Health News & Notes - Spring 2023 - Policy

Policy Issue

Spring 2023

Indian Health Service Fiscal Year: 2024 Federal Budget Updates

Elizabeth J. Coronado, JD

Picayune Rancheria of the Chukchansi Indians Senior Policy Advisor

FY 2023 Budget

On December 29, 2022, President Biden signed into law H.R. 2617, the “Consolidated Appropriations Act, 2023.” H.R. 2617 included $7 billion for IHS in Fiscal Year (FY) 2023 and advanced appropriations for FY 2024 in the amount of $5 billion. Including advanced appropriations for FY 2024 is a monumental step towards honoring trust and treaty obligations to provide health services to American Indian and Alaska Native people. This will ensure predictable funding for the IHS.

The program increases for IHS for FY 2023 include:

• Hospitals & Health Clinics--$2.5 billion (+104 million)

• Tribal Epidemiology Center--$34 million (+10 million)

• Electronic Health Record--$218 million (+73 million)

• Purchased/Referred Care--$1 billion (+12 million) [1.2% increase over FY 2022 enacted]

• Indian Health Professions--$81 million (+8 million)

• Facilities and Environmental Health Support--$300 million (+15 million)

Publication of The Northwest Portland Area Indian Health Board

BOARD

EXECUTIVE COMMITTEE MEMBERS

Nickolaus D. Lewis, Chairman, Lummi Nation

Nate Tyler, Vice Chair, Makah

Greg Abrahamson, Secretary, Spokane Tribe

Shawna Gavin, Treasurer, TBD

Kim Thompson, Sergeant-At-Arms, Shoalwater Bay Tribe

DELEGATES

Twila Teeman, Burns Paiute Tribe

Denise Ross, Chehalis Tribe

Gene H. James, Coeur d’Alene Tribe

Andy Joseph, Jr., Colville Conf. Tribes

Illiana Montiel, Coos, Lower Umpqua & Siuslaw Tribes

Eric Metcalf, Coquille Tribe

Sharon Stanphill, Cow Creek Tribe

Michael Watkins, Cowlitz Tribe

Cheryle Kennedy, Conf. Tribes of Grand Ronde Tribe

Lisa Martinez, Hoh Tribe

Brent Simcosky, Jamestown S’Klallam Tribe

Nick Pierre, Kalispel Tribe

Chanda Yates, Klamath Tribe

Jennifer Dickison, Kootenai Tribe

Francis Charles, Lower Elwha S’Klallam Tribe

Nickolaus D. Lewis, Lummi Nation

Nate Tyler, Makah Tribe

ADMINISTRATION

Laura Platero, Executive Director

Sue Steward, Deputy Director

Patrick Greener, Ops Director

Andra Wagner, HR Manager

Reshell Livingston, HR Assistant

Kadi White, Grants Manager

Katherine Gorell, Grants Manager

Tammy Cranmore, Finance Director

Lori Martin, Fund Accounting Manager

Chelsea Jensen, Compliance Manager

Jackie Curtis, A/P & Payroll Manager

Jordan Reid, A/P Specialist

Olivia McPherson, Purchasing/Travel Agent

Michelle Harris, Accounts Receivable Specialist

James Fry, Information Technology Director

Jamie Alongi, Network Administrator

Jason Arnold, IT Network Support Tech

Katie Johnson, EHR Integrated Care Coordinator

Jaison Elkins, Muckleshoot Tribe

Rachel Edwards, Nez Perce Tribe

Vacant, Nisqually Tribe

Lona Johnson, Nooksack Tribe

Hunter Timbimboo, NW Band of Shoshone Indians

Jolene George, Port Gamble S’Klallam Tribe

Herman Dillion, Puyallup Tribe

Douglas Woodruff, Jr., Quileute Tribe

Noreen Underwood, Quinault Nation

Dana Matthews, Samish Tribe

Tempest Dawson, Sauk-Suiattle Tribe

Kim Coombs, Shoalwater Bay Tribe

Sunny Stone, Shoshone-Bannock Tribes

Miranda Williams, Siletz Tribe

Denese LaClair, Skokomish Tribe

Robert de los Angeles, Snoqualmie Indian Tribe

Greg Abrahamson, Spokane Tribe

Kay Culbertson, Squaxin Island

Jill Malone, Stillaguamish Tribe

Steve Kutz, Suquamish Tribe

J.J. Wilbur, Swinomish Tribe

Teri Gobin, Tulalip Tribe

Shawna Gavin, Umatilla Tribe

Marilyn Scott, Upper Skagit Tribe

E. Austin Greene, Conf. Tribes of Warm Springs

Vacant, Yakama Nation

STAFF

Jonas Greene, Communications Director

Kira Rea, Communications Manager

Roger Peterson, Web Desgigner

Sonya Oberly, Sr. Video Communications Specialist

Adrean Brings Him Back, Events Coordinator

LEGISLATIVE AND POLICY

Candice Jiménez, Health Policy Analyst

Liz Coronado, Senior Policy Advisor

Catherine Stensgar, Executive and Communications Coord.

NORTHWEST TRIBAL EPIDEMIOLOGY CENTER STAFF

Victoria Warren-Mears, Director

Alicia Edwards, HIV Program Manager

Alyssa Farrow, Special Projects Coordinator

Alyssa Yang, Epi & Surveillance Unit Project Director

Ashely Jean Day, ECHO Project Coordinator

Ashley Hoover, HIV Program Manager

Ashley Thomas, NW NARCH Senior Program Manager

Asia Brown, Sexual Health Communications Specialist

Barbara Gladue, OR Tribal PH Improvement Manager

Birdie Wermy, Behavioral Health Manager

Bridget Canniff, PHIT Project Director

Celena Ghost Dog, WYSH Project Manager

Chandra Wilson, BOLD NTEP Program Manager

Clarice Charging, NWTEC Project Coordinator

Colbie Caughlan, THRIVE & TOR Projects Director

Danica Brown, Behavioral Health Program Director

Danner Peter, TEC-IVAC Project Manager

David Stephens, ECHO Clinical Director

Dolores Jimerson, BH Clinical Supervisor

Dondi Head, WTDP Project Specialist

Eitan Bornstein, EIS Officer

Eric Vinson, OR Tribal Tobacco Mgr.

Erik Kakuska, WTD Project Specialist

Grazia Cunningham, NARCH Project Manager

Heidi Lovejoy, Data Hub Epidemiologist

Itai Jeffries, Paths (Re)Membered Manager

Jane Manthei, SMS Communications Specialist

Jeanne Davidson, OR Tribal PH Improvement Coord.

Jerico Cummings, LGBTQ 2 Spirit Comm Engagement

Jessica Rienstra, ECHO RN Case Manager

Jessica Leston, HIV/HCV/STI Clinical Services Project Dir.

