June 2006

Grant Results

SUMMARY

In 2004, the Walking Shield American Indian Society arranged for U.S. military reserve units to provide dental health services to six Indian reservations and conducted an evaluation of this effort.

Key Results

  • A total of 550 individuals from the reservations or neighboring tribes received dental care at the two reservations whose dental services were funded by RWJF. Many individuals came for multiple visits to complete their oral health care.
  • Walking Shield staff wrote a guidebook on how to bring military health care professionals to the reservations. See the Bibliography for more information.
  • Walking Shield staff worked with members of each tribe to help them understand how to sustain an ongoing relationship with the reserve units.

Funding
The Robert Wood Johnson Foundation (RWJF) awarded an unsolicited, one-year grant of $50,000, which provided partial funding of the evaluation and enabled the project to reach two reservations that lacked their own dental facilities.

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THE PROBLEM

Substantial documentation points to the poor health status of Native American populations, including oral health. In 2000, rates for untreated tooth decay among Native American children were two to three times those of children in the general U.S. population, according to the federal Indian Health Service. Periodontal disease in Native American adults was two and a half times that of the general U.S. population.

The Walking Shield American Indian Society began collaborating with the U.S. military in the mid 1990's, arranging for reserve units to visit and perform services at Indian reservations. Under the military's Innovative Readiness Training program, the reserve units gain valuable field experience while assisting impoverished communities. Military personnel who came to reservations provided infrastructure development (such as building roads) and medical and dental care. In 2003, Walking Shield facilitated the military's provision of medical and dental services to 18 reservations. All of those reservations had medical facilities on site.

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RWJF STRATEGY

As noted in RWJF's 2004 Annual Report, "[e]nsuring that all Americans have access to quality health care means eliminating the gaps in care experienced by racial and ethnic minorities. The Robert Wood Johnson Foundation seeks to improve understanding of the multiple factors that lead to racial and ethnic minorities receiving poorer quality care and to work directly with health care systems to improve the quality of care for all patients." This project aimed to provide dental services to members of one underserved minority group, Native Americans.

RWJF has, over the years, supported many different efforts to improve dental care and to improve access to dental care. A partial listing of these efforts includes:

  • Since 2001, Pipeline, Profession and Practice: Community-Based Dental Education has sought to increase access to oral health services by incorporating community-based practice into dental school curricula and to encourage low-income and minority students to become dentists.
  • The Summer Medical and Dental Education Program seeks to bring disadvantaged and minority students into the dental profession, where they are underrepresented.
  • The State Initiatives to Improve Access to Dental Care program is a program designed to increase access to dental services for children enrolled in Medicaid and SCHIP, as well as their parents, other adults with special needs and uninsured children.

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THE PROJECT

The RWJF-funded project sought to bring mobile dental teams and equipment to two reservations that did not have dental facilities and train tribes to access dental care directly from the military. Walking Shield staff coordinated the arrangements to deploy military personnel. Reservation staff and tribal representatives provided military personnel with a cultural orientation, acquainting their visitors with a brief history of their tribe and tribal beliefs, customs and rituals surrounding healers.

The project served two reservations:

  • The 912th Medical Company from Independence, Mo., sent a mobile dental unit to the Kickapoo Reservation in Horton, Kan., a central location for members of the Sac and Fox Nation of Missouri Reservation and the Iowa, Kickapoo and Potawatomi Tribes. (All of these tribes are located in Kansas.) They set up in a community building and provided dental care, prevention education and counseling in healthy habits for oral health one weekend in June and August 2004. Each time, the unit sent six dentists and nine or 10 support staff. U.S. military officials cancelled planned deployments to Kickapoo in October and December because the unit was sent to Iraq.
  • The Army's 808th Medical Company from Fort Sheridan, Ill., sent eight dentists and 22 support staff to the Red Cliff Reservation in Bayfield, Wis., for June 2004. They set up their tent next to the reservation's health clinic and provided a variety of dental treatments — from preventive care to false teeth — in the four dental operatories the tent held. The 4220th Medical Company sent a dentist and an assistant to help with follow-up care. In addition to the Red Cliff Band of Lake Superior Chippewas, neighboring children from the Bad River Chippewa Band's Head Start program received care as well.

The Red Cliff Clinic Director told of a young girl who had chipped one of her adult front teeth. She seldom smiled, and often wondered whether she would ever get her chipped tooth fixed. Her family was unable to have it repaired because of the lack of dentists and their own financial hardship. An army dentist was able to fix her tooth so that it looked as good as new. For the rest of the afternoon, she stood at the Operation Walking Shield registration table and smiled, proud to show off her new tooth to everyone who passed by. The dentist who bonded her tooth was assigned to work at Red Cliff for two weeks. He stayed for an additional two weeks.

