Health News & Notes - April 2022 - Policy by npaihb

HEALTH NEWS & NOTES

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April 2022 Policy

1972-2022

Publication of The Northwest Portland Area Indian Health Board

Indian Health Service Appropriations Updates Elizabeth J. Coronado, JD (Picayune Rancheria of the Chukchansi Indians Tribe) Senior Policy Advisor

FY 2022 Budget On March 15 , 2022, President Biden signed into law H.R. 2471, the Consolidated Appropriations Act, 2022, which passed Congress on March 10.1 The President signed into law the Act just in time before the fourth and final continuing resolution expired on the evening of March 15. President Biden had proposed a historical request of $8.5 billion for the Indian Health Service for Fiscal Year (FY) 2022, including a request for advance appropriations for FY 2023 and to reclassify Contract support costs and 105(l) leases as mandatory. However, the Consolidated Appropriations Act, 2022 fell short of this historic request for IHS appropriations in FY 2022. The FY 2022 budget included a $395 million increase to the IHS and included the following program increases: Continued on page 4

Indian Health Service Appropriations Updates

Chair’s Notes

Major Developments in National Opioid Litigation

WA State Behavioral Health Update and ‘988’ National Suicide Prevention Lifeline

Loved Here, Safe Here: Promoting Youth-Friendly and Non-Stigmatizing Sexual Health Messaging

Happy, Safe, and Healthy Mother’s Day

Soptlight on Shoshone-Bannock Tribes

Rising rates of syphilis and congenital 21 syphilis: a danger to future generations Community Health Aide Program (CHAP) Implementation in the Portland Area Continues Despite Federal Challenges

New Faces

Resolutions

B O A R D & S TA F F EXECUTIVE COMMITTEE MEMBERS Nickolaus D. Lewis, Chairman, Lummi Nation Cheryle Kennedy, Vice Chair, Greg Abrahamson, Secretary, Spokane Tribe Vacant, 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 Tribe Illiana Montiel, Coos, Lower Umpqua & Siuslaw Tribes Eric Metcalf, Coquille Tribe Sharon Stanphill, Cow Creek Tribe Cassandra Sellards-Reck, Cowlitz Tribe Cheryle Kennedy, Grand Ronde Tribe Lisa Martinez, Hoh Tribe Brent Simcosky, Jamestown S’Klallam Tribe Nick Pierre, Kalispel Tribe Gerald Hill, Klamath Tribe Jennifer Dickison, Kootenai Tribe Francis Charles, Lower Elwha S’Klallam Tribe Nickolaus D. Lewis, Lummi Nation Nate Tyler, Makah Tribe Jaison Elkins, Muckleshoot Tribe Rachel Edwards, Nez Perce Tribe Samantha Phillips, Nisqually Tribe Lona Johnson, Nooksack Tribe Hunter Timbimboo, NW Band of Shoshone Indians Jolene George, Port Gamble S’Klallam Tribe Bill Sterud, 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 Selene Rilatos, Siletz Tribe Denese LaClair, Skokomish Tribe Robert de los Angeles, Snoqualmie Greg Abrahamson, Spokane Tribe Kay Culbertson, Squaxin Island Jessie Adair, Stillaguamish Tribe Robin Sigo, Suquamish Tribe Cheryl Raser, Swinomish Tribe Teri Gobin, Tulalip Tribe Althea WOLF, Umatilla Tribe Marilyn Scott, Upper Skagit Tribe Caroline Cruz, Warm Springs Tribe Charlene Tillequots, Yakama Nation

ADMINISTRATION Laura Platero, Executive Director Sue Steward, Deputy Director Andra Wagner, Human Resources Manager Tammy Cranmore, Finance Director Mike Feroglia, Business Manager Eugene Mostofi, Fund Accounting Manager Chelsea Jensen, Compliance Manager Nancy Scott, Accounts Payable/Payroll Olivia McPherson, Purchasing/Travel Agent Michelle Harris, Accounts Receivable Specialist James Fry, Information Technology Director Jamie Alongi, IT Network Administrator Katie Johnson, EHR Integrated Care Coordinator Jonas Greene, Communications Director Kira Rea, Communications Specialist

Itai Jeffries, Paths (Re)Membered Manager Jane Manthei, HNY Outreach Specialist Jenine Dankovchik, Evaluation Specialist/Biostatistician 1 Jerico Cummings, National Evaluation Specialist Jessica Rienstra, ECHO RN Case Manager Jessica Leston, HIV/HCV/STI Clinical Services Project Director Joshua Smith, Health Communications & Evaluation Specialist Karuna Tirumala, IDEA-NW Biostatistician Katie Johnston, Paths(Re)Membered Coordinator Kerri Lopez, WTDP, NTCCP & BOLD Director Kelly Walker, BRFSS Interviewer Kimy Peterson, BRFSS Interviewer Larissa Molina, TOR Project Specialist Mattie Tomeo-Palmanteer, Cancer Prevention Coordinator Meena Patil, MV Biostatistician Megan Woodbury, ECHO Project Coordinator Maleah Nore, THRIVE Project Coordinator PROGRAM OPERATIONS Michelle Singer, HNY Project Manager Morgan Scott, CDC PHAP (Public Health Associate) Candice Jimenez, Health Policy Specialist Nancy Bennett, WA Tribal PH Improvement Mgr. Liz Coronado, Senior Policy Advisor Naomi Jacobson, Training and Outreach Manager Nick Cushman, ECHO Pharmacy Case Manager ENVIRONMENTAL AND PUBLIC HEALTH Nicole Smith, Senior Biostatistician 1 Celeste Davis, Environmental Public Health Director Olivia Whiting-Tovar, TIPCAP IPP Project Coordinator Antoinette Ruiz, Environmental Health Specialist Reshell Livingston, Asthma Project Coordinator Holly Thompson-Duffy, Environmental Health Science Manager Roger Peterson, Text Messaging Specialist Jeanne Davidson, OR Tribal PH Improvement Project Coor. Shoshoni Walker, TEC-IVAC Project Manager Lela Rainey Brown, Environmental Health Specialist Sheila Hosner, CDC Foundation Employee Nicole Smith, EH Informatics Specialist Silas Hoffer, WEAVE-NW Project Coordinator Melino Gianotti, Emergency Management Coordinator Sonya Oberly, CDC Foundation Employee Ryan Sealy, Environmental PH Project Scientist Stephanie Craig Rushing, PRT, MSPI, Project Director Shawn Blackshear, Senior Environmental Health Specialist Sujata Joshi, IDEA-NW Project Director Tam Lutz, Maternal Child Health Programs Director NORTHWEST TRIBAL EPIDEMIOLOGY CENTER STAFF Ticey Mason, NTDSC Director Victoria Warren-Mears, Director Tom Becker, NW NARCH Project Director & Medical Epidemiologist Alyssa Farrow, Special Projects Coordinator Tom Weiser, PAIHS, Medical Epidemiologist, assigned to NWTEC Ashley Hoover, Communicable Disease Epidemiologist Tommy Ghost Dog, Jr., WeRNative Project Coordinator Ashley Thomas, NW NARCH Senior Program Manager Torrie Eagle Staff, Cancer Project Manager Asia Brown, Sexual Health Communications Specialist Tyanne Conner, Native Boost Project Coordinator Birdie Wermy, Behavioral Health Manager Valerie Gaede, PHIT Project Assistant Bridget Canniff, PHIT Project Director Celena Ghost Dog, WYSH Project Manager NPAIHB PROJECT STAFF Chandra Wilson, Tobacco/BOLD Program Manager Andrew Shrogen, TCHP Project Technical Operations Director Clarice Charging, NWTEC Project Coordinator Christina Peters, TCHP Project Director Colbie Caughlan, RC/THRIVE/TOR Projects Director Carrie Sampson-Samuels, CHAP Project Director Courtney Tallis, BRFSS Interviewer Dolores Jimerson, BHA Specialist Danica Brown, Behavioral Health Program Director Kari Kuntzelman DHA Education Specialist David Stephens, ECHO Clinical Director Katie Hunsberger, BHA Student Support Coordinator Dolores Jimerson, Behavioral Health Clinical Supervisor Laura Palomo, NDTI Project Coordinator Don Head, WTD Project Specialist Melissa Bennett, BHA Project Director Eitan Bornstein, EIS Officer Miranda Davis, NDTI Project Director Eric Vinson, ECHO & TOR Project Manager Pam Ready, DHA Education Manager Erik Kakuska, WTD Project Specialist Sasha Jones, CHAP Project Manager Grazia Cunningham, NARCH Project Manager Heidi Lovejoy, NWTEC Substance Use Epidemiologist

