Title VI Director�s Manual - 2007 by 5J3LR8


									            Title VI Director’s
              Manual - 2007

Data Uses

                       ADMINISTRATION ON AGING
                       KAUFFMAN AND ASSOCIATES, INC.
                       NATIONAL RESOURCE CENTER ON
                       NATIVE AMERICAN AGING

NUMBER AoA 90-AM-2751-03
By completing this chapter, you will:

                             Be able to use data obtained
                              from a local, state, or
                              national needs assessment.
                             Understand local
                              community data.
                             Understand the reasons for
                              using community level data
                              and national comparisons.
                             Be able to use data
                              collected after conducting a
                              local needs assessment.
              National Resource Center
              on Native American Aging
 Established in 1994, at the Center for Rural Health, University of
  North Dakota School of Medicine and Health Sciences
 Focuses on:
      Education, Training, and Research
      Community Development & Technical Assistance
      Native Elder Health, Workforce, & Policy
 Web site: http://medicine.nodak.edu/crh/nrcnaa
What is community data?

 Information specific to a group of
  people residing in the same area, in
  this case native elders.
 Residents that may share a               Relevant graphic
  common background or interest in
  the community (some tribes have
  sub communities such as clans).
 Culture, spirituality, economics, and
  or politics may be factors that define
  a community or its members.
What are the uses for community
  It allows you to identify and
    document issues that are
 important for your community.

  It assists you by documenting
  disparities in your community.

    It assists you by providing
extensive information for strategic

It provides essential information for
advocacy efforts at the tribal, state,
         and national levels.

It provides documentation required
 for planning, policy development,
     and grant writing purposes.
 How do I obtain community level
 Community level data is usually obtained in
  the community, by a researcher, consultant,
  or academic partner.
 A needs assessment is required by the
  Administration on Aging (AoA) for renewal of
  the Title VI Native Elder Nutrition Programs.
 According to the Agency for Healthcare
  Research and Quality, four issues should be
  considered by researchers when conducting
  community research:
     Interaction with the community as partners not just
     Use of community knowledge to understand issues and
      develop interventions.
     Community involvement in the design and outcomes
     Immediate benefits from results to participating
         Where can I find help to obtain
            community level data?
 The National Resource Center on Native American Aging
  (NRCNAA) has been working closely with Native elder
  organizations since 1994.
     NRCNAA has a project specific to collecting community
      level data Identifying Our Needs: A Survey of Elders.
     The Center is currently conducting its third such survey of
      social and health needs.
     The goal for this ongoing national project is to serve as a
      resource to tribes to assist them with building their long term
      care infrastructure and increase the quality of life for elders
      residing on reservations, in villages, and other communities.
     A collaborative agreement between the NRCNAA and AoA
      allows the project to provide resources for conducting a
      needs assessment by providing:
         Survey instruments
         Technical assistance
         Regional and national training
General Template for Using NRCNAA
     Needs Assessment Data
 Using NRCNAA Needs Assessment Data

 The NRCNAA template is designed to help people with
 using data from the National Resource Center on Native
 American Aging survey; however, the template can be
 used with other sources if a different survey was used.

 You can follow the examples that follow to expand the
 number of tables or items you include in your presentation
 of the your needs assessment. Please look at the
 comparison sheets to see what else might be important
 for your community and add those to the report using the
 same format. The example is not intended to include
 everything, but it is meant as a starting point for using the
 data for grant and reporting purposes.

 Find relevant data and use it!
General Template for Using NRCNAA
     Needs Assessment Data

Background Information

According to the ___________enrollment office, there
are presently 853 men and women over the age 55
enrolled and living on or around the ________
reservation. Of the 853, there are 492 over the age of
65. According to the National Resource Center on
Native American Aging (NRCNAA), the national Native
elder population ages 55 and over are expected to
grow by 110% between 2000 and 2020. Clearly the
impact of the large cohorts born during post World War
II, now known as the Baby Boom generation, will
become a major source of change for our tribe.
 General Template for Using NRCNAA
      Needs Assessment Data
Chronic Disease

The top chronic diseases found among our elders were high
blood pressure, arthritis, diabetes, depression and
osteoporosis. Each of these lead to limitations on peoples’
ability to take care of themselves and each are diseases
where treatments are available to manage the disease.
Nutritional care is particularly important for high blood
pressure, diabetes and osteoporosis.

