Indian Health Clinic Assessment
Indian Health Clinic Assessment
Indian Health Clinic Assessment
COMMUNITY RESPONSE TO NEEDS ASSESSMENT 15
AN URBAN AMERICAN INDIAN HEALTH CLINIC’S RESPONSE TO A COMMUNITY NEEDS ASSESSMENT
Mary Kate Dennis, MSW, PhD, Sandra L. Momper, MSW, PhD, and the Circles of Care Project Team
Abstract: Utilizing community-based methods, we assessed the behavioral and physical health needs of a Detroit metropolitan Indian health clinic. The project goal was to identify health service needs for urban American Indians/Alaska Natives and develop the infrastructure for culturally competent and integrative behavioral and physical health care. We conducted 38 semi-structured interviews and 12 focus groups with service providers and community members. Interview and focus group data indicated a need for 1) more culturally competent services and providers, 2) more specialized health services, and 3) more transportation options. We then report on the Indian health clinic’s and community’s accomplish- ments in response to the needs assessment.
Major difficulties exist when attempting to identify the health service needs of urban
American Indians and Alaska Natives (AI/ANs) and develop the appropriate infrastructure for
care delivery. Of the 2.9 million people who identify solely as AI and/or AN, 67% live outside of
reservation or tribal lands (U.S. Census Bureau, 2012). Providing for the health service needs of
urban AI/ANs is imperative, as, compared to the general population they struggle with
disproportionate rates of obesity and chronic diseases and are more likely to smoke, less likely to
visit a dentist, more likely to report their health as poor or fair, and less likely to use primary care
services (Glasnapp, Butrick, Jamerson, & Spinoza, 2009; U.S. Commission on Civil Rights,
2004). Urban AI/ANs experience worse health outcomes than the general population as a result
of racial and social inequities; high unemployment rates; cultural and historical trauma; and
limited social, health, and cultural resources (Moy, Smith, Johansson, & Andrews, 2006;
Weaver, 2012).
American Indian and Alaska Native Mental Health Research Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
16 VOLUME 23, ISSUE 5
Urban programs also have the difficult task of providing culturally appropriate behavioral
and physical health care for AI/ANs who represent multiple tribal backgrounds and have varying
levels of knowledge regarding health care that utilizes traditional Native methods of healing
(Urban Indian Health Institute [UIHI], Seattle Indian Health Board [SIHB], 2012b).
Furthermore, urban AI/ANs have limited access to health care and fewer available health
professionals. A U.S. Commission on Civil Rights report (2004) notes that there were 101
mental health professionals available per 100,000 AIs, compared to 173 per 100,000 Whites. The
Detroit metropolitan area, where the clinic in this study is located, is a designated Health
Provider Shortage Area with a score of 17 out of 20 (higher scores indicate more shortages),
revealing the lack of providers throughout the health system (U.S. Department of Health and
Human Services [USDHHS], 2014). Another common barrier to providing the highest quality of
care lies in the significant gaps in behavioral health data for the AI/AN population. An analysis
of the 2006 National Health Disparities report indicated that only 50% of the data for AI/ANs
were available, data were unreliable, samples were too small to be statistically significant, and
only two-thirds of the utilization data were usable.
DETROIT METROPOLITAN INDIAN HEALTH CLINIC
Services Provided by the Indian Health Clinic
American Indian Health and Family Services of Southeast Michigan, Inc. (AIHFS or “the
center”) is funded by Indian Health Service (IHS). Like many urban Indian health clinics, it
receives little funding. For example, tribally run health services and IHS facilities received
approximately 53% and 43% of the 2010 IHS budget respectively, while urban programs
received only 1%, although the majority of AI/ANs reside in urban areas (USDHHS Fiscal Year
2010 Budget in Brief: IHS, as cited in UIHI, SIHB, 2012b.) AIHFS’ service area is composed of
seven counties in southeast Michigan where over 47,900 AI/AN people reside (U.S. Census
Bureau, 2010). AIHFS’ mission is to “empower and enhance the physical, spiritual, emotional,
and mental wellbeing of American Indian families and other underserved populations in SE MI
through culturally grounded health and family services” (AIHFS, 2014). AIHFS provides
medical care, women’s health care, maternal and child health care, diabetes management, dental
referrals, behavioral health care, substance abuse counseling and prevention, tobacco cessation
American Indian and Alaska Native Mental Health Research Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
COMMUNITY RESPONSE TO NEEDS ASSESSMENT 17
programs, youth programming, parent support programming, fitness programs, and traditional
healing ceremonies (e.g., sobriety lodge). AIHFS aspires to integrate traditional AI healing and
spiritual practices with contemporary Western medicine in both treatment and prevention
(AIHFS, 2014). AIHFS also hosts annual health fairs, celebrations, and other cultural events.
Indian Health Clinic Service Needs and Response
At the time of this study, AIHFS served 2,304 clients, approximately 10% of whom were
receiving behavioral health services. Identifying and recruiting specialized providers (e.g., in
behavioral health) who are AI/AN is challenging. The behavioral health program was not able to
provide services to all of the clients in need of those services.
In response, AIHFS recognized that a needs assessment was necessary to increase
organizational capacity and build an infrastructure that could better provide for the health care
needs of the AI/AN population in its service area. A Substance Abuse and Mental Health
Services Administration Circles of Care Infrastructure Development grant funded AIHFS to plan
and perform an in-depth needs assessment of the systems of care impacting the physical and
mental health and wellness of AI/AN children, youth, and their families. The specific purpose
was to assess, plan, and design a culturally appropriate integrative system of behavioral and
physical health care that incorporated traditional healing.
In this paper, we present needs assessment data from AIHFS’ 2008-2011 community
project entitled Gda’shkitoomi (“We are Able”). The data reported here were collected between
April of 2008 and October of 2009. Additionally, we report on the AIHFS’ and the community’s
response to the needs assessment data. This community-based project posed the following
questions: 1) Are health services in general available, accessible, and appropriate? and 2) What
are the culturally appropriate health services needed in the Detroit metropolitan area?
METHODS
Study Purpose
Between April of 2008 and October of 2009, the team conducted 38 semi-structured
interviews with 27 community members and 11 service providers, and also conducted 12 focus
groups, 10 with just community members and 2 with just service providers. We chose these
American Indian and Alaska Native Mental Health Research Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh
18 VOLUME 23, ISSUE 5
qualitative data methods as we felt they would elicit richer data. Data saturation, community and
staff composition, and cost were considered when choosing the number of interviews and focus
groups. The purpose was to collect information from a diverse group of people who could
provide insight into the nature of the health issues (e.g., availability, accessibility, and
appropriateness of treatment; cultural and spiritual relevance of services), recommend solutions,
and provide guidance about integrating behavioral and physical health services. We determined
that it was important to get the views of community members, as they receive the services and
are aware of service improvement needs and preferences, and the views of service providers, as
they were more knowledgeable about currently provided services.