Indian Health Service Appropriations Updates (cont’d) FY 2022 Budget • • • • • •

Hospitals and Health Clinics --$2.4 billion (+161 million over FY 2021 enacted), Purchased/Referred Care --$985 million (+9 million), Tribal Epidemiology Centers --$24 million (+ 14 million), Mental Health--$122 million (+7 million), Alcohol & Substance Abuse --$258 million (+7 million), Electronic Health Record--$145 million (+111 million).

PRC only received less than a 1% increase which means there will be no program increase to fund the access to care factor this fiscal year. Without program increases to PRC, IHS areas without IHS or Tribal hospitals will not receive funding to cover inpatient care. Additionally, almost a third of the IHS budget increase was appropriated for IHS to purchase a new electronic health record system which does not provide direct funding to Tribes for their health information technology modernization efforts. Lastly, the FY 2022 appropriations did not include advanced appropriations for FY 2023 or reclassify contract support costs or 105(l) lease funding as mandatory. President’s FY 2023 Budget Request

NPAIHB Policy

Earlier this month, President Biden released his FY 2023 Department of Health and Human Services (HHS) Budget in Brief.2 For FY 2023, the President is requesting for $9.3 billion in mandatory funding for IHS, a $2.5 billion increase above FY 2022 enacted3. The mandatory funding proposal includes budget increases for IHS each year over ten years that would grow to $36.7 billion by FY 2032. 4 This is a significant step forward towards full funding for the IHS. This Administration continues to show their commitment to honoring treaty and trust obligations to provide for healthcare for American Indian and Alaska Native people. A more detailed budget for IHS in FY 2023 should be released soon. Read the FY 2023 Budget in Brief FY 2024 Budget Updates In February, the National Tribal Budget Formulation Workgroup finalized their FY 2024 budget recommendations for IHS. These recommendations were presented to HHS during the Annual Tribal Budget Consultation on April 6-7, 2022. Portland Area Tribal Leaders also presented the Northwest budget priorities to HHS and its agencies and offices. Written testimony may be submitted to consultation@hhs.gov by May 8, 2022.

1 The White House, Bill Signed: H.R. 2741 (2022). 2 Dept. of Health and Human Services, FY 2023 Budget in Brief (2022). 3 Id. at 9. 4 Id.

4 Northwest Portland Area Indian Health Board www.npaihb.org

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Chair’s Notes Nickolaus D. Lewis Lummi Nation NPAIHB Chairman

This past quarter Congress finalized the Fiscal Year (FY) 2022 budget and President Biden has released his budget request for FY 2023. It was disappointing to see the lack of support from Congress to truly honor their trust and treaty obligations to American Indian and Alaska Native people to provide healthcare. In FY 2022, the final budget only included a $395 million increase to the Indian Health Service (IHS) which is a drop in the bucket of what this Administration has been advocating for a $2.2 billion increase. Additionally, Congress did not provide for advanced appropriations for IHS to ensure reliable and stable funding for our tribal health programs. We need all Tribal Leaders informing their representatives on their disappointment of not including the full $2.2 billion increase for IHS or providing for advanced appropriations. For FY 2023, I was hopeful to see a historical request put forward by this Administration for mandatory funding for IHS. This has been a longstanding request of our Northwest Tribal Leaders. This proposal would include funding IHS at $9.3 billion in FY 2023 that would grow to address population growth and medical inflation to $36.7 billion by FY 2032. 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 to also request for additional resources for Tribes. Earlier this month, I participated in the Department of Health and Human Services (HHS) Annual Tribal Budget Consultation to advocate for our Northwest priorities as the Administration develops their FY 2024 priorities. I urged the agencies to commit to help us address the opioid crisis in Indian Country, for additional resources to Portland to fully implement our Community Health Aide Program, and made a specific request for $22 million to our Northwest Tribes to reimburse for our health information technology modernization efforts. I look forward to following up with written testimony to HHS and encourage our Northwest Tribes to submit testimony as well. The FY 2024 budget request should be released next spring. As we enter into the spring season, I look forward to continue to advocate for our Northwest priorities with the Administration and with Congress to move towards full funding for the IHS. Hy’shqe Nickolaus D. Lewis Lummi Nation Chair, Northwest Portland Area Indian Health Board Secretary, Lummi Indian Business Council

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Major Developments in National Opioid Litigation Geoff Strommer

