With leadership from a local health board, four Oklahoma tribes work collaboratively to understand the substance use and misuse prevention needs within their communities.
About the Collaboration
Oklahoma is home to the second largest tribal population in the United States—with nearly a third of its population identifying as American Indian or Alaska Native.1 When it comes to substance use and misuse, however, the needs of tribal citizens in the state have often remained hidden, due in large part to a lack of tribal-specific data needed to understand and effectively address the region’s health disparities.
To address this data gap—and draw attention to the prevention needs of tribes in their region—the Southern Plains Tribal Health Board, a non-profit organization serving 43 federally-recognized tribes in Kansas, Oklahoma, and Texas, teamed up with four of its member tribes—the Absentee Shawnee Tribe, the Cheyenne and Arapaho Tribes, the Chickasaw Nation, and the Comanche Nation. In 2009, the newly formed Oklahoma Area Inter-Tribal Consortium (OIC) were awarded a Strategic Prevention Framework Tribal Incentive Grant (SPF TIG)* to support their data collection and prevention efforts.
"We knew we had substance abuse issues in Indian Country, but there wasn't a lot of local data on our tribes," says Tom Anderson, the health board's Oklahoma Tribal Epidemiology Center Director. But while the OIC recognized the need for better data at the local level, collecting these data required that they first overcome internal challenges, including resistance from their member tribes to reporting tribe-specific data.
Leveraging guidance from the health board's Oklahoma Tribal Epidemiology Center and SAMHSA’s Center for the Application of Prevention Technologies (CAPT), the OIC worked collaboratively with member tribes to overcome these challenges. Together, the consortium developed a new approach to sharing and reporting tribal data that laid the foundation for eventual prevention activities on the ground.
In November 2015, the consortium presented on their collaborative data-gathering and reporting efforts at an American Public Health Association (APHA) meeting to a standing-room only crowd.2 Their work now serves as a model for other tribes and organizations in how to join together to secure funding and collect the data needed to inform strategic planning for prevention work in their communities.
Elements of Success
Safety in Numbers
Like all SPF incentive grantees, tribes receiving federal funds for prevention work are required to collect data about the nature, scope, and severity of substance use and misuse issues in their communities. In order to collect these data, however, the OIC first needed to overcome deep-seated fears among their member tribes. Tribal partners were concerned that such data might reveal problems in their communities and present the Native community unfavorably – a concern that stemmed far beyond the efforts of the OIC. “Tribes in the past have had people come in and ‘study them,’ and then report their data,” says Carlos Martinez, a prevention specialist who advised the OIC on the data gathering and analysis. “Sometimes those reports have been negative and have had terrible effects on the tribes.”
To address this concern, the OIC agreed to pool data from all four tribes and report it only in aggregate form, as a tribal organization. This approach eliminated the possibility of linking any “negative” findings to a specific tribal entity. With guidance from the Southern Plains Tribal Health Board, the OIC executed data-sharing agreements to formalize this approach and worked with SAMHSA to communicate the importance of reporting data in this way (i.e., as a tribal organization rather than as individual tribes). With SAMHSA’s approval, this approach allowed the OIC to move forward with their data collection efforts.
Create a Shared Vision
Agreeing to pool and report their data as a tribal organization facilitated a shift in perception among OIC partners—from identifying as individual tribes to seeing themselves as a group, with a shared responsibility to address the substance-related issues facing their communities. “Everybody agreed that, instead of serving Natives of one tribe or another, we needed to serve all Natives, regardless of what jurisdiction they lived in,” explains Martinez. In fact, after collecting and analyzing new data (made possible through their data-sharing agreements), the tribal partners now recognized that they shared significant problems with underage drinking and prescription drug misuse, which they collectively adopted as strategic priorities.
But the OIC’s shared vision extended beyond just these strategic priorities: consortium members also embraced the tenet of “Culture as Prevention,” calling upon the strengths of their shared traditions and the uniqueness of American Indian identity to guide their prevention work. “American Indians can feel left out of society, particularly here in Oklahoma where we don't have reservations and tribal members are spread out across the state," Anderson explains. "People opt out of society by abusing drugs and alcohol. Our message in our prevention work is learn about your culture. Be part of your culture. Because what you do impacts not only yourself, but it impacts your family, your community, and most importantly, it impacts the generations to come."
Level the Playing Field
Coming to the table, the OIC partners had varying levels of experience with substance use and misuse prevention, particularly with regard to data collection and reporting. While some had virtually no prevention experience, the consortium’s largest tribal partner, the Comanche Nation, had already been working on its own prevention efforts and was ready to hit the ground running. To get everyone on the same page and ensure the success of the collaboration, the OIC leveraged both the internal and external resources at its disposal.
