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About Spilyay tymoo. (Warm Springs, Or.) 1976-current | View Entire Issue (July 13, 1979)
Page 8 July 13,1979 Spilyay Tymoo Comprehensive Health and Social Services Plan Community needs tapped for health planning by Cynthia Stowell For the first time since O reg o n S ta te U n iv ersity surveyed the hum an and natural resources of the Warm Springs Reservation in the 1950’s, a comprehensive look at this community’s health needs has been completed. Only this tim e, W arm Springs is taking its own temperature. Sal Sahme, prime mover of the “Comprehensive Health and Social Services Plan,’’feels that one measure of the plan’s importance is that it was born of community invol vement. Another fact that dis tinguishes this latest research is the community’s ownership of the plan. Months of interviewing, gathering statistics, observing and analyzing have produced not only an in-depth report on existing needs and services. They have also pointed a direc tion for the community in plan ning for its future. Sahme sees the health plan as just a begin ning, a “foundation... to the obviously constant evolving and changing health and social services needs of the Warm Springs community.” Completion of the compre hensive health plan also earns Sahme a Master’s degree. But unlike much thesis-related research, where “people sub jected to the student’s research usually have little control or practical use for the thesis,” Sahme feels his project is a “meritorious exercise for the Tribes as well.” More input from the Tribes Central to the plan is the assumption that the tribes will in the coming years play a larger role in the planning and provision of health and social services on the reservation. Passage of the Indian Self- Determination and Education Assistance Act (PL-93-638) in 1975 opened the door to tribal contracts with HEW for the provision of services currently handled by the; Indian Health Service. The (ndian Health The history of health care on the reservation has been char acterized by a lack of tribal “control or accountability” states the report. Even as the Tribes have begun providing their own social and mental health services in the last ten years, “growth has been dic tated in accordance with fund ing a v a ila b ility .” C risis orientation and short term planning have plagued existing programs and there has been little attempt to standardize treatment methodologies. And lastly, the “natural care system” founo in the Warm Springs community has not been recog nized and incorporated into programs. What has been, needed, says the report, is longrange plan ning based on identified health and social .service needs “as defined by the community.” The Comprehensive Health and Social Services Plan was designed to form the basis fora “model health care system appropriate to the Warm Springs Confederated Tribes.” Nine months of consciousness- raising Sahme was hired by the Tribes in 1978 as a health planner and given nine months to wade through a dizzying list of 18 objectives, with the health plan as the primary product. ' At the core of the health plan is the survey administered to a random sample of the reserva tion population, all tribal members. But first, Sahme began bringing the community into the process by staging a health legislation w orkshop last October. The workshop intro duced participants to the major pieces of recent health legisla tion and how they might affect the Tribes’ relationships with a number of state and federal agencies. Then began the collection of “raw data” from the programs currently serving the reserva tion, including the Indian Central to the plan is the assumption that the Tribes will in the coming years play a larger role in the planning and provision of health and social services on the reservation. Care Improvement Act of 1976 further commits the govern ment to encouraging the parti cipation of Indians in health planning and management. It was this that enabled Warm Springs to embark on the development of a comprehen sive plan, the plan in turn giving the community the “ to o ls necessary for real participatory impetus to their health status.” But the health plan does not presume the implementation of P.L . 638, noted Sahm e. Rather, it is the groundwork for looking at the feasibility of the Tribes exercising self- determination in the area of health services, “This docu ment will speak to the process of cooperating with the Indian Health Service... and moving toward a hum an services umbrella, away from territor iality,” said Sahme. Health Service, Bureau of Indian Affairs, and numerous departm ents in the Tribal Health and Social Service Branch. Surveying the community’s needs While this information was coming in, Sahme and the Health and Welfare Committee launched the community inter views, in consultation with experts from the University of Oregon’s White Cloud Center. Nine interviewers were selected on the basis of their employ ment in the tribal Health and Social Service Branch and their tribal membership. From the tribal rolls, 165 people were selected for the survey sample, with 108 com pleting the interview. Subjects were asked in confi dential interviews to: indicate • A health resource guide for the reservation should be developed and continually updated. • A feasibility study should be conducted to determ ine whether the Tribes should exercise