  Five most common chronic diseases in our tribe for persons 55 and over
High blood pressure                                  52.9%
Arthritis                                            45.9%
Diabetes                                             36.1%
Depression                                           17.1%
Osteoporosis                                         8.4%
 General Template for Using NRCNAA
      Needs Assessment Data
Data Comparison
Comparisons between our tribe and the
nation provide documentation of disparities
on specific diseases where American Indian
people appeared to be at greater risk than
others in the nation. This information assists
in identifying diseases where health
promotion efforts will assist in making
significant improvements in health status for
our elders. The table on the next slide
presents these diseases.
General Template for Using NRCNAA Needs
Assessment Data
            Chronic diseases with higher rates than the nation

                                  Our tribe               Nation

Arthritis                           45.9%                 28.0%

Congestive heart failure            9.2%                  7.3%

Stroke                              7.9%                  6.5%

Asthma                              14.2%                 10.8%

Diabetes                            36.1%                 14.6%

Colon/rectal cancer                 1.9%                   .4%

Osteoporosis                        8.4%                  4.6%
General Template for Using NRCNAA
Needs Assessment Data
Functional Limitations

Functional limitations serve as the basis for
establishing informal or formal need for care.
Functional limitations or Activities of Daily
Living (ADLs) include bathing, dressing,
getting in or out of bed, walking and using the
toilet. One’s ability to manage each of these
is essential for self care. The following table
shows American Indian people, although
reporting higher rates of chronic diseases,
are significantly less likely to report such
needs for assistance.
General Template for Using NRCNAA Needs
Assessment Data

Activities of Daily Living: Our Tribe & the Nation
                            Our Tribe     Nation
Bathing                     17.6%        36.8%
Dressing                    12.0%        15.8%
Eating                        7.7         8.1%
Getting in or out of bed      11.7       22.1%
Walking                     23.2%        33.7%
Using the Toilet             9.3%        22.8%
 General Template for Using NRCNAA
      Needs Assessment Data

Instrumental Activities of Daily Living

Instrumental Activities of Daily Living (IADLs) serve
as indicators for assistance for living safely in ones
home. This includes meal preparation, shopping,
money management, telephone use, heavy and light
housework and getting outside of the home. With the
exception of meal preparation, our tribe’s elders
reported fewer IADL limitations than the nation. This
may be due to the relatively young age of our elders
compared to the nation.
General Template for Using NRCNAA Needs
Assessment Data

 Instrumental Activities of Daily Living: Our Tribe and the
                                  Our Tribe       Nation
Meal preparation                  20.3%          19.7%
Shopping                          17.7%          34.8%
Money management                  12.2%          17.9%
Use of telephone                   8.4%           9.6%
Heavy housework                   33.3%          51.6%
Light housework                   16.8%          17.0%
Getting outside                   13.5%          44.2%
General Template for Using NRCNAA Needs
Assessment Data.

Levels of Functional Limitation

The measure of need for long term care
contains four levels of limitation; little or
none, moderate, moderately severe and
severe. Each of these reflected differing
levels of need and eligibility for care.
Although our elders are relatively
independent, they are also relatively young.
The table on the next slide contains the
percentages for each level of need for both
our tribe and the nation.
General Template for Using NRCNAA Needs
Assessment Data

   Levels of Functional Limitation: A Measure of
             Need for Long Term Care
                           Our Tribe Nation
Little or none                61.7%       44.9%
Moderate                     20.0%       21.5%
Moderately Severe            5.8%         9.2%
Severe                       12.4%       24.5%
General Template for Using NRCNAA Needs
Assessment Data.
Why Local Survey Data?
The NRCNAA survey asked a series of questions on
whether services were available, whether people were
using them now and whether they would use them. The
following table shows the services now available and the
additional services that would most likely be in future
demand. The survey suggested that people would use a
larger array of services if they were available. In some
instances, the expression of interest is very high when the
services are rarely available. For example, respite care is
almost non-existent, but over 40% indicated they would
use it when the time was appropriate. These results
provide the basis for maintaining and prioritizing services,
and for determining what services the elders need to
continue living in their homes.
 General Template for Using NRCNAA Needs
 Assessment Data
                     Available Services, Extent of Use and
                Projected Use If One Could Not Meet Own Needs
                                    Available       Use Now     Would use
Dietary                              44.5%           25.3%       39.5%
Meals on Wheels                      64.8%           32.2%       47.3%
Transportation                       64.9%           27.9%       49.3%
OT                                   22.0%            3.1%       30.7%
Speech Therapy                       18.8%            1.3%       28.5%
Respite Care                         34.7%            3.4%       40.4%
Personal Care                        32.3%            7.6%       39.7%
Skilled Nursing                      36.7%            8.7%       39.5%
Physician                            45.3%           28.7%       36.9%
Social Services                      59.1%           16.6%       39.3%
PT                                   33.8%            5.5%       42.3%
Home Health                          40.8%            9.1%       41.9%
Adult Day Care                       20.4%            8.7%       30.7%
Assisted Living                      18.5%             .9%       31.3%
Skilled Nursing                      24.8%            1.4%       30.2%
  General Template for Using NRCNAA
       Needs Assessment Data
Weight and Nutrition

