Resources & Tools

Diabetes Talking Circles

Since 2005, the Native Diabetes Wellness Program, in partnership with the Seva Foundation, has supported Diabetes Talking Circles throughout Indian Country, conducted by Lorelei DeCora, RN, BSN (Ho-Chunk/Winnebago Nation, Nebraska). For more information, visit: http://www.seva.org/site/PageServer?pagename=Diabetes_Tutorial

Inspired by the power of talking circles and the Eagle Books messages and characters, the Native Diabetes Wellness Program is developing new stories, which talking circles with youth have helped to inform.

Culture Card

A Guide to Build Cultural Awareness, American Indian and Alaska Natives

Originally developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) in collaboration with communities and representatives from federal agencies (CDC, IHS, and Centers for Medicare and Medicaid Services, SAMHSA and CDC’s Native Diabetes Wellness Program partnered to make the card available for widespread distribution.

The Culture Card is downloadable or can be ordered from SAMHSA’s Health Information Network at www.SAMHSA.gov/shin or by phone: 1-877-726-4727. Reference the following publication: DHHS Publication No. (SMA) 08-4354.

Posters

Traditions of Gratitude Poster Series

The Traditions of Gratitude poster series includes three colorful posters that honor the significant contributions of American Indians and Alaska Natives in diabetes science, diabetes talking circles, and the role of community health representatives.

Anishinaabe artist, Sam English (Turtle Mountain and Red Lake Nations), created the three- poster images in collaboration with the Native Diabetes Wellness Program (Poster Dimensions=18 x 24 inches):

• Standing Tall: Honoring Community Health Representatives 1968-2009
• They Changed the World! A Tribute to Tribal Participants of the Diabetes Prevention Program and Other Diabetes Studies
• Around the Fire: Talking Circles for Diabetes Care and Prevention

Ordering Information

Visit http://wwwn.cdc.gov/pubs/diabetes.aspx to order single copies of the posters. Tribal programs interested in bulk order can place order requests via e-mail cdcinfo@cdc.gov or call 1-800-CDC-INFO (1-800-232-4636), TDY: 1-888-232-6348

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Community Health Representatives

The In-Between People—Community Health Representatives

Community Health Representatives (CHRs) are uniquely skilled to serve as bridges between the health care system and the communities they serve. Described by some as the “in-between people,” CHRs are caring, knowledgeable community members as well as valuable members of the health care team.

This 21-minute DVD was developed by the Native Diabetes Wellness Program to document the critical role of CHRs and other community health workers. Narrated by the president of the IHS Aberdeen Area CHR Association, the film highlights three American Indian communities.

Communities Featured

• The Round Valley Indian Reservation in Covelo, California
• The Cheyenne-Arapaho tribe in Concho, Oklahoma
• The American Indian community in New York, New York
• Two Latino communities
  • Migrant workers in Owatonna, Minnesota
  • Recent immigrants in Brownsville, Texas

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Health Communication Planning

CDCynergy American Indian/Alaska Native Diabetes Edition

CDCynergy American Indian/Alaska Native Diabetes Edition is a step-by-step tutorial developed by the Native Diabetes Wellness Program for health communication program planning and evaluation in American Indian and Alaska Native communities.

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Consultation Policy

Tribal/State Relationships Technical Assistance, the CDC Tribal Consultation Policy, and the American Indian and Alaska Native Culture Card

The Native Diabetes Wellness Program provides technical assistance on state/tribal partnerships and diabetes care and prevention to State Diabetes Prevention and Control Programs (DPCP) through the Division of Diabetes Translation state consultation teams.

Federal law confirms the inalienable and inherent right of tribes to self-governance. The CDC Tribal Consultation Policy (TCP) was established in 2005 and is committed to

• Recognizing and honoring tribal sovereignty.
• Maintaining government-to-government relationships.
• Upholding and supporting the federal trust responsibility.
• Supporting tribal consultation at federal and state levels.

Federal Trust Responsibility is defined as “…The United States government’s moral obligation as defined in treaties. This responsibility is for the United States to honor its obligations, as agreed to in treaties, to represent the best interests of tribes and their members.”

