SILETZ TRIBAL HEALTH DEPARTMENT

Quarterly Report

January 1, 2012- March 31, 2012

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CLINICAL PROGRAMS: MEDICAL Clinic Staff Lisa Taylor, FNP – Family Nurse Practitioner, Medical Officer Erin Carrington, PA – Physician Assistant Stephen Burns, MD – Pediatrician Sean Rash, MD – Pediatrician Stewart Tuft, MD – Family Medicine Warren Sparks, MD – Family Medicine Yen Nguyen, DO – Internist Michele Cornwall, RN – Clinic Nurse, Nurse Supervisor – resigned March 2012 Dixie Morford, RN – Clinic Nurse Cherity Bloom-Miller, RN – Temp. Clinic Nurse – March 2012 Chasta Marceau, MA – Medical Assistant Gabriela Weiss, MA – Medical Assistant – resigned March 2012 Kathy Wilson, MA – Medical Assistant and Radiology Technologist Tiffany Hayes, MA – Medical Assistant and Radiology Technologist Rosalie Derenia, MA – Medical Assistant – last day March 2012 Katherine Daniels, MA – Temp. Medical Assistant – first day March 2012 Jeff Fuller, MA – On-call Medical Assistant Trudy Rector, MA – Temp. Medical Assistant Top reasons for a medical visit Chronic diseases of diabetes and high blood pressure continue to be the top reasons for medical visits. Other diagnoses that are especially common in the winter months are upper respiratory infections (URI) and cough. Also in the top ten reasons for visits are well child visits.

1st Qtr 2012 Total VISITS = 2055 1st Qtr 2011 Total VISITS = 2199 1. 250. DIABETES MELLITUS (81) 2. V20.2 WELL CHILD EXAM (64) 3. 338.4 CHRONIC PAIN (47) 4. 401.9 HYPERTENSION (46) 5. 465.9 ACUTE URI (35) 6. 724.2 LUMBAGO (35) 7. V25.4 CONTRACEPT SURV (34) 8. 490.0 BRONCHITIS (32) 9. 311. DEPRESSIVE DISORDER (31) 10.462. ACUTE PHARYNGITIS (31)

1. 250. DIABETES MELLITUS (85) 2. 465.9 ACUTE URI (56) 3. V20.2 WELL CHILD EXAM (55) 4. 786.2 COUGH (53) 5. 784.1 THROAT PAIN (46) 6. 382.9 OTITIS MEDIA (42) 7. 401.9 HYPERTENSION (42) 8. 724.2 LUMBAGO (36) 9. 311. DEPRESSIVE DISORDER (36) 10.338.4 CHRONIC PAIN (35)

The number of medical providers’ general and preventative care visits this quarter is down 7% compared to this same time last year. The number of telephone calls/chart reviews by medical providers increased by 5%. The‘no-show’ rate in up 8% compared to this same time last year.

Ambulatory Medical Visits Total Visits by Primary Provider

Patients Visits/Patients (Ratio)

1st 12 1st 11 1st 12 1st 11 1st 12 1st 11 General & Preventive Care– Medical Providers

1877 2021 1009 1012 1.8 2.0

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General & Preventive Care– Nursing/ Lab/ Xray/ Dietician

941 1065 575 627 1.6 1.7

No Shows – Medical Providers 259 240 - - - -

Medical Follow up

Telephone Calls/ Chart Review

Patients

Calls/Patients (Ratio)

1st 12 1st 11 1st 12 1st 11 1st 12 1st 11 Medical Providers 2459 2331 773 720 3.1 3.2 Nursing/Lab/Xray/Dietician 1467 1478 729 731 2.0 2.0

Promoting Health and Wellness Managing Diabetes - -Joan continues to work with providers to improve the GPRA clinical performance measures for diabetes patients by notifying both patients and providers when patient tests are due. -Joan saw 9 patients for diabetes and/or nutrition management this quarter for a total of 10 visits. Prenatal - 15 patients were seen this quarter for early obstetrical care, primarily by Erin Hume, PA. We try to have WIC and Medicaid in place before the patient is referred to an Obstetrician at 20 weeks. We continue to share lab with the Newport Obstetrician and are able to co-manage high risk gestational diabetes patients through our diabetes program case manager program. Immunizations

39 of 69 children (57%), ages 0-27 months, on the register are current in DtaP, Polio, Hep B and HIB vaccination. Dixie Morford, RN closely tracks these children and gets them in for well-child exams and immunization. See 2-yr old Immunization Rates - Appendix A.

Total immunizations given 1st quarter at the clinic were 342. Adults received 202 of these immunizations. Total flu shots given this quarter were 113. See Accountability Report – Appendix B.

Activities

Dixie and Cherity continue to assist patients with pharmacy patient assistance. Dixie has assumed responsibility for the vaccine program

Professional Development

Kathy completed radiology licensing – Good job! Diabetes Program Diabetes Program Staff Joan Canan, RN, CDE – Diabetes Case Manager Trish Carey, Diabetes Program Assistant, 24 hours/week Perry Johnson, Fitness Center Assistant, 40 hours/week Rick Leaton, Fitness Center Assistant (on-call) Avery Perkins, Fitness Center Assistant (on-call) Carley Robinson, Fitness Center Assistant (on-call) Spencer Hatch, Fitness Center Assistant (on-call, temp—began March 1 Lane Imbler-Bremner, Fitness Center Assistant (on-call, temp—began March 2) Rhiannon Hamel, Fitness Center Assistant—on medical leave, with last work day January 9 Luann Collier, Fitness Center Assistant (on-call, but not this quarter)

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Siletz Diabetes Talking Circle Siletz holds Diabetes Talking Circle luncheon meetings at Tillicum Fitness Center the third Thursday of each month. This quarter, two meetings were cancelled for severe weather. Month Speaker/Facilitator Topic Attendance January Dr. Sparks’s talk postponed to June 21. No Talking Circle in January. February George Nagel, LCSW, Mental Health Specialist Mental Health & Diabetes 14 March Dr. Schroeder’s talk postponed to April 5. No Talking Circle in March. (April will have two Talking Circles, the 5th and 19th.) Area Office Diabetes Support Groups Salem: SAO continued monthly Diabetes Support Group luncheon meetings, with one cancelled for inclement weather.

Month Speaker/Facilitator Topic Attendance January Cancelled for weather February Cecilia Tolentino Diabetes Basic Information—facts, glucose testing, labels, alternative ingredients 5 March Cecilia Tolentino Exercise challenge/physical activity 10

Portland: PAO held luncheon meetings for Diabetes Roundtable in January, quarterly Diabetes Advisory Group meeting in February, and Lori Johnson Memorial Garden Dedication in March.

Month Speaker/Facilitator Topic Attendance

January 11 Jeri Madsen, L.M.T. Bodyworker Diabetes & Massage 17

February 14 Joan Canan Diabetes Advisory Group meeting 12 March 14 Sherry Addis & Verdene McGuire Lori Johnson Memorial Garden Dedication 45 Eugene: EAO continued monthly evening meetings for a Diabetes Prevention class series offered by Bob Dunas, Health Educator, Cow Creek Band of Umpqua Indians. Month Speaker/Facilitator Topic Attendance January Bob Dunas, Health Educator, Cow Video: “Ruby” Weight Loss Creek Band of Umpqua Indians Journey, Part VI 8 February Bob Dunas, Health Educator Video: “Ruby” Weight Loss Journey, Part VII 8 March Cancelled. Snow day. Other Activities

• Saturday, February 11, The Diabetes Program made arrangements for 45 people to attend the American Diabetes Association Expo in Portland, 9:00am-4:00pm, at the Oregon Convention Center. Participants had fun watching chefs demonstrate healthy cooking, with samples; hearing MDs talk about what is new in diabetes research and what they need to know; joining in lively, hourly activity instruction. Health screenings were available, and 65 exhibitors showed products and services. Ten drove from Salem, and 3 came from Portland. Since Eugene and Siletz participants had long drives, rooms at the Courtyard

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Marriot were provided for 32 people on Friday night (11 from the Eugene area and 21 from the Siletz area). Box lunches were planned for the whole group to eat lunch together on Saturday and share experiences.

