Strategies That Peak How States Include Tribes in Planning

1. Strategies That Peak How States Include Tribes in Planning Building FASD State Systems Colorado Springs, CO May 7, 2008

2. Panel Members • Candace Shelton, M.S., LISAC SAMHSA FASD Center for Excellence • Lorena Burris, PhD Research Associate Center on Child Abuse and Neglect Oklahoma University Health Sciences Center • Suzie Kuerschner, MEd FASD Consultant

3. What is Indian Country? Candace Shelton, M.S., LISAC Senior Native American Specialist SAMHSA FASD Center for Excellence Candace.Shelton@ngc.com (520) 881-8182

4. What is INDIAN COUNTRY? Legally Defined as: • All land within the limits of any Indian reservation under the jurisdiction of the U.S. Government. • All dependent Indian communities within the borders of the United States. • All Indian allotments, the Indian titles to which have not been extinguished. (Title 18, U.S. Code, section 1151)

6. American Indian/Alaskan Native Population • 562 Federally Recognized Tribes • 229 Alaska Native Entities (Federal Register, April 2008) • 69 States Recognized Tribes (Santa Clara Law Review, 2007) • 160 Federally Non-Recognized Tribes (500Nations, 2008)

7. American Indian/Alaskan Native Population • Approximately 2.5 million self-identified AI/AN in the 2000 Census • Approximately 4.1 million AI/AN identified as one or in combination with one or more races • 38% of the AI/AN population is under the age of 18 • 63% of AI/AN reside in urban areas, 37 % of AI/AN reside in rural areas

8. Indian Country is NOT all the same Hopi different than the Seminole Eastern Band of Cherokee different then Zuni Inupaiq (Barrow) different than the Haida (Masset)

9. AI/AN Cultural Practices • Preservation of cultural identity • Strong cultural foundations • Respect for elders • Value placed on children • Extended family structure • Interdependence of family relationships • Use of humor

10. Diversity in Cultural Values AI/ANWestern Sharing Saving Cooperation Competition Being Doing Group Individual Harmony with Nature Mastery over Nature Present Future Respect for Elders Value Youth

11. Community Challenges • Domestic Violence • Child Abuse and Neglect • Substance Abuse • Mental Disorders • Violent Deaths (Unintentional) • Suicide

12. External Barriers Outside assistance introduced to Indian Country: • Lack of cultural knowledge and sensitivity • Language barriers • Distrust • Attitude of superiority; prejudice • Time-limited services • Questionable quality of services offered

13. Internal Barriers Obstacles that deter tribal members from seeking assistance: • Lack of consistency • Lack of professionals with specialized training • Territoriality • Confidentiality • Tribal/agency politics

14. Additional Barriers in Indian Country • Living in isolated areas • Limited services available • Excessive paperwork to receive services • Waiting for service delivery • Stigma-shamefulness/disgrace • Substance abuse • Resistance to change

15. Primary Prevention • Directed at the general population • Involves raising awareness and providing education Examples: - Safe Start Programs - Boys and Girls Clubs in Indian Country

16. Secondary Prevention • Activities directed toward high risk groups • Take Action to prevent or minimize harm Examples: - Early Head Start/Head Start - Home Visitation Programs • Healthy Families America

17. Tertiary Prevention • Focuses on reducing problematic behavior • Involves treating the problem to lessen its effects Examples: - Wellbriety/WhiteBison - Circles of Care - SAMHSA

18. Strategies for Connecting with Tribes • Outside agencies: 1. Establish Trust with the community 2. Be Respectful 3. Beware of Cultural Trespassing 4. WAIT until assistance is requested

19. Strategies for Connecting with Tribes • Within the Indian community: • Obtain support from community leaders • Get to know the Tribe • Introduce new programs and providers to community members • Address the younger population • Utilize the tribal elders

20. Working with Child Maltreatment in Indian Country Lorena Burris, PhD Center on Child Abuse and Neglect Oklahoma University Health Sciences Center Lorena-burris@ouhsc.edu

21. Federal Indian Policy • U. S. Government made treaties with Independent Tribal Nations; in 1870’s federal laws were enacted to extend the trust obligations with tribes. • Early Federal Indian Policy was to assimilate American Indians • Assimilation of American Indian children included : • boarding schools • adoption by non-Indian families

22. Federal Indian Statutes • 1953 Public Law 83-280; Amended in 1968 • 1976 Indian Health Care Improvement Act P.L. 94-437; Reauthorized in 2008 • 1978 Indian Child Welfare Act • 1989 Office for Victims of Crime/Victim’s Assistance in Indian Country (VAIC) • 1990 P.L.101-630 The Indian Child Protection and Family Violence Prevention; Reauthorized in 2003