Joshua Smith, TEC PHI Project Manager

Karin Dean, Everyday is Ceremony Project Manager

Karuna Tirumala, IDEA-NW Biostatistician

Kerri Lopez, WTDP, NTCCP & BOLD Director

Larissa Molina, TOR Project Manager

Luca Green, AmeriCorps Tribal Food Systems VISTA

Maleah Nore, THRIVE Project Coordinator

Marches Armstrong, IT Data & Applications Specialist

Meena Patil, MV Biostatistician

Megan Woodbury, ECHO Project Manager

Michael Mudgett, Substance Use Epidemiologist

Michelle Singer, HNY Project Manager

Mike Feroglia, Project Funding & Contracts Manager

M’Kya Bettega, WEAVE-NW Project Coordinator

Morgan Scott, CDC PHAP (Public Health Associate)

Nancy Bennett, WA Tribal PH Improvement Mgr.

Naomi Jacobson, Training and Outreach Manager

Nick Cushman, ECHO Pharmacy Case Manager

Olivia Whiting-Tovar, TIPCAP IPP Project Coordinator

Reshell Livingston, Asthma Project Coordinator

Shoshoni Walker, FS Initiatives Project Manager

Stephanie Craig-Rushing, PRT, MSPI, Project Director

Sujata Joshi, IDEA-NW Project Director

Tam Lutz, Maternal Child Health Programs Director

Tammie Scott, WEAVE-NW Health Educator

Ticey Mason, NTDSC Director

Tom Becker, NW NARCH Dir., Medical Epidemiologist

Tom Weiser, PAIHS, Medical Epidemiologist, NWTEC

Tommy Ghost Dog, Jr., WeRNative Project Coordinator

Torrie Eagle Staff, Cancer Project Manager

Tyanne Conner, Native Boost Project Manager

Valorie Gaede, PHIT Project Assistant

ENVIRONMENTAL AND PUBLIC HEALTH (EPH)

Shawn Blackshear, Interim EPH Director

Antoinette Ruiz, EPH Specialist

Holly Thompson-Duffy, EPH Service Mgr.

Matthew Ellis, Institutional EPH Program Manager

Melino Gianotti, Emergency Management Coordinator

Nicole Smith, EPH Informatics Specialist

Ryan Sealy, EPH Project Scientist

NPAIHB PROJECT STAFF

Christina Friedt, TCHP Project Director

Carrie Sampson-Samuels, CHAP Project Director

Jared Etl, TCHP Communications Coordinator

Kaitlyn Hunsberger, BHA Student Support Coordinator

Kari Kuntzelman, DHA Education Specialist

Michelle Goldenberg, NTDSC Assistant

Sasha Jones, CHAP Project Manager

Sarah Cook-Lalari, BHA Project Director

Miranda Davis, NDTI Project Director

Pam Ready, DHA Education Manager

Lisa Griggs, TCHP Project Specialist

MorningRose Tobey, TCHP Ed. Data Program Coord.

Indian Health Service Fiscal Year (continued)

President’s FY 2024 Budget Request

President Biden’s Fiscal Year (FY) 2024 budget request was released in March of 2023, which includes $8.1 billion for the Indian Health Service (IHS) and $250 million in mandatory funding for the Special Diabetes Program for Indians (SDPI). The Administration continues to support full mandatory funding for IHS starting in 2025, which would grow to $44 billion by FY 2033. Mandatory funding will require legislative action and would ensure predictable funding over a 10-year period. The National Tribal Budget Formulation Workgroup has convened a working group on mandatory funding that held its first meeting in March. The mandatory funding working group will develop the authorizing language for mandatory funding for IHS and consider full funding needs for IHS.

• Individual program increases for FY 2024 in the President’s Budget Request include the following:

• Hospitals and Health Clinics –$3.6 billion (+$1.1 billion)1

• Purchased/Referred Care--$1.2 billion (+181 million)

• Mental Health--$164 million (+37 million)

• Alcohol/Substance Abuse--$309 million (+43 million)

• Electronic Health Record--$913 million (+700 million)

• Hep C/HIV--$52 million (+47 million)

• M&I--$188 million (+17 million)

• Facilities and Environmental Health Support--$372 million (+ 73 million)

• Sanitation Facilities --$201 million (+5 million)

Read the FY 2024 Congressional Justification of Estimates for Appropriations Committees Here. SDPI is currently authorized at $150 million per fiscal year through the end of FY 2023. Congress must reauthorize SDPI for FY 2024. President Biden has proposed reauthorization of SDPI at $250 million for FY 2024, $260 million for FY 2025, and $270 million for FY 2026, and included a request for exemption from mandatory sequestration. H.R. 2547 has been introduced in the 118th Congress to reauthorize SDPI for five years at $150 million per fiscal year.

FY 2025 Budget

In February, the National Tribal Budget Formulation Workgroup finalized its FY 2025 budget recommendations for IHS, including full funding of $54 billion. These recommendations were presented to HHS during the inperson Annual Tribal Budget Consultation on April 18-19, 2023. Written testimony may be submitted to consultation@hhs.gov until May 19, 2023.

1 The funding amounts with a (+) indicate the increased amount over FY 2023 enacted.

Councilman Nate Tyler of the Makah Nation and Dr. Sharon Stanphill representing the Cow Creek Tribe met with Dr. Rochelle Walensky, Director of the Centers for Disease Control. CDC/ATSDR Tribal Advisory Committee Meeting (photo courtesy of Candice)

Medicaid Continuous Enrollment Unwinding

Elizabeth J. Coronado, JD Picayune Rancheria of the Chukchansi Indians Senior Policy Advisor

The Families First Coronavirus Response Act (FFCRA) created a temporary 6.2 percentage point Federal Medical Assistance Percentage (FMAP) for states to receive that maintain continuous enrollment of their Medicaid programs through the course of the COVID-19 public health emergency. Data show that Medicaid enrollment significantly grew during the public health emergency1, increasing by almost 30% from February 2020 to December 20222. The protections for Medicaid enrollment afforded by the FFCRA have ensured American Indian and Alaska Native (AI/AN) people maintained health coverage that may have otherwise been disenrolled due to administrative reasons, such as failure to respond to notices.

With the passage of the Consolidated Appropriations Act, 2023, at the end of last year, Congress set an end date for the Medicaid continuous enrollment condition to March 31, 20233. Starting April 1, 2023, states can close Medicaid cases for individuals no longer eligible. States have twelve (12) months to initiate Medicaid redeterminations and fourteen (14) months to complete this process. The Act also provides for the increased 6.2% FMAP phase-out through the end of the calendar year if the state meets certain conditions described in the Centers for Medicare and Medicaid Services State Health Official Letter #23-0024.

2023 Calendar Overview

Q2:

Q3: July 1-September 30, 2023

Q4: October 1-December 31, 2023

Temporary FMAP Increase Available

2.5 percentage points

1.5 percentage points

See page 7 for the various plans for the Northwest states to unwind Medicaid continuous enrollment and return to normal operations.

1 See Families First Coronavirus Response Act, Pub. L. No. 116-127, 134 stat. 208.

2 https://www.kff.org/coronavirus-covid-19/issue-brief/analysis-of-recent-national-trends-in-medicaid-and-chip-enrollment/#:~:text=Data%20show%20that%20Medicaid%2FCHIP,80.6%25%20(Figure%202).

