MCH Needs Assessment

A Needs Assessment provides community leaders with a glimpse of local policy, systems, and environmental change strategies currently in place and helps to identify areas for improvement. With this data, communities can formulate a plan for health improvement by creating strategies to make positive and sustainable changes in their communities.

In this episode,  host Alyssa will discuss with special guest Amber-Rose about the importance of collecting  data to conduct a Needs Assessment to improve health outcomes. 

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This podcast was sponsored by the Arizona Department of Health Services through federal funding from the Health Resources & Services Administration, with support from the Navajo Native American Research Centers for Health (NARCH) Partnership between Diné College and Northern Arizona University through federal funding from the National Institute of Health’s National Institute of General Medical Sciences, award number S06GM142121. The views expressed are the sole responsibility of the program staff and do not necessarily reflect the views of the Arizona Department of Health Services or the United States Government.

Transcript

Ya'at'eeh. Welcome to the MCH podcast, where we discuss maternal and child health topics and provide strategies for improving the health of Navajo families. Amá dóó áłchíní ats’íís baa áháyá baa yadelti (Translation, we will be talking about the health of mothers and children).

Amber-Rose 
I’m Amber-Rose Begay. Hashk’ąąhadzohi nishli, Táchii’nii bashichiin. Tábąąhá dashichei doo Naakai Dine’é dashinali. Nataani Nez denashaa. So I’m originally from Shiprock, NM where I live and work at Diné College as a project coordinator of the Diné College Maternal and Child Health Project. I am a Navajo woman and mother of 2. Thank you for joining us today to learn more about maternal and child health on the Navajo Nation. Today, Alyssa and I will be discussing the Navajo MCH Needs Assessment. Before we begin, Alyssa, can you please introduce yourself?

Alyssa
Hi, my name is Alyssa. I'm a senior at Northern Arizona University majoring in public health. I'm currently working on the podcast as a co-editor for my internship. I'm excited to expand my knowledge and raise awareness on all the maternal and child health topics we discuss on these podcasts. If you haven't already, check out the other podcast episodes, we encourage you to listen to them. We have some great guest speakers who provide helpful information. Today, Amber-Rose and I will be discussing the Navajo Maternal and Child Health Needs Assessment to honor Maternal Health Day, which was on Sunday, January 23rd, 2022. We want to bring attention to the crisis of maternal mortality and focus on strategies that help our mothers and birthing people thrive. Amber-Rose, Can you tell us what your role was on the news assessment?  

 Amber-Rose
Yes, and welcome, Alyssa. I was the main project coordinator on the needs assessment. I coordinated efforts with data retrieval and collection, the data analysis, writing and designing of the report, and finally, dissemination. Much of the activities we are conducting now, including this podcast, are all because of the report, and just know I wasn't the only person working on this project. I had many team members from across the Navajo Nation as well as across the United States. So I'd also like to point out for our audience that we have different students from Northern Arizona University joining us and helping with the creation of this podcast, including Alyssa. This is all thanks to the funding and collaboration between the Arizona Department of Health, collaboration with the Navajo Nation Department of Health and Diné College, and Northern Arizona University.   

Alyssa
Thank you. Can you tell us why it's important to create a needs assessment and what information is important to include on it?   

Amber-Rose
Yes, a needs assessment is important to determine the status of health for a community, in this case, the health of children and mothers on Navajo. So this is done by collecting health data either from hospitals, health programs, agencies, and schools that work with children and mothers. We also gathered input from community members and health providers about maternal and child health needs. So once we collect this data, we review it and analyze it. From there, we present this data to our stakeholders and get input on prioritizing health needs based on their own expertise and experience and also using what the data tells us. And every step of this process is quite important. But I feel the most important is the information from the community because their input validates what we see in the data and what we hear from health providers and specialists. The needs assessment goes on to inform people at the local tribal, state, and federal levels. Specifically, it provides a focus of where funding and resources should be allocated.  

Alyssa
I like that you mention that you and you get input from the community because like it's important to overall like better the resources that are provided for them and to give them the overall better quality of health. The general public will have access to the needs assessment, and if they'll be able to understand kind of what goes on the document.  

