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Michael Meit meit-michael@norc.org

Larry Anderson larry.anderson@littlehoop.edu

Joseph Eltobgi jeltobgi@tm.edu

Implementation and Evaluation of

Career Pathways Programs:

Lessons Learned from the Tribal

Health Profession Opportunity

Grants (HPOG) Program

June 14, 2018

Disclaimer

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The views expressed in this presentation do not necessarily reflect the views or policies of the Office of Planning, Research, and Evaluation, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

This work is funded by the ACF Office of Planning, Research, and Evaluation, contract #HHSP233201500052C.

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• HPOG provides eligible individuals with the opportunity to obtain education and training for occupations in the healthcare field that pay well and are expected to either experience labor shortages or be in high demand.

• HPOG Program created in 2010 (HPOG 1.0)• Grants awarded to 32 organizations, including 5 tribal

organizations

• HPOG Program extended in 2015 (HPOG 2.0)• HPOG 2.0 grants awarded to 32 organizations, including 5 tribal

organizations

• Approximately 50 percent are returning grantees

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The Health Profession Opportunity Grants (HPOG) Program

• Focus on a career pathways model

• Participants receive post-secondary education and training, such as: • Certified Nursing Assistant (CNA)

• Medication Aide

• Emergency Medical Technician (EMT)

• Licensed Practical Nurse (LPN)

• Registered Nurse (RN)

• Supportive services provided by HPOG programs include:• Financial assistance for tuition and textbooks;

• Academic supportive services (e.g., mentoring and tutoring);

• Social supportive services (e.g., childcare and transportation assistance);

• Employment related supportive services (e.g., resume development and interview preparation)

• Grantees often form partnerships with educational institutions, social service organizations, and employers in their community to implement the program

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Components of the HPOG Program

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Key

A: Cook Inlet Tribal Council, Inc, Anchorage, AK

B: Ute Mountain Ute Tribe, Towaoc, CO

C: Turtle Mountain Community College, Belcourt, ND

D: Cankdeska Cikana Community College, Fort Totten, ND

E: Great Plains Tribal Chairmen’s Health Board, Rapid City, SD

Tribal HPOG 2.0 Grantees

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A

CD

E

B

• Purpose• To assess program implementation and

participant outcomes of the five Tribal HPOG 2.0 Grantees

• Benefit• Identify promising practices and inform

knowledge base of culturally- and evidence-informed models implemented in Tribal communities

• Build/enhance tribal evaluation capacities

Tribal HPOG 2.0 Evaluation

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• Designed in collaboration with the five Tribal HPOG 2.0 Grantees and Tribal HPOG 2.0 Technical Work Group

• Guided by the seven values outlined in the Roadmap for Collaborative and Effective Evaluation in Tribal Communities,* which provide a pathway for partnering with tribal communities and are grounded in community-based participatory research

• Informed by literature review that provided context and information about appropriate methods for conducting research in American Indian/Alaska Native (AI/AN) communities

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Evaluation Approach

*Tribal Evaluation Workgroup. “A Roadmap for Collaborative and Effective Evaluation in Tribal Communities.” Children’s Bureau, Administration for Children and Families, U.S. Department of Health and Human Services. September 2013.

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Roadmap for Collaborative and Effective Evaluation

in Tribal Communities

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• Qualitative Data • Review of grantee documents (applications, curricula, grantee reports)

• Interviews with grantee administrative staff, program implementation staff, partners, and employers, and program completers and non-completers

• Focus groups with current students

• Quantitative Data• Review data from the Participant Accomplishment and Grant Evaluation

System (PAGES)

• Site Visit Reports• Developed following each annual site visit detailing findings from the data

collected, organized by structure, process and outcomes

• Practice Briefs• Special reports shared with stakeholders and on OPRE’s website

• Final Report• Aggregated analysis of all data collected throughout the evaluation

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Data Collection Methods and Deliverables

• Great Plains Tribal Chairmen’s Health Board (GPTCHB)• Non-profit organization representing 18 tribal communities in the four-

state region of South Dakota, North Dakota, Nebraska and Iowa.

• Program supports Tribal TANF recipients and other low-income individuals from a cross-section of urban sites, rural areas and reservations across western South Dakota.

