PurposeThe Indian Self- Determination Assistance Act (P.L. 93-638), hereafter referred to as the Act, was the first major Indian policy legislation since the Indian Reorganization Act of 1934 (P.L. 73-383). The Act permits the transfer of Federal authority over programs and services to Indians, for effective and meaningful participation by Indians, in the planning, conduct, administration and control of federal programs and services. This report presents the findings of six months of field research and technical reviews of IHS implementation of the Act. The evaluation was performed by the National Indian Health Board (NIHB) and American Indian Technical Services (AITS) between October 1983 and April 1984. The NIHB and AITS evaluated IHS implementation of the Indian Self-Determination (ISD) Process through four basic tasks: 1) define maximum participation and successful outcomes; 2) describe examples of successful outcomes in the implementation of Indian Self-determination; 3) describe how successful outcomes are achieved; and 4) assess types and quality of technical assistance provided by IHS to Tribes and Tribal organizations.MethodsThe evaluation methodology consisted of an interactive process. The study team performed a series of tasks: 1) development of data through telephone and on-site discussions; 2) quantitative and qualitative analysis of the data; and 3) development and refinement of various products and reports. Specific topical issues were developed for both telephone and on-site discussions. In addition, an evaluation measurement tool was developed for use in conjunction with the on-site visits. Respondent groups for the telephone discussions included IHS personnel and voluntary tribal participants from both contracting and non-contracting tribes. Eleven Area/Program Offices (APOs) were included in the telephone discussions. As a result of these discussions, five APOs (including one test site) were selected for onsite discussions. Four Tribes within each selected APO jurisdiction were also visited. An attempt was made to obtain representation from both non-contracting and limited contracting Tribes, as well as from contracting Tribes.ResultsThe findings of the evaluation are: 1) the ISD process has been implemented successfully by IHS; 2) the ISD process has been found adequate in implementing the components of the Act; 3) the Act's law and regulations are understood by both IHS and the tribes, but the Act's philosophy is less well understood by the tribes; 4) planning is perceived as a weakness of the Act by both IHS and the tribes; 5) some staff shortages are evident; 6) the Act's contracting processes are seen with some dissatisfaction by the tribes; 7) some tribes feel that IHS technical assistance is reactive and is provided only after a problem is experienced; and 8) some tribes expressed the opinion that IHS staff were uncommitted to assisting tribes in contracting for health services.ConclusionThe evaluation recommends that: 1) IHS continue to affirm commitment to the ISD process; 2) planning needs to be emphasized; 3) IHS headquarters assume responsibility for implementation evaluation; 4) the Indian Resource Liaison Staff's (IRLS) arbitration and conflict resolution roles must be publicized; 5) IHS should review the roles of other Federal agencies involved in Indian Self-Determination; 6) communication between APOs and the tribes must be improved; 7) the APO role in the ISD process should be clarified and better understood; 8) tribal requests for assistance should be more effectively handled; 9) the Act's contracting processes be clarified and better defined; 10) technical assistance should be expanded in scope; and 11) IHS must improve its capability to deliver technical assistance outside the Act's contracting process area.
Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-36).
Whitecrow JL. Roberts WT. Indian Health Service's implementation of the Indian self-determination process - evaluation report. Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-36). 1984