Eighth Annual Native American Healthcare Conference

Justin O’Connor
President
Native Nation Events

Jim Stroker
Coach
NNE Leadership Solutions Group

Type 2 diabetes mellitus and obesity are two of the greatest health challenges that face this population and the world and are associated with multiple morbidities, mortality, and health care costs.  There are multiple contributions to the growing epidemic of obesity and Type 2 diabetes.  However, recent research has focused on the trillions of microbial organisms that live in our intestines.  These gut organisms are collectively called the microbiome and play a pivotal role in our overall health, food metabolism, nutrient absorption, insulin resistance, weight balance, inflammation, and ultimately the development of overweight, obesity, and Type 2 diabetes.  This timely presentation will focus on the microbiome and how it may influence our overall health, our ability to lose weight, and our tendency to develop both obesity and diabetes.

Leonard R. Sanders, MD, FACP, CDE, BC-ADM, CLS
Director of Diabetes Care
Montage Medical Group
Former Medical Director
Gila River Indian Community

• Under the Affordable Healthcare Act, American Indians and Alaskan Natives are provided opportunities for affordable health coverage through the Health Insurance Marketplace.
• Medicaid plays a key role in providing health care to American Indians and Alaskan Natives, but many facilities only provide primary care, and many members of tribes live in rural communities far from Indian Health Service (IHS) facilities.
• Due to the Byrd Rule, a senate provision, the Indian Healthcare Improvement Act (IHCIA) cannot be repealed through any budget reconciliation process, which is what congress is using to attempt to repeal and replace Obamacare. 

Dr. Pedram Salimpour
Chief Executive Officer & Chairman
Pierce Health Solutions

Wilbur Woodis
Senior Policy Analyst for External Affairs
Indian Health Service
 

• Cultural factors significantly influence the perspectives of American Indians and Alaskan Natives in regards to traditional professional health care practices.
• Common barriers to American Indians and Native Americans accepting health care assistance include both culturally incongruent treatment regimens and cultural differences in concepts of modesty and propriety.
• Last year, the Shoalwater Bay Indian community won a Robert Wood Johnson Foundation “Culture of Health” prize for its dedication to improving and maintaining the physical, social, emotional, and spiritual health of its people. A Wellness Center currently provides medical, dental, and mental health services for the tribe and surrounding community, and the tribe meets monthly in a Pulling Together Wellness group, relying on culture to inform prevention.  
• Acknowledging the turning point to build healthy culture is important to the Tribe.

Charlene Nelson
Chairwoman
Shoalwater Bay Tribe

• A shift away from traditional dietary habits, including diets once rich in fresh fruits in vegetables, as well as increasingly sedentary lifestyles, has dramatically affected the health of American Indians.
• As of 2012, almost 33 percent of all American Indians and Alaskan Natives were obese, including both children and adults.
• According to the American Diabetes Association, 16.1 percent of Native Americans and Alaskan Natives suffer from Type II diabetes, which has been closely linked to obesity.
• The Diabetes Prevention Program (DPP), a national study that included several American Indian communities, found that lifestyle changes, including a healthy diet, adequate exercise, and modest weight loss, can dramatically reduce a person’s risk for getting diabetes.
• Only 1 out of every 3 adults with high LDL cholesterol has the condition under control. Less than half of adults with high LDL cholesterol get treatment. Lowering your cholesterol can reduce your risk of having a heart attack, needing heart bypass surgery or angioplasty, and dying of heart disease.
• According to the Centers for Disease Control and Prevention, American Indians and Alaskan Natives have seen a dramatic decrease in number of diabetes-related kidney failures between 1996 and 2013 (54% reduction). This is largely in part to treatment programs and funding provided for care.

Cheryl Glover, RN
Diabetes Coordinator
Otoe-Missouria Tribe

• Diabetes has reached epidemic proportions among Native Americans. Prevalence of type 2 diabetes in Indian country is 12.2% for those over 19 years of age.
• Diabetes is the most common cause of non-traumatic lower limb amputations, as the risk for leg amputation is 15 to 40 times greater for a person with diabetes.
• The vast majority of diabetic patients with critical ischemia are never referred for evaluation for limb salvage, even though the majority are actually good candidates.  This is most commonly due to misconceptions about the pathophysiology of the disease.
• Amputation rates in Indian country are 3-4 times higher than the general population.