Hobbs, Straus, Dean & Walker, LLP

The national opioid litigation remains a complex and ever-shifting landscape. Two major tribal settlements were recently announced that, if enough tribes and tribal health organizations agree to participate, will bring hundreds of millions of dollars in funding to help ameliorate the opioid crisis in Indian Country. Meanwhile, litigation continues against remaining defendants in courts around the country, and proposed bankruptcy plans await final approval in two related bankruptcy proceedings. Proposed Settlements with Johnson & Johnson and Major Distributors Johnson & Johnson, a major manufacturer of prescription opioids, and distributors AmerisourceBergen, McKesson Corporation, and Cardinal Health have recently reached tentative settlement agreements with tribal plaintiffs in the opioid litigation. In February of 2022, Johnson & Johnson agreed to pay $150 million to settle all tribal claims against it, to be distributed over two payments. The three distributors agreed to pay nearly $440 million to settle all tribal claims against them, to be distributed over six annual payments. All federally recognized tribes and Alaska tribal health organizations are eligible to participate in both settlements, which will take effect once certain participation thresholds are met. Ongoing State Opioid Litigation Despite the settlements, litigation continues around the country. The Cherokee Nation bellwether case continues against three major pharmacy chains and has recently been remanded to state court. Several states also continue to pursue litigation outside of the federal multidistrict litigation. A jury has been selected and opening statements are set for the second week in April in Florida’s case against Walgreens. Opening statements in West Virginia’s case against Johnson & Johnson, Teva, and Allergan began on April 5. Washington State also recently survived motions to dismiss in its case against Amerisource Bergen, McKesson, and Cardinal Health. Washington is asking for $95 billion from the distributors for the State’s damages. Further, generics manufacturers Teva Pharmaceuticals, Anda Inc., and Allergan will soon face a damages trial after a New York jury found the manufacturers liable for creating a public nuisance in Suffolk and Nassau Counties. Bankruptcy Proceedings: Purdue & Mallinckrodt In December of 2021, U.S. Federal District Court Judge Colleen McMahon reversed U.S. Bankruptcy Court Judge Robert Drain’s approval of the initial bankruptcy plan proposed by Purdue Pharma, maker of OxyContin. Among other things, that plan would have created multiple opioid abatement trusts for state, local, and tribal governments using a $4.3 billion cash contribution from members of the Sackler family (the shareholders of Purdue) and other company assets. Judge McMahon’s reversal of the plan was based on her holding that the civil liability releases that were negotiated by the Sackler family in exchange for their cash contribution to the plan are not authorized by the bankruptcy code. That reversal decision has been appealed to the Second Circuit but, in the meantime, Purdue and the objecting states have reached a new agreement that would increase the Sackler family contribution up to $5.5 billion. This new agreement currently awaits approval by the federal courts, but is being challenged by the U.S. Department of Justice on the grounds that the Sackler releases are unlawful.

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Major Developments in National Opioid Litigation (cont’d) In early February of 2022, a federal court approved a bankruptcy plan proposed by Mallinckrodt Pharmaceuticals, a major manufacturer of generic prescription opioids. The Mallinckrodt plan would create a $1.75 billion opioid abatement trust, from which tribal claimants would receive approximately three percent (3%) of dedicated government abatement funds. However, because Mallinckrodt is an Irish company, the plan must also be approved by the Irish courts before the plan can be finalized. The plan is expected to be approved and implemented this spring. McKinsey MDL On February 4, 2022, global consulting firm McKinsey & Co. announced a $573 million settlement with the Attorneys General of 47 states, the District of Columbia, and 5 territories. Thereafter, hundreds of local subdivisions and tribal governments brought suit against McKinsey as well, alleging that it played a key role in the development and implementation of the fraudulent and misleading marketing practices that led to the opioid epidemic through its work with clients like Purdue Pharma and Endo Pharmaceuticals. While the lawsuits were initially joined in the ongoing multidistrict litigation in Ohio, they were eventually moved to a separate multidistrict litigation proceeding in California. McKinsey then moved to dismiss the lawsuits on the grounds that the local government claims were barred by its earlier settlement with the states and that there are jurisdictional defects in many of the underlying cases. The court held a hearing on the motions to dismiss on March 31, and is expected to issue a ruling promptly on whether the claims can proceed. Contract Support Cost Legislative Fix and Third-Party Revenue Claims A major issue being litigated is whether the Indian Health Service (IHS) owes contract support costs (CSC) for health care services funded by third-party revenues that tribes generate under their Indian Self-Determination and Education Assistance Act (ISDEAA) agreements with IHS. The additional services made possible by the collection and expenditure of third-party revenues—or what the ISDEAA refers to as “program income”—require tribal providers to incur additional administrative and overhead costs that meet the definition of CSC. In the 2016 Sage Memorial decision, a federal court in New Mexico ruled that program income expended on additional services is part of the “federal program” entitled to CSC under the ISDEAA. Since then, however, all courts to address the issue have sided with IHS, holding that only funds appropriated to IHS and transferred in the ISDEAA agreement generate CSC requirements. Two of those cases are on appeal: the San Carlos Apache case in the Ninth Circuit, and the Northern Arapaho Tribe case in the Tenth Circuit. The Northwest Portland Area Indian Health Board signed onto amicus briefs supporting the Tribes in both of these appeals. Oral argument in Northern Arapaho took place on January 19, 2022, and a decision could come any day. The San Carlos argument took place on March 7. If either appeal is successful, it would create a conflict with the D.C. Circuit, which ruled against the Swinomish Indian Tribal Community last year. Such a “circuit split” would increase the odds of the Supreme Court granting a petition to decide the issue. In the meantime, several similar cases have been filed in the lower courts, some of which are on hold pending the appeals. A recent court decision has thrown into question the very definition of CSC. In Cook Inlet Tribal Council, Inc. v. Dotomain, the D.C. Circuit Court of Appeals held that any costs associated with activities IHS normally carries out in direct service must be funded (if at all) through the Secretarial amount and are not eligible to be paid as CSC. Since most costs currently reimbursed as CSC are also incurred by IHS when it operates programs directly, this ruling has the potential to drastically reduce CSC payments—as demonstrated in a recent IHS decision cutting the Fort Defiance Hospital’s CSC by almost 90%, from $18,515,007 to $1,887,739. The Council requested a rehearing, but the petition was denied, and Fort Defiance may appeal. In the meantime, tribal advocates have begun working toward a legislative fix to overturn the Cook Inlet decision. On April 8, 2022, Rep. Tom Cole (R-OK) introduced H.R. 7455, the “IHS Contract Support Cost Amendment Act.” The bill would make simple technical amendments to the ISDEAA to essentially overturn the Cook Inlet decision and clarify that administrative and overhead costs normally incurred by IHS (or BIA) but not fully paid in the Secretarial amount can be paid as CSC. This would restore the status quo, not expand the CSC entitlement. The bill has a long, bipartisan list of co-sponsors.

