Invisible in plain sight: Assessing health needs and capacity through reflection and action among North Carolina Tribes and urban Indian associations

Background: This presentation will describe the North Carolina Tribal Health Assessment (NCTHA) Project, which involved an organizational assessment of eight Tribes (enrollment 800- 57,000) and four Urban Indian Associations (membership 150-1,800) to document experiences/capacities to address health. Methods: Assessment site visits to Tribes/Urban Indian Associations (T/UIA) allowed for focus-group interviews with 47 Tribal stakeholders regarding six health-related components: 1) Tribal Health Agenda/Priorities; 2) Tribal Capacity/Experience in Addressing Health Issues; 3) Collaboration/Partnership; 4) Access to Health Care/Services; 5) Data; and 6) Training Needs. We conducted three additional one-day in-person visits with two Tribes invited to participate in an In-Depth Assessment. These additional meetings involved tribally-driven action-oriented activities (e.g., strategic planning, data collection activity, or training event) to assist the Tribe in addressing their health issues in the future. Results: Health Assessment Profiles were developed for each participating T/UIA, which range greatly in experience and abilities to identify and address health needs. All T/UIAs face challenges (e.g., limited AI-specific data; fragile infrastructure; and limited funding and staffing) and most identified with feelings of being “invisible in plain sight” in their own communities. Conclusions: This project, representing the first NC state-wide effort to identify health-related capacity among primarily state-only recognized Tribes, indicates interest in “going beyond the data” to better understand Tribal needs, capacity, and what the NC Office of Minority Health & Health Disparities can do to support them. Methods used to conduct this type of assessment could benefit other states seeking to address health disparities faced by many minority groups/organizations.