National Indian Health Board
Visions: A Tribal Perspective on Methamphetamine and Suicide Prevention 
Have You Heard ...

Webinar: Chronic Pain and Depression

by Snehal Bhatt, MD


 Monday, February 2, 2015 at 12:00 pm EST


Please visit here for the seminar; the passcode is addiction.


Training Session:  The Fundamentals of Writing a Responsive Grant Application

The Health Resources and Services Administration will be hosting an online seminar to help grant applicants better understand:

  • The basics of every grant application
  • Writing your narrative to match the review criteria
  • How the application pieces fit together to respond to all aspects of the Funding Opportunity Announcement 

Experts from HRSA's Office of Financial Assistance Management will be on hand to answer questions on Wednesday, February 11th at 3:00 pm EST. Please visit here for the seminar. 


2015 Tribal Public Health Summit

NIHB has set the date for its 2015 Tribal Public Health Summit. This conference has become the hallmark public health event annually for all of Indian Country. It will be hosted by the California Area and will be held at the Agua Caliente Casino Resort Spa from April 7-9, 2015. 

Coming Soon: New Suicide Prevention App from SAMHSA

As a leader in suicide prevention, SAMHSA is developing a new suicide prevention app for mobile devices, optimized for tablets. The free app called Suicide Safe will help providers integrate suicide prevention strategies into their practice and reduce suicide risk among their patients.

Suicide Safe helps providers:

  • Explore suicide prevention resources, including the SAFE-T (Suicide Assessment Five-step Evaluation and Triage) card and easily download it for use offline.
  • Study interactive sample cases to learn and review the five steps of the SAFE-T.
  • Access information, including suicide prevention wallet/pocket guides, educational opportunities, and other supportive resources.
  • Access patient education materials, including crisis hotline wallet cards, fact sheets, and treatment resources.
  • Browse conversation starters that provide sample language and tips for talking with patients about their suicidal ideation.
  • Use the SAMHSA Behavioral Health Treatment Services Locator to provide timely referrals for patients.

SAMHSA's free Suicide Safe app will be available in 2015 for iOSŪ and AndroidTM mobile devices.

NIHB is hiring!

Director of Public Health Programs and Policy

For full job description and information about how to apply, please click here (PDF).


Public Health Project Coordinator

For full job description and information about how to apply, please click here (PDF).

Tribal Health Care Reform Outreach and Education Program Coordinator

For full job description and information about how to apply, please click here (PDF).



Policy and Program Associate

For full job description and information about how to apply, please click here (PDF).


NIHB MSPI Project Management Toolkit

NIHB has updated its project management toolkit to include new tools, links and webinars.  There is now a powerpoint slide set on sustainability and sustainability planning, as well as a new sustainability readiness checklist.  There is also a powerpoint slide set on logic models, as well as two handouts for logic model.  And lastly there are two tip sheet for recruiting and retaining high quality staff for your programs.  All of these article appear in the


NIHB MSPI Webpages


NIHB tries to disseminate information to all of our Tribal partners.  We have created some mechanisms in order to do that and want to make sure that all of our MSPI Partners are able to take advantage of this.  NIHB posts new and timely information regarding topics such as: training, webinars, funding, publications, conferences, meetings, legislation, Tribal consultation, and open comment periods all on our website as Behavioral or Public Health Alerts.  NIHB operates two separate alert lists to appeal to specific audiences.  We encourage you to check these posts often to remain abreast of current information and ensure that you have access to material in a manner that is timely enough to allow you to plan for it.  

Please bookmark:

"Like " us on Facebook


Don't forget to visit NIHB on our Facebook page and like us.  We frequently post blurbs, updates, and pictures about important public health information, happenings, trainings, and events. 

Mission of the National Indian Health Board
One Voice affirming and empowering American Indian and Alaska Native peoples to protect and improve health and reduce health disparities.

About this Publication
This publication features information on suicide prevention, intervention, postvention and methamphetamine prevention, treatment and aftercare. We welcome your suggestions, questions and comments and invite you to submit materials for future publications.
The What and Why of Program Evaluation

Evaluation is the cornerstone of public health programming.  Without evaluation data we would not know what programs actually work.  Evaluation is simply the practice of examining your project and your activities to ensure you are doing what you said you were going to do and if what you are doing is really working.  We do this by collecting information on the project before, during and after implementation.  Evaluation and project implementation should run parallel, but oftentimes are so far removed from each other that the task of evaluation seems daunting.  It doesn't have to be so ominous.


