Transcript National Indian Child Welfare Association (NICWA) in the U

Circles of Care III Bidders
Meeting
Systems of Care for Native American
Youth
Day 1
January 2005
Welcome and Introductions
• National Indian Child Welfare Association
– Staff members and consultants
• Circles of Care Evaluation and Technical
Assistance Center
– Staff members and consultants
• Center for Mental Health Services
– Project Officer
• Participants/Prospective Bidders
Overview of Agenda
• Understanding Circles of Care
• Basics of the Funding Opportunity
• Working Sessions
– Nuts and Bolts of the application
– Logic Models and strategic planning
– Developing your Project Narrative
• Optional consultation sessions
Meeting Goals and Process
• Primary Goal: assist participants in developing a
strong proposal and application for the Circles of Care
grant program
• Secondary Goal: increase participants awareness of
the systems of care approach to community
development and evaluation that can be used in a
variety of future local initiatives
• Process:
– Facilitated working group sessions
– Individual consultation
– Electronic resource material
Background and History of the
Circles of Care Initiative
Jill Erickson, MSW
CMHS Project Officer
CIRCLES OF CARE III
SM 05-008
• Tribal Infrastructure Grants for Transforming
Behavioral Health Systems for American Indian
and Alaska Native (AI/AN) Children and their
Families
• Standard Grant Announcement, Infrastructure
Grants-INF 05 PA
New Freedom Commission: Transforming
Mental Health Care in America
• Americans understand
that MH care is essential
for all overall health
• MH is consumer and
family driven
• Disparities in MH care
are eliminated, cultural
and rural/remote
• Early MH screening,
assessment and referral:
common practice
• Excellent MH care is
delivered and research is
accelerated
• Technology is used to access
MH care and information.
Goals, Circles of Care
• To develop system of care
models designed by AI/AN
community members, in
partnership with program and
evaluation staff.
• To engage community in
assessing service system
needs, gaps, potential
resources, and plans .
• To include special emphasis
on mental health/substance
abuse.
• To increase system response
and options based on values
of community served
• To evaluate the feasibility per
available resources.
• To support Healthy People
2010 goals: reduce suicides,
increase access to treatment
History of the Initiative
• CASSP grants to States 1984, to plan a system of care,
excluded Tribes
• OTA Report of 1990, found only 17 child trained MH
providers for total Tribal population.
• 1992+ Series of meetings, SAMHSA, Indian Health
Service, other federal agencies, providers, and Tribal
leaders to address disparities.
• Circles of Care I awarded in 1998, followed by Circles
of Care II in 2001.
ELIGIBILITY, Circles of Care
• Tribal Governments, Federally Recognized, as
defined by PL 93-638
• Urban Indian Programs, as defined by PL 94437
• Tribal Colleges and Universities (TCU), added
in 2004
• Previous Grantees not Eligible.
Award Information
• $2.4 Million for 7-9 awards.
• Average annual award, $250k to $350k
• Awards may be requested up to 3 years, depending on
availability of funds
• Cost sharing/match is not required.
• Technical assistance provided on-site and in grantee
meetings
Circles of Care I Grantees
(1998-2001 Projects)
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Cheyenne River Sioux Tribe – SD
Feather River Tribal Health - CA
Shared Vision Project - MT
First Nations Community Healthsource – NM
Oglala Sioux Tribe – SD
Choctaw Nation of Oklahoma
Urban Indian Health Board – Oakland, CA
Fairbanks Native Association- AK
Inter-Tribal Council of Michigan
Circles of Care II Grantees
(2001-2004 Projects)
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Tlingit and Haida Tribes - AK
Pascua Yaqui Tribe - AZ
Salt River Pima-Maricopa Indian Community - AZ
United American Indian Involvement - CA
Blackfeet Indian Tribe - MT
Ute Indian Tribe - UT
Puyallup Tribal Health Authority - WA
Technical Assistance
• National Indian Child Welfare Association,
Program Technical Assistance, (IAA, IHS)
• National Center for American Indian and Alaska
Native Mental Health Research, (IAA, NIMH)
Tribal Consultation
• E.O. 13175, DHHS Policy on Tribal Consultation.
SAMHSA participates in regional meetings with other
agencies and tribes.
