Sewa Uusim System of Care Grant

An introduction to the wraparound processWith The Pascua Yaqui Tribe 

Rural Behavioral Health Symposium Presentation

September, 2010 Sewa Uusim Program Dennis Noonan Project Director

Dennis.noonan@pascuayaqui-nsn.govSystems of Care Program @p y q gSystems of Care Program

Eight Arizona Communities

Phoenix Area:Guadalupe

Tucson Area: New Pascua Guadalupe

CoolidgeHigh TownPenjamo

New PascuaOld PascuaBarrio LibreYoem Pueblo

Number of  Children in Each Pueblo(Ages 12‐21)

Pueblo Adults YouthNew Pascua  3966 861Old P 455 64Old Pascua  455 64Barrios Libre 193 14Yoeme Pueblo 72 12Penjamo 172 20Guadalupe 5,000 615

Sewa Uusim services is spread across eight pueblos from Scottsdale to Tucson. An area of 175 miles. The need for Transportation to attend cultural. Traditional, prevention and community events was an area of focus in the planning grant for Circles of Care and remains an issue for Sewa Uusim

CONTEXT STRATEGIES OUTCOMES

SEWA UUSIM LOGIC MODEL

SYSTEM OF CARESYSTEM OF CARE

Population•Pascua Yaqui youth birth to 21 who have SEBD

System/Workforce•Equality of services by location•Increased use of Yaqui language, cultural and spirituality and increased cultural competency of providers•Increased coordination of 

Hiapsi­ta Luturia, Tui Luturia (HLTL): “To Follow Your Heart to Good Order”

Youth Centered         , Family Focused            Cultural Appropriate 

CHILD & FAMILY SERVICES•Offer family andCHILD & FAMILY SERVICES•Offer family and•Integration of tribal 

services•Increase staff and skills at Guadalupe•Use of traditional methods•Cultural competency training for providers

•Integration of tribal services•Increase staff and skills at Guadalupe•Use of traditional methods•Cultural competency training for providers

SEBD•Community speaks 3 languages: English, Spanish, and Yoeme•26% live on the reservation (New Pascua)•25% live in Tucson/Pima County•48% live in Metro Phoenix

tribal/nontribal services, reduced duplication of services and increased partner commitment•Reduced stigma•Sustainable system of care•Increased family involvement•Reduce gaps in services by providing comprehensive services

•Offer family and community based services, offer 24 hour crisis intervention•Decentralize services to community and neighborhood level,• Accessible hours and at locations that aren’t

•Offer family and community based services, offer 24 hour crisis intervention•Decentralize services to community and neighborhood level,• Accessible hours and at locations that aren’t•Maintain MOUs

•Equalize services•Train community members •Review and Revise policies•Collaborative leadership training

•Maintain MOUs•Equalize services•Train community members •Review and Revise policies•Collaborative leadership training

48% live in Metro Phoenix

Needs/Concerns•Homicide/Suicide•Transitional services•High School drop out rates•Disparities between service systems•Out of home

•Improve policy to flexibly respond to family and community needs•Increase tribal member staff •Improve services to transition groups•Implement wraparound

Service/Individuald d f h l

locations that aren t stigmatized,• review intake process •use of traditional and culture leaders•family focused model of care, •use of Yaqui wellness model use of tribal

locations that aren t stigmatized,• review intake process •use of traditional and culture leaders•family focused model of care, •use of Yaqui wellness model use of tribal•Social Marketing 

campaign, events •Parent & Youth support •Develop policies procedures, and educational materials

•Social Marketing campaign, events •Parent & Youth support •Develop policies procedures, and educational materials

•Out of home placements•Yaqui Workforce•Service Integration•Service Access•Stigma

•Reduced out of home placements •Improved access to services•Culturally‐based services•Improve family involvement •Improve treatment completion 

model, use of tribal definition of SEBD•Train staff on confidentiality•Use of flex funds, •Care Team used to keep families engaged

model, use of tribal definition of SEBD•Train staff on confidentiality•Use of flex funds, •Care Team used to keep families engaged

