1. VA Office of Tribal Government Relations ODMHSAS Specialty Court Training September 3, 2015

2. 2 VA Office of Tribal Government Relations (OTGR) CO Established office in January 2011  In response to President Clinton’s Executive Order 13175 and President Obama’s memorandum on Tribal Consultation dated November 5, 2009  Recognizes unique Government-to-Government relationship with tribes  5 FTEE – Director, Executive Officer, 4 Regional Specialists VA’s Tribal Consultation Policy completed on February 2011  First VA consultations occurred in 2012  Most recently in September 2014/November 2014 OTGR Specialists hired August/September 2011  Responsible for managing a portfolio of relationships with tribal governments within a specific region  Service as a resource to tribal governments for VA services

3. 3 VA Organization OFFICE OF TRIBAL GOVERNMENT RELATIONS Robert McDonald Secretary Peter Vicaire OTGR Specialist Central / Northeast Region L. HoMana Pawiki OTGR Specialist Southwest Region Terry Bentley OTGR Specialist Western Region Vacant OTGR Executive Officer Mary Culley OTGR Specialist Southern Plains / Southeast Region Sloan D. Gibson Deputy Secretary Rob Nabors Chief of Staff Christopher E. O’Connor Interim Assistant Secretary for Congressional & Legislative Affairs Deputy Assistant Secretary Office of Intergovernmental Affairs Stephanie E. Birdwell, Director Office of Tribal Government Relations

4. 4 VA Office of Tribal Government Relations Region 1: Connecticut, Maine, Massachusetts, New York, Rhode Island- Peter North Carolina-Mary Region 2: Alabama, Florida, Georgia, South Carolina - Mary Region 3: Iowa, Michigan, Minnesota, Nebraska, ND, SD, Wisconsin-Peter Kansas-Mary Region 4 Louisiana, Mississippi, Oklahoma, Texas-Mary Colorado, Utah - HoMana Alaska, California, Idaho, Nevada, Oregon, Washington-Terry Region 5 Arizona, New Mexico - HoMana

5.  American Indian and Alaska Native Veterans have played a vital role in the U.S. military for over 200 years.  Native Americans serve at a high rate when compared to other races  Approximately 140,828 Veterans, comprising of 0.7% of almost 20 million Veterans – this is important to note because the AI/AN race is less than 1.0% of the population  36.5% of AI/AN Vets use VA health care * * Source: 2013 American Community Survey American Indian/Alaska Native Service Members and Veterans

6.  Three times more highly rural than non-Native Veterans  Younger as a cohort than all other Service Members and Veterans  17-24 y/o - 1.6% vs 1.5% *  25-34 y/o – 9.8% vs 6.8% *  More female Veterans serve than Non-Native (11.5% vs 8.0%)*  Income levels and educational levels lower  Higher degree of combat service - more service connected Veterans than other non-Native counterparts *Source: 2013 American Community Survey) Challenges Facing American Indian/Alaska Native Veterans

7.  Transportation issues  Language and cultural barriers  Building ‘Trust Relationships’ with the Veterans & the tribal nations servicing them  Understanding the ‘Fiduciary and Trust’ relationships between the government and tribal nations – seeing them as Nations and not a minority group  New to VA’ processes, patience in working with Veterans as tribal staff that service them continue to learn about VA  Receiving and posting updated Benefits info  Receiving and posting updated health care info Challenges Facing (Con’t) American Indian/Alaska Native Veterans

8. Goal 1: Facilitate Increased Access to Health Care & Benefits  Through VA Healthcare Facilities & Vet Centers  Through Veterans Benefits Administration and National Cemetery Administration  Through Tribal Health Programs  Through Indian Health Service Facilities  Tribal Consultation on Section 102(c) of Veterans Access, Choice & Accountability Act of 2014 Goal 2: Promote Economic Sustainability  Through utilization of GI Bill benefits for education  Connecting them to job training and job opportunities  Awareness of federal contract opportunities for Veteran Owned Small Business  Expand knowledge and use of the Native American Direct Loan Program for home loans on trust lands Goal 3: Implement VA’s Tribal Consultation Policy VA OTGR NATIONAL UPDATE VA OTGR – 3 MAIN GOALS

