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

2. 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.

3. Revised Community-Driven Program’s Goals to Include DPP Core Elements
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.

4. 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

5. 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

6. 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…

7. 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)

8. 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

9. 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!

10. WELCOME PACKET

11. Joslin Vision Network

13. 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.

14. 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

15. 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.

16. 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.

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

19. 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.

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