EXPERIENCES IN DEVELOPING A CIRCLE OF CARE FOR CHILDREN WHO HAVE TAWACIN SAGYA WOKAKIJE Serious Emot

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EXPERIENCES IN DEVELOPING A CIRCLE OF CARE FOR
CHILDREN WHO HAVE TAWACIN SAGYA WOKAKIJE(Serious
Emotional Needs)on the Pine Ridge Indian
ReservationIsnala Waste Win Monique Giago,
MSW Executive DirectorWakanyeja Pawicayapi,
Inc.P.O. Box 100, Porcupine, SD
57772605.455.1226, Fax [phone]
mgiago_at_wakanyeja.org

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Introduction

• Purpose of this presentation is to present some
  of the experiences of one grantee community in
  the Circles of Care and System of Care for
  Children with serious emotional disturbances and
  their families.

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WAKANYEJA WAPE TOKECA, Children of a Different
Way Planning Project 1998

• 3 YEAR PLANNING GRANT initially under
  administration of Oglala Sioux Tribe
• Wakanyeja as a sacred being Wape a way of
  being Tokeca different
• Foundation was/is Lakota traditional teachings
  and culture

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Beginning the Process

• Creating a circle where each role is important
  and valuable to the process of planning (e.g.
  administrators, evaluators, service providers,
  community, parents, youth, spiritual elders)
• Using an interpreter model where each role is
  an interpreter for a specific function (e.g.
  evaluators interpret data to use for planning
  parents/youth/family members interpret needs of
  youth with serious emotional disturbances and
  translate for use in plan Traditional Healers
  interpret to/from the spiritual world

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PLANNING, DESIGNING, ASSESSING A SYSTEM OF CARE
FOR CHILDREN WITH SERIOUS EMOTIONAL DISTURBANCES

• Defining Serious Emotional Disturbance for
  Lakota Cultural Appropriateness (Tawacin Sagya
  Wokakije strong suffering of the mind and
  heart)
• Focus Groups, Surveys, training
• Description of Services
• Feasibility Assessment
• Resource Manual for Children and Families on the
  Pine Ridge Indian Reservation
• Implementation of Services Model Development

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CHALLENGES

• Underfunded and overwhelmed service programs and
  agencies not responsive to information requests
• Raising Expectations of Youth, Parents/Family and
  Community that change will happen immediately
  when the focus was on planning for the future.
• Long standing hostile relationship between tribal
  government and state government.
• Colonization of Lakota people created
  disconnect from practicing Lakota traditional
  teachings and perpetuated shame of cultural and
  racial identity.
• Community planning group and staff not accustomed
  to planning, accustomed to operating in
  crisis mode.

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Meeting Challenges

• Invited service providers to community training
  and meetings and acknowledged their important
  work included door prizes, entertainment
• Applied for/received services grant (Nagi Kicopi-
  Calling the Spirit Back) in 1999
• Enlisted support of Tribal President to assist
  with state-tribal initiatives new Governor in
  2004
• Held training on Decolonization partnered with
  Oglala Lakota College on creating Lakota Mental
  Health Care Coordinator certification program
  training in Lakota language. Developed Lakota
  Mental Health Assessment Manual.
• Consulted with Asa Begaye who gave training on
  Participatory Strategic Planning

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PAST ANDCURRENT INITIATIVES

• Nagi Kicopi (Calling the Spirit Back), System of
  Care Grantee (1999-Present)
• Established 501c3 Non-profit Wakanyeja
  Pawicayapi, Inc. (The Children First) and
  chartered by the Oglala Sioux Tribe-Year 2000
• 1.8 million Construction Project Childrens
  Mental Health Center to be completed in Spring
  2005
• Contract with South Dakota Department of
  Corrections to provide services to Native Youth
  in correctional system-2004
• Maza Tiopa (Iron Door)Program funded by
  Administration for Children and Families (ACF),
  Mentoring Children who have a Parent in Prison
  2004
• Historical Trauma training held entirely in
  Lakota language-2004

The Children First
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Wakanyeja Pawicayapi, Inc.

• Oyate Ta Woakipa Etan Woasniye
• (Healing from the Peoples Trauma Program)
• Our Program is Federally Funded for 4 years
  through the Substance Abuse Mental Health Service
  Administration (SAMHSA) under the National Child
  Traumatic Stress Network (NCTSN)
• Services provided
• -Project Venture-cultural, spiritual youth camps
• -Outpatient Individual Therapy for children who
  have experienced trauma
• -Cultural interventions

STAFF MEMBERS Eileen Iron Cloud Program
Director Vacant -Researcher/Clinician Ramona
White Plume- Community Facilitator Reuben
Weston- Administrative Assistant
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Wakanyeja Pawicayapi, Inc.

