1

26th Biannual Tribal Advisory Committee Meeting Summary 

September 6, 2023, 9:00 am–6:00 pm (CT)

September 7, 2023, 9:00 am–4:00 pm (CT)

Green Bay, WI | Virtual Zoom Hybrid Platform

Contents

26th Biannual Tribal Advisory Committee Meeting Summary.....................................................................1

CDC/ATSDR TAC Meeting Participants and Attendees..................................................................................2

TAC Member Attendees ............................................................................................................................2

Federal Participants and Presenters..........................................................................................................3

Introduction ...................................................................................................................................................4

TAC Business Summary..................................................................................................................................4

Addressing Reporting Burdens and Streamlining Processes:.........................................................................5

Presentation Summaries and Request from the CDC/ATSDR TAC ................................................................5

Budget Presentation:.................................................................................................................................5

Questions, Comments, and Requests from the TAC on the Budget Presentation:...............................6

Indigenous Tribal Ecological Knowledge (ITEK) Presentation: ..................................................................7

Questions, Comments, and Requests from the TAC on the Indigenous Tribal Ecological Knowledge 

Presentation...........................................................................................................................................9

Improving Access to Data with Electronic Case Reporting (eCR) Presentation: .....................................10

Questions, Comments, and Requests from the TAC on the Improving Access to Data with Electronic 

Case Reporting (eCR) Presentation: ....................................................................................................11

National Institute for Occupational Safety and Health’s (NIOSH) American Indian and Alaska Native 

Worker Safety and Health Steering Committee Presentation: ...............................................................11

Questions, Comments, and Requests from the TAC on the American Indian and Alaska Native 

Worker Safety and Health Steering Committee Presentation: ...........................................................13

Exploring CDC’s Evaluation Approaches Presentation: ...........................................................................14

Questions, Comments, and Requests from the TAC on Exploring CDC/ATSDR’s Evaluation 

Approaches Presentation: ...................................................................................................................16

Progress Update on Indigenous Evaluation Toolkit - 25th Biannual Meeting Follow-Up:......................17

Questions, Comments, and Requests from the TAC on the Progress Update on Indigenous 

Evaluation Toolkit - 25th Biannual Meeting Follow-Up Presentation:................................................18

Maternal Mortality Prevention and Tribal Voices in Maternal Mortality Review Committees:.............19

Questions, Comments, and Requests from the TAC on the Maternal Mortality Prevention and Tribal 

Voices in Maternal Mortality Review Committees Presentation:.......................................................20
2

Appendices ..................................................................................................................................................21

Appendix B: TAC Roster (As of August 25, 2023) ....................................................................................23

Appendix C: Additional Attendees...........................................................................................................24

CDC/ATSDR TAC Meeting Participants and Attendees

TAC Member Attendees

Jared Eagle (Representative)

Tribal Health Director

Great Plains Area CDC Standing Proxy 

Mandan, Hidatsa, & Arikara Nation

Councilman Conrad Jacket 

Ute Mountain Ute Tribe

Albuquerque Area Delegate 

Second Chief Del Beaver

Muscogee (Creek) Nation

National At-Large Tribal Member

Councilman Nate Tyler

Makah Tribe

Portland Area Delegate

Legislator Connie Barker (TAC Co-Chair)

The Chickasaw Nation

National At-Large Member Delegate

Deputy Principal Chief Bryan Warner (TAC Chair)

Cherokee Nation

Oklahoma Area Delegate

Debra Danforth, RN, BSN

Oneida Nation

Bemidji Area Alternate

Chairman Timothy L. Nuvangyaoma

Hopi Tribe

Phoenix Area Delegate 

Councilwoman Herminia Frias

Pascua Yaqui Tribe

National At-Large Member Delegate

Councilwoman Jennifer Webster 

Councilwoman

Oneida Nation

Lisa Pivec, MS

Cherokee Nation

Oklahoma Area Alternate 

Sharon Stanphill, MD

Cow Creek Band of Umpqua Tribe of Indians

National At-Large Member Delegate

Absent TAC Members

Affiliation/Tribal Area Name Title

Ft Peck, Assiniboine, and Sioux Tribes Area Bryce Kirk Councilman 

The Navajo Nation Area Dr. Buu Nygren President

San Carlos Apache Tribe/Phoenix Area David Reede Executive Director

Native Village of Karluk Area Joyce Jones TAC Alternate 

Morongo Band of Mission Indians Area Teresa Sanchez Councilwoman 
3

Federal Participants and Presenters 

Danielle Arellano, MPH

Public Health Advisor, Division of Reproductive 

Health, National Center for Chronic Disease 

Prevention and Health Promotion, CDC

Jim Kucik, PhD, MPH

Health Scientist, Office of Public Health Data, Surveillance, 

and Technology, CDC

Wanda Barfield, MD, MPH, FAAP, RADM USPHS 

(ret.), Director, Division of Reproductive Health, 

National Center for Chronic Disease Prevention and 

Health Promotion, CDC

Daniel Kidder, PhD, MS

Chief Evaluation Officer, Office of Policy, Performance, and 

Evaluation, CDC

Ashley Busacker, PhD

Epidemiologist, Division of Reproductive Health, 

National Center for Chronic Disease Prevention and 

Health Promotion, CDC 

Jose Montero, MD, MHCDS

Director, Office of Recipients Support and Coordination,

National Center for State, Tribal, Local, and Territorial 

Public Health Infrastructure and Workforce, CDC

Ann Cronin, Senior Advisor, Office of 

Appropriations, Office of Financial Resources, Office 

of the Chief Operating Officer, CDC

Delight E. Satter, MPH

Senior Health Scientist, National Center for State, Tribal, 

Local, and Territorial Public Health Infrastructure and 

Workforce, CDC

Elizabeth Dalsey, MA

Health Communications Specialist, Western State 

Division, National Institute for Occupational Safety 

and Health, CDC 

Nirav D. Shah, MD, JD 

Principal Deputy Director (PDD)

Immediate Office of the Directors (IOD), CDC

Leslie Ann Dauphin, PhD

Designated Federal Official (DFO) and Director, 

National Center for State, Tribal, Local, and 

Territorial Public Health Infrastructure and 

Workforce, CDC

Seh Welch, PhD, MBA (Blackfeet)

Acting Director, Office of Tribal Affairs and Strategic 

Alliances (OTASA), National Center for State, Tribal, Local, 

and Territorial Public Health Infrastructure and Workforce, 

CDC

CAPT Ryan Hill, MPH

Director, Western State Division, National Institute 

for Occupational Safety and Health, CDC

Daniel Kidder, PhD, MS

Chief Evaluation Officer, Office of Policy, 

Performance, and Evaluation, CDC

Stacey Ann Willocks, MS

Behavioral Scientist and Evaluator, Division of Injury 

Prevention, National Center for Injury Prevention and 

Control, CDC

David Wilson, PhD

Senior Policy Advisor, White House Council on Native 

American Affairs, White House
4

Introduction 

The 26th Biannual Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease 

Registry (CDC/ATSDR) Tribal Advisory Committee (TAC) meeting hosted by Oneida Nation was held inperson and virtually on September 6-7, 2023, in Green Bay, Wisconsin. 

The first day began with a virtual greeting from Dr. Nirav D. Shah, CDC/ATSDR Principal Deputy Director. 

During day one, the TAC reviewed language in the charter around the nomination process, reviewed and 

voted on the Rules of Order (a complement to the TAC charter), and planned for hybrid meetings in 

2024. Additionally, CDC/ATSDR provided a budget update followed by a discussion with TAC members. 

The day also featured a cultural enrichment activity with site visitations to various Oneida Nation 

facilities, including the Oneida Community Health Center, the Tsyunhehkwa Agriculture Program, the 

Oneida Orchard, Amelia Cornelius Culture Park, and other Oneida Nation facilities.

On the second day, CDC/ATSDR subject matter experts presented on TAC priority topics. The sessions 

covered topics such as Indigenous Tribal Ecological Knowledge, improving access to data with Electronic 

Case Reporting (eCR), the American Indian and Alaska Native (AI/AN) Worker Safety and Health Steering 

Committee, and updates on CDC/ATSDR's evaluation approaches. In the afternoon, CDC/ATSDR

continued with a progress update on the Indigenous Evaluation Toolkit. The day ended with a discussion 

on maternal mortality prevention, focusing on the need to expand tribal voices in maternal mortality 

review committees and the Enhancing Reviews and Surveillance to Eliminate Maternal Mortality (ERASE 

MM) initiative. 

