SD Discretionary Funding Fiscal Year 2020

The Pine Ridge Reservation, governed by the Oglala Sioux Tribe (OST), is located in southwestern South Dakota in Oglala Lakota and Bennett counties, and portions of Jackson and Sheridan counties. It is more that 2,469 square miles (larger than Delaware and Rhode Island combined) and is home for more than 32,152 American Indians (American Indian and Population and Labor Force Report, 2013). The Oglala Sioux Tribe Ambulance Service covers the entire Pine Ridge Reservation, so resources are already stretched thin across this area. The OST Ambulance Service has struggled to recruit and train EMT's to join their team and is currently understaffed and underfunded. The program is supposed to include 45 EMTs and paramedics, but the current staff is 28 employees, 24 of whom live off the reservation in Rapid City, South Dakota. The purpose of this project is to recruit and train local people to join the OST Ambulance Service and increase the representation of American Indian EMT's on the Service. Recruiting local people will help make the Ambulance Service shifts more sustainable by shortening them and provide the dual benefit of increasing the cultural and linguistic diversity of the staff. Training 20 new EMTs will allow the Ambulance Service to increase staffing to their full capacity and dramatically increase the success rate of previous training sessions. The training will occur in two courses that happen simultaneously on the East and West side of the Pine Ridge Reservation. Current staff will be supported to maintain their certifications to ensure the continued efficacy of the OST Ambulance Service. In addition to recruiting and training new staff, this project will also increase the capacity of the OST Ambulance Service to offer training through the SAMHSA TTC by purchasing computers. The OST Ambulance Service currently has one computer that is nearly 10 years old and defunct, so they are not able to do online training for their staff. This capability will greatly expand the service's ability to offer professional development to staff and will serve as an enduring investment in the technological capacity of the program. In short, this project will bring critical resources to a department that is stretched thin, especially following COVID-19 and will improve rural emergency services in the poorest county in the United States.

South Dakota (SD) Disaster Response: 605 STRONG will mobilize trained crisis counselors to conduct community outreach to a projected 2,500 individuals impacted by 2019-weather related disasters, which caused significant damage to public and private infrastructure and continues to impact the farm/rural economy due to lingering financial impacts from those events. Through screening and referral processes, we anticipate providing behavioral health treatment assistance and recovery support services to 1,500 adults and 950 school-aged youth in the 20-county catchment area. Skill development in post-disaster evidence-based practices (EBPs) is central to the state's approach. Clinicians serving adults and families will have access to training in selected EBPs. Recovery support services will also be issued to clients based on need. Specific to the K-12 population, comprehensive school safety planning will be facilitated, in partnership with experienced trainers in the PREPaRE model and in-state subject matter experts at the University of South Dakota, impacting at least 20 school districts and an estimated 300 school-based professionals in the catchment area. Following additional training in mental health crisis interventions post-disaster events, an estimated 40 school-based and partnering community-based mental health professionals will be better equipped to recognize risk factors that predict psychological trauma and provide mental health crisis interventions in school settings to impacted youth. A cohort of up to 20 of these trained professionals will be recruited to become in-state trainers in the model, building a sustainable platform to expand the model statewide. School-based mental health professionals will be supported by a new Behavioral Health Support in Schools program hosted by the University of South Dakota's ECHO Hub. Schools will also have access to mini-grants to support installation of telehealth equipment, which can be leveraged to provide in-school mental health supports via virtual networks. Lastly, the state will develop regionalized plans that pair community-based resources with available state-level services to support rapid mobilization of behavioral health response in disaster situations.

South Dakota's Emergency COVID-19 response funding will support crisis intervention services, mental health and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic. As the Single State Authority and State Mental Health Authority, the South Dakota Department of Social Services, Division of Behavioral Health, will lead the project in collaboration with community behavioral health providers to identify and address the needs of individuals with serious mental illness (SMI) or serious emotional disturbance (SED), individuals with substance use disorders (SUD), and individuals with mental disorders that are less severe than serious mental illness, including those in the healthcare profession. Key outcomes of this project will include increasing and enhancing infrastructure to support access to services via telehealth, purchasing of personal protective equipment, funding for increased utilization of evidence-based behavioral health services for those with SUD and/or SMI/SED, and increased funding for outpatient treatment to support individuals with substance use disorders and individuals with mental disorders less severe than SMI, including healthcare practitioners. The vision is to ensure the needs of individuals with mental health or substance use disorders impacted by the COVID-19 pandemic are met.

