Transition Plan for Healthy Children

American Indian/Alaska Native Child Health

The confluence of historical and continuing trauma, poverty, and severe under-funding have resulted in large, unmet health needs for American Indians and Alaska Natives (AI/AN). Over one-third of the AI/AN population is under the age of 15. The administration must support the critical work of the Indian Health Service (IHS) to provide access to quality services to meet the health and developmental needs of Native children and communities.

Improve the quality of health services for AI/AN children, youth, and families. The administration must ensure that the IHS has the leadership support and financial and staffing resources needed to improve both the quality and quantity of medical and behavioral health services available to Native children, including in urban settings.

Improve IHS workforce recruitment and retention. Effective recruitment and retention are central to ensuring IHS has the workforce necessary to meet the health needs of Native children. The administration must support the IHS budget proposal to make the Indian Health Service Health Professions Scholarship Program and Health Professions Loan Repayment Program tax exempt. IHS should fully fund these programs and support their tax-exemption to improve recruitment for IHS health professionals. In addition, IHS should invest in programs that create sustainable pathways into health professions for Native youth.

Address neonatal abstinence syndrome and substance use disorders in pregnant Native women as a public health issue. Centuries of harmful federal policies have systematically under resourced Native communities. Inequities and experiences of historical trauma generate significant health disparities, including unmet substance use disorder treatment needs. Punitive policies and a lack of access to evidence-based and culturally appropriate care for pregnant and parenting Native women negatively affect child and family health. IHS should expand its efforts to improve access to appropriate treatment and services to ensure families can remain safely together.

Expand access to health care services. IHS should maximize the size, scope, and flexibility of the Purchased and Referred Care (PRC) program to ensure that AI/AN children and youth have access to all needed specialty services not available through IHS and Tribal service providers, including behavioral health services. In addition, Health and Human Services (HHS) policy should support maximal third-party coverage to ensure sustainable payments for health services to promote expanded access to care.

Address the crisis of Missing and Murdered Indigenous Women and Girls (MMIWG). The Department of Justice (DOJ) and IHS should partner on a comprehensive and cross-cutting response to address the crisis of Missing and Murdered Indigenous Women and Girls (MMIWG). This is both a public health and criminal justice crisis and necessitates interagency coordination to ensure an effective response to its effects on Native women and girls, their children and families, and their communities.

Protect the Indian Child Welfare Act (ICWA). Despite being a gold standard of child welfare practice, ICWA continues to face legal challenges. DOJ should intervene in challenges to the legality of ICWA to defend its appropriateness and its role in ensuring Native children retain ties to their families and Tribal communities to promote their health and wellbeing across the life span.

Promote Tribal self-determination for health programs. IHS policy supporting Tribal self-determination has been successful in ensuring that health services and public health programs are responsive to communities’ needs, thereby maximizing their child health benefits while addressing the spirit of U.S. treaty obligations. IHS should pursue all possible opportunities to promote autonomous local administration of health services and public health programs through Tribal self-determination.

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American Academy of Pediatrics