, John Auerbach, acting director,

Office for State, Tribal, Local and Territorial Support; CAPT Tom Hennessy, director, CDC’s

Arctic Investigations Program; and Gregory Smith, tribal liaison officer, Program Services 

Branch, Division of State and Local Readiness, Office for Public Health Preparedness and 

Response, CDC. Dr. Bauer reported on the Tribal Practices that Promote Health and Well-
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Being convenings. The purpose of the convenings was to explore what the federal 

government is doing to understand the importance of tribal health practices. Dr. Bauer 

reviewed progress to date and stating that the final convening was planned for later in 

August. At the August convening, the group will finalize standardized funding opportunity 

announcement (FOA) language that her center will include in FOAs moving forward. Dr. 

Bauer also discussed the Good Health and Wellness in Indian Country program, sharing that 

in the FY17 Presidential Budget Initiative, an additional $15 million was proposed to 

augment the existing program’s work (the FY16 funding level was $15 million). She provided 

context for how the funds would expand programming if the budget request is approved. 

John Auerbach gave updates on the Zika virus, the Office for State, Tribal, Local and 

Territorial Support, and the Office of the Associate Director for Policy. Regarding the Zika 

virus, Mr. Auerbach stated that there has been a definitive increase in travel-associated 

cases of the virus, and that Florida is the first state showing laboratory-confirmed local cases 

of transmission. Regarding tribes and tribal engagement in the agency’s Zika response 

activities, Mr. Auerbach reported that the inclusion of a tribal point of contact within the 

CDC Emergency Operations Center’s State Coordination Task Force has been critical in a 

seamless engagement response. He said that the Office for State, Tribal, Local and 

Territorial Support would work the EOC to institute a standing protocol to ensure that tribes 

are routinely engaged early in every response activity. Mr. Auerbach shared that the Office 

for State, Tribal, Local and Territorial Support is in the process of identifying a permanent 

director and that he expects the decision to be finalized very soon. Mr. Auerbach also 

updated the TAC on Public Health Associate Program, National Public Health Accreditation

Program, and Public Health Law Program successes. Mr. Auerbach then shifted focus to the 

work in the Office of the Associate Director for Policy, sharing that Dr. Frieden specifically 

asked the office to strengthen the relationship between the public health sector and the 

healthcare delivery system. He gave examples of these efforts, stating that one important 

outcome of this work has been developing billable activities for public health work with the

Centers for Medicare & Medicaid Services. Mr. Auerbach shared that this has been rolled 

out to large commercial payers, but the Office of the Associate Director for Policy is looking 

to identify a tribal pilot site to launch. CAPT Tom Hennessy, director, Arctic Investigations

Program, National Center for Emerging and Zoonotic Infectious Diseases, CDC, addressed 

the TAC next, focusing on Arctic activities of greatest importance to tribes in Alaska. CAPT 

Hennessy gave several examples of current projects, one of which will look at the lack of 

clean water sources for many Native families in Alaska. Lastly, Gregory Smith, tribal liaison, 

Program Services Branch, Division of State and Local Readiness, Office of Public Health 

Preparedness and Response, CDC, addressed the TAC regarding the Public Health 

Emergency Preparedness grant program, sharing that, in collaboration with the Tribal 

Support Unit, the Division of State and Local Readiness has drafted improved language in 

the FY17 FOA to strengthen state engagement with tribes and has included accountability 

mechanisms to improve the successes of the sub-awards. This session concluded with a 

brief discussion during which CDC leaders answered additional questions from the TAC.

Tribal Testimonies

Eight Tribal testimonies were presented. TAC members raised themes such as the opioid 

epidemic in Indian Country and the need for behavioral health specialists to address suicide 
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prevention. Other calls for action included a comprehensive approach through education and 

systems strategies to prevent violence, an interagency plan to address adverse childhood 

experiences, culturally relevant intervention strategies, and funding for cancer prevention. 

Hot topics included the Zika virus, emergency preparedness and response, proactive 

analysis of impacts on Native youth from the legalization of marijuana, and the need for 

creative funding and technical assistance partnerships between tribes and the agency. The 

reading of the eight testimonies into the record concluded the 15th Biannual CDC/ATSDR 

Tribal Consultation Session.

