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Paiute Indian Tribe of Utah 2019 Annual Report

440 North Paiute Drive, Cedar City, UT 84721

435-586-1112 *utahpaiutes.org

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TABLE OF CONTENTS

Tribal Chairwoman’s Message ............................................................................ Page 3

Administration .................................................................................................. Page 4

Finance ............................................................................................................ Page 7

Human Resources .............................................................................................. Page 9

Information Technology ..................................................................................... Page 11

Maintenance... .................................................................................................. Page 12

Education .......................................................................................................... Page 14

Cultural ......................................................................................................... Page 16

Enrollment ........................................................................................................ Page 18

GAP Program .................................................................................................. Page 20

Compliance ...................................................................................................... Page 22

Health .............................................................................................................. Page 23

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Maik, I would like to thank every Paiute Indian Tribe of Utah Tribal Member for attending functions and being actively involved in the tribe. We wouldn’t have programs, events, and gatherings without the continued support of tribal membership throughout the 2019 year. I would also like to thank Tribal Members for understanding and actively participating in social distancing during this worrisome time. We will strive to continue to put in the time, effort and energy to continue in a new direction in leading the tribe. We have had tremendous growth in our administrative accomplishments. The best way I can describe our accomplishments are; “From the outside looking in, you can never understand it. From the inside looking out, you can never explain it.” It may look like we haven’t accomplished numerous milestones, but the best transitions are those that have few interruptions and are not felt. Tribal operations should never interfere or have direct effect on tribal membership. If it does, that means we are not doing our jobs as your elected officials. This past year, the Paiute Indian Tribe of Utah Council has continued to support the Texas v. Zinke litigation, advocating for permeant funding and position for the Utah Department of Health, Indian Health, and being actively involved with and testifying on behalf of Missing Murdered Indigenous Women Day on May 5. The Paiute Indian Tribe of Utah Tribal Council will continue to strive to keep tribal members abreast by providing a follow-up after every annual meeting. The latest updates were sent out during December of 2019. We will also try and remain transparent by providing newsletters and access to our member portal. Our goal is to provide minutes, ordinances, newsletters, fliers, and live streaming our Tribal Council Meetings by accessing the member portal that is currently live. Internal tribal conflict is something that we never thought we would have to bear. The internal tribal conflict has ripped apart a Tribe that was already broken—however, there is one thing that is clear, in our history and in the law—all five Bands together and every one of you make this Tribe what it is. We must look at the past and fight for our future. This Tribe was established as a public body corporation in the 1972 because our Elders fought for us. They knew that being a singular band without the backing of a “tribe” would never allow them to make it to Restoration. We had to assemble as one, because it made our voice stronger. We now must assemble as one to heal, but to also restore this Tribe and move forward with much needed Constitutional Amendments that are based on input, review, and passage by all Tribal Members. Constitutional Amendments are a goal that this current council has prioritized, and the Constitutional Amendment Board has gathered feedback. As with anything in life, it will be difficult to get there through all the conflict and internal fighting, but I’m hopeful that we will all work together. The Tribal Council looks forward to continually working with and for the Tribal Membership. Respectfully,

Tamra Borchardt-Slayton The Paiute Indian Tribe of Utah Chairperson

TRIBAL CHAIRPERSON

Tamra Borchardt-Slayton Tribal Chairperson 435-586-1112 ext 3102

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The Tribal administrator directs the overall operations of the Paiute Indian Tribe of Utah which includes

implementing strategies that improve productivity, development of key objectives, creating high levels of

accountability and compliance, utilization of strong performance management and promoting a culture

of continuous process improvement that maximizes productivity and efficiency. Under the direction of

the Tribal Council, the Tribal Administrator manages the day-to-day administrative operations of tribal

government programs and services, the implementation of strategic initiatives, and achieving

organizational goals. The Tribal Administrator oversees the Administration Department, Finance

Department, Health Department, Behavioral Care Department, Education Department, Cultural Resource

Department, Environmental Department, and the Maintenance Department. The Tribal Administrator is

responsible for managing growth, new operational initiatives, programs, projects, financial objectives,

and goals and/or tasks defined by the Tribal Council. The Tribal Administrator helps coordinate and

negotiate contracts and grants with the various funding agencies, in collaboration with the program

directors.

There were numerous accomplishments in achievements in 2019, below is a summary of some of our

more significant accomplishments:

1. For 2019, our internal Core Value Focus was integrity. Each year we focus on a different core

value to help us strengthen our foundation, our principles, to increase accountability and to guide

our decisions. 2. We continue our focus on being a goal driven organization and increasing our internal operational

standards. Each department developed work plans and goals to accomplish in 2019, to improve

the program and to be more efficient. 3. We collaborated with Southern Utah University to rejuvenate an old grant for Paiute History and

Language Preservation. Through this grant, we were able to conduct initial language classes in

each of the Band areas. Also, we were able to increase education opportunities through

scholarships, creating an intro to college through the Paiute Educational Access Camp Experience

(P.E.A.C.E) summer program, and continued support for cultural perpetuation activities. 4. We strengthened our partnership with Southern Utah University. We have had impactful and

meaningful discussions with executive leadership at Southern Utah University related to our

Administration

Shane Parashonts Tribal Administrator 435-586-1112 ext 3101 sparashonts@utahpaiutes.org

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partnership, our goals for our Paiute People to increase access to post-secondary education, and

our commitment to collaborate and work together. To this end, we are working on developing a

new Memorandum of Understanding (MOU) for working with Southern Utah University. 5. We were the host Tribe at this year’s Governors Native American Summit. As the host Tribe, we

were able to highlight our culture, our traditions, and our accomplishments. We were able to

have our youth perform, play flute music, and attend specialized youth workshops. It was an

honor to have the opportunity to highlight our Paiute people at the summit. 6. We continue our efforts to build and strengthen our relationship with the Town of Springdale. It is

our goal to protect the Tribe’s land in Springdale and to eventually apply to put the land into trust.