• Circles of Care was developed over 5 year period,
beginning with exploratory meeting at the National
Indian Health Board.
• An advisory committee of tribal leaders and providers
in the field developed the concept for the grants.
Special Journal Edition, U of CO
• American Indian and Alaska Native Mental
Health Research, V.11, #2, 2004
• Circles of Care I, outcomes
• http://uchsc.edu/ai/ncaianmhr/journal/11(2).pdf
Circles III, New Announcement
• Announced December 16, 2004
• Due date: February 25, 2005
• Notification planned to all tribal programs,
urban Indian programs, TCU’s
• TA for prospective applicants, January 2005
• www.samhsa.gov
SAMHSA - New Address
• 1 Choke Cherry Road, Rockville MD, 20857
– Center for Mental Health Services
– Center for Substance Abuse Treatment
– Center for Substance Abuse Prevention
• [email protected]
• (240) 276-1926
Systems of Care Philosophy:
A Native Perspective on the National
Initiative
Andy Hunt, MSW
NICWA
Director of Community Development for
Children’s Mental Health
System of Care Principles
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Family Focused
Culturally Competent
Community Based
Accessible
Individualized
Least Restrictive
Accountable
Interagency
Coordinated & Collaborative
Family Focused
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Not about only children
Not about only parenting
“Family” is defined by the community
Families are involved as key partners at every
level of the system, from direct service to policy
and evaluation
Cultural Competence
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Awareness and acceptance of difference
Awareness of own cultural values
Understanding the “dynamics of difference”
Development of cultural knowledge
Ability to adapt practice to fit the cultural
context of the client/family
Cultural Competence
• At the system level…
“A set of congruent behaviors, attitudes, [practices] and
policies that come together in a system, or
agency…and enable that system, or agency… to work
effectively in cross-cultural situations”.
(Cross, et. al)
Community-Based
• Children should be served in their own
community by people from the community
• The community should shape and drive the
design of the system
• The system should reflect the values of the local
community
• Community members should remain an integral
part of the service delivery and planning process
Accessible
• Children and families should be able to get all
necessary services with ease
• Elimination of barriers to service:
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Physical/Geographic Location
Policy, Procedures and Processes
Language and culture
Stigma and perceptions
Funding restrictions
Individualized Care
• Assessments that are based on discovering the
strengths of each child
• A “plan of care” that is truly unique to meet the
needs of each individual child
• A wraparound approach that respects
individuals
• Services are flexible and adapted to the family
Least Restrictive
• Children should remain in their own homes and
communities or in the most home-like setting
possible
• Creativity is needed to develop alternatives to
more restrictive service models and keep
children in their own communities
• Group residential treatment should be avoided
unless clinically indicated
Accountable
• Everyone in the system is answerable to each other to
meet the needs of the children being served
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The system to the community members
The system to the funding source
Service providers to the families
Service providers to their supervisors
Partners agencies to each other
Standards of practice and ethics
Interagency
• Systems of care involve multiple agencies to
meet the multiple needs of children and families
• Interagency agreements are formalized
• New partnerships are sought out
• Care is taken to build relationships between
agencies at service level, and leadership level
Coordinated and Collaborative
• Agencies and other partner organizations work
together cooperatively towards the same goals
• Each agency, partner and stakeholder has input
and offers resources to meet the community’s
goals
• Everyone is on the same page, and everyone
knows and understands their role in working
together to meet the goals
Partnership in Action:
The Indian Children’s Mental Health Initiative
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SAMHSA (CMHS & CSAT)
Indian Health Service (IHS)
Department of Justice (DOJ)
National Indian Child Welfare Association (NICWA)
Circles of Care Evaluation and Technical Assistance
Center (CoCETAC)
• American Institutes for Research (AIR)
• American Indian/Alaska Native Communities
Systems of Care
Children’s Mental Health Program
• Program funded though CMHS began in early 1990’s
for State, Counties, and Cities as 5 year grants
• First Tribe funded in 1994 (Navajo)
• Grants extended to 6 years in 2001
• US Territories are eligible to apply as of 2003 when
grants became “cooperative agreements”