• February 14, the Diabetes Advisory Committee meeting met at the Portland Area Office. Attendance: 12, including community health advocates from Siletz, Portland, Eugene, and Salem, Diabetes Case Manager, 6 community members (2 representing EAO, 1 from SAO, 3 from PAO), and a participating Portland transporter. In absentia, Trish Carey was welcomed as the new Diabetes Program Assistant.

• March 19, the Diabetes Case Manager spoke with the Cancer Support Group about links between increases in incidence of diabetes and certain cancers; relation to certain medications; and modifiable risk factors such as diet, physical activity, smoking, and alcohol.

• March 26, Spring Into Action exercise challenge began at all area offices, to run for 12 weeks, ending June 15. In Siletz, 60 people of all ages registered, 28 at Portland, 28 at Eugene, and 89 at Salem.

• Saturday, March 31, the Lincoln County Diabetes Education/Prevention Coalition presented the 10th Annual Diabetes Update at Best Western Agate Beach in Newport, 9-3. The Diabetes Case Manager attended planning meetings, arranged for Dr. Rick Letherer to speak on Diabetes and the Human Eye, and manned a table of donated meters at breaks, showing people how to use them. Speakers were excellent, including endocrinologist Dr. Boyle. The event included lunch, ADA and some other exhibitors, physical activities, and donated gifts, including from Chinook Winds. Evaluations were very positive. Fifty people attended, not counting vendors, who also heard speakers. Growing the audience is a focus for next year.

Breastfeeding Support Program • The SDPI Grant provides funding for SCHC Breastfeeding Support, a primary prevention program.

Breastfed infants have been shown to have reduced incidence of obesity as children and adults and reduced risk of developing Type 2 diabetes.

• The Diabetes Program provides supplies to support moms who choose to breastfeed their infants. Supplies sent to each area office on request include disposable nursing bra pads and lanolin as well as electric breast pumps (some manual) when needed for women returning to work or school.

• Michele Cornwall, RN, has moved with her family to a new job in Alaska. At this time there is not a replacement for her in Lactation Consultant training.

Rapid Assessment of Physical Activity (RAPA) Last July the Diabetes Program began providing the 1-page RAPA, a self-assessment, for SCHC clients at their appointments. Periodically assessing level of physical activity is an important part of one of our selected IHS best practices, Physical Activity for Diabetes Prevention and Care. Our FY2012 continuation application of last July gives our first objective for this best practice as documenting an annual assessment of physical activity for at least 60% of native patients at SCHC diagnosed with pre-diabetes or diabetes. By the end of Q1, 2012, we had documented RAPA numbers for 113 native patients diagnosed with diabetes (93 Siletz and 20 other native individuals) plus19 native patients diagnosed with pre-diabetes. Annual assessment can help correlate change in self-reported activity levels with health. Exercise Options Siletz Area

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Siletz tribal members, family members and dependents may use Tillicum Fitness Center with no charge. Other natives who receive care at Siletz Community Health Clinic or who live within 10 miles of Siletz may also use Tillicum Fitness Center with no charge. (Non-native CTSI or Chinook Winds employees and Siletz Community members may use the fitness center by paying $2/use, $15/10-visit card, or $35/month unlimited use.)

Tillicum Fitness Center

Total Siletz & other Tribal Family of Tribal

member Non- Native CTSI Employee

Non-tribal/Non-Employee Community

3/31/11

3/31/12 %

Chg

3/31/11

3/31/12 % Chg

3/31/11

3/31/12 %

Chg

3/31/11

3/31/12 %

Chg

3/31/11

3/31/12

% Chg

Usage 392 269 -31% 167 141 -16% 39 39 No change 11 3 -73% 112 74 -34%

Visits 2800 1919 -31% 1524 1069 -30% 345 186 -46% 87 27 -69% 830 576 -31%

Average visits/person/qtr

7.1 7.1 No change

9.1 7.6 -16% 8.8 4.8 -45% 7.9 9.0 +14% 7.4 7.8 +5.4%

Fees ($) 1st Qtr 2011 $1,173

1st Qtr 2012 $862

-26.5%

In Q1 2011, 4 unspecified people made a total of 15 visits. In Q1 2012, 9 unspecified people made a total of 61 visits. Beyond Siletz — The Diabetes Exercise Program Throughout the Tribe’s 11-county service area, the Diabetes Exercise Program offers gym memberships to tribal members who live farther than 10 miles from Tillicum Fitness Center. Priority is given to those with diabetes and pre-diabetes. Participants commit to exercise at their chosen facility at least 8 times each month in order to continue to receive support. The diabetes grant provides up to $40/month for each gym membership for 45 tribal members 18 years and older. New members are started each quarter; gym use is confirmed. The FY2012 CTSI-SDPI Budget provides $26,400.00 (55 slots x $40/mo x 12 months) and will include 10 monthly slots for youth under 18, when form is finalized. As of March, 2012, 40 people were continuing their programs. Of these, 7 are from PAO, 16 are from SAO, 12 are from EAO, and 5 are from Lincoln City/coast. 20 people were on the waiting list to start in the May-June-July quarter. Healthy Traditions Grant Staff Sharla Robinson, Program Coordinator Activities

Radio interview “Spotlight on Siletz” about Healthy Traditions programming 1/4/12 Attended Oregon Food Bank “Cooking Matters” cooking class in Astoria. 1/6/12 Sponsoring 2 Tribal Member volunteers to become Master Gardeners. In return for their training, they

will volunteer at Healthy Traditions garden events. Classes held January-March. Portland Area Office Garden Club Meetings - 1/17/12 How to grow sprouts, 2/21/12 How to grow

strawberries, 3/20/12 How to start seedlings Found rock oysters and began asking elders for stories Potato digging at Siletz Tribal Community Garden with K-2nd Grades from Siletz Valley School.

Potatoes went to the SVS lunch program. 2/2/12 USDA kitchen counter installed and ready for cooking classes. Adrienne Crookes, Eugene Community

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Healthy Advocate, planned design and supervised the install. Made presentation about Healthy Traditions at Elders Meeting and asked for stories about rock oysters

and other traditional foods. 2/11/12 Scouted gathering sites south of CWCR. 2/11/12 Managed CDC Traditional Foods Conference staff and volunteers. Coordinated planning for food, space, schedule, invitations, and entertainment for CDC Conference. CDC Traditional Foods Conference. 2/28/12 thru 3/1/12 Cherokee Stickball event was attended by around 40 people. 2/28/12 Traditional Foods dinner received a standing-ovation from conference attendees 2/29/12. Conference attendees toured Yaquina Head. 3/1/12 Portland Area Office obtained 400 sq. ft. community garden from Portland Parks Bureau, 3/1/12 Project Coordinator received lesson on cutting elk meet from Robby Rilatos. 3/6/12 Seed planting at SVS. 3/8/12 PAO Lori Johnson Memorial Learning Garden Dedication Event. 3/14/12 Project Coordinator attended a Food Share Cooking Demo in Newport. 3/24/12 Project Coordinator assisted Youth Services with spring break activity at Splash. 3/26/12 Developed indoor herb gardening lesson plan for PAO Garden Club.

Administrative

Design monthly Siletz News advertisements. Submitted article to Siletz News about Traditional Foods Conference and Stickball.