Specifically related to nutrition are the findings about
weight, diet and exercise. Using the people’s weight and
height, a Body Mass Index was calculated to determine
how many people are overweight (BMI 25 to 29) or
obese (BMI 30 and over). Weight issues have become a
focus of concern due to the relationship between weight
and chronic disease (diabetes, arthritis, hypertension,
and cancer) and functional limitations (ability to get
around). Our results for the Body Mass Index are found
on the next slide.

Another method used to determine weight issues is waist
TOPIC 7 – General Template for Using
NRCNAA Needs Assessment

        Proportions in each Weight Category
                   for Our Tribe

Low/normal weight                 21.4%

Overweight                        35.5%

Obese                             43.1%
General Template for Using NRCNAA Needs

Dietary concerns are reflected in an
item that asked about eating habits and
conditions that are important to
consider when designing nutrition
programs for our elders. A large
proportion of the elders reported too
few fruits and vegetables in their diet
and many have an insufficient number
of meals per day to receive adequate
 General Template for Using NRCNAA Needs
                                Responses to nutritional items.
I have an illness or condition that made me change the kind and or       28.0%
amount of food I eat.
I eat fewer than 2 meals per day.                                        19.0%

I eat few fruits and vegetables or milk products.                        38.9%

I have 3 or more drinks of beer, liquor or wine almost every day.        2.3%

I have tooth or mouth problems that make it hard for me to eat.          14.6%

I don’t always have enough money to buy the food I need.                 13.3%

I eat alone most of the time.                                            28.1%

I take 3 or more prescription or OTC drugs a day.                        40.4%
Without wanting to, I have lost or gained 10 lbs in the past 6 months.   12.2%
I am not always physically able to shop, cook and/or feed myself.        13.1%
  General Template for Using NRCNAA
  Needs Assessment
Social and Housing Characteristics

One third of the elders in our community live alone. These results
indicate that 1/3 of our elders are at risk for requiring help from
outside the household – formal services or informal care from
relatives who do not live with them. This proportion is large and
suggests a strong need for building home and community based
services that can support both the elder and his or her informal care
provider. Additionally, our elders reported 56% had received care
from family members. Again, this supports the need for family
caregiver support services as well as formal services for the elders.

Almost a third (30.4%) of the elders reported providing care to
grandchildren. This responsibility is high and must be considered
when designing programs for the elders. They have responsibilities
and tasks that in many other contexts would not be present. This
responsibility for child care limits their options for using some
  Specific Areas to use Your NCRNAA
  Needs Assessment Data
Page 5: Title VI - Application Guidelines: e) other nutrition

•The first three nutrition items on Question 35 on your
  comparison sheet will help to establish a baseline of need.
    •Persons reporting illnesses or conditions that require them
     to change their diet are in need of education and
    •The next two items, fewer than 2 meals per day and eating
      few fruits and vegetables, are also both important for
      nutritional education and counseling.
•The thirteen (home delivered meals) and fourteenth
 (congregate meals) items now using and would use on
 Question 46 of your comparison sheet reflect current level of
 use and receptivity to nutritional services and will also assist in
 answering this question.
  Specific Areas to use Your NCRNAA
        Needs Assessment Data
Page 6: Question 6: “Describe the results
and benefits expected…”

•The thirteen (home delivered meals) and fourteenth
 (congregate meals) items on Question 46 now using
 document access; whereas, the would use column
 indicates an increase in demand for the next funding
•Use Question 35 to document levels of dietary
 adequacy and state that you expect the percentages
 with fewer than 2 meals a day and those with few fruits
 and vegetables to decrease over the next 3 years.
 You can monitor progress by comparing the
 percentages from this year to three years from now.
  Specific Areas to use Your NCRNAA
        Needs Assessment Data
Page 6: Section B: Information and Assistance.

Use items from Question 46 to establish a baseline for
the percentage that are now using or would use in the
future if needed. Each of these baseline percentages
can be compared with the next survey in 3 years to
see if they changed. Each should improve and exhibit
higher percentages after 3 or more years.

Section on Native American Caregiver Support
Program – Will be completed by summer!
   Specific Areas to use Your NCRNAA
         Needs Assessment Data
Page 10: Question 4.

•Question 44 on the comparison sheet will assist in
 reporting the number of elders who are receiving care
 from a family member.

