Systems of Care Philosophy: A Native Perspective on the National Initiative Andy Hunt, MSW NICWA Director of Community Development for Children’s Mental Health

System of Care Principles Family Focused Culturally Competent Community Based Accessible Individualized Least Restrictive Accountable Interagency Coordinated & Collaborative

Family Focused Not about only children Not about only parenting “Family” is defined by the community Families are involved as key partners at every level of the system, from direct service to policy and evaluation

Cultural Competence 1.Awareness and acceptance of difference 2.Awareness of own cultural values 3.Understanding the “dynamics of difference” 4.Development of cultural knowledge 5.Ability to adapt practice to fit the cultural context of the client/family

Cultural Competence At the system level… “A set of congruent behaviors, attitudes, [practices] and policies that come together in a system, or agency…and enable that system, or agency… to work effectively in cross-cultural situations”. (Cross, et. al)

Community-Based Children should be served in their own community by people from the community The community should shape and drive the design of the system The system should reflect the values of the local community Community members should remain an integral part of the service delivery and planning process

Accessible Children and families should be able to get all necessary services with ease Elimination of barriers to service: –Physical/Geographic Location –Policy, Procedures and Processes –Language and culture –Stigma and perceptions –Funding restrictions

Individualized Care Assessments that are based on discovering the strengths of each child A “plan of care” that is truly unique to meet the needs of each individual child A wraparound approach that respects individuals Services are flexible and adapted to the family

Least Restrictive Children should remain in their own homes and communities or in the most home-like setting possible Creativity is needed to develop alternatives to more restrictive service models and keep children in their own communities Group residential treatment should be avoided unless clinically indicated

Accountable Everyone in the system is answerable to each other to meet the needs of the children being served –The system to the community members –The system to the funding source –Service providers to the families –Service providers to their supervisors –Partners agencies to each other –Standards of practice and ethics

Interagency Systems of care involve multiple agencies to meet the multiple needs of children and families Interagency agreements are formalized New partnerships are sought out Care is taken to build relationships between agencies at service level, and leadership level

Coordinated and Collaborative Agencies and other partner organizations work together cooperatively towards the same goals Each agency, partner and stakeholder has input and offers resources to meet the community’s goals Everyone is on the same page, and everyone knows and understands their role in working together to meet the goals

Partnership in Action: The Indian Children’s Mental Health Initiative SAMHSA (CMHS & CSAT) Indian Health Service (IHS) Department of Justice (DOJ) National Indian Child Welfare Association (NICWA) Circles of Care Evaluation and Technical Assistance Center (CoCETAC) American Institutes for Research (AIR) American Indian/Alaska Native Communities

Systems of Care Children’s Mental Health Program Program funded though CMHS began in early 1990’s for State, Counties, and Cities as 5 year grants First Tribe funded in 1994 (Navajo) Grants extended to 6 years in 2001 US Territories are eligible to apply as of 2003 when grants became “cooperative agreements” Plan, design and implement a children’s mental health system of care Target population: Children with Severe Emotional Disturbance and their families

Native CMHS Service Sites (6 Year Implementation Grants) Navajo Nation – NM (Graduated 1999) Passamaquoddy Tribe – ME (Graduated 2003) Sacred Child Project – ND (Graduated 2003) Saulte Ste. Marie Chippewa Tribe – MI (Graduated 2004) Northern Arapaho Tribe – WY (Graduated 2004) Oglala Sioux Tribe – SD (Year 6) Yukon Kuskokwim Health Corp. – AK (Year 6) United Indian Health Services – CA (Year 5.5)

Native CMHS Service Sites (6 Year Cooperative Agreements) Fairbanks Native Association – AK (Year 3) Choctaw Nation – OK (Year 3) Urban Trails Project – CA (Year 2)

Circles of Care Grant Program 3 Year grant funded though CMHS Tribal and Urban Indian programs Plan, design and assess feasibility of implementing a culturally appropriate system of care Target population: American Indian/Alaska Native children with Severe Emotional Disturbance and their families Goal to give grantees opportunity to compete for System of Care implementation grants

Tribal System of Care Communities = SoC = CoC I = CoC II

For more information visit some of the following websites: Campaign/default.asphttp://mentalhealth.samhsa.gov/cmhs/Childrens Campaign/default.asp