The specialized language and vocabulary can also be confusing and new to many people.  In essence, there are three kinds of evaluation that community and Tribally-based programming should be doing.

  • Formative Evaluation: the process of collecting information on what the prevalent needs of the community are, who is at risk for specific conditions, and what public health programming may best need these needs.  In more familiar terms, we call formative evaluation a community assessment (or gap assessment, needs assessment, etc.). We use this information to create programs.
  • Process-based Evaluation: this is the process of collecting information about how a program is running, what services are being delivered, to whom, and what resources are being used to deliver the services.  Having people sign-in when they attend an educational session so you know how many people attended is process-based evaluation.  You are simply collecting information about the process used to deliver a service and asking yourself, "Did this process do what we intended it to do?"
  • Outcome-based Evaluation: this is the process of collecting information about what changes occurred because you implemented a program.  For example, if people learned something, then that is a change in knowledge.  If people quit smoking, then that is a change in behavior.  These changes are called outcomes and reporting on our outcomes tells us if the programs/services were effective or not.  And sometimes knowing if something is not working is just as helpful as knowing if something is working.

Knowing what you want to learn from your program implementation can tell you right up front what kind of data you will need to collect throughout your project.  For example, if you want to know if the community likes the program, then you will need to collect satisfaction-based information from people who attend your activities as well as community members who may not have attended an activity but are still impacting your work.  If you want to know if your collaboration with another department or Tribe has been successful, then you will have to collect information from employees and staff as well.  Laying out what you want to know, how you will get the information, and when is called evaluation planning.  Creating an evaluation plan should be done at the same time as program activities are planned-ideally when writing a funding proposal. 


Evaluation serves many different purposes, but for MSPI projects there are some key reasons why evaluation is vital to the success of MSPI.  Of course, at the Tribal level, it tells project managers and directors how well the project is performing.  That information is wonderful to ensure implementation of success projects, and to explore opportunities for improvement.  It also creates an evidence-base for best practices in Indian Country.  For the Indian Health Service, they can take information on project performance and use it to justify the budgetary expenditure needed to sustain the Methamphetamine and Suicide Prevention Initiative.  So, in essence, a good evaluation at the Tribal level can help to secure the future of the project in the coming years. 


Evaluation is not a fruitless waste of time. By understanding why we do it, the needs for it and how to perform evaluation more efficiently, we can strengthen our case for funding, improve our projects, and share with other communities what is working - all of which are solid contributions to the public health of Indian Country.


Working with an Evaluator

Ideally, Tribes should seek to raise their own capacity to conduct their own evaluation.  However, if that is not an option, then there are a variety of resources available for Tribes to explore to secure evaluation services.  Tribes may consider contacting their area Tribal Epidemiology Centers or Area Indian Health Boards to see if contract evaluation services are available.  Tribal Colleges are also a good place to search for evaluation services (from faculty or students); the same is true for non-Tribal institutions as well (even community colleges).  There are a large number of consulting firms that specialize in public health programming.  These firms are willing to assign a staff member to a specific project for the length of the project, and can provide a sense of continuity of the length of the project. There is no single listing of all of the evaluation firms in the country, but as word of mouth is their primary form of marketing, asking colleagues or even funders will generally provide a healthy list from which to start an inquiry. 


Contract evaluators will work with one Tribe or a number of smaller projects at the same time.  The scope of work will impact the consultant fees requested, but smaller projects coming together can pool funds to hire a single contractor.  A contract with an evaluator can be expensive, and every contract evaluator will have differing rates.  Most contractors will charge an hourly rate.  Tribes should plan on meeting with contract evaluators up front to discuss expectations and tasks, and then it is up to the contractor to prepare a proposed scope of work and total fees requested.  Tribes should feel negotiated this to align with their budgets.  And when considering a fee schedule, Tribes should consider creating performance-based contracts - where contractors are only paid upon completion and submission of specific deliverables (not on a regular pay basis). 


An evaluator (whether staff or contract evaluator) can and should do many things for a project - design an evaluation plan, create instruments, test instruments, conduct evaluation activities (hold focus groups, do phone interviews, etc.), analyze data, and/or prepare evaluation reports.  A contract evaluator can also be a source of capacity building assistance for Tribal programs.  An evaluator can provide training and one on one assistance to Tribal programs so that they understand the evaluation processes and can, in the future, conduct their own evaluation activities. 