Amber-Rose
Yes. So the report is actually titled The 2020 Navajo Nation Maternal and Child Health Needs Assessment, and it's available on the Navajo epidemiology website under their report. So if you haven't visited that website, it's online and it's under the Navajo Department of Health and then under the Navajo Epidemiology. And so you can review a copy or print off a copy there, but you can also we still have copies available. So if you'd like a copy, you can go ahead and reach out to us. We did distribute two copies to all 110 chapter houses. Right now. I'm sure they're closed due to the pandemic, but you can also request a copy from us. And the report is easy to understand. It has charts for visual learners, and then we also interpret the findings. You know, there's a lot of stuff written within that report, but it should be easy to read. I'd like to put special emphasis on the Environmental Health section. As many of our listeners probably know, there are a lot of environmental health concerns, like around air, water quality, the abandoned uranium mining sites. So there's a lot of environmental health issues that continue to impact the health of the Navajo Nation. So we have a section that reviews previous research projects that have looked into these issues and have suggestions for improving these issues. So that's a good, one way we wanted to address these environmental health concerns, which usually isn't a part of a lot of needs assessments, but that is taken into consideration when we discuss health.  

Alyssa
Yes, I like that you said that you have charts for visual learners because I know sometimes needs assessments can have a lot of information and kind of very technical so it can help everyday people just understand what's going on. So what was something interesting that you discovered when you were creating the assessment?  

Amber-Rose
So this was my first project I ever had to coordinate out of. I'm fresh out of college while 2019 I graduated and I only assisted with research projects before then, so I never actually coordinated just assisting with data collection, analysis, dissemination. But thankfully, I had a lot of guiding and mentoring colleagues here at Diné college. I've actually worked with my supervisor, Dr. Mark Bauer. He was, previously when I was in school, my instructor, and then he hired me on for a few of their research projects that they had. So I had guidance from him as well as our faculty members. Dr. Christopher Dickerson, and then we have a partnership with Northern Arizona University. We work with Dr. Nicolette Teufel-Shone, Kelly McCue. And then we had some graduate students, Marissa Tutt and Kristen Tallis. I'm sorry if I forgot anyone. Oh, we also had some other individuals that helped with this needs assessment, including Craig Manning, and he really helped with the design and layout of the report and also any other technical assistance we needed. So I really had a good team, not to mention our group of advisory members that helped us with every stage of the other needs assessment process, including our collaboration with the Navajo Department of Health, and they provided some guidance when it came to retrieving data and then how we should disseminate this information to whom. And also they housed the report on their Navajo EPI website. So I feel that the most interesting thing that I discovered about this needs assessment was that it was never done before, being the largest federally recognized tribal group in the United States. You would think that this kind of needs assessment for mothers and children would have been already completed. But there have been efforts in addressing maternal health by the Navajo Department of Health, previously. They are able to access maternal health data through the PRAMS, which is the Pregnancy Risk Assessment Monitoring System. We had a podcast on that. I think that was our last podcast upload. But data-wise, I think the most interesting thing would be that there are national goals that are in place for maternal and child health that we need to be reaching. And so when we're reviewing some of this data, especially data from the PRAMS, we saw that prenatal care in the first trimester, which is important for mom and baby's health, Navajo women fell below that national goal by about 10%. This number may mean a lot of things, but to me is a good goal for us to improve. Thinking back to our people that came before us, they didn't have to attend prenatal care appointments. But, you know, today we have a lot of factors that impact health and also these numbers that we're seeing. So these are things that we can all work to improve. And what I mean by all I mean us as women, mothers, fathers, aunts, uncles, grandparents, community health workers, tribal leaders. We can all become educated on proper health care for ourselves at different stages of our lives and work to make sure that we're attending appointments. If we don't know about something about ourselves or about these systems, you know, we can ask questions.  

Alyssa
That is interesting that Needs Assessment hasn't been done before. So what is being done to raise awareness about Navajo maternal and child health?  

