Returning to Tipi- Combining the Past & Today

The Pine Ridge Indian Reservation is located in Oglala Lakota Couty in the eastern corner of South Dakota. According to the Indian Health Service patient population, the Pine Ridge Indian Reservation is home to 22,945 Oglala Sioux Tribal members[1]. However, the OST Enrollment Office has 19,911 members and 20,661 off-reservation. According to the 2020 Census, there are only 3,657 housing units in Oglala Lakota County and 50.2% owner-occupied housing units.[2] Due to the lack of housing on the 3,468 square mile reservation, many homes are often overcrowded, with 13 families living under one roof.[3] The official poverty rate for individual American Indians in the United States on reservations is 29.4 percent, compared to the U.S. national average of 15.3 percent[4]. However, on the Pine Ridge Indian Reservation, it is estimated that 80% of families are living in poverty-stricken conditions.

OSLH has 17 low rent housing clusters, mainly in the 11 main towns spread across the 3,468 square (the size of Rhode Island) miles of the reservation. There are 1,338 units in these clusters, and often many families are unable to get their own homes or even rent a place to live without leaving the reservation. In 2021, ERAP assisted 12,645 households with assistance. Our waitlist, however, is over 500 tribal members and over 5 years long. Due to the consistent turnover in administration, OLHA has been unable to sustain the housing demands in the area. As a solution, we are creating communities of support to assure the longevity of our homes and our people.  Tipi will provide a supportive environment that reconnects residents to Lakota culture. 

[1] Pine Ridge Service Unit (2021). Personal interview with CEO conducted on 11/30/21. Pine Ridge, South Dakota.

[2] United States Census Bureau (2020). Retrieved 1/7/21 from: https://www.census.gov/quickfa...

[3] Oglala Lakota Housing Authority. Personal interview with CEO conducted 6/12/2019.

[4] Indian Country Media Network 

A quality-driven self-sustaining Community Health Worker program has taught us that the need for self-management goals in our tenant low-income housing units has increased for those struggling with substance abuse. As an intervention to create a process for interconnectedness-relational self-management health interventions by creating a supportive housing model based on Lakota-culture principles while providing technology and space for tribal members to live and heal. This initiative improves maternal dramatically and child health outcomes, substance use access to services, addresses gaps in health care throughout the Pine Ridge Indian Reservation, and is designed as a model for scale for all tribal nations.

The Oglala Lakota Housing Authority (OSLH) will use solar energy Tipi (Lakota word for home) solutions supportive housing model with a community center for recovery to serve as the traditional fire unification place and create space for communities of healing. This model consists of regularly solar energy-efficient homes built in a circular community. In the middle of that community will be the Pejta (Fire) community center, where peer-led recovery, community events, and cultural ceremonies can be held to unite as a community. This will be a drug and alcohol-free community that is built to support a lifestyle of recovery and healing. The community will host Lakota ceremonies to reintroduce the culture to those community members who may have lost it during the boarding school era. 

Traditionally, Lakota community foundations were those stories, ceremonies, and gatherings around the fire. The Tipi model allows us to integrate the supportive housing ideologies of today with Lakota cultural traditions.

This is a native-led solution hosted through the Oglala Lakota Housing Authority. Alongside frontline community health care workers and the reservation, OSLHA created the reservation's first point-of-care interconnectedness-relational model designed based on the traditional Lakota home-dwelling- a tipi. This interconnectedness-relational housing model will be piloted in each of the nine reservation districts and contain a centralized meeting space in place of the traditional fire. This will provide tribal members in need of recovery with the freedom to use westernized (AA, tele-behavioral health therapy, virtual Wellbriety and AA meetings as a group) and traditional Lakota (smudging for prayer, space to learn traditional songs and arts, host traditional Lakota ceremonies such as Lakota naming ceremonies, wiping off the tears, small local powwows, and doctoring for those who need it. This model will allow OSLH to connect the traditional with the modern as our community does not have access to recovery and behavioral health services. Wait times for substance abuse treatment have a six-month to 1-year turnaround, and behavioral health appointments are often scheduled months in advance. Our community needs to adopt evidence-based clinical care protocols using high-quality care with real-time data trends to tailor health self-management and educational goals to Pine Ridge Indian Reservation members. The need for the individual family needs and to improve the health care delivery system while simultaneously addressing the need for confidential individual therapy through telehealth services. The reservation OSLH uses Housing Data Systems (HDS) to monitor the number of connections between our supportive housing unties while meeting reportable data reporting requirements. Additionally, we will partner with Avera Health in South Dakota to increase access to services and partner with our OSLH CHW program that allows tribal members to have a chance to get the behavioral health services they need using the technology of today.

