Aberdeen Area Model Diabetes Programs

Fort Berthold Model Diabetes Program
Fort Totten Model Diabetes Program
Whirling Thunder Wellness and Diabetes Programs
Omaha Tribe of Nebraska, Four Hills of Life Wellness

Fort Berthold Model Diabetes Program
New Town, North Dakota

Erna Granbois, RN, MSN
Nurse Educator/Coordinator
erna.granbois@ihs.gov

Minni-Tohe Health Center
1 Minne-Tohe Drive
New Town, North Dakota 58763
Phone: (701) 627-7925
FAX: (701) 627-3913

Program Description

Located in New Town, North Dakota, serves the Three Affiliated Tribes (Mandan, Hidatsa, Arikara) who reside on the Fort Berthold Indian Reservation. Program began in 1990, sponsored by the Indian Health Service. Community and clinical focus. Staff includes: fitness director, registered dietitian/Certified Diabetes Educator (C D E), medical clerk and nurse educator/coordinator.

Data & Epidemiology

• Number of diabetes cases as of 4/01/00 - 507, population base-6500
• During Fiscal Year (F Y) 1991 and F Y 1995, staff assisted in data collection for the American Indian school children height and weight survey. Survey results published in the 8/93 I H S provider.

Clinical Accomplishments

• Partner with the Tribal dialysis unit to provide pre-renal clinic
• Nutrition and exercise classes, assessments for nutrition and fitnesscator/Coordinator,
• Diabetes support groups
• Self-blood glucose monitoring program
• Diabetes optometry clinic
• Diabetes foot clinic
• Provide diabetes screening in all communities
• Provide diabetes education to people with diabetes and family members.

Community Activities

• Participation in diabetes activities on the local, state, regional and national level
• Fort Berthold Diabetes Program Advisory Board, meets quarterly, composed of Tribal and I H S staff and community members
• Cooking classes/grocery store tours, menu planning for area schools and Tribal programs
• Assisted in Community Health Representative training
• Provide services in all outlying communities of Fort Berthold
• Fitness Activities Director is member of the N D Prairie Rose State Games Board.

Education Programs

• Provide diabetes in-service/education to professional, para-professional and community
• Nutrition news radio spots, available in I H S National Diabetes Program resource clearinghouse
• Provide diabetes related news spots on the local radio station
• Provided education through "Diabetes Bingo"
• Participate in area school health fairs.

Resource and Product Development

• Developed protocol for self glucose monitoring program
• Provide news spots for local radio stations

Challenges

• Space Small area for exercise room, lack of space to provide group activities at the main health center and in the communities
• Distance Large distances between communities, involves a lot of travel time
• Funding The yearly recurring base does not meet the needs of staffing and program implementation. The current funds only allow one trip to each of the six communities. If it were not for the Diabetes Special Initiative Funds, we would not be able to provide a self glucose monitoring program or the diabetic optometry and foot clinic.
  
  
  

Fort Totten Model Diabetes Program
Fort Totten, North Dakota

Karen Frohlich, Coordinator
P H S Indian Health Center
P. O. Box 309
Fort Totten, North Dakota 58335
Phone: (701) 766-1600
FAX: (701) 766-1620
E-mail: Karen.Frohlich@ihs.gov

Program Description

Clinical

• The clinical physicians continued to provide services for Diabetes Clinics 2 times/month on a rotating schedule
• Monthly optometry clinics for people with diabetes
• Family Nurse Practitioner position filled September 1999.

Community

• Worked with the Diabetes Fitness Program (Diabetes Grant Money) providing 2 community Diabetes Workshops. (1/99 & 10/99)
• Diabetes Walk/Run in partnership with Diabetes Fitness Program
• Diabetes Alert Day: Community blood sugar screening & health fair
• CHR training in Grand Forks in partnership with University of North Dakota School of Nursing
• Other community awareness events include partnerships with headstart, Tribal Law Enforcement, Elderly Meals, Four Winds School, Tribal W I C program, and Expanded Food & Nutrition Education Program
• Radio spots for Public Service Announcements, Eldersly Meals, Four Winds School, Tribal W I C program,
• Community diabetes screening with Public Health Nursing.