8 Northwest Portland Area Indian Health Board www.npaihb.org

Brackeen: A Broad Challenge to the Indian Child Welfare Act In its upcoming term, the United States Supreme Court will hear arguments in Haaland v. Brackeen (No. 21-376), a case challenging the Indian Child Welfare Act (ICWA) on several constitutional grounds, including the equal protection clause, the anti-commandeering doctrine, and the non-delegation doctrine. The case is being closely watched, not only for its potential impacts on the ICWA, but also for its potential legal implications for a broad range of federal laws and regulations that single out tribes and Indians for special treatment on the basis of their unique political and legal status. The case began in 2017 when a non-Indian family (the Brackeens) and the State of Texas mounted a facial attack on ICWA, suing the United States and several U.S. officials. Five other individuals and two other states (Indiana and Louisiana) have since joined as plaintiffs, and five tribes (Cherokee Nation, Oneida Nation, Quinault Indian Nation, Morongo Band of Mission Indians, and Navajo Nation) intervened as defendants. At the district court level, the U.S. District Court for the Northern District of Texas invalidated most of ICWA in a sweeping decision. On appeal, a three-judge panel of the U.S. Court of Appeals for the Fifth Circuit reversed and upheld ICWA in its entirety, in a nearly unanimous opinion. The Fifth Circuit then agreed to rehear the case en banc. On en banc review, the full court upheld ICWA in large part, holding that Congress had the power to enact the ICWA and that its “Indian child” definition does not violate equal protection. However, the full court split 8-8 on some of ICWA’s specific provisions, thereby reinstating the district court’s judgment striking down these provisions. The invalidated provisions include recordkeeping requirements for state courts, a requirement that parties seeking to effect foster care placement or termination of parental rights to an Indian child make certain “active efforts” to prevent the breakup of the Indian family, and adoption and foster care placement preferences that include “other Indian families.” The parties will submit briefing in the case over the summer, with arguments to be held in the fall or winter. The Native American Rights Fund (NARF) and its Supreme Court Project are undertaking a broad effort to coordinate amicus briefs submitted in support of ICWA and the federal and tribal defendants to ensure that the arguments made best support and represent the significant tribal interests at stake in the Brackeen case. Title VI – Update on Efforts to Expand Self Governance at the Department of Health and Human Services The Self-Governance Communication and Education Tribal Consortium (SGCETC) is reengaging in efforts to expand Self-Governance at the U.S. Department of Health and Human Services (HHS). The ISDEAA authorizes tribes and tribal organizations to be funded by the federal government to provide services that the federal government would otherwise be obligated to provide due to the legal and trust responsibilities and treaty obligations of the United States. At present, the ISDEAA applies to only one agency within HHS: the IHS. This legislation would expand Self-Governance to as many as two dozen other programs at HHS. The Workgroup members had some initial Hill visits with congressional staff to gauge interest in bill introduction. These offices included: the Office of Congressman Markwayne Mullin (R-OK); Office of Congressman Tom Cole (R-OK); House Committee on Natural Resources (Majority and Minority Staff); Office of Congressman Tom O’Halleran (D-AZ); Senate Committee on Indian Affairs (Majority and Minority Staff); Office of Congressman Raul Ruiz (D-CA); and Office of Congressman Joe Neguse (D-CO). All of the offices we met with were generally supportive of the initiative and said that they would look further into these issues and potentially speak to their Member of Congress about introducing the legislation. In addition, SGCETC hosted two virtual congressional briefings for Members and staff on March 30 and 31, 2022. Several dozen bipartisan staff members attended the sessions. They asked questions about the cost of the legislation, the opportunity to provide authority through the Appropriations process, and information on logistics. If your tribe or tribal organization would like to directly support these efforts, we can provide sample letters and tribal resolutions that you can use with your congressional delegation. We are also able to provide talking points and additional assistance if you would like to reach out directly to your Members of Congress.

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WA State Behavioral Health Update and ‘988’ National Suicide Prevention Lifeline Candice Jimenez (Confederated Tribes of Warm Springs) Health Policy Specialist

Northwest Tribes in Washington State, in partnership from the American Indian Health Commission (AIHC) and Health Care Authority (HCA), have been supporting behavioral health crisis response improvements throughout the state via the Tribal Centric Behavioral Health Advisory Board. The Tribal Centric Behavioral Health Advisory Board (TCBHAB) was developed as a statewide board to oversee the implementation and operation of Tribally operated inpatient behavioral health facilities across Washington State. These facilities will offer needed behavioral health crisis care to all American Indians and Alaska Natives in Washington State. This will include a freestanding Evaluation and Treatment Center, secure withdraw management and stabilization with potential for crisis stabilization, outpatient behavioral health and crisis services offering a wide variety of services including aftercare and outpatient treatment options for maximizing federal participation and ensure that utilization will be based on medical necessity and identify a specific geographic location where a Tribal Evaluation and Treatment facility will be built. The TCBHAB is made up of membership from each of the five regions that align with the HCA Office of Tribal Affairs Regional Service Areas (RSA). The five regions are made up of the Tribes and Urban Indian Health programs in each region. AIHC supports the TCBHAB by: •

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Facilitating twice weekly workgroups to update on – ○ Crisis response protocols template; ○ Policies for designated crisis responders; and ○ Process improvements between tribal providers, police and hospitals Hosting and preparing templates for the TCBHAB and 988 Tribal Subcommittee, currently focused on – ○ Providing feedback on a statewide assessment of the crisis response system; and ○ The technical and operations plan for 988 implementation across the state

Additionally, the HCA supports the TCBHAB by: • • • • • •

Providing support for the facilitation of the upcoming Technical and Operational Plan Roundtable on April 20, 2022 with related Tribal Consultation in September and the roundtables on the Comprehensive Assessment through 2022 with Tribal Consultation in December 2022; Development of internal and external processes and statement of work for Tribal Designated Crisis Responders (DCR) funding and data collection; Participation on meetings with AIHC and Tribes to update the Crisis Protocols template; Support for upcoming presentations on the Indian Behavioral Health Hub and the Native and Strong Lifelines with AIHC and the Department of Health (DOH) at national and local conferences; Support of Volunteers of America (VOA) hiring activities to staff the 24/7 Native and Strong Crisis Line and presentations to communities on the launch of the 988 National Suicide Prevention Lifeline, including hiring of new staff for the Indian Behavioral Health Hub; and Support of AIHC and HCA-OTA to attend meetings with Arizona crisis programs to learn information about their system including attending with WA State legislators Senator Dhingra and Representative Orwell.

10 Northwest Portland Area Indian Health Board www.npaihb.org

988, National Suicide Prevention Lifeline As noted above, both AIHC and HCA, will play an integral role in supporting WA Tribes in the technical and operational plans for 988, or National Suicide Prevention Lifeline rollout beginning this summer. In 2020, Congress designated the new 988 dialing code to operate through the existing National Suicide Prevention Lifeline’s (1-800-273-8255) network of over 200 locally operated and funded crisis centers across the country. • • •

On July 16, 2022, the U.S. will transition to using the 988-dialing code, and it is a once-in-a-lifetime opportunity to strengthen and expand the existing Lifeline. 988 is more than just an easy-to-remember number—it’s a direct connection to compassionate, accessible care and support for anyone experiencing mental health-related distress – whether that is thoughts of suicide, mental health or substance use crisis, or any other kind of emotional distress. Community members can also dial 988 if they are worried about a loved one who may need crisis support.

The Northwest Portland Area Indian Health Board’s suicide prevention project, THRIVE (see: www.npaihb.org/thrive), has partnered with the Indian Health Service (IHS), tribes, and tribal organizations across Indian Country to write up a description of what the 988 direct 3-digit mental health emergency resource is and how it can affect Tribal Nations and Communities. This resource will be updated and re-circulated as the 988 line and partners answering the calls evolve and looks forward to supporting NW Tribes with this resource to meet community where they are.