Started on proposal to sell CTSI promo items and Healthy Traditions gathering calendars

Pharmacy Staff Leatha Lynch, PharmD, RPh – Pharmacist in Charge (hired January 2012) Elisa Kaiser, Certified Pharmacy Technician Darcey Jimenez, Certified Pharmacy Technician Laura Bremner, Pharmacy Technician Services Pharmacy continues to monitor the efficacy of many drugs and find ways to keep costs down. The Pharmacy serves only CHS and Direct patients. The number of prescriptions dispensed increased 13% compared to this quarter last year. See Pharmacy Activity Report – Appendix C. Third party reimbursement is down 14% this quarter compared to1st quarter last year. Amy and Leatha are working closely to identify rejects and ensure rejects are addressed. Pharmacy costs increased and new prescriptions/refills increased compared to this same time last year.

Pharmacy

Prescriptions 1st Qtr 12

Prescriptions 1st Qtr 11

Change

New prescriptions/refills 9,020 7,878 +14% 3rd party reimbursement $146,427 $167,187 -14% SCHC Pharmacy Costs (IHS) $224,997 $205,780 +.09%

Issues and Activities

Leatha completed a Self Inspection report and formatted a new Board Of Pharmacy binder in order to be compliant with the board.

Leatha was hired on regular status as of February 13, 2012.

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Pharmacy staff completed an annual inventory.

Pharmacy Committee Discussed pharmacy changes. Reviewed formulary.

Professional Development

Laura tested and received her certified technician license – Great job! Technicians are working on their CE credits for re-licensure. Leatha continues to acquaint herself with RPMS and enter data.

Laboratory Staff Jody Greene, MA – Lab Manager Services Jody continues to perform all lab functions with Lisa Taylor, FNP, as Lab Director. Lab served 745 patients this quarter. This now includes the POC tests that are done on the floor. The total number of tests done during the quarter was1741 of which 1180 were sent to the Reference lab and 561 were done in-house. Plus 25 POC tests done on the floor by the nursing staff or the medical assistants

Lab 1st Qtr 12 1st Qtr 11 Patients 745 704 Visits 455 602 Tests In-house 561 560 Tests sent to Reference Lab 1180 1235

TOP TEN LABORATORY DIAGNOSES 1. 788.1 DYSURIA (45) 2. V74.5 SCREEN VENERAL DISEASE (37) 3. 250.0 DIABETES (35) 4. 401.9 HYPERTENSION (32) 5. V22.1 SUPERVISE NORMAL PREGNANCY (30) 6. V76.2 SCREEN MAL NEOP-CERVIX (29) 7. 272.4 HYPERLIPIDEMIA (27) 8. 272.2 MIXED HYPERLIPIDEMIA (25) 9. 244.9 HYPOTHYROIDISM (23) 10. 780.79 OTHER MALAISE AND FATIGUE (23)

Quality Assurance The laboratory continues to participate in several proficiency challenges through the American Association of Biocatalysts. These include drug testing, immunology, fluid analysis and hematology. The laboratory has a 100% score in all areas. We continue to work on the set up and implementation of the Bidirectional Interface and EHR. Activities The laboratory is now fully Bidirectional. The providers can now see all send out labs (Reference) results in EHR. This has been a long process but the outcome is well worth it. We will continue to get a paper copy that goes into the patients chart. EHR will greatly add to the efficiency of the lab and soon make paper obsolete. Our IT manager is working on integrating the machines in the lab with RPMS. The Clinitx-Status was our first to be hooked up and is working great. The providers can now see the Urinalysis results in EHR almost immediately. The IT manager will soon have the Pentra and Piccolo working alongside the Clinitex-Status.

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Professional Development Radiology Staff and Services

Tiffany Haynes, MA and LRT Kathy Wilson, MA and LRT

Tiffany continues to manually input radiology reports into EHR allowing providers increased access to patient information. Increased access has also been made possible by utilizing Virtual Radiology as cloud storage. Image and report retrieval is accessible to our providers and referral specialist.

1st Qtr 12 Radiology Top Reasons for Visits Visits = 297 Images = 122 Ratio = 2.4

1st Qtr 11 Radiology Top Reasons for Visits Visits = 158 Images = 414 Ratio = 2.6

1. 786.2 COUGH (18) 2. 719.41 JOINT PAIN SHOULDER (9) 3. 719.46 JOINT PAIN L/LEG (9) 4. 719.42 JOINT PAIN-UP/ARM (5) 5. 742.5 BACKACHE (5)

1. 724.2 LUMBAGO (20) 2. 786.2 COUGH (16) 3. 723. CERVICALGIA (9) 4. 719.46 JOINT PAIN L/LEG (7) 5. 719.41 JOINT PAIN SHOULDER (6)

Quality Control

Goal: Maintain repeat films under 10% - There was 1 repeat image out of 414 images taken this quarter

Professional Development Kathy completed all radiology licensing.

CLINICAL PROGRAM: OPTOMETRY Staff Sky Schroeder, OD – Optometrist Kathy Furgason – Optometry Assistant Chasta Marceau – Optometry Assistant Services – Optometry services are available Tuesday and Thursdays.

Optometry Visits 1st Qtr 12 1st Qtr 11 Optometrist 161 172 Optometry Asst 172 269

Monitors

Ongoing efforts to reduce the no-show rate are proving effective. Up 10% from this time last year the no-show rate is at 21%.

Goal: to improve the number of correct prescription being dispensed to patients – 7 returns this quarter: 3 lab errors, 1 doctor error and 3 staff errors.

Activities

Optometry is available to all registered patients. Optometry Assistants continue to set goals to reduce costs and improve quality. To keep dispensary fully stocked of supplies and dispensary clean, up-to-date and comfortable place for

patients.

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Professional Development CLINICAL PROGRAM: MENTAL HEALTH and TRIBAL YOUTH PROGRAM SERVICES Staff and Services George Nagel, MSW - Medical Social Worker Scheduled Appointments: 83 Monthly MDT: SSP, ICW, A&D, Healthy Families, Housing. Clinical consultation: Alcohol and Drug Program. Monthly two hours. As requested needed on specific cases. Contract Health Related Activities: Contract Health Service Gatekeepers: Weekly. As needed for committee consultation on mental health and alcohol and drug related referrals. Tribal Youth Programs Grant OJJDP: Lauren Patterson hired as Youth Mental Health Specialist under this grant has been providing outpatient mental health services to tribal youth in Portland and Salem. Lauren has also been participating with the tribal education program in activities provided to youth in those areas. There is approximately 18 months left on this grant funded position. NARA/SAMSA Youth Suicide Prevention Grant: NARA was refunded for a 3rd grant cycle through this Garrett Lee Smith SAMSHA grant. NARA has been working on a different contracting process with the tribes. A proposed contract has been drafted and submitted to the tribal attorney for review. Expectations are that each tribe will be able to receive around the same funding as previously; approximately $15,000 per year. Targeted areas for this grant are bullying prevention/intervention and youth gender diversity. 2011 Tribal Youth Conference: Was not funded for last year. After inter program discussion a EPR Request was submitted for 2012. Ropes Course: Renovations to the ropes course are now completed. The course is fully functional. All funds for renovation of the course came from grant funds from the NARA SAMSHA grant. A behavioral health staff tribal member completed a level one ropes course training through SYNERGO. There is now two staff capable of providing high ropes course facilitation. There is a group of staff who has begun to meet on a regular basis to increase number of tribal staff to facilitate and utilize the ropes course. The ongoing group is open to any staff member from any department approved by their supervisor/program manager. Crossroads Non-violence Education: Don Chapin, Crossroads director, has entered into a collaborative relationship with tribal mental health services. Don comes to Siletz once a month to co facilitate a men’s “Returning to Honor” session. Tribal men and community members can come to the session at no cost. Those who are mandated to complete Crossroads services for anger management and domestic violence get credit for the session towards completion of their program. Sessions have taken place as scheduled during the quarter. There were three monthly sessions this past quarter held at Behavioral Health. Three Men’s Group session were held during the quarter. Lincoln County Juvenile Department: There is currently one tribal youth involved with the Lincoln County Juvenile Dept. who was initially placed through the tribal ICW Program at the Cedar Bough residential program