• Traditional Healing Research Grant
• Subcontract under the Black Hills American Indian
  Health Center (BHAIHC), Rapid City, SD.
• Description of services
• Research of Contextual issues in Traditional
  Lakota Healing
• Staff members
• Ethleen Iron Cloud-Two Dogs, Principal
  Investigator
• Monique Giago, Project Coordinator
• Rick Two Dogs, Supervisor
• Joe Giago, Research Assistant
• Laretha Brown Bull, Research Assistant

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Wakanyeja Pawicaypi, Inc.

• MAZA TIOPA
• (Behind the Iron Door Mentoring Program)
• Services Provided
• Mentoring children of parents who are
  incarcerated
• Cultural interventions activities

STAFF MEMBERS Mary Jane Iron Crow Acting
Director Marty Two Bulls Media Coordinator
Colleen Little Moon Acting Administrative
Assistant Virgil Bush Sustainability Coordinator
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TIWAHE WICOZANI PI KTETOWARD HEALTHY FAMILIES

• SERVICES PROVIDED
• MENTORING
• EQUINE THERAPY
• PARTNERING WITH SCHOOLS
• AFTER SCHOOL ACTIVITIES

• STAFF MEMBERS
• LEONARD LONE HILL, DIRECTOR
• LINDA WHITE FACE, MENTOR
• JASON BUSH, MENTOR

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Wakanyeja Pawicayapi, Inc.

• Traditional Lakota Healing
• Services provided
• Inipi
• Wopasi Imahetuyahci (Spiritual Assessments)
• Woapiye (Healing)
• Nagi Kicopi (Calling the Spirit Back Ceremony)
• Service Provider
• Rick Two Dogs, Wakan Iyeska (Interpreter of the
  Sacred/Spirits)

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Strengths of Our Lakota Nation

• Wakanyeja (Sacred Beings/Children)
• Traditionally historically our children were
  thought of and treated as sacred.
• Elders
• Wisdom keepers, teachers, and advisors
• Tiospaye System
• Collaboration, everyone helped each other.
• Kinship roles responsibilities intact
• Spiritual Connection
• 7 Sacred Rites Inipi, Wiwayang Wacipi,
  Hanbleciya, Hunka, Isnati Awica Lowanpi, Nagi
  gluha pi, Tapa Wankayeya pi
• Cannupa

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How Did We Get Here?

• Historically, European culture treated children
  as property sold into slavery, child brides,
  sexual objects philosophy still deeply ingrained
  today, e.g. 40 million children in poverty
• Historically, Lakota children seen as sacred, we
  have become disconnected from that value as
  evident by the high rates of child abuse
• Grief, Loss and Trauma

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WOUNDED KNEE MASSACRE 1890 Impact

• Extreme Shock and Trauma to the individual,
  family and Nation
• Shockwaves still felt today, e.g. post-traumatic
  stress syndrome
• Entire generation of knowledge and teachings not
  passed on
• Disconnection of Spirit
• (from individual, family, Nation)

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Disconnection of Spirit and Co-Occurring Disorders

• A person can become traumatized by
  physical,sexual, emotional abuse or by having
  witnessed a traumatic event. Can result in loss
  of spirit. Many of us experienced trauma in the
  boarding schools.
• Symptoms include life pattern of wandering,
  searching, inability to sustain relationships
  alcoholism, nightmares, chronic depression,
  wanting/waiting to die, hopelessness.

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• Lakota belief that mental, emotional, physical
  and spiritual aspects of a person are integrated
• What affects one aspect of person affects all
  other aspects of that person
• E.G. Historical Grief Impact of 1890 Wounded
  Knee Massacre

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REINTEGRATION OF MIND, SPIRIT, BODY, EMOTIONS

• Spirit must be reintegrated with mind, body and
  emotions in order for healing to begin
• Specific ceremonies and cultural interventions
  among Indigenous peoples to begin the
  reintegration process and healing process

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Assumptions about children/youth with
co-occurring disorders that need to change

• Medication is the answer - Research shows
  medication is most effective when combined with
  counseling and behavioral and family intervention
  
• People dont know what they need e.g. talking
  only to the adults and not getting the
  child/youths input
• Pathology as the foundation for care planning
  strength based vs deficit based model
• Diagnosing Native youth according to
  western-based models

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Lakota Stages of Life
  NAGI YATA (spirit world)
Pre-Birth
Return to Spirit World
Interruptions to Natural Life Cycle
(e.g. abandonment, trauma at age 3)