We continue to work with the Town of Springdale and collaborate on potential projects, and we

are also getting invited to participate in events the town is planning. This is a huge step forward in

a positive direction. We are currently working with the Town of Springdale on connecting the

walking trails that currently cross our property and creating a new proposed trail on our property. 7. Cedar Band Travel Plaza ICDBG Project. We continue to work with and support the Cedar Band

Travel Plaza Project and are very excited about the progress of the project. We continue to work

as a partnership with the Cedar Band Corporation Executive team to ensure this project is

completed on time, on budget, and will be a tremendous boost to the economic development

endeavors of the Cedar Band. 8. We continued our efforts to support our constituent Bands.

A. We continue to support the Kanosh Band with their water system management. B. We submitted a Tax Exemption application to Sevier County for the Koosharem property

which is pending fee-to-trust application. This was approved. C. We worked with the Cedar Band and the Cedar Band Corporation with the interpretation

of the constitution to support the Cedar Band Corporations Mortgage Company. D. We continued to work on the NRCS agreement to support the Shivwits Band and the Santa

Clara River project on the Shivwits Reservation. 9. Vehicle Fleet. For years, the Tribe has utilized GSA to source its vehicles for program use. The GSA

vehicles were leased by the Tribe and at the end of the lease, we would return the vehicles to GSA.

In 2019, we decided to break away from GSA and to purchase our own vehicles. We now have a

fleet of vehicles that are owned by the Tribe. We now own and have assets with more control

over the use and maintenance of our vehicles. This also resulted in significant savings for the

Tribe, almost half of the cost of using GSA. 10. Fiscal Management. The Paiute Indian Tribe of Utah is 100% dependent on contract and grant

funding for all our programs, departments, and operations. At the year-end (2019), we were

managing over 40 grants. Each grant funding has restricted use and purpose. Over the past three

years, we have been able to turn our financial management around and have successfully

completed our annual audits for 2017 and 2018. We continue to update our financial policies and

strictly follow our policies and federal regulations to ensure we protect the Tribes’ finances and

assets.

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restrooms, and served breakfast on Sunday morning for the second year. Our staff actively

volunteered were needed to support the Restoration pow-wow and look forward to continuing to

support the Restoration Pow-wow. 12. We completed the Annual Meeting Follow-up Report and sent the report out to our Membership.

We continue to see progress and make changes within the Tribe to better serve our people. We are very

pleased with the accomplishments we are able to highlight in this year’s Annual Report. It is also

important for us to remember the perspective that “we did not come this far to only come this far” (Jeffrey

R. Holland). As leadership, we will continue our focus on continuous improvement and strategizing new

ways to improve and increase the programs and services we offer to our people, as an integrated and

cohesive unit. We look forward to the work ahead of us and the opportunity to do more, to be more, and to

move the Tribe forward. We will continue to work towards turning our potential into a reality.

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The Chief Financial Officer is responsible for overseeing the daily financial activities and operations of the

Tribe. The CFO develops policies and procedures relating to financial and budget activities, establishes

and enforces internal financial controls, maintains tribal books of record and cash balances, and ensures

compliance with all applicable legal requirements and generally accepted accounting principles. The CFO

assists in developing and monitoring budgets, provides financial information to department directors,

safeguards Tribal assets, monitors third party billing and PRC expenditures, manages cash flow, and serves

as liaison to external parties regarding financial information. The CFO is responsible for keeping the Tribal

Council apprised of the Tribes ongoing financial position and provides strategic input in establishing goals,

strategic plans and policies to ensure the Tribe’s financial stability and program and/or grant compliance.

2019 Accomplishments: 1. In 2019, the Tribe’s Finance Department oversaw the Tribe’s budget which included grants, contracts, payroll, purchasing, accounts payable and general ledger maintenance.

2. The Tribe completed the annual audit, with a clean audit opinion showing no significant deficiencies or material weaknesses.

3. In 2019 the Tribe transitioned financial institutions which has helped meet the needs of our organization.

4. The Finance Department completed the process of implementing electronic payments to help expedite payments to tribal members as well as outside vendors.

5. The Finance Department has supported passthrough grants for the Cedar Band ICDBG project through HUD.

6. The Finance Department continues to support all departments to ensure programs and departments stay on budget and that all spending is compliant with the funding agencies rules and regulations. Financial performance for 2019:

The Tribe had revenue totaling approximately

$11.8 million dollars, expenditures of $10.4

million dollars and a surplus of approximately

$1.4 million dollars. In 2019, 70% of the Tribe’s

revenue was from grants and 29% from

generated revenues at the Health Clinics. The

Tribe has historically relied solely on grants as its

primary source of funding.

FINANCE

Tyler Prisbrey Chief Financial Officer 435-586-1112 ext 3104 tprisbrey@utahpaiutes.org

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The Human Resource Department within the Paiute Indian Tribe of Utah focuses on recruitment, management, and providing direction for the people who work within the Tribe. It deals with issues related to people such as compensation, hiring, performance management, organization development, safety, wellness, benefits, employee motivation, communication, administration and training.