operated by Youth Villages (Formerly Christie Care.). After a difficult initial stay he was transferred to a cottage on the main campus. The Juvenile Dept. has primarily worked with the ICW program. Mental Health Services has continued to provide services upon request by the family. Oregon Youth Authority: Loraine Butler has assumed tribal representation at the quarterly OYA Native American Advisory meetings. There is one tribal youth at Stepping Stones residential in Eugene that mental health services has continued to provide service to him and his family. There was participation in one MDT/Treatment review over the past quarter. Youth Villages (Formerly Christie Care) Native American Residential Facility: There has been one Native American Advisory Council meeting at Christie this last quarter. Lauren Patterson has been attending advisory meetings at the Christie Care Cedar Bough program quarterly. Cedar Bough has gone through a number of changes and is viewed as being a program in transition. Currently there is one Tribal youth placed at the Cedar Bough Program through the Tribal ICW program. The youth was initially placed on the main campus and was later transferred to that program. Referrals/Contacts/Consultations: Voluntary/Self Referrals: 18 Indian Child Welfare Program: 1

Tribal Alcohol and Drug Program: 5 Contract Health/Gatekeepers: 0 Head Start: 0 Clinic providers: 2 Self Sufficiency Program: 0 Juvenile Dept.: 0 Parole and Probation Contacts/Consultation: 1 DHS: 0 Tribal EAP Related Contacts: 2 Siletz Valley School: 0

Activities: Consultation to Youth Council. Youth Conference Planning group Classroom observation to Head Start Siletz and to Child Care Center Lunch presentation to the Diabetes Support group

Professional Development:

Ericksonian Internation Congress on Clinical Hypnosis and Strategic Psychotherapy CLINICAL PROGRAM: DENTAL Staff Douglas Chadwick, DDS - Dental Officer Megan Saxton, DMD – Staff Dentist Mary Ellen Volansky, EPDH, MS – Dental Hygienist David McCullough, DDS – Orthodontist (two days a month) Bonnie McAlpine, CDA – Certified Dental Assistant Allison Noble, CDA –Certified Dental Assistant Misty Reed, CDA – Certified Dental Assistant Bobbi Foley, CDA – Certified Dental Assistant Dental Services Special Clinics were held with orthodontics saw 55 visits. Dental Hygiene service saw 182 visits and also performed 59 Head Start screenings. Dentists saw 660 visits. The dental clinic did 41% more dentistry (RVUs) compared to 1st quarter 2011.

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Dental 1st Qtr 12 1st Qtr 11 Total Visits 956 1023 Patients 818 842 ER Visits 227 182 Productive Procedures

4586 3679

Rvu 6531.05 4613.86 Broken Appts. 135 (14.1%) 144

Issues and Activities

First Tooth was a lecture that was organized by Alison Noble in an effort to bring together the medical and dental staff to work toward great access to oral health. This lecture was a step in implementing the I.H.S. Grant that Ms Noble and Dr Chadwick applied for and received.

Volunteers, including people who stepped forward from their usual and comfortable jobs, made this year’s SVS Sealant Clinic run smoothly included the following people: Adrianne Crooks, Sharon Mason, Silvia Butler, Trisha Carey, Chuvonne Metcalf, Verdene Mcquire, Cecilia Tolentino, and Wendi Schamp. Thank you for a job well done.

Prevention Activities

2012 SVS Annual Sealant Clinic – This was our best year, seeing 182 students and providing the following services: 875 sealants, 182 screenings, and 181 fluoride varnishes. These services would have cost a total of about $55,713.00; these services were provided over three days. The cost to an individual would have been $306.12. The Sealant Clinic is an awesome service provided to the community. It also allows for students into the clinic for further services, such as treating the 185 visible cavities recorded at that clinic.

Students at Siletz and Lincoln City and Tenas Illahee Head Start programs were seen for screening and Fluoride Varnishes, all were given Home Care supplies to take home.

Children at the Tenas Illahee Child Care Center were seen for screenings and Fluoride Varnishes, Home Care supplies were given.

Miscellaneous

Dr Saxton, Adrianne Crookes, and Mary Ellen Volansky volunteered for the 11th Annual Children’s Free Sealant Clinic in Lane County, held at Lane Community held on March 3, 2012. Ms. Volansky is on the planning committee for this annual clinic.

Six students at SVS each won a battery operated Sonicare Tooth Brush for their participation in the SVS Sealant Clinic. The introduction of these awards yielded a jump in participation the first year and participation has increase each year since.

Professional Development

Alison Noble was recently accepted to Pacific University Department of Oral Health, as a student in their Bachelors of Science Degree in Dental Hygiene. She will begin classes in August of this year.

Dr Saxton and Ms. Volansky attended a two hour lecture at Lane Community College on the uses of

Silver Fluoride in the treatment of cavities, lecture provided by Dr S. Duffin. This lecture was part of the Sealant Clinic at Lane Community College and provided four hours of CEUs.

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CLINICAL SUPPORT SERVICES

MEDICAL SUPPORT Staff Bev Baumgardt, Medical Support Supervisor Sara Bell, Patient Care Coordinator (Check-In) Kristi Martin-Bayya, Patient Care Coordinator (Scheduling) Tracy Lancaster, Patient Care Coordinator (OHP Support) Amie Fisher, Health Clerk Activities:

43 new patients of which 6 were newborns were registered this quarter. There were 6 deaths documented.

402 updated patient registrations. Registrations are checked for completeness by administration. This quarter 14 patients were selected from the Oregon Health Plan Standard Reservation List to

complete the OHP application. Tracy continues to screen patients and add eligible patients to the OPH list, which makes them eligible for future drawings.

Tracy completed 14 OHP applications and assisted 55 people with OHP questions, copies, and etc. 13 patients were accepted for OHP See Operations Summary – Appendix E and Tribe of Membership by Age – Appendix F.

Insurance Type Increased or decreased Medicare B +14 Oregon Health Plan +101 Other Insurance +126

Professional Development

Sara, Tracy and Bev attended a Care Oregon Meeting in which they discussed the services they provide and the ease of access.

INFORMATION SYSTEMS Staff Sunshine Keck, Information Systems Tech 1 Chuvonne Metcalf, Data Entry Technician Activities Data Entry Technician

Training: Chuvonne enrolled in an online Medical Coding course to become a Certified Coder. She has completed and passed the online course. She is currently studying for her certification exam.

Chuvonne continues to implement Pharmacy POS Patch 42 D.0. The patch was installed on Dec 29th and Chuvonne has worked on updating current insurers to the new D.0 format and working closely with the pharmacy staff and patient accounts to troubleshoot prescription rejections/errors. Formats are constantly changing and need immediate fixes.

Chuvonne continues to work with the Coding Queue to verify correctness of data before being released to Patient Accts.

Chuvonne continues to work with Marci & the providers to get incomplete medical visits cleaned up & billed to third party insurances.

Chuvonne has started learning VA Fileman and other RPMS data mining techniques to find visits needing correction.

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Chuvonne processes the weekly Electronic Claim folders for Medicare & Medicaid. Chuvonne continues to provide assistance with Point of Sale (POS) to Patient Accounts & Pharmacy as

needed. Chuvonne is the primary contact for maintaining the fax machines, copiers and primary contact for

printers as well as toner and printer ribbons for the clinic and CHS. IHS Site Manager / Information Systems Tech 1

Training: Sunshine completed the IHS Security Awareness annual course required for all users accessing the IHS intranet.