Additional Resources

For more help with conducting and using evaluation, feel free to contact NIHB for technical assistance.  And please feel free to look at these additional resources:


Community Toolkit

CDC Program Evaluation Resources

Save the Date: Tribal Public Health Summit



Please plan on reserving April 7-9, 2015 to join public health professionals, Tribal leaders, federal and academic partners, and community advocates from across Indian Country in warm and beautiful Palm Springs, California for the National Indian Health Board's Tribal Public Health Summit, hosted by the California Area. 


This year's Summit will feature:

  • Longer workshop times to allow for more skills-building and networking opportunities;
  • Listening sessions with federal agencies
  • A dynamic and resource-filled exhibit hall 
  • New and refreshing panel plenary presentations

For more information, please visit the conference website. Further information can be found for:

We are also seeking MSPI products for the MSPI booth. If you would like to share promotional items that you have produced as an example of the wonderful things your programs are doing, please contact Jackie Engebretson at 

 Tips for Caregivers: Talking to Youth about Difficult Subjects 


There are many conversations caregivers should have with youth as they grow up. Some of these conversations have sensitive subjects, like sex, drugs, eating disorders, suicide, and many others. While these are difficult subjects to discuss, they're also incredibly important. These tips can help make conversations easier and more productive.


Start early: Most difficult subjects are easiest to discuss in age appropriate increments. Conversations don't have to be awkward and drawn out like in movies; instead they can be factual discussions. For instance, discussions about sex could start with teaching toddlers about their body parts, including their genitals. As children get older the conversation can move from discussing genitals using anatomically correct terms to talking about how babies are made. If you didn't start talking about a subject at a young age, that's okay-start discussing now; it's never too late.


Build trust: It's important to answer questions openly and honestly. Many caregivers put off difficult topics because they're afraid of questions they may receive during discussions, especially if the question is regarding your own behavior. For example, during a discussion about how drugs are harmful, a teen may ask if you've ever done drugs yourself. It may be detrimental to deny if you have, as they may eventually hear from someone else and lose trust in you. It's also not necessary to divulge every detail. A productive way to answer is to keep the conversation about the youth and frame your answer in a way that acknowledges your previous behaviors while still explaining why you believe using drugs is a mistake. The Partnership for Drug-Free Kids has a guide called "How to Talk to Your Kids about Drugs if You Did Drugs" that is useful for framing answers.


Talk about your values: Clearly explain to youth how you feel about the subject. Don't give blanket statements like, "make smart choices." Take the time to discuss what smart choices look like and why they're smart choices. Say things like, "In this family we believe you shouldn't drink until your twenty-one because it's dangerous and illegal, what do you think?" This allows youth to understand your values while also opening up for further discussion. Another approach is to discuss your tribe's traditional values. You could say something simple, like, "traditionally our tribe has not consumed alcohol; we honor our tradition by abstaining from alcohol."


Be patient and nonjudgmental: Mistakes and lapses in judgment happen. It's important to react in a calm, cool manner. That's not to say you shouldn't discipline youth-it's important to explain why you believe their actions were unacceptable. By reacting in a calm manner instead of a harsh, criticizing, or lecturing manner, youth are more likely to listen to your message. This also helps build trust by letting them know that you respect them, without judgment. Should they make a mistake in the future, they may be more inclined to share with you.


Build self-esteem: Youth who feel loved tend to make better choices for themselves. Help youth build a healthy self-esteem by encouraging them to participate in activities they enjoy. Show youth you care by spending quality one-on-one time. The quality time could be something simple like playing board games, teaching them how to make a family recipe, or participating in cultural events. Participating in cultural activities, like beading, language classes, and spending time with elders help youth feel more grounded in their cultural identity. Most importantly, tell youth that you love them unconditionally. Let them know you're by their side every step of the way, even if they make mistakes.


Continue the dialogue: Don't end with one conversation. Difficult topics are complex and will require many conversations over time. Take opportunities to discuss events occurring around you. For example, if you're watching a movie together and one of the characters has an unplanned pregnancy, take the opportunity to discuss safe sex. The conversation doesn't have to be a long one, but you could perhaps you could say, "What do you think that character could have done to prevent an unplanned pregnancy?" This open ended question will allow you to gauge what your youth already understands and can open dialogue regarding safe sex practices. Frequent conversations will encourage youth to come to you with any questions or concerns when they're ready.


