Little Earth Community Partnership
Report date
April 2017
What has been most instrumental to your progress?
The innovation to create a Little Earth Comprehensive Health Plan (LECHP) allowed Little Earth (LE) to create a culturally rooted vision and strategic pathways to health for LE's residents' collective future. We used data/methods from the Adult Health Survey (2014) and created programming for reawakening and practicing indigenous Culture, Care Coordination (CC), Opioid Chemical Dependency Prevention (OCDP), Community Safety (CS) and Healthy Living (HL). Bridges to Primary Health Care addressed primary health care navigation to encourage resident participation in driving down the total cost of health care, supporting MN’s Accountable Care Organization health care reform plan. CC helps residents build trust with providers, navigate the health care system and insurance with MNSURE navigators and participate in preventative health care maintenance. Throughout the LECHP process we discovered how foundational historical trauma is to LE residents' experience of health. CC helps residents lower their stress level+ assists in developing care plans: health goals, barriers, solutions and access to specialty care as well as transportation, follow-up appointments and access to medication.
The LECHP focus on opioid prevention (OCDP: see above Answer #1) was significant, responding to the opioid epidemic at LE. Many over-doses and deaths have resulted in the grant period from opioid use. LE created a Strategic Opioid Prevention Plan as a result of this innovation grant that involved community residents, partners and stakeholders. We interviewed service providers and researched other prevention programs that have similar dynamics to LE. The plan is a harm reduction approach to the opioid epidemic at LE, primarily focused on education, awareness in the community. NARCAN training was provided to 40 residents through a partnership with Valhalla Place Drug Addiction Treatment Center. Purple ribbons were distributed to residents that had NARCAN kits--signifying to other residents who had training and a kit. As of March 2017 (when this report is being finalized), there were 41 deaths prevented at LE in (2016) through the use of NARCAN.
Community Safety was another key component to develop throughout this Innovation grant. LE needed to raise awareness about the need to create safety in the community. Safety has been identified as a primary barrier to health/wellness: cultural, emotional, physical and mental @ LE. This component of the LECHP coincides with the Department of Justice planning grant focused on discovering the drivers behind crime, violence, drugs, gangs and human trafficking. With the ongoing issues of drug use, overdoses, death, violence, poverty and social economic issues related to health disparities, we are actively seeking a strategic approach to untangling the interrelated issues above, to find and create solutions to safety at LE. At this writing (March 13, 2017), the DOJ planning grant is complete, and an implementation proposal has been submitted. LE is likely to hear back between Oct. 2017 and Jan 2018. LE's first hosting team meeting w/the Barbara Schneider Foundation was Mar 9, 2017,to develop an Indigenized Critical Incident process and de-escalation training at LE for residents, staff and community partners. Momentum to discover innovations that create greater safety is building.
Key lessons learned
Addressing the health concerns of the community meant taking a public health, harm reduction approach to all the key areas of health that affect this community. The LECHP utilized a comprehensive, community-based participatory Strategic Planning approach. Substantial gains in community-building, education, awareness, passion and momentum through engagement activities are taking us much closer to a cultural shift toward greater health and wellness. The creation of the LE Health Advisory Council has resulted in community members being more informed about health programming progressing at LE and how to provide guidance on health programming implementation. As programming is being tested and piloted, we have collectively discovered best practices. This active feedback helps the organization adapt to norms and concerns, while validating residents’ experiences, perspectives and needs. We've learned that engagement fosters trust and a willingness to contribute to, participate in and support programming at LE. Little Earth is actively developing into a community that both informs itself and offers residents and management guidance on the best ways forward.
Accountability and transparency are key dynamics that are evolving at LE. The residents’ voices are being heard, documented and shared; the leadership of the organization is making active efforts to hear the needs of the residents by being part of the community meetings and hearing community feedback. Community members have openly shared an interest in having non-resident board members be more involved in community engagement activities. There are many residents at LE that are actively involved and seeking a positive change in their community and having board members at community events helps build trust amongst the community regarding how the organization is being managed and lead. Residents want to know their board members are listening to their concerns by seeing them directly involved in community events. This dynamic of accountability and transparency between the leadership of the organization and the residents is contributing positively to a cultural shift. This shift, we are learning is foundational to creating the greater basket of indigenous remembrance and identity that now leads Little Earth--toward being--and becoming-- a safer and healthier community.
The LE Urban Farm (LEUF) is 1.9 acres near the Hiawatha sound wall. During the grant period, LE expanded the production capacity of the LEUF by 3,000 sq. ft., thereby being able to provide produce and indigenous medicines to LE programs (Youth Dev. Center, Elders, Women's Grp., and traditional ceremonies: Women's Full Moon ceremony, Tobacco ceremony, Naming ceremonies and the health Progress Pow-Wow's. We learned many things: 1) It took a village of 30 to build the long raised beds! With the help of many volunteers, LE residents and staff, we got it done. Greats lesson in collaborative learning. 2) Having the capacity to grow more food didn't mean we could do that effectively with the resources we had. The LE farmers weren't able to keep up with the necessary tending, weeding and watering for the new beds to thrive uniformly as envisioned. Things were much more doable once the irrigation system was installed, late summer/fall of 2016 (due to coordination of contractors and securing materials). With new collaborations and leadership, the LEUF is gaining renewed energy and resources. The 2017 growing season promises to make the most of the 2015-2016 Innovation Grant resources.