9. OTGR Goal 1: Facilitate Increased Access to Health Care  OTGR works closely with tribes to implement the VA, Indian Health Service and Tribal Health Programs Reimbursement Agreements. VA reimburses IHS and THP programs for direct care services provided to eligible American Indians and Alaska Native Veterans. These agreements increase access to care for American Indians and Alaska Native Veterans nationwide, in particular those highly rural Veterans living within Indian Country.  Listed below are the current agreements and reimbursement amounts: 83 IHS agreements at 108 IHS sites 80 Tribal Health Program (THP) 49 THPs In Progress $24.2 Million Reimbursed (from FY12 to June 2015-FY15)  Tribal Consultation Dec 30, 2015-Jan 14-2015, Section 102 (c), Veterans Choice and Accountability Act of 2014  OTGR Conducts Veterans Training Summits within Indian Country to promote VA services and benefits 21 nationwide (2012 to 2015) 2,536 participants VA OTGR NATIONAL UPDATE Connecting Tribes to Goals

10. OTGR Goal 1: Facilitate Increased Access to Health Care  OTGR works closely with tribes to implement the VA, Indian Health Service and Tribal Health Programs Reimbursement Agreements. VA reimburses IHS and THP programs for direct care services provided to eligible American Indians and Alaska Native Veterans. These agreements increase access to care for American Indians and Alaska Native Veterans nationwide, in particular those highly rural Veterans living within Indian Country.  Listed below are the current local agreements and reimbursement amounts: Thirteen (13) Indian Health Service agreements Nine (9) Tribal Health Program (THP) Four (4 ) THPs In Progress $3.5 Million Reimbursed (from FY12 to June 2015 FY15)  OTGR Conducts Veterans Training Summits within Indian Country to promote VA services and benefits  Conducted two (2) Native American specific Homeless Stand Downs  227 Total Participants  40 Total Native American female Veterans  21 Total widows 3 Veterans Training Summits locally (2012 to 2015) 369 Total participants for both summits VA OTGR NATIONAL UPDATE Connecting Tribes to Goals (Southern Plains Region)

11. OTGR Goal 2: Promote Economic Sustainability Expand Knowledge and Use of Native American Direct Loan (NADL) Program Veterans Benefits Administration (VBA) product 86 Tribal Governments signed NADL MOU 1 Tribal Governments in process to sign NADL MOU HUD-VASH Program Jan 30, 2015-announced expansion of HUD-VASH Housing Vouchers directly to Native American communities $4 million will be invested specifically to support NA Veterans HUD’ Tribal Consultation with Tribal Nations ended Feb 25 th tribalhudvashcomments@hud.gov tribalhudvashcomments@hud.gov Connecting Tribes to Goals

12. OTGR Goal 2: Promote Economic Sustainability Expand Knowledge and Use of Native American Direct Loan (NADL) Program Veterans Benefits Administration (VBA) product 2 Oklahoma Tribal Governments have a signed NADL MOU - Muscogee (Creek) Nation - Ponca Nation - Kansas Tribal Government has signed a NADL MOU - Prairie Band Potawatomi Nation 1 Oklahoma Tribal Government in process to sign NADL MOU - Seminole Nation Expand Knowledge and Use of National Cemetery Administration’ Tribal Cemetery Grant 1 Oklahoma Tribal Government received Cemetery Grant 2014 - Seminole Nation – Dedication Ceremony was November 2014 1 Oklahoma Tribal Government pending grant approval - Ponca Nation – pending architectural review and approval to move forward with grant Connecting Tribes to Goals (Southern Plains Region)

13. -Establishing relationships with tribal staff -Attend their tribal health fairs, mental health summits -Invite tribal healthcare staff to your summits -Teach tribal staff your processes and how to manipulate your systems to better serve the NA Veteran population -Invite a Tribal mental health representative to be a guest speaker at your events – allow them the opportunity to teach your staff true cultural competence -Expand your knowledge of their programs Establishing “Trust” Relationships with NA Veteran Populations

14. -Be patient – when working with both staff & Veterans – learning new government programs they have never encountered before is not easy -Be cognizant of the small facial cues -If I nod “yes” while you are speaking does not necessarily mean I understand you -Ask them if they understand before continuing -Native American people are generally quiet – so ask to make sure they understand -Never expect big crowds the first time you have a tribal event - Understand “Historical Trauma” Establishing “Trust” Relationships with NA Veteran Populations

15. Department of Veterans Affairs Office of Tribal Government Relations StephanieElaine.Birdwell@va.gov 202-461-7400 Mary.Culley@va.gov 405-456-3876 www.va.gov/tribalgovernment www.va.gov/tribalgovernment - Main website Tribal.agreements@va.govTribal.agreements@va.gov – VA-IHS-THP Reimbursement Agreements Tribal.Consultation@va.gov Tribal.Consultation@va.gov – email for tribal leaders to submit inquiries directly to VA Office of Tribal Government Relations Office of the Director 15