After the meeting, staff members from CDC/ATSDR’s National Center for State, Tribal, Local, and 

Territorial Public Health Infrastructure and Workforce, Office of Tribal Affairs and Strategic Alliances 

(OTASA) collected, categorized, and tracked follow-up items using the following categories: “request,” 

“recommendation,” or “question,” and will ask the applicable CDC/ATSDR centers, institutes, and offices 

(CIOs) to respond as needed. The final report will be posted on CDC's Tribal Health Website. 

TAC Business Summary 

During the 26th Biannual CDC/ATSDR TAC meeting, several important topics took center stage during

the TAC Business session. These discussions covered critical areas, and the TAC took concrete actions to 

strengthen its membership and operational framework.

The TAC deliberated and voted on adding “resolutions” or other similar official documents from tribes as 

official documentation to be considered in the recruitment process. This important change will be 

reflected in the updated TAC Charter. Additionally, under the TAC Charter, careful consideration and 

approval were given to the TAC Rules of Order through a voting process.

Looking ahead, the 27th Biannual TAC Meeting has been officially scheduled for February 21–22, 2024, 

in Atlanta, GA at CDC/ATSDR Headquarters, potentially in collaboration with the Substance Abuse and 

Mental Health Services Administration (SAMHSA). Furthermore, the TAC voted to hold the 28th Biannual 

meeting in Indian Country on August 7-8, 2024, on Cow Creek lands. Dr. Sharon Stanphill, National At 

Large Tribal Member, will serve as the TAC Delegate lead for this meeting.
5

Deputy Principal Chief Warner (TAC Chair) encouraged TAC members to actively provide input on 

agenda items and assured them that any questions raised during the meeting would be addressed in the 

follow-up report. In summary, the TAC business portion of the meeting included vital updates, the vote 

to update the TAC charter, the adoption of the Rules of Order, and confirmation of the dates and 

locations for hybrid meetings in 2024.

Addressing Reporting Burdens and Streamlining Processes: 

The TAC requested for CDC/ATSDR to conduct a comprehensive review of the existing reporting 

requirements, with a special focus on the 477 reporting by the Federal Communications Commission 

(FCC), to identify areas where the reporting burden on tribal nations can be reduced. The 477 also 

allows tribes to combine grants into one budget line so that it streamlines reporting and fiscal 

management. 

Another key request is to ensure that any proposed changes to reporting requirements undergo a 

consultation process with tribal nations. This consultation process is essential to making reporting 

procedures more efficient and less burdensome for tribal communities.

Additionally, the TAC members have called for cross-agency collaboration with relevant entities, such as 

the Bureau of Indian Affairs (BIA), to work together in streamlining reporting processes and identifying 

opportunities for improvement. These collaborative efforts are seen as crucial for achieving more 

effective reporting procedures.

Presentation Summaries and Request from the CDC/ATSDR TAC

Budget Presentation:

Presenter: Ann Cronin, Senior Advisor, Office of Appropriations, Office of Financial Resources, Office 

of the Chief Operating Officer, CDC

Overview of CDC Budget Presentation

The presentation primarily focused on CDC budget details and initiatives for fiscal years 2023, and 2024, 

and a brief mention of 2025.

Budget Overview:

The presenter outlined the various fiscal year budgets managed by CDC/ATSDR, with a focus on the 

enacted budget for FY 2023, which amounted to $9.3 billion.

New Initiatives and Funding:

Ms. Cronin highlighted new initiatives, including the Center for Forecasting and Outbreak Analytics and 

Data Modernization Initiative (DMI) funding for tribes, underscoring CDC's emphasis on tribal support 

and infrastructure improvement.

FY 2024 Budget:

Ms. Cronin shared that the FY 2024 President’s Budget request initially stood at $11.7 billion but faced 

disparities between House and Senate marks. The presenter noted the potential for a government 

shutdown or continuing resolution due to budget disagreements.
6

Key Initiatives in FY 2024:

The FY 2024 budget request focuses on cross-cutting initiatives, infectious disease prevention, and 

various health programs. Specific attention is given to HIV funding, chronic diseases, environmental 

health, mental health, and injury prevention. The need for improved data systems and infrastructure in 

public health was highlighted.

Budget Rigidity and Initiatives:

Ms. Cronin explained the inflexible nature of CDC/ATSDR's budget, largely consisting of categorical 

programs. They discussed the challenges associated with introducing new initiatives, often originating 

from the Administration, and noted the Biden Administration's focus on cross-cutting initiatives.

FY 2025 Budget and Tribal Consultation:

Ms. Cronin briefly mentioned the upcoming FY 2025 budget and the ongoing tribal consultation process. 

Budget details are embargoed, but the presenter expressed readiness to discuss public health priorities 

and directions.

In summary, the presentation provided insights into CDC/ATSDR's budgetary concerns, new initiatives, 

and challenges facing public health funding. The evolving budget landscape and the importance of crosscutting initiatives were central themes throughout the presentation.

Questions, Comments, and Requests from the TAC on the Budget Presentation: 

The TAC requested CDC allocate a 10% budget set aside specifically for tribal nations. This allocation is 

crucial to cater to the unique health needs of tribal communities. It is intended to provide dedicated 

resources that can be utilized effectively to improve the health outcomes and well-being of AI/AN

communities.

Furthermore, the TAC has asked CDC/ATSDR to take proactive steps in developing a comprehensive 

proposal outlining the specifics of this 10% set-aside. This proposal should encompass its purpose, 

allocation methods, and intended outcomes. Importantly, the TAC proposes involving tribal leaders and

stakeholders in the review and feedback process, ensuring that the set-aside aligns with the needs and 

aspirations of the tribal communities it aims to serve.

Additionally, the TAC members have urged CDC/ATSDR to initiate a consultation process with tribal 

nations to discuss the proposed 10% set-aside. This consultation process seeks to gather input, 

concerns, and suggestions directly from tribal leaders. The goal is to ensure that the set-aside is finely 

tuned to meet the unique and diverse needs of tribal communities, fostering a sense of ownership and 

collaboration.

Furthermore, the TAC has emphasized the importance of transparency and accountability. The TAC

requested CDC/ATSDR provide regular updates and transparent reporting on the allocation and 

utilization of the set-aside funds to tribal leaders. Timely information sharing is critical in maintaining 

trust and ensuring that the resources are being used effectively to address healthcare disparities among 

tribal nations.

Lastly, the TAC members have urged CDC/ATSDR to actively advocate for legislative support to formalize 

the 10% set-aside mechanism. This advocacy effort should be undertaken in close partnership with tribal 
7

leaders to ensure the sustainability of this vital initiative. By seeking legislative support, the TAC aims to 

solidify the commitment to addressing tribal healthcare needs and securing the long-term success of the 

10% set aside.

Indigenous Tribal Ecological Knowledge (ITEK) Presentation:

Presenter: Delight E. Satter, MPH, Senior Health Scientist, National Center for State, Tribal, Local, and 

Territorial Public Health Infrastructure and Workforce, CDC 

Presenter: David Wilson, PhD, Senior Policy Advisor, White House Council on Native American Affairs

This presentation was a comprehensive overview of the government's efforts to recognize, respect, and 

incorporate Indigenous knowledge into federal policies and programs while partnering with tribal 

communities on this effort. This guidance, released in November 2022, by the White House's Office of 

Science and Technology Policy (OSTP) and the Council on Environmental Quality (CEQ) represented a 

significant step towards promoting equity and inclusivity in federal decision-making.

Ms. Satter shared that the primary goal of this presentation was to provide insights into governmentwide guidance for recognizing and incorporating Indigenous knowledge, as articulated in the executive 

memorandum released in November 2022.

Dr. Wilson explained the purpose behind the guidance. He highlighted the government's commitment to 

fostering more equitable and inclusive relationships with tribal communities. This commitment was 

driven by the recognition of the need for more effective responses to the evolving challenges faced by 

these communities, encompassing health, environmental, and cultural aspects.

The importance of Indigenous knowledge was a central theme throughout the presentation. Dr. Wilson 

and Ms. Satter stressed that Indigenous knowledge represents a valuable resource for preserving and 

enhancing the well-being of tribal communities. This knowledge, deeply rooted in generations of 

experience and interaction with the environment, is seen as complementary to conventional scientific 

knowledge, offering unique insights and perspectives.