• Cook Inlet Tribal Council (CITC)• Private, non-profit 501(c)(3) tribal social service organization providing

basic skills and trainings to TANF recipients and other low-income individuals.

• Returning grantee from HPOG 1.0.

• Serving AI/AN people within the Municipality of Anchorage and throughout the Cook Inlet Region.

Tribal HPOG Grantee Models: Tribal Social Service Organization

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• Ute Mountain Ute Tribe• A reservation-based tribe located in the southwest corner of

Colorado, with reservation lands extending into Utah and New Mexico.

• Program began by primarily serving low-income AI/AN on the Ute Mountain Ute and White Mesa reservations.

• Expanded to native and non-native residents throughout Montezuma County, Colorado, and the municipalities of Blanding, Utah; Ignacio, Colorado; and Farmington, New Mexico.

Tribal HPOG Grantee Models: Tribal Government

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• Cankdeska Cikana Community College• Federally recognized Tribal Land Grant College located on the

Spirit Lake Reservation in North Dakota

• Next Steps II; returning grantee from HPOG 1.0

• Program implemented across four regional areas within North Dakota

• Turtle Mountain Community College• Tribal college for the Turtle Mountain Band of Chippewa Indians,

located on the Turtle Mountain Reservation

• Health Education Access through Rural Training (HEART) Project; returning grantees from HPOG 1.0.

• Primarily serves residents of the Turtle Mountain reservation in Belcourt, ND

Tribal HPOG Grantee Models: Tribal College

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NEXT STEPS IIEMPOWERING AMERICAN INDIANS/LOW INCOME INDIVIDUALS TO PURSUE CAREERS IN HEALTHCARE

Larry D. AndersonCankdeska Cikana Community College

2018 Dakota Conference on Rural and Public Health

WHAT IS THENEXT STEPS II PROGRAM

A Health Professions Opportunity Grants (HPOG) Program

is a grant awarded to the Cankdeska Cikana Community

College. The grant is awarded by the Department of Health

and Human Services, Administration for Children and

Families, Office of Family Assistance as a Demonstration

Project

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AWARDS

First Awarded in 2009 for the period 2010-2015 funding level 8.7 million

Selected competitively in 2014 for second award for the period 2015-2020 funding level 6.3 million

WHO DOES THE PROGRAM SERVE• Statewide project with concentrations on Tribal Nations in North Dakota

• Spirit Lake Nation in Fort Totten, ND• Standing Rock Sioux Tribe in Fort Yates, ND• Three Affiliated Tribes in Fort Berthold, ND• United Tribes Technical College in Bismarck, ND

• Our Target Population is American Indians enrolled in federally recognized Tribe, TANF, and Low Income. Individuals who experienced generations of poverty and socio-economic hardships.

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PROGRAM GOALS • Our objective is to break generational poverty cycles by providing

them with the necessary support

• To successfully complete an educational and training program in healthcare,

• Secure gainful employment with a livable wage, • Break the generational poverty cycle and position them to provide

a better life for themselves and their families.

PROGRAM MODELTo achieve our objectives we have adopted a mentor model developed by the University of North Dakota, College of Nursing, RAIN Program (Recruitment and Retention of American Indians in Nursing)• This model is a no excuses model and is founded on the basis of providing an

individual mentor assigned to each and every student.

• The mentor works intensively with the student by developing a personal supportive relationship and assists the student with the following.

• Navigating the educational process from start to finish by engaging with the student in planning, problem solving, and overcoming adversity, confronting barriers and obstacles

• Providing necessary supportive services such as child care and transportation to help ensure there are indeed no excuses to completing and achieving personal goals.

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PROGRAM MODEL• Under this model the mentor is available 24-7 and guides the

student through the educational process and coaches and mentors the skills necessary to succeed in education and in life.

• In our program the mentor has the following responsibilities• Recruitment and Retention• Objective assessment eligibility• Placement staff are provided to assist in securing employment for the

participant upon education and training completion based on the relationship that had been developed in the mentoring process.

• This model proved to be very successful for us in Next Steps I and is being replicated in Next Steps II.

