Tribal Connections Project, Phase 1
Final Report:
May 1998 - April 2001

Accomplishments As learned from our advisory panel and our targeted communities, the central objective for enhancing the use and exchange of health resources in tribal communities is improving technology infrastructure to reduce the digital divide. Other key objectives include sustainability of the improved system through partnerships, collaborations, and development of onsite technical support to provide leadership and advocacy. With these factors in place, the ultimate objective to reduce health disparities through self-sustaining skills to use, create, and exchange health data and information can be addressed. Collaboration The community-based approach to planning technology and infrastructure improvements in Tribal Connections communities resulted in newly developed inter- and intra- tribal collaborations, new partnerships with external agencies, and a strengthened economic base for local or Native-run vendors. For instance:

Index to TC Phase 1 Final Report Staff Overview Project Background Project Description Lessons Learned Accomplishments

At the Wellpinit Reservation, the Department of Health and Human Services in the Spokane Tribe developed a successful partnership with the Indian Health Service Regional Office in Portland to share Internet access on the IHS system. This groundbreaking collaboration was a model for similar agreements at Ft. Peck, Nez Perce, Samish, Sauk Suiattle, and Stillaguamish, all initiated by the Tribal Connections Project.

The South East Alaska Regional Health Consortium (SEARHC) collaborated with the local Regional Technical Vocational Center (RTVC) that houses a small library, for placement of three computers used as public access terminals. The RTVC agreed to promote public access and to provide a computer-training site for SEARHC.

At the Nez Pierce tribe, the planning process for use of Tribal Connections funds resulted in intertribal agreements that ultimately prevented duplicate efforts to improve technology infrastructure.

Several tribes were successful in linking to the Washington State Inter-Governmental Network (IGN). In each of these communities, the IGN became a community-wide solution to once poor telecommunications infrastructure provided by US West. This has meant improved communications between local and state level departments with similar functions or mutual interests. Several other communities noted that connectivity to state and Federal programs through both the state IGN and the Federal IHS system has streamlined health care administrative tasks, such as reports and billing.

Technical Support

The challenge of supporting telecommunications technology in remote areas is a common concern among tribes and a natural reason to develop inter-tribal support networks. Several tribes noted that the Tribal Connections project has helped to realize an increasing awareness and support between tribes on issues of technology and information access. There is a developing tribal librarian support network for not only professional librarians in tribal libraries, but also staff that are developing some type of tribal library service. The network currently provides skills sharing, and will potentially encourage group purchasing, e-mail support, templates for policies or planning documents, or position descriptions, resources sharing, book recommendations and distance learning. Several communities noted that the contacts with information systems personnel in partner organizations, such as the RML, the IGN, and IHS, helped to develop increasingly sophisticated vision about the potential applications for technology. These contacts helped reduce a sense of isolation or helplessness about improving and using technology infrastructures.

Increased Familiarity, Motivation, and Skill in Using Information Technology

Several communities noted that the demonstration and training sessions helped staff and community become more comfortable with information technology. Just having new equipment and access options helped staff become more familiar and comfortable with its potential. For example, some tribes specifically mentioned that staff formerly reluctant to try new technology became more intrigued or motivated when they saw others using it. E-mail seems to be a primary motivating influence for adopting information technology innovations and it has made a significant impact on workflow and staff communications. In addition, through e-mail, tribal members who may be geographically dispersed are able to keep in touch with each other and remain a part of tribal activities. For tribes without robust information systems departments or expertise, the process of planning for TCP with the assistance of the Project Manager was noted as helpful in developing awareness and increasing comfort with new skills and technology.

Use of Current and Credible Health Information

Communities noted that staff and community members are benefiting from the convenient and fast access to current and credible health information offered by Internet resources. The types of information searched on the Web are variable, but several tribes mentioned diabetes, cancer, nutrition, heart disease, Medicaid, continuing education, and scholarships for careers in health care.

At Ft. Peck, two servers are installed for health providers and their clients for access to information about AIDS and diabetes information. One of those servers has a local website developed by a tribal task force member of the Montana State Governor’s AIDS Council. This provides privileged communication and access to educational material through a secured server.

At Lower Elwha, health providers are very satisfied with the ability to get patient education information at the point of need. One community health nurse expressed how grateful she was to now download whatever patient education is most needed, rather than stocking print materials based on an estimate of the topic and number of materials needed.

At Nez Perce, the clinical director says that he is getting an increasing number of Internet search questions from staff about the Internet, especially for patient education materials on diabetes. He has established bookmarks to track diabetes sites for downloading patient materials.

At Nisqually, until the clinic establishes Internet connection with the IGN, the Library serves as the only location for Internet access among community members and tribal staff. The Library has noted a significant increase in Internet use to as much as 50% of the health staff that use it regularly.

Unanticipated Outcomes

Distance Learning

Because Lower Elwha was able to get tribal wide Internet access, the Peninsula College selected their community to locate a computer lab as a training facility. For a total of six years, the College has provided twelve computers to be placed in the tribe’s classroom space with tables, chairs, and Internet access provided by Lower Elwha. The College uses the space for long distance learning, though staff and community members of the tribe also use the classroom for Internet access during off hours.

In the Suquamish community, the Computer Learning Center (CLC) has become a center for web-based learning including certificate programs, computer-based courses for college credit, and continuing education.

Youth Education

The Tribal Connections Project originally envisioned health providers as the primary audience for promoting awareness, motivation, and skill in accessing health information on the Internet. In the participatory planning process, some tribes clearly preferred to target community members, and particularly the youth. The impact of this approach is illustrated by a few examples. At Lower Elwha, Mary Wilgocki’s advocacy for tribe wide Internet access was noticed by a 15 year old youth who became interested in searching, using, and creating web pages. He is now the tribal site webmaster.

Also, health promotion staff at Lower Elwha conduct a smoking cessation program that is targeted, in part, to youth. One tactic to encourage youth participation has been to recruit teenagers to do Internet research about smoking cessation. Program directors start out by asking three or four of the youth leaders, who get their friends excited about learning to use the Internet, and learn about smoking at the same time.

In the Suquamish community, the Computer Learning Center (CLC) is located downtown — a place that was formerly rejected by youth as a destination point. Because of their interest in Internet access learning opportunities, youth are now frequently seen in the downtown area as regular users of the new Computer Learning Center. They have sensed peer acceptance in learning Internet skills and therefore come to the computer lab without fear of peer ridicule.

At the Confederated Tribes of the Umatilla Indian Reservation, the envisioned tribal wide network will link websites currently under development by all tribal services departments. Each department provides Internet access to community and staff and is developing links to sites for maternal and child health, child development, and for teen's social and health issues to benefit welfare of their children and youth.