Consultation with tribal communities was a key component of the guidance's development. Ms. Satter 

highlighted the extensive consultation process, involving tribal communities, native-serving 

organizations, and other entities. This inclusive approach sought to gather input and promote 

meaningful engagement with tribal communities, respecting their local knowledge and specific needs.

The official release of the guidance at the 2022 White House Tribal Nations Summit was a significant 

milestone, as emphasized by Dr. Wilson. This event saw key government leaders express their support 

for the initiative, signifying a collaborative effort that involves multiple partners across the federal 

government.

The content of the official guidance document was briefly touched upon, with a focus on the importance 

of understanding, defining, and utilizing Indigenous knowledge. Ethical research and the responsible 

application of Indigenous knowledge were identified as critical elements.

The presentation provided a comprehensive definition of Indigenous knowledge, acknowledging its 

multifaceted nature. It encompassed various types of knowledge, spanning biological, physical, social, 
8

cultural, and spiritual aspects. This definition reflected the richness and diversity of Indigenous

knowledge systems.

The dynamic nature of Indigenous knowledge was highlighted, emphasizing that it has evolved over 

millennia and continues to adapt to changing circumstances. This adaptability underscores its relevance 

in addressing contemporary challenges.

The inclusivity of Indigenous knowledge, encompassing both the environment and the people within it, 

was underscored. Dr. Wilson and Ms. Satter referenced a prayer that illustrated the interconnectedness 

of plants, land, animals, water, and air within this knowledge system. The transgenerational 

transmission of Indigenous knowledge emphasized its enduring importance.

Cultural sensitivity and protocol were discussed to highlight the sacredness and specificity of Indigenous

knowledge. This knowledge may belong to families, clans, or individuals, and sharing it may involve 

specific protocols. The presentation emphasized the need to respect these sacred and sensitive aspects 

of Indigenous knowledge.

Indigenous knowledge was presented as valid evidence in federal policy, research, and decision-making. 

Dr. Wilson and Ms. Satter stressed that this recognition eliminates the need to prove its validity and 

reinforces the importance of effectively working with and applying it.

The coexistence of Indigenous knowledge with Western knowledge systems was a central theme. The 

presenters argued that these knowledge systems can complement each other, with discrepancies seen 

as opportunities for further analysis and refinement, rather than flaws in the research.

Common features shared between Indigenous knowledge and Western science methodologies were 

highlighted. These commonalities included systematic understanding, shared attributes, observation, 

innovation, verification, repetition, and empirical approaches, enabling effective integration.

The historical marginalization of Indigenous knowledge in scientific processes, including publication and 

research, was acknowledged. The presentation emphasized the need to address structural 

discrimination in native research and publication.

The application of Indigenous knowledge extends beyond environmental aspects and encompasses all 

facets of life. Dr. Wilson and Ms. Satter provided examples of how federal agencies could incorporate 

Indigenous knowledge into their processes, such as embedding it in funding announcements. This 

approach reflects the comprehensive nature of Indigenous knowledge and its relevance to various policy 

domains, including public health.

The responsibility for research and the relevance of research to tribal communities were key 

considerations. The "6 Rs for Indigenous Research" framework was introduced, encompassing 

Responsibility, Respect, Relevance, Reciprocity, Relationship, and Representation. Engaging with 

communities and prioritizing their perspectives in research design and implementation was highlighted 

as essential.

Respecting tribal sovereignty was a foundational principle throughout the research and implementation 

process, acknowledging the authority and self-determination of tribal communities. This respect for 

tribal sovereignty underscored the commitment to building equitable and respectful relationships.
9

The presentation ended with confirmation that ethical training programs were being developed for the 

federal workforce to ensure respectful and ethical engagement with tribal communities.

Questions, Comments, and Requests from the TAC on the Indigenous Tribal Ecological 

Knowledge Presentation

The TAC members requested a comprehensive set of initiatives aimed at improving CDC/ATSDR's 

engagement with tribal communities and enhancing public health outcomes in AI/AN communities. They 

emphasized the importance of regular site visits to tribal communities, not only for public health 

assessments but also for active cultural engagement, encouraging participation in tribal events, 

ceremonies, and traditions to gain a deeper understanding of the cultural context in which public health 

initiatives are implemented. Additionally, the TAC urged that these visiting teams include individuals 

with cultural competence or those from respective tribal backgrounds to facilitate effective 

communication and trust-building.

Furthermore, the TAC called for robust support for traditional healing and medicine, recognizing their 

integral role in tribal communities for generations. They urged CDC/ATSDR to explore avenues for 

financial support to traditional healers, develop training programs, and establish partnerships with tribal 

healers, all while ensuring that collaboration with tribal nations is respectful and culturally sensitive.

The committee stressed the importance of culturally relevant health education programs developed in 

collaboration with tribal communities. These programs should incorporate Indigenous knowledge and 

practices and involve working closely with tribal leaders, healthcare professionals, and elders to create 

materials, workshops, and training programs addressing prevalent health issues—all while respecting 

cultural norms and traditions.

Advocating for increased funding for tribal health programs was another key request. The TAC called on 

CDC/ATSDR to work alongside tribal leaders in lobbying for a larger share of federal funding allocated for 

tribal health, particularly for those tribes heavily reliant on tribal contributions to sustain their 

healthcare programs. Additionally, CDC/ATSDR was encouraged to support tribes in grant applications 

and funding proposals to secure additional resources for public health initiatives.

Community health workers within tribal communities were identified as vital assets, and the TAC 

proposed expanding and investing in these programs. They emphasized the need for training and 

certification programs for community health workers that incorporate cultural competence and 

Indigenous knowledge to ensure effective outreach and engagement within tribal communities.

Additionally, the TAC proposed the development of culturally relevant health education programs and 

the expansion of community health worker programs within tribal communities.

The committee also stressed the importance of conducting comprehensive research to measure the 

impact of community-based health programs in tribal communities, with a focus on sharing the results 

and success stories of these programs with other tribes to encourage the adoption of effective practices 

and interventions.

In addition, the TAC highlighted the significance of nurturing the next generation of healers and 

practitioners within tribal communities through mentorship and training programs. These initiatives 

should provide opportunities for youth to apprentice under experienced healers or medical practitioners 

in their communities.
10

The TAC urged the establishment of a platform or mechanism for tribes to share their best healthcare 

practices, particularly in managing chronic conditions like diabetes. This could involve creating a national 

database or organizing regular gatherings where tribes can exchange knowledge and experiences.

Finally, the committee emphasized the need to advocate at the federal level for equitable distribution of 

healthcare funding to all tribal nations, ensuring that tribes of all sizes and demographics receive the 

necessary resources to address their unique healthcare needs. They emphasized the importance of 

maintaining ongoing dialogue and engagement with tribal leaders, healthcare professionals, and 

community members through regular meetings, consultations, and feedback sessions to strengthen the 

partnership and collaborative efforts between CDC/ATSDR and tribal nations.

Overall, the TAC's primary request in this presentation was for CDC/ATSDR to enhance its cultural 

engagement with tribal communities during site visits. They urged CDC/ATSDR to not only focus on 

public health assessments but also actively participate in tribal events and traditions to gain a deeper 

understanding of the cultural context. 

Improving Access to Data with Electronic Case Reporting (eCR) Presentation:

Presenter: Delight E. Satter, MPH, Senior Health Scientist, National Center for State, Tribal, Local, and 

Territorial Public Health Infrastructure and Workforce, CDC 

Presenter: Jim Kucik, PhD, MPH, Health Scientist, Office of Public Health Data, Surveillance, and 

Technology, CDC 

Presenter: Sarah Sobonya, PhD, MA, Public Health Analyst, Office of Public Health Data, Surveillance, 

and Technology, CDC

Ms. Satter set the stage for the presentation by emphasizing the significance of the tribal data 

modernization initiative. She highlighted the collaborative efforts between tribes and CDC/ATSDR in this 

endeavor and underscored the partnership's value in addressing the data challenges faced by tribal 

communities.

Dr. Sobonya, from CDC/ATSDR's eCR team, delved into the crucial role of electronic case reporting in 

facilitating public health reporting. She explained that eCR involves the automated generation and 

transmission of case reports from healthcare facility electronic health records to public health 

departments/districts. Dr. Sobonya stressed that this automation ensures timely reporting of notifiable 

diseases and conditions, making it a vital component of modernizing data systems for public health.