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Loved Here, Safe Here: Promoting Youth-Friendly and Non-Stigmatizing Sexual Health Messaging Celena J. Ghost Dog, MPH, CPH (Dine/Navajo) WYSH Project Manager

Safe, inclusive, and welcoming spaces are critically important for 2SLGBTQ (Two Spirit, lesbian, gay, bisexual, transgender, and queer/questioning) community members. A safe space is a place, program, or community that is intentionally working to affirm 2SLGBTQ identities. For many Native youth, having the knowledge that 2SLGBTQ allies exist across their tribal community can help create a welcoming and safe environment. Creating welcoming spaces is a continual process. It requires accountability and buy-in from everyone who creates the space and accesses it. There are several ways to create welcoming spaces, especially in the clinical and educational environments. With that in mind, the Adolescent Health Team at the Northwest Portland Area Indian Health Board (NPAIHB) has created a campaign around health promotion materials to affirm 2SLGBTQ youth in clinical settings, tribal schools, and community programs. These health promotion materials are for tribal clinics and those who engage with Native youth (such as health educators, teachers, advisors, counselors, coaches, youth recreation staffers, etc.) to support and provide an affirming environment for 2SLGBTQ youth. The campaign materials – Loved Here, Safe Here. – were designed in collaboration with AI/AN LGBTQ and Two Spirit community members and can be posted, printed, or shared with your networks. You can read more on our one-pager document, Click here! Safe Spaces Poster The health promotion materials are designed for both online and in-person spaces, including 30-second PSAs, social media materials, and printed social marketing campaign materials. All of these materials can be found online to download and use, Click Here! When navigating to the location, notice you’ll need to click on the last menu tab on the left once you land on the site. You can see it in this screen grab indicated by the green dot.

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Social Media Materials Digital packets include background images for Zoom, TikTok, and Google Classroom, plus pre-packaged social media graphics and posts for Facebook and Instagram. Printed Social Marketing Campaign Materials The Adolescent Health Team will send printed materials to the 43 Northwest tribes. Shipments will include complete – Loved Here, Safe Here. – packets, including posters, window clings, and magnets, in addition to temporary tattoos, enamel pins and stickers.

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These materials are also available online for printing on demand – Click here to download and share with your local printers! Tips for using these campaign materials in Tribal communities: • •

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Hang posters in Tribal service buildings, such as: health clinics, gyms, administration buildings, schools, local stores, and businesses. Hand out the temporary tattoos, stickers, magnets, and enamel pins at school or community events and health fairs. Have them available in clinic waiting rooms or place them in information packets provided to patients. Download the materials from the NPAIHB website and post them on your Tribe’s website or social media pages. Promote the materials during Health Observances and holidays, such as May – Teen Pregnancy Prevention Month; or June - PRIDE Month, etc.

We appreciate your feedback: Please share how you’ve used the materials in your community, by taking this 5-minute Survey: Click Here! For more information or to request a packet for your community, contact Celena Ghost Dog at cghostdog@ npaihb.org, www.npaihb.org/wysh Thank you to our funders: • • • •

GYT Poster

Minority HIV/AIDS Fund (MHAF) through Indian Health Services (IHS) The Office of Public Affairs (OPA) through U.S. Department of Health & Human Services (DHHS) Artwork by: Ameyalli Mañon-Ferguson, she/her, Osage/Mazahua and Dove Little Home, he/they, Two-Spirit, Sapphic Multiracial Indg-Amskapi Piikani Blackfeet, Rocky Boy & Little Schell Cree Angelino A. Celebrating Our Magic: Resources for American Indian/Alaska Native transgender and Two-Spirit youth, their relatives and families, and their healthcare providers. Seattle Children’s Hospital Center for Diversity and Health Equity, Northwest Portland Area Indian Health Board; 2019

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Happy, Safe, and Healthy Mother’s Day Tyanne Conner, MS Native Boost Project Coordinator

With Mother’s Day coming soon, we want to provide the most up-to-date information about COVID-19 illness and prevention that affects those who are pregnant or breast/chest* feeding. Protecting mothers and our future generations is extremely important. In honor, we want to share with you what we know about pregnancy, breastfeeding, and vaccines in the era of COVID-19. We wish for all** people to be safe and healthy in these uncertain times. To that end, we want to provide useful vaccine-related information so that each person may make the best and most informed decision for themselves and their families. American Indians and Alaska Natives have been negatively affected by COVID-19 at disproportionate rates compared to non-Natives, and while Tribes have done great work to reduce the spread and to distribute vaccines, there is still work to be done to safeguard our communities. To protect the most vulnerable including mothers, babies, elders, and others with serious health conditions, we must make sure each of us does everything we can. The safest and best way to do that is by making sure that all eligible people are up to date with COVID-19 vaccines including children who are eligible for vaccination because they can carry the illness and spread it to others. Vaccines are one of the most studied, regulated, and safest medical interventions ever created. Increased safety monitoring has been put into place for all COVID-19 vaccines including monitoring for those who are pregnant. The FDA has stated that for currently available COVID-19 vaccines, there are no contraindications for those who are pregnant or breastfeeding. In fact, antibodies generated from the vaccine have been found in both breast milk and umbilical cord blood. This means that immunity from the vaccine is passed from mother to baby, giving baby the best possible chance at good health. One study found that “maternal completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy was associated with reduced risk for COVID-19 hospitalization among infants aged <6 months.” It has been shown that COVID-19 infection is associated with increased risk of maternal mortality or serious morbidity. Pregnant people with COVID-19 are more likely to experience severe illness, be in the intensive care unit, ventilated, or to die than those who are not infected. Though it is rare, it is possible for babies to get COVID-19 through the placenta, during or after birth. For these reasons, it is especially important to provide accurate vaccine information so that those who are pregnant or who intend to become pregnant came make informed decisions.

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Understanding vaccines arms us with the information we and our communities need. Messenger RNA or mRNA vaccines DO NOT contain the live virus so CANNOT give someone COVID-19. Viral vector vaccines like the Johnson & Johnson (J&J) vaccine also DO NOT contain the COVID-19 virus and thus cannot make us sick with COVID-19. In response to questions whether vaccines are safe for those who are pregnant, the World Health Organization (WHO) states, “COVID-19 vaccines approved for use by WHO can be taken by people who are menstruating, pregnant, trying to get pregnant, or breastfeeding.” V-safe, a smartphone-based tool that prompts an online health check-in by answering simple questions after vaccination helps us gather more information on safety of vaccines. Pregnant people who have been vaccinated are highly encouraged to participate. Vaccinated pregnant people also may choose to enroll in a registry that gathers more information about their experiences. As of early April 2022, more than 210,000 people have enrolled in the registry and the more who register, the more safety information can be gathered. MotherToBaby, a trusted source of information about medications and other exposures during pregnancy and breastfeeding, includes information regarding COVID-19 exposure, and vaccine safety during pregnancy. More information from the FDA on vaccines currently available can be found here. As after most vaccines, some mild side effects are possible, but those go away within a day or two. It takes time for the immune system to protect us after vaccination and that is why we must continue to use protective measures such as distancing, wearing face coverings, washing hands, monitoring for symptoms and getting vaccinated. We recommend the following precautions, based on the data and research to date: • • • • • • • •

Get the COVID-19 vaccine as soon as you can. Get up to date with all vaccines. Maintain physical distance. Keep connected to your family and community, but please do so in a way that is safe. Wear a mask at all times when out in public and when with others who are not from your household. This is true even after vaccination. Wash hands frequently with soap and water, or an alcohol-based hand sanitizer that has at least 60% alcohol if no water is available. Monitor for symptoms of COVID-19 including fever, shortness of breath, and aches, and new loss of taste and smell. Please be aware that many illnesses have the same symptoms as COVID-19 so we must be diligent to prevent against spread. It is also possible to spread the virus even if you have no symptoms. COVID-19 tests are widely available for free. Order your free home test kits here. Check in with your medical provider if you have questions or concerns.

