Tule River Indian Health Center Inc

SPECIAL DIABETES PROGRAMS FOR INDIANS

YOUTH TREATMENT AND RECOVERY ENHANCEMENT AND EXPANSION (YOUTH TREE) PROJECT

TRIBAL YOUTH SUICIDE PREVENTION PROJECT

TRIBAL MATERNAL, INFANT, AND EARLY CHILDHOOD HOME VISITING PROGRAM GRANT

SPECIAL DIABETES PROGRAM FOR INDIANS - TULE RIVER INDIAN HEALTH CENTER, INC. INTENDS TO ADDRESS DIABETES ON THE TULE RIVER RESERVATION AS WELL AS TULARE COUNTY RESIDENTS WHO FALL WITHIN THE SERVICE AREA OF TRIHCI. THROUGH THE MULTI-DISCIPLINARY TEAM, WE WILL FOCUS ON ADDRESSING THE CHOSEN BEST PRACTICES. THE TRIHCI DIABETES STAFF WILL CONDUCT MONTHLY WALKS/EDUCATIONAL MEETINGS WHICH WILL ADDRESS VARIOUS TOPICS PERTAINING TO DIABETES. THE DIABETES STAFF WILL ALSO COLLABORATE WITH OTHER TRIBAL ENTITIES IN THE COMMUNITY TO PROVIDE EDUCATIONAL BOOTHS AT EVENTS THAT ARE ALREADY TAKING PLACE. CHART REVIEWS FOR PATIENTS WITH DIABETES WILL ASSIST IN MONITORING PATIENTS' COMPLIANCE AND WILL ALLOW TRIHCI TO OBTAIN INFORMATION NEEDED TO BE COMPLIANT WITH THEIR DIABETES CARE.

INSAXO - TRIBAL COMMUNITY HEALTH WORKER PROJECT

MOVING UPSTREAM TO INVESTIGATE AND ADDRESS HEALTH INEQUITY THROUGH PUBLIC HEALTH SERVICES AT THE TULE RIVER INDIAN HEALTH CENTER

