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Rural Health Information Hub

Considerations for Services Integration Programs for Tribal Populations

American Indian and Alaska Native populations face barriers to accessing health and human services.

Addressing Barriers to Care

Services integration programs serving tribal populations must address barriers to care. Approximately 50% of tribal populations do not live on tribal lands and may have limited access to services provided by the Indian Health Service (IHS). This is because individuals must be enrolled members of their tribe in order to access their tribe's IHS services, which are usually located on their home reservation. Individuals who do not live on their tribal lands may need to travel long distances to their home reservation in order to obtain IHS services.

Tribal populations may also experience other barriers to care, including:

  • Physical barriers (e.g., lack of access to transportation, adverse weather conditions, poor roads, long distances)
  • Social barriers (e.g., limited child care options)
  • Economic barriers (e.g., inability to afford missing work)

In addition, the mental health and substance abuse treatment capacity may be inadequate in many tribal communities.

The Need to Build Trust

The importance of the family and community unit is central to culture in tribal communities. The needs of the unit often take precedence over the needs of the individual. This can create a barrier to accessing health and human services. Providers need to establish strong relationships with community members to build trust.

For example, the Butte Community Diabetes Network has taken strides to encourage participation of American Indian populations in their diabetes prevention classes and support groups. After noting the low participation of this population in their regular programs, the program coordinator began attending cultural nights at the local Native American community center in order to build a relationship with community leaders. After conducting this outreach, the network brought their weekly diabetes management and prevention courses to the local Native American community center.

Another rural services integration program implemented by The Lake County Tribal Health Consortium included representatives from all six local tribal governments on its board of directors.


Trauma among tribal populations has also affected the health of this population for generations. Rural Tribal Health should be approached in a culturally sensitive manner and with the understanding of the health disparities that exist in American Indian and Alaska Native populations.