Evolution & Future Trajectory of Integrated Systems of Care Implications for communities of color & culture Holly Echo-Hawk, MSc Organizational Behavior Breaking Chains– St. Paul, Minnesota April 26, 2019

Learning Objectives Understand the successes and challenges of System of Care evolution Identify continuing shortfalls in future behavioral health direction Recognize ways to heighten culture and resilience in service Gain new ideas of how to engage youth

System of Care values & principles Core Values Family driven & youth guided Strength-based Culturally and linguistically competent Guiding Principles (5 of 12) Available holistic services - traditional and nontraditional services, including informal and natural supports Individualized care Least restrictive, most normative environment Cross system collaboration

Why Systems of care? Conventional approaches to BH not working Silo services Other key supports left out Workforce challenges No youth or family voice No changes in disproportionality statistics Human and financial costs too high Minority becoming majority New ways have to be explored

Natural Systems of Care Caring systems Intact families Everyone had job that supported the community Positive traditions were reinforced Leadership was respected Housing was available Food was shared Joy in dance and song

Federally Funded Systems of Care Validated family voice Built on lived-experience Institutionalized cultural competence Introduced formal evaluation for many communities Introduced social marketing for many Later validated youth voice Principle driven: strength-based, family driven, individualized care, wraparound Philosophy and framework Each community re-built or constructed new SOCs

System of Care leveled the playing field on who is the “Expert”

Challenges to the New view of Expert Families didn’t trust – some parents angry Young people confused – now what? Philosophy changed, but key aspects of system change did not Some SOC approaches were cultural misfit Youth as leaders in tribal communities slower to take off

Soc supported integrated care Integrated care: mental health, substance use, medical health, and recovery providers work together with the same client Patient centered care reinforces that the patient is the key stakeholder Systematic integrated care: integrated care should part of routine care & work flow Integrated care does not mean all providers have to be in the same location Integrated care makes sense, but lots of challenges with implementation Different systems have different training, credentialing, languages, and approaches

SOC Challenges Parents were angry Parent “organizations” were cultural misfit Complex change was hard (change the world in 4-6 years) Lots of grant money in community caused friction Travel and training opportunities caused friction Leadership and community understanding that SOC was not a “program” Meeting evaluation requirements Complex grant management was hard

System of care helped many Over 25 years, billions of dollars went to communities in need (states/territories/tribes) to rebuild or create new systems of care Tribal communities receive a significant portion, why? Tribal communities led the way in addressing culture as core of services

Future Direction

N’we Jinan (na-wee-ja-nan) Founded 2014 working to inspire and uplift communities through musical opportunities for over 600 Indigenous youth Power of storytelling through music and art David Hodges – hip hop producer and youth worker from Montreal, Quebec Joshua Iserhoff – Youth Grand Chief of Cree Nation Youth Council in Quebec N’we Jinan Foundation info@nwejinan.com 541-668-9159

Music is a universal language, it creates a safe space for young people. David Hodges, co-founder of the N’we Jinan music initiative

Home To Me Written and produced by Grassy Narrows (Ontario) First Nations youth 2014 N’we Jinan Artists

Future Direction

Future trajectory of integrated system of care? Complex public heath challenges Complex change management

Future trajectory of integrated system of care Resilience Trauma Cultural connectedness Workforce development Recovery resources Culture & EBPs Mobilizing youth

Resilience Strength in culture and traditions Culture as healing Culture is sense of belonging to something larger than yourself Resilience Questionnaire (http://www.stlrhc.org/wp- content/uploads/2014/08/Resiliency-Questionnaire-2014.pdf) Scoring system modeled after the ACE Study questions

Trauma Historical: deeply ingrained in some communities Personal: traumatic episodes or witness to trauma Institutional: deeply entrenched practices can re-traumatize Secondary trauma Vicarious trauma and lateral violence On going challenges: Family separation Incarceration separation

Trauma informed resource Trauma Informed Care in Behavioral Health – TIP 57 (https://www.integration.samhsa.gov/clinical- practice/SAMSA_TIP_Trauma.pdf ) Secondary Traumatic Stress Informed Organization Assessment tool (http://www.uky.edu/CTAC/STSI-OA)

Social Connectedness Social Connectedness Scale – relationships and sense of belonging (http://youthrex.com/wp-content/uploads/2016/07/The-Social- Connectedness-Scale-Revised.pdf) New studies on impact of electronic communication and social media 75 percent of all American teenagers have actively participated on a social media site and 80 percent own a smartphone Is digital communication good or bad? Can increase connectedness and decrease social isolation; screen time and bullying can have opposite effects

Cultural Connectedness First Nations Cultural Connectedness Scale, A. Snowshoe (https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=4670&context=etd) U.S. urban Indian youth adaptation of cultural connectedness scale (https://natap.prev.org/assets/docs/Evaluation%20in%20Indian%20Count ry%20Part%201%20FINAL%20032917.pdf) Includes items like: When I am overwhelmed with my emotions, I look to my Native American/Indigenous culture or community for help.

Workforce Development Education & credentialing critical (Dennis Mohatt video) Higher education access challenge Annapolis Coalition focuses on behavioral health workforce development Tribal SOC example of workforce development: Passamaquoddy Nebraska tribes and Summer Youth conversion to BH career theme

Expansion of recovery resources Recovery resources critical to lasting wellness Transitioned to trauma informed Sober Housing – critical support yet often lacking and frequently location-challenged New challenge of abstinence based & Medication Assisted Treatment (MAT)

Culture & evidence-based practices New approaches to integrate – cultural adaptation of CBT EBP & Practice-Based Evidence (PBE) NREPP and support for Emerging Evidence in communities of color Internal and External Validity (Dr. Joseph P. Gone) Funding traditional practices (Dr. Spero Manson)

Mobilizing Youth We Matter movement (Kelvin Redvers)

All Native Children are Brilliant

Resource information Great Lakes Addiction Technology Transfer Center (ATTC) University of Wisconsin Madison, WA https://attcnetwork.org/ Holly Echo-Hawk echohawk@pacifier.com Voice: 360.737.4747

Supaman: Why Christian Parrish Takes the Gun, known professionally as Supaman Supaman and Acosia Red Elk