• Plan, design and implement a children’s mental health
system of care
• Target population: Children with Severe Emotional
Disturbance and their families
Native CMHS Service Sites
(6 Year Implementation Grants)
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Navajo Nation – NM (Graduated 1999)
Passamaquoddy Tribe – ME (Graduated 2003)
Sacred Child Project – ND (Graduated 2003)
Saulte Ste. Marie Chippewa Tribe – MI (Graduated
2004)
Northern Arapaho Tribe – WY (Graduated 2004)
Oglala Sioux Tribe – SD (Year 6)
Yukon Kuskokwim Health Corp. – AK (Year 6)
United Indian Health Services – CA (Year 5.5)
Native CMHS Service Sites
(6 Year Cooperative Agreements)
• Fairbanks Native Association – AK (Year 3)
• Choctaw Nation – OK (Year 3)
• Urban Trails Project – CA (Year 2)
Circles of Care Grant Program
• 3 Year grant funded though CMHS
• Tribal and Urban Indian programs
• Plan, design and assess feasibility of implementing a
culturally appropriate system of care
• Target population: American Indian/Alaska Native
children with Severe Emotional Disturbance and their
families
• Goal to give grantees opportunity to compete for
System of Care implementation grants
Tribal System of Care Communities
= SoC
= CoC I
= CoC II
For more information visit some of the
following websites:
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www.nicwa.org
www.systemofcare.net
www.air.org/tapartnership/
http://mentalhealth.samhsa.gov/cmhs/Childrens
Campaign/default.asp
• http://www.uchsc.edu/ai/coc/
Tribal Perspectives on
Wraparound and CommunityBased Strategic Planning
Ethleen Iron Cloud Two Dogs
Oglala Lakota Nation
Annette Squetimkin-Anquoe
Puyallup Tribal Health Authority
Participatory Evaluation
Mary Phillips, BME
Former Circles of Care Program Coordinator, Oakland and
an Evaluator, Los Angeles, CA
It’s Not Just an Evaluation Methodology
• “We all have a lot in common. We all care very deeply about the
communities that we come from and about American Indian and
Alaska Native communities across the country. We all share deep
concern about the well-being and future of Indian children and
families. We are all very self-sacrificing. We are in this business
because of our personal beliefs and our desire to make a
difference. Our personal backgrounds, our training, our
education, and our professional experience all contribute to our
desire to make a difference.”
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Holly-Echo Hawk, M.S., Echo Hawk and Associates
It’s Not Just an Evaluation Methodology
• Participation Evaluation is a key component of the
systems of care evaluation process that informs the
mission, vision and authority of the Tribe/community
throughout the Circles of Care program.
• Participation evaluation allows the community to
voice its cultural values and promote cultural
appropriateness in systems changes development at all
levels.
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It’s Not Just an Evaluation Methodology
• The Circles of Care initiative represented one of the
first opportunities for American Indian/Alaska Native
AI/AN families and their communities have substantial
input into the design of services to address the needs of
their children, from their own understanding of these
needs.
• The Standard Infrastructure Program Announcement,
INF 05 PA and the Circles of Care III NOFA have
included community involvement and participation
measures that you MUST address throughout the
application and are considered in the review process.
How it Works
• blends evaluation process
components to actively involve
members of the community to
collect qualitative data that better
informs the system.
• Having members who are
knowledgeable about cultural
norms of the community bared an
unobtrusive context to present
systems change.
The Process of Participatory Evaluation
• Planning the assessment will require a working
process between the project staff and evaluation staff
and the key informants of each community. Taking into
consideration the current status of delivery systems for
Native youth and mental health, developing the
assessment tool(s) was pivotal in getting necessary
information on contextual issues of the system.
• Example: Community Readiness Model was developed
at the Tri-Ethnic Center for Prevention Research at
Colorado State University to measure systems change
in Native American and other communities.
Community Readiness Model
• An innovative methodology to evaluate systems
change and focus community efforts toward
realizing its objectives. It identifies
characteristics related to problem awareness and
readiness for change within the community,
fostering sound strategic planning, ongoing
feedback, and realistic assessments of
accomplishments.
Community Readiness Model
• The tool focused on collective information from these
Native American resources: 3 community identified
leaders, 3 agency directors, 2 cultural advisors, 3
community members and 2 youth group
representatives.
