Strategies From American Indian and Alaska Native Community Partners on Effective Emergency Response Collaboration

In the United States, there are 567 federally recognized Indian Nations (also referred to as tribes, communities, pueblos, rancherias, bands, native villages, and nations) that span 35 states.¹ Each of these Nations are culturally, linguistically, and regionally different from each other.^2,3 While each Indian Nation is different, the US recognizes each Nation as a sovereign and self-governing entity.^2,3 As sovereign nations, each nation has the authority to enact their own regulations to protect the health, safety, welfare, and overall well-being of their communities.⁴ The different jurisdictional authorities within Indian Nations are complex, especially in public health preparedness and response (PHPR), as the delivery of services are distributed across federal, state, local, and tribal systems.⁴ Thus, addressing sovereignty and multiple jurisdictions is critical to building and maintaining an effective tribal and multijurisdictional response network.

Unfortunately, the integration of tribal public health partners into the multijurisdictional response network is often lacking. Supporting and sustaining an efficient network requires effective communication and collaboration to build capacity and capability. To assist in the identification of barriers that hinder effective collaboration and communications with tribal preparedness partners, the Mountain West Preparedness and Emergency Response Learning Center (MWPERLC) at the University of Arizona’s Mel and Enid Zuckerman College of Public Health was awarded a cooperative agreement from the Centers for Disease Control and Prevention (CDC) focused on the translation, application, and evaluation of research products and trainings to improve public health preparedness and response practices, policies, and programs.

The overall goal of the MWPERLC project was centered on “Building an Effective Tribal and Multijurisdictional Response Network to Improve Preparedness and Response.” To meet this goal the MWPERLC developed and distributed a regional tribal, state, and local needs assessment survey to validate the existing preparedness and response gaps of our tribal partners and to identify collaboration gaps between tribal, state, local, federal, and territorial preparedness partners. The needs assessment was distributed electronically to three separate groups: (1) MWPERLC advisory board members, (2) constituents and (3) members on the MWPERLC listserv. These individuals represented a wide array of agencies and jurisdictions and provided the MWPERLC team with multiple perspectives on the preparedness challenges within their respective jurisdictions and diverse communities.

Data collected from the needs assessment were analyzed quantitatively to summarize and identify trends and analyzed qualitatively using a thematic approach to identify commonalities in the responses. To validate the specified needs identified in the needs assessment, the MWPERLC utilized an approach that included organizing an advisory board meeting and using the state-specific capability planning guides and the 2016 CDC National Snapshot⁵ as benchmarks for comparison.

STRATEGIES

To further understand the deeper issues identified in the tribal needs assessment survey, the MWPERLC engaged its tribal advisory board members in root cause analysis to define success in collaboration and communication among preparedness partners.⁶ Root cause analysis is a vigorous evaluation methodology used in a variety of different disciplines to determine the real cause of an issue.⁷ Root cause analysis is also a structured problem-solving approach to assist in the identification of the real cause of a problem and to identify actions leading to a permanent solution to that problem.⁷ To begin root cause analysis, a problem statement needed to be identified and defined.⁶ The root cause analysis proposed the following problem statement: “There is less than effective collaboration between all formal preparedness partners.”⁶

The root cause analysis identified the following top three issues:

• lack of face-to-face personal interaction with partners;

• lack of understanding of how tribal governments work with nontribal partners; and,

• lack of preparedness infrastructure (i.e., often no formal public health emergency preparedness or emergency management programs) within the community.

The resulting root cause analysis map is shown in Figure 1.

FIGURE 1—

Root Cause Analysis Map

Note. EM = emergency management; PHEP = public health emergency preparedness.

The root cause analysis identified opportunities to increase collaborative efforts between all preparedness partners.⁶ Additionally, to enhance collaboration among tribal, state, local, and federal preparedness partners, the results from the root cause analysis led to the development of a guidebook that addressed the gaps associated with the three identified issues. The guidebook identified seven strategies for effectively working with American Indian and Alaska Native (AI/AN) communities. The strategies include:

1. Understand the history of AI/AN peoples in the United States: Recognize the deep-rooted and complex histories among AI/ANs and how it has affected their PHPR efforts.

2. Recognize the different structures of tribal governments among AI/AN peoples: Understand that federally recognized tribes are diverse in structure and decision-making processes and tribal nations represent a unique part of the US emergency management system.

3. Acknowledge all AI/AN communities are different: AI/AN communities share similar values and ways of life, but every tribe is different, and these differences can play an integral role in their understanding of PHPR and in how a tribal nation responds to a disaster.

4. Establish trust with AI/AN peoples and their communities: To effectively work with tribal nations it is important to build relationships and maintain trust within each tribe.

5. Develop effective communication with AI/AN communities: Maintaining communication skills and patterns that are relevant to each AI/AN tribe is a crucial step in PHPR efforts.

6. Solicit tribal consultation: Ensure there is a process in place to seek, discuss and consider the PHPR views of AI/ANs.

7. Understand key definitions that apply to AI/AN peoples: Know the concepts, terms, and definitions that are specific to each group (i.e., AI/AN, Indian Country).

CONCLUSIONS

The communication and collaboration in emergency preparedness and response is most effective when cultural and social differences are considered when working with diverse groups.⁸ Public health preparedness partners at the federal, state, and local level often face challenges when trying to connect with tribal communities to coordinate emergency planning and response. The strategies guidebook developed by the MWPERLC is an attempt to provide state, local, and federal preparedness partners with strategies to potentially overcome these challenges. The strategies serve as a general overview to enhance public health emergency preparedness communication and collaboration, as well as cultural and societal competency, when working with tribes.⁸ The strategies presented have been identified as useful and effective ways to assist tribal preparedness partners in the planning, coordination, and execution of their preparedness efforts.⁸ Moreover these strategies may be valuable and adaptable across a wide range of activities, where engagement between those developing and implementing programs and those being served is critical for success and sustainability.