Amber-Rose
Yeah. So this needs assessment kind of started off like a chain of events for myself personally, just education-wise, finding out what's going on in this area on Navajo. As well as just in general for our project. I, you know, I found that there's already a lot being done at each level. And what I mean by level, I mean like at the infant level, even before the perinatal level, the infant/child, adolescent and maternal. Which to me is another interesting thing I discovered there. Again, just stating that there have been efforts previously by the Navajo Department of Health. They actually work with the New Mexico, Utah, and Arizona PRAMS to put together reports about Navajo mothers, their attitudes, behaviors, and experiences before, during, and after pregnancy. So this kind of data is very important to help inform, you know, policy and public health efforts or even health efforts in general. So they ask questions on the PRAMS, such as, around health issues like diabetes, vitamin intake, health care visits, substance and tobacco usage, and breastfeeding. So these are things that we can learn from whether, you know, where our health status is currently and how we can improve. So that's just one thing that I was happy to know that has been completed. And we continue this partnership with these three states and the PRAMS projects, what this needs assessment that we complete and going forward also other things being done are all the efforts around early childhood health and education, and I'm just going to list a few programs: First things first, Navajo Head Start and Navajo Project I-launch. They all address infant and childhood mental, social, emotional, and physical health and development. And what's good is that they're using Navajo cultural frameworks and teachings within this and also the Navajo language. And they're really building like a sustainable framework that not only their programs can use, but other programs not only within the Navajo community but in other tribal communities. And then I think we've all seen like an increased social media involvement, especially from the Navajo Nation Department of Behavioral and Mental Health. They have many presentations that coincide with the cultural teachings and the cultural season, should I say. So they were sharing a lot of winter stories, teachings, especially those around substance use and mental health. And that's been very helpful, I think, since the pandemic hit. And not everyone has access to, you know, teachings that they would have otherwise received either at school or at home or if they go to ceremonies. And then also if they were utilizing, you know, behavioral and mental health services, it's really great that they've been able to adapt to that online presenting. And so I've been very appreciative of that myself. And I've also been made aware with this work of traditional birthing services being offered by the Diné Breastfeeding Coalition and the Changing Woman initiative. These are the two main groups are programs that I've interviewed. I've had the pleasure of interviewing and collaborating with in the past. And just keep in mind our needs assessment covers the infant, child, adolescent, and maternal health domain. So there's a lot that has to be addressed in each stage. I believe, like for adolescent, I believe we have about 11 to 12 priority areas that we want to help to improve, and that's just adolescents from 12 to 17. So I'm, you know, coming into this, I don't know everything and everyone. So this has been such a learning experience. So these two programs, which again, I kind of go back to my own experience being a mother and having given birth twice, I didn't know that these kind of programs existed, let alone that they offered traditional birthing services. So they're, you know, accommodating women and mothers with their well-woman visits, their prenatal and postpartum care visits, as well as their labor and birthing experiences. So I think this is very important and something that we identify through our, another additional like a community input session that women want these services, but they don't know how to access it. They can't access it. So our efforts currently, you know, we're trying to bring more training for people who want to become doulas, who want to be able to counsel women with their breastfeeding experiences. I think these are really great programs to highlight. And they're also efforts in raising awareness for our murdered and missing Diné relatives, as well as missing and murdered indigenous women and girls and two-spirit people. I'm very appreciative and my heart goes out to the families that have lost loved ones and are continuing to fight for answers and justice every single day. I know Delegate Amber Crotty and her work with this and with the families. It's very inspiring and continues to motivate me to include our missing and murdered loved ones in our work. So there's so much more. But through this pandemic, it all has been great to see all these programs and the communities come together to continue to improve health, not only for children and mothers but also our fathers are those that take on the male roles in our life, our cheiis, our uncles. And so I work in research and prevention since 2016, and I'm just so amazed by all the new projects and the innovative ways that they are revitalizing Navajo cultural ways.  

Alyssa
Those are really great programs. So what do you love about working on the Navajo Needs assessment or the projects your team have been working on over the past year?  