• Input from key stakeholders and community members
was collected through interview questions related to:
– Community Efforts, Knowledge of Efforts, Leadership,
Community Climate, Knowledge About the Issues,
Resources for Prevention Efforts.
Community Readiness Model
• The information collected allowed our program
to measure where the urban Native American
community stands with respect to its knowledge
and readiness to implement a specific program
(Strategic Plan for Urban Native Americans and
their families Oakland, CA
Ongoing Particpation
• The evaluation participation process also incorporated
resource development within the community. Linkages
were made throughout the project as community
coordinators and cultural leaders were provided
information on the core elements of the system of care.
This process required continuous interaction between
agencies and cultural groups that concentrated the
efforts to achieve child and adolescent behavior goals
among agencies and family empowerment through
focus groups.
Items from Standard Infrastructure
Program Announcement and Circles of
Care NOFA
• Respond to each of these required information items
with statements to let the reviewer know what work has
been done; the work that the program intends to do;
and how you will address each issue.
• Though not all requirements listed here are given
points, providing this information can help understand
the ability of the program to connect and involve the
community.
• These should be written in Sections B. Proposed
Approach, C. Staff, Management and Relevant
Experience, D. Evaluation and Data
Items from Standard Infrastructure
Program Announcement and Circles of
Care NOFA
• Program Goals:
– Engage their community members in assessing service
system needs, gaps, potential resources, and plan
infrastructure development strategies that meet those needs.
– Increase the participation of families, tribal leaders, and
spiritual advisors in planning and developing service systems
and treatment options based on the values and principles of
the AI/AN community served by the project.
– (Circles of Care III NOFA, p.2)
Items from Standard Infrastructure
Program Announcement and Circles of
Care NOFA
• Grantees must use funds to carry out the
following required activities:
– Facilitate culturally respectful strategic planning
activities engaging community members, key
stakeholders, youth, elders, spiritual advisors, and
tribal leaders to identify outcome expectations and
measures; (Circles of Care III NOFA, p.3)
Items from Standard Infrastructure Program
Announcement and Circles of Care NOFA
• In “Section D: Evaluation and Data,” add the following
bullet:
– Describe how project staff will work with evaluation staff to
support the evaluation effort. The program planning
activities and the evaluation activities will be expected to
inform each other in a constant cycle, locally and
collectively. (Circles of Care III NOFA, p.12)
• The Circles of Care process values participatory,
community-based outcomes that are reflected heavily
in the planning process.
Items from Standard Infrastructure
Program Announcement and Circles of
Care NOFA
• Providing a venue for the Tribal/community to receive
information and respond to with appropriate audience
members can include meetings at all levels within the
community.
• Example: Two community-visioning meetings were
conducted at 2 separate locations within the
community, and were documented based on invited
quests, attendance, activities planned to collect
feedback, and information passed on to community
participants. This type of community visioning
planning resulted in setting priority areas to build a
Youth Development Facility.
Community Vision
Native American Youth Development Facility
A Visioning Meeting On Community Priorities Held July 28 th, 2001
The Community has spoken through valuable input on community needs at the first of
several community visioning meetings for the Youth Development Facility. Compounded
interests created a face for delivery services to be later realized after the facility is
established.
Needs assessment of the community’s priorities have reached new
perspectives as participants were given the opportunity to give a direct voice on what
they consider to be a model vision for youth .
Priorities
focused on monies to be spent on curriculum-based programs for youth
expanding the areas of academia, computer science, technology, fitness, sports, and a
centralized community location for youth social and cultural events. Developing areas in
innovative directions in response to needed youth services include fine arts, an American
Indian public charter high school and affordable housing.
Goals
in correspondence to the our Youth Services Department are to develop and
implement youth programs through assets within the community. Building consensus on
every level of program structure and to maintain youth involvement throughout this
process has created positive reinforcement in intervention and prevention, a basis for
youth ownership.