The Cheyenne River Sioux Tribe is applying for funding under Department of Health and Human Services Substance Abuse and Mental Health Services Administration – Tribal Behavioral Health Grant program – Native Connections. We will provide prevention, intervention and postvention services to our youth population that is at risk of Suicide and Substance misuse behaviors. Through culturally tailored evidenced based practices, our project is designed to use standardized screening tools to delineate which of the population is at risk. Along with a collaborated efforts with community stakeholders the project will have a referral system to our Cheyenne River Sioux Tribe Behavioral Health Addiction Counseling and Therapy services to provide treatment and long-term recovery.

To continue providing the Kul Wicasa Oyate (Lakota translation Lower Brule People) with needed behavioral health services and support, the Techa Kin Wawokyia (Lakota translation Helping Youth) Program looks to build upon the foundation of the collaborative work facilitated through the Waokiya Okalakiciya (Society of Care). The Helping Youth Initiative not only ensures that all 1644 tribal members living on the Lower Brule Reservation receive access to culturally appropriate behavioral health care, but also provides necessary resources specifically to youth under the age of 24. By providing additional culturally relevant training and programs (Circles Peacemaking, Equine Assisted Learning, specifically-tailored Crisis Intervention and Restorative Justice, to name a few) and implementing additional personnel to fill critical gaps in services, the Helping Youth Program will promote substance abuse prevention to create a 20% decrease in use, reduce suicide attempts by 10 percent, and increase behavioral health awareness promotion. In accomplishing these goals, more adolescents and their families will attend their mental health appointments, youth and community members will be actively involved in behavioral health training programs, and youth will exchange negative activities for more positive ones. During the five years of the initiative, access to mental health care and awareness will grow by 20 percent, and in the subsequent four years increase incrementally

Ohitika Wa’sake’-Brave Strong Project will be implemented within the Marty Indian School, which is located on the Yankton Sioux Tribe which serves 250 students annually with an estimated 1,300 total students and community members reached throughout the entirety of the project timeframe. Cultural and community connectedness are critical tools for addressing suicide in Indian Country. At our school, cultural connectedness – such as learning Dakota language and participation in cultural activities – promotes a sense of belonging and helps students cope with challenges and traumas. Marty Indian School in partnership with the Yankton Sioux Tribal Business and Claims Committee, provide this request for support of the Ohitika Wasake (Brave Strong) Nurturing the Spirit through Education, Culture and Wellness Proposal. Our Dakota traditions teach us that the “wakanyeja” (children) are sacred and at the heart of all that we do. Understanding the importance of restoring cultural traditions requires a comprehensive approach to healing a traumatic past. Marty Indian School, along with Tribal leadership, understands the need to preserve and rebuild Dakota language and culture through counseling, academic and residential programming. A critical element in this endeavor involves empowering youth with the tools required for restoring cultural identity. A strong cultural identity will strengthen student resiliency and increase student achievement.

The Oglala Sioux Tribe (OST), headquartered in Pine Ridge South Dakota in partnership with the OST Attorney General's Office, Courts, Child Protective Services (CPS), Department of Corrections, Tribal Educational Department, Housing (Prevention), Rapid City mental health providers, youth and family consumers, and many others, proposes to implement a Circle of Care initiative in Pine Ridge, South Dakota. While our reservation's population is constantly influx, the total OST enrollment is about 38,332, with 19,639 living on the reservation. In Oglala Lakota County, labeled the "poorest" county in the nation, the per capita income of our residents is $8,768. Fueled by poverty and addiction, the unemployment rate hovers around 80%. Addiction is endemic. In addition to opioid and meth problems, for years 11,000 cans of beer a day were poured into the Pine Ridge reservation (liquid genocide), causing untold damages. Up to two-thirds of adults live with alcoholism. While progress has been made since 1990 when one in four newborns was affected by prenatal alcohol exposure, Pineridge newborns are still at a disproportionately high risk for Fetal Alcohol Spectrum Disorders (FASD). The suicide rate for South Dakota young people, ages 13 to 30, is four times the average rate in the nation and in 2014, the Reservation declared a state of emergency after 14 youth killed themselves. These and other health disparities informed the selection of our population of focus: OST children, youth and young adults (Y/YAs) up to 25-years of age, and their families (300 or more in Yr. 3 pilot). Despite incremental improvements to both access and quality of health and behavioral health care for our OST members, the continued development of mental health and co-occurring (COD) infrastructure is essential in order to keep pace with growing demand. We must rely on the limited resources of our current systems which include the department of public safety, tribal courts, IHS, Anpetu Luta Otipi (a comprehensive alcohol and substance abuse prevention and treatment program for the OST), and other tribally operated social service agencies which continue to experience respective service challenges. In too many cases, mental health service access for children, youth and young adult (Y/YA) necessities up to a two-hour drive to Rapid City. While we have many strengths on which we continue to build, we have many challenges, gaps, and infrastructure needs: Behavioral health myths. An increasing volume of clients. Misunderstanding about treatment and treatment processes. Limited resources stretched over many sites and large geography. Workforce (esp. licensed) recruitment, retention, and mentoring challenges. Bureaucracy which threatens our agility and autonomy. Our overarching goal is: Develop our own capacity and infrastructure to plan, design, pilot, evaluate, and sustain an effective system of care (SOC) to improve the mental health/COD, and wellness of our Y/YAs up to age 25 and their families (300 in Year 3 pilot). Our process and outcome evaluation will involve data collection that will be utilized to manage, monitor and enhance this important initiative.