PROGRAM PERFORMANCE

R E G I S T E R E D N U R S E S T R AI N E D F R O M 2 0 1 0 -

C U R R E N T

M AS T E R S D E G R E E S B AC H E L O R S D E G R E E S AS S O C I AT E S D E G R E E S

4211 8

23

REGISTERED NURSES

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PROGRAM PERFORMANCE

10

11

2

1

3

1

9

1 1 1

2

LOCATIONS WHERE RN'S TRAINED

PROGRAM PERFORMANCE

Race of RN Students

American Indian or Alaskan Native White

Asian Black

Native Hawaiian or other Pacific Islander Hispanic/Latino

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PROGRAM PERFORMANCE

0 2 4 6 8 10 12 14

Turtle Mountain Band of Chippewa

Three Affiliated Tribes

Northern Cheyenne of Montana

Standing Rock Sioux

Cheyenne River Sioux

Sisseton-Wahpeton Oyate Lake Traverse Reservation

Spirit Lake Sioux Nation

Hualapai Nation

Red Lake Band of Chippewa

Tribal Affiliation

PROGRAM PERFORMANCE

55 55

1 2

LPN's

LPN's Trained from 2010 - Current All Associates Degrees

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PROGRAM PERFORMANCE8

1 2 3

28

5

1

6

1

S I T T I N G B U L L

C O L L E G E

F O R T B E R T H O L D

C O M M UN I T Y C O L L E G E

D I C K I N S O N S T AT E

U N I V E R S I T Y

L AK E R E G I O N

S T AT E C O L L E G E

U N I T ED T R I B E S

T E C H N I C AL C O L L E G E

N O R T H D AK O T A

S T AT E S C H O O L O F

S C I E N C E

B O AR D O F N U R S I N G

S I S S E T O N WAH P E T O N

T R I B AL C O L L E G E

S O U T H D AK O T A

S T AT E U N I V E R S I T Y

LOCATIONS WHERE LPN'S RECEIVED EDUCATION

PROGRAM PERFORMANCE

Race of LPN Students

American Indian or Alaskan Native White

Asian Black

Native Hawaiian or other Pacific Islander Hispanic/Latino

Two or More Races

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PROGRAM PERFORMANCE

0 2 4 6 8 10 12 14

Crow Nation Crow Creek Sioux Tribe

Turtle Mountain Band of Chippewa Three Affiliated Tribes Standing Rock Sioux

Cheyenne River Sioux Sisseton-Wahpeton Oyate Lake Traverse Reservation

Spirit Lake Sioux Nation Oglala Lakota Sioux Tribe

Fort Peck Tribe Kiowa Tribe of Oklahoma

Blackfeet Nation Omaha Tribe of Nebraska

Lower Brule Sioux Tribe Choctaw Nation of Oklahoma

Rose Bud Sioux Cherokee Nation

Tribal Affiliation

PROGRAM PERFORMANCE

NUR SI NG ASS I STAN TS TR AI NED FR OM 2010 -

CUR R ENT

R ECE I VED CER T I F I CATE

D I D NOT RECE I VE CER T I F I CATE

152 13517

CNA'S

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PROGRAM PERFORMANCE

1 1

6

20

6 7

33

9

30

4

33

1 1

LOCATIONS WHERE CNA'S TRAINED

PROGRAM PERFORMANCE

CNA's Race

American Indian or Alaskan Native White

Asian Black

Native Hawaiian or other Pacific Islander Hispanic/Latino

Two or More Races

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PROGRAM PERFORMANCE

0 10 20 30 40 50 60 70 80

Absentee Shawnee Oklahoma

Assiniboine Sioux

Cheyenne River Sioux

Fond du lac

Fort Peck Sioux

Mandan Hidatsa Sahnish Nation

Navajo Nation

Oglala Sioux Tribe

Red Lake Nation

Sisseton-Wahpeton Oyate Lake Traverse Reservation

Spirit Lake Sioux

Standing Rock Sioux

The Navajo Nation

Turtle Mountain Band of Chippewa

White Earth

Yankton Sioux Tribe

Tribal Affiliation

CHALLENGES• The majority of our participants are single mothers with anywhere

from 1 to 4 children.• The greatest challenge in moving these individuals from

generational poverty, socio-economic hardship, poor/limited academic preparation is instilling in the individual the attitude and belief that they can do it, that they can overcome and rise above the poverty that has limited them and prevented them from achieving their dreams and goals for themselves and their families.

• The program provides the means, but they have to believe and be willing to put in the work and the effort to make it happen.