YOUTH CONNECTIONS EXPANSION PROJECT - THE REQUESTED FUNDING WILL ENABLE THE TULE RIVER INDIAN HEALTH CENTER, INC. (TRIHCI) TO IMPLEMENT THE YOUTH CONNECTIONS EXPANSION PROJECT. THE PROJECT WILL EXPAND AND ENHANCE THE ORGANIZATION’S YOUTH CONNECTIONS PROJECT AND CONTINUE TO ESTABLISH A HEALTHY NETWORK OF SYSTEMS, SERVICES, AND PARTNERSHIPS TO HELP PREVENT AND REDUCE SUICIDAL BEHAVIOR AND SUBSTANCE MISUSE, REDUCE THE IMPACT OF TRAUMA, AND PROMOTE MENTAL HEALTH AMONG AMERICAN INDIAN/ALASKA NATIVE (AI/AN) YOUTH UP TO AGE 24 LIVING IN TULARE COUNTY, CALIFORNIA (CA). THE TRIHCI SERVES 2,500 NATIVE AMERICANS ON AND OFF THE RESERVATION. THE HIGHEST PERCENTAGES OF AI/AN RESIDENTS IN TULARE COUNTY ARE IN PORTERVILLE AND VISALIA. THE RESERVATION IS AN IDENTIFIED ECONOMICALLY DISADVANTAGED COMMUNITY. THE PER CAPITA INCOME ON THE TULE RIVER INDIAN RESERVATION IS $24,276, WHICH IS TWO-THIRDS THE AMOUNT OF THE U.S. $37,638 PER CAPITA INCOME; AND 43% OF TULE RIVER CHILDREN UNDER 18 LIVE IN POVERTY. IN TULARE COUNTY, 24% OF AI/AN 7TH GRADERS HAD 3+ MONTHLY ABSENCES FROM SCHOOL, MUCH HIGHER THAN ANY OTHER RACE; 26% EXPERIENCED CHRONIC SADNESS/HOPELESSNESS, 10% HAVE CONSIDERED SUICIDE, AND 4% USE ALCOHOL/DRUGS. IN 2022, OF THE YOUTH SERVED BY TRIHCI, NO SUICIDES, NO SUBSTANCE OVERDOSES, ONE SUICIDE ATTEMPT, AND TWO SUICIDE IDEATIONS WERE RECORDED. HOWEVER, TRIHCI STAFF ARE WELL AWARE THAT INCIDENTS OF SUICIDE, OVERDOSE, SUICIDE ATTEMPT, AND SUICIDE IDEATION AMONG YOUTH ARE DRASTICALLY UNDERREPORTED. ACCORDING TO POST-EVENT REPORTS FROM PATIENTS/LOVED ONES TO TRIHCI STAFF WHO LIVE ON THE RESERVATION, AN ESTIMATED 10-15 NON-FATAL, UNREPORTED OVERDOSE INCIDENTS OCCUR MONTHLY AND MANY OVERDOSE DEATHS ON THE RESERVATION ARE REPORTED AS “ACCIDENTAL” DUE TO THE STIGMA/SHAME OF AN OVERDOSE FOR TRIBAL MEMBERS. HISTORICALLY, INCIDENTS RELATED TO SUICIDE ON THE RESERVATION HAVE BEEN REPORTED AS ACCIDENTAL DEATHS BASED ON LAW ENFORCEMENT POLICY TO ONLY IDENTIFY A DEATH AS A SUICIDE IF A SUICIDE NOTE IS PRESENT. FAR TOO MANY INCIDENCES GO UNREPORTED, WHICH MEANS YOUTH WHO NEED INTERVENTION SERVICES ARE NOT BEING IDENTIFIED OR SERVED. TRIHCI IS AWARE THAT THIS PROTOCOL PRESENTS A DISTORTED IMPRESSION OF THE GROWING RISK OF SUICIDE AMONG TRIBAL YOUTH AND LIMITS TRIHCI’S ABILITY TO IDENTIFY YOUTH AND LOVED ONES AT RISK OF SUICIDE CLUSTERS. RELATIVES AND FRIENDS OF SUICIDE VICTIMS ARE 65% MORE LIKELY TO ATTEMPT SUICIDE THAN IF THE PERSON DIED FROM NATURAL CAUSES. THE RISK OF ATTEMPTED SUICIDE IS ONE IN 10 IF THE RELATIVE OR FRIEND DIED OF SUICIDE.10 INDIVIDUALS WHO SELF-INJURE ARE NINE (9) TIMES MORE LIKELY TO ATTEMPT SUICIDE, AND MANY INDIVIDUALS WHO REPORT SELF-HARM ALSO DESCRIBE CHRONIC SUICIDAL THOUGHTS AT THE TIME OF INJURY. UNDERREPORTING SUICIDE PUTS AI/AN YOUTH AT SIGNIFICANT RISK. THE GOALS OF THE PROJECT ARE: 1) DEVELOP AND IMPLEMENT TRANSPARENT, PRACTICAL CRISIS PROTOCOLS IN AN EMERGENCY, INCLUDING FOLLOW-UP PROCEDURES TO CARE FOR AT-RISK YOUTH; 2) STRENGTHEN INFRASTRUCTURE SUPPORT IN THE FIGHT AGAINST YOUTH SUICIDE/SUBSTANCE MISUSE; 3) EXPAND AND ENHANCE ACCESSIBLE YOUTH-FOCUSED BEHAVIORAL HEALTH CARE, GROUNDED IN THE AI/AN TRADITIONS IN TULARE COUNTY; 4) ENHANCE PROTECTIVE FACTORS TO BUILD RESILIENCE AGAINST SUICIDE AND SUBSTANCE MISUSE AMONG AI/AN YOUTH UP TO AGE 24; 5) REDUCE THE IMPACT OF RISK FACTORS FOR SUICIDE AND SUBSTANCE MISUSE IN AI/AN YOUTH; AND 6) IMPLEMENT TIER III STRATEGIES TO PROVIDE INTERVENTIONS FOR AI/AN YOUTH WITH HIGHER LEVEL NEEDS RELATED TO RISK OF SUICIDE AND/OR SUBSTANCE MISUSE. THE YOUTH CONNECTIONS EXPANSION PROJECT WILL ESTABLISH A STAKEHOLDER ADVISORY BOARD, ESTABLISH A YOUTH ADVISORY BOARD, COMPLETE A COMMUNITY NEEDS ASSESSMENT, COMPLETE A COMMUNITY READINESS ASSESSMENT, AND DEVELOP AND IMPLEMENT A TRIBAL STRATEGIC ACTION PLAN.

