Performance Improvement 1996. Indian Health Service

02/01/1996

Contents

Case Study of Family Violence in Four Native American Communities: Final Report

Evaluation of Diabetes Services Provided by IHS Model Diabetes Program: Final Report

Evaluation of IHS Midlevel Health Providers: Final Report

Phase III Final Report: Child Abuse and Neglect in American Indian and Alaska Native Communities and the Role of the Indian Health Service

TITLE: Case Study of Family Violence in Four Native American Communities: Final Report

ABSTRACT NUMBER: 094

ABSTRACT: This study examines family violence on four American Indian reservations (the Confederated Tribes of Warm Springs, the Eastern Band of Cherokee, the Navajo Nation, and the Rosebud Sioux). It uses a case study approach to collect primary and secondary data about the nature and prevalence of family violence, and the intervention and prevention measures planned or in place on each reservation. The report's strengths include the broad range of informants interviewed, the wide variation in characteristics of the sites, and the objectiveness used by the contractor to gather data. Its limitations include the facts that case study data, by nature, are not representative and that informants feel pressure not to disclose unfavorable information. The report finds that the eight components of family violence interventions include (1) adoption of a family violence code, with mandatory arrest and incarceration or treatment of offenders; (2) establishment of a victim support system; (3) institution of new police procedures for dealing with family violence; (4) increase in community education and involvement; (5) coordination of resources and programs across agencies; (6) development of an information tracking system; (7) staff training initiatives; and (8) establishment of an abuser treatment protocol. The report also offers six recommendations based on these interventions. See also PIC ID 6000.1. (Final report 52 pages, plus appendixes.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Leo Nolan

PHONE NUMBER: 301/443-4700

PIC ID: 6000

PERFORMER ORGANIZATION: Indian Health Service, Office of Planning, Evaluation, and Legislation, Rockville, MD

TITLE: Evaluation of Diabetes Services Provided by IHS Model Diabetes Program: Final Report

ABSTRACT NUMBER: 095

ABSTRACT: This project evaluates the IHS diabetes model projects. It uses data from 634 patient medical records, 4 focus groups, and 20 information interviews to describe these projects and to examine their effects on patient health outcomes, blood sugar control, and hospitalizations. Two diabetes project sites (Winnebago, Nebraska, and Fort Totten, North Dakota) and on "usual care" site (Rosebud, South Dakota) were selected for the evaluation. Data from the 1993 Diabetes Program Audit were used to assess whether the findings from this evaluation could generally represent other diabetes team approaches in other IHS areas. The report finds that (1) patients followed at diabetes project sites experienced lower rates of poor blood sugar control than patients followed at the usual care site; (2) patients at the project sites were at reduced risk of having a first diabetes-related hospitalization over a followup period than patients at the usual care site; (3) data from the 1993 audit cannot provide a clear answer about whether the results from this evaluation can be generalized to the larger IHS service population, but projects in general seem to be similar in their rates of poor control and diabetes care characteristics; and (4) focus groups and informant interviews indicated that patients desired more education and that medical staff believe that patients' refusal to accept their diagnosis is a barrier to their adherence to a care regimen. (Final Report variously paginated, plus appendixes.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Frank E. Marion

PHONE NUMBER: 301/443-4700

PIC ID: 6005

PERFORMER ORGANIZATION: Native American Consultants, Inc., Washington, DC

TITLE: Evaluation of IHS Midlevel Health Providers: Final Report

ABSTRACT NUMBER: 096

ABSTRACT: IHS must determine its needs for midlevel health providers (MLHPs), such as physician assistants, nurse practitioners, certified nurse midwives, and clinical nurse specialists, through the year 2000 and must address recruitment and retention of these professionals. A survey of 254 MLHPs and 25 primary care managers and visits to three sites yielded responses from 119 MLHPs (47 percent of the current MLHPs) and 14 primary care managers. The report finds that MLHPs say that the key retention points in their consideration to remain with IHS are increases in salaries, Continuing Medical Education benefits, and recognition as health care professionals with policymaking privileges. Serious dissatisfaction in these areas indicates a need for IHS action. The report also finds that (1) the quality of health care in clinics will deteriorate significantly if sufficient MLHPs are not provided by the year 2000; (2) the recruitment of more local Native Americans will bolster this already good situation; (3) significant decline in the numbers of IHS physicians will negatively impact physician performance; and (4) more administrative support will be required to free MLHPs for almost exclusive attention to primary health care duties. The report provides several recommendations. (Final report 15 pages, plus appendixes.)

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Frank E. Marion

PHONE NUMBER: 301/443-4700

PIC ID: 6013

PERFORMER ORGANIZATION: Native American Consultants, Inc., Washington, DC

TITLE: Phase III Final Report: Child Abuse and Neglect in American Indian and Alaska Native Communities and the Role of the Indian Health Service

ABSTRACT NUMBER: 097

ABSTRACT: In 1990, IHS instituted a study of its response to child abuse and neglect in American Indian and Alaska Native communities. This report provides a comprehensive assessment of the effectiveness and impact of IHS policies, procedures, and protocols in this area. It also evaluates the capacity of IHS personnel to recognize and treat the abuse and neglect of American Indian and Alaska Native children and proposes a culturally sensitive intervention program to address child abuse and neglect in these communities. The report finds that (1) 34.4 percent of American Indian and Alaska Native children are at risk of abuse, neglect, or both, according to IHS and Bureau of Indian Affairs estimates; (2) staff are reluctant to report abuse, even though reporting is mandatory for Federal employees; (3) staff lack adequate training and computerized record systems; (4) a disproportionate number of abuse and neglect victims are under age 5, and although boys and girls are equally likely to be victims of physical abuse and neglect, girls are more likely to be victims of sexual abuse; and (5) abusers are equally likely to be male or female, although sexual abusers are more likely to be male. A model intervention program of the secondary prevention type has been piloted and includes home visitor services, the promotion of healthy child growth and development, and other key program elements. The report concludes that IHS can profoundly reduce the incidence of abuse and neglect in its role as a public health provider.

AGENCY SPONSOR: Office of Planning, Evaluation, and Legislation

FEDERAL CONTACT: Leo Nolan

PHONE NUMBER: 301/443-4700

PIC ID: 6009

PERFORMER ORGANIZATION: National Indian Justice Center, Petaluma, CA