Community Assessment Of Priorities | Youth Development Facility
Paper Money Amount Given to Community
Total $13,733,000
1) Housing
2) Computer Training Center
3) Gymnasium
4) AIPCS High School
5) Cultural Arts Center
6) Youth Business Center
7) Outdoor Space
8) Kitchen
9) Multipurpose Community Room
10) Fitness Center
$785,000
$560,000
$908,000
$2,653,000
$1,017,000
$2,150,000
$1,129,000
$1,160,000
$1,561,000
$1,810,000
Participatory Feasibility Assessment
• Complete the feasibility assessment and process
evaluation, leading to adoption of the model. (Circles
of Care III NOFA, p.4)
– Strengthening Tribal capacity for evaluation of service
systems through ongoing involvement with staff and
evaluation partners.
– Careful deliberation on setting up effective strategies with an
“evaluation team”, to engage all participants that have a stake
in the evolution of the infrastructure.
– This integration of tasks contributes to and OPEN style of
communication that in turn enhanced the collaboration of
evaluation and program staff.
Participatory Evaluation related to
President’s New Freedom Commission
Goals
• The agenda of the President’s New Freedom
Commission’s Report towards a transformation of
mental health systems states:
– 2. Mental Health Care is Consumer and Family Driven
• Involve consumers and families fully in orienting the mental health
system toward recovery. (Circles of Care III NOFA, p.5)
• The consumer of the community has a voice in the
process and is able to tell their story at the point in the
process they choose.
• Parents are empowered through ongoing interaction in
the process.
Participatory Evaluation related to
President’s New Freedom Commission
Goals
• Circles of Care approach emphasizes flexibility as
stakeholders shift positions and encourage converge of
a the cultural knowledge base within children’s mental
health.
• Example: A parent that attends parent focused support
groups from the AI/AN clinic and has a child receiving
services that is also attending the school in the same
community will better inform on how services are
impacting the service needs and accessibility.
Participatory Evaluation related to
President’s New Freedom Commission
Goals
• The outcome of involving parents can result in a
cultural definition of Severely Emotionally Disturbed:
– “Emotional disturbance is a temporary disharmony often
involving the family, school, and community, which may
affect the mental, physical, spiritual, and/or emotional well
being of its members.” Choctaw Nation of Oklahoma, Circles
of Care I grantee.
Evaluation to Support Strategic
Planning in Indian/Native
Communities
Doug Novins, PhD
Candace Fleming, PhD
The Role of the Evaluation in CoC
• Provide a knowledge base for the planning
effort
• Facilitate the process for developing the
capacity for ongoing evaluation efforts
• Examine the feasibility of the service system
models
• Document and disseminate the results of the
initiative
Key Differences:
CoC versus Typical Evaluation
• In CoC, evaluation provides important
information (“data”) that is used in the planning
effort
A Typical Evaluation Model for Strategic Planning
Efforts
Design Service System
Model
Assess Service System Model
(Feasibility Assessment)
Refine Service System
Model
Assess Planning
Effort
(Process Evaluation)
The Circles of Care
Evaluation Model
Assess Needs and Existing Services
Measure Development
Design Service System
Model
Assess Service System Model
(Feasibility Assessment)
Refine Service System
Model
Assess Planning
Effort
(Process Evaluation)
Key Differences:
CoC versus Typical Evaluation
• In CoC, evaluation provides important
information (“data”) that is used in the planning
effort
• In CoC, the evaluator is a full participant in the
planning effort, and not an outside “objective”
observer
A Typical Evaluation Model for Strategic Planning
Efforts
Program
Staff
Evaluator
The Circles of Care
Evaluation Model
Program
Staff
Evaluator
The Circles of Care
Evaluation Model
Program
&
Evaluation
Team
Key Differences:
CoC versus Typical Evaluation
• In CoC, evaluation provides important information
(“data”) that is used in the planning effort
• In CoC, the evaluator is a full participant in the
planning effort, and not an outside “objective” observer
• In CoC, the community is an active participant in
designing and implementing the evaluation plan, not
simply the “target” of evaluation activities
A Typical Evaluation Model for Strategic Planning
Efforts
Program
Staff
Evaluator
Community
The Circles of Care
Evaluation Model
Community
Program
&
Evaluation
Team
The Circles of Care
Evaluation Model
Community
Program
&
Evaluation
Team
Components of the Evaluation
Outline Goals
Marshal Resources
Components of the Evaluation
Outline Goals
Marshal Resources
Assess
Community
Needs
Define Serious
Emotional/Behavioral
Disturbance
Describe
System of
Services
Components of the Evaluation
Outline Goals
Marshal Resources
Assess
Community
Needs
Define Serious
Emotional/Behavioral
Disturbance
Design/Modify the Service
System Model
Describe
System of
Services
Components of the Evaluation
Outline Goals
Marshal Resources
Assess
Community
Needs
Define Serious
Emotional/Behavioral
Disturbance
Describe
System of
Services
Design/Modify the Service
System Model
Develop Outcome
Measures
Components of the Evaluation
Outline Goals
Marshal Resources
Assess
Community
Needs
Define Serious
Emotional/Behavioral
Disturbance
Describe
System of
Services
Design/Modify the Service
System Model
Develop Outcome
Measures
Assess Feasibility
Components of the Evaluation
Outline Goals
Marshal Resources
Assess
Community
Needs
Define Serious
Emotional/Behavioral
Disturbance
Describe
System of
Services
Design/Modify the Service
System Model
Assess Planning Effort
(Process Evaluation)
Develop Outcome
Measures
Assess Feasibility
Our Role and Mandate
• To provide a clear framework for the grantees to
use in designing their evaluation efforts
• To allow the grantees to design an evaluation
effort that is most consistent with the priorities
of their communities.