­MOU’S ­Strategic Plans­Resources DirectoryCommunity Advisory Board

­Wraparound Services­Quality Assurance/National Evaluation­Natural Supports

­Individualized Plan of Care­Family Participation­Cultural CompetencyYouth Voice heard

SYSTEM LEVEL PROGRAM LEVEL CHILD & FAMILY LEVEL

EVALUATION

­Community Advisory Board­Community Collaboration­Scope of Care

­Natural Supports­Professional Supports­Staff Training­Resource Development

­Youth Voice heard­Comprehensive Assessment

Service Delivery Model

• Based on NICWA’s Nine Principles of Practice

• Wraparound in Indian Country methodology

B i i N t l d• Brings in Natural and Traditional support

• Collaboration With Existing Sewa Uusim Provides

Service Flowchart

Wh i W d?What is Wraparound?

A facilitate, team based service and support process.pp p

• Instead of traditional counseling, the youth creates their own team of supportyouth creates their own team of support.– 4 to 8 people who know and care for the youth and their familyyouth and their family

Wh d d?Who needs wraparound?

All Youth need services and supports that reflect theirthat reflect their uniquenessYouth and Families with most complex needsTraditional servicesTraditional services have been tried and failed

Wh W d?Why Wraparound?

• Families: Give the power of choice 

• Professionals: Focus on their skills for the Youthfor the Youth

• Add support for:Y th– Youth

– Parent

S i id– Service Provider

SupportsN t l S t P f i l S tNatural Supports

• Family Members

F i d

Professional Supports

• Behavioral Health 

S i l S i• Friends

• Spiritual Leaders

• Social Services 

• Tribal Program

• Cultural Leaders

• Elders  

• School Counselor

• Probation Office

• Teachers • Other agencies

Values of WraparoundValues of Wraparound

V i d Ch i• Voice and Choice: – Families have a voice and are able to 

h h i Pl f C– chose their Plan of Care

• Compassion:– Work together with a caring spirit

• Integration: – Different department and agencies work– together for the good of the family

Principle of WraparoundPrinciple of Wraparound

C i b d• Community‐based:– Look to the community for solutions first. If ibl k h h i i b– If possible, keep youth near their community by utilizing family, friends and local service.

• Individualized:• Individualized:– Everyone is different. The Plan of Care (Treatment Plan) should be flexible and unique to each youth.Plan) should be flexible and unique to each youth.

– No “cookie‐cutter” plans.

Principle of Wraparound cont.p p

• Strength based:• Strength based:– The focus is on the strengthens of the family

• Culturally Competent:• Culturally Competent:– The family’s culture is important to identify

• Partners with the family:• Partners with the family:– Not about us… with us. Do not tell the family what they need– Do not tell the family what they need

– Work with the family

Principle of Wraparound contPrinciple of Wraparound cont.

• Team Driven:Team Driven:– Everyone aggress– Service Providers and family agrees with the Plan of y gCare

• Flexible Funds:– One time funding used to support a special need

• Balance of Processional and Natural Supports:– More family and community support– Less service providers

P i i l f W d tPrinciple of Wraparound cont

• Unconditional Care:– Never give up 

– If something isn’t working change it

• Outcomes Measures:– Have a vision for tomorrowa e a s o o o o o

PHASES AND ACTIVITIES OF PHASES AND ACTIVITIES OF THE WRAPAROUND PROCESS

a) Orient youth and family to the wraparound

Phase I- Engagement and Team Participation

a). Orient youth and family to the wraparound processb) Stabilize process by addressing crisis needs) F ili i i h h d f il b c) Facilitate conversations with youth and family by

exploring strengths, needs, culture and visiond) Engage other team members) g ge) Plan meetings