Dr. Kucik emphasized CDC/ATSDR's commitment to fostering partnerships and collaboration around 

public health data and surveillance. He highlighted the importance of addressing tribal-specific needs in 

data modernization and shared ongoing projects and initiatives aimed at enhancing data capacity. Dr. 

Kucik also discussed the formation of a tribal expert workgroup to ensure that tools and strategies meet 

the unique needs of tribal public health.

Throughout the presentation, the presenters actively engaged with the audience, seeking input and 

feedback. They posed essential questions, such as how to make eCR and other data modernization 

projects more beneficial to tribes and how to improve communication about these initiatives. The 

presenters also expressed their commitment to supporting tribal public health efforts and addressing 
11

data modernization concerns specific to tribal communities, ultimately aiming to enhance the 

accessibility and use of data for improved public health outcomes.

Questions, Comments, and Requests from the TAC on the Improving Access to Data with 

Electronic Case Reporting (eCR) Presentation:

The TAC members suggested that incorporating tribes into the Data Modernization Pilot Program 

involves several key steps. First, the initiative should commence by engaging in conversations with tribal 

leaders, including those representing the mentioned reservation in Oklahoma, to gauge their interest in 

participating in the data modernization pilot.

Following this, collaborative efforts with tribal representatives should be undertaken to formulate 

comprehensive guidelines delineating how data will be collected, stored, accessed, and shared. This 

collaborative approach ensures transparency and data security.

To further support tribes in this endeavor, the TAC suggested the establishment of a dedicated technical 

assistance team is imperative. Such a team would provide on-the-ground assistance to tribes during the 

implementation process, promptly addressing any technical challenges that may arise.

TAC members recommended a streamlined process should also be created to facilitate data sharing, 

ensuring that any tribe expressing interest can participate and receive the necessary support. 

Collaboration with the Indian Health Service (IHS) and other relevant government agencies is essential, 

recommending the formation of a working group to explore potential coordination efforts regarding 

data sharing and electronic health records.

The TAC recommended CDC/ATSDR consider implementing monitoring mechanisms to guarantee the 

appropriate use of shared data and adherence to privacy and security standards. Additionally, active 

engagement with tribal communities should be prioritized through regular meetings and consultations, 

soliciting their input and feedback to tailor data modernization efforts to their unique needs.

TAC members mentioned that tribal hospital and healthcare provider cooperation is crucial to 

identifying and addressing technical issues related to data sharing within the healthcare system and

ensuring seamless data flow. Ongoing communication channels must be established with tribal 

representatives to provide updates, address concerns, and maintain continuous collaboration.

Lastly, a continuous evaluation process should be implemented to assess the success of the data 

modernization pilot program. Feedback from participating tribes should be gathered, and necessary 

adjustments made for ongoing improvement.

Overall, the TAC's primary request in this presentation was for the inclusion of tribes in the data 

modernization pilot program. They urged CDC/ATSDR to initiate discussions with tribal leaders to gauge 

their interest in participation and to provide comprehensive technical assistance during the connection 

process. The TAC emphasized the importance of clear data usage and access guidelines and open data

access for interested tribes. Additionally, the TAC called for collaboration with IHS and other relevant 

agencies and the establishment of communication channels to gather input and feedback from tribal 

communities. The request also included the continuous assessment of the pilot program's effectiveness.

National Institute for Occupational Safety and Health’s (NIOSH) American Indian and 

Alaska Native Worker Safety and Health Steering Committee Presentation:
12

Presenter: CAPT Ryan Hill, MPH, Director, Western State Division, National Institute for Occupational 

Safety and Health, CDC

Presenter: Elizabeth Dalsey, MA, Health Communications Specialist, Western State Division, National 

Institute for Occupational Safety and Health, CDC

American Indian and Alaska Native (AI/AN) Initiative

Ms. Dalsey highlighted the significance of prioritizing workplace safety for AI/AN communities and 

introduced herself as the manager of NIOSH's AI/AN Initiative. It was underscored that this initiative has

thrived through robust collaborations with AI/AN communities, tribal organizations, and various 

partners.

Strategic Plan Development

A substantial portion of the presentation was dedicated to detailing the development of the AI/AN

Worker Safety and Health Strategic Plan. This strategic plan, which was developed from 2013 to 2023, 

was conceived through a meticulous process. It was informed by:

1. Site Visits: NIOSH representatives visited tribal communities, gaining firsthand insights into their 

unique challenges and opportunities in terms of occupational safety and health.

2. Tribal Public Health Conferences: The team actively participated in tribal public health 

conferences, fostering dialogue around the challenges and successes experienced in the field.

3. Tribal Consultations: A critical element of the plan's development was engaging in tribal 

consultations, involving tribal representatives and individuals interested in the domain.

4. Partnerships: NIOSH leveraged partnerships to ensure the strategic plan's relevance and 

applicability.

The strategic plan defines and prioritizes occupational safety and health (OSH) research related to 

American Indian and Alaska Native (AI/AN) workers for 2023–2032. The strategic plan's core focus areas 

were identified as policy, research, practice, and capacity building. An essential aspect emphasized 

throughout the presentation was the plan's commitment to honoring tribal sovereignty while guiding 

efforts at tribal, local, state, federal, and organizational levels. It was portrayed as a comprehensive plan

designed to benefit the entire nation.

Ongoing Activities

The presentation delved into the ongoing activities conducted by NIOSH to further advance the AI/AN

Worker Safety and Health Strategic Plan. Two key activities were highlighted:

1. Internal AI/AN Workgroup: NIOSH has established an internal AI/AN workgroup to identify 

specific objectives within the plan that NIOSH can actively collaborate on with tribes and 

partners.

2. New Project: The organization has secured internal funding for a new project aimed at gaining a 

better understanding of the well-being of AI/AN workers in the IHS Portland area. This research 

endeavor underscores NIOSH's commitment to actionable research.
13

Plan Dissemination

Efforts to disseminate the AI/AN Worker Safety and Health Strategic Plan were also discussed during the 

presentation. The plan is readily accessible on NIOSH's website and CDC/ATSDR Tribal Consultation 

page. Moreover, it has been widely shared at conferences and through newsletters. Elizabeth Dalsey 

encouraged participants to provide suggestions for additional avenues of dissemination, underscoring 

the importance of reaching the widest possible audience.

Development of AI/AN Steering Committee

The presentation concluded by seeking input and feedback from the audience regarding the formation 

of an AI/AN Steering Committee. The primary objective of this committee would be to advance the 

strategic plan's goals. The audience was invited to offer recommendations on how to solicit tribal 

representation effectively and to identify potential tribal organizations or partners for inclusion in this 

committee.

In summary, the presentation by CAPT Hill and Ms. Dalsey effectively conveyed NIOSH's dedication to 

improving occupational safety and health for AI/AN workers. The AI/AN Worker Safety and Health 

Strategic Plan developed through extensive collaboration and research, stands as a testament to their 

commitment to this vital cause. The presentation served as a platform for dialogue and collaboration 

with the audience, further reinforcing the importance of collective efforts in achieving safer workplaces 

for all.

Questions, Comments, and Requests from the TAC on the American Indian and Alaska Native 

Worker Safety and Health Steering Committee Presentation:

TAC members emphasized the paramount importance of prioritizing safety within tribal gaming 

enterprises, recognizing their significance within many tribal communities. They articulated a need for 

CDC's support in identifying these enterprises and establishing essential communication links with their 

leadership and human resources departments. Clear communication channels were seen as a 

fundamental starting point for collaboration in bolstering safety measures.

Secondly, the TAC members underscored the unique challenges faced by tribal gaming enterprises. They 

stressed the necessity of creating safety plans specifically tailored to address the distinct needs and 

operations of these establishments. The members expressed a readiness to work closely with 

CDC/ATSDR to develop comprehensive safety plans that would effectively mitigate the unique risks 

associated with the gaming industry, ensuring the well-being of both employees and visitors.

Thirdly, the scope of the discussion expanded to include the promotion of safety within the construction 

industry. TAC members sought CDC/ATSDR's assistance in identifying and disseminating information 

about national and regional construction safety conferences. Notably, they highlighted the importance 

of conferences organized by the National Tribal Employment Rights Offices (TEROs), viewing them as 

critical forums for keeping tribal construction firms informed and engaged in the latest safety best 

practices.

