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
- 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
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.