Towards a Comprehensive Advisory Policy: The Secretary’s Tribal Advisory Committee STAC
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With the wide range of successful programmatic innovations made— and challenges faced—by tribal governments, it can be an arduous task for tribal leaders to make inroads into the proper forum to share their priorities with federal policymakers. The policy issues encompassing Indian child welfare have a multitude of interrelated dimensions; work in any one issue affects others, making it counterproductive to work on issues in isolation from each other. To further complicate matters, these issues don’t neatly fit into a single policy area corresponding to any one agency’s authority and service responsibility. In response to calls by tribal leaders to have a single forum to advocate for the diverse priorities of their communities, the Department of Health and Human Services (HHS) established a cabinet-level advisory committee composed of tribal leaders and federal agency directors. The Secretary’s Tribal Advisory Committee (STAC) is the first of its kind and represents a remarkable advancement in the development of a collaborative and comprehensive tribal advisory policy.
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Background on Formation of STAC HHS has a long-standing commitment to collaborate with tribes to build meaningful partnerships. Starting in 2009, the Obama Administration set out to reaffirm and strengthen the federal government’s consultation policies with tribal governments. The President’s Executive Memorandum on Tribal Consultation emphasized the importance of robust tribal participation in forming public policies affecting their interests. Federal agencies are tasked with updating and fully implementing the consultation procedures first established by Executive Order 13175 by the Clinton Administration in 2000.
In order to ensure compliance with the memorandum, HHS engaged in a series of consultation sessions with tribal leaders in July 2010. After significant feedback on the need for a more coordinated response to the issues facing their communities—and in order to further the department’s government-to-government relationship with tribes—former HHS Secretary Kathleen Sebelius formed STAC, which first convened Continued on next page
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December 14, 2010. At STAC’s inaugural meeting, members identified addressing health disparities faced by American Indian and Alaska Native (AI/AN) communities as their number one priority. NICWA Executive Director Terry Cross emphasized the critical nature of STAC’s work, stating, “The wide range of mental health and child welfare services provided to AI/AN communities by HHS make it absolutely vital for the agency to create genuine partnerships with tribal governments and be responsive to the unique needs of these communities.” How STAC Can Help Your Community STAC provides tribal leaders with a unique opportunity to voice their priorities before the directors of the HHS operating divisions. The wide range of programs operated by HHS significantly SUMMER 2014 Pathways Practice Digest is published by the National Indian Child Welfare Association, Inc. Terry L. Cross Executive Director Nicole Adams Editor Justin Boro, Adrian Smith Contributors National Indian Child Welfare Association, Inc. 5100 SW Macadam Avenue, Suite 300 Portland, OR 97239 Nonprofit rates are paid at Portland, OR. Published quarterly. Submissions and Back Issues Submissions are accepted. As long as back issues are available, they may be ordered for $4 each, plus S/H. Quantities of 10 or more are $2 each, plus S/H. To make submissions or order reprints, contact Nicole Adams, editor, at (503) 222-4044 x133, or at nicole@nicwa.org. Policy Information in the articles and opinions expressed do not necessarily reflect the policy or opinions of NICWA.