CDC-RFA-TO-23-0001: STRENGTHENING PUBLIC HEALTH SYSTEMS AND SERVICES IN INDIAN COUNTRY - THE TULE RIVER TRIBE OF CALIFORNIA IS A FEDERALLY RECOGNIZED TRIBE IN THE CALIFORNIA HHS REGION AND WITHIN THE CALIFORNIA AREA OF THE INDIAN HEALTH SERVICE, SERVED BY THE TULE RIVER INDIAN HEALTH CENTER, INC. THERE ARE NUMEROUS PUBLIC HEALTH CHALLENGES AND INEQUITIES WITHIN THE TULE RIVER COMMUNITY. OUR MOST PRESSING PUBLIC HEALTH QUESTION IS NOT, “WHAT DO WE DO?” BUT RATHER, “WHAT DO WE DO FIRST?’ THE TULE RIVER PUBLIC HEALTH AUTHORITY PROPOSES TO USE THIS COOPERATIVE AGREEMENT TO PURSUE DATA MODERNIZATION AND WORKFORCE STRATEGIES TO INCREASE THE CAPACITY OF ITS PUBLIC HEALTH SYSTEM IN ORDER TO DESIGN DATA-DRIVEN SERVICES THAT WILL BE MOST IMPACTFUL TO REDUCE HEALTH INEQUITIES. BY THE END OF THE PROJECT PERIOD, THE GOAL OF THIS PROJECT IS TO IMPROVE PUBLIC HEALTH OUTCOMES AND REDUCE HEALTH INEQUITIES IN THE TULE RIVER COMMUNITY, AS MEASURED BY IMPROVEMENT IN AT LEAST 2 HEALTH OUTCOME METRICS, OR DECREASE IN INEQUITY AS COMPARED TO THE STATE, LOCAL COUNTY, OR OTHER TRIBAL NATION. IN ORDER TO ULTIMATELY IMPROVE HEALTH OUTCOMES AND REDUCE DISPARITIES, OUR INTERMEDIATE GOALS ARE (1) TO IMPROVE PUBLIC HEALTH ORGANIZATIONAL AND SYSTEMS CAPACITY FOR OUR PHA, AND (2) TO INCREASE AVAILABILITY OF/ACCESS TO PUBLIC HEALTH PROGRAMS, SERVICES, AND RESOURCES THAT ADDRESS HEALTH DISPARITIES AND/OR SOCIAL DETERMINANTS OF HEALTH IN THE TULE RIVER COMMUNITY. THE ACTIVITIES WE AIM TO PURSUE UNDER THE DATA MODERNIZATION STRATEGY ARE: 1) COLLECT AND SHARE DATA THAT PROVIDE INFORMATION ON CONDITIONS OF PUBLIC HEALTH IMPORTANCE AND HEALTH STATUS OF THE POPULATION, 2) ANALYZE PUBLIC HEALTH DATA AND USE RESULTS TO IMPROVE POPULATION HEALTH, 3) IDENTIFY, ENGAGE PARTNERS IN IDENTIFYING AND REFINING THE DATA SET ACCESS POINTS, PERMISSION AND AVAILABLE ANALYSIS TOOLS, AND 4) SUPPORT ENHANCEMENTS THAT ENABLE INTEROPERABILITY AND BIDIRECTIONAL DATA EXCHANGE BETWEEN THE PHA AND PARTNERS IN STATE AND LOCAL PUBLIC HEALTH DEPARTMENTS AND CLINICAL CARE. THE ACTIVITIES WE AIM TO PURSUE UNDER THE WORKFORCE STRATEGY ARE: (1) ENCOURAGE THE DEVELOPMENT, RECRUITMENT, AND RETENTION OF QUALIFIED PUBLIC HEALTH WORKERS, (2) IDENTIFY AND ADDRESS CONTINUING EDUCATION FOR CORE AND DISCIPLINE-SPECIFIC COMPETENCIES AND LEADERSHIP DEVELOPMENT NEEDS, (3) EXPAND PRACTICE-BASED CONTINUING EDUCATION FOR PUBLIC HEALTH PROFESSIONALS, AND (4) IDENTIFYING COMPETENCIES AND STAFFING POSITIONS WITHIN THE DEPARTMENT.

