User:Mikalzere/sandbox

Health
There are two outpatient clinics located on the reservation. There is one located in Arapahoe and the second one is located in Ft.Washakie. The clinics offer a variety of services such as Behavioral Health, Social Services, Business Office, Community Health Nursing, Purchased/Referred Care (PRC), Dental, Diabetes Program, Laboratory/Radiology, Medical Records, Medical Services, Nursing, Optometry, Office of Environmental Health, Utilization Review and Compliance. . The reservation has faced many health issues such as high suicide rates. The New York times published an article in 1985 discussing more than 40 attempted suicides in the beginning of the year. Also, low employment rates and lack of activities for teenagers has created boredom and desperation. In 2005, Casper Startribune also discussed another health concern which was the high rates of alcoholism. Of the 79 deaths from 2004, a quarter of the deaths were attributed to alcoholic cirrhosis and half of the deaths were related to alcoholic deaths due to car crashed and homicide killing connected to drugs. Wind River residents are also facing high rates of diabetes. Approximately 71 % of the population is obese and 12% have diabetes.

In 2009, the reservation received a 5-year grant in funding from the Merck Foundation Alliance's for Reducing Diabetes Disparities (ARDD) to improve patient care, community clinical system of care, and clinicians. The ultimate goal of the funding is to find an ideal model or solution that can be repeated at other reservations to decrease the rate of diabetes. After receiving funding, the project team gathered other members who shared an interest in preventing and managing diabetes on the reservation. They recruited members of the Wind Reservation Coalition for Diabetes Management and Prevention, Wind River Indian Health Service, Fremont County Public Health, The University of Wyoming’s Centsible Nutrition Program, Sundance Research Institute, and the State of Wyoming Department of Health’s Diabetes Prevention program. These members help create focus groups consisting of residents from the reservation to understand the barriers and the issues with the health service. The group created a disease management program based on the Chronic Care Model which focused on looking at members with or at risk of diabetes views on diabetes. They created specific exercises and nutrition programs that took in account of the lifestyle and culture of the residents. For individuals that were already diagnosed, the program created a self-management education program. After the 5 year program, the results showed improved clinical outcomes. 47% of the participants saw a decrease in their HbA1c levels, improved diabetes management with a mean decrease of 1.12 points. Due to the success of the program, a 2-year grant from the AstraZeneca Foundation proposed to help 350 reservation residents who are at risk for cardiovascular disease.

Education
Only 50% of Native Americans complete high school, while compared to 80 percent of the White students graduate high school. The Wyoming Department of Education is looking to collaborate with the North Central Comprehensive Center is looking to improve the reservations education so they conducted 3 listening sessions with 40 people attended in different schools within the reservations. After the session, both parents and students came to the consensus that the Wind River reservation schools needed more teachers that are Native American. The Wind River reservation dropout rate is 40 percent more than twice the state average. Teenagers are twice as likely to commit suicide compared to other young adults within Wyoming. Other issues such as child abuse, teenage pregnancy, sexual assault, and domestic violence are endemic, and alcoholism are common problems within the reservation. There was the death of an eighth grader at Wyoming Indian Middle School who was killed by voluntary manslaughter in April 2010. Wind River’s crime rate is 5-7 times the national average, and it has a long history of gang violence. Also there is alarming number of gangs, so they also advocated for more security in order to lessen bullying and gangs, and more Native American relevant courses, such as the Native American Language. Lastly, students and parents want a standard for academic expectations that should be held within all schools within the reservation. One of the parents remarked “My grandson goes to the school in Lander. We won’t transfer him back here to the reservation because they’re two years behind where my grandson is.” Megan Degenfelder, Wyoming Department of Education Policy Advisor, said the inputs from the listening sessions has the department headed in the right track “to improve education for Native American students and to best be able to allocate our resources and time.”