American Indian Policy Review Commission, 1997. GPO, p. 130.

CDC/ATSDR Tribal Consultation Policy—Excerpts

• Federal Law (Article I, Section 8, U.S. Constitution), Executive Orders, and Presidential Memoranda require federal agencies to relate to federally recognized tribes and to consult with American Indian and Alaska Native (AI/AN) representatives on matters that may affect their communities.¹
• Aligning with these laws that confirm the inalienable and inherent right of tribes to self-governance, the CDC-TCP was established (2005). The TCP is committed to
  • Recognizing and honoring tribal sovereignty.
  • Maintaining government-to-government relationships.
  • Upholding and supporting the Federal Trust Responsibility.
  • Supporting tribal consultation at federal and state levels.
• Health and Human Services (HHS) Tribal Consultation Policy calls for HHS agencies “to assist states in developing mechanisms for consultation with tribal governments and native populations before taking any actions that affect tribal governments and Native people. States will receive assistance in developing state plan assurances for the delivery of services to tribal governments and Native people. State consultation with tribal governments shall be done in a meaningful manner that is consistent with the definition of consultation as defined in this policy…”
• Consultation is defined by the TCP as “an enhanced form of communication that emphasizes trust, respect, and shared responsibility. It is an open and free exchange of information and opinion among parties that leads to mutual understanding and comprehension. Consultation is integral to a deliberative process that results in effective collaboration and informed decision making with the ultimate goal of reaching consensus on issues.”
• The TCP strives to ensure “appropriate benefit to AI/AN populations from CDC funds awarded to states,” (e.g., Diabetes Prevention and Control Program award).
• If data or needs of AI/AN tribes are included in state proposals to justify funding requests, documentation of tribal involvement in design and implementation of proposed activities should be provided.
• The CDC will provide DPCP Project Officers an orientation and training process, emphasizing cultural awareness of American Indian/Alaska Native populations.*

*Culture Card: A Guide to Build Cultural Awareness, American Indian and Alaska Native, by the Substance Abuse and Mental Health Services Administration (SAMSHA), Indian Health Service (IHS), and CDC is available from the CDC Native Diabetes Wellness Program.

Excerpts from the CDC/ATSDR TRIBAL CONSULTATION POLICY; Section V, para 2. Issued 10/18/05.

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Stories

Stories To Reach, Teach, and Heal

Over the ages, and across cultures and continents, stories have served to reach, teach, and speak for people in times of hardship and illness. Stories from diverse cultures speak of human resilience, survival, resistance to oppression, and empowerment. Such stories are often drawn from deep wells of wisdom and adaptation.

Recognizing the power of stories, and with the input of diabetes educators, master storytellers, and people with diabetes, CDC’s Native Diabetes Wellness Program has developed a new guide, Stories To Reach, Teach and Heal. The stories illustrate additional ways health educators can use storytelling to share wisdom and inspire people to develop healthy coping skills and problem-solving abilities.

The booklet offers guidance on ways to incorporate story sharing into one-on-one or group diabetes education classes, into clinical practice and in helping patients deal with challenging circumstances. Community leaders may also find suggestions for outreach activities using story sharing to stimulate discussion of how diabetes affects their communities as well as actions for diabetes prevention and control. Stories To Reach, Teach and Heal includes an audio compact disk (CD) in an inside cover pocket with recordings of 11 stories used in this publication as told by master storyteller and diabetes care advocate, Cathy Feste.

As a public domain publication, Stories To Reach, Teach and Heal is copyright-free and can be reproduced without special permission.

