sábado, 5 de abril de 2014

Circles of Care

SAMHSA's planning grants help American Indian/Alaska Native (AI/AN) communities develop comprehensive systems of care for youth and their families. The Culture Card helps providers understand and meet the needs of AI/AN people.

A GONA, or Gathering of Native Americans, is community-building process where participants engage in facilitated cultural activities and discussion.

Circles of Care Address Health Disparities in Native Communities

In the 16 years since SAMHSA launched the Circles of Care grant program, 38 communities have received funding to plan and create collaborations to reduce health disparities among American Indian/Alaska Native (AI/AN) children and their families.

The purpose of this program is to provide tribal and urban Indian communities with tools and resources to plan and design a holistic, community-based, coordinated system of care to support mental health and wellness for children, youth and families. These grants will increase the capacity and effectiveness of mental health systems serving AI/AN communities.

The Circles of Care grant program draws on the system of care philosophy and principles. A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with mental health needs and their families. In a system of care model, families and youth work in partnership with public and private organizations to design mental health services and supports that are effective, that build on the strengths of individuals and that address each person's cultural and linguistic needs.

"The Circle has healing power. In the Circle, we are all equal. When in the Circle, no one is in front of you. No one is behind you. No one is above you. No one is below you. The Sacred Circle is designed to create unity."
- Dave Chief, Oglala Lakota

The planning grants provide AI/AN communities resources to reach out to public and private organizations in mental health, substance use, or both.

AI/AN communities have a significantly higher prevalence than the general population of health and behavioral health issues. Suicide is the second leading cause of death with AI/AN people between the ages of 15 and 34 and substance abuse is a major concern as well.

Because Native communities may not have adequate prevention and treatment supports on reservation, outside community understanding and collaboration is especially important. Service providers need to understand the unique cultural and gender factors that may influence attitudes and behavior. For example, eye contact, style of dress, physical touch, personal space, decision making, and humor may influence an AI/AN’s openness to working with a provider or organization.

For example, an American Indian may be raised in a culture where speaking quietly, thinking before speaking, and waiting for a silent pause, or invitation to speak, is how to communicate GONA was originally created by AI/AN leaders through the Center for Substance Abuse Prevention in the early 1990s “All communities are different - history, beliefs, practices, communication, and the language used to talk about mental health issues,” said Captain Hunt.

Many of the grantees use Gatherings of Native Americans (GONAs) as a way to orient the broader community on the cultural, spiritual, and historical practices of that AI/AN community. GONA was originally created by AI/AN leaders through the Center for Substance Abuse Prevention in the early 1990’s and is a community-building process where participants engage in facilitated cultural activities and discussion. The organizing themes of belonging, mastery, interdependence, and generosity are the foundation of the process.

Culture Card

The SAMHSA-produced pocket guide called the American Indian and Alaska Native Culture Card describes Native cultural differences, customs, and identity; spirituality; communication styles and etiquette; the role of veterans and elders; and health and wellness challenges.

It was originally designed for the U.S. Public Health Service Commission Corps who were deployed in response to suicide clusters or other traumatic events throughout Indian country. This publication has become one of the most requested SAMHSA resources.

Many grantees share the Culture Card at GONAs as a way to connect with outside community members on a deeper level and start the dialog that eventually leads to collaborations for the system of care planned under the Circles of Care grant.

The Department of Veterans Affairs (VA) is also using the Culture Card. It currently has plans to disseminate it nationally. The VA is also encouraging VA staff to participate in a related webinar with Captain R. Andrew Hunt, Public Health Advisor in SAMHSA’s Center for Mental Health Services. Captain Hunt co-authored the Culture Card and is an enrolled member of the Lumbee Tribe of North Carolina.

“All communities are different - history, beliefs, practices, communication, and the language used to talk about mental health issues” said Captain Hunt. “The Culture Card provides basic information so others can adjust and adapt their approach to meet that community and their cultural context.”

Social Media

Social media has become a very practical outreach tool for the Circles of Care grantees to connect with people in their AI/AN community and to engage essential partners.

The Fresno American Indian Health Project (FAIHP) has been using Facebook since 2012. Project participants have noticed that postings would get an immediate response from community members. They use social media to promote events and community activities and, as a result, have seen an increase in community interest and engagement.

This community also uses social media to fulfill data collection, which is important to the goals of their Circles of Care grant. They promote focus group opportunities, conduct elder interviews, and collect data through youth and adult surveys to inform their Community Needs Service System Assessment Report.

FAIHP is now carrying out the plan for the system of care model developed through Circles of Care. Soon they will begin providing and coordinating direct services to clients based on the input and feedback they received from youth, families, and community members.

FAIHP is not the only grantee using Circles of Care to engage in this important work. Grantees share with other communities and professionals through presentations at various professional meetings and conferences and there is increasing recognition that Circles of Care is making a difference in the lives of real people.