Ph 2 I iti l Pl D l tPhase 2‐ Initial Plan Development

A) Develop an initial plan of careA) Develop an initial plan of care1. Ground rules2. Document strengths3. Create a team mission4. Prioritize needs/goals5. Select strategies for meetings5. Select strategies for meetings6. Assign action steps

B ) Develop a Safety PlanB.) Develop a Safety Plan1. Determine risk factors2. Create safety plan

Phase 3 ‐ ImplementationA) Implement a wrap planA) Implement a wrap plan

1. Action steps for each strategy2. Track process of action steps3 E l f i3. Evaluate success of strategies4. Celebrate success

B.) Revisit and update plan1. Consider new strategies as

necessary

Phase 3 ImplementationPhase 3‐ Implementation  continued…

) c) Maintain and build team cohesiveness and trust

1. Maintain awareness of team members satisfaction andbuy in

2 Address issues of team 2. Address issues of team cohesiveness and trust

d.) Complete necessary documentationd land logistics1. Complete documentation and

logisticsg

Phase 4 ‐ Transitionase a s t oA) Plan for cessation formal wraparound

1. Create a transition planp2. Create a post-transition crisis

management plan3 Modify wraparound process to3. Modify wraparound process to

to reflect transition

) C C /CB.) Create a Commencement/Celebration1. Document team work2. Celebrate success

C) Follow-up with the Family1 System for Check- in1. System for Check- in

When, How, With Who?

Wh t W d T l k likWhat a Wraparound Team may look like

B th Nana/Tia/Brother

Sister

DadTeacher

Nana/TataTio

YOUTH

Dad

M

CoachYOUTHMom

Pastor/PriestCultural

Youth Social ProbationCounselor/Therapist

PriestCultural Leader

Other Youth

ProgramSocial Worker Office agency

How it worksHow it works

Wraparound Facilitator/Care Coordinator:Wraparound Facilitator/Care Coordinator:◦ Initially meets youth to explain the process◦ Identifies Youth’s Supports◦ Contacts and orientates ◦ Facilitates the Wraparound Meetings◦ Documents Team’s ProcessWraparound Team:Wraparound Team:◦ Strengthens Discovery◦ Identifies Needs◦ Develops the Plan of Care (Treatment Plan)Develops the Plan of Care (Treatment Plan)

Based on Youth’s goals.◦ Tasks are given out to the team

How it works. cont.How it works. cont.

• Youth‐Centered:– Youth choose Life Domains:

– Residence, Family, Social, Behavioral, Educational, Safety, Legal, Health, Crisis, Spiritual, Cultural, i i lFinancial

– States Long‐term Goal; six months or more

– States Short‐term Goal; less than one month

– Peer Mentors (Sewa Uusim)

H i kHow it works. cont.

• Family Focus:– Family is fully aware what the Youth is working ony y g

– Able to offer support

– Parent Mentors (Sewa Uusim)Parent Mentors (Sewa Uusim) 

• If something isn’t working, change it

Stages of ChangeYAQUI SYMBOLS STAGES OF CHANGEYAQUI SYMBOLS STAGES OF CHANGE

Maala Meecha/Moon

The Beginning

Pre‐contemplation

ContemplationThe Beginning. Contemplation

Mochik/Turtle

Basis of Yaqui thought and character.

Determination

Hu’upa/Mesquite

h l

Action

Learning how to live

Semalulukut/Humming Bird

Action/Insight

Action II/

MaintenanceAction/Insight Maintenance

Sewa/Flower

Life in bloom

Maintenance/

Completion

Care Plan HR # ____________________ Date: _________________

Life Domain (circle one) Long Term Goal (in this Life Domain; mos., or more)

Residence Family Social

Care Specialist/Care Advocate: __________________________ Youth: ________________

Behavioral Education SafetyLegal Health CrisisSpiritual Cultural FinancialStrengths (in this Domain): Needs ( in this Domain):

Short-term goals (in this Domain; less than one month:

Plan(include names, d f d

Budget Outcomes*To be filled in a subsequent plans (include d d )dates of expected

completion and description of tasks

dates and reasons)