Dr. Scott Brannan
Interventional Radiologist & Co-Founder
First Nations Limb Preservation Foundation

Dr. Keith Goss
Podiatrist
First Nations Limb Preservation Foundation

Dr. Kimberly Wolfensperger
Podiatrist
Gila River Health Care

• Coushatta Casino Resort struggled to provide effective healthcare for their large employee population and dependents due to the poor access of quality care in their area.
• An onsite PCMH solution was implemented in October 2011 to reduce overall health risks through evidence-based medicine and help curb unnecessary costs.
• Through the onsite health program, implementing targeted EBM strategies allowed Coushatta to improve wellness outcomes and eliminate unnecessary tests and treatment. This allowed the care team members the opportunity to spend more time with patients to educate them, manage their expectations and monitor their care.
• Powerful results were seen including providing better access to care and fewer visits to expensive community resources. In addition, a net savings of $3.6M was generated in two years with the onsite program and reduced health center spend by 45%.

Greg Baker
Vice President, Pharmacy
Premise Health

Bill Gadberry
Director, Human Resources
Coushatta Casino Resort

Lisa Buddenhagen
Director, Benefits & Compensation
Coushatta Casino Resort

• Crime in Indian country is often under reported to both tribal authorities and federal authorities.
• According to the NIJ and CDC, 17 percent of Native American and Alaskan Native women have been stalked in their lifetime.
• The U.S. Department of Justice reported that alcohol and drugs may play a larger role in sexual attacks on American Indian and Alaskan Native women compared to other racial/ethnic groups. Over two-thirds of victims believed that their attackers had been drinking and/or using drugs before the offense. 
• American Indians and Alaskan Natives are 2.5 times more likely to experience sexual assault crimes compared to all other races. 
• One in three women in the American Indian and Alaskan Native community reports having been raped during her lifetime.

Olivia Gray
Program Coordinator
Osage Nation Family Violence Prevention Program

Marilyn Gobert
Lead Advocate/Supervisor
Blackfeet Domestic Violence Program

Melanie Jones
Grants Manager
Choctaw Nation Behavioral Health

• Wellness is an important facet of health and general welfare among American Indians.
• The health status of American Indians is below that of the general U.S. population and has been for many years, affected in part by high-risk behaviors such as smoking, poor nutrition, risky sexual practices, and sedentary lifestyles.
• Obesity rates in American Indian children, adolescents, and adults are higher than the respective U.S. rates for all races combined.
• Type 2 diabetes has reached epidemic levels in American Indian communities and is thought to be associated with obesity and low physical activity.
• Many of the health problems facing American Indians are related to individual behaviors and would be amenable to changes in lifestyles.
• Relaxation techniques incorporated in yoga can lessen chronic pain, such as lower back pain, arthritis, headaches and carpal tunnel syndrome.  Yoga can also lower blood pressure and reduce insomnia. 

Jim Stroker
Coach
NNE Leadership Solutions Group

Thomas Yazzie
Master Fitness Specialist
San Carlos Apache Healthcare Corporation-San Carlos and Bylas Fitness Centers

Melody Thomas
Certified Personal Trainer
San Carlos Apache Healthcare Corporation-San Carlos and Bylas Fitness Centers

• Over the past 30 years, research has linked moderate and severe traumatic brain injury to a greater risk of developing Alzheimer’s disease or another type of dementia, years after the original head injury. 
• A self-contained community for dementia patients gives them freedom, but also caregiver support and safety when they experience memory deficits that can be a source of confusion and agitation.
• The VNRC will be a state of art research and care facility for people who have been diagnosed with Alzheimer’s disease, Post-Traumatic Stress Disorder, Traumatic Brain Injury, and victims of Military Sexual Trauma.
• The Cocopah Tribe is concerned with elders developing dementia and the care available to them at an affordable cost.
• The research component is to collect data on young vets diagnosed with TBI, which generally leads to dementia, Parkinson’s, and Alzheimer’s. This will be done over years while the vet and family are offered job training, an education program and employment working with the elderly in one of the facilities. In addition, the VNRC offers an online degree program, canine and equine therapy & training. The goal with the young vet is to put them and their family on a career path while collecting data.
• The data is being done by recording all physiological changes without drugs. The VNRC will also be installing intellectual toilets which will read and analyze all evacuations.  These toilets will have a fingerprint read on the flush to identify the person being monitored. This data will be made available to compare with research that has been done on dementia and Alzheimer’s patients.  The goal is to find a cure, to at least stop the deterioration process and possibly reverse it.

Richard Neault
CEO
MMG Medical Management Group-Veterans Neurological Research Center

Natalie Abeita
Administrator
Pueblo of Isleta – Assisted Living and Memory Care Facility

Gary Magrino
Business Development Manager
Cocopah Tribe

• The cost and incidence of chronic wounds is increasing, due in part to the aging of the population, increased prevalence of diabetes, and rising obesity.
• The current wound care industry, especially as it pertains to chronic injuries, is massive and continues to grow by leaps and bounds each year. In America alone, there are some 6.5 million patients, with annual costs well over the $25-billion mark. (CDC).
• Healing chronic wounds is especially challenging due to a variety of barriers and patient co-morbidity. Fortunately, advanced treatments and technologies facilitate the care of these wounds and promote healing. These advancements are having a positive impact in terms of shortened healing times and reduced hospital stays.