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BEST PRACTICES/LESSONS LEARNED:

We learned early in our project that our target population was poorly prepared and lacking in the skills necessary to navigate the education process successfully, but were also deficit in the essential workplace skills necessary to find and retain employment.

EMPLOYER ENGAGEMENT• To address this challenge our project developed an aggressive

and ambitious employer engagement initiative that called for:

• Engaging with employers in the state to bring them into our program make them aware of our program.

• Developing trust with them that our program produces well qualified well prepared employees to help them meet their workforce needs.

• This involved developing relationships with employers a network of employers who we partnered with in guiding and directing our program through an Employer Advisory Council.

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EMPLOYER ENGAGEMENT• Our employer engagement went beyond an advisory approach but

included an assessment of workforce needs with employers through a series of Workforce Development Workshops we conducted to engage with employers directly on approaching workforce shortages, Apprenticeship and our program.

• Networking and Active Engagement• Governor’s WFDC (WIB) AHEC• ND Center for Nursing JSND (WIOA)• ND Department of Human Services (TANF) Tribal TANF

Community Options (JOBS)

• Educational Providers

EMPLOYER ENGAGEMENT• Developing relationships and partnerships with major healthcare providers

• Altru Health Systems

• Sanford Health

• CHI St Alexius

• Eventide Senior Living Communities

• Dakota Travel Nurse

• Knife River Care Center

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JOB READINESS SKILL DEVELOPMENT

• In addition to address the essential workplace skills for our graduating students we developed an employability skills workshop that worked to instill the necessary workplace skills including:

• Skills in how to look for work, where to look for work, how to interview and finally how to retain employment.

• Participants work in groups and one-on-one developing skills with resumes, cover letters, interview process and job retention skills.

JOB READINESS SKILL DEVELOPMENT

• In Next Steps II we are building on these workshops and plan to work to develop essential leadership and life skills including:

• Communications

• Team building/group dynamics

• Conflict management/problem solving

• Leadership skills in the workplace and in life

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JOB READINESS SKILL DEVELOPMENT

• Basic Skills – Skills Development Program (SDP)• Academic Skill Development

• Math• Reading• GED Preparation

• Job Readiness Skill Development• You in the Medicine Wheel• Effective Communication Skills• Resume & Cover Letters• Preparing for the Job Interview• Effective Teamwork in the Workplace

NEXT STEPS II

•Building better lives for individual and their families

•Addressing critical workforce needs in our state:

•Questions

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Turtle Mountain Community College

Joseph Eltobgi, Project Director Health Education Access through Rural Training 

(HEART) Project

• First site visits conducted Fall 2017

• Grantees partner with colleges and universities in their states, across state lines, and online to provide a wide range of academic programs in healthcare.

• Current participants, as well as those that have completed their training(s), have expressed interest in returning to their reservations to serve their communities, or have done so already.• “In my nursing home, there are Native American elderly that feel

comfortable with me because we grew up the same way. So they feel comfortable when they see another Native American.”

Preliminary Findings and Outcomes

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Preliminary Findings and Outcomes

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As of October 31, 2017:• 373 unique* participants have enrolled** in Tribal HPOG

healthcare trainings across all grantees

• 216 unique participants have completed at least one Tribal HPOG healthcare training across all grantees

• “I have already done a CNA course, [and am] doing pre-requisites for nursing. [My] mid-term goal is RN, long-term is nursing anesthetist.”

• 94 participants were employed in a healthcare occupation across four of the grantees

• “I want to be a paramedic. I want to work anywhere they need me to work because there is such a nationwide shortage.”

*Unique participants refers to only counting students once, regardless of how many trainings they enroll in

**Students are classified as enrolled if they have not completed the program and have not dropped out of the program.

• “I am so proud to be a part of this program at this time. It’s incredible the things that we are able to do for these communities.”

• “None of us would be doing this without HPOG. [Being in a] small town, we have to be at work consistently and can’t get ahead. There aren’t a lot of jobs that let us get ahead, [but the] medical field is where you can get ahead here.”

• “They go above and beyond any scholarship I have ever received.”

• “This program, along with a few other resources, grounded me in not only education, but life skills. Just the people, everyone I came in contact with, they were exceptional. I can’t express how thankful I am for the few people, they do a lot.

Preliminary Findings and Outcomes

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Thank You!