Additional Resources


For more tips, including issue specific tips, please visit the follow resources:


American Psychological Association

Children Now

National Eating Disorders Association

Partnership for Drug-Free Kids

Designing Successful Prevention Programs


All public health programs seek to satisfy multiple needs-those of the funder, the community, and the leadership are just three important stakeholders of many.  Creating programs to meet these needs can be challenging, and one of the pivotal issues is finding the balance between research and practice-academia and the 'real world'.  Regardless of when you are in athletic coaching, mental health, community based prevention, clinical practice, or organizational development-all of these fields rely heavily upon advances in the field to move local practice along, but somewhere along the way reality sets in and what appears ideal in a journal article or during a conference presentation looks very different when implemented at the community level.  The first step in seeking to remedy this translation issue is to be well-versed in fundamentals of prevention program design. 

  • Evidence-based: this refers to the conscientious and explicit use of current best evidence systematic research and program evaluation when either creating or adopting a new program.  There are compendiums that list out programs that have been deemed evidence-based because they have a strong base of data that show that the program produces: 1) what is says it will, and 2) positive health outcomes.  The belief is that this program, if replicated exactly, will produce identical health outcomes in other communities.[i]
  • Science-based: this means that it has a scientific and/or theoretical foundation, Programs that are locally developed can still be science-based.  Science-based doesn't necessarily refer to a program having a research or evaluation foundation, rather it means that the program relies heavily upon scientific principles and theories of change and change management.  For example, a program that consistently relies upon the Stages of Change model to help move a person from contemplation in their readiness to quit smoking methamphetamine to the preparation stage can be called science-based.  Likewise, a program that uses other theories of change to identify what might be leading to or deterring certain behaviors and then create strategies to modify those facilitators or barriers to change is also science-based.[ii]
  • Practice-based: a practice-based approach works with a much deeper link with the realities of public health service delivery.  Practice-based programs recognize the context and limitations of scientific research and replication and recognizes that firsthand knowledge about what works locally can be used to construct a program that can still produce positive health outcomes.  Practice-based programs are generally locally-developed programs based upon the thoughtful consideration and work of a small group of people.[iii] Practice-based evidence is also where Tribes can begin to develop an evidence base for the effectiveness of culturally-based programming and cultural integration. 

It is possible that a single MSPI project can have components that are science-based, another component that is practice-based, and another that is evidence-based.  The terms are not mutually exclusive; some activities can be classified as all three (almost all evidence-based practice and evidence-based interventions are also science-based).  Most federal funding streams encourage their grantees and awardees to use evidence-based practices because they have more confidence in the program's potential effectiveness.  However, the MSPI project allows Tribes to explore their own community needs, resources, and Tribal culture and create, adapt or customize unique projects.  These programs generally are a combination of different activities and events.  The challenge for MSPI projects will be to combine all of the activities and events together underneath a common umbrella that will drive the programs logically towards the same outcomes. This refers to the 'logic' of a program/intervention.  The internal logic of a program is the relationship between three primary components: behavioral determinants, activities, and outcomes.  Behavioral determinants are those pieces of scientific behavioral theory that pinpoint what might be leading to high risk behavior in the community.  Activities are those structured interactions with the community that seek to address the behavioral determinants and ultimately promote behavior change.  Outcomes are what happened as a result of the activities (what change occurred because people engaged in the activities).  The relationship between these three components form the heart of any intervention or program (which science, evidence, or practice-based). 


By understanding the conceptual basis of MSPI programming, MSPI projects stand an increased chance of implementing a successful program. 

[i] Messeear, D. C., & Tanner, C. A. (2013). Evidence-based practice. Advanced Practice Nursing: Essentials of Role Development, 242.

[ii] Lohr, J. M., Lilienfeld, S. O., & Rosen, G. M. (2012). Anxiety and its treatment: Promoting science-based practice. Journal of anxiety disorders, 26(7), 719-727.

[iii] Leeman, Jennifer, and Margarete Sandelowski. "Practice-Based Evidence and Qualitative Inquiry." Journal of Nursing Scholarship 44.2 (2012): 171-179.


The National Indian Health Board welcomes your input!  If you would like to submit materials for consideration, please contact the NIHB Public Health Department through Acting Director of Public Health Programs and Policy, Robert Foley at or (202) 355-5494.