3 See Consolidated Approps Act 2023, Pub. L. No. 117-328.

4 https://www.medicaid.gov/federal-policy-guidance/downloads/sho23002.pdf

Medicaid Continuous Enrollment Unwinding (Continued)

Below are the various plans for the Northwest states to unwind Medicaid continuous enrollment and return to normal operations.

Idaho

Idaho Department of Health and Welfare has a total of 450,000 enrollees during the public health emergency. One hundred fifty thousand of those individuals are in Medicaid protection because they either have not been in contact with the state, completed an application, or reported changes and are no longer eligible. Idaho has one of the most aggressive timelines to conduct Medicaid re-determinations in the country. The first round of notices was issued on February 1, 2023, giving enrollees 60 days to respond to the Idaho Department of Health and Welfare (DHW) to determine eligibility before removal. Idaho plans to complete re-evaluations by this fall.

DHW has found that 23,577 individuals in Medicaid protection are ineligible. For up-to-date statistics on Medicaid protection, visit https://healthandwelfare.idaho.gov/medicaidprotection.

Through numerous meetings with the Tribes, DHW has decided to move all AI/AN enrollees to the end of the reevaluation timeframe in August. However, this may not apply to certain AI/AN enrollees if their re-determination becomes due between now and August 2023. DHW will also establish an AI/AN hotline in July to handle all calls related to redetermination and eligibility. NPAIHB Policy Team will be tracking re-determination efforts in Idaho closely.

Oregon

The Oregon Health Authority (OHA) will send out notices starting on April 1, 2023, to individuals to determine eligibility, and individuals will have 90 days to respond. This redetermination process will continue until January 2024. OHA has been approved through their 1115 waiver to provide temporary Medicaid coverage for individuals between 139%-200% of the Federal Poverty Level (FPL). This will extend coverage to the “churn” population, always in and out of Medicaid eligibility. Those individuals between 200-400% of the FPL will be eligible for insurance through the exchange. For more information on OHA redetermination, visit https://www.healthshareoregon.org/providers/redetermination.

Through consultation with the Tribes, OHA has agreed to move AI/AN enrollees to the end of the re-determination process starting in September. The only exception to this is for individuals that OHA knows will maintain eligibility. OHA has been able to share data with tribes to prepare for this redetermination effort.

Washington

Washington is starting their re-determination process on April 1, 2023, and will be completed by the end of May 2024. The Health Care Authority estimates that 300,000 individuals could be affected during the 12-month redetermination period. Individuals not eligible could lose their coverage as early as April 30, 2023. For additional details on their unwinding plan, visit https://www.hca.wa.gov/assets/free-or-low-cost/unwinding-the-phe-for-apple-health.pdf

Chair’s Notes

Nickolas D. Lewis Lummi Nation NPAIHB Chairman

This past quarter, we have been advocating with the new 118th Congress seated this past January. Republicans have a narrow majority in the House of Representatives, and Democrats retained their slim Senate majority. During recent advocacy visits in Washington, D.C., in February and until the April Quarterly Board Meeting, we have learned what is ahead of us and how to proceed with your leadership directing the 2023 legislative and policy priorities. Our main goal is to ensure that any new legislation honors trust and treaty obligations to American Indian and Alaska Native people to provide quality healthcare. The President’s Fiscal Year 2024 Budget, released on March 9th, builds on the historic enactment of advance appropriations for the Indian Health Service (IHS) provided in FY 2023. We continue to advocate across Congress to meet further the budget priorities, which uplift IHS and other HHS agencies to ensure reliable and stable funding for our tribal health programs, including staffing and resources. We strongly encourage all Tribal Leaders to inform their congressional representatives of these priorities during tribal advocacy visits, meetings, town halls, or roundtable opportunities.

Going into FY 2024, I continue to be hopeful to see a sustained request put forward by this Administration to provide mandatory funding for IHS and a commitment to collaboratively co-create and enhance this proposal with Tribal nations and with Congress. This has been a longstanding request of our Northwest Tribal Leaders. This proposal would include approximately $9.7 billion for the IHS, which includes an adjustment to the advance appropriation provided for FY 2024 to provide an additional $2.2 billion for IHS Services and Facilities accounts that would grow to address population growth and medical inflation to $44 billion by FY 2033. This request also includes increased funding to address the opioid epidemic hitting our communities. Addressing the high rate of opioid overdoses is a priority of this Administration, and I’m glad to see this Administration request additional resources for Tribes.

The Special Diabetes Program for Indians (SDPI) will expire on September 30, 2023, unless Congress acts now to reauthorize SDPI. These are life-saving funds that support our diabetes programs. I urge our Northwest Tribal Leaders to advocate with their Congressional representatives to support the reauthorization of SDPI and to increase funding to $250 million, as SDPI funding has not been increased since 2004.

Earlier this month, I participated in the Health and Human Services (HHS) Annual Tribal Budget Consultation to advocate for our Northwest priorities as the Administration develops its FY 2025 priorities. We urged the agencies to commit to helping us address the opioid crisis in Indian Country, for additional resources to Portland to fully implement our Community Health Aide Program, and made specific requests to congressional and agency representatives to support the 2023 National Tribal Opioid Summit in August with their presence to address the opioid-fentanyl epidemic in our tribal communities. I continue to encourage our Northwest Tribes to submit testimony, speak with your congressional representatives, and interface with HHS agencies to bring forward northwest priorities.

As we enter the spring season, I look forward to continuing advocacy with all of our Tribal leaders for our Northwest priorities with the Administration and with Congress to move towards full funding for the IHS.

Hy’shq,

Nickolaus D. Lewis | Lummi Nation Chair, Northwest Portland Area Indian Health Board Councilman, Lummi Indian Business Council

Update on Department of Veterans Affairs (VA) Advisory Committee on Tribal and Indian Affairs (ACTIA): 2022-2023 Health Subcommittee Recommendations and

April 2023 Meeting

Candice Jiménez, MPH

History

The Advisory Committee on Tribal and Indian Affairs (ACTIA) is a statutory committee established as required by the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 to provide advice and guidance to the Secretary of Veterans Affairs on all matters relating to Indian tribes, tribal organizations, Native Hawaiian organizations, and Native American Veterans. See VA ACTIA Charter, here.

Members

The ACTIA is comprised of 15 voting Members selected by the Secretary from among nominated individuals. Twelve members must come from the 12 Indian Health Service (IHS) service areas and be nominated by Indian tribes or tribal organizations from that service area. At least one member must represent the Native Hawaiian Veteran community and be nominated by a Native Hawaiian Organization and at least one member represents urban Indian organizations (UIOs) and is nominated by a national urban Indian organization. Not fewer than half of the Members shall be Veterans, unless the Secretary determines that an insufficient number of qualified Veterans were nominated. No member of the ACTIA may be an employee of the federal government.

The Portland Area is represented by Nickolaus Lewis (Lummi Nation), Lummi Indian Business Council Member and Chairman of the NPAIHB.

Committee Report: Health Subcommittee Recommendations

As a part of the first annual report filed by the Advisory Committee on Tribal and Indian Affairs (ACTIA) and in its advisory capacity, the ACTIA sought to formulate and present recommendations to the Secretary on ways the U.S. Department of Veterans Affairs (VA) can improve its programs and services to better serve Native American Veterans.

