Inter Tribal Council of Arizona, Inc. Tribal Epidemiology Center Update for the Tribal Leaders Diabetes Committee (TLDC) Jamie Ritchey, MPH, PhD ITCA TEC Director September 23, 2016
Background
ITCA TEC ITCA TEC is part of a larger national effort to provide public health services to Tribes in each region. “To provide its m ember tribes with a united voice and the means for united action on matters that affect them collectively or individually” – ITCA Constitution
Background • Based on the top five causes of death in AZ, NV, & UT 1 : – Heart disease, cancer, and injury are in the top five for American Indians in all three states – Diabetes, liver disease & cirrhosis are target areas for American Indians in Arizona – Disease rates can suggest areas of concern, yet it is an incomplete picture… 1 Combination of data from 2009 and 2011 where available from Arizona, Nevada and Utah State vital statistics registries
Background In 2013, 52% Tribal Health Directors in the Phoenix and Tucson Service Areas identified the top health concerns and technical assistance needs of their Tribes as: Health Concerns Technical Assistance Needs Diabetes • Community health profiles / • Needs assessment assistance Obesity • Public Health Trainings • Cancer • • Grant writing technical assistance • Substance abuse Other concerns, included: • suicide prevention, elder care, oral health, injury, Rocky Mountain spotted fever, and heart disease
Background • ITCA TEC Previous Diabetes Data improvement & Technical assistance (TA) – RPMS Diabetes module and PCC workshops – Special Diabetes data reporting TA – Community Health Profile data exploration – Literature review investigating diabetes and periodontal disease – Good Health and Wellness in Indian Country C1 and C2 diabetes, heart TA for GHWIC Traditional foods projects for disease and stroke prevention healthy eating & exercise Technical assistance (TA) and evaluation
Background ITCA Area Agency on Aging (AAA) Region 8 partnership (55 yrs. + and grandchildren 0-18 yrs.) • TEC developed MyPlate for Older Adults brochure TEC held a qualitative data • training with ITCA AAA team to construct relevant focus group questions together TEC performed the AAA • qualitative program evaluation for Home and Community based services — overall attitudes toward the home delivered meals and community based Portion control and label reading service programs are positive
Background AAA Region 8 Elders & Tribal staff Home delivered meals evaluation found: Staff Needs: “…a little more support and training for the cooks. A lot of the training isn’t • provided but [is] required by ITCA. Food preparation. Menus.” • “We are not delivering what they want culturally (food). Finding a way to provide a meal that involves traditional culture is hard to do. All they learn is you eat fatty foods, that [is] bad for you. In our menu we cut out cultural food…” • “One topic I have a passion for is research. The community wellness grants. State didn’t apply but they didn’t offer those to the tribes to apply for. Planning, feasibility, choosing program to implement what I wanted to do was look at services we have and what can be supported. But to sit down with the state to apply for this money to see what areas they can assist us with .” Elder Needs: • “ You do know the food from AAA is dictated to each tribe, the size and what kind of food. You have to eat tuna. They won’t come for tuna. That meal goes to waste. We are not fish tribe .” • “Provide more traditional foods.” “…having the food match their diet and medications that they are on” • • “… would like more options for beverages other than milk”
Additional Funding
Additional Diabetes Funding ITCA TEC trainings and meetings for diabetes data improvement Provided 2 RPMS Diabetes module • trainings at Phoenix Area Office & Pyramid Lakes, NV (post-training and 6- month follow up conducted) • Provided 1 PCC / QMAN data training at Tribal request from 6-month follow up survey in Pyramid Lakes, NV Participated in the NCAI Policy Research • Center and Black Hills Center for American Indian Health, diabetes research group meeting, Seattle, WA
Additional Diabetes funding ITCA TEC Diabetes data reporting • 44 Tribal Community Health Profiles & 1 Regional Health Profile (AZ, NV, UT), indicators: – *Hospitalizations for Diabetes 2 – Hypertension in Diabetics 3 – Glycemic Control 3 – Cholesterol Measurements in Diabetics 3 – Diabetic Eye Exams 3 – Glucose Measures in Non- Diabetics 3 1 U.S. Census Bureau 2014 American Community Survey 5-Year Estimates 2 State Hospital Discharge Databases (AZ, NV, UT) 3 Indian Health Service Epi Data Mart
Additional Diabetes Funding ITCA AAA local menu data analysis, education, and data capacity building Registered Dietician (RD) • approved diabetes friendly analyzed menu plans for senior centers based on prior feedback Quarterly Nutrition education • training developed by RD to promote healthy lifestyle AAA Program managers Grant • writing pilot to pursue chronic disease self-management education and community gardening grants
Additional funding In summary, the additional funds supported… • Improvement of patient diabetes data entry at the Tribal level in the Phoenix and Tucson Service Area Analysis of 6 Tribal diabetes indicators using IHS and state • hospital discharge data for 44 Tribes / bands in the Phoenix and Tucson Service Area Analysis of AAA Region 8 menu plan data for 3 Tribes that do • not have a Registered Dietician on staff • Data Exploration and collaboration with other TECs, National Congress of American Indians (NCAI), and Tribal diabetes researchers (nationally) Built local capacity regarding using diabetes and other • chronic disease data when grant writing to improve health and wellness for Elders
Future Diabetes Work – Continue to support data quality improvement at the local level – Policy improvement via partnership with IHS and AAA Tribal Senior Centers to focus on: • Inclusion of more Tribal-specific traditional foods and home cooked foods into AAA Region 8 program balanced menu plans for those living with diabetes • Traditionally hunted and harvested foods included in program foods (Title 6) to lower cost and improve health – Work with Tribal community colleges to promote local RD training at licensure and the local level
Phone: 602.258.4822 Fax: 602.258.4825 TECinfo@itcaonline.com
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