Furthermore, the TAC members emphasized the need for direct engagement with tribal construction 

firms. They recognized the value of outreach efforts and technical support in helping these firms 

implement effective safety measures. The overarching goal was to cultivate a robust culture of safety 
14

within tribal construction projects, with a specific emphasis on reducing workplace accidents and 

injuries.

In addition to these initiatives, TAC members expressed their commitment to providing comprehensive 

safety training for tribal community members entering the workforce. They requested CDC/ATSDR's 

guidance and resources for the development of safety training materials and videos. These materials 

would play a pivotal role during the onboarding and orientation processes, ensuring that tribal workers 

are well-prepared to contribute to safe and healthy workplaces.

Moreover, TAC members identified a potential knowledge gap within tribal communities regarding the 

distinctions between NIOSH and the Occupational Safety and Health Administration (OSHA). They 

requested the CDC/ATSDR's assistance in crafting clear explanations of these differences and ensuring 

effective communication of this information to tribal communities, ultimately fostering a better 

understanding of these vital agencies.

Additionally, TAC members expressed their desire to promote the NIOSH Health Hazard Evaluation 

program among tribes and tribal organizations. They emphasized the program's role in addressing 

workplace concerns and hazards and sought to empower tribal communities to take proactive steps in 

addressing health risks within their workplaces.

Clear and continuous communication emerged as a recurring theme in the TAC's feedback. The 

members highlighted the importance of maintaining open channels of communication between tribal 

leaders, representatives, workers, and CDC/ATSDR. These channels would serve as essential conduits for 

gathering feedback, addressing concerns, and ensuring that occupational safety and health initiatives 

remain relevant, responsive, and effective.

Lastly, TAC members stressed the significance of continuous monitoring and adaptation. They 

underscored the need to closely track the progress of safety initiatives, soliciting feedback from tribal 

communities. This iterative approach would allow for timely adjustments to enhance the effectiveness 

of these initiatives, ensuring that they remain aligned with the evolving needs of tribal workplaces. In 

summary, the TAC's feedback outlines a comprehensive strategy for improving safety and health in tribal 

communities, emphasizing collaboration with CDC/ATSDR to achieve these vital objectives.

Overall, the TAC's primary request in this presentation was to promote safety and health in tribal 

gaming enterprises and the construction industry. They suggested that CDC/ATSDR compile a list of 

tribal gaming enterprises and offer safety presentations and workshops. The request included the 

development of safety plans for tribal gaming, identification of safety conferences, and engagement 

with tribal construction firms. Additionally, the TAC emphasized the need to clarify the distinctions 

between NIOSH and OSHA and promote NIOSH's Health Hazard Evaluation program to tribes. The 

request also included maintaining clear communication channels and continuous monitoring of safety 

initiatives.

Exploring CDC’s Evaluation Approaches Presentation: 

Presenter: Daniel Kidder, PhD, MS, Chief Evaluation Officer, Office of Policy, Performance, and 

Evaluation, CDC

This presentation was an informative and comprehensive exploration of CDC's approach to evaluation. 

He began by acknowledging the audience's enthusiasm for the subject and expressed his intention to 
15

shed light on how CDC/ATSDR views evaluation. He emphasized that evaluation is not a one-size-fits-all 

concept but rather a nuanced and dynamic process that requires careful consideration.

The presentation then shifted its focus to the Foundations for Evidence-Based Policymaking Act of 2018, 

also known as the Evidence Act, a pivotal piece of legislation, which Dr. Kidder pointed out had received 

bipartisan support. He highlighted that the Act underscores the importance of evidence in various forms 

for decision-making and improving government programs. Title I of the Act stresses the significance of 

evaluation as a critical function of all federal agencies.

Dr. Kidder emphasized a shift in perspective from viewing evaluation as merely an auditing function to 

understanding it as a tool for learning and improvement. He noted that evaluation should involve the 

assessment of both the effectiveness and efficiency of programs. Furthermore, he highlighted the 

importance of embracing failures as valuable learning opportunities and emphasized the concept of 

continuous program improvement. The goal, he stressed, is to align with the vision of an evidence-based 

government by continually enhancing the initiatives in place. The core of the presentation revolved 

around CDC/ATSDR's evaluation framework. Dr. Kidder introduced this framework, which encompasses 

six distinct steps and four standards. He highlighted that the framework's purpose is to guide the 

process of evaluating CDC/ATSDR programs. He noted that this framework has been instrumental in 

shaping evaluations not only within CDC/ATSDR but also beyond, as it has been cited and used in various 

fields. While he did not delve deeply into the specific components of the framework, some details about 

its structure and purpose were shared.

Six-Step Process: The framework comprises a six-step process that outlines the logical sequence for 

conducting evaluations. These steps can include elements such as planning, data collection, analysis, 

interpretation, and reporting. Each step plays a crucial role in guiding evaluators through the evaluation 

process.

Four Standards: Dr. Kidder mentioned that the framework includes four standards. While he did not 

explicitly state what these standards are, they are likely key criteria or principles that evaluations 

conducted at CDC/ATSDR should adhere to. These standards may pertain to issues like data quality, 

ethical considerations, and evaluation rigor.

Flexibility: It was implied that the framework is designed to be flexible, allowing evaluators to adapt it to 

various evaluation contexts. This adaptability is important because different programs and projects 

within the CDC may have unique requirements and goals, and the framework should be versatile enough 

to accommodate these differences.

Guidance for Program Evaluation: Dr. Kidder emphasized that the framework serves as guidance for 

program evaluation. This suggests that the framework is specifically tailored to evaluate public health 

programs and interventions. The framework encompasses aspects such as defining evaluation 

objectives, selecting appropriate evaluation methods, collecting and analyzing data, and using 

evaluation findings to inform decision-making and program improvement.

The existing framework, published in 1999, is over two decades old, and significant changes have 

occurred in the field of evaluation during this time. To address these changes, he initiated a process to 

refresh the framework. He emphasized that the goal was not to discard the existing framework entirely 

but to adapt it to contemporary needs while preserving its flexibility.
16

To inform this refresh, Dr. Kidder and his team engaged in extensive insights gathering. They conducted 

sessions within CDC/ATSDR, collaborated with federal staff, organized listening sessions with various 

stakeholders, including tribal representatives, and issued a public request for information. Through this 

process, they sought to understand how the framework had been used, what was working, what could 

be improved, and how it could better incorporate cultural competence, health equity, and data 

governance.

The presentation concluded with Dr. Kidder highlighting the three key changes being considered for the 

refreshed framework. First, they intend to broaden the first step to encompass a more comprehensive 

assessment of the context in which evaluations occur. Second, they aim to infuse collaborative 

engagement, equity considerations, and data usage throughout all steps of the framework. Lastly, they 

are working to replace terminology that may carry negative connotations for specific groups, making the 

framework more inclusive and sensitive to cultural nuances.

In summary, Dr. Kidder's presentation offered a detailed and insightful view of CDC/ATSDR's approach 

to evaluation. It underscored the evolving nature of evaluation practices, the need for a refreshed 

framework, and the importance of inclusivity, equity, and continuous learning in the process. His 

presentation provided valuable context and a roadmap for enhancing CDC/ATSDR's evaluation practices 

to better serve public health needs.

Questions, Comments, and Requests from the TAC on the Exploring CDC/ATSDR’s Evaluation 

Approaches Presentation:

The TAC suggested incorporating the Tribal Evaluation Framework into CDC/ATSDR’s evaluation 

practices. The TAC emphasized the importance and relevance of this framework in assessing tribal 

programs, particularly in the context of diabetes prevention and care. They urged CDC/ATSDR to 

recognize the success of tribal diabetes management and integrate tribal methodologies into their 

evaluations.

Another critical recommendation was the establishment of a CDC/ATSDR Tribal Training Program. This 

proposed program would aim to educate CDC/ATSDR staff and leadership on tribal sovereignty, selfgovernance, and cultural competence. By fostering a deeper understanding of tribal communities, this 

training program would enhance CDC/ATSDR's ability to engage effectively with tribal nations.

The TAC also recommended the creation of a dedicated Tribal Evaluation Committee within CDC/ATSDR. 

