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SAMHSA’s Award-Winning Newsletter
July/August 2009, Volume 17, Number 4 

Image of Native American children with law enforcement’s “crime dog”

Local children learn lessons in safety from law enforcement’s “crime dog.”

Tiwahe Wakan: Families Are Sacred

Meeting the Needs of Reservation Children

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).

Quote from Angela A. Stokes about services for young people on the reservation

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.



  Statistics on Substance Abuse,  
  Mental Health  
State by State Estimates

State by State Estimates

Every state faces a different set of challenges with substance abuse and mental health issues, including binge drinking and depression.

Treatment Discharges: Latest Data

Treatment Discharges: Latest Data

SAMHSA's Treatment Episode Data Set (TEDS) recently updated its data on discharges from treatment facilities.


  Treatment Updates  
TIP 50: Literature Review

TIP 50: Literature Review

Part 3 of TIP 50, Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment, is available.

Alcohol Abuse Treatment: Need, Barriers

Many people who need treatment for an alcohol problem are not seeking help. Why?

National Directory Updated and Available

National Directory Updated and Available

An updated guide to finding local substance abuse treatment programs is available.


  Real Warrior Campaign  
Reaching Out Makes a Real Difference

Reaching Out Makes a Real Difference

The Real Warriors Campaign is fighting the stigma of asking for help.


  Prevention Update  
Retail Tobacco Sales to Youth

Retail Tobacco Sales to Youth

Retail sales of tobacco products to young people continue to drop.

Parent Involvement Makes a Difference

Parent Involvement Makes a Difference

Parents play an important role in preventing substance abuse.

Suicide Prevention Update

Suicide Prevention Update

New funding, Web site redesign to improve navigation, and more.


  Grants  
Prevention Awards

Prevention Awards

To advance community-based prevention programs, $190 million to 25 grantees.

Calculating Program Allotments

A new guide provides information on procedures to calculate allocations for some key block and formula grants.

Drug Free Communities: Continuation Awards

More than 500 community coalitions nationwide recently received Drug Free Communities (DFC) continuation awards for their programs.


  Health Reform  
Nine Core Principles

Nine Core Principles

Ensuring current reform efforts include mental health and substance abuse issues.


  Mental Health  
Forecasting the Next 5 Years

Forecasting the Next 5 Years

Changes are coming to create “whole health,” person-centered care.


  Adolescents & Young Adults  
Need Treatment? Many Say No

Need Treatment? Many Say No

Nearly 7 million Americans age 18 to 25 were classified as needing treatment in the past year.


  Recovery Month  
Celebrating 20 Years of Recovery

Celebrating 20 Years of Recovery

Get up–to–the–minute updates on September's events.


  Also in this Issue  
Under the Influence: Fathers and Alcohol Use

Under the Influence: Fathers and Alcohol Use

Does dad's drinking affect his adolescent children?

Methadone Advisory

New information on the dangers of methadone in combination with other drugs.



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