The Tiwahe Glu Kini Pi -TGKP- System of Care on the Rosebud Reservation in South Dakota serves the Sicangu Lakota, known as the Rosebud Sioux. TGKP will expand services to Bring the Family Back to Life - Tiwahe Glu Kini Pi - by initiating a telehealth program that increases the availability of counselors to TGKP relatives and schools, will expand opportunities for trauma-informed service and healing practices to parents, school personnel, and tribal employees, and expand Lakota-centric Equine Assisted Mental Health Therapy to two schools and communities. Within the TGKP Expansion, there are three goals and nine objectives. Goals and Objectives include: GOAL 1 - Strengthen the Counseling capacity on the Rosebud Reservation to help relatives (clients) meet their treatment goals by initiating a Telehealth Program that increases the number of counselors available to meet with students and families and decreases the likelihood of missed sessions and incomplete treatment plans due to traveling times, distances, and weather considerations. GOAL 2 - Increase the capacity of the local school districts to use trauma-informed practices to reduce anti-social and disruptive behaviors of students that may contribute to poor attendance and low achievement rates. GOAL 3 - Increase the capacity of the local school districts to use Lakota equine-centric practices to improve the social and academic environment of the various schools. The TGKP Expansion Project will serve 50 youth each year, ages 3-21 and their families, called relatives within the TGKP. Relatives may come from any of the 20 tribal communities, may be referred from one of the TGKP partners, or may self-refer.

The mission of the Veterans Memorial Youth Center’s Youth Lodge Program is to foster positive youth development among Sisseton Wahpeton Oyate youth through traditional cultural teachings, connectedness, and a holistic health. In order to address this goal, we will focus on addressing serious emotional disturbances, serious mental illness, and related risk factors among youth who are members of the Sisseton Wahpeton Oyate of the Lake Traverse Reservation. The project will work with not only the youth who are affected, but also the families involved to foster healing throughout our communities. Our program goals include: Goal 1: Increase the capacity of the Veterans Memorial Youth Center's Youth Lodge Program and Sisseton Wahpeton Oyate tribal programs/organizations to provide mental health treatment and related support services to Sisseton Wahpeton Oyate youth with serious emotional disturbances (SED) and those with early signs and symptoms of serious mental illness (SMI). Goal 2: Identify and address SED and associated risk factors among Sisseton Wahpeton Oyate youth through the development and implementation of culturally appropriate and community relevant prevention, psychological services, and life skills development strategies.

South Dakota's National Strategy for Suicide Prevention (SD NSSP) will focus on adults aged 25 and older who are at-risk for suicide. Our approach will include system-wide implementation of training behavioral health providers, direct care staff, employers and family members, and implementing a rapid follow-up plan for those discharged from an inpatient behavioral health unit for suicidal ideation or attempt, to ensure a holistic approach in supporting these high-risk adults. As the Single State Authority, the South Dakota Department of Social Services, Division of Behavioral Health (DSS-DBH), will lead the project in collaboration with the Helpline Center, behavioral health and primary care providers, and inpatient behavioral health units to identify, leverage, and enhance community-based resources in the area of suicide prevention and behavioral health services. The project will be lead by a DSS-DBH Prevention Program Specialist, with enhanced project support through key personnel to assess, identify, and support the implementation of strategies that directly address DSS-DBH's goals and outcomes of this funding opportunity. Key goals and outcomes will include improving continuity of care and targeted follow-up to individual at risk for suicide after discharge from inpatient behavioral health units by establishing or enhancing care transition protocols in addition to increasing confidence and competence among critical stakeholders to better identify those at risk of suicide. Another key focus is on the veteran population in South Dakota. Veterans in South Dakota approximate 51,000, or 8.2 percent of the state's population, according to the most recent census data. Our goals for the veteran population is to increase the available interventions and engagement with at-risk veterans who are not currently receiving services through the Veterans Health Administration (VHA) by utilizing information through state clearinghouses, such as the Department of Motor Vehicles and South Dakota Department of Veterans Affairs, as well as established veteran's organizations to meet the needs of at-risk veterans throughout the state. The total number of individuals to be served through the life of the grant is 68,456 (Year one: 17,080, Year two: 32,706, Year three: 18,670).