When the National Advisory Committee on Rural Health and
Human Services (NACRHHS) was looking for a location to
learn about the realities of child poverty, it had to
look no further than the home of committee member Barb
Fabre. Mahnomen, Minnesota is at the heart of the White
Earth Indian Reservation.
At the September
meeting of NACRHHS, committee members heard from
healthcare and human services professionals from across
the region about the needs of rural children and families
living in poverty. Due to the meeting location, many of
the topics discussed were presented through a tribal
lens. Insights gained from the meeting will be included
in an upcoming NACRHHS Policy Brief to HHS Secretary
Sylvia Mathews Burwell.
Jim Koppel, Assistant Commissioner for Children and
Family Services within the Minnesota Department of Human
Services, discussed how policies shape what children are
able to access and achieve. To improve child health
outcomes, housing, food, healthcare, and human services
all need to be addressed. Koppel asserted that ending
poverty isn't necessarily an attainable short-term goal.
However, providing stability for children so that they
can function at their best is a first step.
“People can be self-sustainable in
poverty,” said Koppel.
“Predictability and stability make well-being a
Looking at population outcomes, not just program
outcomes, is necessary to properly address child poverty.
The Executive Director of Mahube-Otwa Community Action
Partnership, Inc., Leah Pigatti, shed light on the many
risk factors that children face that could hinder their
overall well-being. Lack of education, transportation,
nutrition, and shelter makes a child's life unstable
which can contribute to poor physical, mental, and oral
health. On tribal reservations, however, other issues
also play a factor, such as historical trauma.
“It has had a lasting cause and effect on
generational poverty with individuals,” said
Fabre in an interview following the meeting.
Samantha Beauchman, of Sanford Health Mahnomen Clinic,
discussed how important cultural competency was to the
delivery of care in the area.
Building relationships with families and service
providers is important, especially in rural
communities. The isolation factor in rural communities
leads to distrust for outside agencies or outside
The lack of providers in the region, coupled with the
distance involved with receiving care, often leaves
people seeking services only when a crisis arises.
Beauchman touched on the importance of holistic care, and
how collaboration can increase the access to care.
Several representatives of the committee voiced the
advantages of mobile health clinics and telehealth
programs. Unfortunately, in the White Earth area, the
lack of broadband availability is a significant barrier
Fabre added, “Building relationships with
families and service providers is important, especially
in rural communities. The isolation factor in rural
communities leads to distrust for outside agencies or
outside community members.”
Thomas Schreiner, of Indian Health Service, said a large
Indian reservation like White Earth requires multiple
satellite clinics. However, these clinics have limited
services and hours due to staff shortages. Indian Health
Service is currently working to utilize local home health
nurses and Community Health Workers (CHWs) to combat this
barrier and better serve residents.
Fabre notes that progress has been made. Social service
programs and tribal government/programs have been working
more closely together to find new innovative approaches
to delivering care in the area.
“More communication between programs
— tribal and non-tribal — has helped
increase awareness, services, and outreach to families
through home-visiting, an innovative case management
delivery system, data collection, and thinking outside of
the box,” said Fabre.