Because there is no way to know who will get severely ill from a COVID-19 infection, it is extremely important to protect those who are vulnerable by doing everything we can to guard against this disease. Future generations are depending on us to create a safe path through this pandemic and we have the strength, resilience, and vision to be able to do it in a healthy, positive way! Happy Mother’s Day! * Chest feeding refers to feeding your baby milk from your chest and recognizes the diversity of parenting experiences. ** We recognize that not all people who are pregnant or breastfeeding identify as female or as mothers and we wish to honor all people who are carers of babies and children.

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Spotlight on Shoshone-Bannock Tribes Tyanne Conner, MS Native Boost Project Coordinator Tribes around the Northwest have been doing great work throughout the pandemic to keep their communities safe, to keep up good spirits, and to continue traditions of caring for others. We want to highlight member Tribes that are using their passion, creativity, culture, and knowledge to serve others in their area and beyond. Recently, the Shoshone-Bannock Tribes created a TikTok contest for Fort Hall youth under the age of 24 to inspire messages of good health during the pandemic. Using the hashtag #stayfitforthall, submissions show a wide range of ways to stay healthy. Check out the details below. BE RESILIENT TIKTOK Challenge Contest It’s time to “Be Resilient” and have some fun with a TikTok Challenge for our Tribal youth ages 24 and under. How are you staying healthy and resilient during the pandemic? Maybe you’re exercising, or choosing to get your COVID-19 vaccine before powwow season. Or perhaps you’re using humor and healthy food to stay strong. Whatever your “Be Resilient” is, we want you to create a TikTok video and share with us. Have some fun and use #StayFitFortHall in your original video. Then it’s time to enter the contest - submit your entry at https://shobanhealth.shortstack.page/Rj6wWW for a chance to win a new PlayStation 5 console, gift cards, select game, and a beaded medallion. Send your friends and family to that same website to vote for their favorite video, hopefully yours. The contestant with the most likes on this contest page before April 15th at 5PM MST will win. Additional rules apply, please visit the official contest site for more details. Good luck youth, and let’s show how fun healthy can be! Enter the “Be Resilient” TikTok Challenge official contest at: https://shobanhealth.shortstack.page/Rj6wWW You won’t want to miss these incredible submissions! You can find them at tiktok/shobantribes. Give them a follow and keep up with their future happenings as well! TikTok isn’t the only way they share good news and helpful messaging. Check out their Instagram, Facebook pages and Youtube videos for some great messaging as well! For more information, you can reach Randy’L Teton Public Affairs Manager/C19 Communications at rteton@sbtribes.com and Mike Stone, owner of Sunflicker LLC at mike.stone@sunflicker.com.

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Rising rates of syphilis and congenital syphilis: a danger to future generations Eitan Bornstein, MD

Jessica Leston, MPH

Ashley Hoover, MPH

Epidemic Intelligence Service Officer (EISO)

Clinical Programs Director

Communicable Disease Epidemiologist

Syphilis is a sexually transmitted infection (STI) that has been long nicknamed “The Great Pretender,” as its symptoms change over time and it can mimic many other diseases. Many thought “The Great Pretender” was nearly eliminated in the US as antibiotic treatment was widely available since the 1940s. Doctors, nurses and other clinical staff studied syphilis in textbooks, but were not seeing many cases in their practice. However, over the past decade, cases of syphilis began to re-emerge. According to the CDC, between 2014 and 2020 the national rate of total syphilis cases increased 175% (14.8 to 40.6 per 100,000). In 2020, the rate of reported new syphilis cases among American Indian and Alaska Native (AI/AN) persons was nearly four times the rate among non-Hispanic White persons (26.9 versus 6.9 cases per 100,000 population, respectively). The rate was particularly alarming for AI/AN females, at over seven times greater than the rate among nonHispanic White females (21.3 to 2.9 per 100,000). It is important to note that these higher rates are not caused by race, ethnicity or heritage, but by social conditions including those who have trouble accessing quality sexual health services, distrust of healthcare systems, fear of discrimination and negative feelings around testing and treatment for STIs.

* Per 100,000 | National Overview - Sexually Transmitted Disease Surveillance, 2020 (cdc.gov)

* Per 100,000 | National Overview - Sexually Transmitted Disease Surveillance, 2020 (cdc.gov) NPAIHB 21

Syphilis can spread from a mother to her unborn baby, referred to as congenital syphilis (CS). Congenital syphilis can be devastating, causing miscarriage (losing the baby during pregnancy), stillbirth (a baby born dead), prematurity (a baby born early), or death after birth. Congenital syphilis can also cause deformed bones, severe anemia (low blood count), enlarged liver and spleen, jaundice (yellowing of the skin or eyes), brain and nerve problems, including blindness or deafness, meningitis, and skin rashes. It is possible that a baby with CS won’t have any symptoms at birth. But without treatment, the baby may develop serious problems. Usually, these health problems develop in the first few weeks after birth, but they can also happen years later. Babies who do not get treatment for CS and develop symptoms later or can die from the infection. They may also be developmentally delayed or have seizures. When CS occurs, it is a marker of a significant amount of syphilis spreading in the larger community. Communities in Indian Country are unfortunately experiencing this first-hand, and some are now facing high rates of syphilis and CS. Nationally, from 2016 to 2020, the rate of reported congenital syphilis increased over 400% among AI/AN babies (37.7 to 190.6 cases per 100,000 live births).

Why is syphilis a problem? While there is easy and effective antibiotic treatment available to cure syphilis, if you don’t know you have syphilis and aren’t treated, it can be passed on to sexual partners and cause serious health problems. Syphilis can present in several stages. The first or primary stage pf syphilis is often a small, painless sore on the genitals, called a chancre. It may not be noticed as it typically resolves even without treatment. Most patients who seek medical care for syphilis do so during the secondary stage several weeks later. During the secondary stage, symptoms might include a non-itchy rash on their palms and soles, sores called mucous patches in the mouth, vagina or anus, fever, swollen lymph nodes, sore throat, patchy hair loss, headaches, muscle aches, weight loss, or fatigue. Left untreated, syphilis can cause hearing issues, paralysis, blindness, dementia and even death in later stages sometimes 10-30 years after the person’s initial infection. A pregnant woman can pass syphilis to her child during any stage of infection and at any trimester of pregnancy. However, the risk of transmission is highest if the mother has been infected recently. Up to 40% of babies born to mothers with untreated syphilis (if infected within four years prior to delivery) will be stillborn or die in infancy.

