Editor’s Note: The Kodiak Area Native Association (KANA) is one of eight primary care community clinics receiving funding through the federal Social Innovation Fund (SIF) initiative to spread the IMPACT program, also known as Collaborative Care, in the rural Pacific Northwest.
The John A. Hartford Foundation was one of just four new awardees chosen in 2012 to serve as an intermediary between SIF and subgrantees implementing innovative care models. As a result, $3 million in federal grants have been matched by $3 million in money from the John A. Hartford Foundation, with additional matching grants from the subgrantees, to spread the IMPACT/Collaborative Care model in Washington, Wyoming, Alaska, Montana, and Idaho.
The Gulf of Alaska frames the gleaming green island of Kodiak, nestled in the core of the gulf and known as Alaska’s emerald isle for its mossy woodlands. Kodiak is the second-largest island in the United States; not to be confused with the archipelago, which is comprised of several surrounding islands—home to some of the last remaining cultures native to this country.
These villages survive by subsisting on nature’s bounty, as they are separated by great walls of mountains, salty seawater bays, freshwater rapids, and miles of uninhabited wildlife refuge.
On the northwestern side of Kodiak Island, divided from the city of Kodiak by a barrier of rolling hills and towering mountains, 37 village residents live a quiet life of close companionship with their neighbors.
This is the hometown of Sophie Shepherd.
Born in 1927 in the village of Karluk, Sophie is one of the last remaining cultural pillars for the Alutiiq people. She has spent most of her life serving others. This life of service began at home, where Sophie was one of seven children. Like many in the village, her family was poor, but everything they ate was fresh from the earth and in line with their traditions, which she carried with her long into adulthood. Sophie’s mother taught her to speak Alutiiq as a child, a proficiency she was later punished for in school, and now is one of the last remaining Karluk descendants who are fluent in this dwindling ancient language.
She continued serving others when she and her mother moved to Larsen Bay, a village on the fin of salmon-shaped Uyak Bay, to work alone in the cannery as the chef for five years. After her 12 children had grown, Sophie returned to the kitchen, serving as the chef at the hospital and then in the Kodiak jailhouse; her favorite part was standing up to the prisoners when they complained. Her strength has inspired many in the community despite their heritage. She contributes to the perpetuation of the Alutiiq language by participating in language club and sharing her stories wherever she can.
Sophie’s life has been one of great selflessness and joy, but also horrific tragedy. She lost three of her brothers to alcoholism and dire events related to the addiction. One of her sons never returned home from working on a salmon rig and is now assumed deceased. Sophie is a three-time cancer survivor, and in recent years both her mother and sister have passed—their deaths only two months apart.
These recent deaths have been the catalyst for her participation in IMPACT—a team-based model of care offered by the University of Washington AIMS Center and supported from the beginning by the John A. Hartford Foundation—that delivers effective depression treatment for older patients in primary care settings.
In the Fall of 2014, the Kodiak Area Native Association (KANA) received an award of $384,000 over two years to implement the evidence-based depression treatment model. Before she started seeing Meara Baldwin, a care manager working with KANA, Sophie felt lonely no matter how many people were near her. She exhausted herself to ease her mind by keeping her home in order, cleaning, reading, and spreading the beauty of her culture.
Now, after three months of participating in the IMPACT program, Sophie is experiencing a second wind. Meara has helped Sophie uncover memories that make her happy, like watching children of Karluk skate on the pond and the volcano Novarupta spewing fire in the night.
Meara has helped her discover that her physical pain is linked to her mental health. Since she’s been enrolled in the IMPACT program, Sophie’s doctor visits are less frequent and, with the support of KANA’s psychiatric consultant, her physicians are more confident with maintaining her level of medications. The option of support over the telephone has been vital in Sophie’s success with the program, as she frequently travels back and forth from Kodiak to Anchorage for medical treatment.
No matter where she is, she is able check in with her care manager on her progress, using the skills she has gained during her IMPACT appointments. Meara has also helped Sophie discover that attending language group discussions and cultural rejuvenation activities help her mental state.
Sophie’s latest PHQ9—the nine-item depression scale of the Patient Health Questionaire—reports a five-point improvement and her doctors continue to see improvement in her physical condition. KANA’s IMPACT program serves the native people of Kodiak Island and its veterans; we look forward to continuing success when we open our Community Health Center this summer—a resource that will be open to all of Kodiak Island and its people regardless of race or ability to pay.
Since its implementation in the Fall of 2014, IMPACT in Kodiak has served more than 60 patients, with 23 of them experiencing five-point reductions in their PHQ9 and 19 reporting a 50 percent improvement at 10 weeks. Sophie won’t be our only success story, but by improving her life, we have perpetuated the Alutiiq culture, educating a new generation of Kodiak residents about the pillars on which this community was built.
For more information on the John A. Hartford Foundation’s SIF projects, visit our Social Innovation Fund page.
This is the second in an occasional series of Health AGEnda posts on the Hartford Foundation’s Social Innovation Fund projects. Read the previous post: