Circles of Care: Creating Models of Care for American Indian and Alaska Native Youth
By Rebecca A. Clay
Building resilience and reducing the impact of substance abuse and mental illness on young people in American Indian and Alaska Native tribal communities is a challenge.
Whether these young people live in urban areas or remote reservations, “Indian kids have higher rates of just about everything,” said Captain R. Andrew Hunt, M.S.W., L.I.C.S.W., a public health advisor in SAMHSA’s Center for Mental Health Services (CMHS) and an enrolled member of the Lumbee Tribe of North Carolina. “There are very few services available, particularly those that are culturally and linguistically competent.”
To help, Circles of Care, a SAMHSA program, is committed to change these existing conditions. Launched in 1998, the program gives tribes and urban Indian organizations 3-year grants to identify and analyze community needs systematically. The grants provide funding to develop culturally appropriate strategies that can be put into action effectively to serve young people with serious behavioral health challenges. Families of these youth also participate.
With the help of the entire community, grantees develop models of care, create new partnerships, and position themselves to obtain additional resources to help them realize plans for comprehensive and culturally appropriate behavioral health services for children, youth, and families.
Now on its fourth round of grantees, SAMHSA’s Circles of Care program currently supports eight tribes and urban Indian organizations across the country. They include the Crow Creek Sioux tribe of South Dakota, the Karuk tribe of California, the Pueblo of San Felipe in New Mexico, the Standing Rock Sioux Tribe of North Dakota, the Mashantucket Pequot Tribal Nation, the American Indian Center of Chicago, and the Indian Center in Lincoln, NE.
See a complete list of all Circles of Care grantees, past and present.
“These grants increase the capacity and effectiveness of behavioral health systems serving American Indian and Alaska Native communities,” said SAMHSA Administrator Pamela S. Hyde, J.D. “As a result, Circles of Care grantees become equipped to reduce the gap between the need for behavioral health services and the availability of services for children, youth, and families.”
San Felipe Pueblo Circles of Care: (left to right) Front row—Christian Gering, Joseph Ansera III, D’Alan Sandoval; 2nd row—Paulina Sanchez, Lindsey Sanchez, Alicia Sandoval, Jimel Sandoval, Reshawna Sandoval, Esther Tenorio; 3rd row—Verna Valencia (orange shirt), Trivia Sanchez, Serrena Sandoval, Bernice Chavez (purple shirt), Samantha Pasena, Tia Sanchez, Gail Aguilar; 4th row—Edward Valencia (navy shirt), Darian Townsend, Bethany Garcia, Julian Valencia (cap), and Paul Valencia (at tree).
At the foundation of the Circles of Care program is the idea of creating a system of care—a coordinated network of holistic, community-based services and supports to help meet the needs of children and youth with serious mental health challenges.
To create a model system of care, Circles of Care grantees bring together the entire community—including representatives from agencies serving children and youth, tribal leaders, spiritual advisers, family members, and young people themselves. Together, they assess gaps in services and develop a plan for filling those “holes.” The goal is to create a coordinated system that is community-based, family-driven, and youth-guided.
“What they end up with is a blueprint,” said Captain Hunt, who serves as SAMHSA’s Project Officer for the Circles of Care program. “In the process, grantees build community coalitions, strengthen partnerships among child-serving agencies, and blend western and traditional approaches to care.”
The blueprint might address workforce development, for example. “It’s hard to find professionals willing to go out to remote reservation communities,” said
Captain Hunt. “The number of Indian mental health professionals is very small.” The blueprint might also address the lack of coordination among mental health, child welfare, juvenile justice, and other systems. Or the blueprint might identify ways to incorporate traditional healers or ceremonies into a youth’s care.
As a way of increasing their community’s sense of relatedness to the process, grantees may develop their own definitions of “serious emotional disturbance.” Doing so helps communities reduce the stigma of behavioral health services and incorporate indigenous beliefs about illness and wellness, explained Candace Fleming, Ph.D., Associate Director of the Circles of Care Evaluation Technical Assistance Center at the University of Colorado Denver.
