EXPANDING THE CIRCLE OF CARE

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EXPANDING THE CIRCLE OF CARE

• South Puget Intertribal Planning Agency (SPIPA)

Presenters Jutta Riediger, SPIPA HIV/AIDS
Project Coordinator Karina Uldall, Evaluator
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SPIPA Organization

• Consortium of five Western Washington tribes
• Shoalwater Bay Tribe (population 963)
• Squaxin Island Tribe (population 2,082)
• Nisqually Tribe (population 3,450)
• Chehalis Tribe (population 2,160)
• Skokomish Tribe (population 1,333)
• Governed by Board of Directors/Tribal Members
• Financial and programmatic management of
  community services and health projects

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SPIPA Mission

• SPIPA is a Tribally chartered, non-profit
  consortium formed to provide
• planning
• technical assistance
• fundraising and
• direct services
• in response to the directives of the member
  Tribes
• in support of each Tribes sovereignty

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Map of SPIPA Tribes
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Community Characteristics

• Low HIV testing rates
• High injection drug use
• High STD rates
• High Hepatitis C rates
• Fear of HIV epidemic
• American Indians are tied for first place in
  population incidence in WA

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Tribal Health Systems

• HIV testing offered at clinics primarily to
  pregnant women
• Existing mental health and substance abuse
  programs offer some HIV counseling testing
• Little coordination between social and medical
  services
• All are 638 contracted and managed by the Tribes

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SPNS Project Goals

• To increase the number of American Indians that
  knows their HIV status, particularly those that
  are at increased risk due to substance abuse or
  mental illness
• To increase the number of HIV-seropositive
  American Indians who are receiving comprehensive
  and culturally relevant care

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Project Objectives

• To decrease HIV/AIDS stigma in the three Tribes
  through outreach and education
• To increase willingness to be tested as measured
  by HIV testing rates
• To increase HIV testing and counseling
  opportunities at the three Tribal sites

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Project Objectives

• To increase awareness of HIV/AIDS risk behaviors
  among the Tribal members
• To facilitate entry of HIV-seropositive
  individuals into comprehensive, culturally
  relevant care

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Project Model Tribal Teams

• Tribal Leader at each site to coordinate
  activities
• Testing, Counseling and Prevention Advocate to do
  outreach
• Youth Leader to engage young people in the
  project activities

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Community Involvement

• Each tribe is a different culture and environment
• Each site has access to different programs and
  resources
• Program implementation details will be largely
  decided upon by the tribal team and through
  community input

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Community Input

• Advisory Committee
• Tribal Teams
• Focus Groups
• Community Surveys

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Tribal Staffing Challenges

• Tribal staff hired by local tribes, but
  supervised by SPIPA
• Staffing pattern does not allow adequate time for
  focused outreach
• Combination of different part-time jobs of tribal
  staff does not give focus to HIV/AIDS outreach

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Squaxin Island Tribe
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Squaxin Island Health Clinic
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Squaxin Island Museum
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Girls Listening to Story in the Museum
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Kamilche Trading Post
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Northwest Indian Treatment Center
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Squaxin Island Tribal Staff Issues

• One staff member at 20 hours, working as Team
  Leader and Testing/Counseling Advocate
• The eight hour Youth Leader position is currently
  not filled
• It is difficult to get all of the work plan tasks
  accomplished by the tribe with one person working
  20 hours per week

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Shoalwater Bay Tribe
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Shoalwater Bay Tribal Center
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Shoalwater Bay Clinic Waiting Room
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Shoalwater Bay Tribal Team Leader
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Shoalwater Bay Tribal Staff Issues

• The Team Leader works 8 hours, but is also the
  receptionist and clinic support staff
• The Testing and Counseling Advocate works 16
  hours, but is also the Community Health
  Representative (with many other volunteer tasks
  added to her work week)
• There is no Youth Leader at the Shoalwater Bay
  Tribe

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Nisqually Tribe
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Nisqually Tribal Center
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Nisqually Tribal Health Clinic
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Nisqually Tribal Canoe
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Nisqually Tribal Staff
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Nisqually Tribal Staff Issues

