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.