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					   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


(520) 881-8182
Legally Defined as:
  (a) All land within the limits of any Indian
      reservation under the jurisdiction of the
      U.S. Government.
  (b) All dependent Indian communities within
      the borders of the United States.
  (c) All Indian allotments, the Indian titles to
      which have not been extinguished.
                       (Title 18, U.S. Code, section 1151)
American Indian/Alaskan Native
 • 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
                            (500Nations, 2008)
  American Indian/Alaskan Native
• 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
• 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
• 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
  •   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
 – Territoriality
 – Confidentiality
 – Tribal/agency politics
Additional Barriers in Indian Country
   • Living in isolated areas
   • Limited services available
   • Excessive paperwork to receive
   • 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
 - Safe Start Programs

 - Boys and Girls Clubs in Indian Country
      Secondary Prevention
• Activities directed toward high risk
• Take Action to prevent or minimize
    - Early Head Start/Head Start
    - Home Visitation Programs
       –Healthy Families America
       Tertiary Prevention

• Focuses on reducing problematic
• Involves treating the problem to lessen
  its effects
    - Wellbriety/WhiteBison
    - Circles of Care - SAMHSA
 Strategies for Connecting with
• 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
           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
       (503) 228-4185
Building Sustainable State Systems
  & Collaborative Circles of Care
          Tribal and State
    F.A.S.D. Service Integration

                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

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

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

Behavioral Health Service Components

      Family/Parenting                    Substance Abuse
         Services                           Prevention

                       Family Support,
                        Advocacy, and
                      Care Coordination

      Mental Health                   Substance Abuse
        Services                         Treatment

Considering Diversity Factors in Integrated Behavioral Health Service Delivery

     Norms for
                                         Degree of               Child Nurturance
                                      Assimilation and            and Discipline
  Friendship, and
                                       Acculturation               Approaches

   Language and              Diversity Factors to
                                                                  Neighborhood and
       Dialect                 Consider When                         Community
   Differences and
                           Implementing Integrated                   Resources
                          Behavioral Health Services

                       History of Societal                             Generational
                     Oppression, Resulting         Economic
  Social Mores and                                    Class            Differences
  Religious Values   in Mistrust (including                             Regarding
                       ethnic, gay, lesbian        Differences
    and Beliefs                                                          Cultural
                          and bisexual                                  Practices

Systems are most successful when:

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

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

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

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

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

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

 Health

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

 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

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

 Employment & Living

  • Vocational education
  • Career development
  • Housing

     Potential Forms
   Possible Templates
Task Force Team Members

    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

A Rosy Picture of Hope

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