• Nisqually Tribe has only one staff member working
  20 hours per week as Team Leader and
  Testing/Counseling Advocate
• She also works as Womens Wellness Advocate
• Nisqually has no Youth Leader
• The Nisqually staff member came on board during
  the last month of the first year of the grant

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Institutional Barriers

• Contractual conflicts with the University of
  Washington over Intellectual Property Rights
• Difference of understanding between Data and
  Intellectual Property
• Resolved after lengthy negotiations
• SPIPA retains rights to any data and intellectual
  property

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Institutional Barriers

• Delay in survey completion due to contractual
  negotiations and delay of IRB approval
• Delay in fiscal reporting due to turnover of
  SPIPA accountant
• Delay in progress of project due to change in
  project coordinator

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Local Barriers

• Difficulties in hiring competent tribal staff
  with the limited work hours permitted in the
  contract
• Jurisdictional issues with tribal staff hiring
  staff is hired by the tribe, but responsible to
  SPIPA for completion of project tasks
• Lack of support from tribes for the project
  tribal staff do not get private office settings
  and often lack cooperation with other health
  services

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Accomplishments

• Outreach to mental health and substance use
  services for enhanced HIV education and
  participation in community surveys
• Outreach to Northwest Indian Treatment Center for
  monthly HIV training and for potential OraQuick
  Test Pilot Site

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Accomplishments

• The Advisory Board has expanded to include
  members representing federal, state, regional and
  local public health agencies, as well as
  community based organizations
• The Advisory Board meetings include short
  briefing sessions on important topics, such
  OraQuick testing protocol for WA state and
  various Region X funding options

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Accomplishments

• Tribal staff are beginning to work as a team,
  sharing and exchanging ideas
• Tribal staff now meet monthly for three hours to
  review workplan tasks and to get training on
  particular topics of interest

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Accomplishments

• SPIPA hired a project publicity consultant who
  has worked extensively with the Tribes with other
  health related projects
• Together with the consultant, Tribal and SPIPA
  staff decided to develop a unified logo for the
  project, posters and four sets of fact sheets for
  use at the Tribes

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Accomplishments

• The Shoalwater Bay Tribe has held two successful
  dinners with HIV positive speakers using a very
  practical HIV question and answer game coupled
  with a small incentive
• The Shoalwater Bay Tribal Team Leader and
  Testing/Counseling Advocate completed over 30
  community surveys

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Accomplishments

• The Squaxin Island Team Leader/Testing and
  Counseling Advocate has printed effective
  brochures and flyers advertising her services
• She has had phone calls from prospective clients
  and one request for testing and counseling. The
  Tribal member asked to be taken to the next
  county for testing due to confidentiality
  concerns.

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Accomplishments

• The newly hired Nisqually staff has participated
  in a health fair and administered community
  surveys
• She is going to be participating in the state
  mandated 7 hour licensing training and the 3 day
  counseling and testing training

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Accomplishments

• Tribal and SPIPA staff met with the
  directors/staff of the mental health and
  substance abuse services in the three Tribes and
  in the Northwest Indian Treatment Centers to
  discuss enhanced services
• MOA have been signed and are being processed
  through SPIPAs contract office

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Next Steps

• Implementation of Project Publicity Campaign
  through
• Community Dinners
• Youth Events
• Participation in Health Fairs and other Tribal
  events
• Elder Dinners
• Presentation to Tribal Health Board and Tribal
  Councils

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Project Publicity Campaign

• Develop a logo for use on all printed material
• Produce posters showing recognizable Tribal
  members with targeted HIV outreach messages
• Develop Fact Cards with specific information
  based on the community survey results

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SPNS Project Logos
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Next Steps

• Community Focus Groups with all three Tribes
• Enhancement of services with the Nisqually Tribe
• Additional training for Tribal staff members
• Completion of community surveys (33 per Tribe)
• World AIDS Day events at each Tribe
• Collaboration with local public health
  departments

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Community Involvement

• Community Survey Delivery
• Community Forums
• Community Outreach
• Community Awareness
• Community Participation