The Tucson Indian Center (TIC) proposes to implement an IHS 4-in-1 grant to ensure the highest possible health status for Urban Indians among Tucson's American Indians and Alaska Natives (AI/AN). TIC was founded in 1963 and is the only Urban Indian Organization in Southern Arizona. TIC offers social services, wellness services as an Urban Indian Health Program and will offer on-site primary care in the summer of 2022.
AI/ANs account for 4.2% of Tucson’s population, or 41,312 of 537,726 residents. The majority of AI/AN who reside in Tucson are Tohono O’odham, Pascua Yaqui (Yoeme) and Navajo (Diné). Tucson’s AI/AN population is much younger than the Non-Hispanic White (NHW) population, and very few elders remain to share their wisdom. AI/AN people are more than 3 times as likely to live in poverty compared to NHW people. AI/AN children are nearly four times as likely to live in poverty. This extreme poverty level is the result of low educational attainment and high unemployment. AI/AN adults are five times as likely not have a high school diploma, one third as likely to have a bachelor's degree and 2.3 times as likely to be unemployed compared to NHW. Nearly one third of AI/AN are uninsured, triple the level of uninsured NHW.
Mental health and alcohol and substance abuse sometimes border issues such as domestic violence, child maltreatment, and injury. TIC partner, the Emerge Center Against Domestic Abuse, reports serving 375 AI/AN clients in 2021. TIC partner, the Southern Arizona Center Against Sexual, provided forensic exams for 28 AI/AN in the same year, but this does not include other crisis or counseling services. The Urban Indian Health Institute reports 31 Missing and Murdered Indigenous Women and Girls (MMIW) in Tucson, more than half (57%) of all MMIW in Arizona, which ranks third in the nation. The AI/AN infant mortality rate is ten times the rate among NHW, suggesting vulnerable family dynamics for a child’s first year of life. Alcohol-related disorders was the top reason for AI/AN emergency department visits in 2018-2019. Chronic liver disease/cirrhosis is the 4th cause of death among Tucson’s AI/AN, behind diabetes, neither of which make the top causes for NHW.
TIC is strengthening services, including the 4-in-1 program, to evaluate and address critical health issues in the realm of health promotion/disease prevention, immunization, alcohol and substance abuse, and mental health. TIC seeks to serve AI/AN individuals and families in a manner that is culture- and language-appropriate. TIC will screen clients for these risk factors in the above 4 health areas. Advocates will utilize motivational interviewing and trauma-informed care to provide crisis response, case management and referral, as well as conduct community outreach, education and marketing.
TIC has letters of commitment from: the TIC Board of Directors; Pima County Health Department; University of Arizona College of Medicine, and the Urban Indian Health Institute.
Grant funds will be used to support 1.4 FTE staff positions. TIC will contract with an evaluator to assist with process and outcome evaluation. The Urban Indian Health Institute will assist TIC and partners to develop data sharing agreements in order to establish baseline measures for measurement of outcomes over the five years of the grant.