TULE RIVER TOR PROJECT - THE TULE RIVER INDIAN HEALTH CENTER, INC. (TRIHCI) WILL IMPLEMENT THE TULE RIVER TOR PROJECT, WHICH WILL EXPAND/ENHANCE THE ORGANIZATION’S EFFORTS IN THE FIGHT AGAINST OPIOID AND OTHER STIMULANT MISUSE AMONG NATIVE AMERICAN INDIVIDUALS LIVING IN TULARE COUNTY, CALIFORNIA. THE TULE RIVER TOR PROJECT WILL BUILD UPON THE EXISTING FOUNDATION OF TRIHCI SERVICES. THE PROJECT WILL HELP IDENTIFY MORE TRIBAL MEMBERS WHO MISUSE OPIOIDS/OTHER STIMULANTS, AND EXPAND/ENHANCE THE NUMBER OF OPIOID/STIMULANT USE DISORDER PATIENTS WHO RECEIVE THE FULL SPECTRUM OF TREATMENT, RECOVERY SUPPORT, AND HARM REDUCTION SERVICES. PEER RECOVERY SUPPORT SERVICES: TO LAUNCH THIS EVIDENCE-BASED PRACTICE, THE TRIHCI WILL HIRE A TULE RIVER TRIBAL MEMBER (MALE OR FEMALE) WITH LIVED EXPERIENCE WHO HAS BEEN/IS IN RECOVERY TO RECEIVE THE TRAINING NEEDED TO BECOME A CERTIFIED PEER RECOVERY SPECIALIST. THE PEER RECOVERY SPECIALIST WILL SERVE AS A MENTOR/ROLE MODEL, HELP FACILITATE NARCOTICS ANONYMOUS AND OTHER SUPPORT GROUPS, PROVIDE TRANSPORTATION AND ENCOURAGEMENT TO HELP PATIENTS GET TO NEEDED TREATMENT, AND SUPPORT HARM REDUCTION ACTIVITIES. SUBSTANCE ABUSE COUNSELING SERVICES: A NEW FULL-TIME SUBSTANCE ABUSE COUNSELOR WILL BE HIRED WHO WILL PROVIDE IN-DEPTH ASSESSMENT SERVICES TO DETERMINE MAT AND OTHER MOUD ELIGIBILITY. THE SUBSTANCE ABUSE COUNSELOR WILL DEVELOP A TREATMENT PLAN; PROVIDE ONE-ON-ONE SUBSTANCE ABUSE COUNSELING; REFER ELIGIBLE PATIENTS TO MAT, OTHER MOUD TREATMENTS, CULTURALLY-RELEVANT GROUPS DESIGNED FOR NATIVE AMERICANS, AND YOUTH SERVICES; AND WILL TRACK THE CLIENTS’ PROGRESS AND PERSISTENCE IN THOSE SERVICES. TRIBAL SUPPORT SERVICES: PATIENTS WITH OUD/STIMULANT USE DISORDER SERVED THROUGH THE TULE RIVER TOR PROJECT WILL BE REFERRED TO A VARIETY OF TRIBAL SUPPORT SERVICES, INCLUDING: NARCOTICS ANONYMOUS/ALCOHOLIC ANONYMOUS SUPPORT GROUPS USING THE WHITE BISON MEDICINE WHEEL AND WELLBRIETY 12 STEPS, A CULTURALLY-DRIVEN TRIBAL PROGRAM THAT EXPLORES THE HISTORICAL ROOTS OF ADDICTION WITHIN THE NATIVE POPULATION; AND TALKING CIRCLES, A TRAUMA-INFORMED CULTURAL PRACTICE THAT FOSTERS POSITIVE PSYCHOLOGY THROUGH PEER SUPPORT FOR TRIBAL PARTICIPANTS. TRIBAL SUPPORT SERVICES FOR YOUTH: YOUTH (AGES 12-24) IMPACTED BY OPIOID AND OTHER STIMULANT MISUSE PARTICIPATE IN ACTIVITIES, WHICH INCLUDE: THE WEEKLY YETCHA MI YETI YOUTH GROUP THAT ENCOURAGES HEALTHY CHOICES AND SOBRIETY, YOUTH GATHERINGS OF NATIVE AMERICANS (GONAS), AND SPECIAL EVENTS. THERAPEUTIC COUNSELING SERVICES WILL BE PROVIDED IN-KIND BY AN MSW INTERN, SUPERVISED BY A TRIHCI CLINICAL SUPERVISOR. THESE SERVICES INCLUDE: SCREENING AND ASSESSMENT; DIAGNOSIS; INDIVIDUAL, GROUP, AND FAMILY THERAPY; CASE MANAGEMENT; REFERRALS; AND CONSULTATION/COLLABORATION WITH OUTSIDE AGENCIES. THERAPEUTIC SERVICES WILL BE PROVIDED USING POWERFUL, EVIDENCE-BASED MENTAL HEALTH TREATMENT TECHNIQUES FOR INDIVIDUALS WITH A HISTORY OF TRAUMA TO HELP PATIENTS RELIEVE THE STRESS OF PAST TRAUMA THAT LED THEM TO ADDICTION AND SHIFT THEIR COGNITIVE PROCESSES TO MORE PRODUCTIVE PATTERNS. IF NEEDED, A CLINICAL PSYCHOLOGIST WILL PROVIDE AN ADDITIONAL PSYCHOLOGICAL ASSESSMENT, DIAGNOSIS AND FOLLOW-UP TO ACUTE, CHRONIC, OR MODERATELY DISTURBED SEVERELY MENTALLY ILL CLIENTS AND/OR PATIENTS. PURCHASE AND DISTRIBUTE ADDITIONAL MOUDS AND TESTING SUPPLIES: TO DECREASE THE POSSIBILITY OF A FATAL OVERDOSE UNTIL THESE PATIENTS ARE READY TO ADDRESS THEIR OPIOID/STIMULANT ADDITION, THE TOR PROJECT TEAM WILL OFFER AN OVERDOSE KIT TO THEIR FAMILY MEMBERS. EACH KIT WILL CONTAIN A CANVAS BAG WITH NALOXONE NASAL SPRAY, COMBINATION TESTING STRIPS FOR FENTANYL AND XYLAZINE, INSTRUCTIONS, AND AN INFORMATIONAL BROCHURE. COUNTYWIDE NALOXONE DISTRIBUTION: THE SUBSTANCE ABUSE COUNSELOR AND THE PEER RECOVERY SPECIALIST WILL EXPAND THE ORGANIZATION’S COUNTYWIDE NALOXONE DISTRIBUTION. LOCK BOX DISTRIBUTION: EACH TOR PATIENT’S FAMILY WILL RECEIVE A LOCK-BOX AND TAUGHT THE IMPORTANCE OF SECURING MEDICATIONS AND NEVER SHARING PRESCRIPTION MEDICATIONS.