DEPARTMENT GROWTH

Departments 2019 2020

Administration 4 4

Behavioral Care 5 5

Clinics 16 19

Cultural 1 1

Dentist 3 10

Education 1 1

Environment 1 1

Family Services 6 6

Finance/Billing 5 5

Health 6 3

Human Resource 1 1

IT 1 1

Maintenance 8 8

Patient Outreach 0 3

Prevention 2 2

Substance Abuse 3 3

HUMAN RESOURCES

LaTosha Mayo Human Resources 435-586-1112 ext 3102 lmayo@utahpaiutes.org

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Employee Title Dept. Years of Service

BETTY CUCH Accounts Payable Specialist Finance 39 Years

PATRICK CHARLES Adult Services Specialist Family Services 31 Years

LORA TOM Patient Outreach Support Specialist Patient Outreach 26 Years

ALLEN PITTS Compliance Officer Administration 19 Years

SONYA MITCHELL Patient Care Coordinator Health 18 Years

DORENA MATINEAU Cultural Resource Director Cultural 17 Years

SHANDA FRANCISCO Substance Abuse Manager Substance Abuse 16 Years

CAROLINE GARCIA Executive Assistant Administration 14 Years

MERLA RUTHERFORD Clinic Receptionist Kanosh Clinic 10 Years

TYLER GODDARD Health Director Health 9 Years

DEBRA HEALTH Administrative Assistant Health 9 Years

KIMBALL LLOYD Facilities Director Maintenance 9 Years

HOPE SILVAS Wellness Coordinator Behavioral Care 9 Years

RICHARD PERSONS Clinical Director Health 8 Years

CARMEN CLARK Clinic Receptionist Health 8 Years

TRACIE LUND Family Services Manager Family Services 8 Years

TINA WARHURST Mental Health Program Manager Behavioral Care 8 Years

CHARLOTTE DOMINGO GAP Coordinator Administration 6 Years

TYLER PRISBREY Chief Financial officer Finance 6 Years

BROOK ROGERS Primary Care Provider Richfield clinic 6 Years

WES NIELSEN Primary Care Provider Cedar Clinic 6 Years

CASSANDRA RICHARDS Medical Assistant Richfield Clinic 5 Years

MERTIN BOW Custodian Maintenance 5 Years

WE ARE TRULY BLESSED TO HAVE SUCH AMAZING AND DEDICATED STAFF

TO PUSH FORWARD OUR MISSION & VALUES FOR THE PAIUTE PEOPLE

YEARS OF SERVICE RECOGNITION

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The IT Manager maintains all IT systems for the various departments of the Tribe, including computers, printers, networks, telephones, servers, and related software and technologies. The IT Manager is responsible for monitoring the stability and security of the IT infrastructure for the various departments of the Tribe to ensure it meets industry best practices and applicable laws and regulations. Department Accomplishments in 2019: Communications: The IT department successfully implemented upgrades to phone and internet infrastructure at all clinics and facilities. The upgrades were designed to improve availability of staff to Tribal members and limit outages and failures. During the second half of 2019, service outages were significantly reduced. More measurable improvements are planned for 2020. Security: The IT department worked with the maintenance department to update building security and video monitoring at all facilities. Building security systems enhanced with modern IT created a safer space for members and will improve response times from emergency services. Live Scan: New solutions and hardware for electronic fingerprinting were coordinated, acquired, and are ready for deployment in 2020. This will allow employees and volunteers to have fingerprints collected and background checks completed in a safe and efficient manner. Cloud Infrastructure: Improvements made in 2019 by the IT department involved work collaboration and telehealth solutions—both secured and implemented in advance of the virus outbreak. This has afforded PITU staff a higher degree of availability to stay connected in service of members, while minimizing technical barriers.

INFORMATION TECHNOLOGY

Eric Jorgensen IT Manager 435-586-1112 ext 3111 ejorgensen@utahpaiutes.org

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Department Accomplishments in 2019:

1. Repairs on the gym floor. 2. Painting the gym bleachers. 3. Completed various office renovations. 4. Installed exterior lighting at the

Administration Building. 5. Completed the roof project which included

repairing the failing roof, installing new HVAC

units, and thermostats throughout the facility. 6. Completely re-wired all network wiring in the

Administration Building. 7. Poured a new kitchen patio and completed

the landscaping by the kitchen. 8. Completed the new railing at the front

entrance of the Administration Building. 9. Installed new security systems at all facilities. 10. Assisted with purchasing the new fleet of

vehicles for the Tribe. 11. Resurfacing the Kanosh clinic parking lot. 12. Repairs on the parking lot at PITU facilities. 13. Chip Seal at the Cedar Band / Hamilton Fort

road.

14. Finished the sprinkler system at the PITU headquarters. 15. Winterized all water systems. 16. Completed the landscaping at the new

Richfield clinic. 17. Installed dental equipment at the Richfield

clinic. 18. Completed the build-out of the new Cedar

Dental Clinic 19. Completed repairs at the Kanosh, Shivwits,

and St. George clinics. 20. Moved medical and dental equipment at each

of the clinics. 21. Repaired the fence around pow-wow grounds. 22. Removed center pole at pow-wow grounds. 23. Installed a new electrical panel at the pow-

wow grounds announcer stand. 24. Installed a new electrical panel at the pow-

wow grounds for vendor plugs. 25. Expanded the road at the pow-wow grounds

for venders. 26. Supported the pow-wow event.

MAINTENANCE

Kimball Lloyd Facilities Director 435-586-1112 ext 3601 klloyd@utahpaiutes.org

The Facilities Department provides maintenance, custodial support, and construction management for

seven facilities and two parks; oversees the cleaning and landscaping of buildings and grounds; and

diligently supports numerous department and community events, programs, and activities in our

communities. The Facilities Department provides public works services which include water management

and road maintenance management. The Facilities Department utilizes skilled tradesmen, janitors, and

groundskeepers to take care of the properties. The Facilities Department oversees transportation fleet

management of PITU owned vehicles and equipment.