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What can be done to address rising cases of syphilis? Screening: •

More people need evaluation and screening for syphilis, including: ○ Anyone with symptoms, or a partner with symptoms ○ All pregnant women when they learn about their pregnancy, at 28 weeks and at their delivery ○ Women who experience a stillbirth after 20 weeks of pregnancy ○ People who are incarcerated ○ People who use drugs ○ People who exchange money or drugs for sex

•

Newborns should not be discharged from the hospital unless the mother has been tested for syphilis at least once during pregnancy and at time of delivery Consider using rapid testing for: ○ People experiencing houselessness ○ People accessing the Emergency Room or Urgent Care ○ Local screening events

•

Know more about rates of syphilis in your community: • •

Coordinate with tribal health departments, regional tribal epidemiology centers, local and state health departments to get information about new cases of syphilis – this is a notifiable condition Hire and train public health team members to assist with testing, contact tracing, case management and treatment of those with syphilis and their partners

Engage local medical providers: • • • • •

Ensure access to antibiotic treatment for people diagnosed with syphilis Make syphilis screening and sexual health visits routinely available Expand condom distribution campaigns Treatment should be offered to anyone who reports sexual exposure to someone with syphilis, even in the absence of signs or symptoms of infection While clinicians should test people exposed to syphilis, treatment should not be withheld while awaiting test results

To better protect tribal communities and future generations it is important to offer safe, supportive and judgement-free prenatal and sexual health care that readily offers these screening, treatment and prevention methods. For more information please visit: Works Cited: The Facts - Syphilis (cdc.gov) National Overview - Sexually Transmitted Disease Surveillance, 2020 (cdc.gov) STD Facts - Syphilis (cdc.gov) Increasing Congenital Syphilis in Oregon Health Advisory: Increase in Syphilis Cases among Heterosexuals living Homeless & Identification of Congenital Syphilis in King County and Washington State – January 25, 2021

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Community Health Aide Program (CHAP) Implementation in the Portland Area Continues Despite Federal Challenges Christina Friedt Peters, MJ Tribal Community Health Provider Project Director

CHAP Education Programs We’ve had a busy quarter with our tribal and education partners. The Dental Health Aide Therapy (DHAT) education program at Skagit Valley College received their Commission on Dental Accreditation (CODA) site visit in February. The visit went well and we anticipate accreditation of the program this summer. If accreditation is granted, we will begin accepting students in the fall of 2022. Dental Health Aide (DHA) education at the level of Primary Dental Health Aide is now available through NPAIHB. Courses can be incorporated into existing tribal high schools or offered at tribal community locations, as well as in partnership with Tribal health clinics. Please contact Pam Ready, Dental Health Aide Education Manager, at pready@npaihb.org to learn about partnering with NPAIHB to offer DHA courses or to request this education for your community members. The Behavioral Health Aide (BHA) education programs at Heritage University is preparing to accept their next cohort. Students at the Northwest Indian College (NWIC) BHA education program are half way through their first year. Lummi Nation, Confederated Tribes of Umatilla Indian Reservation, NPAIHB, and NWIC have laid the foundation for development of a Community Health Aide (CHA) education program. Project staff have offered learning sessions to NW Tribes about this new health provider role and we are excited for the expansion of CHA education in the coming years. We will be working on the standards and procedures and the curriculum with the Tribal Community Health Provider Advisory Workgroup. If you are interested in joining this workgroup, please contact Sasha Jones, CHAP Project Manager sjones@ npaihb.org DHAT SPA Consultation CMS hosted a tribal consultation on January 12th to solicit feedback from tribal leaders on the proposed use of an 1115 demonstration waiver amendment to facilitate Medicaid reimbursement for services provided by DHATs working in tribal health programs. CMS was proposing this as a potential solution after denying the Washington State Plan Amendment to include DHATs as a reimbursable provider. That denial is still pending a decision in the Ninth Circuit Court of Appeals. Washington Tribal leaders spoke out overwhelmingly against the 1115 waiver because it did not honor tribal selfdetermination and sovereignty and did not support the long-term expansion of CHAP in our area.

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National and Area CHAP Certification Boards The Portland Area CHAP Certification Board had its 5th meeting split over two days in February and March. The Dental Academic Review Committee (DARC) had its first meeting and the Behavioral Health Academic Review Committee (BARC) is set to have its first meeting on Tuesday, April 26th from 12:30pm – 2:30pm. For questions about the DARC or BARC, please contact Tanya Firemoon tfiremoon-contractor@npaihb.org The PACCB will be certifying the Portland Area CHAP education programs over the course of 2022. The NPAIHB staff, PACCB, and Portland Area IHS Staff continue to work closely in partnership to figure out a solution for certification of CHAP providers in the Portland Area. The National Certification Board Charter will be reviewed by the IHS Community Health Aide Program Technical Advisory Group (CHAP-TAG). The next CHAP TAG meeting is Tuesday, April 26th from 9:30 am-12:30pm.

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New Faces Naomi Jacobson Quileute Tribe Training & Outreach Manager

Hello, I’m Naomi Jacobson, a member of the Quileute Tribe and I’m pleased to join NPAIHB TEC as the Training and Outreach Manager. Over the course of my career, I have worked in various leadership roles within my tribe, mainly in the areas of prevention and intervention services. I was elected to two consecutive terms on my Tribal Council, serving from 2011-2017. Having a background in Organizational Leadership, I have a passion for planning and developing programs to reach people near and far. I have 5 children and 4 grandchildren and when I am not spending time with the family, my self-care includes spending time at the barn with the horses. Kelly Walker Confederated Tribes of the Colville Reservation; South Okanagan Tribe; Penticton Band of the Okanagan Tribe of Canada BRFSS Interviewer Kelly Walker is from of the Confederated Tribes of the Colville Reservation, South Okanagan Tribe, and the Penticton Band of the Okanagan Tribe of Canada. She is a third generation Portland Urban Indian. As an undergraduate, Kelly studied Native American history and history of the west. Kelly is a librarian and currently works in academic libraries, with prior experience in public libraries. She enjoys creating programming and outreach that centers Native voices and experiences and doing her part to decolonize libraries. Andrew Shrogen TCHP Project Technical Operations Director

Greetings! My name is Andrew Shogren (he/him) and am familiar to many of you! It is an honor to join the NPAIHB team as the Tribal Community Health Provider Project Technical Operations Director. I have served as the COO and Health Policy Director for didgwalic Wellness Center (Swinomish), the Tribal Health Clinic Director for the Suquamish Tribe and the Health Director for the Quileute Tribe. From sunny San Diego, I graduated with a Master of Public Health, Health Service Administration from San Diego State University. And from rainy Seattle, I hold a Juris Doctorate from the University of Washington School of Law and a Bachelor of Arts Political Science from the University of Washington. As the former chair of the NPAIHB CHAP Advisory Workgroup, I know we are committed to the success of this project. I want to thank the Workgroup for all the work that we’ve done to ensure the success of the Portland Area CHAP Certification Board and am humbled to be able to continue this work for you. My family lives on a small farm in the magnificent North Olympic Peninsula between the Strait and the mountains. We have sheep, a goat named Melvin, and chickens. NPAIHB 26