YOUTH CONNECTIONS PROJECT

ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES

ARP ECONOMIC DEVELOPMENT GRANT FOR RURAL HEALTH CARE FACILITIES

OATA-2023

OATA-2020-2022

RURAL TRIBAL COVID-19 RESPONSE

TULE RIVER MAT PROJECT - THE TULE RIVER MAT PROJECT WILL PROVIDE THE TULE RIVER INDIAN HEALTH CENTER, INC. (TRIHCI) WITH THE STAFFING, RESOURCES, RECOVERY PROGRAMS, TOOLS, AND DATA ANALYSIS STRATEGIES NEEDED TO ENABLE TRIHCI TO PROVIDE MEDICATION-ASSISTED TREATMENT (MAT) SERVICES AT THE ORGANIZATION’S PRIMARY AND SATELLITE CLINICS. THE PROJECT WILL HELP TO ADDRESS THE OPIOID CRISIS AMONG THE TULE RIVER INDIAN TRIBE, OTHER INDIGENOUS INDIVIDUALS, AND MEDI-CAL PATIENTS LIVING IN TULARE COUNTY, CALIFORNIA. THE TRIHCI IS POISED TO LAUNCH THE PROPOSED MAT SERVICES, BECAUSE THE ORGANIZATION HAS COMPLETED EXTENSIVE PLANNING, INFRASTRUCTURE CREATION, PARTNER BUILDING, POLICY DEVELOPMENT, EHR DEVELOPMENT RELATED TO MAT SERVICES, OUTREACH/EDUCATION, STAFF TRAINING, AND NEGOTIATING WITH A MAT PROVIDER DURING THE PAST FOUR PLANNING YEARS. AS A RESULT, IT WAS DETERMINED THAT A PART-TIME (16 HOURS A MONTH) TELEHEALTH MAT PHYSICIAN WOULD BE THE MOST EFFECTIVE STRATEGY TO PROVIDE MAT SERVICES. A FULL-TIME ON-SITE PROJECT COORDINATOR/CASE MANAGER POSITION WILL BE FILLED BY A REGISTERED NURSE (RN) TO ASSIST THE MAT PHYSICIAN BY CONDUCTING THE PRE-MAT PHYSICAL ASSESSMENT (E.G., URINALYSIS/TOXICOLOGY REPORT), ACCOMPANY PATIENTS DURING TELEHEALTH VISITS, AND TRACK PATIENT UNDERSTANDING OF AND COMPLIANCE WITH MAT PROTOCOLS. REFERRALS TO THE MAT PROJECT WILL BE WELCOMED FROM ANY RESERVATION DEPARTMENT (E.G., EMERGENCY MEDICINE, PUBLIC SAFETY, EDUCATION, TRIBAL COURT, FAMILY AND SOCIAL SERVICES, ETC.) AS WELL AS FROM TULARE COUNTY MEDI-CAL PROVIDERS. PRIMARY CARE PHYSICIANS WILL BE TRAINED TO CONDUCT AN OPIOID USE RISK ASSESSMENT USING THE AMERICAN SOCIETY OF ADDICTION MEDICINE (ASAM) QUICK ASSESSMENT, THE PHQ-9, AND ACES (ADVERSE CHILDHOOD EXPERIENCES). THE OUTREACH WORKER WILL PROVIDE OUTREACH/EDUCATION (E.G., IMPACT OF TRAUMA ON OPIOID USE, SUCCESS STORIES OF MAT PATIENTS) AT TRIBAL AND NON-TRIBAL COMMUNITY EVENTS (E.G., HEALTH FAIRS) IN PORTERVILLE AND VISALIA. MAT BANNERS WILL BE PLACED IN HIGH VISIBILITY AREAS ON THE RESERVATION AND IN VISALIA AND WILL INCLUDE PROJECT CONTACT INFORMATION. THE OUTREACH WORKER WILL POST OPIOID USE WARNINGS AND MAT-RELATED POSTS ON FACEBOOK, INSTAGRAM, TIKTOK, AND ON THE WEBSITE TO PROVIDE EDUCATION AND ALERT PEOPLE TO PERTINENT EVENTS (E.G., MEDICATION TAKE BACK DAYS, NALOXONE DISTRIBUTIONS). THE TULE RIVER MAT PROJECT WILL ALSO INCORPORATE SEVERAL CULTURALLY RELEVANT PROGRAMS (E.G., YETCHA MI YETI – A LEADERSHIP YOUTH GROUP WITH MALE, FEMALE, AND CO-ED WEEKLY SUPPORT GROUPS; DAUGHTERS OF TRADITION II (A CHARACTER-BUILDING PROGRAM FOR GIRLS); AND CULTURAL CRAFT DISTRIBUTIONS, AS WELL AS THE WHITE BISON MEDICINE WHEEL AND WELLBRIETY 12 STEPS, A CULTURALLY-DRIVEN TRIBAL PROGRAM THAT EXPLORES THE HISTORICAL ROOTS OF ADDICTION WITHIN THE NATIVE POPULATION; TALKING CIRCLES, A TRAUMA-INFORMED CULTURAL PRACTICE, FOSTER POSITIVE PSYCHOLOGY THROUGH PEER SUPPORT FOR TRIBAL AND NON-TRIBAL PARTICIPANTS; AND A YOUTH GATHERING OF NATIVE AMERICANS (GONA), WHICH WILL EQUIP 100 TRIBAL YOUTH PER YEAR TO SUPPORT EACH OTHER TO MAKE POSITIVE CHOICES FOR MENTAL WELLNESS. THE TULE RIVER MAT PROJECT WILL ALSO SUPPORT IMPORTANT HARM REDUCTION ACTIVITIES -- NALOXONE DISTRIBUTION, MEDICATION LOCK BOX DISTRIBUTION, AND MEDICATION TAKE-BACK DAYS.

