# Presentation: 896277

## Strategies That Peak How States Include Tribes in Planning

- Building FASD State Systems
- Colorado Springs, CO
- May 7, 2008

## 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*

## What is Indian Country?

-        Candace Shelton, M.S., LISAC
- 	 *Senior Native American Specialist*
*	** **SAMHSA FASD Center for Excellence*
- 	_[Candace.Shelton@ngc.com](mailto:Candace.Shelton@ngc.com)_
- 	 (520) 881-8182

## 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)

## 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)

## 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

**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)

## 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

## Diversity in Cultural Values

- 		_AI/AN_				_Western_
- 		Sharing				Saving
- 		Cooperation			Competition
- 		Being				Doing
- 		Group 				Individual
- 		Harmony with Nature		Mastery over Nature
- 		Present				Future
- 		Respect for Elders		Value Youth

## Community Challenges

- Domestic Violence
- Child Abuse and Neglect
- Substance Abuse
- Mental Disorders
- Violent Deaths (Unintentional)
- Suicide

## 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

## Internal Barriers   

-  Obstacles that deter tribal members from seeking assistance:
- Lack of consistency
- Lack of professionals with specialized training
- Territoriality
- Confidentiality
- Tribal/agency politics

## 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

## Primary Prevention

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

## 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

## Tertiary Prevention

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

## 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

## 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

## 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

## 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
**	****	****	**
**	**

## 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

## 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)

## 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

##  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)

## 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

## Suzie Kuerschner, MEdFASD ConsultantPortland, Oregon(503) 622-3973suziekuerschner@Gmail.comNPIHB(503) 228-4185

## Building Sustainable State Systems& Collaborative Circles of CareforTribal and StateF.A.S.D. Service Integration

- SLBK

## 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

## Provider Partnerships

- **	**State, county and 	tribal systems model 	multi-disciplinary trust, 	promoting a climate 	conducive to positive 	collaborative  	relationships with 	families

- SLBK

## 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

## Behavioral Health Service Components

- Family/Parenting
- Services

- Substance Abuse
- Prevention

- Mental Health
- Services

- Substance Abuse
- Treatment

- Family Support,
- Advocacy, and
- Care Coordination

- SESS

## Diversity Factors to Consider When Implementing Integrated Behavioral Health Services

- SESS

- Norms for Maintaining Family, Friendship, and Professional Relationships

- Degree of Assimilation and Acculturation

- Child Nurturance and Discipline Approaches

- Neighborhood and Community Resources

- Language and Dialect Differences and Similarities

- Social Mores and Religious Values and Beliefs

- History of Societal Oppression, Resulting in Mistrust (including ethnic, gay, lesbian and bisexual oppression)

- Economic Class Differences

- Generational Differences Regarding Cultural Practices

## Systems are most successful when:

- SLBK

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

- SLBK

## 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

## 3) Case coordination reflects family focus

- and utilizes forms and delivery strategies
- that respect this focus and conform to laws
- of confidentiality

- SLBK

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

- SLBK

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

- SLBK

## State, County & Tribal SystemsIntegrate Traditional Knowledgeand Clinical Best PracticeBuilding on Existing Structures:

- SLBK

##   Health

- Public Health
- Tribal Health Services
- Behavioral Health
- 	◦  state, county and tribal

- SLBK

##  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

##   Justice

- Assist arrested individuals in understanding court procedures
- Assist courts and judges with appropriate sentencing guidelines

- SLBK

##  Employment & Living

- Vocational education
- Career development
- Housing

- SLBK

## Potential Forms

**and**
**Possible Templates**
**for**
**Task Force Team Members**

- SLBK

## 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

## A Rosy Picture of Hope

**A Rosy Picture of Hope**

- VSBBK

- SLBK