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

2. 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

3. 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

4. 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)

5. 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

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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. Contact information
Holly Echo-Hawk
(360)