Age 12
Age 50
Positive/Enhancement to natural development of
life cycle, e.g. quitting drinking/drugs at age 30
Age 21
E. Iron Cloud-Two Dogs, 2004
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Oglala Diagnostic Model
Wopasi (Assessment) GAF score
Description 1 to 7 Woksape Cognitive Tacan Ph
ysical Tawacin Emotional Nagi Spiritual

• Okapha
• (Transgenerational nature)
• Presence
• Description

Level severity 1.Ikame/stressed 2.Ikakije/suffer
3.Iyanuge/ Twisted in the personality
Hutkan Root of the problem Described using
Spiritual Assessment
Care planning recommendations Woksape Tacan Tawac
in Nagi
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Examples of Lakota Cultural Diagnoses

• Sica Teya e.g., a baby/child smells everything,
  refuses to eat, becomes depressed, failure to
  thrive. Cause overpowering influence of female
  on her monthly purification time sitting on or
  stepping over the baby/childs belongings.
• Sil Okihanpi extreme violation of spirit of
  person resulting from sexual abuse and/or
  physical abuse.

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Recommendations for Working with Native Youth
with Co-Occurring Disorders

• Develop, implement and evaluate culturally-based
  diagnostic and care models particularly for
  reintegration of spirit with mind and body.
• Preparing system for readiness to change
• Leadership key to change
• Collaboration
• Using the strengths of the culture and natural
  supports, e.g. the extended family,
  culturally-based diagnostic systems and
  interventions
• Partnering with Families of Youth

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FACTORS IN JOINING/PARTNERING WITH FAMILIES

• Definition of family nuclear vs. extended
  family system (includes elders, aunts, uncles)
• Research shows that partnering with families
  reduces the length of stay in foster care,
  residential treatment and psychiatric hospitals
  (Benedict White, 1991 Davis et al, 1996) and
  improves child well-being (Davis et al, 1996
  Cantos et al, 1997)

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How does Partnering/Joining with Families affect
Service delivery?

• Some studies show that families who participated
  in the planning of their care were offered more
  relevant services by their caseworkers
  (Rzepnicki, 1987)
• Staff attitudes toward parents changed as the
  family involvement increased (Carlo, 1988 1993a
  and Williams, 1998)
• Increased family involvement resulted in more
  collaboration among service providers and systems
  (Koren, et. al, 1997)

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Barriers to Family Partnerships

• Not including them in planning from the very
  beginning
• Negative Staff attitudes e.g. looking down on
  families, labeling them as dysfunctional
  blaming parents for mental health of child
• Policies and rules that restrict parent
  participation and contact
• Acting as if the childs problem/need exists in
  isolation.
• Resistance to sharing power with parents/families
  in the therapeutic relationship
• Logistics availability of transportation
  geographic distances
• Work schedules of staff (children and families
  need help in the evenings, weekends and holidays
  not just Monday through Friday, 830 to 500 p.m.
• Work schedules of parents/caregivers
• School/activity schedules of children

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Increasing Success of Partnerships with Families

• Building on the strengths of the child and family
  instead of focusing on the deficits (NO LABELS)
• Including parents/caregivers in training sessions
  and program meetings
• Including parents/family members in the decision
  making
• Offering childcare, transportation, gas money and
  reimbursement for expenses and time taken off
  from work
• Training staff to be respectful of
  parents/caregivers and children e.g. welcoming
  them, talking with them instead of at them
  and to them.
• Lakota example treating children,
  parents/family members as relatives rather than
  as clients, cases

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Continued

• Parent/family member involvement in evaluation
  developing the questions assessing the
  tools/instruments that will be used
  interpretation of results.
• Using measures in evaluation that are meaningful
  to families e.g. how many times did the school
  call on the childs behavior how many meals did
  the family have together does the child feel
  better is the childs school experience better
  than before?
• Strong leadership needed to initiate, develop and
  maintain strong family partnership focus.

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Substance Abuse
Child Welfare
Education/Special Education
Tiwahe
Juvenile Court and JDC
Law Enforcement
Wakanyeja
Parent Advocacy Group
Employment/Job and Skills Development
Health and Emergency Services
Housing
Emergency Youth Shelter
WOKIGLEGA THE GOAL Okiciyapi Helping Each
Other COMMUNITY TEAM
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Collaboration is Key We cannot do it alone

• So I know it is a good thing I am
• going to do and because no good
• thing can be done by any man
• alone, I will first make an offering
• and send a voice to the Spirit of the
• World, that it will help me to be
• true.
• Black Elk,1930

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OUR HOPE FOR THE FUTURE