Working Effectively with Tribal Governments

1. Working Effectively with Tribal Governments

2. Objective • To understand the role of emergency services in Indian Country and the importance of collaboration and partnering with other Tribes and collaborators

3. No Health Care Through Indian Health Services • Large number of tribes in California, too many to work with • Tribal population not concentrated in areas-made establishment of services cost prohibitive • Large non-federally recognized population of tribal people • Lack of clear policy, non-compliance with federal law, no advocacy for health care • Tribes lack awareness of eligibility for services/benefits for health care via IHS

4. Health Care Status of California Indians • No real information/data was maintained • State and county agencies did not provide services • Did not recognize the needs of tribal people-rural areas still practiced discrimination, law prohibited Indian people from public places, Indian people were not allowed to vote until 1920, did not allow Indian Children in public schools till 1924, • Did not feel they had any obligation to serve tribal people as they were wards of the federal government-Indians got services from federal government

5. Characteristics of Health Conditions of California Tribal People 1940-60’s • Isolated from services-geographical locations of tribes/members • Access to services difficult due to lack of transportation/access to transportation in rural areas. • High levels of chronic diseases - obesity, diabetes • High incidence of trauma – mental health needs • High levels of alcohol and drug use

6. Health Conditions, cont. • Little or no pre-natal care • Little or no post-partum care • High infant mortality/morbidity rates • High TB rates – place in institutions • No access to hospitals for delivery of babies • Poor nutrition, physical fitness • No mental health care

7. Emerging Advocacy • Late 1960’s Early 70’s Tribal advocates begin to meet about • lack of pre-natal, post-partum care for tribal women • High infant mortality/morbidity rates for tribal women • Lack of health care for infants and children

8. Indian Health Services 1900’s • Other States • Indian Health Services Hospitals • IHS Clinics • IHS Studies • IHS Initiatives • State Public Health Agencies • County Health Departments • Non-profit organizations • California • Provided by State Public Health Agencies • County Health Departments • Non-profit organizations

9. Tribal Representatives Approach Federal and State Government • Federal • IHS – slow to respond citing lack of population base and concentration of tribes to merit hospitals or clinics • State • Bureau of Maternal and Child Health- starting to document and plan response based on information presented by County Health Departments and tribal representatives

10. Tribes Advocate for Initial Funding • Began meeting 1969-70 with Bureau of Maternal and Child Health • Lake County (Dorothy Partida, Frank Treppa, Ed Simon) • Mendocino County (Doris Renick, Hiram Campbell, NormWhipple) • Humboldt/Del Norte (H.D. Williams, Darryl Hostler, Joy Sunberg ) • Tuolumne County (Luna Wessel, George Wessel) • San Diego (Adeline Rhoades, Dennis McGee)

11. New Era in Tribal Health Care Begins 1970-71 • State of California, Bureau of Maternal and Child Health Make Grants for First 9 Indian health clinics in State of California. • California Rural Indian Health Board is created. • First Indian Health Program Directors are hired, and health programs begin

12. Original Funded Projects • 1. Hoopa Reservation Health Project2. Modoc County Indian Health Project3. Round Valley Reservation Health Project4. Lake County Indian Health Project5. Tuolumne Rancheria Health Project6. Tule River Reservation Health Project7. Owens Valley Health Project8. Morongo/Soboba Health Project9. Pala Reservation Health Project

13. First Community Health Representatives Trained • Community health outreach conducted • Contracted Care evolved to full medical, dental, health education programs • IHS begins partially funding tribal health clinics due to CRIHB and tribal advocacy at federal level

14. Tribal Leadership Moves Indian Health Care Into 21st Century • Tribal Health Clinics expand funding base, scope and capacity-WIC, Nutrition Programs, Health Education, Alcohol and Drug Counseling/Intervention/Prevention • Contract care, licensed facilities, third party revenue generating • Expand service areas, multi-site facilities and projects • Advocate for federal policy and laws-more health care for tribal people.