Many spoke of very warm relationships that developed between the children and reservists who came to Red Cliff. Reservists participated in various community activities, including a softball game at the Red Cliff Recreation Center. Photos captured smiling kids squeezing into pictures of the Reserve team. As one officer put it, "Everybody from our unit is raving about the people here. They've been well taken care of and respected."

Other Funding

The Hasbro Children's Foundation ($50,000), the Henry Niles Foundation ($50,000) and the Red Cliff Band ($20,000) also provided funds to the project.

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RESULTS

The project director reported the following results:

  • A total of 550 individuals received dental care at the two reservations, with many coming for multiple visits to complete their oral health care.
  • Walking Shield staff wrote a guidebook on how to bring military health care professionals to the reservations. See the Bibliography for more information.
  • Walking Shield staff worked with members of each tribe to help them understand how to establish continuous assistance from the military program, including developing a five-year plan of possible rotations of dental personnel. Project staff provided an overview of Operation Walking Shield and taught tribal members how to fill out necessary paperwork and deal with such details as patient scheduling and transportation.

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EVALUATION

The Fielding Graduate Institute evaluated Walking Shield's role in bringing dental services to six reservations in 2004, including the two RWJF helped to fund. Evaluators and Walking Shield staff interviewed tribal leaders, tribal health services staff, patients, parents, military staff and others in June 2004. Evaluators presented their findings to the project staff so that they could improve the way they administered the project.

Evaluation Findings

The project director reported the following as key findings from the evaluation:

  • Walking Shield staff needs to smooth out some roadblocks that impede the delivery of services, such as difficulty with "credentialing." Both the Army and the Indian Health Service separately obtain and verify health professionals' licenses, insurance and other certifications, which involves extra time and expense.
  • Walking Shield staff needs to help develop management and leadership capacity within the tribes. The success of the project rests on the tribe's ability to manage the scheduling, preparation, marketing, transportation and follow-through.
  • Walking Shield staff also needs to plan for the continued growth of Operation Walking Shield. The current staffing level will have difficulty managing operations as they grow. Walking Shield staff needs to expand the organization's capacity to coordinate and control the process.

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LESSONS LEARNED

  1. When sending a team of medical providers to a site, carry out proper pre-planning and site visits, and develop backup plans. When dental supplies ordered by the 808th did not arrive in time, Red Cliff health administrators could respond because they had ordered extra supplies. When generators brought by the 912th did not work, staff borrowed generators from the Kickapoo Fire Department. (Project Director)
  2. When bringing in medical personnel to work at a tribe, all participants should know the reasons for their arrival and work — not just the senior management in charge. At each reservation, sometimes only the tribal officials knew the reasons for the military's arrival. The sight of military personnel frightened some Native Americans. Similarly, dentists and support personnel might do an even better job if they knew why they were providing dental services at a reservation. (Project Director)

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AFTER THE GRANT

In 2005, the military provided dental care to five reservations. Walking Shield received $50,000 from both the Hasbro Children's Foundation and the Henry Niles Foundation for its health care project. Officials at the Army's 912th Medical Company have agreed to return to the Kickapoo reservation every two or three months. According to the project director, Air Force officials have committed to send military dentists to the Red Cliff Reservation in 2006. Walking Shield staff members report that they plan to request military medical and dental care for 2007.

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GRANT DETAILS & CONTACT INFORMATION

Project

Providing Dental Services to Native Americans Living on Reservations

Grantee

Walking Shield American Indian Society (Tustin,  CA)

  • Amount: $ 50,000
    Dates: April 2004 to March 2005
    ID#:  047198

Contact

John Castillo, M.S.W., Ph.D.
(714) 258-7025
walkingshieldjc@msn.com

Web Site

http://www.walkingshield.org

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Reports

Operation Walking Shield Health Care Support Guidebook for the Red Cliff Band of Lake Superior Chippewas. Tustin, Calif.: Walking Shield American Indian Society, March 2005.

Operation Walking Shield Health Care Support Guidebook for the Sac and Fox Nation of Missouri in Kansas and Nebraska. Tustin, Calif.: Walking Shield American Indian Society, March 2005.

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Report prepared by: Susan G. Parker
Reviewed by: Antonia Sunderland
Reviewed by: Robert Narus
Reviewed by: Marian Bass
Program Officer: Judith S. Stavisky