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“The wide range of mental health and child welfare services provided to AI/AN communities by HHS make it absolutely vital for the agency to create genuine partnerships with tribal governments and be responsive to the unique needs of these communities.” —Terry Cross affect the health and well-being of AI/AN communities; programs include providing child welfare and mental health services through the Administration for Children and Families and the Substance Abuse and Mental Health Systems Administration, implementation of the Affordable Care Act (ACA), administrating Medicaid and the Indian Health Service (IHS), and providing a host of programs and funding opportunities to support resilient families and communities. STAC convenes directors of HHS’s 11 operating divisions to coordinate department-wide strategies. This helps prevent the compartmentalization of service responsibility that can occur when issues implicate multiple agencies’ policies. This advisory body gives HHS staff an opportunity to identify gaps in the provision of services that may not be identified by individual agencies when consulting tribes. The tribal membership of STAC is composed of one delegate and alternate for each of the 12 IHS areas and one delegate and alternate for five atlarge members who are nominated by their peers. Some notable accomplishments made by STAC to date include: • At the request of committee members, former Secretary Sebelius wrote a letter to governors urging them to P A G E
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establish their own tribal consultation policy (TCP), which resulted in a number of states seeking advice on their TCP, Maine requesting technical assistance from HHS to establish a TCP, and greatly facilitated tribal-state collaboration during ACA Marketplace meetings; Former commissioner of Administration on Children, Families, and Youth wrote a letter to states reminding them of their obligations to meet the requirements of the Indian Child Welfare Act (ICWA) and work collaboratively with tribes as required under a number of federal child welfare laws; IHS and Health Resources and Services Administration designated IHS and tribal healthcare facilities as National Health Service Corps sites, greatly increasing these facilities’ ability to recruit physicians by extending the program’s scholarship and loan forgiveness incentives; The Centers for Medicare and Medicaid Services denied approval of state plans for Medicaid expansion under the ACA due to states’ failure to consult tribes; and HHS reviewed existing department grants, resulting in the Grants Eligibility Tool, which allows tribes to access and compare HHS grants Continued on next page
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and assists the department in addressing barriers to tribes being awarded HHS grants.
As the examples above illustrate, HHS is leading the way in creating a genuinely inclusive tribal advisory policy. Stacey Ecoffey (Oglala Lakota), principal advisor for tribal affairs at HHS, notes, “The senior level HHS staff that comprise STAC are committed to answering questions, responding to the priorities and recommendations of tribal leaders, and working with them to address their concerns. STAC members bring first-hand experience on the issues they are facing, which informs how the department tailors approaches to address the unique needs of these communities.” NICWA’s Role in STAC To support and inform the tribal leadership who comprise it, STAC also requires the services of technical advisors. These technical advisors are experts in their field and provide critical information to tribal leaders in the development of policy solutions. David Simmons, government affairs director at NICWA, serves as one of these technical advisors to STAC, providing expertise in the areas of human service programming and policy. In his role, Simmons brings knowledge of federal laws and programming and their interface with tribal application. In the last three years, he has also helped tribal leadership understand the complex issue of the disproportionality of AI/AN children in state foster care systems and how this is correlated to: • Non-compliance with ICWA; • Limited access to in-home services, which can prevent the
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placement of AI/AN children into foster care; and Tribal-state relationships.
Simmons has also provided information to tribal leadership regarding the need for additional children’s mental health funding to promote community and culturally based children’s mental health services within tribal communities. Current funding is very limited. Many tribes that face increasing social problems related to unresolved trauma, such as youth suicide, have little or no opportunity under current funding sources to develop trauma-based prevention and treatment services. Another important role that both STAC technical advisors and members play is making sure that the work of STAC is carried to other experts and organizations in the field. In this role, Simmons works with tribal leaders and mainstream child advocacy organizations to inform them of the priorities and work of STAC and seek their participation to advance this work. Connecting STAC leadership with other tribal leaders and mainstream child advocacy organizations ensures that the work of STAC gains additional support and flows through the various networks of advocates that focus on child and family issues.
participation in the formulation of public policy is a key component to improving the delivery of services to AI/AN communities. No one is better suited to advocate for the needs and priorities of a polity than people who live in that community. Poarch Band of Creek Indians Treasurer and NICWA Board Member Robert McGhee is an atlarge STAC member and shared, “It has been very rewarding to work with HHS to identify and address the issues facing Indian Country. After each meeting, I return home with important updates to share both with my tribe and the wider community.” STAC is truly breaking new ground in establishing an inclusive and comprehensive tribal advisory policy, one in which the participation of tribal leaders is a vital component of how HHS delivers services to AI/AN communities. As Sylvia Mathews Burwell steps into her role as HHS Secretary, she will be well positioned to continue the department’s commitment to leading the way in integrating the advice of tribal leaders when formulating policy.