The ACTIA internally organized into three separate subcommittees to better focus on different areas under the jurisdiction of the VA. ACTIA members sought to identify evolving issues of relevance to Indian tribes, tribal organizations, urban Indian organizations, Native Hawaiian organizations, and Native Veterans relating to programs and services of the VA; to propose clarifications, recommendations and solutions to address issues raised at tribal, regional, and national levels, especially regarding any tribal consultation reports; and to provide a forum for Indian tribes, tribal organizations, urban Indian organizations, Native Hawaiian organizations, and the VA to discuss issues and proposals for changes to VA regulations, policies, and procedures.

Confederated Tribes of Warm Springs Health Policy Analyst

Recommendations were grouped under three main headers:

1. Administrative

2. Veterans Benefits Administration and National Cemetery Administration

3. Veterans’ Health Administration

Recommendation: Behavioral Health/Suicide Prevention

The ACTIA recommended that VA provide information on its efforts to collect data on:

1. Veteran suicides that occur on tribal lands which can be included in the VA/IHS MOU operational plan; and

2. American Indian and Alaska Native Veteran suicides that occur in urban areas. Data concerning urbanicity of Native Veteran suicides needs greater specificity. VA data indicates that the suicide rate in rural versus urban areas was 14.6% lower for American Indian or Alaska Native Veterans, but how VA defines these areas is unclear.

VA should begin collecting data by October 2023, publish its first report by October 2024, then annually publish the results at the beginning of each fiscal year thereafter in October of each calendar year.

Recommendation: Cultural Healers/Natural Helpers

The ACTIA recommended that:

• VA, incorporating input gathered in tribal consultation and urban confer, amend VA policy and relevant Veterans Health Administration (VHA) Directives to champion and/or allow the use of traditional healing as a legitimate and evidence-based practice that promotes the wellbeing of American Indian, Alaska Native, and Native Hawaiian Veterans. VA should complete this recommendation by October 2024; and,

• VA incorporate traditional healing for American Indian, Alaska Native, and Native Hawaiian Veterans as part of its Whole Health expansion and work with the ACTIA to develop a timeline identifying the steps and process necessary to include spiritual healers, cultural healers, and natural helpers in reimbursement agreements established under the Memorandum of Understanding between VHA and Indian Health Service (VHA-IHS MOU). . VA should complete this recommendation by January 2024 and,

• VA should create objectives in the operations plans of each region to increase Whole Health offerings by 3% each year with at least .5 % increase in American Indian, Alaska Native, and Native Hawaiian communities. VA should provide quarterly updates with information on progress made or a justification on why the goal was not reached. VA should gather information on the number of American Indians, Alaska Natives, and Native Hawaiians that currently participate in the program, including their tribal affiliation. VA should create a trending chart when tracking its response to the VA High Risk List Action Plan Update—Managing Risks and Improving VA Health Care report to the U.S. Government Accountability Office (GAO). VA should complete this part of the recommendation by March of 2024; and,

• VHA should work with the ACTIA to design a program that would bring American Indian, Alaska Native, and Native Hawaiian spiritual leaders equal to the VA Chaplain program by January 2025.

Recommendation: Homelessness as a Health Disparity

The ACTIA recommends that VHA Homeless Programs Office amend its Strategic Plan to target a 5% increase in Stand Downs located on tribal lands, rural communities, Native Hawaiian communities, and in urban areas with a high population of American Indians and Alaska Natives. VA should create objectives in the operations plans of each region to ensure the target increase percentage in Stand Downs can be met. VA should provide quarterly updates with information on progress made or a justification on why the goal was not reached. VA should gather information on the number of American Indians, Alaska Natives, and Native Hawaiians that attend each event, including their tribal affiliation. VA should complete this recommendation by October 2025.

Recommendation: Joint Advisory Committee Meetings

The ACTIA recommended that VA facilitate regular joint meetings and recommendations between its Advisory Committee on Tribal and Indian Affairs and Advisory Committee on Homeless Veterans, as well as its Advisory Committee on Women Veterans, to increase understanding, opportunities for collaborative efforts, and the development of effective strategies that strengthen common goals and objectives. VA should begin facilitating these joint meetings by October 2023.

Recommendation: Advance Appropriations for IHS

The ACTIA recommended that VA support the Administration by:

1. Writing to the to the House and Senate Budget, Appropriations, and authorizing committees, affirming that advance appropriations for the VHA have reduced budget uncertainty effects of continuing resolutions and government shutdowns, as reported by the GAO.

2. Affirming to OMB and the White House that advance appropriations have helped the Veterans Health Administration.

3. Providing budget formulation and execution technical support upon request to the IHS.

Looking Ahead: 2023 and VA ACTIA Action Items

The most recent VA ACTIA meeting took place at the Seven Feathers Casino Resort hosted by the Cow Creek Band of Umpqua Tribe of Indians on April 4-6, 2023. At the meeting, committee members received updates on the PACT Act, Tribal HUD-VASH program, co-pay exemptions for Native American Veterans, Veterans Health Administration/Indian Health Service (IHS) Memorandum of Understanding, IHS/Tribal health program reimbursement agreements and purchased referred care.

On the second day, both the Secretary of the VA, Denis McDonough, and IHS Director, Roselyn Tso provided updates and a panel discussion with senior officials from VA and IHS. Subsequent updates and briefings were provided on the White House Council on Native American Affairs Health Committee; Tribal Veterans Representation Expansion Project; Veterans Benefits Administration Claims events in Indian Country; Native American Direct Loan; and the Native American Veteran Program.

On April 6, 2023, the Committee received a briefing on AI/AN Data for Veteran suicide/behavioral health. This was followed by a discussion on the transition plan for the Committee with new and outgoing members. The Committee held open discussion on topics relevant to the Committee and addressing follow-up and action items including dates for next meeting. After the meeting officially ended, members of the committee met with Operation Tiny Home for an event honoring a Northwest tribal veteran with a new ‘tiny home’, which directly put into action a response to meeting housing needs of AI/AN veterans – a recommendation brought forward by the health subcommittee.

i 38 U.S.C. § 547.

iiThe VA Indian Health Service/Tribal Health Programs/Urban Indian Organization (I/T/U) Reimbursement Agreements Program (RAP) provides VA reimbursement to IHS, Tribal Health Programs, and UIOs for services provided to eligible AI/ AN Veterans. RAP was first initiated in 2012 with IHS and Tribal Health Programs and in 2022 expanded to include UIOs. The program is part of a larger effort to improve access to care and coordination for AI/AN Veterans under the broader VHA-IHS Memorandum of Understanding.

iii See Memorandum of Understanding Between the United States Department of Veterans, Veterans Health Administration and United States Department of Health and Human Services, Indian Health Service (Oct. 1, 2021), available at: https://www.ihs.gov/sites/newsroom/themes/responsive2017/display_objects/documents/2021_Letters/60086-2VHA-IHS-MOU-enclosure-10-26-2021.pdf.

