Systems of Care Philosophy: A Native Perspective on the National Initiative

Systems of Care Philosophy:A Native Perspective on the National Initiative Andy Hunt, MSWNICWA 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 • Awareness and acceptance of difference • Awareness of own cultural values • Understanding the “dynamics of difference” • Development of cultural knowledge • 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 CareChildren’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: • www.nicwa.org • www.systemofcare.net • www.air.org/tapartnership/ • http://mentalhealth.samhsa.gov/cmhs/ChildrensCampaign/default.asp • http://www.uchsc.edu/ai/coc/

Systems of Care Philosophy: A Native Perspective on the National Initiative