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DOJ Task Force Hearings Conclude, Report Forthcoming As part of the U.S. Attorney General’s Defending Childhood Initiative, the Task Force on American Indian and Alaska Native Children Exposed to Violence (“the Task Force”) was created in 2013. Its creation was a direct response to previous government findings that indicated American Indian and Alaska Native (AI/AN) children face exceptionally high rates of violence in their communities and that AI/AN communities face unique barriers to prevention programing and service provision. The Task Force is comprised of an appointed advisory committee of experts and a work group that includes U.S. Attorneys and Department of the Interior and Department of Justice officials. To gather information on the scope of the problem and potential solutions, the Task Force held a series of four public hearings and listening sessions beginning in late 2013. Each listening session focused on a particular situation where AI/AN children may be exposed to violence. NICWA was invited share its expertise with the Task Force through both oral and written testimony at three of the four hearings. The first of the four hearings addressed AI/AN children exposed to violence in the home. Sarah Kastelic, NICWA deputy director, was invited to present testimony to the Task Force on the maltreatment of AI/AN children. Kastelic presented recent statistics highlighting the high risk for abuse and neglect that AI/AN children face. She described how complicated jurisdictional schemes, inadequate funding, and a dearth of trainings and technical assistance create multiple barriers to effective child protection interventions in Indian Country. She concluded her testimony by sharing common elements of successful child protection models in Indian Country. These include programs and services “designed with input from the community and implemented by those with intimate knowlThe final report will edge and deep understandings of the unique community needs and present a set of findings the tribal culture.” Collaboration across and within different tribal, along with a comprehen- federal, state, and local governments is also essential to addressing jurisdictional, funding, and service delivery challenges, accordsive set of policy ing to Kastelic. Understanding the importance of familial connecrecommendations tions as a protective factor for AI/AN children, providing accessible community-based services, and using blended and braided funding designed to decrease sources were all also emphasized during her testimony.
AI/AN children’s exposure to violence and increase treatment and support when exposure does occur.
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NICWA next provided testimony at the Task Force’s third hearing that addressed violence in the community. The hearing included a panel specifically focused upon Indian Child Welfare Act (ICWA) compliance. NICWA Executive Director Terry Cross provided impassioned testimony, along with Chrissi Nimmo, attorney general for the Cherokee Nation; Shannon Smith, executive director of the ICWA Law Center; and Jack Trope, executive director of the P A G E
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What’s Working? A Look at Innovation and Success in Tribal Child Welfare
Throughout NICWA’s recent highprofile testimony to the Department of Justice Task Force on American Indian and Alaska Native Children Exposed to Violence, examples of model programs and best practices were included to help policymakers and the field of child welfare understand what is working in Indian Country. Often times, attention is paid to the challenges or deficiencies facing the tribal child welfare system. While these challenges remain a consistent reality, it is also important to share the success stories of those models and programs in Indian Country that are succeeding in spite of the obstacles.
Tribes across the country are providing effective culturally based child welfare programs. For example, Minnesota’s Mille Lacs Band of Ojibwe Indians improved outcomes for children when the tribe began implementing new culturally based service models. According to Casey Family Programs, these and other improvements “led to an increase in the percentage of children served in their parents’ homes; an increase in the percent of out-of-home care in relatives’ homes; and a decrease in the percentage of children in nonNative, out-of-home care.”1
a result, ACF states these tribes “made substantial progress at implementing system-level changes to improve coordination and collaboration.”2
Tribes are also expanding their capacity. For example, numerous tribes have recently applied for funding to build their capacity to independently run foster care, adoption, and guardianship programs and begin implementation of these programs. Notably, eight out of the nine Lakota tribes in South Dakota have already received or have applied for such funding, as has the Navajo Nation. They join Washington State’s Port Gamble S’Klallam Tribe, who became the first tribe in the nation to run its own Title IV-E program in 2012.
Finally, it is important to note that tribes are leading the way when it comes to innovative child welfare practices. For example, the White Earth Nation developed its customary adoption process which has successfully engaged the community in an effort to increase permanency for tribal children by providing culturally meaningful alternatives to traditional adoption.3 The Mississippi Band of Choctaw Indians and Cahuilla Band of Indians are pioneering A report by the Administration for innovative efforts to better idenChildren and Families (ACF) also tify the risk factors for child abuse describes multiple tribes—among and neglect in their community in them, the Nooksack Tribe, Forest County Potawatomi, and the Alaska order to improve the services they provide.4 Native village-serving Association of Village Council Presidents—that In Alaska, the Western and have effectively integrated their Pacific Child Welfare Implementachild welfare services with their tion Center (WPIC) has developed Temporary Assistance to Needy Families (TANF) programs to honor and implemented a tribal in-home culture and to improve services and services model based on extensive review of tribal services and outcomes in their communities. As P A G E
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capacity and from peer-to-peer collaboration. WPIC created planning and assessment tools for the model consistent with state standards and responsive to tribal needs. WPIC provided input into the development of tribal licensing standards with a focus on cultural considerations and conducted training on new licensing standards. To further enhance the overall implementation of the tribal in-home services model, WPIC offered extensive trainings to build tribal staff capacity in leadership and court practice.5
Despite systemic barriers, these tribes and Native-serving organizations demonstrate the extent to which tribes are advancing enhanced services to their communities, families, and children. Footnotes 1. Casey Family Programs. (2014, May). A declaration of hope. Seattle, WA: Casey Family Programs. Retrieved from www.casey. org/media/2014_SignatureReport.pdf. 2. Pirkko, A., Diaconis, A. Hafford, C., Keating, K., Morales, J. & Vu, C. (2013). Coordintion of tribal TANF and child welfare services: Early implementation. Washington, D.C.: U.S. Department of Health and Human Services. Retrieved from: www.acf.hhs.gov/sites/default/ files/opre/initial_findings_rprt_final.pdf 3. National Resource Center for Adoption. (n.d.). White Earth Band of Ojibwe: Customary adoption. Southfield, MI: NRCA. Retrieved from: www.nrcadoption.org/ wp-content/uploads/2011/02/CustomaryAdoption-C.pdf 4. U.S. Department of Health and Human Services. (n.d.). Tribal and migrant programs for community-based child abuse prevention. Washington, DC: DHHS. Retrieved from: www.childwelfare.gov/management/funding/ funding_sources/tribal.cfm. 5. National Indian Child Welfare Association. (2014, June). American Indian/Alaska Native children exposed to violence: An overview of Alaska Native children exposed to violence in the home, the community, and the juvenile justice system. Portland, OR: NICWA. Retrieved from: www.nicwa.org/government/ documents.
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Documentation and Case Records: Managing Tribal Child Welfare Data Responsibly For tribal child welfare departments and workers who want to improve caseload management, developing sound documentation protocols and procedures and case record management systems can prove challenging. However, NICWA Executive Director Terry Cross asserts that, within child welfare systems, the lack of documentation puts children and families at risk. He quotes the late Sharon Donaldson who said, “When I realized that our children were dying because my tribe did not have data, I began to value data.” Indeed, for children involved in the child welfare system, there is great value in developing effective data systems (which Cross defines as “systems that transform small units of information into usable knowledge to support wise choices”) in order to ensure their care. “We’ve been doing documentation for a long time,” Cross says, pointing to examples including wampum belts, sand paintings, time balls, and hide painting to illustrate how complex histories have traditionally been recorded in tribal communities. In much the same way, the documentation included in a case record includes information most important to a child’s well-being and care, is organized around that child, and reflects every aspect of how a program is working with a family or child, accessible to all involved in providing services to the child. Common Elements of Case Records While Cross emphasizes that there is no one correct way to organize case records, there are many elements that appear nearly universally. Each serves an important purpose and includes varied information. NICWA’s Enhancing Basic Skills for Tribal Child Welfare Workers Webinar Series presents each of these in much more extensive detail, but some examples are included below. A child’s case record typically begins with the face sheet. The face sheet makes information readily available for anyone who needs access. This could include critical information on a child’s placement, intake and referral history, information on allergies and medication, and more. Usually in a case record there is information on the presenting problem and investigation (if there was one) that includes intake documentation. In the event PATHWAYS SUMMER 2014
there was an investigation, this portion of the record should include documentation surrounding every contact with parents, child, and other collateral contacts; and results of the physical examination, if applicable. Most importantly, it should document the facts and findings of the investigation. Similarly, if a child came to the attention of the organization through a child abuse and neglect referral, there would be an additional record dedicated to a safety assessment plan. Like the face sheet, this record needs to be updated regularly; the assessments may change if the threats of harm change. Case activity is usually documented as a log. A contact log, service episode forms, and progress notes are just a few examples of what would be included in this section of the case record. Following the case activity log, Cross emphasizes that, “It’s important to take case notes that record information on a daily basis whenever the family or child is seen. Always remember the parent is likely to see them. Do not include anything you wouldn’t say to parents and avoid judgments and drawing conclusions.” Case notes provide more extensive information than the case activity log. While it usually includes a contact log with the date, time, place, who was present, topics discussed, etc., the notes also elaborate on the services provided (such as, “Provided coaching in preparation for school conference”) and the progress being made as related to the case plan (for example, “Parent completed parent education curriculum”). Cross encourages child welfare workers to document all of the incidents of service provision, noting, “Some of the very best parent training happens while transporting a parent to an appointment and having a discussion about child development.” Brevity is fine in case notes as long as there is enough information to trigger the memory about what happened. In fact, Cross states, “If people try to write too much, they get bogged down and behind in their case note writing. Just a couple of words recorded in the case notes will help when it comes time to write a court report or give testimony.” Recording parent and family involvement in the record can get complex, as there may be multiple
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parents, step-parents, and caregiver relatives on both sides of the child’s family tree. But because this part of the case record often includes a relative search, it is important to do a thorough job. Cross elaborates, “As the case progresses and you’re developing a concurrent plan, it’s so important to be thinking about permanency. In the beginning of the case, you would already be doing a relative search so that the child’s sense of belonging is taken care of. Too often, we don’t look far enough into the child’s relationships. For most children, there are many blood relatives who may be a placement. Parents should take an active role in mapping out these relationships.” It is nearly universal that parent service plans are part of the record, developed and agreed upon jointly between the worker and the parents. Included here are agreements, a plan for care coordination if multiple systems are involved (as is often the case), service referrals, and reports, to name just a few. While the parent service plan may include information on child protective service visits to the home, the legal documentation is found in the court documents section. It includes all the documented court orders and reports, ordered visitation plans, guardianship information, and much more. Specific to the child, the record should include a child service plan with clear goals, service referrals, notes, and reports. Cross warns that cultural resources— ranging from the child’s extended family and clan, relationships they may have, and the community surrounding other cultural activities they do—and the plan to keep the child connected to them, should not be overlooked. Complete health and education sections should also be included in the record, done individually for each child in the family.
Cross highly recommends documenting the child’s trauma history, taking note of possible triggers. He explains, “Many of our kids who come into care have some type of trauma. Often times, foster parents will see behavior that doesn’t make sense outside of the context of that child’s trauma history.” Cross cites an example of one young child who was subjected to an emergency removal during which the child’s clothes and belongings were hastily stuffed in plastic grocery sacks. Later, when the child’s care provider asked the child to pick up toys and put them in grocery bags, it triggered the trauma of being removed. The child ran away crying. While this is just one example, it helps illustrate why it’s important to note what triggers exist and what the response should be in the case record. Managing information on care providers is also essential. This includes a section with details of the child’s placements. Other documentation including a detailed release of information section, financial transactions section, and photographs section are common. Cross states, “It’s very important to remember that for many kids in the child welfare system, their child welfare record may be the only place where a history of their childhood is recorded. Therefore, just as important as documenting details of child abuse and neglect investigations is the documentation of childhood milestones, sibling photos, and school pictures. Items such as these should be viewed as a part of the child’s own history, and be preserved for the child long term.” Paper-and-Pencil or Electronic? When to Automate When it comes to maintaining case records, which system is better: traditional paper-and-pencil files or electronic record keeping? In short, Cross says there is no one-size-fits-all solution and that both have advantages and disadvantages. In making this decision, Cross reminds case workers to remember the purpose of a good record system is to facilitate “the process for getting information from those who have it to those who need it.” It sounds simple, but Cross emphasizes that the buy-in, training, and participation required by child welfare department staff is essential to whatever system is implemented. He states, “No record system is sustainable without a value on the information to
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be documented. If you value what you gather, then that’s information that will be able to support good practice.”