Internally, the Comanche Nation took a lead role in mobilizing their tribal partners. “The Comanche already had the fire in their belly to [implement substance use prevention efforts],” explains Martinez. The Southern Plains Tribal Health Board also provided key guidance throughout the process, advising on the type of personnel that tribes would need to fulfill the grant requirements, what data they would need to collect, and how they should approach the process of selecting appropriate prevention strategies for their communities.
Externally, the OIC leveraged the support of SAMHSA’s Center for the Application of Prevention Technologies (CAPT), which provided tailored training to meet the needs of each tribal partner. “I can’t say enough good things about the CAPT,” says Melanie Johnson, the health board's SPF-TIG Grant Lead Project Manager. “They have gone out of their way, above and beyond the call of duty, to provide cultural sensitivity for American Indians.” The CAPT also helped the OIC overcome challenges related to high staff turnover: “When you’re working with tribal organizations, people come and go. The CAPT was instrumental in helping us rebuild that capacity within our organization.”
The Oklahoma Area Inter-Tribal Consortium serves as a model for how other tribes can work together to better understand and address their communities’ substance use problems. "This collaboration shows other tribes that you don't have to do everything on your own," says Aron Wahkinney, the health board's communications specialist and member of the Comanche Nation. "Smaller tribes can work together, and with each other and with larger tribes, to pool prevention resources, and to share information to get the data needed to take advantage of funding opportunities."
As noted in their presentation at APHA, the OIC model is “a win-win for tribes and funding agencies.” Smaller tribes, the presenters explained, tend to be at a disadvantage when it comes to grant funding: “Funding agencies want to maximize their dollars by having the greatest effect, and funding individual tribes with low membership may not achieve this. Funding a consortium of tribes to address a common problem, not only increases the population affected but also strengthens efforts of consortium members.” Nowhere are the strengths of the OIC’s collaboration more apparent than in their prevention activities on the ground. Informed by a clear understanding of the substance misuse issues affecting their communities, the four tribal partners have each embarked on prevention activities, tailored to local needs:
- the Absentee Shawnee Tribe initiated a partnership with tribal and county law enforcement on using Naloxone to prevent opioid deaths, leading the way for other tribes to adopt similar initiatives;
- the Cheyenne and Arapaho Tribes have implemented the ‘Tradition Not Addiction’ campaign, designed to teach tribal youth traditional ways of respect, honor, and integrity;
- the Chickasaw Nation worked with their Division of Aging to educate seniors about safe storage and proper disposal of prescription drugs and to provide drop-off medication lock boxes at Senior Sites;
- the Comanche Nation has developed a popular prevention program—IAMNDN (pronounced I Am Indian)—dedicated to empowering Native youth to live drug free.
Members have presented at multiple national conferences, including the National Indian Education Association Annual Conference and the 2016 National Rx Drug Abuse & Heroin Summit. They were also congratulated on their prevention efforts by U.S. Surgeon General Vivek H. Murthy, M.D., who visited with the tribes in May 2016 at what is heralded as the first-ever meeting between a U.S. Surgeon General and tribal leaders. "There's a lot of interest in what we're doing," Anderson says. "Tribes can work together effectively. We've shown how it can be done."
According to Johnson, the collaboration is still a work in progress. "We’re still coming to that 'Aha!' moment where everyone says, 'OK, now we get it,'" Johnson says. "But we’re paving the way for what it could look like for other tribes to work together." Her advice to other tribes seeking to join forces and collaborate for prevention? "Things can get a little chaotic. But stay grounded, stay focused, stay committed.”
*Strategic Prevention Framework Tribal Incentive Grants are infrastructure grants provided to federally recognized tribes and tribal organizations to implement SAMHSA's Strategic Prevention Framework.
1. U.S. Census Bureau. (2012, January). The American Indian and Alaska Native Population: 2010. Retrieved May 19, 2016, from http://www.census.gov/prod/cen2010/briefs/c2010br-10.pdf
2. Working together: Addressing prescription drug abuse and underage drinking—a collaboration between the Absentee Shawnee Tribe, the Cheyenne and Arapaho Tribes, the Chickasaw Nation, the Comanche Nation, and the Oklahoma City Area Inter-tribal Health Board. Presented at the American Public Health Association (APHA) Annual Meeting, Chicago, Illinois. (November 2, 2015.) Available online at https://apha.confex.com/apha/143am/webprogram/Paper324991.html