Participants

Tribal Advisory Committee Members

• Alicia Andrews (Native Village of Karluk): President, Karluk IRA Tribal Council; Alaska Area 

Delegate

• Chester Antone (Tohono O’odham Nation): Councilman, Tohono O’odham Nation; Chair, 

Tribal Advisory Committee; Tucson Area Delegate

• Travis C. Brockie (Lummi Nation): Council member, Lummi Indian Business Council, Lummi 

Nation; Portland Area Delegate

• Delia M. Carlyle (Akin Indian Community): Vice Chairman, Ak-Chin Indian Community; Chair; 

Phoenix Area Delegate 

• Robert Flying Hawk (Yankton Sioux Tribe): Chairman, Yankton Sioux Tribe; Great Plains Area 

Delegate

• Jefferson Keel (Chickasaw Nation): Lieutenant Governor, Chickasaw Nation; Oklahoma Area 

Delegate

• Adam Geisler (La Jolla Band of Luiseño Indians): Secretary, La Jolla Band of Luiseño Indians;

Chair; California Area Delegate

• Darcy Marrow (Sault Ste. Marie Tribe of Chippewa Indians): Board Member, Sault Ste. Marie 

Tribe of Chippewa Indians; Tribes-at-Large Delegate

• Jonathan Nez (Navajo Nation): Vice President, Navajo Nation; Co-Chair, TAC; Navajo Area 

Delegate

• Robert TwoBears (Ho-chunk Nation): Legislative District V Representative, Ho-Chunk 

Nation; Bemidji Area Delegate

CDC and ATSDR Senior Leaders

• John Auerbach, MBA: Associate Director for Policy, CDC, and Acting Director, Office for 

State, Tribal, Local and Territorial Support (OSTLTS), CDC

• Ursula Bauer, PhD, MPH: Director, National Center for Chronic Disease Prevention and 

Health Promotion, CDC

• CAPT Thomas Hennessy, MD, MPH: Director, Arctic Investigations Program, National Center 

for Emerging and Zoonotic Infectious Diseases, CDC

• Roderick McClure, MBS, PhD, FAFPHFAICD: Director, Division of Analysis, Research and 

Practice Integration, National Center for Injury Prevention and Control, CDC
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Presenters/Discussants

• Annabelle Allison (Navajo Nation): Deputy Associate Director, Tribal Support Unit (TSU), 

OSTLTS, CDC

• Shyanne Boston: Domestic Violence Director, Native Women’s Resource Center

• Daniel Calac, MD (Pauma Indian): Chief Medical Officer, Indian Health Council, Inc.

• CAPT Carmen Clelland, PharmD, MPA (Cheyenne and Arapaho Tribes): Associate Director,

TSU, OSTLTS, CDC

• LCDR Jessica Damon: Lead Public Health Advisor, TSU, OSTLTS, CDC

• Elaine Davidson, MD: Physician, Indian Health Council, Inc.

• Jennifer Geisler, RN (Kumeyaay/Shoshone): Research Coordinator, Preventing Underage 

Drinking Project, Indian Health Council, Inc.

• David Gilder, MD: Senior Staff Scientist, Department of Molecular and Cellular 

Neuroscience, The Scripps Research Institute

• Keely Linton: (Íipay and Cupeno Native from the Mesa Grande Band of Mission Indians):

Senior Staff Scientist, Department of Molecular and Cellular Neuroscience, The Scripps 

Research Institute

• J. Antonio (Tony) Luna, MA (Tlingit/Chicano): Project Coordinator, Indian Health Council, 

Inc.

• Georgia Moore, MS: Associate Director for Policy, OSTLTS, CDC

• Roland Moore, PhD: Center Director and Senior Research Scientist, Pacific Institute for 

Research and Evaluation

• Pierre Rollin, MD: Deputy Branch Chief, Viral Special Pathogens Branch, Division of HighConsequence Pathogens and Pathology, CDC

• Bonnie Salgado (Iipay Nation of Santa Ysabel): Cultural Arts Specialist, Indian Health 

Council, Inc.

• Wendy Schlater (La Jolla Band of Luiseño Indians): Director, La Jolla’s Avellaka Program

• Gregory Smith, MPA: Tribal Liaison Officer, Program Services Branch, Division of State and 

Local Resources, Office of Public Health Preparedness and Response, CDC 

• Beth Turner, MPH: Director of Health Promotion Services, Indian Health Council, Inc.

• Del Yazzie, MPH (Navajo Nation): Director, Navajo Epidemiology Center

Acronyms

ATSDR Agency for Toxic Substances and Disease Registry

CDC Centers for Disease Control and Prevention 

CR Continuing Resolution

NCCDPHP National Center for Chronic Disease Prevention and Health Promotion 

NCEZID National Center for Emerging and Zoonotic Infectious Diseases

NIHB National Indian Health Board

OSTLTS Office for State, Tribal, Local and Territorial Support

TAC Tribal Advisory Committee 

TSU Tribal Support Unit