Amber-Rose
Yes, I'm not going to lie. It's a lot of work. When I was a college student, my focus was public health and then psychology. So at the same time, I took on many roles. I was a mother, I was a student, I was a daughter. I worked part-time again with these different research projects, still trying to figure out what I wanted to do. But I kind of had a sense that I wanted to become a counselor. I wanted to teach, and I wanted to conduct research. I felt like those were the best ways to help others, help those mentor others, as well as be as informed as I can be about different topics, or at least the topic or the field I wanted to get into. So when I graduated, I mean, I didn't really have a plan where I was going to work. I just sort of took the work that came my way, which also includes this needs assessment and the overall maternal and child health project. I knew I wanted this work to be meaningful and to make a difference. And this is exactly what I get from this work. As a Diné woman and mother, it's my honor to have this kind of responsibility. You know, just some things I get to do. I get to review data; I get to listen to feedback from the community and stakeholders about their needs, which I feel like I've always done. I've always kind of made sure to be aware of, you know, what's going on in the community, you know, kind of listening in on what my parents and their needs were at their age and then also taking note of my own needs as a student, as a mother. So, you know, just getting that kind of feedback. It really helps to inform the work that I do and that I think any researcher does. And then also being able to collaborate with stakeholders and listen to their program needs and how they're helping to address some of these issues that we have, some of these challenges and barriers on Navajo, and then addressing those needs that are identified and being able to carry out activities in these fun and innovative ways such as this podcast. So again, like this podcast came about from the needs assessment, from finding a way to be able to educate young Navajo families to older generations on how they should be taking care of themselves, you know, if they're pregnant, if they're breastfeeding, if they're, you know, just overall just living their life, how we can help to provide resources and inform them. We also created PSAs over the radio and these PSAs aired. We had two-minute and ten-minute PSAs on KNDN and KTNN, and these align much with our podcast topics. But this was another way we could reach adults and the older generations about the work that we're doing and to educate them. Because I feel like a lot of times our younger generation look to our older generation for advice, for guidance, for help, and if we're informing them, giving them the right information about prenatal care, about breastfeeding, about COVID, you know, COVID in general and COVID vaccinations, they're able to pass that on to their loved ones. And I love also collaborating. And we do collaborate with all three states, tribal leaders, stakeholders on and off the Navajo Nation, different maternal and child health programs, providers, traditional healers, and public health students at Northern Arizona University and Diné College and the community. This project, you know, just knowing that with all of these collaborators that this really is a team effort. You know, when we go into meetings, committee meetings or team meetings, I know like, okay, you know, we're all here for the same reason to help improve maternal and child health. And, you know, that really kind of takes, you know, maybe the jitters that I have or any kind of nervousness that I have away from me so I can help to provide support to these stakeholders. And just thinking about this in some ways, what this role on this project, I do get to counsel. I get to let others know the most accurate and helpful information on maternal and child health that we know of. And then also I get to teach, I get to present. I've presented so many times on this needs assessment to students, college students across the nation, to community members, to different universities, to our leaders. It's just been a really great way to inform others about this data and how it's going to help to improve health. And I get to conduct research. You know, this needs assessment in and of itself is research, looking at data, reviewing it, analyzing it, and then disseminating that information. So I get to actually do all those three things that I wanted to do, you know, coming out of college. And overall, it's really cool because I get to create a path that hasn't been carved yet. So to me, it's work that I'm happy to do for our people.  

Alyssa
Yeah, that is really great. So speaking back on the technology and social media, that's pretty much part of all of our daily lives. I like how these podcasts have become a thing because podcasts have become so popular, so you can reach a larger group of people to inform them on all of the topics that are being discussed. So what do you hope for the future of Navajo maternal and child health?  

Amber-Rose
I hope that not only maternal and child health, but overall family health, you know, including again, you know, like on Navajo, we have multi-generational homes. So the cousins, aunts, uncles, the grandmas, the cheiis. I hope that, you know, we improve health for all of these people, through our collective efforts. I also hope that we build sustainable maternal and child health programs here at the college. We have been able to continuously mentor, you know, undergrad/ graduate students like yourself, and then also high school students through the project. So I hope that we can continue to do that here because, again, this is a collective effort where we can teach and mentor students about the importance of maternal and child health and at the same time, address these needs through their help. And I think the other thing is that we can continue to collaborate across the board to ensure we're all supporting and uplifting one another because there's, again, there's like so much happening already in maternal and child health on the Navajo Nation. And so I'm really excited to be able to work with everyone that I come across. And then I'm also excited to make future contacts with anyone who would like to help with this effort. Even community members, please don't hesitate to reach out.  

Alyssa
That's great. Well, thank you, Amber-Rose, for joining us today. We really appreciate your time and all the valuable information you provided. 

Amber-Rose
Thank you. Ahe'hee'

Amber-Rose
Ahe’hee. Thanks for listening to the MCH Podcast. For more information about the Diné College MCH project, please visit Navajo MCH Project at Diné College on facebook.