State and National Activities

• Presentations (2) at the annual North Dakota American Diabetes Association meetings
• Poster sessions (2) for the Diabetes in American Indian Communities conference, Albuquerque, New Mexico.
  

Administration

• Workshop on Telephone Triage for clinic and other Health Program Staff
• Participation in Aberdeen Area I H S Diabetes Peer Review
• Sponsored inservice program on Staged Diabetes Management for clinic staff
• Developed Staged Diabetes Training workshop for clinic staff and Community Health Programs
• Organized C P R training for the clinic staff to comply with J C A H O Standards
• Annual comprehensive diabetes audit
• Successful recruitment of a Family Nurse Practitioner to clinic staff
• Participation in annual Aberdeen Area Diabetes Meetings
• Program dietitian, Karen Frohlich, received Ruggles Stahn Award for Diabetes Education & Management
• Working with clinic nurses in developing and distributing a monthly newsletter for the Community
• Annual reports for Aberdeen Area
• Working with Aberdeen Area Office on Government Performance Results Act (G P R A) measures.
  
  

Whirling Thunder Wellness Program
Winnebago, Nebraska

Rose Shindelbower, R N, B S N, Coordinator
P O Box 487
Winnebago, Nebraska 68071
Phone: (402) 878-3187
FAX: (402) 878-2819
E-mail: upwellness@huntel.net

Program Description

Established as an I H S Model Diabetes Program site in 1979, Winnebago Tribe of Nebraska contracted the program under P. L.93-638 in April 1995 creating the Whirling Thunder Wellness and Diabetes Programs. A multidisciplinary team, with 76 years of cumulative diabetes experience, includes physician assistant, two R N's, fitness director, dietician, prevention specialist, two fitness specialists, eye care manager and administrative manager. Four staff currently hold certification as diabetes educators.

Data/Epidemiology

• Winnebago diabetes incidence and prevalence rates are 7.7% and 8.8% times the U. S. all-race rates, respectively
• Current diabetes registry totals 827
• Service population 3250; Winnebago Reservation & surrounding are include Sioux city, Iowa.
• Special registries track impaired glucose tolerance, gestational diabetes, at risk children, diabetes & hypertension, and all major complications
• Statistics complied annually to track Diabetes Standards of Careby I H S audit.

Clinical Services

Staged Diabetes Management and the I H S Diabetes Standards of Care are the adopted treatment models utilized in all clinics.

• Monthly endocrinology clinics
• Monthly ophthalmology clinics
• Weekly optometry clinics
• Twice weekly diabetes and podiatry clinics
• Weekly Wellness Center based evening diabetes clinic.

Secondary Prevention Programs

• Seniors on the Move
• Community Spot Checks
• Employee Health Screenings
• C H R Client Case Reviews
• 16 Hour Diabetes Education for each Drug Dependency Unit Client Cycle
• Weekly Diabetes Support Group
• Wellness Center based Walk-in Diabetes services.

Primary Prevention

• Adult Health Promotion - Six to eight week block format with themed activities, pre & post assessments
• On-going Adult Fitness programs; volleyball, basketball, circuit training, cardiovascular equipment, walking clubs, martial arts, pre & post natal exercise, low-impact aerobics, water exercise, PowWow Road Race, and PowWow Health Choice Food stand
• Youth Primary Prevention Programs -- Six week block format with specific themed activities, pre and post assessments included during after-school hours
• Summer Youth Primary Prevention programs -- Two week block format
  Pedaling to the Four Winds Sports Camp Kidz Café
• Hunt for the Lost Tribal Treasures Kidz Neat Treats Rock & Roller Blading
• Swimming Lessons & Open Swim Lifeguard Training

On-going Youth Primary Prevention Programs

• Whirling Thunder Youth Sports: cross-country, basketball, track & field, bowling,
  Ho-Chunk Summer Gardening Project
• " Teen Break" Talking Circle
• Junior & Senior High Bago Late Night
• Succeeding Spirit Incentive Store
• Acanthosis Nigricans Screening for diabetes risk.