Native Boost: Stay safe, Stay healthy, Stay up-to-date

Tam Lutz, MPH, MHA Lummi Nation Maternal Child Health Programs Director

Tyanne Conner, MS

Native Boost Project Coordinator

Vaccines are essential to keep your family safe from illness and serious diseases, including cancer. They complement other ways you stay healthy, including nutritious foods, traditional medicines, and healing practices. In the past, before vaccines were available, many people died from illnesses that now can protect the whole family at all stages of life.

Vaccines during pregnancy and breast/ chestfeeding help keep parent/s and baby safe. The immunity that babies get during gestation and breastfeeding wears off. Making sure baby is vaccinated on schedule makes sure they are safe and healthy. It is always better to vaccinate than to allow a baby to get sick from a vaccine-preventable illness.

The CDC has updated the vaccine schedule for children. Below are the vaccine plans for children from birth to 6 years old and 7 to 18 years old. You will also see descriptions of the diseases that these vaccines prevent.

Native Boost (Continued)

To find vaccine support and resources, including guides like the ones shown below, PSAs, and links to social media, check out the Native Boost webpage.

NATIVE & STRONG LIFELINE

AVAILABLE 24/7 in Washington State

Free and confidential

TWO EARS. ONE HEART.

Your time here is sacred, and we want to walk beside you in your difficult journey. You don't have to be enrolled or even have a tribal home in Washington state.

We are here to listen and care for our Native community with compassionate help, emphasizing cultural and traditional practices related to healing.

The Native and Strong Lifeline is an American Indian and Alaska Native suicide, crisis, and help line that provides culturally relevant counseling and mental health support to Indigenous peoples.

It is fully staffed and operated by Native people, so when you call 988 and choose option 4, it is answered by a Tribal Crisis Counselor who is a Tribal member and descendant closely tied to their community.

Weaving Together the National HIV, STI, and Viral Hepatitis Plans: The Indigenous HIV/AIDS Syndemic Strategy

Alicia Edwards, MPH, CHES Colville Confederated Tribes HIV Program Manager

Vision: We envision a world in which all Indigenous people are healthy in mind, body, and spirit; the spread of HIV, STls, and viral hepatitis is prevented; every person knows their status and lives free from stigma and discrimination; and every person has access to high quality, holistic care that reflects Indigenous values, promoting relationships with each other, the land and all beings.

This vision includes all Indigenous people, regardless of age, sex, gender identity, sexual orientation, religion, disability, geographic location, socioeconomic circumstance, or health status.

To decrease HIV, HCV, and STI acquisition and improve outcomes for those currently living with HIV, HCV, or STls, the Indian Health Service (IHS) National HIV/HCV/STI Program, in collaboration the Northwest Portland Area Indian Health Board (NPAIHB), is leading the development of an implementation strategy for ending the HIV/HCV/STI Syndemic in Indigenous communities in the U.S. Our advisory committee included representatives from all IHS Areas, including Hawaii.

As members and leaders of our Indigenous communities, we may use our Syndemic Strategy to improve the health and well-being of our communities, including progress toward addressing the HIV, STI, and viral hepatitis syndemic. Our conceptualizations of wellness focus on promoting a holistic approach that emphasizes a balance between the spirit, mind, emotions, body, and relationship with land, community, and all creation. This way of requiring an integrated strategy to address conditions such as HIV, STls, and viral hepatitis.

Our Syndemic Strategy adopts a syndemic approach, addressing HIV, STls, and viral hepatitis in an integrated way. We hope a syndemic approach will promote a broader array of interventions, centering a holistic perspective that aligns with the needs of our communities and honors the principle of Indigenous Sovereignty.

To guide the development of our Syndemic Strategy, the Advisory Committee identified promising programs and practices across Indigenous communities; contributed their clinical, professional, and community perspectives; provided wisdom and feedback on select documents; and guided the direction of our Syndemic Strategy.

With guidance from the Advisory Committee, partners conducted listening sessions, including 22 key informant interviews and two focus group discussions with established networks, to gather insight from Indigenous communities and inform our Syndemic Strategy.

Our Syndemic Strategy centers core values that partners agreed were common across Indigenous communities, relies on the Medicine Wheel as a framework for improving the well-being of Indigenous people, and incorporates traditional medicines to acknowledge the fundamental role of Indigenous culture and ways of knowing in supporting Indigenous health and well-being.

The Indigenous HIV/AIDS Syndemic Strategy emphasizes main messages throughout the goals, objectives, and activities. These main messages are:

• Sovereignty: Centering Indigenous sovereignty in the design and delivery of health services, including sexual health services

• Partnerships: Strengthening partnerships to improve systems of care for Indigenous people

• Availability and Capacity: Developing capacity to support diagnosis, treatment, prevention, and response to HIV/STls/viral hepatitis

• Cultural Responsiveness: Delivering culturally- and linguistically-responsive health services, including sexual health services

• Awareness and Stigma: Reducing sexual-related stigma will normalize conversations around HIV/viral hepatitis/STls and the availability of treatment and care

• Data Systems: Improving data systems to grow the knowledge, evidence, and practice base related to Indigenous health and well-being

The Northwest Portland Area Indian Health Board, alongside the Indian Health Service National HIV Program, and other partners, aim is to promote a broader array of clinical and preventive interventions that center a holistic perspective that aligns with the needs of our communities and honors the principle of Indigenous Sovereignty.

To read the full Syndemic Strategy, please visit www.indiancountryecho.org/indigenous-hiv aids-syndemic-strategy/.

If you have any questions or would like to connect, please reach out to Jessica Leston, title, at jleston@npaihb.org

Summer Programs to Support Native Youth

Join the NPAIHB Youth Delegate Program

The Northwest Portland Area Indian Health Board’s (NPAIHB) Youth Delegates are a group of Native youth (ages 15-24) representing the tribes in Idaho, Oregon, and Washington. They collaborate to share their voice on health programs and policies and learn more about health and wellness careers. Youth Delegates serve a 1-year term and are the official youth policy-making body for the Northwest Portland Area Indian Health Board and its member tribes.

Youth Delegates provide recommendations to the NPAIHB and other state and federal agencies about health programs and policies that affect young people. Participants meet several times throughout the year in-person at an NPAIHB Quarterly Board Meeting (3 days) and monthly virtual meetings. Virtual meetings typically last around 45 minutes; students can attend via mobile phone or computer. Additional leadership opportunities may also be a possibility.

• Apply today! The application is open for new and returning applicants and closes May 30, 2023: www.surveymonkey.com/r/NPAIHBYouthDelegate2023

• Learn more: www.npaihb.org/youth-delegate/

Join the NW NARCH Public Health Research Academy

This summer, the Northwest Native American Research Center for Health at the NPAIHB is launching a new year-long Research Academy for Native high school students to introduce them to relatable public health topics and conclude with a youth-driven community project. Our goal is to inspire future Native public health researchers. The program includes an in-person kick-off week in Portland, OR in June (NW NARCH will cover the cost of travel to Portland) and 6-8 virtual learning sessions with guest speakers during the 2023-24 school year.

In April, we recruited four educators to mentor 2-4 students in their community. Selected sites/mentors will receive $5,000 to cover the time and effort of mentors and any other expenses associated with the project.

