While analysis is still in process, two years of work have yielded some initial findings:

1. The pre-Reservation diet is extremely healthy, and is:
   • High in fiber
   • Low in saturated fat
   • High in healthy fats
   • Low in cholesterol
   • Low in sodium and processed sugar
   • Rich in a wide variety of whole foods
   • Filling, with little volume
2. The pre-Reservation diet is seasonal; varying with the seasons, tying individuals and the community to the natural order of seasons in terms of nutrition, activity, and ceremony. 
3. In pre-Reservation times, food production was the basis of activity and movement, economy, ceremony, and political structure.
4. The traditional Apache relationship with food is deeply personal, respectful, and spiritual.

For more information contact:

Seth Pilsk

Department of Forest Resources

San Carlos Apache Tribe

(928)475-2329 ext. 343

sethpilsk@gmail.com

 _______________________________________________

The number of American Indians and Alaska Natives that tested positive for the Human Immunodeficiency Virus (HIV) rose by 8.7% between 2007 and 2011.  This was the largest percent increase among any race/ethnicity.  Tribes have responded to this growing concern by stepping up both prevention and testing efforts.  More and more Native clinics are adopting routine HIV testing as a standard clinical practice.  However, in order to align this practice with community demand and need, it will be important for clinical and administrative staff to understand the technology and testing options that are available.  HIV tests have come a long way - from waiting two weeks for test results twenty years ago to twenty minutes and now waiting just one minute. 

The INSTI Rapid HIV Antibody test was approved on Dec. 1, 2012 (World AIDS Day) for distribution and use in the United States.  It is a single-use, rapid, chemical test used to detect HIV Type 1 antibodies in human whole or fingerstick blood or plasma specimens in as little as 60 seconds.  The U.S. clinical trial data show minimum sensitivity and specificity of 99.8% and 99.5% respectively in these samples.  The test itself does not require refrigeration or specialized storage, and is currently the fastest HIV diagnostic test available today. As with all rapid HIV tests, reactive test results are considered preliminary and must be confirmed before establishing a diagnosis of HIV infection.

A test with such a rapid processing time could be helpful to Native programs that are working in high prevalence and/or high-volume settings, or in challenging outreach settings.  Although it would also mean that programs would need to re-examine their counselling and referral protocols in order to account for a decreased required amount of time spent with each person. Programs and clinics should meet with their staff and health directors to determine what testing technologies will work best for their staff, clinic flow, and community.  Sometimes, while a quicker test may appeal to staff, it could simultaneously alarm community members or not provide community members enough time with a clinician to feel truly comfortable to talk about and address sensitive topics.

The Native American Community Health Center (NATIVE HEALTH), a non-profit health organization in Phoenix, Arizona, recently implemented the use of the one minute test as part of their Native Pathways HIV program. Due to the increasing rate of HIV incidence in Arizona, NATIVE HEALTH wanted faster result times so that people could be linked to care sooner - an important piece in providing seamless HIV care.

Several other HIV/AIDS organizations throughout the country are also using the one minute test, and it appears to be another tool that Native programs can place in their HIV prevention and testing 'toolkit.'  For more information on the one minute test, contact your local tribal health department or local Indian Health Service facility.

With the advent of the Affordable Care Act, the United States has been examining the state of its healthcare infrastructure and workforce.  Significant shortages have been noted in the number of people entering the healthcare field, and these shortages are compounded by the growing demand for quality healthcare services by an aging population. 

Programs are now being put in place to address the shortage of those pursuing healthcare careers.  In 2009, the Administration for Children and Families (ACF) Office of Family Assistance (OFA) utilized funds through the Affordable Care Act to create the Health Profession Opportunity Grant (HPOG) program to provide education, training, assistance and support to recipients of Temporary Assistance for Needy Families (TANF) and other low-income individuals who are interested in pursuing a career in the healthcare field.  Five HPOG grants were awarded to Tribal organizations and Tribal Colleges (Blackfeet Community College [Browning, MT], Cankdeska Cikana Community College [Fort Totten, ND], College of Menominee Nation [Keshena, WI], Cook Inlet Tribal Council, Inc. [Anchorage, AK], and Turtle Mountain Community College [Belcourt, ND]). 

