Cow Creek Band of Umpqua Tribe of Indians Diabetes Program Sharon Stanphill – Oregon

Smaller tribe with limited funding and resources for both the community-driven and DPP Programs. Small tribe located in southern Oregon. We have limited funding for the community-driven grant and are part of a consortium which means we split the DPP funding 3 ways. Thus, staff, resources and funding is limited.

Revised Community-Driven Program’s Goals to Include DPP Core Elements 2005-06 Grant Objectives revisions included: Adding Prediabetes/Metabolic Syndrome registries Combined both program staff to diabetes team with updates of both SDPI program components at monthly meetings/reports 2006, include pre-diabetes patients into diabetes clinics 2-4 times per year following the IHS Guidelines for Prediabetes/Metabolic Syndrome) Same goals as DPP 7% loss of body weight and maintenance of weight loss 150 minutes per week of physical activity Frequent contact with educator PHASE 1 - As we hired 1-2 staff for the DPP we knew we would have to eventually incorporate them into SDPI program. So, we began making plans in 2005 to integrate both grants.

Multidisciplinary Team Clinic staff, podiatrist, Behavioral Health, A&D, PHN, RD, exercise specialist, CHR, lifestyle coaches (DPP), JVN technician and support staff. Intensively operating team: Meet monthly, hold a clinic with all staff monthly and have a diabetes coordinator meeting monthly. Team photo here

Diabetes Care Team (DCT) Meeting August 20, 2008 1:00-2:00 PM Minutes from July 30, 2008 Accreditation (Standard 1, Level 3) Team – structure and processes identified Roles of each team members (structure) Meeting frequency, minutes, agenda, etc. (processes) Evidence of integrated diabetes education & medical standards Education Focus Group – Meet weekly for approx. 4 weeks Registries – addition on complications for pre-diabetes – Terrie/Cynthia Grant(s) Diabetes Prevention Program (15 more months of intensive/Aftercore) Screening for next group (# thus far for group #6) After-Core update – any new ideas plans Less-intensive (recruitment): health fairs, picnic, other Community-Driven Program Diabetes “Pet” walk/run Update (Sept) - Tricia Clinic: Education/SOC Welcome Packet contents/plans – Sharon Exercise Prescription Program - Bob JVN – Heidi Home Blood Glucose Monitoring- Mary/Carol Implementation of risk assessment template – Cynthia Fall Newsletter - Jen Registry, access to care, future scheduling – Terrie Visit Checklists (initial exam/ongoing management) - Sharon

Adopted a New Clinical Care Practice “First-Line Therapy” 4 major components Nutrition – modified Mediterranean Diet (very science based) and supplements even with balanced diet. Stress Management (major emphasis with decreasing Cortisol levels which makes body resistant to insulin and breaks down lean muscle mass versus burning fat) Building Lean Body Mass (track body composition) Optimizing Hormones (if hormones are out of balance… nothing works well…) Phase 2 – 2006, we were at a place in our first year of the DPP where our primary physician was retiring and so we met with our board of directors and shared our concerns to change our clinical practice a bit. Wanted to hired 2 FNP who specialize in functional medicine and an internal medicine provider with experience in the field of endocrinology. Change system from the clinic out…

Focus: Standards of Care (Prediabetes, MS or Diabetes) Multiple stations “First Line Therapy” (clinic w/RD) JVN Tobacco Cessation Meter program & strips (diaries pre-) Podiatry (Nike Shoe/Crocs program) Exercise prescriptions Behavioral Health (eating & depression)

Lesson from DPP Pilot Project – 2007 Frequent Contact/Case Management Works!!! All program staff’s time will be used to fully establish intensive case-management with “active” prediabetes/diabetes patients Goal: 20 patients first year Teams of 3-4 staff: 1 patient PHASE 3 - 2007

Intensive Phase “First-Line Therapy” Clinics Curriculum (adapted “Life with Diabetes” ADA manual and DPP curriculum) Personal exercise trainer (lean body mass) Nutrition (intensive with both providers and RD) Individualized weekly/monthly meetings with Life Style Coaches Participation with group activities & support group Phase 3 – 2007, just recently added lifestyle coaching with staff other than providers. Looks lot like DPP!

WELCOME PACKET

Joslin Vision Network

Educational Reinforcers $25 Nutrition Card (correlate with weekly sessions e.g. stocking pantry, eating whole foods, 1 Turkey = 5 meals) Store items Food processor, appliances Health-related reading materials Exercise items Healthy recipe books Gardening items Intensive participants (Duffle bag, T-shirt) Incorporated from the DPP. Tools to assist with maintaining new lifestyle changes.

Nutrition Card Grocery store card with $25 available to purchase selected items from the cards list Contract signed to comply with guidelines Evaluation completed for each card given. Picture Nutrition Card

Blood Glucose Meters Meter allows data to be downloaded and given to patient so they can work with their team. Exercise specialist, dietician, BH counselor and provider.

Successful Community-Driven Program Strong Self-Management Education Program Newly diagnosed classes (whole team) Ongoing monthly education opportunities (differ each month on all topics) Weekly cooking classes in 2 communities Weight management clinics (provider, exercise specialist, dietician) Walking, Pilates and circuit weight-training clubs Diabetes templates and referrals with EHR system Quarterly Community activities Cooking Classes – lot whole foods and use nutrition card. Support of clinical services.

Promoting Healthy Lifestyles with Children Strengthening the Next Generation Classes Youth Diabetes Prevention Workshops

Less-Intensive Activities Draw a Crowd Lessons Learned DPP Physical Activities Community Walk Runs Walk Across America (Patient Teams) Yoga/Pilates Circuit Training Group Hikes (monthly) “Poker Walks” Lunch & Learns Family & Youth Activities Screen for prediabetes but encourage all tribal members & employees to exercise.

Wellness Champions Lessons Learned DPP 10 DPP Mentors – lost weight 7 kept it off! 5 “First-Line” Mentors – decreased medications!