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FourPoints Richfield

FourPoints Richfield –construction

Tribal Building, Roof Repair

FourPoints Richfield Clinic

Dental Entrance-Cedar City

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Department Accomplishments in 2019:

1. Funded 11 students during the Spring semester and 8 during the Fall semester.

2. Provided training about native education to various programs and agencies throughout the State of Utah by speaking at colleges and attending school district meetings. Thereby giving much needed insight on how to improve native education. Conducted a one day ‘Native 101’ training for school counselors, teachers, and principals from schools throughout Southern Utah. The goal of this training was to educate professionals to better understand and serve our Paiute students. Training points ranged from Native Values, Native Family Structure, Native Stereotypes, Native Do’s & Don’ts, Native Bullying, etc.

3. Supported the Paiute language class which was taught by a Paiute elder during the first part of 2019 in each community area. A typical class included lessons focused on learning numbers, songs, colors, and phrases.

4. Helped coordinate the P.E.A.C.E (Paiute Education Access Camp Experience) summer program in partnership with Southern Utah

University. We had 12 high school students participate in the program, which provided our students a glimpse into the life of a College Student. All the students stayed on SUU campus and took science and nutrition classes by taught by SUU professors, participated in Paiute history and Paiute language classes, and toured Dixie State College and Zion National Park.

5. Participated and supported various community events; including the Trunk or Treat and the Veterans Thanksgiving Dinner, that is planned with the Title VI program of Iron County School District as a way to show thanks to our native veterans in the community. We also supported the Restoration Pow Wow weekend by participating in the parade and sponsoring the 5K Fun Run.

6. Supported our Native High School Graduates by attending as many graduations as possible and handing out graduation stoles for each graduate to wear on their graduation day. The stoles are all handmade and has the tribal seal embroidered on it.

EDUCATION

Xavier Garcia Education Director 435-586-1112 ext 3201 xgarcia@utahpaiutes.org

Program Overview: The Education Department oversees the Higher Education Program, that supports enrolled members of the Paiute Indian Tribe of Utah who want to pursue post-secondary education at an accredited institution. The department oversees the Johnson O’Malley program that provides limited supplemental assistance for al-lowable educational needs (such as school supplies, class fees, band equipment rentals, PE gym shoes, etc.) for our enrolled students who reside in our 5-county service area.

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7. Participated in the Native American Month Celebration in November. Each year the Education Department brings in students and teachers from across Iron County, Washington County and Sevier County to participate in a cultural presentation centered on our Native American Culture where we showcase our heritage and dancing. This year we had over 600 students attend.

8. Participated in the Governors Native American Summit. We had over 20 of our Paiute students attend the Summit at Utah Valley University in Orem, UT. The students stayed 2 nights and participated in many hands-on classes.

9. Hosted the Education and Career Exposition. We had approximately 200 Native American high school students attend this year’s event. Students were able to interact with over 20 booths representing colleges from Utah, Arizona, and Nevada to encourage our students to pursue post-secondary education. This event has proven to be the largest event for colleges aiming to recruit Native American students.

Left side:

• Paiute Language Night

• Youth Dance Presentation

• Students making lip balm at Utah

Governor’s Summit

Right Side:

• Veterans Honoring Dinner

• Native High School Education Fair

• Summer College Prep Program

• Helping at Back to School Fair

• Teaching “Native 101” class

to teachers

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Accomplishments in 2019:

1. Helped coordinate the Paiute Language

Class in each the Band areas. People seemed to

appreciate the class that Karma Grayman

taught and were willing to listen and learn. We

felt it was a success.

2. Assisted the Children’s Museum with a

small “Navajo” display of a rug weavings and

provided guidance on what Paiute Culture and

traditions they could display and use.

3. Participated in the Native American

Remains Review Committee meeting hosted by

the Paiute Indian Tribe of Utah. We were

invited to go to SUU to see the archives

downstairs of Paiute basketry and cultural

items.

4. Attended the Iron Springs dedication of a

Celebration of Local History to Native

Americans, Spanish explorers, Pioneer women,

iron miners and sheep rancher .

5. Participated in the Utah DoD Annual

American Meeting in Bluffdale, Utah, where we

went on a tour of the base, listed to updates

on current and upcoming projects, and had

discussions on ways the DoD can better work

with the Tribes.

6. Worked with Brenda Beyal on a Native

American Lesson Plan project. The goal of this

project is to help students better understand

native cultures.

7. Attended the Governor’s Native American

Summit and represented the Tribe and

FourPoints Health at the Tribes booth. This was

a fun event.

8. Coordinated the Kwiyamuntsi Camp, which

was held at the Kaibab National Forest. Youth

were able to see a different landscape, climb

the Fire Tower, and learn about the different

types of trees and plants in the area.

9. Attended the Native American Remains

Review Committee meeting in Moab, Utah. We

went out on a hike to Sego Canyon to see the

Petroglyph site. Terry Knight, a tribal member

from the Ute Tribe, talked to us about how

they got started working with the state and on

how they started their repatriation process.

10. Attended a Story Telling event in Zion’s

National Park with the Alumni from the two

Youth Camps, Yevingkarere and Kwiyamuntsi

CULTURAL RESOURCES Dorena Martineau Cultural Resources 435-586-1112 ext 3107 dmartineau@utahpaiutes.org

The Cultural Resource Manager is the primary and official point of contact in all matters relating to cultural resources and protects and preserves the Tribe’s cultural heritage. The Cultural Resource Manager represents the Tribe when dealing with other agencies on cultural resource issues, establishes and updates rules, regulations and ordinances as related to cultural activities, and catalogs and archives cultural resource research materials and recordings.

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Camp. We talked to the youth about what

they remember and learned from the camps

from the tribal teachers over the years. Youth

were asked if they felt that these camps were

important and needed to continue teaching

their culture, and what it meant to them.

11. Attended the Kaibab Youth Hunt, which is

a camp that teaches the youth about the deer

hunt and how to harvest the deer meat, how

things were done long ago, and how things

have changed over the years. 40 youth attend-

ed.