Existing eHealth solutions are not adequate to support the needs of the Pine Ridge Indian reservation, where most prenatal, childhood wellness care, behavioral health services are inaccessible, let alone the technology to access online services. There is currently no interconnectedness-relational model for supportive housing and TIPI integrates behavioral health through telehealth services as well as communal space in the middle of the circle housing (where the fire would have been traditionally kept).  and many community members do not attempt to access it due to historical breaches in confidentiality. To keep processes simple, MIT will allow OSLH to digitize and use electronic records were designed for simplicity of the technology and national data reporting requirements. Our user-centered design approaches will help residents of our housing and supportive housing communities determine if the project impacts and avoids the traditional barriers to adopting new eHealth strategies by engaging tribal members to maximize their ability to interact and simplify national data reporting requirements. This project serves as an innovative solution that strengthens access to service workflows, provides real-time individualized data trends to tailor health education, and supports the data requirements of national governments and hospitals to meet the needs of residents. Nurses can enter individual data and track individual and family health trends over time. Users can shift between personal and group health assessments depending upon the workflow of the AVERA health facility. Tribal members can track their individual and health status through periodic 'health reports' that include photographs of their trends in accessing care over time that can be printed and taken home.

Progressive web application technology addresses internet latency by allowing data storage on individual electronic devices until the internet is available. Once the internet is available, the application will connect directly to the reservation State of South Dakota Collaborative of Community Health Workers reporting platform. The system will minimize delays, remove redundancy, and improve the quality and efficiency of reporting. Data will be accessible from any device, thus laying the foundation for a robust national health record that provides facility-independent access to individual health information. They will assist in the

The concept of Tipi came through the OSLH community wellness department and the identified need to combat the diabetes epidemic in the elderly, methamphetamine/alcoholism in adult populations, suicide in youth, and teen pregnancy in young families. This model replicates our successful quality improvement program initially created to improve the quality of care and empowers with skills to improve their systems of tribal members are inspired to adopt and sustain healthy behaviors.

OLHA implements the Tipi model in each of the nine reservation districts to increase peer support access to housing and substance abuse disorder. OSLH will use homelessness data, and homeless complaint data scale our locally developed interconnectedness-relational self-management TIPI program for those who have completed substance abuse treatment. Our existing Community Health Worker program will empower at-risk housing tenants by creating self-management health goals throughout the reservation. This initiative will eradicate homelessness and increase access to substance abuse support, decreasing subsequent violence, trauma, and substance abuse disorders.

Designing TIPI solutions will integrate technology for tenants and providers to teach them how to use iPad and iPhones at the home sites. OSLH will provide tenants with equipment to increase access to recovery support, tele behavioral health, and case management coaches. This technology will collect data incongruence white frontline healthcare workers ensures effective and efficient utilization by the end-user. We begin by assessing the needs of healthcare workers and community members while ensuring relevance to the larger health system. CHW is standardized to reflect national self-management goal plans and will assist our tenants in connecting to the resources they need. this TIPI model demonstrates the interconnectedness-relational self-management health goal that strengthens the TIPI model by providing tribal members the s to live alcohol and free lifestyles with culturally appropriate interventions.

How technology is integral to our solution:

The TIPI solutions increase peer recovery and provide Interconnectedness-relational self-management health goals that will revolutionize how TIPI solutions are developed and implemented around the globe. OLHA and frontline healthcare workers created CHW because no existing interconnectedness-relational model health records were designed to support nurse workflows at rural health centers or utilize real-time data trends to tailor health education to their patients' needs. CHW uses technology to improve the quality and efficiency of care at the local level while promoting the adoption of national health protocols, compliance with federal reporting requirements, and achievement of lasting improvements in health outcomes.

We would like to have more partners that can make our dream a reality. With Ramon Bear Runner in leadership, we are now more progressive than ever and ready to address the needs of [people in our community. We would like to partner with MIT as you are the best in the nation and can assist us in building the human and technological capacity to make this project a reality. Since we are so rural having specialized training in either is uncommon. We appreciate your time and consideration! Wopila (Thank you) in Lakota!

A quality-driven self-sustaining Community Health Worker program has taught us that the need for self-management goals in our tenant low-income housing units has increased for those struggling with substance abuse. As an intervention to create a process for interconnectedness-relational self-management health interventions by creating a supportive housing model based on Lakota-culture principles while providing technology and space for tribal members to live and heal. This initiative improves maternal dramatically and child health outcomes, substance use access to services, addresses gaps in health care throughout the Pine Ridge Indian Reservation, and is designed as a model for scale for all tribal nations.

The Oglala Lakota Housing Authority (OSLH) will use solar energy Tipi (Lakota word for home) solutions supportive housing model with a community center for recovery to serve as the traditional fire unification place and create space for communities of healing. This model consists of regularly solar energy-efficient homes built in a circular community. In the middle of that community will be the Pejta (Fire) community center, where peer-led recovery, community events, and cultural ceremonies can be held to unite as a community. This will be a drug and alcohol-free community that is built to support a lifestyle of recovery and healing. The community will host Lakota ceremonies to reintroduce the culture to those community members who may have lost it during the boarding school era. 

Traditionally, Lakota community foundations were those stories, ceremonies, and gatherings around the fire. The Tipi model allows us to integrate the supportive housing ideologies of today with Lakota cultural traditions. This solution is innovative as I am unaware of how other indigenous communities bridge the distance between traditional, cultural living to the housing requirements of the United States today.

The TIPI Project will be piloted in the district of Pine Ridge and will be refined based upon user feedback. Developers will build one ten housing unit model using circular community, with a community center in the middle to represent what would have been the traditional fire for community gatherings. These Tipi-inspired solar saving homes will be piloted for those families recovering from substance abuse disorders. These ten houses will be placed in a circle with a community center in the middle. Tipi housing tenants will use this community center for tele behavioral health, group recovery meetings, and cultural events. By June 2024, Tipi pilot one will be initiated, and The Tipi pilot supportive housing will spread the model to the other eight districts. This will improve the quality of care provided to 44,000 Oglala Sioux Tribe. This pilot will assist us in refining our implementation strategy based upon our experience with our initial roll-out.

How many people we will be serving with our solution in the 12 months and the next three years:

Expansion of the OSLH community wellness department began January 2022 and served the entire Pine Ridge Indian reservation, which has a population of over 44,000 enrolled tribal members. The Tipi supportive housing pilot project will allow OSLH to address the gap in access to behavioral health care, enabling OSLH to improve the quality of care of tribal members. We aim to increase the quality of care provided to all tribal members, leading to significant overall morbidity and mortality improvements. During this time, Olawale works closely with Avera Health to prepare for the expansion of CHW and assure health services provided to the community are bill about through South Dakota Medicaid and Medicare services.

The skills our solution team has that will enable us to attract the different resources needed to succeed and make an impact:

Our team is comprised of a diverse and complementary group of experts in clinical care, public health, health informatics, and human-centered design that provides expert viewpoints from a wide array of fields. Our OSLH leadership has expertise in rural health needs and national health requirements. In contrast, our Executive Director's extensive experience as an end-user of electronic health records in the United States allows our team to draw upon the successes and failures of US-based digital health records. The TIPI model works directly with regional and national housing networks to increase access to supportive housing.

The TIPI Project achieves lasting improvements in health outcomes by promoting local innovation within national housing systems. That integrates behavioral health as a solution to our social substance abuse epidemic. Using digital health records is being sought after at a pace that we had not anticipated, largely because of our ability to integrate the needs of Community healthcare workers with the expectations at housing. We are applying to Solve because we would benefit from assistance with our scale and revenue models and our ability to validate the impact we are achieving. This partnership would also further our goal of becoming a thought leader in health system design. 

Our goals are: 

# of housing units secured/built

# of tenants in recovery when intiative

# of tenants within 3 months, 6 months, 1 year

Individual behavior Neighbors more frequently call on one another for
assistance.
Increased parent involvement in their child’s education.
Residents vote more frequently.
Changes in health Decreased blood pressure.
Families have access to a “medical home”.
Changes in family stability Families’ children attend the same school for all of
their elementary grades.
Families maintain a stable residence.
Changes in financial status Increased family income.
Increased family savings.

telebehavioral health as described in previous page 

Everyone is included and the model can be replicated in any tribal community.

The revenue generated from rent of the homes and community center will generate revenues.

Earlier this month, we received notification that we were awarded funding from the South Dakota Community Health Collaborative to create an internal billing department. Also, we are applying to the Department of Treasuries Capital Projects Funds to acquire cell phones/hotspots/tablets to allow people to connect to online recovery groups, therapy, and behavioral health interventions.