OATA-2019

2011-12 TITLE6_A

2014-16 TITLE6_A

INJURY PREVENTION PROGRAM

SUPPORTING TRIBAL PUBLIC HEALTH CAPACITY IN CORONAVIRUS PREPAREDNESS AND RESPONSE ? 2020

FY2026 (OATA) OLDER AMERICANS ACT TITLE VI, PART A - GRANTS FOR NATIVE AMERICANS - OLDER AMERICANS ACT TITLE VI, PART A - GRANTS FOR NATIVE AMERICANS

OATC-2023

OATC-2020-2022

2010 TITLE6_A

2009 TITLE6_A

2008 TITLE6_A

TRPH-2022

OATC-2019

NAC3-2020

2011-12 TITLE6_C

2014-16 NSIP - (TRIBE) NUTRITION SERVICES INCENTIVE PROGRAM

FY17-19 PROJECT CYCLE

OANT-2020-2022

2011-12 NSIP - (TRIBE) NUTRITION SERVICES INCENTIVE PROGRAM

2014-16 TITLE6_C

FY2026 (OATC) OAA TITLE VI, PART C - GRANTS FOR NATIVE AMERICAN CAREGIVERS SUPPORT - OAA TITLE VI, PART C - GRANTS FOR NATIVE AMERICAN CAREGIVERS SUPPORT

NAC6-2021

OANT-2023

TRIBAL ELDERS FALL PREVENTION PROJECT

NAC2-2020

TCC6-2021

2010 TITLE6_C

2009 TITLE6_C

NAC5-2021

2008 TITLE6_C

2010 NSIP - (STATE) NUTRITION SERVICES INCENTIVE PROGRAM

FY2026 (OANT) OAA NUTRITION SERVICES INCENTIVE PROGRAM FOR THE NATIVE AMERICANS - OAA NUTRITION SERVICES INCENTIVE PROGRAM FOR THE NATIVE AMERICANS