12. Attended the Native American Month As-

sembly where we had students come and

learn about the regalia, types of dances and

what their meaning, and watched a video of

moccasins and types of dress that were worn.

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The Enrollment Officer is responsible for maintaining and updating the official enrollment records of the

tribes, keeping the official individual files for the membership and their descendants and updating the files,

providing official tribal ID’s to membership, reorganize the current filing system for enrollment records

including sorting files, scanning and uploading documents into the Enrollment System, relabeling, storing,

retrieving, monitoring, and updating records, and information and presentations to council on membership

applications.

Here are the Tribe’s current enrollment data as of 12/31/2019:

ENROLLMENT

Carol Garcia Enrollment Officer 435-586-1112 ext 3112 cgarcia@utahpaiutes.org

As of December 31, 2019

Band Members Shivwits 314 Cedar 286 Kanosh 152 Koosharem 124 Indian Peaks 43 Total: 919 *Deceased Members - 2019 11 *Relinquishments - 2019 3 *Enrolled - 2019 10 Enrolled Cedar 0 Kanosh 3 Shivwits 7 Total: 10

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The Gap Coordinator is responsible for managing the Environmental Department program and activities, including developing policies, ordinances, and overseeing the General Assistance Program (GAP) grant deliverables. The GAP Coordinator is responsible for identifying the environmental needs in the various Tribal communities, developing program priorities, monitoring program budget, and submitting timely reports to the EPA. Community Engagement

1. Attended the Cedar and Kanosh Band meetings. 2. Presented a letter to each Band Chairperson requesting their help in completing the ETEP for the

Tribe. 3. Attended the Kanosh Water System site visit with IHS and Kanosh Band Council members. 4. Met with Mr. Beavers from IHS Ft. Duchesne regarding solid waste applications for septic tanks in

Band areas. 5. Research issues brought up at Band meetings. 6. Participated in the Restoration parade with an Environmental entry. EPA 1. Created a program workplan for 2020. 2. Completed and submitted GAP Quarterly Reports. 3. Completed and submitted the amended 2-year work plan for the GAP grant. A. 2-year work plan was approved through September 2021. 3. Completed the draft EPA-Tribal Environmental Plan (ETEP). The ETEP is a living document that will be

updated and changed on an on-going basis. A. Once the ETEP is approved, grants apply for can be brought to the tribe. 5. Started the TAS application – need additional input and information from EPA and the Tribe. 6. Researched additional EPA programs the tribe may be interested in pursuing in the coming years to be

incorporated into the EPA budget for 2020 and on. 7. I was accepted to attend Super Fund training in April 2020 as one of 20 tribes. 8. Completed year-end report for GAP. RTOC 1. Attended quarterly RTOC meetings and received updates on ETEPs, received additional information on

Max.gov, Changes to GAP guidelines, network with other tribes, many of whom are willing to help as needed.

2. Participated on RTOC conference calls. 3. Attended the South Dakota RTOC training workshop on Climate Change. 4. Attended trainings and webinars related to ETEP, Clean Water Act changes, climate change,

community outreach, indoor air quality, water and E. coli, proposed changes to CWA, Tribal water/lands.

GAP PROGRAM Charlotte Domingo GAP Coordinator 435-586-1112 ext 3801 cdomingo@utahpaiutes.org

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Meetings • Attended the Super Fund Training in Flagstaff, toured several mines and networked with other tribes

who are willing to help in the process to remediate or reclaim contaminated land.

• Attended the Tribal Lands and Environmental Forum in California.

• Attended trainings and webinars related to ETEP, Clean Water Act change, climate change, community outreach, indoor air quality, water and E. coli, proposed changes to CWA, Tribal water/lands.

• integrating water quality & grants, risk assessment emergency response, and employee productivity.

• Attended the Southwest Regional Citizen Corps Council (SWRCC) meeting which consists of southern agencies in different counties who are part of emergency management in their area.

• Attended the Utah Emergency Management Conference.

• Attended the Crisis Counseling Emergency Managers Citizen Corp meeting.

• Attended listening session in Salt Lake for CWA 404

• Attended a workshop for non-point source with DEQ and NRCS

• Attended the Kanosh Water System site visit with IHS and Kanosh Band Council members.

• Met with Mr. Beavers from IHS Ft. Duchesne regarding solid waste applications for septic tanks in Band areas.

• Research issues brought up at Band meetings. Participated in the Restoration parade with an Environmental entry

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The Compliance Officer is responsible for ensuring the Tribe is always maintaining and improving the high quality of care and services offered by our programs and departments. The Compliance Officer thoroughly investigates all concerns and complaints that are reported to the Tribe. The Tribe takes all concerns and complaints very seriously. It is our goal to actively correct any issues and to continuously make improvements to our clinics, programs, and departments.

We make it a priority to track the number of concerns and/or complaints related to the health care services we provide. In 2019 we received 12 reports, and in 2018 we received 13 reports. All concerns and/or complaints have been thoroughly investigated, reported on, and closed out. The reported concerns have been very valuable in our efforts to improve the services we provide.

The privacy and security of your healthcare information is another priority of the Compliance Officer. Continuous training and education are critical components of achieving this goal. The Compliance Officer assists in providing training for all staff through on-line training courses, group trainings and one-on-one education.

If you have a concern regarding the service you received from the Paiute Indian Tribe of Utah, such as Clinic Access, Health, Behavioral Care, Family Services, Wellness, Education, etc., we want to hear from you. All reported concerns are confidential. The concern will be thoroughly investigated by the Compliance Officer. A summary of the investigation will be shared only with individuals that need to know, such as the Tribal Administrator, Tribal Council or Program Director. You will also receive a response at the end of the investigation.

The Tribal Administration is committed to continuous improvement and to providing the very best services possible. When you report your concerns, it provides us with an opportunity to improve.