Primary focus: Stuart Whitehead of the IS Department has taken over the lead on this project. Currently we are waiting on Check Point and RSA to resolve a communication issue between the RSA server and our Check Point. Setting up a secure login (VPN) from home for providers was moved to the highest priority. Until then, Electronic Health Record (EHR) providers have to stay late at night to complete their documentation.

Primary focus: Lab Instruments (Urinalysis, CBC, and Piccolo Chemistry) interfaced with Data Innovations and RPMS were moved to the top 5 priorities for Clinic Info Systems. Sunshine completed the Urinalysis instrument and is now working on the CBC. Interfacing the instruments allows lab results to move directly into the patient’s record in EHR.

Primary focus: Electronic claims were mandated by CMS to move to 5010 format. We were approved by Medicare for 5010 claims in December but automated reports failed. These have been corrected and we are now in 5010 production. Medicaid approved production for 5010 claims by the end of first quarter. Some of the reports still need adjustment but we are in production status.

Primary Focus: A document management program is mandatory for EHR so that outside reports and internal forms can be stored electronically and attached to the patient’s record in EHR. This eliminates the need for filing more paper in the already full paper charts. The VA uses software that would be more efficient than the IHS version but we would be the first IHS site to try to integrate the software. The decision was made to stay with the IHS software called VistA Imaging. This will be the primary focus as soon as the lab instruments are interfaced.

Staffing change: Edward Biancone left the CAC position. Sunshine and Chuvonne have been helping with EHR and scheduling issues in his absence.

AAAHC prep: Sunshine submitted revised forms for approval and is updating procedures and other documentation.

Continuing focus: IHS mandated a change to Point of Sale for Pharmacy claims. The program patch and training were not released until Dec. 19th. The patch removed our POS-A/R link which heavily impacted Data Entry and Patient Accounts staff. We installed a custom patch restoring our POS-A/R link and this got us back on track. Formats continually change and need immediate attention.

Resolved: Health Information Exchange (HIE) is being mandated by CMS and IHS. Oregon and Washington have already implemented changes. Sunshine enrolled the Clinic in One Health Port and set up user access for Clinic staff. We are now in maintenance mode, adding/removing staff as needed.

Xray Data issue: Radiology’s Image Pilot server only saves data to its local hard drives. We have completed transfer of our historical images to our vRad group who reads the X-rays and also stores them on-line in a secure server environment. Besides safety and access to the data, we can grant access to consulting physicians and/or hospitals, etc., so they can have immediate access to our patients’ X-rays. Our providers who are on-call after hours will also have that access which will be a benefit to our patients.

IHS mandates: HHS and IHS continue to load multiple software updates to increase security, add “Meaningful Use” compliance, and keep up with the national IHS requirements. Sunshine can only focus on the most critical and try to maintain existing packages. New packages that are not critical for our clinic’s use have to be put on hold for now.

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Annual Inventory: Wendi Schamp has taken over the responsibility for all Clinic inventory. Test Server on Hold: Sunshine and IHS set up a TEST database in Ensemble / EHR so that Rhonda

Attridge, our CHS Lead Tech, can start testing the full version of the IHS CHS RPMS package – without the Selby modifications. If successful, we can move to the standard IHS package which should reduce software errors. Progress on this is stalled due to other higher priorities.

PAMS on Hold: Clinic Information Systems and Patient Accounts accepted the challenge of doing Beta testing of the IHS PAMS software in an EHR environment. The payback is a savings of $60,000 for the normal cost of the installation and conversion of existing Accounts Receivable. The PAMS team completed on-site review and draft plan. Several on-line and phone conferences have been conducted. “Event date” default identified as a major issue. The project has been delayed due to other higher priorities and staffing issues.

Challenge: Sunshine is learning how to manage the firewall appliances (CheckPoint) which protect Clinic data in particularly and the entire CTSI network. This is taking in-depth study and trial and error.

IHS RPMS packages have been updated on schedule. Sunshine has updated three quarters of the Clinic Timesheet folder replacing staff names with user

groups to save time in managing user rights and organization of data. The new clinic data server is backed up to encrypted, secure off-site storage. CTSI Info Systems team helps upgrade phones, computers, printers, and provide user assistance. Many

thanks to Robert, Debbie, Stuart and Clint! Stuart has been able to provide additional assistance which staff appreciates.

We added a part-time nurse, diabetes program assistant, a TLC manager, and a PA student. We had 4 staff terminate. Sunshine and Darcy Jimenez added 30 outside prescribers. Computer access was updated for contractors, staff, as needed.

Sunshine maintains clinic Sonitrol access levels and clinic staff changes. Heating and cooling system remote access computer is in use; still needs external IP set up for remote

support. As needed, Sunshine assists Clinic management and staff with reports and RPMS questions plus

Pharmacy Point of Sale (POS) processes. User pc and printer requests are delayed due to lack of time – Sunshine’s time is consumed with the top

five priorities and mandatory CTSI, IHS, EHR, system and security needs. CTSI IS team is helping with the backlog.

Phone support and Internet email access are coordinated with CTSI IS team.

Quality Improvement for Health Administration Information Systems: Sunshine is focusing on the Lab, VistA Imaging, IHS security enhancements, clinic servers, domain

configurations, IT security, Dentrix, and phone and printer setups. The CAC when hired will focus on EHR, Pharmacy, and Radiology package set up. EHR still requires

major time commitment. Chuvonne is learning to use the IHS EHR package and data extract utilities. She works with Patient

Accounts via the Coding Queue as she reviews and releases RPMS data from EHR. We do not have a trained Data Entry backup person on staff.

See IS Project Priority List – Appendix I. ELECTRONIC HEALTH RECORD (EHR) Staff Vacant, Clinical Applications Coordinator *No report

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BUSINESS OFFICE Staff Amy Garrett, Business Office Manager Elaine Greene, Business Office Clerk Ronda Ramsey, Patient Accounts Representative LaRita Lundy, Patient Accounts Representative Brenda Howell, Patient Accounts Representative Rhonda Attridge, Contract Health Technician I Joella Strong, Contract Health Technician II Kathryn Dick, Contract Health Technician II Patient Accounts Activities and Goals:

Identified payment process breakdown with State Medicaid program. Developing document that outlines the submitted reimbursable claims and outstanding payment amount. OMAP Tribal liaison contacted week of April 16th. Progress memos will be submitted to Health Director.

o Issue is related to HNA coding of the patients Medicaid eligibility file. Patients continue to be enrolled in managed care after HNA information is provided. We are receiving payments from the managed care plan, but the State continues to deny our claims for encounter rate payment as “bill managed care”.

o Medicaid accounts for 45% of the Clinic total accounts receivable. We currently have $198,460 in Medicaid claims aged over 90 days. This amount makes up 44% of the A/R over 90 days. PA staff has spent the first quarter of 2012 adjusting any non collectible Medicaid accounts.

Continue cooperative duties with pharmacy to maximize insurance payments. Further develop positive

and productive communication with pharmacy department. Goals: o Understand when Pharmacy has stopped working a rejected claim and ensure that PA staff takes

responsibility for revenue potential. o Ensure that each Direct patient has either paid for their prescription, been authorized for an

adjustment/write-off or will be billed via patient statement. o Ensure that PA staff is able to maintain standard billing and posting duties, while effectively

working pharmacy claims.

