Skip to main content
Rural Health Information Hub
Rural Health Information Hub

Considerations for Services Integration Programs for Tribal Communities

Addressing Barriers to Care

Services integration programs serving tribal communities must address barriers to care. Tribal members who do not live on tribal lands may have limited access to services provided by the Indian Health Service (IHS), often having to travel significant distances. 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.

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

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

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

The Need to Build Trust

The importance of the family and community unit is central to tribal life. 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 tribal communities 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 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 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

Trauma among tribal communities has also affected the health of this population for generations. The provision of healthcare and human services should be approached in a sensitive manner and with the understanding of the root causes of disparities that exist.