Concerns can be reported to the PITU Compliance Officer in writing, by email, by phone call or in person to:

Allen Pitts, Compliance Officer Paiute Indian Tribe of Utah

Email: apitts@fourpointshealth.org Phone: (435) 586-1112 x3405 Address: Paiute Indian Tribe of Utah

Attn: Allen Pitts 440 N. Paiute Dr. Cedar City, UT 84721

When reporting a concern in writing, please include a detailed description of your concern including dates, times, individuals involved, and a phone number to reach you in case more information is needed.

COMPLIANCE Allen Pitts Compliance Officer 435-586-1112 3405 apitts@fourpointshealth.org

* Please remember,

if you have a concern regarding the Tribal Government or individual Band, contact the respective Council

directly. The Compliance Officer does not get involved in Governance matters. *

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HEALTH Tyler Goddard Health Director 435-586-1112 ext 3401 tgoddard@fourpointshealth.org

Health Department Annual Report – 2019 Annual Accomplishments, Major Items and Upcoming Projects

Health Administration, led by Tyler Goddard Programs and Services: Medical Clinics, Dental Clinics, Patient

Outreach and Support, Behavioral Health (mental health and

substance abuse treatment) - Integrated with Medical Clinics, Family Services, Youth Prevention/Native

Youth Program. Department Goals and Initiatives: Completed 135 of 141 tasks on our annual Department workplan. Four

of the remaining six are end of year tasks and are on track to be completed by the end of January 2020 and

two will be carried over to 2020. Below is a draft of our 2020 workplan goals: 1. Increase capacity for quality healthcare by bringing on additional specialty providers and services,

specifically for our tribal members (i.e. pediatrics, psychiatry, orthodontia, dialysis) 2. Improve patient care coordination and support with a fully functional Patient Outreach and Support

Program. 3. Integrate Medication Assisted Treatment (MAT) into our Substance Abuse Program. 4. Solidify youth prevention funding beyond 2020. 5. Have a successful HRSA Operational Site Visit with no conditions placed on our funding. 6. Have a successful BIA Annual Program Review.

Major Items: HRSA Operational Site Visit (OSV) will occur Spring or Summer 2020.

The OSV monitors our compliance with our HRSA grant and looks

at our policies, procedures, service delivery and documentation.

Our Management Team is reviewing the OSV protocol and

preparing for this visit. Part of this process will be to review and

update our policies and procedures.

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Grants/Funding:

• Met with federal and State officials to raise awareness about and address legislative issues impacting

tribal and community health care.

• Finalized negotiations for the 2020 annual Funding

Agreement with Indian Health Services.

• Closed out the HRSA construction grant for the

Richfield clinic.

• Continue to meet grant and contract reporting

requirements and remain in positive standing with

each of our granting/contracting agencies.

• Continue to look for additional funding for

continuing and/or expanding services, especially

for the youth prevention program.

• Community Engagement Nights

• These events proved to be well attended and helpful as our staff were able to engage with each

community and identify and resolve concerns before they became major issues. For instance, the

Kanosh Band requested additional information for their community members on identifying and

preventing substance/opioid abuse and we were able to bring in Michelle Chapoose from the Utah

State University Tribal Opioid Response program to provide a special presentation on December 19th.

• In 2020, we will continue with the monthly Community Nights following the same schedule (4th week

on the Native Youth night for that community), starting with Richfield on January 27th. We are open

to suggestions or special requests from the Bands for improving these activities.

It is an honor to serve as the Health Director. Looking back, 2019 has been a great year with a lot of

growth and accomplishments. I look forward to continuing to serve the PITU tribal members, our patients

and the community in 2020. As always, our goal at FourPoints Health is to provide excellent service every

day and to improve the overall health and wellness of

our patients and our community.

Quote: "When we seek to discover the best in others,

we somehow bring out the best in ourselves."

- William Arthur Ward

Respectfully Submitted,

Tyler Goddard, Health Director

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Medical & Dental Clinics, led by Rich Persons (Clinical Director): Services/Program Summary: FourPoints Health provides high quality preventive and primary health care to

patients including: Primary care, Screenings, Emergency and after hour services, Immunizations, Diagnostic

laboratory, Pharmaceutical services, Chronic Care Management, Eligibility assistance, Healthy Start

(Mothers) Program, Woman’s Health, and Basic Dental services.

• Opened two new clinics in 2019, to increase capacity and services to better meet patient needs.

• The new Richfield Clinic is on Main Street and opened on June 14th with an increase from two medical

exam rooms to six, a behavioral health counseling room, an integrated dental clinic and a group/

conference room. There is also a full basement that will be finished in the future to add additional ser-

vices and specialties when appropriate. Richfield Clinic has seen an increase from 225 average patient

visits per month to 316 for medical and behavioral health. Additionally, Richfield Community Pharmacy

is housed within the Richfield Clinic and has a drive-up service to provide better access to medications to

our patients living in the Sevier and Millard County communities. Bulloch’s Drug continues to serve Iron

and Washington counties.

Total Patients seen Workload Report Dec. 2019 Total

Cedar 337 4,324

Shivwits 111 1,206

Richfield 287 2,949

Kanosh 113 1,455

Total 848 9,934

Total Patient No-Shows 2019 Total

Cedar 5% 4.13%

Shivwits 3% 2.55%

Richfield 5% 4.33%

Kanosh 2% 3.83%

Average 4% 3.69%

After Hours On Call Numbers 2019 Total

323 3,004

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• St. George Clinic opened on October 28th to better serve tribal and community members living

throughout Washington County. The new clinic has ten medical exam rooms, a larger nurse’s station,

counseling offices and business offices that will allow us to bring in additional specialty services. Although

it has only been open for a few months, St. George has already seen an increase in average monthly

patient visits from 116 to 136 for medical and behavioral health.