“There’s one grantee that uses a phrase meaning ‘a strong suffering of the mind and heart,’ ” she said. “You can see there’s a different emphasis here compared to the English phrase ‘serious emotional disturbance.’ ”
The Circles of Care approach is working well, added Dr. Fleming.
Of the 23 grantees that “graduated” from Circles of Care since the program’s inception, 9 have obtained direct funding from SAMHSA’s Comprehensive Community Mental Health Services for Children and Their Families Program—also known as the Child Mental Health Initiative (CMHI). This funding helped put their plans, developed during their Circles of Care grant, into practice. Four others obtained additional funding by partnering with other CMHI grantees. Others used alternative strategies to activate their models developed through Circles of Care.
What’s more, said Dr. Fleming, the Circles of Care approach appears to be spreading throughout Indian Country. “With each cohort applying to Circles of Care, there are greater levels of community engagement,” she said. “Indian communities are embracing this concept.”
For more information about the Circles of Care grantee program, please contact Captain Andrew Hunt at SAMHSA at Andrew.Hunt@samhsa.hhs.gov.
Circles of Care I
1998 to 2001
|Inter-Tribal Council of Michigan
|Fairbanks Native Association, AK
||Circle of Children
|Choctaw Nation of Oklahoma
||Chi Hullo Li, C.A.R.E.S. Project
|† Native American Health Center, Oakland, CA
||Circle of Care
|Cheyenne River Sioux Tribe, SD
||Restoring the Balance Project
|In Care Network, MT
||Shared Vision Project
|Feather River Tribal Health, CA
||Circles of Care
|Oglala Sioux Tribe, SD
||Wkanyeja Wape Tokeca (Children of a Different Way)
|† First Nations Community HealthSource, NM
||Circles of Care
Circles of Care II
2001 to 2004
|Blackfeet Nation, MT
||Blackfeet Family Circles of Care
|Central Council Tlingit and Haida Indian Tribes of Alaska
||Southeast Alaska Native Youth Mental Health Services
|Pascua Yaqui Tribe, AZ
||Sewa Uusim (flower
children, our hope, our light, our future)
|Puyallup Tribal Health Authority, WA
||Helping Hand Project
|Salt River Pima Maricopa Indian Community, AZ
||Toward a Healthy Himdack/Huudoishizish
|† United American Indian Involvement, CA
||UAII Circles of Care
|Ute Indian Tribe, UT
||Peemchuenum (love, value and cherish)
Circles of Care III
2005 to 2008
|† Denver Indian Family Resource Center, CO
||Keeping the Circle Whole
|† Native American Rehabilitation Association, OR
||Strengthening Our Families
|Muscogee (Creek) Nation, OK
||Momen Ayeckvtes (To Carry On)
|* Rosebud Sioux Tribe, SD
||Sinte Gleska University Circle of Care
|Quileute Nation, WA
||Quileute Circles of Care
|Cook Inlet Tribal Council, AK
||Cherish the Children
|† Indian Health Care Resource Center of Tulsa, OK
||Strengthening Our Children
Circles of Care IV
2008 to 2011
|† American Indian Center of Chicago, IL
||Leading, Engaging, Empowering and Providing for Youth and
|† American Indian Health and Family Services of Southeast Michigan – Detroit, MI
||Gda’shkitoomi (We are Able!)
|Crow Creek Sioux Tribe, SD
||Circles of Care Project
|Karuk Tribe of California, CA
||Hav pa anav (The medicine is good)
|Pueblo of San Felipe, NM
||Children’s Mental Health Systems Development Project
|Standing Rock Sioux Tribe, ND
||Circles of Care Project
|† Indian Center, Inc., Lincoln, NE
Urban Indian Centers System of Care Program
|Mashantucket Pequot Tribal Nation
||Mashantucket Pequot Tribal Nation
† Urban Indian organization
* Tribal College