Community Innovations

• Fall Harvest Celebration
• Memorial Sobriety Walk
• Healthy Choice PowWow Food Stand
• " Bison in Nutrition" intervention
• Mobilizing community volunteers
• Primary Case Management for Prevention
• Staff serve as adjunct faculty for Little Priest Tribal College
• Fitness staff requested by tribal leaders to manage swimming pool and design programs with health benefits for all ages
• Diabetes program staff requested by tribal leaders to coordinate Kidz Café to offer healthy menus and provide nutrition education.

Unique Program Contributions

• Multiple community, state and regional linkages
• Acanthosis Nigricans Screening: assessment of diabetes risk in children
• Specific concepts and program development regarding Dual Diagnosis of Diabetes and Substance Abuse
• Introduction of fitness director position to I H S M D P's
• Coordinated N I H funded grant titled "Obesity Prevention in Northern Plains Indian Children"
• M D P successes have resulted primarily from working in partnership with tribal leaders' vision for a diabetes-free future.
  
  

Omaha Tribe of Nebraska Diabetes Program
Macy, Nebraska

Debra Parker, M A, H P E R, C D E, Coordinator
Carl T. Curtis Health Education Center
P. O. Box 250
Macy, N E 68039
Phone: (402) 837-5381
FAX: (402) 837-5303
E -mail: dparker@macy.aberdeen.ihs.gov

Program Description

The Four Hills of Life Wellness Center is located in Macy, Nebraska. This P. L. 93-638 program includes a diabetes registry that currently serves 320 diagnosed patients (10% prevalence from the active service population of 3,200) and a tribal enrollment of 6,400. Facilities include the Wellness Center, community swimming pool and Nautilus gym. Diabetes team includes:

• Clinic services with a physician, podiatrist, R N and secretary
• Community outreach and prevention program includes L P N and 2 Prevention specialists
• Consultant Registered Dietitian.

Data/Epidemiology

• Diabetes care tracked with manual registries and R P M S
• Registries include diabetes, gestational diabetes, dialysis, opthamology/laser, amputation, H b A 1 c, self-blood sugar monitoring program
• Annual heights and weights of school children, ages 3-18
• Acanthosis nigricans screening of headstart through high school children and adolescents.

Clinical Services

• Diabetes clinic weekly
• Optometry clinic twice a month
• Cardiology clinic monthly
• Nephrology clinic weekly
• Opthamology clinic monthly
• Podiatry clinic weekly

Clinical Accomplishments

• Weekly meetings of diabetes and outreach teams
• Diabetes program policies and procedures
• Screening for diabetes in adults and prenatal screening for gestational diabetes
• Chart auditsl audit criteria; program planning
• Hemoglobin A 1 c monthly tracking system
• Diabetes flow sheet developed with educational component
• Provision of monitors and supplies
• Health maintenance guidelines (eye exams, P A P tests, immunizations, labs)
• Screening for acanthosis nigricans 3 years to 18 years
• Coordination with Tribal grants to help diversify and improve diabetes care and prevention programs. Some examples include:
  " Dreamcatchers-Out of the Classroom and into the Community"
  Grant for interdisciplinary training for diabetes care
  State of Nebraska Family Preservation Grant--teen pregnancy prevention
  Special Diabetes Grant Program for American Indians
  Nebraska Native American Public Health Act Grant

Community

• Fitness center equipped with full (over 10) nautilus gyms, treadmills, and bikes
• Youth mentoring program; high school youth mentor K-4 in nutrition & physical activity
• Summer wellness camp for youth
• Diabetes prevention fitness activities at PowWow and other community events
• Cholesterol screening and blood sugar screening at casino, tribal offices, health center, Senior center, and on request
• Walk-in educational visits at home or at wellness center
• Buffalo appreciation dinner
• Coordination with public school Title 9 program: Tribal elders work with youth to teach cultural skills and healthy lifestyles
• Goal is to be partly staffed within the new Macy public school (2 years).

Education

• Cooking demonstrations with food and drink samples (no fat or sugar items)
• Smoking cessation & drug prevention activities
• Individual counseling
• Inservices and training available to clinical staff
• Developing comprehensive school health curriculum, with diabetes education & wellness component.

Resource Development

• Prevention and Control Pamphlet
• Developing a snack cookbook for the youth.

Challenges

• Staff turnover
• Lack of volunteers for youth programs
• Vandalism and theft, especially in fitness facility.