Students will receive $2,000 to cover their learning and researchrelated expenses during their experience and a certificate of completion. Students will be paid $1,000 after the week-long orientation and $1,000 after presenting their community health research project (April/May).

• Selected Mentor/Chaperones and Parents will fill out a THRIVE Youth Conference Registration Form (that confirms parent permission to travel/participate).

• Learn more: www.npaihb.org/public-health-research-academy/

Summer Programs (Continued)

Host Youth Interns

This summer, the Northwest Native American Research Center for Health at the NPAIHB is launching a new year-long Research Academy for Native high school students to introduce them to relatable public health topics and conclude with a youth-driven community project. Our goal is to inspire future Native public health researchers. The program includes an in-person kick-off week in Portland, OR in June (NW NARCH will cover the cost of travel to Portland) and 6-8 virtual learning sessions with guest speakers during the 2023-24 school year.

The NPAIHB is committed to supporting Native youth interested in pursuing Public Health professions. Please consider hosting, mentoring, or supervising student interns this summer. The site supervisor can determine the timing and duration of the internship. Some internships last one or two weeks (meeting or shadowing all day), and others carry on all summer (working a few hours per week).

Youth and Site Stipends: Selected sites will receive $2,500-$5,000 to cover student stipends, the time/effort of mentors, and any other expenses associated with the internship. (Depending on the number of participating sites/ students).

Scope of Work: Host sites will provide one or more students with hands-on training in public health careers, health promotion strategies, research and evaluation methods, or community-based participatory research.

• Public Health internship activities for Middle School Students

• Activities for High School Students

• Activities for College Students

Number of Awards Available: 3-6 sites will be selected Internship Dates: June-August 2023

Eligible Internship Sites: Middle Schools, High Schools, or Colleges; Tribal health and wellness programs; IHS, Tribal or Urban Indian Clinics (1/T/U); Indian Health Boards and Tribal Epidemiology Centers; and other clinics serving AI/ANs.

Due: Applications will be accepted on a rolling basis, but are due by May 1, 2023. Interested in Hosting? Please fill out the Site Application Form.

Summer Programs (Continued)

Text INSPIRE to 94449

COVID shined a spotlight on Public Health practitioners and increased our awareness of their important role. But public health is truly Indigenous. Tribes have protected the health of their land, water, air, and people since immemorial. Using cultural teachings to hunt and prepare indigenous foods, using traditional plants as medicines, and hosting talking circles to support mental health ... are all CORE aspects of public health. To best serve our communities, we need more Native public health professionals working in the field.

You can help us inspire them. The INPSIRE text messaging campaign is designed share diverse Indigenous voices, and the pathways youth can take to work in public health. Help youth text “INSPIRE” to the short code 94449. Youth who sign up will receive 2-3 text messages per week for 8 weeks. Throughout the series, we’ll share tips and ideas to help them on their academic journey.

Download digital materials to help promote the campaign: www.healthynativeyouth.org/resource/text-inspire-to-94449/

N W N A R C H

Northwest American Research Center for Health

Current opportunities for American Indian & Alaska Native Youth, Undergraduate Students, Graduate Students, and Professionals

PUBLIC HEALTH RESEARCH ACADEMY

Introductory program for Native high school juniors and seniors

June 2023-May 2024

In-Person & Virtual Features hands-on activities, live learning sessions, and communitybased research project

TRIBAL RESEARCHERS' CANCER CONTROL PROGRAM

Designed to develop AI/AN cancer researchers

Summer session: June 5-16

One week follow-up in fall

Distance learning

Peer & Career Mentorship

APPLY BY APRIL 20, 2023

SUMMER RESEARCH TRAINING INSTITUTE

Virtual June 12-June 23, 2023

Skill-building courses include Grant Management, Data Visualization, Technical Writing & more

Lunch Seminars

RESEARCH SUPPORT FELLOWSHIPS FOR UNDERGRADUATE & GRADUATE STUDENTS

Regular virtual seminars

Near-peer mentorship

Travel awards to conferences

Financial support for research completed

ROLLING DEADLINE

THRIVE Conference

There is less than three months until the 2023 THRIVE Conference! This year, the Conference will take place on the Portland State University campus from June 26th-30th. Tribal youth from the Pacific Northwest and beyond will build protective factors, connect with Native peers and mentors, gain healthy coping mechanisms, and embrace their culture and identity all while learning through art, service, and movement. Workshops include:

• Beats, Lyrics, Leaders - Using Hip Hop Education, youth will build character and leadership skills through the art of music, beat making, lyric writing, and song structure. Participants will explore the art of business, culture, dreams, and entrepreneurship within team building and skill building exercises.

• Movement is Medicine - Movement is medicine and can serve as a great way to improve mental health. Participants will be active all week as they learn different movement games and relate them to improving and coping with daily struggles. All movement activities will be adapted so everyone will have fun and participate, no matter the skill level.

• Introduction to Print-Making - Through print-making, youth will practice healthy ways to express emotions, work towards goals, and create change in their community. Participants will learn the steps to printing on clothing from design to implementation, using materials that can easily be acquired at home.

• The NARCH High School Public Health Research Academy will introduce Native high school students to public health pathways, and will feature hands-on activities, campus tours, and field trips in Portland, OR. The year-long learning journey will kick-off at THRIVE and continue throughout the school year. Participation in the track is limited to enrolled participants. Visit our website to learn more about it!

Conference registration opens in early April. Registration is free; tribes from our service region (Washington, Oregon, and Idaho) will be prioritized in registration. To receive updates about the conference, email THRIVE Project Coordinator Maleah Nore at mnore@npaihb.org to be added to the THRIVE Listserv.

New Faces

Adrean Brings Him Back

Oglala Lakota Sioux

Events Coordinator

Hey Folks, my name is Adrean Brings Him Back! I am an enrolled member of the Oglala Lakota Sioux tribe, use He/Him/His pronouns, and am new to NPAIHB - starting as an Events Coordinator.

I was born and raised here, in Portland, Oregon and just finished my Masters of Public Health from OHSU with a focus in health management and policy. I have spent most of my career working with Portland’s urban-indigenous population at The NAYA Family Center and look forward to starting a new chapter here, at NPAIHB. If there is one thing you should know about me it is that I absolutely love my 2 dogs (Chleo & Hashbrown) and my cat (Pesto).

Laura Joseph

Northern Arapaho Tribe

Cancer Prevention Project Temp

My name is Laura Joseph, I am enrolled with the Northern Arapaho Tribe and I grew up in Portland OR.

I have been involved with the Native community and look forward to servicing my community in positive ways.

Puyallup Tribe

Healthy Native Youth Outreach Specialist

My name is Taylor Dean (they/them). I am a member of the Puyallup Tribe of Indians and I was raised in Portland, Oregon. I am excited and honored to serve the NPAIHB Healthy Native Youth project as an outreach specialist.

My professional background is in fine arts, graphic design, and education. I had the incredible opportunity to complete my Master’s of Fine Arts at Pratt Institute in Brooklyn. My Master’s thesis exhibition pulled inspiration from the traditions of Coast Salish design and my experiences as a mixed race, urban Native and an Oregonian.