Tribal HPOG programs created supportive systems and educational processes that more closely aligned to the culture and realities of their respective communities - which varied from other non-Tribal HPOG programs.  An evaluation conducted by the National Opinion Research Center (NORC), National Indian Health Board (NIHB), and Red Star Innovations found that there were recurring elements within the programs that both faculty and students cited as significantly contributing to the success of the programs.  This writing seeks to highlight some of these factors.  A more detailed account of the evaluation, factors for success, challenges and lessons learned can be accessed at www.nihb.org. It is important to understand the diverse programming put forth and the outcomes produced in order to enhance program sustainability, share lessons learned, avoid unnecessary duplications, and inform the broader field about how to establish similar programs in their own communities. 

Strong and Dedicated Program Staff

Staffing remains a cornerstone of most public health programming, and it is no surprise that within a program that seeks to bolster healthcare staffing, that staffing itself is noted as a key programmatic element.  All of the Tribal HPOG sites noted that a dedicated, strong, and consistent staff were important to the success and sustainability of the programming. 

The dedication of the staff was important, as students in the program were able to feel the level of engagement, commitment, and concern that the staff displayed.  Students noted that the quality of the staff and the consistent presence of the staff really conveyed a sense of dedication to the program and a caring for the success of the students. Many of the staff working in the HPOG programs are Tribal members.  Students appreciated this fact, as it made them feel comfortable in approaching staff and sharing some of their more personal concerns or issues.  Staff noted that being Native themselves allowed them to better empathize with the experiences of today's Native students; they were able to tap into similar experiences that they had when they were college students. 

A strong staff also contributed to the sustainability of the programming.  This went beyond securing continued funding, however. Having a strong staff ensured that students viewed the program as sustaining source of support where they could continue to access the services being offered. A dedicated staff created a strong program presence on campus and in the community.

Application and Screening Process

The Tribal HPOG programs all had some manner of screening or application process in place for those students seeking to enroll to receive services.  The eligibility criteria varied, as did the actual application processes, but included some of the following components: verification of Tribal enrollment, income requirements, background check, letters of reference, individual interviews, applications that included essay questions, and faculty and student review of applications.

Those with more stringent screening requirements felt that it was a very important step in ensuring that students are eligible, but more importantly that the process would help identify those likely to be successful.  Screening for earnest interest in healthcare, academic performance, and commitment were important indicators of potential success. Such a thorough screening (including a background check) may also prevent a student who may perform exemplary academically from being denied certification because of past criminal charges, or other similar barriers.  By ensuring that only the most committed and dedicated students enter the program, staff can be assured that the resources are directed to students most likely to succeed and ultimately, graduate. The screening and application process ends up being a strategy for student retention. 

Use of Assessments to Create Support Plans

Once students enter an HPOG program, an assessment was found to be a critical step in the development of an individualized success plan.  Assessments varied from site to site, but were used primarily to examine academic achievement and identify current academic and supportive needs. 

This was seen as critical because it allowed staff to learn about their enrolled students, prioritize what assistance was most needed, and provide assistance that was based upon actual needs reported by the students (not those assumed by the staff).  Some common academic needs identified included: monetary support for tuition, books, and tutoring. Other common supportive needs included housing, transportation, and childcare.  As needs were different for each student, a thorough assessment was required to identify the individual, specific, most pressing needs.  The results of the assessments were used to formulate a tailored success plan for students.  The plan was used to measure progress and create benchmarks which staff could use to monitor the students' success.  The plan was also used as a tool to continually engage the students in the program, which helped to ensure that the proper support was being offered.

Instilling Sense of Pride and Accomplishment

Students that participated in the evaluation efforts displayed a deeply held sense of pride in their accomplishments to date.  This feeling ended up serving as a significant motivating factor in working hard. Some students believed that what they were doing and how they were composing themselves would prove them to be positive role models for their children and future generations.  Students felt that the program was contributing to their personal and professional betterment, and helping them avoid setbacks such as unemployment or underemployment.  This sense of pride in their participation, and esteem for the program was reflected in the ways they connected and referred to other students in the HPOG program.