• To facilitate a process for identifying common
domains for each of the evaluation components.
Our Role and Mandate
• To provide a clear delineation of CoCETAC and
grantee roles and responsibilities in the
evaluation effort.
• To provide consistently high quality technical
assistance through a specific set of activities.
CoCETAC Technical Assistance Activities
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Grantee Meetings
Evaluator Meetings
Site Visits
Scheduled Technical Assistance Conference Calls
Ad Hoc Conference Calls and Email Exchanges
Detailed Reviews and Critiques of Evaluation Reports
Maintain World Wide Web Site
CoC Distribution List
Grantees Role and Mandate
• Development of site specific domains, constructs, and
measures
• Obtain necessary IRB and other research approvals
• Data collection, reduction, and analysis
• Provide site-specific content to CoCETAC website
• The writing and submission of local interim and final
reports.
AIANP Resources
on the World Wide Web
• AIANP
– http://www.uchsc.edu/ai
• CoCETAC:
– http://www.uchsc.edu/ai/coc
• NCAIANMHR
– http://www.uchsc.edu/ai/ncaianmhr
• The Healthy Nations Initiative
– http://www.uchsc.edu/ai/hni
Former Circle of Care Grantee
Experiences
Ethleen Iron Cloud Two Dogs
Oglala Lakota Nation
Annette Squetimkin-Anquoe
Puyallup Tribal Health Authority
Cultural Collaboration:
The Evaluators’ Role
Brenda Freeman, Ph.D.
Kenneth Coll, Ph.D
Friere on Oppression
• Domination, aggression and violence are an
intrinsic part of human and social life. Few
human encounters are exempt from oppression
of one kind or another because by virtue of race,
class, or gender, people tend to be victims
and/or perpetrators of oppression.
People’s knowledge/expert knowledge
•O Officially sanctioned knowledge
•K Knowledge pipeline – reversing the flow
• “We should not be objects of observation for those
who do nothing to help us.” (Vine Deloria, Jr.)
•G Massacres, history as the tale of the victors
Question 1
In what ways might an evaluator contribute to
oppression?
Cultural Challenges to Evaluators
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“Status”
“Expertness”
Privilege
“Proceeding in the right way”
Paternalism (the culture of the project is not
authenticated)
• Being seen as an “Indian agent” for the
government (historical mistrust)
Cultural Challenges to the Project
• Dealing with the two-sided issue of “unequal
credentials”
• Example: a Ph.D.(“western education”) vs.
indigenous/traditional knowledge
Question 2
How does the evaluator interface with project
staff?
Participatory Research (PAR) Model
– Community ownership and leadership of the
evaluation process (e.g., survey design,
methodology, data analysis and results
dissemination).
Comparison
Initiative Background Role of
Evaluator
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Outcome
Externally
driven
Credentials
Works “on
behalf of”
Internally
driven
People’s
knowledge
Works “with” Builds
capacity
Dependent
Question 3
• What evaluator attitudes and behaviors promote
project success?