23. Violence in Indian Country Child abuse & neglect: 1 substantiated report of a child victim of abuse or neglect for every 30 American Indian children age 14 or younger (U.S. Bureau of Justice, 1995) Rate of victimization for American Indian children was 15.9 cases per 1000 children. Rate of victimization was 12.1 per 1,000 children in the population. (NCANDS 2006)

24. Violence in Indian Country • Violence Against Women Act (2005) - Tribal Title (Title IX) included AI/AN women - AI/AN women 2.5 times more likely to be raped or sexually assaulted (Amnesty International, 2007) • Domestic Violence/Intimate Partner Violence Less likely to be reported in Indian Country • Due no or slow response from tribal police • Failure to prosecution • Domestic/Family Violence and Child Abuse

25. Jurisdiction in Indian Country • Factors that determine jurisdiction • Whether the victim is: • Indian or Non-Indian • Victimless • Whether the offender is: • Indian or Non-Indian • Whether the offense occurred on tribal land or not • Whether or not Public Law 280 (or other relevant federal laws apply)

26. Reporting Child Abuse & Neglect in Indian Country • Federal Jurisdiction: for violation of federal offense (major crimes) • Local law enforcement agency • Local child protective services agency • BIA Child Abuse Hotline 1-800-633-5155 • State Jurisdiction: when under PL 280 follow state or state-tribe agreement exists • Child protective services agency • Law Enforcement agency • Child Abuse Hotline • Tribal Jurisdiction: committed on tribal land • Child protective services agency • Local law enforcement agency • Federal Bureau of Investigation

27. Suzie Kuerschner, MEdFASD ConsultantPortland, Oregon(503) 622-3973suziekuerschner@Gmail.comNPIHB(503) 228-4185

28. Building Sustainable State Systems& Collaborative Circles of CareforTribal and StateF.A.S.D. Service Integration SLBK

29. Planning Goals • Facilitate integrated service delivery from a family focused, Collaborative Circle of Care model that insures culturally congruent and developmentally appropriate case coordination • Facilitate community design of systems to include mentors, natural helpers and elders that can increase the frequency and duration of support SLBK

30. Provider Partnerships State, county and tribal systems model multi-disciplinary trust, promoting a climate conducive to positive collaborative relationships with families SLBK

31. Creating and Facilitating Collaborative Community and Provider Systems  Non-stigmatic delivery of services  Dynamics and integration of professional and community member volunteers  Identification and list of community specific resources … inclusive of providers, natural helpers and elders SLBK

32. Behavioral Health Service Components Family/Parenting Services Substance Abuse Prevention Family Support, Advocacy, and Care Coordination Mental Health Services Substance Abuse Treatment SESS

33. Considering Diversity Factors in Integrated Behavioral Health Service Delivery Norms for Maintaining Family, Friendship, and Professional Relationships Degree of Assimilation and Acculturation Child Nurturance and Discipline Approaches Diversity Factors to Consider When Implementing Integrated Behavioral Health Services Language and Dialect Differences and Similarities Neighborhood and Community Resources History of Societal Oppression, Resulting in Mistrust (including ethnic, gay, lesbian and bisexual oppression) Generational Differences Regarding Cultural Practices Economic Class Differences Social Mores and Religious Values and Beliefs SESS

34. Systems are most successful when: SLBK

35. 1) Providers are educated about child development; consequences of organic brain damage; components of behavioral health; parenting stressors and family life issues SLBK

36. 2) Families feel equal in service relationships. Delivery is not “done to” but “designed with” and participation in their lives is understood as a privilege by providers SLBK

37. 3) Case coordination reflects family focus and utilizes forms and delivery strategies that respect this focus and conform to laws of confidentiality SLBK

38. 4) Sustainable behavioral change is understood as the result of both skill acquisition and habituation over time SLBK

39. 5) Providers are knowledgeable about the special parenting challenges of parents who themselves have special needs SLBK

40. State, County & Tribal SystemsIntegrate Traditional Knowledgeand Clinical Best PracticeBuilding on Existing Structures: SLBK

41.  Health • Public Health • Tribal Health Services • Behavioral Health ◦ state, county and tribal SLBK

42.  Education • Early Intervention/I.F.S.P. Planning • Early Childhood Education/Headstart • Elementary Middle & Secondary School/I.E.P. Planning ◦ Tribal and public education Post Secondary College Support SLBK

43.  Justice • Assist arrested individuals in understanding court procedures • Assist courts and judges with appropriate sentencing guidelines SLBK

44.  Employment & Living • Vocational education • Career development • Housing SLBK

45. Potential Forms and Possible Templates for Task Force Team Members SLBK

46. To move forward in healing we must remember that as Native people we do not live in our communities but our communities live in us. Then and only then do we really realize what collects our choices and directs our decisions SLBK

47. A Rosy Picture of Hope VSBBK SLBK