2008 NSIP - NUTRITION SERVICES INCENTIVE PROGRAM

2009 T6_ARRA

2009 NSIP - (STATE) NUTRITION SERVICES INCENTIVE PROGRAM

2014 MIPPA TRIBAL GRANTS

2009 MIPPA TRIBAL GRANTS

EMERGENCY MEDICAL SERVICES TRAINING PROJECT - THE TULE RIVER INDIAN HEALTH CENTER, INC. (TRIHCI) WILL IMPLEMENT THE EMERGENCY MEDICAL SERVICES TRAINING PROJECT, WHICH WILL RECRUIT AND TRAIN EMERGENCY MEDICAL SERVICES PERSONNEL IN RURAL AREAS OF TULARE COUNTY, CALIFORNIA, WITH A PARTICULAR FOCUS ON ADDRESSING MENTAL HEALTH, BEHAVIORAL HEALTH, AND SUBSTANCE USE DISORDERS. A MINIMUM OF 136 PARAMEDICS, EMERGENCY MEDICAL TECHNICIANS (EMTS), AND EMT STUDENTS (FROM THE LOCAL PORTERVILLE COLLEGE EMT PROGRAM) WILL PARTICIPATE IN A WIDE RANGE OF TRAINING OPPORTUNITIES, INCLUDING: ADVANCED CARDIAC LIFE SUPPORT, PEDIATRIC ADVANCED LIFE SUPPORT, PRE-HOSPITAL TRAUMA LIFE SUPPORT, MENTAL HEALTH FIRST AID FOR ADULTS, MENTAL HEALTH FIRST AID FOR YOUTH, NALOXONE, AND CERTIFIED AMBULANCE DOCUMENTATION. FURTHER, PROJECT PARTICIPANTS WILL HAVE MULTIPLE OPPORTUNITIES TO STRENGTHEN CLINICAL COMPETENCY THROUGH STATE-OF-THE-ART TRAINING MODALITIES. FOR EXAMPLE, PROJECT PARTICIPANTS WILL USE THE SIMMAN 3G PLUS, WHICH IS A REALISTIC "FULL-BODY ADULT" PATIENT SIMULATOR THAT IS EASY TO OPERATE AND DESIGNED FOR A FULLY IMMERSIVE SIMULATION EXPERIENCE, TO PARTICIPATE IN INDIVIDUAL AND GROUP TRAINING DESIGNED TO IMPROVE AND ENHANCE CRITICAL EMERGENCY MEDICAL SERVICES SKILLS (E.G., COMMUNICATION, DECISION-MAKING, PATIENT CARE, ETC.). FURTHER, PROJECT PARTICIPANTS WILL HAVE ACCESS TO "SCENARIO" TRAINING THROUGH VRPATIENTS -- A STATE-OF-THE-ART "VIRTUAL REALITY" TRAINING SYSTEM. THE PROPOSED PROJECT WILL ACHIEVE THE FOLLOWING GOALS: 1) RECRUIT, HIRE, AND TRAIN THREE (3) PARAMEDICS AND THREE (3) EMERGENCY MEDICAL TECHNICIANS (EMTS) TO SERVE THE RURAL TRIHCI EMERGENCY MEDICAL SERVICES (EMS) DEPARTMENT; 2) ENHANCE AND EXPAND EMS HANDS-ON TRAINING FOR RURAL-SERVING EMS PERSONNEL; 3) INCREASE EMS MENTAL HEALTH, BEHAVIORAL HEALTH, AND SUBSTANCE USE DISORDER RESPONSE TRAINING; AND 4) PROVIDE EMS TRAINING FOR PARTNER