• Exploring funding options for a new health care facility in Cedar City to better meet the needs of the Iron

County community.

• Added in-house dental services in Richfield (three chairs) and Cedar City (4 chairs). Currently transporting

tribal patients from Kanosh and St George areas or providing referrals for specialty and/or more complex

cases. Looking into possibility of adding orthodontics.

• Brought in a Rheumatologist on a voluntary basis once a month in St George to see tribal members. Dr.

Jensen saw 21 tribal patients during the six months he volunteered with us in 2019. Rheumatology

patients typically have to be referred out of the area and schedules are often booked out six months, so

this was a huge benefit to our tribal patients and cost savings to our program.

• Created a new Patient Outreach and Support Services team under Sonya Mitchell. This team will provide

additional follow up, home visits, transportation and health education to higher risk patients as identified

by their providers. These patients may include those with diabetes or pre-diabetes, our elderly and

disabled patients, or other patients with chronic conditions.

• The Billing Team was able to secure several new contracts, including working with the Veteran’s

Administration so that our clinics can now accept VA patients.

• Partnerships = Increased Services and Cost Savings: our partnership with Intermountain Healthcare’s

voucher program for labs and imagery has resulted in significant cost savings to our program as

demonstrated by the following table:

• We worked with the Huntsman Cancer Institute and are now able to provide women’s cancer screenings

through their voucher program at no cost to the Tribe. We are also working with Huntsman to bring their

Mobile Mammography Bus to our Cedar City (April 2nd) and Richfield (April 3rd) clinics in 2020, to provide

free screenings.

January is Cervical Cancer Awareness Month. FourPoints Health has scheduled a well-woman clinic (with

a female medical provider available) in each area:

January 10, 2020 – St. George January 17, 2020 – Cedar City January 24, 2020 – Kanosh January 31, 2020 – Richfield

Volume Dollar Our Cost Savings

2019 Total 326 $402,960 $16,300 $386,660

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Patient Outreach and Support, led by Sonya Mitchell (Patient Care Coordinator)

• Services/Program Summary: Case management and treatment coordination for patients needing a higher level of follow up; Patient advocacy; Home visits to assess care needs and to provide home-health treatment, Follow-up care post-surgery and/or emergency room, InstaCare, or hospital discharge; Special Diabetes Program for Indians (SDPI) - Diabetes outreach, education, prevention and treatment including diabetic shoes screenings and fittings (diabetic shoes only available to tribal patients who are Purchased Referred Care-PRC eligible); and Non-emergency medical transportation for those without access to a vehicle for medical appointments (currently only available to tribal patients).

• We are successfully facilitating two National Diabetes Prevention Program courses in Richfield with another cohort beginning in 2020. NDPP Courses are being scheduled in St George, Cedar City and Kanosh in 2020 (either in person or via video conference). The Richfield cohorts have seen many positive results, including helping participants with significant weight loss and even helped one participant bring her A1c down from 7.2 to 5.3!

• Monthly Nutrition Classes are being held in each area with incentives provided for tribal member participants. Flyers with class schedules will be provided to the Health Board representatives, posted in Band areas, on Facebook, and on the website. Contact a member of the Patient Outreach and Support team at 435-586-1112 with questions or more information.

Behavioral Health, led by Tina Warhurst (Mental Health Program Manager) and Shanda

Francisco (Substance Abuse Program Manager) Services/Program Summary: Mental health assessment, treatment, and support for individuals, couples,

families, and groups of all ages; Domestic Violence Evaluations and Treatment for both perpetrators and

survivors/victims; Substance use disorder assessment and treatment (outpatient, intensive outpatient,

and residential – only for PRC eligible tribal members) for individuals, couples, families, and groups; Red

Road to Sobriety – 12 step/Alcoholics Anonymous (AA) meeting Incorporating Native American traditions;

Substance Abuse Classes; Prime for Life – 16-hour drug and alcohol education course designed to

challenge common beliefs and attitudes that directly contribute to high-risk alcohol and drug use, such as

driving under the influence (DUI). Behavioral Health services are available to Purchased Referred Care

(PRC) eligible tribal members free of charge or to anyone on a fee for service basis.

• Behavioral Health goals for 2020 include increasing capacity, implementing new clinical and support

groups (i.e. life skills, DBT, Seeking Safety, coping skills), increasing access via tele-health, and policy

review/updates.

• Our mental health program has grown; we now have a Mental Health Program Manager and six full-time therapists, with counselors available in each area. Additionally, we also have several contract

providers and are finalizing the necessary IT improvements in order to offer tele-behavioral health to

better meet the need in each area.

• Three of four of our mental health counselors completed their basic consultation hours for EMDR

(trauma treatment) certification. They will complete advanced consultation and training in 2020.

• Developed a weekly triage office coverage schedule to ensure a counselor is available for tribal

members who call or come into the clinic with urgent mental health needs.

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• Focused on becoming a trauma-informed workplace and on counselor self-care to ensure our staff are

regularly assessing and resolving secondary trauma.

• Our substance abuse program is staffed with a manager, a substance abuse counselor, a traditional

counselor and a part-time peer support specialist. Demand for our outpatient program continues to

grow and we are one of the premier providers in the area.

• Below are some behavioral health data for our HRSA funded clinics (currently Richfield and Kanosh) in

2019 through our Integrated Behavioral Health Services funding:

Family Services, led by Tracie Lund (Family Services Manager)

Services/Program Summary: Tribal General Assistance (GA) – financial assistance to help adult clients

become self-sufficient; Vocational Assistance – designed to help adult clients to gain self-sufficiency by

obtaining additional vocational or technical training, pay for testing/licensing fees, or purchase necessary

employment supplies; Burial Assistance – one-time financial assistance paid to the funeral home to meet

expenses incurred by the death of a tribal member; Adoption or Guardianship Subsidy Assistance – monthly

subsidy to help provide for the basic needs of children who have been in foster care and help give them a

permanent home with family or within the Tribe; Case Management - a service that assists Tribal members

to gain access to needed medical (including mental health), social, educational, and other services; Indian

Child Welfare - provided in conjunction with the State child welfare agency to help ensure that children are

safe and remain with family when possible.

