Tribal Systems of Care: A 20-Year Retrospective Holly Echo-Hawk California Urban Indian Health Conference 2017 June 23, 2017

System of Care SOC is . . . Organizational Framework and Philosophy for system reform to improve children’s mental health SOC Principles/Values Community-Based Culturally-Competent Family-Driven Youth-Guided Individualized Strength-Based

COC and SOC Circle of Care are 3-year planning grants Planning based on SOC philosophy Approximately $100,000/year System of Care cooperative agreements are 4-6 year implementation grants System Reform of children’s services Mental health & other services for qualified children and their families Approximately $1 million/year

COC & SOC Investment Since 1993, over $2 billion of federal funding has been granted to communities across the country to reform ineffective and disjointed children’s mental health services As of October 2016, one hundred and one (101) American Indian and Alaska Native communities received system of care funding from SAMHSA (includes Circle of Care 3-year planning grants, and the multi-year System of Care grants and cooperative agreements)

Types of tribal grantees Funded tribal communities diverse Included tribes, tribal consortiums, tribal colleges, urban Indian organizations, and tribal-city, tribal-county, and tribal-government partnerships

Approximate % of Tribal System of Care Funding 1993 - 2016 All Others (82%)

Tribal Challenge Funded tribal communities underwent complex change to develop and sustain their system of care

Observations Based on 20-years of experience in support of the developing tribal systems of care Observed trends and commonalities among the collective group of funded tribal communities Summarized 13 Strengths & 13 Challenges

13 Strengths Grassroots Foundation Local leadership Culture as Core Influence of Language Vision for Future Power of Communication Organizational Infrastructure Developing College Partnerships Integrating New Treatments Building Tribal Wraparound Investment in Advocacy Tribal-County-State Relationship Tribal Peer Support

13 Challenges Impact of Trauma Changes in Leadership Recruiting and Retaining Staff Workforce Availability Organizational Infrastructure Communication Disconnect Integrating Family Voice and Choice Youth and Family Organizations Grant Implementation Tribal Wraparound Services Data-Driven Decisions Tribal-State Relationships Investment in Advocacy

Some areas were both . . . Strength Challenge Local leadership Power of communication Organizational infrastructure Building tribal wraparound Investment in advocacy Tribal-State relationship Changes in leadership Communication disconnect Organizational infrastructure Tribal wraparound fidelity Investment in advocacy Tribal-State relationship

New Observations Great! Increased use of technology Great! Increased partnership with health care Not so great . . . Opioid and Meth in communities Not so great . . . Impact of increased drug use and increased crime on youth & families

Summary Building a new system of care is hard work! Collective experiences of the rural reservation, Alaska Native, urban Indian, and other tribal communities illustrate the power and influence of culture on all aspects of system reform Efforts to improve services result in rich resource of strengths and challenges, and lessons learned for other tribal communities

Contact information Holly Echo-Hawk echohawk@pacifier.com (360) 737-4747