•Question 45 will assist in reporting the number of
 elders providing care to their grandchildren.

•The percentages from these two questions will provide
 a baseline for service use and acceptability of people
 involved in caregiving relationships. These should
 improve over time and will be measured again after 3
   Specific Areas to use Your NCRNAA
         Needs Assessment Data
Page 11: Question 4.

•The question asks for the expected results of providing
 assistance. Here you should first list the assistance to be
 provided, and then take those services from question 46 for
 use as baseline data. Once again you predict improvement
 and will re-measure this in 3 years.
   Example: If you provide respite care during this funding
   period, you would report the percentage now using for
   acceptability and report the would use column to estimate
   the increase for the next 3 years. Do this for each service
   you intend to provide.

The NRCNAA needs assessment data is designed to have many
uses. We urge you to also use this data in other applications to
provide documentation of your current level of need and to set
baselines. These efforts will help your organization to
determine if your goals are being met!
                        Best Practices

Wisdom Steps-Health Promotion

Wisdom Steps was organized as a partnership between Minnesota
American Indian communities and the Minnesota Board on Aging.
Wisdom Steps is governed by a Board of Directors that is made up of a
representative from each of Minnesota’s eleven reservations and from the
cities of Duluth, Minneapolis, and St. Paul. Wisdom Steps developed a
logo to provide for recognition, consistency, and ownership. The
logo consists of a pair of worn, tipped, moccasins surrounded by
symbols from the Dakota and Ojibwe tribes. The moccasins identify with
the American Indian community and the worn and tipped represent the
wisdom of the elderly.

One of the first things Wisdom Steps did was to conduct a needs
assessment. Wisdom Steps formed a partnership with the National
Resource Center on Native American Aging (NRCNAA) to find out what
elders could tell us about their health. The survey, Identifying Our Needs:
A Survey of Elders was conducted in each interested community and the
results were used for planning Wisdom Steps activities.
                  Best Practices
Elders are encouraged to participate in three
preventive health activities:
•Health Screenings - Elders are encouraged to practice
  good preventive health by visiting their physicians and
  setting personal health goals. Elders are encouraged
  to have annual screenings for blood pressure, blood
  glucose, cholesterol, and weight.
•Health Education – Elders are encouraged to attend
 education programs that support their health goal, and
 to watch and learn how and why preventive health is
•Healthy Living Activities – Elders are encouraged to
 practice good health by walking or joining in
 preventive health promotions that encourage routine
              Best Practices
These preventive health activities
correspond to the little or none category of
the functional limitations chart developed
by NRCNAA. Based on the needs
assessment results, the majority of
Minnesota’s American Indian elderly fell into
this category.
Additionally, a model project was developed
for each of the preventive health activities.
Health screenings contain “Medicine Talk”
where communication is encouraged
between elders and pharmacists.
              Best Practices
For more information on the Wisdom Steps
program, please contact:

Minnesota Board on Aging Indian Elder Desk
444 Lafayette Road
St. Paul, MN 55155-3843
Telephone: (651) 297-5458
Or visit their website at
                  Best Practices
Eagle Shield Senior Citizens Center-Home
and Community Based Services

The Eagle Shield Senior Citizens Center is a program
developed by the Blackfeet Tribe to provide assistance
to the elderly of the Blackfeet Reservation. The
Blackfeet Reservation is located in the northwestern
part of Montana and encompasses approximately 1.5
million acres. Over the years, the Eagle Shield Senior
Citizens Center has developed from a bare bones
operation to a program that offers a wide range of
senior services, from nutrition education and meal
delivery to home personal assistance and social
                  Best Practices
•The nutrition program includes meal services that are
 provided as congregate meals at the Eagle Shield site,
 home-delivered meals, and medical waiver provided
 meals to disabled individuals.
•Social activities at the Center provide the elders with
 a place to visit, read newspapers, or just hang out.
 Other social activities at the Center include television
 viewing with videos of Blackfeet history, card and
 board games, space for quilting, a pool table, an arbor
 and picnic tables for outdoor meals and socializing.
•In addition, the Center serves as a base for community
 health activities such as flu shot clinics, eye
 examinations for glaucoma and cataracts, educational
 and social gatherings for cancer and dialysis patients and
their families.
                      Best Practices
•Cardio-glide exerciser and aerobics are available for the elders should
 they desire to exercise. The Center operates separately from the local
 Community Health Representatives and Indian Health Service, but
 works in conjunction with them to provide health services to the
•Eagle Shield Senior Citizens Center also provides access to services
 from other programs such as the Personal Care Attendant Program,
 Green Thumb Volunteers Worksite, and the Visually Impaired
 Program Volunteers.
•The Personal Care Attendant (PCA) Program offers in-home care
 tasks that are medically necessary for recipients whose health
 conditions cause them to be functionally limited in performing
 activities of daily living. This program is an option with the purpose of
 delivering services to the elderly and/or disabled for their comfort and
 safety. Services can include assistance with activities of daily living
 and/or personal hygiene, assistance with meal preparation, and
 household tasks.
               Best Practices
•Start up funds for the PCA program was provided
 by the Tribal Business Council and continues with
 the aid of Medicaid reimbursements. An added
 benefit to the PCA program is that in a rural
 community that has over 70 percent
 unemployment, it employs and provides training
 for local individuals of the Blackfeet Indian
•In 2001, the PCA program employed over 100
 personal care attendants and maintained a pool
 of about 300 trained individuals.
          Best Practices