Upon graduating, I moved back west and spent the last year and half working in education and as a freelance graphic designer for Salish Style. For the 2021-2022 school year I was an AVID tutor during which I assisted first generation college bound students with study skills and critical thinking. Over the summer I was an art teacher for Beaverton School District’s elementary summer school program. Lastly, this fall I was a substitute teacher at Canby High School for their English and ELD departments. I am certain my eye for aesthetics and my experience working with youth in education will be a boon to the Healthy Native Youth project.

When I am not working I spend my time making art, reading, and playing tabletop games. At the moment I have been especially interested in teaching myself to sew clothing and reading about the history of fashion.

Taylor Dean

New Faces

Jared Etl Cow Creek Sioux Tribe

TCHP Communication Coordinator

Hau mitakuyepi, Wašiču čuzewaye Jared Etl emakiya. Kangi wakpa oyanke ematahan. Damakota. Wambdi tanka tiospaye ematahan. Malakota. Tatanka Sapa tiospaye ematahan. Waniyetu yamni sam manumpa. Thawicu wan bduha. Čhinkši yamni wan bduhe. Wanna, othunwe wan Lummi oyanke ed eyapi kin ed wati. Northwest Indian College ed, Native Studies Leadership ed waniyetu topa wahecetuya.

Nina pidamaye do iciciyapi.

Hello my relatives. My name is Jared Etl. I come from the Crow Creek “Sioux” tribe located in South Dakota. I am both Lakota and Dakota. I represent both the Big Eagle and Black Buffalo Bull families. I’m 32 years young. I am married with 3 young boys living as a guest on Lummi Reservation.

Currently, I am attaining my BA at Northwest Indian College with expectation to graduate this upcoming summer from the Native Studies Leadership Program with emphasis on language & culture. Going forward, my next steps are to attain an MA from Oglala Lakota College in Lakota studies Leadership with aspirations to be a fluent speaker of both Dakota and Lakota dialects and a traditional practitioner.

In my free time, I enjoy speaking and practicing my language with relatives back home & with my kids. When I can, I make time to travel back home to visit family and attend ceremony. I also enjoy reading, playing video games with my kids and taking walks with my family.

I am thankful to be a part of the Northwest Portland Area Indian Health Board serving as the TCHP Communication Coordinator and part of a larger family with intention to serving tribal communities.

Wopida tanka iciciyapi do (thank you everyone).

Rebecca Washakie

Shoshone-Bannock Tribes of Fort Hall

Environmental Public Health Project Coordinator

Bunah (Hello). My name is Rebecca J. Washakie, and I am a member of the Shoshone-Bannock Tribes Fort Hall, Idaho. I am excited to join NPAIHB Environmental Public Health team as the Environmental Public Health Project Coordinator. I’ve had the honor to work and serve my tribe and community for 30 plus years, promoting healthy behaviors and disease prevention. I graduated from Idaho State University with a Bachelor of Science in Health Education.

In my spare time I enjoy everything outdoors and road trips, and my 5 grandchildren. I look forward to getting to know and working NPAIHB Staff and tribal personnel. I feel it’s a privilege serving indigenous populations and communities, and sharing knowledge and culture.

Oose (Thank You).

New Faces (continued)

Jordan Reid A/P Specialist

Hello everyone! My name is Timothy Reid but I have always gone by my middle name, Jordan. I am a lifelong Oregonian and Eagle Scout who received his degree in history from Brigham Young University in 2014.

I have been in the accounts payable field for several years now, which may not have a whole lot to do with my degree, but I continue to learn all I can about those who came before us in my free time and greatly enjoy what I do professionally.

In addition to this I write movie and TV reviews for my local newspaper, The Keizertimes, as well as participate in local theatre productions as both an actor and crewmember.

I am greatly looking forward to this new chapter in my life and see it as a great chance to better know some of the historic cultures and people that help to make up this beautiful chunk of land we call the Pacific Northwest.

I am always down for a good Star Wars conversation as well!

Hello my name is Lucy John (Kilwat) a member of the Yakama Nation. I am excited to join NPAIHB team or “the Board” as the Native Boost Project Coordinator.

Previously, I worked at Northwest Justice Project as the COVID Native American Outreach Worker before taking maternity leave to care for my son Aswan.

Michelle Goldenberg

NTDSC Project Assistant

Michelle Goldenberg is originally from Yakima Washington, but has lived in the Portland area for over 20 years. Michelle has recently returned to Portland State University to complete her 4th year as a psychology major. She is an experienced Treasurer and Vice President for a variety of collage clubs, as well as a Retail Manager. She is driven by her commitment to her peers and team.

As a leader, her goals included creating and maintaining a safe and healthy work environment and diversifying the work force.

In addition to her primary functions, Michelle has been recognized by Portland Community College for her extraordinary commitment to encouraging women to pursue education in STEM fields.

Lucy John Yakama Nation Temp Native Boost Project Assistant

New Faces (continued)

Rochelle Fassler Native Village of Shishmaref

NARCH Project Coordinator

Hello! My name is Rochelle Fassler (she/her/hers) and I am Iñupiaq and Athabaskan Alaska Native. I am a newly enrolled tribal member of the Native Village of Shishmaref. I was born and raised in Anchorage, Alaska and moved to Oregon during the beginning of the pandemic.

Prior to moving to Oregon, I was working at Southcentral Foundation Optometry as an Ophthalmic Technician. Southcentral Foundation primarily provides health and wellness support to the Native community across Alaska. During this experience is when I realized my passion for working with underserved Native populations. As I was completing my Wy’east Post-Baccalaureate Pathway, I worked as a NPAIHB Research Intern, so a few of you may recognize me.

I am happy to be back with NPAIHB working with the NARCH team as a project coordinator! Outside of work, I enjoy road tripping with my fiancé, hanging out with my dog, seeing new parts of the world with the most recent being Germany and finding new cool restaurants and cafes.

Stephanie Christian

TCHP Education Program Director

Stephannie Christian currently resides in Grants Pass, OR. Where she currently lives with her husband and two daughters. She enjoys spending time with her family, going fishing, and working on her small farm.

She graduated from Stanford University in 2006 as a Physician Associate. She worked two years in Obstetrics and Gynecology in California, before moving to Alaska. She has worked with the Community Health Aide Program since 2009 with Tanana Chiefs Conference. She spent many years working in the field as a PA-C with the Health Aides and teaching at the Health Aide Training Center. She has sat on the Academic Review Committee and the Review and Approval Committee for Alaska's Health Program.

Karlen Yallup

Confederated Tribes of Warm Springs

Temp Environmental Public Health Policy Analyst

Hi everyone, I go by K. I am a member and grew up on the Confederated Tribes of Warm Springs of Oregon.

I graduated from the University of Idaho with dual Bachelor Degrees, B.S. Forest Resources and B.S. Fire Ecology. During this time I was a Wildland Firefighter. I just graduated from Lewis & Clark Law School focusing on Indian Law and the environment. I have one Fur-Niece, "Penny." As far as hobbies, I like to listen to old country music my Gramma and I use to jam to on her record player when I was young. With my extra time, I am working on a children's book focusing on Tribal history.