This committee would include tribal members and experts who would guide evaluation strategies, 

cultural sensitivity, and data collection methodologies for tribal programs. Moreover, the TAC requested

increased support for tribal data collection, offering resources and guidance to tribal programs to 

improve their data collection and reporting capabilities, with an emphasis on culturally relevant 

indicators.

Collaboration was a central theme in the TAC's recommendations. They recommended collaborative 

evaluations between CDC/ATSDR and tribal programs, allowing for the integration of federal standards 

with tribal-specific metrics. To facilitate knowledge-sharing, they proposed the creation of a centralized 

repository of tribal evaluation resources within CDC/ATSDR. Furthermore, the TAC recommended the 

recognition of tribal programs that meet or exceed federal standards, highlighting positive health 

outcomes achieved by tribal communities.
17

The dissemination of tribal success stories is also crucial in showcasing effective strategies and positive 

impacts. The TAC suggested that CDC/ATSDR communication channels be utilized for this purpose. To 

ensure effective collaboration, the TAC recommended the enhancement of cultural competence training 

within CDC/ATSDR and encouraged the adoption of continuous quality improvement methodologies by 

tribal programs.

Engagement with tribal evaluators and experts was another key recommendation, with an emphasis on 

mutual learning and knowledge exchange. The TAC suggested organizing regular consultations and 

dialogues with tribal leaders and representatives to address evaluation challenges and gather feedback 

on CDC initiatives.

Finally, recognizing the specific challenges faced by tribal diabetes programs, the TAC recommended 

technical and financial assistance tailored to their unique needs. This support would aim to enhance 

their data collection capabilities, ultimately improving the health outcomes of tribal communities.

Overall, the TAC's primary request in this presentation was to improve CDC/ATSDR evaluation practices 

regarding tribal programs. They urged CDC/ATSDR to incorporate the tribal evaluation framework into 

its evaluations, develop a CDC/ATSDR Tribal Training Program, and establish a dedicated Tribal 

Evaluation Committee. The request included support for tribal data collection, promotion of 

collaborative evaluations, sharing of tribal evaluation resources, and recognition of tribal efforts that 

meet or exceed federal standards. Additionally, the TAC emphasized the need for enhanced cultural 

competence training, support for continuous quality improvement, engagement with tribal evaluators, 

and regular consultations with tribal leaders. The request also included the facilitation of consultations 

with tribes.

Progress Update on Indigenous Evaluation Toolkit - 25th Biannual Meeting Follow-Up: 

Presenter: Stacey Ann Willocks, MS, Behavioral Scientist and Evaluator, Division of Injury Prevention, 

National Center for Injury Prevention and Control, CDC

Indigenous Evaluation Toolkit:

Ms. Willocks provided an in-depth overview of the Indigenous Evaluation Toolkit. This toolkit was 

developed by the Seventh Directions Public Health Institute, the first Indigenous public health institute, 

with a primary objective to support tribal communities in conducting evaluations rooted in Indigenous

epistemologies and community narratives. Notably, it was emphasized that this toolkit is a communitybased tool, designed by and for Indigenous communities. It is structured into four flexible and iterative 

phases: envision and design, embark, assess progress, and celebrate and act. These phases allow 

communities to incorporate local Indigenous knowledge into their evaluations and interventions 

effectively.

Ms. Willocks emphasized that while the toolkit is accessible to all, it is not mandatory for CDC/ATSDR

recipients. This stance respects the diversity of evaluation approaches within tribal communities. She 

also highlighted the toolkit's unique and visually appealing design, making it both practical and 

aesthetically engaging.

Dissemination and Implementation:
18

The presentation transitioned to the dissemination and implementation of the toolkit. Ms. Willocks 

outlined how the toolkit has been shared with tribal communities, including virtual gatherings, email 

campaigns, and other communication channels. She also mentioned that a manuscript related to the 

toolkit is currently in development.

In terms of programmatic integration, Ms. Willocks explained how CDC/ATSDR is integrating the toolkit 

into various projects, such as a collaborative interagency initiative with the National Highway Traffic 

Safety Administration (NHTSA) and funding for Tribal Epidemiology Centers. Importantly, the toolkit is 

offered to these programs but not mandated, respecting the autonomy of tribes to choose their 

preferred evaluation approaches.

Future Expansion and Engagement:

The presentation concluded with Ms. Willocks presenting three thought-provoking questions to the 

audience, reflecting the CDC/ATSDR's commitment to actively engage with tribal communities and 

continually improve the toolkit's impact:

1. What would the audience like CDC/ATSDR to learn from the Indigenous Evaluation Toolkit?

2. How can CDC/ATSDR be more accountable to unfunded tribes and distribute resources?

3. How would the audience like to see this work expand and benefit their organizations and the 

people they represent?

These questions underscored CDC/ATSDR's dedication to listening, learning, and evolving as they 

collaborate with tribal partners and communities in further developing and implementing the 

Indigenous Evaluation Toolkit.

Questions, Comments, and Requests from the TAC on the Progress Update on Indigenous

Evaluation Toolkit - 25th Biannual Meeting Follow-Up Presentation:

Question 1: What would the audience, specifically the TAC members, like CDC/ATSDR learn from the 

Indigenous Evaluation Toolkit?

The TAC members shared insights into how they plan to utilize the Indigenous Evaluation Toolkit. One 

TAC member mentioned that they are interested in expanding their evaluation capacity to other 

programs across tribal divisions, emphasizing the importance of internal evaluation within tribal 

programming. They aim to use the toolkit to spread the message of public health to other divisions in 

their tribe, enhancing self-determination and sovereignty. This response highlights the toolkit's potential 

to empower tribal communities to take control of their evaluations and improve their programs.

Question 2: Regarding the TAC members’ interest, how can CDC/ATSDR be more accountable to 

unfunded tribes and distribute resources?

While this specific question wasn't directly addressed during the discussion, there were references to 

how the toolkit is being made accessible to all tribal communities, regardless of CDC/ATSDR funding. The 

presentation emphasized that the toolkit is not mandatory for CDC/ATSDR recipients, respecting the 

diversity of evaluation approaches within tribal communities. CDC/ATSDR's approach of making the 

toolkit available for free online and offering technical assistance suggests an effort to be inclusive and 

accountable to all tribes, including those that may not receive direct funding.
19

Question 3: How would the TAC members like to see this work expand and benefit their organizations 

and the people they represent?

Several TAC members provided suggestions on how the work surrounding the Indigenous Evaluation 

Toolkit could expand and benefit their organizations and communities. One TAC member suggested 

sharing the toolkit within their Northwest Portland area and using it during tribal meetings, which could 

facilitate knowledge exchange among tribes. Another TAC member highlighted the importance of 

strengthening public health systems and services through national partnerships, acknowledging the 

positive impact of the program and funding received through it. These responses illustrate the desire for 

broader dissemination and practical utilization of the toolkit to benefit a wide range of tribal 

organizations and communities.

Overall, the TAC members' engagement and feedback showcased the relevance and potential impact of 

the Indigenous Evaluation Toolkit within tribal contexts, aligning with CDC/ATSDR's commitment to 

collaborate and learn from tribal communities.

The TAC's primary request in this presentation was to promote the Indigenous Toolkit for Overdose 

Prevention and Response. They suggested developing a comprehensive promotion strategy and 

collaborating with tribal health organizations for toolkit dissemination. The request included support for 

tribal public health initiatives, strengthening partnerships with national organizations, and establishing a 

dedicated CDC liaison for tribal engagement. Additionally, the TAC emphasized the dissemination and 

presentation of the toolkit at tribal gatherings and conferences, evaluation capacity building, and 

ongoing support for tribal communities.

Maternal Mortality Prevention and Tribal Voices in Maternal Mortality Review 

Committees: 

Presenter: Wanda Barfield, MD, MPH, FAAP, RADM USPHS (ret.), Director, Division of Reproductive 

Health, National Center for Chronic Disease Prevention and Health Promotion, CDC

Presenter: Danielle Arellano, MPH, Public Health Advisor, Division of Reproductive Health, National 

Center for Chronic Disease Prevention and Health Promotion, CDC 

Presenter: Ashley Busacker, PhD, Epidemiologist, Division of Reproductive Health, National Center for 

Chronic Disease Prevention and Health Promotion, CDC

During their presentation, Dr. Barfield, alongside colleagues Ms. Arellano and Dr. Busacker, underscored 

the significance of tribal Maternal Mortality Review Committees (MMRCs) in enhancing maternal health 

outcomes for American Indian and Alaska Native mothers. 