AGENCIES, WHICH WILL INCLUDE TULE RIVER FIRE EMTS, CAMP NELSON VOLUNTEER AMBULANCE STAFF, IMPERIAL AMBULANCE, OTHER LOCAL RURAL-SERVING AMBULANCE COMPANIES, AND TULARE COUNTY FIRE EMTS AND PARAMEDICS. THROUGH THE IMPLEMENTATION OF THE EMERGENCY MEDICAL SERVICES TRAINING PROJECT, A NUMBER OF MEASURABLE OUTCOMES WILL BE REALIZED, INCLUDING: 1. A MINIMUM OF SIX (6) NEW EMERGENCY MEDICAL SERVICES PERSONNEL (THREE PARAMEDICS AND THREE EMTS) WILL BE RECRUITED AND HIRED BY THE TULE RIVER INDIAN HEALTH CENTER EMS DEPARTMENT DURING THE 12-MONTH FUNDING PERIOD. 2. A MINIMUM OF 136 UNDUPLICATED EMS WORKERS WILL BE TRAINED THROUGH GRANT FUNDS AS APPROPRIATE TO MAINTAIN LICENSES AND CERTIFICATIONS RELEVANT TO SERVE IN AN EMS AGENCY DURING THE 12-MONTH FUNDING PERIOD. 3. A MINIMUM OF 136 OF EMS PERSONNEL WILL BE LICENSED/CERTIFIED AS A RESULT OF FUNDING SUPPORT FROM THIS GRANT PROGRAM DUE TO THE COMPLETION OF CEU HOURS WITHIN THE 12-MONTH FUNDING PERIOD. 4. A MINIMUM OF 17 DIFFERENT TRAINING COURSES WILL BE CONDUCTED THAT QUALIFY GRADUATES TO SERVE IN AN EMS AGENCY THROUGH THE COMPLETION OF THE REQUIRED CEUS. IN ADDITION TO ACLS, PALS, AND PHTLS, THE FOLLOWING COURSES WILL HELP GRADUATES TO SERVE IN AN EMS AGENCY: AMBULANCE DOCUMENTATION, FOUR VIRTUAL REALITY SIMULATION MODULES, SIX SIM MANIKIN TRAINING MODULES, HEMORRHAGE CONTROL TRAINING. 5. FIVE COURSES ABOUT MENTAL HEALTH AND SUBSTANCE USE DISORDERS WILL BE OFFERED AS A RESULT OF THIS FUNDING: MENTAL HEALTH FIRST AID FOR ADULTS, MENTAL HEALTH FIRST AID FOR YOUTH, NALOXONE USE TRAINING, A TWO-HOUR SIM MANIKIN MODULE FOR BEHAVIORAL EMERGENCIES AND OVERDOSE EMERGENCIES, AND ONE VIRTUAL REALITY SIMULATION SCENARIO RELATED TO MENTAL HEALTH/SUBSTANCE ABUSE. 6. A MINIMUM OF THREE CASES OF NALOXONE WILL BE PURCHASED AND A MINIMUM OF 13 EMS PERSONNEL WILL BE TRAINED IN THE USE OF EMERGENCY OPIOID OVERDOSE MEDICATION. THE NALOXONE WILL BE DISTRIBUTED TO TULE EMS TEAM HOUSED AT THE TULE RIVER INDIAN HEALTH CENTER, THE TULE RIVER EMS TEAM HOUSED AT THE CASINO, AND TO THE CAMP NELSON VOLUNTEER AMBULANCE TEAM.

TBH COVID-19