Ordering Information

For free copy of Stories To Reach, Teach and Heal contact:
Phone: Toll free 1-800-CDC-INFO (232-4636)
1-888-232-6348 TTY
E-Mail: cdcinfo@cdc.gov

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Publications & References

1. Acton KJ, Burrows NR, Wang J, Geiss LS. Diabetes prevalence among American Indian and Alaska Native children, adolescents, and young adults, 1994-2004. MMWR 2006;55(44):1201–1203.
2. Brownstein JN, Chowdhury FM, Norris SL, Horsley T, Jack, Jr., L, Zhang X, et al. Effectiveness of community health workers in the care of adults with hypertension: a systematic review. Am J Prev Med 2007;32(5):433–437.
3. Bryan R, Schefer RM, DeBruyn LM, Stier D. Public health legal preparedness in Indian Country. Am J Pub Hlth 2009;99(S3):1–8.
4. Chino M, DeBruyn LM. Building true capacity: indigenous models for indigenous communities. Am J Public Health 2006;96(4):596–599.
5. Chino M, Dodge-Francis C, DeBruyn L, Short L, Satterfield D. The convergence of science and culture: Developing a framework for diabetes education in tribal communities. J Health Dispar Res Pract 2007;1(3):75–87
6. Dodge FC, Coulson D, Kalberer B, DeBruyn L, Freeman W, Belcourt J. The significance of a K-12 diabetes-based science education program for tribal populations: evaluating cognitive learning, cultural context, and attitudinal components. J Health Dispar Res Pract 2010;3(3):91–105.
7. Hosey G., Llorens-Chen S.A., Qeadan F., Crawford D., Wilson C., & Yang W. Assessing behavioral health risks, health conditions, and preventive health practices among American Indians/Alaska Natives in Nevada. J Health Dispar Res and Prac 2007;1(3)29–44. http://chdr.unlv.edu/JHDRP.htm.
8. Hosey G, Aitaoto N, Satterfield D, Kelly J, Apaisam CJ, Belyeu-Camacho T, et al. The culture, community, and science of type 2 diabetes prevention in the US Associated Pacific Islands. Prev Chronic Dis 2009;6(3).
9. Jack L, Satterfield D, Rodriguez B, Liburd L, Rivera M, Lester A, et al. American Association of Diabetes Educators (AADE) position statement: cultural sensitivity and diabetes education: recommendations for diabetes educators. Diabetes Educ 2007;33:41–44.
10. National Congress of American Indians Policy Research Center. Research that benefits Native People: A guide for tribal leaders [online]. 2009. [cites 2009 September]. Available at http://www.ncaiprc.org/research-curriculum-guide.
11. Norris SL, Chowdhury FM, Van Le K, Armour T, Brownstein JN, Zhang X, et al. Effectiveness of community health workers in the care of adults with diabetes: A systematic review. Diabet Med 2006;23:544–566.
12. Satterfield D, Eagle Shield J, Buckley J, Taken Alive S. So that the people may live (Hecel Lena Oyate Ki Nipi Kte): Lakota and Dakota elder women as reservoirs of life and keepers of knowledge about health protection and diabetes prevention. J Health Dispar Res Prac 2007;1(2):1–28.
13. Satterfield DW, Lofton T, May JE, Bowman BA, Alfaro-Correa A, Benjamin C, et al. Learning from listening: common concerns and perceptions about diabetes prevention among diverse American populations. J Public Health Manag Pract 2003;Suppl:S56–63.
14. Satterfield DW, Murphy D, Essien JDK, Hosey G, Stankus M, Hoffman P, et al. Using the essential public health services as strategic leverage to strengthen the public health response to diabetes. Public Health Rep 2004;119(3):311–21.
15. Satterfield DW, Thompson-Reid P. We make the road by walking, with the people. Diabetes Spectr 2003;16(3):213–15.
16. Satterfield D, Burd C, Valdez L, Hosey G, Eagle Shield J. The "In-between people": participation of community health representatives in diabetes prevention and care in American Indian and Alaska Native communities. Health Promotion Prac 2002;3(2):166–175.
17. Satterfield DW, DeBruyn LM. The malignment of metaphor: Silos revisited – repositories and sanctuaries for these times. Am J Prev Med 2005;29(3):240–41.
18. Satterfield DW, Volansky M, Caspersen CJ, Engelgau MM, Bowman BA, Gregg EW, et al. Community-based lifestyle interventions to prevent type 2 diabetes. Diabetes Care 2003 Sep;26(9):2643–52.
19. Wilson KE, Satterfield DW. Where are we to be in these times? The place of chronic disease prevention in health promotion. Prev Chronic Dis 2007;4(3).

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