Association on Indian Affairs.
In deciding where and what to automate, Cross advises departments to ask, “Are we doing one thing 100 times or are we doing 100 things one time each?” In the case of the former, where there are many complex cases, automation will likely help. “Unfortunately,” Cross says, “our case records are very much like the second option. One of the challenges of automation is that these systems work best when there is a clear path. The problem is that often in our children’s complex cases, there isn’t a clear path. Automating is not terribly efficient in the case of records like these.” For case loads of under 50 records, Cross advises that a well-designed paper-and-pencil system is probably adequate, stating, “You will spend more money and more time training and supporting an electronic system than it would cost you to do a paper system at that rate.” However, for departments who manage over 50 records, an electronic system may be advisable. Depending on the number and complexity of cases, it might pay to implement a well-designed computerized record system.
Like Kastelic, Cross concluded by presenting information on best practices. He emphasized the need for ICWA and cultural competence training for social workers, court personnel, and attorneys. Providing practitioners access to ICWA compliance tools such as guides and checklists, improving data collection, supporting states who wish to codify ICWA in state law, and creating state ICWA-specific units were also included as tangible recommendations to the Task Force. The last hearing, which took place in Anchorage, Alaska, sought information on the unique experiences of Alaska Native (AN) children exposed to violence. After providing data about AN child maltreatment, Kastelic advocated for child welfare system reform that supports and strengthens AN families. She described NICWA’s work with the Western and Pacific Child Welfare Implementation Center (WPIC), where NICWA worked with tribal communities to keep children safely in their homes by improving in-home service models. As with previous testimony, NICWA shared current successful models, such as WPIC, and provided concrete policy recommendations.
Now that the hearings and listening sessions have been completed, the Task Force will spend the summer and early fall writing its final report, which it describes as “a Still, Cross warns against seeing an electronic blueprint for preventing [AI/AN] children’s exposure to recording-keeping system as a panacea. Yes, violence and for reducing the negative effects expericomputer software is capable of processing large enced by children exposed to violence across the United amounts of information to make it useful in a more States.” The report will be based on hearing testimony, timely fashion. However, documentation relies on public comments from listening sessions, and the compeople not computers. Cross elaborates, “People of- prehensive research done by the Task Force itself. The ten think, ‘If we just got an electronic record system, final report will present a set of findings along with a we’d have better records.’ In fact, what most tribes comprehensive set of policy recommendations designed find is that if people won’t fill out a paper-and-pencil to decrease AI/AN children’s exposure to violence and system, they won’t fill out an electronic system eiincrease treatment and support when exposure does ther. Tribes have spent a lot of resources on impleoccur. menting big computer data systems that then no one uses.” In providing examples of best practices and policy recCross emphasizes, “No system can produce wise decisions out of data; people can.” Indeed, Cross counsels tribal child welfare workers to not lose sight of this very important purpose of documentation, stating, “Documentation is about putting information into the record so that other people can use it to make wise decisions regarding the safety, health, and well-being of children. As keepers of a child’s personal history, we must take this responsibility very seriously.” PATHWAYS SUMMER 2014
ommendations, NICWA intended to set forth concrete solutions. Kastelic, who looks forward to the release of this document, says, “It was a real honor and privilege for NICWA to be an invited expert at multiple proceedings hosted by the Task Force. Reports from a task force like this one can be amazing tools. The information they will compile, the findings they will make, and the recommendations they will provide help policymakers understand the issues and know what changes need to be made.”
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