See Interim Report – Appendix G and Accounts Receivable – appendix H 1th Qtr 2012 1th Qtr 2011 Change Total Revenue $1,357,347.48

$1,576,688.17 14% decrease

Total Deposits $370,128.04 $416,772.26 11% decrease % Total A/R over 90 days 51% 45% 15% increase CONTRACT HEALTH SERVICES ACTIVITIES

Medicare-Like-Rates resulted in a savings of $197,450.57 in 1st Quarter 2012. Out of Area Benefits (OOA) distributed in January 2012 with benefits authorized of $67,400.00. 75 tribal

members were served with benefits as follows: hearing – 1, vision 25, dental -32, and medical- 17. Alternative Health Care (AHC) approved 107 patients for either chiropractic, massage or acupuncture

services. Of the 107 approved, 68 patients sought treatment with approximately 164 visits.

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Contract Health Denial Types: Outpatient denials continue to be the highest, which accounts for 95.6% of dollars denied. The top two reasons for denials are No notification and Alternate resources available.

CHS Denials 1st qtr 2011 1st qtr 2012 1st qtr 2011 1sr qtr 2012 Type Number Number Dollars Dollars Ambulance 1 2 $720.27 $180.35 Dental 9 9 $280.00 $1,392.00 Inpatient 7 3 $53,864.31 $33,250.37 Outpatient 350 301 $182,138.95 $174,179.64 Total 367 315 237,003.53 $209,002.36

CHS Financial Status through March 2012 2385 Obligated Purchase Orders $569,734.17 Unobligated Balance: $1,930,265.83Weeks left: 39 Weeks of funding left: 44 Contract Health continued on deferred status level 3 ending 3/31/12. At Gatekeepers this had the following impact:

Gatekeeper Reviews

Total reviewed And deferred

Not within Medical Priority (NWMP)

1st Qtr 12 393 Reviewed w/76 Deferred

41

Reports – See Deferred Reasons List – Appendix H; CHS Denials Report – Appendix I; CHS Detailed Financial Status – Appendix J COMMUNITY HEALTH SERVICES Staff Vacant, Community Health Director, Siletz Adrienne Crookes CHA-II, Eugene Area Office Community Health Advocate Cecilia Tolentino, Salem Area Office CHA-II Verdeen McGuire, Portland Area Office CHA Sharon Mason, MA, Siletz Area Office CHA-II Verdene Mcguire, CHA, Portland Area Office Home Visits:

> A Total of (6) visits were conducted for the following purposes: • Delivery of food supplements to Elders (3) • Elders health concerns home visit to check on her (1) • Elders health concerns hospital visit (2)

Office Visits:

> A total of (66) office visits were conducted for the following purposes: • Over the counter medications distributed (20) • Child safety seats distributed (1), Booster (2) • Child Helmet distribution (0) • UA’s random (4) Pre-Employment (2) • Discuss medical visit procedures on contract health (12)

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• Discuss Diabetes Exercise program w/Client (25)

Dental/Medical Transports: > A total of (43) transports were provided. • Local ( 24) • Siletz (6) • Oregon City (2) • Chemawa (6) • Cancelled (4) • No show (1)

Health Education Activities: >Monthly CHA community newsletter articles: January, February & March • January-Diabetes Luncheon (13) • February Quarterly Diabetes Meeting (12) • March – Diabetes Luncheon (45) • March 20, 2012 Oregon Food Bank, Healthy Cooking for Adults (4) • March 29, 2012 Oregon Food Bank, Healthy Cooking for Adults ( 6)

Prevention and Screening Activities:

• February 11, 2012 ADA Diabetes Expo (3) • March 17, 2012 ADA Kidney Screening (self)

Professional Development/Training:

• February 1, 2012, “Teenage Dating Violence” Webinar • March 26, 2012, Food Handlers Certification on-line.

Administrative Functions: • January 24, 2012 – Healthy Traditions Steering committee Meeting, Siletz • January 17, 2012 - Community Garden club meeting, PAO • February 1, 2012 Pillar Meeting at PAO • February 7, 2012 Healthy Traditions Steering Committee meeting in Siletz • February 7, 2012 Healthy traditions Conference meeting in Siletz • February 14, 2012 – Diabetes Quarterly Meeting • February 21,22,23 2012 Dental Sealant clinic, Siletz • February 23, 2012 Healthy Traditions Conference meeting, Siletz • February 24, 2012 Wisdom of the Elders meeting • February 28, 29, & 3/1, 2012 Healthy Traditions Conference, Siletz • March 1, 2012 Healthy Traditions Steering Committee meeting in Siletz • March 21, 2012 NCAC w/ PPR Luncheon meeting • March 23, 2012 Wisdom of the Elders meeting

Cecilia Tolentino, CHA, Salem Area Office Home Visits:

A total of (11) visits were conducted related to assisting in resources for tribal members: • Medication Safety Assessment (1)

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• Elder Assessment of Needs (2) • Medical supply delivery (8)

Dental/Medical Transports:

A total of (41) transports were conducted related to the following locations: • Local (22) • Siletz (12) • Woodburn (1) • Grand Ronde ( 4)

Health Education Activities:

A total of (9) health education activities were completed this quarter: • Monthly community newsletter articles: January, February and March • January Support Group 1/18/12 • February Support Group 2/15/12 • March Support Group 3/21/12 • Hearing/Vision screenings Salem Head start 1/12/12 • Head start Parent resource night 1/31/12 • OHP Healthy kids Day (All day assistance open house for tribal member to apply for OHP

no appointment necessary) 2/1/12 Office Visits

A total of (119) office visits were conducted related to the following concerns: • Child Safety Seat education/installation/distribution (9) • Child passenger Seat recheck (7) • Blood pressure check (6) • OTC meds (12) • Assist with OHP/Chemawa/Grand Ronde Patient registrations (24) • Weight/Height/Measure (4) • Prescription reorders (11) • Oral Hygiene Information/ Tooth brush kits (30) • Contract Health Update (16)

Professional Development

A total of (12) events were completed this quarter. • Healthy Traditions steering committee meetings 1/24/12, 2/7/12 • Healthy Traditions subcommittee conference meeting 1/24/12, 2/22/12 • Diabetic Advisory Board Meeting • Siletz dental Sealant clinic 2/21, 2/22, 2/23 • Healthy Traditions Conference 2/28, 2/29, 3/1 • MDT meetings 1/11/12 & 2/8/12 • Food Handlers recertification 3/19/12 • Webinar Safe Transportation of Children in Other Vehicle CEU Credits 1/27/12 • Webinar Tech's Guide to Recalls CEU Credit for CPS recertification 1/27/12

Adrienne Crookes, CHA-II, Eugene Area Office Home/Hospital Visits:

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A total of (4) visits were conducted related to the following concerns: • Maternal/Child (1) • Elder Assessment of Needs (1) • Delivery of elder medical/safety supplies (2)

Transports:

A total of (5) transports were conducted related to the following locations. • Siletz (5)

Health Education:

Diabetes Prevention Classes (2) Siletz Exercise Challenge for Eugene area participants Healthy Traditions Conference in Siletz Nutrition Education Classes (2) Submitted numerous Healthy News articles for EAO newsletter

Prevention and Screening:

Assisted with Dental Sealant Clinic at Siletz Health Clinic

Other: A total of (52) office visits were conducted related to the following concerns: • UAs (1) • Blood Pressure (4) • Car Seat Education/Installation/Distribution (1) • Bicycle Helmet Education/Fitting/Distribution (0) • OTC Medications (19) • Assist with OHP/CHS/Chemawa applications (9) • Weight/Height/Measure (6) • Toothbrush/toothpaste/oral hygiene information (8) • Assist with locating a physician (4)

Professional Development/Training/Committees:

Participated on Diabetes Advisory Group Participated on Healthy Traditions Steering Committee Hosted monthly Master Food Preserver meetings (2) at Eugene Area Office Attended OPS Manual Training in Eugene