• According to research from 2012, tribal veterans have 1.9 times higher odds of being uninsured as compared to non-Hispanic white veterans. 
• American Indian and Alaskan Native veterans have reported difficulty navigating between the Veterans Association and the Indian Health Service in order to receive optimal health services.
• S.304, re-introduced in Senate in February of 2017, is a bill that amends the Indian Health Care Improvement Act to permit the Indian Health Service to pay copayments owed to the Department of Veterans Affairs by Indian veterans for medical services authorized under the Purchased/Referred Care program and administered at a VA facility.

Majed Ibrahim, PE
Acting Director
Family and Special Veterans – VHA Office of Community Care

Stephanie E. Birdwell, M.S.W.
Director 
Office of Tribal Government Relations
VA Office of Governmental Relations

Wilbur Woodis
Senior Policy Analyst for External Affairs
Indian Health Service
 

• According to the CDC, suicide among young American Indians and Alaskan Natives is almost double the national rate, with native teens experiencing the highest rate of suicide of any population group in the United States.
• In 2015, the CDC reported that among American Indian and Alaskan Native young adults, there were an estimated 34.3 suicides per 100,000 population for males and 9.9 suicides for females. These rates are most likely underestimated due to previous findings indicated that Indian country underreported deaths by 30%. 
• According to the National Alliance on Mental Illness, almost 90 percent of suicides are linked to mental illnesses that are often treatable. In the American Indian and Alaskan Native community, there is a small supply of mental health resources that don’t always reach those in need.

Dr. Carrie L. Johnson
Director 
Seven Generations Child and Family Services – United American Indian Involvement, Inc.

Jacqueline Manley
Director of Family Services
Southern Indian Health Council, Inc.

Kori D. Novak, Ph.D., MBA
Chief Executive Officer
Karuk Tribe Health & Human Services

Alexandra Maschino, MPH
Research Associate
Center for American Indian Health
Bloomberg School of Public Health
Johns Hopkins University

Kristina Pacheco, LADAC
Program Manager
Pueblo of Laguna Behavioral Health Services

• Native Americans are more likely than other ethnic groups to report past year illicit drug abuse.
• Higher rates, as compared to the national average, in the use of cigarettes (16.8 percent compared to 10.2 percent overall), marijuana (13.8 percent compared to 6.9 percent overall), and non-medical uses of prescription drugs (6.1 percent compared to 3.3 percent overall) were reported among adolescents between the ages of 12 and 17 in American Indian and Alaskan Native communities.
• American Indians and Alaskan Natives have the highest rates of alcohol, marijuana, cocaine, and hallucinogen use disorders, as compared to other racial/ethnic groups in the United States. They also have the second highest methamphetamine abuse rates, following that of Native Hawaiians.
• According to the 2013 National Survey on Drug Use and Health, 12.3 percent of American Indians were current users of illicit drugs, compared with 9.5 percent of whites, 8.8 percent of Hispanics, and 10.5 percent of African Americans.
• A relatively low percentage of American Indians refer themselves for treatment, reflecting the need for more culturally sensitive programs for education, outreach, and treatment.

Dr. Dan Dickerson
Assistant Research Psychiatrist
UCLA Integrated Substance Abuse Program

Dr. Marcy Ronyak
DBH Deputy Director, Division of Behavioral Health
Indian Health Services Headquarters

Sam Bradshaw
Project Director
Cherokee Nation Behavioral Health Prevention Program

Kristi Allen
Director of Programs
C.A.R.E. – Community Advocacy Research & Evaluation Consulting Group

• Alcoholism is one of the leading public health programs in Indian country, with American Indians five times more likely than whites to die of alcohol-related causes.
• According to a report issued by the Centers for Disease Control and Prevention, and the Indian Health Service, excessive alcohol consumption is the number one cause of preventable deaths among American Indians and Alaskan Natives.
• American Indians and Alaskan Natives have some of the highest rates of fetal alcohol spectrum disorders (FASD) in the United States.
• Effects of FASD include physical problems and problems with behavior and learning, including birth defects, hearing, and vision problems.
• Circles of Care is a care model focusing on providing support to children who have severe emotional disturbances and their families.

Jacqueline Left Hand Bull
Administrative Officer
Northwest Tribal Fetal Alcohol Spectrum Disorder Project

Nora Boesem
President & Associate
Roots to Wings FASD Support and Advocacy

Suzie Kuerschner
Project Specialist, Contractor
Northwest Tribal Fetal Alcohol Spectrum Disorder Project

The Winner will receive One Free Conference Registration to a future Conference or Training, good through November 30, 2018, and a $100 gift card. 

 ***Winner must be Present to win***