15. Tribute to Our Leaders • Started with nothing • Saw the need • Took the chance • Had A vision for us • Laid a Path for Us to Be where we are today • Recognize their contribution to the growth and progress of our children and families today

16. The Preservation of Life, Land and Culture Through Emergency Management 2009 California Tribal Emergency Management Homeland Security (CTEMHS) Grant Project

17. PURPOSE • The California Tribal Emergency Management and Homeland Security Project (CTEMHS), a U.S. Department of Homeland Security grant-funded project administered through California Emergency Management Agency (Cal E.M.A.), in partnership with Inter-Tribal Council of California (ITCC) • The overarching goals of the grant are to assist California Tribal Governments in developing the capacity to prepare and manage emergencies, and to ensure that California’s Indian lands are included in statewide homeland security and emergency management planning efforts

18. PURPOSE • The project is not a substitute for government-to-government relations and consultation • Instead it is meant to complement the federal trust relationship by steadily building tribal capacity despite decreases in federal funding and to assist Tribes with meeting federal requirements to access funding directly • The opportunity for California Tribes to create a path so that it incorporates their own vision of how Tribal, Local, State, and Federal governments in establishing Cooperate, Communicate, Coordinate, in order to Collaborate before, during, and after emergencies

19. GOALS FOR FY08 • Communication Cooperation  Coordination  Collaboration • Create a communication network with Tribes • Strengthen Tribal cooperation with State and Local Government • Coordinate a broad range of tribal issues to help unify overall preparedness, planning, response and recovery in Indian country • Collaborate with other Tribes with a regional focus for better use of resources and information sharing

20. PROJECT MEETINGS • Project Advisory Committee -Tribe’s will have the opportunity to sit on an Advisory Committee that consist of tribal leaders, technical advisors, and state and local government • Kick-Off Summit – Scheduled for September 22-23, 2009 • Regional Training Workshops – Oct/Nov 2009 and Feb/Mar 2010

21. CTEMHSGrant Project Overview • Improve existing Tribal/State engagement. • Opportunity to address Tribal priorities • Homeland Security Grant funding mechanism

22. CTEMHSGrant Project Overview ITCC – Connie Reitman-Solas • ITCC – Project Sponsor • Vision for Tribal, Local, State, and Federal government communication, coordination, and collaboration. • Establish solid foundation for all California Tribes (federally and non-federally recognized) to move forward together to improve Tribal preparedness.

23. CTEMHSGrant Project Overview Guiding Principles: • Early and genuine engagement • Honoring of Tribal sovereignty and status • Acknowledge Tribal contributions and achievements • Increase Tribal capacity • Identify and document best practices

24. CTEMHSGrant Project Overview Phase I: • Project Advisory Team • Communications network • Statewide Summit –Tribal needs assessment • Regional workshop and training – with further work on Tribal needs assessment • Recognize leadership of Tribe, state, and local governments within the system, initiate assessment – capacity building

25. CTEMHSGrant Project Overview Phase II: • Implementation Framework - • Gap analysis • “Concept of Operations” for all phases of emergency management • Governance structure • Strategy to move forward

26. CTEMHSGrant Project Overview Phase III: Implementation Framework utilized to: Institute change on identified issues. Coordinate the allocation of homeland security grant funds towards identified priorities on Tribal lands. Enhance capacity of Tribes.

27. Functional/operational • COOP--- Who will be the first responders? • Tribal lands: (Elk Valley, Hoopa, Tule River, Susanville Rancheria) • Metropolitan Areas: SCIHP, SNAHC, Fresno, San Diego • Rural Locations: Northern Valley, Lake County Tribal Health, and Consolidated Tribal Health

28. Cal-EMA • State Emergency Management System - Statewide - Regional (3) - Areas (6) - Operational Areas (58)

29. Communications • Tribal: What would it look like? • Rural: “ • Metropolitan Areas: “ What are existing efforts?

30. Governance • 109 Federally Recognized Tribes • 3 Regions/Tribes within those regions • 6 Areas/ Tribes within those areas • 58 Operational Areas/Tribes within those areas

31. Operations • Allocation of resources • Coordination of resources • Location of EOC’s - Proposed Statewide Tribal EOC in Sacramento County • Regional Tribal EOC’s (4 Proposed)

32. Additional Training - If your Tribe or Organization has identified additional training needs, please contact ITCC’s office: (916) 973-9581 (office) (916) 973-0117 (fax) lorettag@itccinc.org www.itccinc.org