New Faces (continued)

MorningRose Tobey

Assiniboine-Sioux Tribes of Fort Peck

TCHP Education Program Data Coordinator

Hello! My name is MorningRose Tobey and I am an enrolled member of the Assiniboine-Sioux Tribes of Fort Peck, Montana. I’m 25 years old and currently reside in Pocatello, Idaho with my fiancé and 2 dogs.

I’ve earned my BA in Public Health and have worked for multiple Tribal communities doing what I’m passionate aboutleading disease prevention and health and wellness workshops and camps for tribal youth.

In my free time I love to dance at powwows, play in basketball tournaments and travel with my family and fur babies.

I’m excited to join the NPAIHB team as the new TCHP ED Data Coordinator and work with so many great people and continue helping our tribal communities!

New Faces (Interns)

Asher Smith

Environmental Public Health Program

My name is Asher Smith and I am from Clackamas OR. I am currently a first-year student at the University of Oregon and plan on majoring in finance, but I still enjoy taking a wide variety of courses.

When I'm not busy with school and life, I love to play sports and go hunting whenever I can. I also love my cat ;).

Kylee Manley Suquamish Tribe

Communications Intern

I'm Kylee Manley (She/Her). I'm your new intern with the communications department! I am currently in my final quarter of my Bachelor’s degree in Community Health at Tacoma Community College. I have an incredible interest in public and community health as well as psychology and will be continuing my education with all three. I am a member of the Suquamish Tribe located around Poulsbo WA.

I was born and raised in Tacoma, Washington where I still currently live. I am currently working with the homeless population in my city and working in community and public health and I'm beyond excited for this experience.

Off the Clock: Pets

Even before the COVID-19 pandemic emerged, many Americans had a furry companion living at home. Approximately 44% of households across the United States had a dog and 35% had a cat. That’s roughly 78 million dogs and 86 million cats!

With the pandemic temporarily shutting down businesses closing offices and people remaining mainly at home for extended periods – shelter and breeder adoptions skyrocketed. Nearly 1 in 5 American households welcomed a dog or cat into their home (that’s 23 million households)! Of those adoptions, nearly 90% of dogs and 85% of cats are still in the same household – even as COVID-19 restrictions were lifted and people returned to some level of normalcy, returning to schools, in-office work, and traveling.

Cats and dogs are amongst the most common domesticated animals for human companionship, and our bonds are known to provide psychosocial health benefits. It probably doesn’t come as any surprise to those of us with pets that animals have a unique way of uplifting our spirits, improving our mental and physical health, and generally being adorable to have around!

But what exactly are the benefits?

Owning dogs always requires a little bit of energy. Depending on the breed, they can need heavy and frequent exercise, prompting owners to spend more time outdoors, whether on a walk, run, or a short trip to the dog park. Exercise is important for humans too! Studies suggest 60% of dog owners who take their dogs on one or more walks a day are considered to get moderate to vigorous exercise.

Cats are known for their purrs, but it’s not just a cute habit! Purring is known to lower stress hormones and blood pressure – aiding in promoting healing. Cat purring frequency falls between 25 and 140 Hz – the same frequency known to aid in healing broken bones, joint and tendon repair, and wound healing. Some studies even show that people with cats are 40% less likely to experience fatal heart attacks.

Pets offer comfort, companionship, and love – no surprise, this helps break the cycle of loneliness many of us face daily, especially during the COVID-19 pandemic. Domesticated animals have evolved to be acutely aware of human behavior and emotions. Dogs can understand many of the words we use, but they’re even better at recognizing body language and tone of voice. Dogs and cats, especially, reduce stress, anxiety, and depression. One of the most therapeutic effects of pets is their ability to fulfill the basic human need for physical touch and connection.

Whether you have a dog, cat, horse, snake, or any other animal, pets are undeniably critical to our family and social structures and provide numerous physical and mental health benefits.

Victoria Warren-Mears

Hi! My names is Pearl. I am a 12 year old Black Lab Mix. I was adopted when I was 6 months old when my family adopted me from the Oregon Humane Society. I was born near Mt. Shasta. My hobbies are sleeping, playing with my family and laying in the sun. I am a cancer survivor. My real name is Black Pearl. My mom works on her computer all day and I really wish she would feed me treats!

She was a stray in South Dakota and I (lovingly) tricked her into my car about 10 years ago. Even though she once cost me a $500 vet visit because she was purposely breathing hard for attention, she’s still an absolute national treasure.

Maple, she turns 2 on July 11. Maple came to our family after three close family members passed in the summer of 2021, she brought much needed laughter, licks, & love into our household just when we needed it.

“Quinn”

Chi and my husband, Victor.

Kadi White

Colbie Caughlan

Olivia Whiting-Tovar

Larissa Molina

My furry nieces and nephews - Mylie, Sarah Lee, Chad, and Blue. All rescue dogs who are named after characters in the Elvis movie Blue Hawaii!

When the cats Loki, Patches, and Matty are done ignoring me because I was traveling and all want lap time! And Leo’s favorite pass time – tug- o-war!

Tom Weiser

Lucy hiking on the coyote wall trail, near White Salmon, WA in the gorge. July 3, 2022.

Michelle Singer

Nancy Bennett

Sujata Joshi

Ninki, our 7-month-old purr monster, turned out to be more of a shoulder cat than a lap cat.

Itai Jeffries

Tsu Tsu the Medicine Dog.

Pamela Ready

Osiris (Belgian Malinois), Takoben (German Shepherd) and “The Reverend” (black and white mutt). Guess who’s the boss?

Tyanne Conner

We lost our beloved Shirley suddenly in March and were so happy to find a new angel we named Birdie. So happy to have another dog love in our lives!

My GSD’s name is Sonny (but he has so many nicknames). When he was a puppy, before his ears fully stood up, he loved when the wind blew them around and it would give him the zoomies. So, his middle name is “hulí,” meaning “wind” in the Umatilla language.

On the left (Black and White) is Buddy! He is 2 ½ years old and we got him on the Pine Ridge Reservation when he was a puppy. He is a Pitbull and maybe a Shepard or Border Collie but overall, a rez dog.

On the right (Black and Brown) is Chewy! He is 4 ½ years old and we got him on the Cheyenne River Sioux Reservation. He is Pitbull and Husky and overall, a rez dog as well.

Alyssa Farrow

Grazia Cunningham

Lupo Keeping watch!

Torrie Eagle-Staff

NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD JANUARY

2023 RESOLUTIONS

23-01-01 Oregon Tribal Community Health Aide Program Future Ready Oregon Youth Program Funding Opportunity

23-01-02 Tribal Community Health Provider Project Building Capacity for Workforce Programs Funding Opportunity

23-01-03 Washington State Healthcare Authority RFA# 2022HCA25: Statewide Recovery Organization Funding

23-01-04

Condemnation of Harm to Indian Health Care System Caused by Disruptions in Federal Appropriations and Resultant Continuing Resolutions

23-02-01 U.S. Department of Education, Office of Elementary and Secondary Education, Office of Safe and Supportive Schools: CFDANUMBER, 84.184X: Mental Health Service Professional Demonstration Grant Program

Photo credit: E. KakuskaDancing in the Square Powwow 2018