Reflections on the community innovation process
The thread that runs through the 2014 and 2015-2016 grant periods is capacity building. With the many now acute/chronic health issues/needs arising from European settlement during the 1600's to present, residents are internalizing what it means to claim self-determination. Building on the inherent, ancestral values (love, respect, honesty, wisdom, humility, truth, courage) with resident participants over 3.5 yrs, residents continue to learn about themselves: their gifts, contributions, how to do community participatory research, quest into ?'s and discover, communicate with community partners to better understand the situation, and to have their perspectives and needs heard; what trusting oneself and a collaborative process looks and feels like, the difference that healthy spiritual/cultural, emotional, physical and mental choices makes in their own and their families' lives. The current unfolding + critical life-giving work LE is embarking on with the Indigenizing Crisis Intervention Training is, and will continue to require, residents to truly live into the values of their cultures with great courage. This is what it looks like to take a stand for Life, and lead authentically.
Progress toward an innovation
LE has discovered a breakthrough by creating a Health Plan with a clear vision for the future that was driven by residents and community partners. It is truly remarkable how this organization captured the research of best practices and identified health programming needs from both a quantitative study in partnership with the University of Minnesota, and the qualitative engagement process of the LECHP. These practices, needs and methods from both quantitative and qualitative perspectives were cross-referenced in the LECHP and within the community to determine challenges, solutions and action steps for future health programming at LE. Both of these processes engaged and were lead by residents. From this point on, the specific program areas will evolve in their own areas to coalesce with other programming such as education, employment, youth leadership and community empowerment. LE is leveraging the Health Action Council and the Community Safety Champions to move from helping identify needs and solutions to practical action steps. The public health approach applied to this project resulted in a comprehensive blueprint to create the future of, with and for LE residents.
What it will take to reach an innovation?
Little Earth feels that it did achieve innovation through the process and product of the LECHP. What is required from here is to seek out ways to sustain, and build on the experiences and wisdom of the residents and community partners to apply and fully wield the power of potential embedded in the Little Earth Comprehensive Health Plan and the hearts of residents and staff who live and work at Little Earth. Breakthrough is having the courage to be self-aware and make choices aligned with ancestral teachings about the sacred gift that life is. Breakthrough lives in the collective consciousness, awareness and intention of the residents who live at Little Earth. Day by day, and person by person, residents are reclaiming their inner knowledge.
If you could do it all over again...
We could have focused more on trauma-informed programming throughout the innovative process. During the grant cycle we have discovered a growing concern and need to have more onsite mental health (MH) support services. The community is impacted with deaths from opioid use accompanied by physical+sexual abuse, + social/economic issues that continue to affect the families of this community. We need resources to substantiate our need for MH awareness/education to combat the stigma of these services and encourage people to speak up. about Suicide continues to impact AI families in the county. We are discovering drug abuse/addiction seems to be the preferred way of suicide by numbing out the emotional pain/depression LE faces. More youth are trying drugs due to that behavior being modeled in the family. Therefore, we need drug prevention/intervention programming, healthy activities for all + parent activism to increase youth awareness of drugs' potent dangers. Recommendations for future health projects @ LE are: direct research and programming, pilot projects to train residents in MH-1st Aid training and provide more MH services to build resilience. We need to evaluate these programs
One last thought
Throughout the duration of the 2015-16 grant, LE was featured in several conferences: 1) An American Public Health Association presentation in Chicago with the LE resident coordinator for the 2014 Adult Health Survey, LE staff and U of M Program in Health Disparities Research (fall of 2015), 2) Same group presented at Dartmouth College, then 3) participated in a national panel Native American Youth conference in Washington D.C. and 4) a U of M Health Equity conference.
LE's wide web of community partners that have contributed to the projects and gatherings at LE during the grant period. We are grateful for the support of: Bush Foundation, BCBSF, Hennepin County Omniciye and Human Services+Public Health Dept; IHB, NACC, CUHCC and Fairview Clinics, HCMC+Children's Hospitals; U of M Schools of Medicine+Public Health, Dartmouth College, Minnesota Indian Women's Resource Center, The George Family Foundation Catalyst Initiative, Indigenous Seed Keepers Network, White Earth Urban Office, Valhalla Place, Mashkiikii Gitigan (Medicine Garden), Dream of Wild Health, Indigenous People's Task Force, MAIC, Women's Environmental Institute, Wellshare International, Youth Care+more. Miigwetch!
LE's wide web of community partners that have contributed to the projects and gatherings at LE during the grant period. We are grateful for the support of: Bush Foundation, BCBSF, Hennepin County Omniciye and Human Services+Public Health Dept; IHB, NACC, CUHCC and Fairview Clinics, HCMC+Children's Hospitals; U of M Schools of Medicine+Public Health, Dartmouth College, Minnesota Indian Women's Resource Center, The George Family Foundation Catalyst Initiative, Indigenous Seed Keepers Network, White Earth Urban Office, Valhalla Place, Mashkiikii Gitigan (Medicine Garden), Dream of Wild Health, Indigenous People's Task Force, MAIC, Women's Environmental Institute, Wellshare International, Youth Care+more. Miigwetch!