New Faces Kimy Peterson Squaxin Island Tribe BRFSS Interviewer

My name is Kimy Peterson (She/Her/Hers), I’m a member of the Squaxin Island Tribe and I grew up with my family in Skokomish, WA. I currently work as a Data Technician for the Squaxin Island Tribe’s Natural Resources Department, previously worked for the Squaxin Island Health Clinic, and have a background in social services case management. I’m passionate about behavioral determinants of health, psychology, and public service and am currently preparing to go to graduate school to further my training in research. Outside of work, I love to play and watch rugby, make art, and I spend a lot of my spare time hiking with my husband and dogs. I’m excited to be working remotely for NPAIHB’s EpiCenter as a BRFSS Interviewer/Data Entry Clerk for the next few months! Lela Rainey Brown Environmental Health Specialist

Lela Rainey Brown (they/them) works to restore the ecological balance of the land by providing solidarity and resources for indigenous and other cultural people. Lela holds an MPH in Environmental Systems and Human Health from OHSU and a BA in Community Development from Prescott College, focusing on environmental justice, collaboration across knowledge systems, and improving ethics in public health. With a background in commercial plumbing and outdoor education, Lela has worked in many aspects of environmental health, including lab research, food systems, policy, emergency management, and community engagement. Lela loves growing plants, traditional stories, spending time in nature, and making things by hand. Dolores Jimerson Behavioral Health Clinical Specialist

Hello! My name is Dolores Jimerson - originally from the east where I grew up an urban Indian, reared traditionally Seneca, bear clan in Little Italy (resonating with my Italian/Irish mother.) I now live on the Olympic Peninsula where it seems “it’s always Twilight”. I’m so excited to join NPAIHB as we develop behavioral health programming to support tribes in meeting their needs. My lived experience pairs nicely with my three plus decade career of working in behavioral health from service provider to policy maker in PA, WY, OR and WA. Previous national level work included serving as Director of Community Development for NICWA. I’m a caregiver and community organizer at heart who is passionate about creating services that resonate with re-membering us into our greatness. I retain my LCSW in both WY and OR along with being a certified Acudetox Specialist (ear acupuncture) and Registered Trainer. You can find me gardening, beach combing, traveling, writing, or serving as comedic muse when I am not working. NPAIHB 27

New Faces Alyssa Farrow Confederated Tribes of the Cayuse, Umatilla, and Walla Walla Special Projects Coordinator My name is Alyssa Farrow and my traditional name is Eesamoolamaxsh (Little Black Bear). I am a member of the Confederated Tribes of the Cayuse, Umatilla, and Walla Walla peoples. I graduated from Stanford University in 2020 with a BA in Psychology with a Health and Development specialization. Growing up on the Umatilla Indian Reservation, and experiencing life throughout Indian Country, I became increasingly passionate about empowering and promoting the health and wellness of Native people. I enjoy spending my time with my dog, Sonny, gathering my traditional foods, traveling, and adventuring outdoors. I’m thrilled to join NPAIHB as the Special Projects Coordinator and look forward to working with and for the tribes of the Northwest. Michelle Harris Accounts Receivable Specialist

I was born and raised in Portland, Oregon. I received an AA in Accounting and Finance from Portland State and studied language in Pankow- Berlin Germany at Humboldt University. I’ve been in the accounting field for quite some time and had the pleasure of working for a few great local companies such as The Oregonian Publishing Company for about eleven years. Also, I have been a Foster Parent for two lovely siblings who are now 18 and 19 and I mentor a Little Sister from the Big Brother Big Sister program. When I’m not working you can find me enjoying The Gorge or playing somewhere in the great Northwest. I greatly appreciate and look forward to this exciting opportunity to work with you! Kari Kuntzelman Chickasaw Nation DHA Education Specialist

Chokma! (Hello). My name is Kari Kuntzelman and I am a member of the Chickasaw Nation. I am married to my husband, Aaron, and I have a 2 year old daughter, Eden (we also have an 8 year old dog and cat). We live in Estacada, Oregon where we moved to in January 2020. I have been a practicing Dental Therapist since graduating from the Alaska Dental Therapy Education program in 2019 and am extremely passionate about oral health and minimally invasive approaches. I am the president of the American Dental Therapy Association and a member of the Oregon Rules Making Committee for Dental Therapy. I am excited to join the NPAIHB team and to be a contributing factor in helping improve our peoples quality of life!

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New Faces Jerico Cummings Chayenne River Sioux Tribe National Evaluation Specialist

Jerico Cummings (he/they), is a member of the Cheyenne River Sioux Tribe and grew up in Rapid City, SD. When they graduated high school, Jerico made the move to Bozeman, MT where they studied Sociology with a minor in Native American Studies at Montana State University. They are most passionate about bringing people together to share lived experiences, learn from one another through storytelling and monologues, and inspiring young leaders via the exploration of labels and their meanings as one develops a strong sense of self and their identity. Jerico is most excited about exploring Oregon and nearby Washington with their dog, and is really looking forward to being a part of meaningful change in the lives of Indigenous folks while embarking on this new journey with NPAIHB. Courtney Tallis Navajo Nation BRFSS Interviewer

My name is Courtney Tallis and I’m from the Navajo Nation in Northern Arizona. I am currently living in Spokane WA working with a non-profit company, collecting blood for the hospitals in the area. For the last 6 years I have traveled all over Western Washington, Northern Idaho and Western Montana. I love to read history books about prominent leaders, military and medicine. My favorite thing to do in Spokane is get some coffee and walk the downtown area. My favorite thing to do with friends is prepare a Navajo Taco dinner and talk. I’m also very interested in teaching cultural arts and crafts from my Navajo Tribe and learning from the Native Tribes in the area.

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New Faces (Interns & Partners) Ahnna Whykoff Klamath Tribes NDTI Communications Intern

I’m Ahnna Wyckoff (she/her) and I am the new NDTI Communications Intern! I’m a descendant of the Klamath Tribes and have grown up in Salem, Oregon, where I currently live. I’m a fourth year student at the University of Oregon majoring in public relations with a minor in sustainable business, and am graduating this June! I’m so excited to be a part of this team and help increase online engagement for the Native Dental Therapy Initiative. Sonya Oberly Nez Perce Tribe Communications Specialist; CDC Foundation Employee

Sonya Oberly has worked in the field of digital media for over 15 years. Sonya attended the University of Nevada completing a Bachelor’s Degree in Psychology. She worked in the counseling field until pursuing graduate studies. In 2009, she earned her MFA degree in Film and Television Production from the University of Southern California. Most recently, she worked in the Nez Perce Tribe’s education department. Sonya is Nez Perce, Comanche and Osage.

30 Northwest Portland Area Indian Health Board www.npaihb.org

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2121 SW Broadway • Suite 300 • Portland, OR 97201

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NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD APRIL 2022 RESOLUTIONS 22-04-06 Oregon Buys #S-44300-00001806/OHA RFGP 5328: Tribal Community Health Provider Project 22-04-06 Support for the Northwest Tribal Epidemiology Center’s Application for CDC Tribal Epidemiology Centers Public Health Infrastructure Funding 22-04-06 Support for the Northwest Tribal Epidemiology Center’s Application for CDC Tribal Epidemiology Centers Public Health Infrastructure Funding

Photo credit: E. Kakuska Dancing in the Square Powwow 2018