For more information about Eagle
Shield please contact
Connie Bremner, Director
at (406) 338-3483
or visit their Web site at
    Regional and National Data Use

The wide range of tribal participation in the Identifying
Our Needs: A Survey of Elders throughout the United
States has resulted in the largest Native elder database
in the country. The project is crucial to documenting
Native elder disparities at the regional and national level
to bring awareness to the health and social disparities
experienced by these populations.

The National Resource Center on Native American Aging
(NRCNAA) has provided testimony and documentation
to educate tribal, state and congressional
representatives as to the high level of need experienced
by Native elders. NRCNAA staff could not have done
this without our tribal partners and the data they allow
our office to use in these efforts.
      Regional and National Data Use

The applications for the data at these levels are
numerous and focus on:

Training for increasing skills for Native elder service
Advocating for resources at the state, regional, and
 national level
Developing policy for informing national Native elder
Filling the research gap for Native elder related
Training Native researchers in the aging field
  Regional and National Data Use

The following examples highlight an array of
analyses at the regional and national levels that
show how assessment data may allow an
examination of disease prevalence and health
disparities. The material is valuable to
establishing the extent of need and the extent of
unmet need in Indian communities.

Prevalence of Chronic Disease Among American
Indian and Alaska Native Elders, October, 2005.
Patricia Moulton, Ph.D. Leander McDonald, Ph.D.
Kyle Muus, Ph.D. Alana Knudson, Ph.D. Mary
Wakefield, Ph.D., R.N. Richard Ludtke, Ph.D.
  Regional and National Data Use

Regional aggregation of data is useful in examining both
health and social conditions and services. In this type of
use, the regional data may be used as evidence that is
derived from a larger and more detailed examination of
conditions. In some cases, one might prefer to use
regional estimates of need when the tribe is very small
and local data is limited by small population size.

American Indian Elders in the Aberdeen IHS Area:
Prevalence of Chronic Disease and Functional
Limitations, presented by Kyle Muus and Leander R.
McDonald at the Dakota Conference on Rural and Public
Health, held March 8-10, 2005 in Bismarck, ND.
   Regional and National Data Use

Needs assessment data establish the
direction for patterns of change in Indian
country and serve as a basis for targeting
health promotion and wellness. The
following type of use represents another
dimension for creative use of needs
assessment data.

Reducing Long Term Care Needs Through
Health Promotion and Disease Prevention,
presented by Alan Allery, PhD to Wisdom
Steps & WELCOA.
 Regional and National Data Use

Our use of the data for locating policy
recommendations could be replicated
for regional, state and local efforts, all of
which would lead to eventual
improvements in care for elders.

Policy recommendations for Native
Elders, paper prepared for the National
Congress of American Indians 2005 Mid-
Year Conference, June 14, 2005, Green
Bay, WI.
                 Final Overview

Data Use Summary

                     Data          Data provides
Data identifies   documents          extensive
 community        community       information for
   issues.        disparities.       strategic

        Data offers         Data presents the
          specific            essentials for
       information         advocacy efforts at
         for policy          the tribal, state,
      development.         and national level.
Center for Rural Health
 Established in 1980, at the University of North Dakota School
  of Medicine and Health Sciences in Grand Forks, ND
 Focuses on:
     Education, Training, & Resource Awareness
     Community Development & Technical Assistance
     Native American Health
     Rural Health Workforce
     Rural Health Research
     Rural Health Policy
 Web site: http://medicine.nodak.edu/crh
For more information contact:
               Rick Ludtke
               Kyle Muus
         Twyla Baker-Demaray
               Mary Gattis
         Center for Rural Health
         University of North Dakota
   School of Medicine and Health Sciences
       Grand Forks, ND 58202-9037
            Tel: (701) 777-3265
          Fax: (701) 777-6779

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