Local children learn lessons in safety from law enforcement’s “crime dog.”
Tiwahe Wakan: Families Are Sacred
By Rebecca A. Clay
Angela A. Stokes, Ph.D., is a psychologist, but the children she works with have problems that go far beyond the realm of mental health. One recent patient, for example, was an infant suffering from possible malnourishment.
“I know people tend to think of SAMHSA’s Comprehensive Community Mental Health Services Program for Children and Their Families as a mental health program, but it’s really not,” said Dr. Stokes, Project Director of Tiwahe Wakan, a grantee working in South Dakota’s Yankton Sioux Reservation. “It’s a care coordination program.” (See Coordinating Care for Children with Serious Mental Health Challenges.)
Young people on the reservation face serious challenges, said Dr. Stokes. The reservation has extremely high rates of domestic violence, unemployment, and poverty, she noted. Families often have long histories of alcohol and drug abuse, and the community as a whole has experienced what Dr. Stokes calls “historical trauma.” As a result, many children experience anxiety, depression, or even post-traumatic stress disorder (PTSD).
But before Tiwahe Wakan received a 6-year SAMHSA grant in 2005, said Dr. Stokes, there were very few services for young people on the reservation. And the services that did exist didn’t always communicate with each other.
The Indian Health Service has a child therapist in the community, but that person focuses primarily on medication management. Therapists must come from Yankton or Sioux Falls, cities 1 and 2 hours away. “The kids would see the counselors, but those counselors would never talk to the Indian Health Service,” Dr. Stokes explained. “That was bad for kids.”
Now Tiwahe Wakan unites counselors, social workers, child welfare representatives, primary care physicians, court personnel, and anyone else charged with improving children’s lives.
Together, they come up with a plan to get families whatever they need to thrive, whether that’s food, stable housing, transportation to the clinic, or mental health and substance abuse services.
“We don’t just coordinate mental health. We coordinate all the services a family needs,” said Dr. Stokes. “We try to put services and supports in for the family, so that the family can be successful. That will ultimately lead to better quality of life for the young person.”
Families play a central role in the process, a commitment expressed in Tiwahe Wakan’s meaning of families as sacred. “Parents or caregivers drive the process,” explained Dr. Stokes, noting that families work with coordinators to involve community elders, spiritual leaders, extended family members, and anyone else the family believes will be helpful. The family also decides what services they want for their children.
That emphasis on family involvement works, said Dr. Stokes, pointing to “very positive results in terms of decreases in symptoms.” It also helps reduce the stigma of seeking mental health and substance abuse treatment, she added.
At the project’s beginning, Dr. Stokes explained, “a lot of families from the Native American communities were very suspicious and not trusting.” That’s changing now. “As families have seen other families be involved in this, we’re getting a lot more referrals from families calling or just walking in and saying, ‘Can you help us?’ ”
SAMHSA’s Web site offers more information on Systems of Care.