Behavioral Health Counseling Patients Encounters Cedar CHC 42 409

Kanosh CHC 5 12 Richfield CHC 20 57 Shivwits CHC 8 34

Totals: 75 512 2019 Total: 2,381 6,257

Behavioral Health Support Activities (Red Road, Classes, Groups) # Activities # Hours # Youth # 18-24 # 25-54 # Elders

Totals

Cedar 28 26 6 20 149 25 200 Kanosh 0 0 0 0 0 0 0

Richfield 0 0 0 0 0 0 0 Shivwits 4 9.5 4 8 21 8 41

Totals: 32 35.5 10 28 170 33 241

2019 Total: 277 224 2,116 403 3,020

Total unduplicated patients receiving SUD services 223 Total visits of patients receiving SUD services 569 Total unduplicated patients receiving MH services 656 Total visits of patients receiving MH services 1628 Patients (age 12+) screened for depression with a follow-up plan 558

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• These services include in-home, foster care and adoption; Family Violence Prevention Program - offers a variety of services to assist victims of domestic violence, sexual assault and stalking; Child Care Assistance - helps pay for childcare for low-income families with parents who work, attend school/training, are looking for work (up to six weeks), or are participating in treatment (medical or behavioral health); Family Crisis Assistance - food vouchers (up to $30 per household member, limited to families with children), DI vouchers for clothing and household items, monthly food boxes (mobile food pantry), bus passes (if seeking employment, limited availability) hygiene kits, diapers and other aid to Tribal members during periods of economic hardship; LIHEAP - utility assistance for Native American households during periods of economic hardship.

• We now have a full Family Services team with a Family Services Manager, three social workers, an Adult Services Specialist and a Program Assistant.

• LIHEAP/Utility Assistance was transferred to the Family Services Program in 2019. Over 50 applications received and processed so far for FY2020.

• One focus for 2020 is on raising awareness of the need for Tribal/Native American foster homes. We once had enough relative homes for children who needed to be placed out of their homes but most of those homes filled up or situations changed. Many families are able to take care of children informally without State involvement, but for those who cannot, these foster homes are invaluable.

• Another focus is on training, especially since half of our Family Services team is new. Staff are being cross trained on all programs and services so there will always be someone available to help answer questions or process an application. We have been and will continue to work with the Bureau of Indian Affairs Social Service Representative regarding ongoing training.

• Family Services has also been working with the IT Manager on an electronic client database that would allow for all programs and services to go paperless. Tribal members would be able to apply for services online or in person by themselves or with one of our workers. The system will have built in eligibility checks to help ensure compliance with program/funding requirements. Family Services Clients/Cases Encounters Food Boxes

Cedar 20 37 32

Kanosh 2 11 13

Richfield 1 1 2

Shivwits 4 4 22

Totals: 27 53 69

2019 Total: 300 627 1198

Month Child Abuse/Neglect Referrals: 10 2019 Total Child Abuse/Neglect Referrals: 23

Month Adult Abuse/Neglect Referrals: 0 2019 Total Adult Abuse/Neglect Referrals: 1

Total DV Services/Referrals: 2 2019 Total DV Services/Referrals: 5

Monthly General Assistance Cases: 1 2019 Total General Assistance Cases: 36

Child Care Assistance Cases (# of children served): 13

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• 10 families and 18 children received Child Care Assistance in 2019, all of whom received assistance while the parent/guardian worked.

• Assistance is also available for parents who are attending approved schooling or training, job seeking, or participating in ongoing medical or behavioral health treatment. • Average monthly subsidy payment was $230 • Average of 142 hours of childcare per month. • 87% received care in their own home or the home of a family member.

Native Youth Prevention Program, led by Roger Clark (Prevention Coordinator)

Services/Program Summary: Support tribal youth in improving physical, mental, emotional, and spiritual

wellbeing; Provide safe, pro-social activities for youth incorporating evidence-based strategies, cultural

activities, and education; Prevention and counseling support for children, youth, and young adults;

Coordinate with other tribal programs, schools, and parents to encourage better outcomes for tribal youth.

• Established positive working relationships with school counselors and administrators in order to better

advocate for the needs of our Native Youth. These relationships have helped us identify and resolve

school issues before they became more serious problems.

• Consistently held youth activities in each area. These activities focused on cultural practices (making

gourd, shawl and hand drum), health and nutrition, science and astronomy, finances and budgeting,

and presentations by Tribal elders (learning about Paiute history and traditions).

• Worked with the Inter-Tribal Council of Arizona (ITCA) to develop improved data collection and

reporting processes.

• 2020 activities will begin with a focus on science and technology with the youth learning about robotics

and computer programming.

• As our current grant funding through the Indian Health Services (MSPI) ends in September of 2020, we

continue to look for additional funding options to ensure the continuation of our Prevention Program.

Youth and Community Prevention Activities* # Activities # Hours # Youth # 18-24 # 25-54 # Elders

Totals

Cedar 11 18.5 72 17 36 28

153

Kanosh 5 6 19 5 16 8

48

Richfield 3 4.5 18 0 9 5

32

Shivwits 2 2.5 17 2 9 2

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Total Prevention: 15 18.5 126 24 70 43

263

2019 Total: 187 280.5 2,416 236 756 437

3,845

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front and back cover-Fish Lake