The presenters noted the core objectives of the division encompass gathering and disseminating vital 

maternal health data, comprehending the root causes of pregnancy-related fatalities, and strategically 

directing interventions to prevent future losses. Under CDC/ATSDR's Enhancing Reviews and 

Surveillance to Eliminate Maternal Mortality (ERASE MM) program, initiated in 2019, the division has 

extended support to maternal mortality review programs across states and territories through 46 

awards. Dr. Barfield called for collaborative efforts to improve maternal health outcomes, recognizing,

and honoring the sovereignty of tribal nations and emphasizing the need for their knowledge and 

priorities to guide CDC/ATSDR's work.
20

Ms. Arellano and Dr. Busacker outlined the upcoming topics, including an overview of MMRCs and a 

discussion of the current activities undertaken by the CDC/ATSDR's Maternal Mortality Prevention 

Team. Ms. Arellano and Dr. Busacker highlighted the gravity of maternal mortality as a crucial 

population health indicator and presented data on pregnancy-related mortality ratios and racial/ethnic 

disparities. The presenters noted the role of MMRCs in providing a more profound understanding of 

maternal mortality, encompassing both medical and non-medical contributors to death, with the 

primary objective of formulating recommendations for prevention. Ms. Arellano and Dr. Busacker 

described the comprehensive process undertaken by these committees, underscoring that their focus is 

on prevention rather than assigning blame. They furnished examples illustrating how MMRCs have 

catalyzed positive changes in various states. Moreover, the presenters emphasized the imperative of 

elevating tribal voices in this work and investigating the feasibility of tribal-led MMRCs.

The presentation also touched upon CDC/ATSDR's ongoing projects and partnerships with tribal 

organizations, including the National Indian Health Board and Chickasaw Nation. These initiatives are 

geared toward exploring the feasibility of tribal-led MMRCs and bolstering capacity. In conclusion, the 

presentation solicited input and collaboration from the audience regarding the current approach, 

engagement strategies, long-term funding opportunities, and the pertinence of maternal mortality 

prevention in their respective regions. In summary, Dr. Barfield, Ms. Arellano, and Dr. Busacker provided 

a comprehensive overview of CDC/ATSDR's commitment to improving maternal health outcomes and 

the pivotal role of tribal MMRCs in achieving this objective.

Questions, Comments, and Requests from the TAC on the Maternal Mortality Prevention and 

Tribal Voices in Maternal Mortality Review Committees Presentation:

The TAC urged CDC/ATSDR to enhance the Maternal Mortality Review Information Application (MMRIA,

or “Maria") data system, ensuring it continues to serve as a valuable resource for collecting maternal 

mortality data among tribal nations. Additionally, they emphasized the importance of collaborating with 

tribal nations to customize data collection tools, making them more attuned to the unique needs and 

concerns of Indigenous communities.

In the realm of data privacy and sovereignty, the TAC stressed the need to uphold these principles by 

granting tribes control over their data and establishing clear protocols for data sharing, ultimately 

allowing tribes the final say in how their data is utilized and shared.

Moreover, in their quest to improve maternal health, the TAC requested the allocation of resources and 

technical assistance to help tribal communities establish maternal mortality review committees and 

sought tailored training programs and resources aligned with Indigenous cultural contexts.

Regarding maternal health promotion, they urged the continuation of the "Hear Her" campaign, 

emphasizing the importance of adapting campaign materials to resonate with tribal communities and 

fostering collaborations with tribal leaders and healthcare providers to create culturally relevant 

maternal health awareness programs.

In addressing environmental health concerns, the TAC called for collaboration with tribal and 

environmental health experts to research environmental factors affecting maternal health in tribal areas 

and advocate for policies and actions to mitigate environmental hazards contributing to maternal 

mortality in tribal communities.
21

Additionally, the TAC emphasized the need for ongoing collaboration and partnerships between 

CDC/ATSDR and tribal health organizations, respecting tribal sovereignty and cultural diversity, and 

encouraged the establishment of communication channels for sharing research findings, best practices, 

and resources related to maternal health in tribal communities.

To improve healthcare access, especially in remote areas, the TAC called for initiatives that address 

transportation and facility challenges affecting Indigenous populations. They also emphasized active 

engagement with tribal leaders, health professionals, and community members to ensure CDC/ATSDR

initiatives align with tribal needs and priorities.

In the realm of policy advocacy, the TAC urged CDC/ATSDR to advocate for healthcare policies that 

prioritize maternal health and address disparities, considering the unique challenges faced by tribal 

nations.

Lastly, the TAC advocated for environmental justice, supporting efforts to mitigate environmental 

hazards such as uranium waste affecting tribal communities. TAC members shared their commitment to 

improving maternal health and well-being among tribal nations while respecting their sovereignty and 

unique cultural contexts.

Overall, the TAC called for continued improvement of the maternal mortality data system and support 

for the development and implementation of maternal mortality review committees in tribal 

communities. The ask included upholding data privacy and tribal sovereignty principles, allocating 

resources, providing technical assistance, promoting maternal health awareness, and conducting 

research on environmental factors affecting maternal health. Additionally, the TAC emphasized the need 

for collaboration, healthcare access improvement, community engagement, policy advocacy, and 

environmental justice initiatives.

In summary, each presentation highlighted specific requests or asks from the TAC, ranging from cultural 

engagement and funding support to data access and safety promotion, all to improve public health 

outcomes in tribal communities.

Appendices

Appendix A: Acronym List

AI/AN American Indian/Alaska Native

ATSDR

APHL

APHL AIMS

BIA

Agency for Toxic Substances and Disease Registry

Association of Public Health Laboratories

Association of Public Health Laboratories Informatics Messaging Services (AIMS)

Bureau of Indian Affairs

CDC Centers for Disease Control and Prevention

CEQ Council on Environmental Quality

CIOs

CSTE 

CSTLTS

Centers, Institute, and Offices

Council of State and Territorial Epidemiologists

Center for State, Tribal, Local, and Territorial Support
22

DD Developmental Disabilities

DFO Designated Federal Official

DMI

eCR

ERASE MM

HIPAA

Data Modernization Implementation

Electronic Case Reporting

Enhancing Reviews and Surveillance to Eliminate Maternal Mortality 

Health Insurance Portability and Accountability Act 

HIS

IET

MMRC

MMRIA

NCCDPHDRH

Indian Health Service

Indigenous Evaluation Toolkit

Maternal Mortality Review Committees

Maternal Mortality Review Information Application

National Center for Chronic Disease Prevention and Health- Division of Reproductive 

Health (DRH)

NCIPC

NCUIH

NIHB

National Center for Injury Prevention and Control

National Council of Urban Indian Health

National Indian Health Board

NIOSH 

NNPHI

The National Institute for Occupational Safety and Health (NIOSH)

National Network of Public Health Institutes 

OA Office of Appropriations 

OCOO Office of the Chief Operating Officer 

OD Office of the Director

OFR Office of Financial Resources

OMB

OPPE

OPHDST

Office of Management and Budget

Office of Policy, Performance, and Evaluation

Office of Public Health Data, Surveillance, and Technology

OSHA Occupational Safety and Health Administration

OTASA Office of Tribal Affairs and Strategic Alliance

PHIC National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and 

Workforce

SAMHSA Substance Abuse and Mental Health Services Administration

TAC Tribal Advisory Committee

TEC

TECPHI

TIBC 

Tribal Epidemiology Center

Tribal Epidemiology Center Public Health Infrastructure

Tribal Interior Budget Council
23

TOPP Tribal Overdose Prevention Program (TOPP)

Appendix B: TAC Roster (As of August 25, 2023)

Area Office Delegate Alternate

Alaska Area

Term Expires: 

June 30, 2025 

VACANT Joyce Jones

Councilwoman 

Native Village of Karluk

Albuquerque Area

Term Expires:

June 30, 2025

Conrad Jacket

Councilman 

Ute Mountain Ute Tribe 

VACANT

Bemidji Area

Term Expires:

August 31, 2025

Jennifer Webster 

Councilwoman

Oneida Nation

Debra J Danforth, RN, BSN 

Division Director-Operations

Oneida Comprehensive Health Division

Oneida Nation

Billings Area 

Term Expires:

August 31, 2025

Bryce Kirk

Councilman

Ft Peck, Assiniboine, and Sioux Tribes

VACANT

California Area

Term Expires:

October 31, 2023

Teresa Sanchez

Councilwoman 

Morongo Band of Mission Indians

VACANT

Great Plains Area

Term Expires: 

June 30, 2025

Mark Fox

Chairman

Mandan, Hidatsa, & Arikara Nation

Monica Mayer, MD 

Councilwoman 

Mandan, Hidatsa, & Arikara Nation 

Nashville Area

Term Expires:

VACANT VACANT

Navajo Area

Term Expires:

June 30, 2025

Dr. Buu Nygren

President

The Navajo Nation

Kim Russell

Executive Director

Navajo Department of Health

Oklahoma Area

Term Expires:

October 31, 2023

Bryan Warner (TAC Chair)

Deputy Principal Chief

Cherokee Nation

Lisa Pivec, MS

Executive Director, Cherokee Nation 

Public Health

Cherokee Nation
24

Phoenix Area

Term Expires:

June 30, 2025

Timothy L. Nuvangyaoma

Chairman

Hopi Tribe

Darren Vicenti, MD

Director Hopi Health Dept

Hopi Tribe

Portland Area

Term Expires:

August 31, 2025

Nate Tyler

Councilman

Makah Tribe

VACANT

Tucson Area

Term Expires:

VACANT VACANT

National At-Large 

Tribal Member

Term Expires:

October 31, 2023

Sharon Stanphill, MD

Chief Health Officer

Cow Creek Band of Umpqua Tribe of 

Indians

VACANT

National At-Large 

Tribal Member

Term Expires:

August 31, 2025

Connie Barker (TAC Co-Chair)

Tribal Legislator

Chickasaw Nation

VACANT

National At-Large 

Tribal Member

Term Expires:

August 31, 2025

Herminia Frias

Councilwoman

Pascua Yaqui Tribe 

VACANT

National At-Large 

Tribal Member

Term Expires:

June 30, 2025

Del Beaver

Second Chief

Muscogee (Creek) Nation

VACANT

National At-Large 

Tribal Member

Term Expires:

VACANT VACANT

Appendix C: Additional Attendees 

A.C. Locklear Chandra Jennings Jesica Jacobs Marissa Taylor Smith Rou

Aajma Thapa Chandre Chaney Jessica Elm Mary Bertulfo Sonal Doshi

Aaron Bernstein Charisse Pelaez 

Walcott

Jessica Imotichey Mary Hall Sophie Xie

Abbigail Tumpey Christina Chung Jessica Kumar Matthew O'Shea Starr PenaJohnson
25

Ada Dieke Cimone Husbands 

Marianos

Jessica Rudolfo Maya Wright Stephanie 

Dunson

Ada Funmaker CoCo Villaluz Jessica Wiens McCanlies Erin Stephanie 

Neitzel

Dr. Ademokun 

Oluwatomiloba

Colin Gerber Jill Klosky Meghan 

OConnell

Stephen Hayes

Adriana Martinez Connie Barker Joanne 

Odenkirchen

Melanie 

Duckworth

Steven Rodgers

Adrienne Gill Constance 

Franklin

Jocelyn Steward Melinda Golub Summer Hassan

Ahmed Kassem Courtney 

Emerson

John Hough Melissa Dulcey Susanna Trost

Ahwireng Eugene Dana Mitchell John Richardson Melissa Nuthals Tahir Tahir-Farid

Alana Laanui Danielle LaFleur Jonathan Mermin Mellisa Roskosky Tanni Deb

Alanna Cronk Danielle Taylor Jose Noriega-Rios MG` Holloway Tassy Parker

Alarcon Jemma Darren Vicenti Joseph Madden Michelle Sauve Taylor Polk

Alarcon Walter Dave Goodman James Beck Michon Mabry Taylor Soniat

Alcantara Iris Dawn Tuckey JT Theofilos Miranda Carman Taylor Yutan

Aleshire Noah Dawn Vick Judith Qualters Mirdens Lambert Teresa Daub

Alicia LaLoggia Dean Seneca Júlia Valera 

Paloma

Miriam Van Dyke Tia Yancey

Alisha Etheredge Debbie Yembra Julianna Reece Mohamed Kakay Toby Merkt

Alishahi Musheng Debra Danforth JULIUS OPOLOT Mona Zuffante TR Fuller

Aliza Bolling Demetria Gardner Justin Casto Monique 

Vondall-Rieke

Tracey Hardy

Alleen Weathers Diane Hall Kait Wingate Moolosi Joyce 

Mukani

Turcina McNeilly

Allison Bay Dianna Carroll Kamea Duncan Neil Rainford Veda Harrell

Allison Gately Dillon Shije Karen CobhamOwensNichole Cottier Victoria McBee

Alston Bailey Donna McCree Karen Hacker Niharika 

Palakodety

Victoria Phifer 

Gyebi 

Amanda McWhorter Ebony Johnson Karen Remley Nikki Hunt William Tanner

Amber Dukes Eli Krebs Karl Sieber Nikolay Lipskiy Yasmine Sharifai

Anaba Michelle Elizanette Lopez Karla Checo Noaga 

KONKOBO

Yessenia Ibarra

Anason Andrea Eric Vinson Karrie Joseph Novaline Wilson Yvette Diallo

Andrade Nancy Erick Quinones Katherine Turner 

Hoffman

Pharah Morgan

André Hopkins Erika Corrales 

Materne

Kathleen 

McDavid Harrison

Pol Sarah

Andrea Diarte Ermias Belay Katie Spears Poonam 

Mahajan

Andrea Steege Eugene Elwell Kathleen Holmes Pradnya Garud
26

Andrea Williams Evelyn Dunn M 

Dunn

Kayla Griffith Priscilla Markin

Andrea Young Francisco 

Palomeque

Kayla Johnson Rachel KossoverSmith

Andrews Courtni Georgia Moore Keira Wickliffe 

Berger

Rachel West

Angela Jarnaghan Gibbs CheBreia Kelly Bishop Rebecca Gurvich

Angela Marr Gladys Lewellen Kelly McAleer Rebekah Buckley

Angie Deokar Goldie 

MacDonald

Kelly Plymesser Reshana 

Peterson

Ann O'Connor Grear Brittany Kia Parker Rhonda Beaver

Ann Wells Harpriya Kaur Kim Hoch Rhonda Tuni

Anna Mnatsakanova Harriet Jett Kimberly Badger Roberto Henry

Annalisa Ginocchi Hayley Murdoch Kira Givens Sailaja Savanam

Anne Marie Coleman heather dennehy Kira Stiggers Saja Faisal

AnnMarie Chase Heidi Cox Lakeasha 

Thrasher

Sally Thigpen

April Blowe Heidi Davidson Laura Fisher Samantha 

Puvanesarajah

Arlene Sherman 

Lewis

Heidi Pfeiffer Laura Kollar Samantha 

Weber

Ashley Busacker Helen Malcolm Laura Sawney Sara Patterson

Ashley Verma Helen Tesfai Lea Theodorou Sarah Carrigan

Audrey Dowling Holly Billie Lesliann Helmus Sarah Foster

Beth Pollak Hope Johnson Leslie Ross Sarah Meehan

Betty Wong Hope White Letitia PresleyCantrellSavannah Scott

Brandon Wisneski Huijun Park Linda Neff Seth Manthey

Brieana Watts Ines Siepmann Lindsay WardGokhaleShanna Cox

Brittani Carter Jack Gu Lisa Pivec Shannon 

Applegate

bruce Smith Jacob Kerns Loretta Haven Shannon

Rossiter

Cammie K Chaumont 

Menendez

Jade Daniels Lori Garg Shannon Saltclah

Candy Henderly James Beck Lori Phillips Sharunda 

Buchanan

Carla Winston Jane Li Lynette Wasson Sharyn Parks 

Brown

Carmen Jones Jason Hymer Mackenzie 

Leonard

Shauna Mettee 

Zarecki

Carol Zafiratos Jeannie Hong Maggie Carlin Shay Drummond

Carole Simmons Jeffrey Shire Maredith Thomas Shelby Rhee

Carri Cottengim Jeffrey Wells Margot Bailowitz Sheri Brooks
27

Chaity Naik Jennifer Marsh Marilyn Metzler Sheryl Goodson