Sharon Mason, Community Health Advocate II, Siletz Area Office Home, hospital and office visits:

A total of (178) visits listed as follows: • Home visits (1) medication reviews (1) ER visits (2) • Medicine/Supply drops offs (12) • Professional/transporter visits to my SCHC office (123) • Paperwork and providers offices (12) • Car seats dispensed (20) • Helmets dispensed (7)

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Transportations totals as Follows: Total transportations = 400 Cancelled appointments = 114 • Transporters = 280 • Sharon Mason = 6 • Med pick up/drop offs = 12

Health Education Activities

A total of (5) health education activities were completed this quarter • Diabetes advisory meeting – PAO-2/14/2012 • Diabetes round table lunch – none • Healthy Traditions Mtg – 2/01/2012 • CDC Convention - 2/27-28-29-&3/1/2012 Worked in kitchen for numerous hrs. each day. • Cancer Support Group Lunch/Speaker – 3/19/2012

Prevention and Screening Activities:

A total of (3) Prevention & Screening activities accomplished as follows • Siletz Clinic Annual Sealant Program – 2/22-3/01/2012 • MRSA Pamphlets given to client with concerns and questions. • Head Start Blood Pressure check at Siletz Child Care Center – 2/1/2012

Administrative Functions:

• Total calls received/Made (1,517) • Professional (695) • Transportation set-ups & questions (822) • Home visit set-ups (1) • Office visits (123) 3 = paperwork • Minutes typed up for DMAB meeting – PAO-2/14/2012 • All Staff Mtg.= 1/3 & 2/3/2012 • Transporter Mtg. = 3/30/2012 • Car seats dispensed (25) • Helmets dispensed (9) • Created & finished 1st & 2nd Qtr. Reports for ODOT Transportation of Clinic 2011

Professional Development and Committees

• Head Start Health Advisory Committee – 1/31/2012 • Healthy Traditions meeting- 2/1/2012 • Steering Committee meeting – 1/242/2 – 2/4/- 2/7/2012 • CDC Committee meeting – 1/24 – 2/7 – 2/24/2012 • Transportation ODOT meeting – 1/12 • Dental Sealant Program – Feb 21, 22 & 23 2012

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ALCOHOL AND DRUG Staff Janet Wicklund - Program Director Conrad Douma, – Salem Area Office Counselor Delina John – Siletz Office Counselor Zebuli Payne – Siletz Office Counselor Trainee Sue Langstaff – Data Coordinator/Receptionist. Bernadette Ray - Housing/TLC Coordinator – temporary, part-time Bernadette Ray – Prevention Coordinator – temporary part-time Jenifer Metcalf – Prevention Coordinator, left her position in the quarter Ellen Hamilton – Part-time Women’s TLC Resident Aid Andrew Eddings – Part-time Men’s TLC Resident Aid, contractual Hal Darst - Part-time Eugene Area Office Counselor Allen Nelson – Part-time Portland Area Office Counselor Cynthia Druba – Strategic Prevention Framework Coordinator Jeremy Lacewell – WEX Prevention Assistant, position ended in the quarter Outpatient Treatment Services Provided in the Quarter:

Total clients served 118 Siletz Tribal Members 98 Other Native Americans 9 Hispanic 0 Others 11 Adults 109 Youth 9 Males 65 Females 53

Primary Drug Used 53 clients identified Alcohol as their primary drug used 25 clients identified Methamphetamine as their primary drug used 21 clients identified Cannabis (Marijuana) as their primary drug used 9 clients identified Opiates as their primary drug used 10 clients identified another drug as their primary drug used, or did not admit to drug use Referral Sources 34 clients were referred from a court or the Department of Corrections (not DUII) 24 clients were referred from a court due to a DUII 9 clients were referred from ICW or DHS 5 clients were referred by family members or friends 36 clients were self-referred 0 clients were primarily referred by their medical provider 0 clients were referred by their employer 3 clients were referred by the 477 Self-Sufficiency Program 0 clients were referred by Siletz Indian Housing 5 clients were referred by another treatment provider 2 clients were referred by their school

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Urinalysis Results 395 specimens were submitted for testing from 131 different donors. 132 specimens were positive. Overall positive rate was 33.42%. Of the positive specimens:

12were positive for Amphetamine 33 were positive for Benzodiazepines 43 were positive for Opiates 37 were positive for THC (marijuana) 7 were positive for EtG (within 80 hours of alcohol use)

Services provided:

Assessment - Individual Counseling - Group Counseling- Family Counseling - Case Management - Home Visits - Jail Contacts - Court Appearances - Transportation - Referral to other community resources including self-help - Referral to residential treatment - Residential treatment contacts

Bench Marks:

16 Clients who participated in recreational activities 6 Clients successfully completed outpatient treatment 6 Clients were referred to and entered residential treatment 1 Clients successfully completed residential treatment 0 Clients entered residential treatment with their children 0 Clients regained custody of their children during the quarter 7 Clients gained employment during the quarter 6 Clients gained housing during the quarter 46 Clients had improved health care during the quarter 53 Clients stayed out of legal trouble during the quarter 44 Clients who were participating in treatment for 90 days or longer. 4 Clients referred for infectious disease testing

Women’s TLC Services

Total residents: 4 adult residents and 1 child resident and 1 visiting child Siletz Tribal Members: 2 adults and 1 child resident and 1 visiting child Other: 2

Volunteer hours: 0

Resident services provided: Transportation, referral, case management, and weekly House Meetings. All adult residents participate in outpatient treatment and are monitored by urinalysis testing.

Men’s TLC Services

Total residents: 2 Siletz Tribal Members: 2

Volunteer hours: 0

Resident services provided: Transportation, referral, case management, and weekly House Meetings. All residents participate in outpatient treatment and are monitored by urinalysis testing.

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ATOD Prevention and Juvenile Crime Prevention/Tribal Youth Programs Services The Prevention Coordinator left employment in this position in the quarter and did not submit data for

this report. SPF/SIG (Strategic Prevention Framework/State Incentive Grant)

Facilitated monthly CEDARR coalition meetings Attended other Lincoln County coalitions. During these three months conducted interviews with community members and tribal staff

about the SPF/SIG process and data gathering. Conducted the community readiness interviews for the SPF/SIG project. Consulted with SPF/SIG resources regarding requirements for data gathering and planning. Conducted a survey with Lorrie Syms’ film class, 17 students. Submitted monthly articles for the Siletz News. Served on subcommittee planning for the upcoming prescription drug abuse summit. Worked with Toledo Police Department and got a temporary prescription drug take back day,

April 28, 2012.