self determination in respect to local IHS pro grams. • A time clock study of IHS clinic operations should be completed. • Warm Springs’ natural care system should be sanctioned and incorporated into health , delivery. • The health planning function should continue and a longi tudinal study should be launched to evaluate the longterm effectiveness of the Tribes’ plan. DIAGNOSIS - 77ie reservation is taking its own temperature and prescribing a new approach to health care, incorporating traditional and modern methods of treatment. Spilyay Tymoo Photo by Stowell their awareness of and rate the services offered by the various health and social service pro grams; prioritize perceived health needs of children and elderly; comment on their knowledge of Indian medicines as well as prescription medi cines; define ill health and its causes; and suggest improve ments in the health delivery sy- stem in Warm Springs. Responses were analyzed on the basis of simple frequencies, with more complex cross- statistical analysis to come later. Several results stand out in Sahme’s mind. Natural care and self-reliance Most .outstanding was the support lent to the notion that Warm Springs has a strong and viable “natural health care sy stem.” When asked where they go for advice and why, well over half the respondents said they go to friends or relatives because they trust them and find them to'be understanding. “We have to be aware of and utilize this system ,” said Sahme, but recognize that drawing a lot of attention to it and disrupting “delicate, natu ral balance” could cause it to break down. Sahme was also struck by people’s positive response to a question about self-reliance. People would like to rely on their own resources, according to their responses, a philosophy already in practice within the Tribal Health and Social Servi ces Branch. Also notable were people’s ratings of existing services which tended to cluster in the “fair” zone. To Sahme this indi cated a lack of exposure to a variety of other services as a basis of comparison. “People need to know what quality ser vices can be available," he remarked. In terms of service needs, people listed easier access and less waiting time at the top of the list. With 89% of the respondents going to the Indian Health Service Clinic for their physical health needs, it is significant that over half have experienced more than 60 minutes of waiting to see a doc tor and two-thirds would like to see the IHS move into new larger quarters. Converting needs to action The Comprehensive Health and Social Services Plan con verts these recommendations to goals, objectives and action steps, offering a time frame, suggesting responsible persons or departments and estimating costs involved. The plan is designed to address a ten-year time frame. The most immediate action will center on the securing of funds for fiscal years 1981-1984 for improved services and con struction of a health services complex. In the meantime eight different objectives are recom mended for inclusion in the Health Branch’s 1980 budget, ranging from 24-hour emer gency care to training staff. People were asked to indicate their awareness of services offered, prioritize perceived health needs, comment on their use of Indian medicines, define ill health, and suggest improvements. People also indicated a need for drug and alcohol education . for children as well as increased culture education and recrea tion. Many saw a need for increased cultural awareness among staff. Others suggested more home care and better transportation for the elderly. A large percentage said they would use a budget assistance program if it was offered. Launch pad of recommenda tions Based on people’s responses and the information gathered from e x istin g p ro g ra m s, Sahme assembled a list of recommendations that serve as a launch pad for the compre hensive health plan. Some of these recommendations are: • Make adequate space a v a il able for provision of direct services. Specifically, the construction of a new health services complex is recom mended. • Dental services must be accessible and optometry and audiology services must be consistantly available. This fall, a time clock study will be conducted by the I.H.S.’s Office of Research and D ev elo p m en t to m onitor- elapsed time during patients’ visits to the clinic. It is expected that findings will indicate the clinic is being used to capacity and that its four examination rooms cannot handle current patient load, according to the director of the project. Perhaps most importantly, the Comprehensive Commun ity Health Plan will foster a holistic approach to the preser vation of this community’s health. Sahme explains holistic as the treatment of the mind, body and soul as one, not separating physical and mental health. In a broad sense “holistic” might also describe the plan’s implied trend toward more cooperation between tribal and governmental services, creating a “human services umbrella” for the reservation. Copies of the Warm Springs Community’s Comprehensive Health and Social Services plan are available from Sal Sahme 553-1161 ext. 225 or the Health and Welfare Committee • A professionally staffed (553-1161 ext. 258). Emergency Medical Service Program is needed. • All human service providers should take part in a compre Next: What are Warm Springs’ hensive continuing educa identified health needs? tion program.