Tobacco Prevention and Education, Siletz Community Outreach

Community outreach 4 activities were: • CEDARR – February • Youth Services meeting • Tobacco Advisory meeting • Second step- Siletz valley school

Policy Development

A total of 3 policy activities: • Youth council/youth alliance tobacco group • CDC planning meeting • Healthy Traditions - Seed planting at Siletz Valley School

Youth Activities

A total of 9 youth activities: • 3 on 3 basketball tournament – 40 youth • Grand Ronde Wellness day – 12 youth 4 girls, 8 boys • Grand Ronde Round dance – 21 youth 4 girls, 8 boys • Spring basketball tournament – 99 youth 33 girls, 36 boys • Splash – 72 youth 27girls, 45 boys • Movie-the Lorax – 99 youth 60 girls, 39 boys • Roller Skating – 54 youth 35 girls, 19 boys • Rec center- Linfield college – 28 youth 7grils, 19 boys • Sitka – 6 youth 6girls, 0 boys

Health Education & Promotion

A total of 4 health education and promotion activities: • Newspaper article- Quit Lines info • Newspaper article- Quit Line Info • Newspaper article- beading class

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• Portland area office Pow-wow class DHS- Department of health and Human Services, TPEP Grant-Related activities

A total of 3 DHS activities: • Monthly call with State • Winter swing • Webinar

Outpatient Staff Delina John: Theories of Cognitive Behavioralism; Language of Supervision (CBT); Opiates training March 9th; presentation to students in the SVS film Project for Prescription Drug Abuse Prevention. Conrad Douma: Good Road of Life; Theories of Cognitive Behavioralism; monthly MDT meetings. Hal Darst: Attended Theories of Cognitive Behavioralism; webinar on Mindfulness and Therapy, monthly MDT meetings. Allen Nelson: Attended DSM IV webinar training; Motivational Interviewing training; monthly MDT meetings. Zebuli Payne: Attended the following trainings to complete course required for certification: Good Road of Life; Theories of Addiction Treatment; Professional Ethics; Theories of Cognitive Behavioralism; Language of Supervision (CBT). Prevention Staff Cyndee Druba: Attended Nine Tribes quarterly meeting in Lincoln City, January 9th, 10th and 11th; Positive Community Norms Training in Denver, CO, January 23rd -26th; Conference call with state SPF/Sig Coordinator, book study #1 on January 19th; Prevention Ethics training in Woodburn on February 15th; SPF webinar with state SPF/Sig Coordinator on February 21st; Capacity building, SPF/SIG in Woodburn on February 27th & 28th; Tobacco prevention webinar on February 5th. Tasha Mason: attended the 9 tribes prevention quarterly, Denver positive community norms and CDC conference Program Director Janet Wicklund: Participated as a Lincoln County Drug Court team member; attended monthly CEDARR meetings; attended and served as coordinator for Nine Tribes MOU quarterly meetings; attended monthly CPT meetings; attended monthly MDT meetings; served on the Siletz Community Health Clinic Pain Committee addressing opiate misuse; attended Oregon Council on Addictions meeting. HEALTH DEPARTMENT ADMINISTRATION Staff Judy Muschamp, Health Director and General Clinic Administrator Marci Muschamp, Administrative/Quality Improvement Coordinator Wendi Schamp, Administrative Assistant Charlie Butler, Day Maintenance Lawrance Navarro, Evening Maintenance Lark Logan, Evening Maintenance Health Administration Activities

Health Administrator is responsible for: o Daily administrative duties of reviewing new and updated registrations, review of clinic, CHS

and other Tribal Health purchase orders and check requests o Participate in weekly gatekeeper, CHS appeals, and pain management reviews.

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o Supervise day-to-day operations including staffing issues, authorizing leave and signing time sheets

o Administer all aspects of Self-Determination contracts between IHS and Siletz Tribe o Represents the Tribal Health Department to the public and to Tribal Members o Authorizes CHA client transports from Siletz o Participates in Tribal Management meetings every other week o Attends monthly Fringe Benefits Meeting at Chinook Winds o Represents the Tribal Health Department to the Tribal Health Committee and Tribal Council o Overseeing Clinic Expansion Project o Participates tribal health as an Oregon Health Fund Board Finance Committee member

In addition, this quarter:

o Attended RHED meetings o Attended Oregon Health Exchange meeting o Attended Tribal Consultation meetings

Administrative Assistant is responsible for: o Communicating Health Department Administration policies and procedures to patients, public and

staff o Purchasing, storing, maintaining inventory. Participates on Safety Committee o Oversight of check requests and purchase orders o Sending and distributing mail and correspondence o Directing clients and visitors to appropriate programs or personnel o Assist staff with managing an scheduling appointments, meetings, travel arrangements o Cross-train and backup clinic staff where needed, specifically Medical Support and Pharmacy o Prepare agenda and meeting minutes for Health Committee, and other Clinic meetings o Maintain fax and copy machines o Assist with transportation requests and distributing bike helmets for CHA program o Backs up Admin/QI Coordinator in coordinating meetings and schedules Massage appointment for

staff In addition, this quarter, Wendi:

o Annual inventory o Attended Document Manager demonstration o Facilitated cleaning of supply room and basement o Assisted with Sealant Clinic – staff support o Assisted pharmacy while they were short staffed

Reports - See APC 1a Report Tribally Operated Programs Workload Report –– Appendix K; See Tribal Membership by Age Report –– Appendix L; See GRPA Summary – Appendix M; See Provider Production Report -Appendix N Risk Management – Patient and Staff Satisfaction Because We Care Forms: There were 6 concerns and 3 compliments and 1 incident documented this quarter. All complaints/incidents were investigated.

Two incidents involved dental. The first concern was regarding staff. Discussed concern with staff and patient address both patient rights and responsibilities. The second concern was regarding patient

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conduct. Patient was provided letter with copy of tribe’s conduct policy and clinic’s Rights and Responsibilities.

One incidents involved transportation. Conducted was address with both client and transporter. Three incidents and three compliments involved Medical Support. Three incidents related to patient

conduct. Each patient was provided a letter with copy of tribe’s conduct policy and clinic’s Rights and Responsibilities. The three compliments acknowledge Tracy and Kristi’s helpfulness at patient check-in.

The incident involved the safety of a patient during a lab visit. Communication devices have been purchased for lab and radiology. Staff is to use communication devices in case they need assistance and are unable to leave the patient to seek help.

Safety/Infection Control Committee

Quarterly Building Inspection - March Quarterly drill – January Addressed patient safety in lab and radiology – recommended purchase of communication devices for

emergencies Remedying Fire Marshall findings.

Facilities Monitors/Repairs/Improvements

Thyssenkrupp monthly elevator service Harvey & Price – repaired multiple sprinkler leaks RLSM – heating/cooling unit leak repair Valley Fire Control – retagged/recharged fire extinguishers Cummins – quarterly maintenance on generator

Quality Improvement/Communications Goals of Admin/QI Coordinator are to maintain the Clinic’s high standards and to encourage changes that improve patient care and personal growth. Activities

Schedule and assure that minutes are taken at regular and special meetings with Clinic staff and Health Committee.

Solicit information, run reports and prepare quarterly report. Worked with departments to present progress on goals in each quarterly report. Present summary information to Health Committee and Tribal Council.

Coordinate meeting calendar and Medical Provider scheduling oversight. Work with departments on goals, objectives and budgets. Serve as Acting Health Director in Judy’s absence. Serve as Administrative member of Clinic’s Safety Committee, backup for Tribal Safety Committee and

Administrative Floor Monitor for Clinic.

Committees Medical Staff • Providers meet every other week to do case review, review formulary requests and communicate on

schedules, new forms and procedures. Other staff attends as needed.

Planning/QI Committee

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• Reviewed 2011 QI studies • Identified 2012 QI Studies • Reviewed policies • Reviewed 2011 Patient Satisfaction Surveys •

Credentials Executive Committee – • Reviewed pharmacist credentials; reviewed peer review

Health Committee • CHS appeals – 1 • HIPAA training • Confidentiality training • Reviewed 2011 QI studies • Reviewed policies • Reviewed 2011 Patient Satisfaction Surveys • Committee concerns discussed

Monitor – Patient Access Medical - Next available 30-minute follow-up appointment:

Dr. Burns Dr. Rash Lisa Erin Dr. Tuft Dr. Sparks Dr. Nguyen 13 days 1 days 8 days 5 days 4 days 2 days 7 days

Dental - Next available 1-hour appointment

Dr. Chadwick Dr. Saxton Mary Ellen 20 days 23 days 6 days

Optometry – Next available 30-minute appointment: (limited visits due to move)

Dr. Schroeder 1days

*Same day medical visits are available each day On-line viewing – contact Marci @ 541-444-9663 for copies of the appendices.