Collaborative Goals
• Evaluator:
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A mirror
Part of the circle
As a “passenger, not the driver”
With and for – not on behalf of
A tool, and an equal
Values the culture, not overwhelms it
Question 4
• How does the culture of the staff fit with the
characteristics of the evaluator?
Screening suggestions for selecting
evaluators
• Develop a culturally appropriate screening
method
• Screen for:
– Authenticity
– Genuineness, respectfulness
– Identity Achievement
Process after selection
• Orientation
• Community acceptance through on-going
interaction with community members on a
“human” level
Nagi Kicopi’s Culturally Collaborative
Practice
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Inipi
Local site sets the agenda
Cultural Trainings
Evaluation Trainings
Community ownership
Following cultural protocol
Review of NOFA Requirements
Circles of Care and Standard
Infrastructure Grants
Jill Shepard Erickson, MSW
Project Officer
Center for Mental Health Services
Application Review Information
Page 21, Infrastructure Grants
Page11, Circles of Care
Section A: Statement of Need,
10 points
• Describe target population, numbers, language, culture,
geography, and socioeconomic factors
• Document the need, tribal, state, SAMHSA data.
• Describe service gaps, barriers
– Describe stakeholders and resources
– Identify initiatives funded by Indian Health Service,
Department of Justice, other SAMHSA grants, etc.
– Describe how initiatives will be coordinated
• Describe needs related to priorities of state, county, or
tribe. (Copies of strategic plans in Appendix 5)
Section B: Proposed Approach
35 Points
• State purpose with goals, objectives per NOFA and
community
• Describe proposed project
• Provide logic model
• Describe advisory body
• Describe partner organizations, (letters of commitment
in Appendix 1)
– Describe and include community schools and tribal college if
available
Section B continued
• Describe how age, race/ethnicity, culture, language,
sexual orientation, disability, and gender will be
addressed
• Describe how members of the target population have
been and will be involved in proposal
• Describe potential barriers
• Describe how activities will improve substance abuse
prevention and treatment and/or treatment of mental
health services
• Provide a plan for sustainability
Section C: Staff, Management, Relevant
Experience - 25 points
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•
•
•
Time line on chart or graph, (include within narrative)
Capability and experience with target population
List staff and roles each will play
Describe racial/ethnic and linguistic characteristics of
staff, re target population
• Describe resources, facilities
Section D: Evaluation and Data
30 points
• Describe the process and outcome evaluation, performance measures and
target outcomes re goals and objectives
• Describe ability to collect and report required performance measures per
NOFA
• Describe plans for data collection, management, analysis, interpretation and
reporting (instruments in Appendix 2)
• Describe reliability and validity of evaluation methods and instruments per
gender/age/culture of target population
• Describe how collection, analysis, and reporting of data will be integrated
• Describe how project staff will work with evaluation staff to support the
evaluation effort, informing each other in a constant cycle, locally and
collectively
Evaluation and Data #2
GPRA Measures (Preliminary)
Document plan for collecting and reporting:
1. Involvement of community leaders, consumers and
families in planning, policy development and strategy
for treatment planning implementation in:
– quarterly reports
– Completion of cross-site evaluation tasks
– Minutes from community planning meetings
Evaluation and Data #3
GPRA Data
2. Plan for documenting improved access to
quality care for AI/AN children, youth and
families of community, examples include:
– New sources of funding
– Increased use of telemedicine, telepsychiatry
Evaluation and Data #4
GPRA Measures
3. Adherence to the TA guidance provided
– Products developed
– Timely completion of phases of activities
– Feedback on satisfaction with TA provided
Individual clinical/patient data will not be collected
SAMHSA Standard Grant
Announcements and NOFA’s
Basics of the Funding Opportunity
FY 2005
Jill Erickson, CMHS Project Officer
Four Standard Grant Announcements
1. Infrastructure: Increase capacity of service systems
to support effective programs and services
2. Services: Funding to implement services
3. Best Practices Planning and Implementation: ID
practices and adapt for pilot-testing
4. Service to Science: Document and evaluate
innovative practices to fill gaps, not yet formally
evaluated.
Notice of Funding Availability
(NOFA/Circles of Care)
• Used in addition to a Standard Grant Announcement
• Specifies purpose, target population, issue area, and
other requirements of the program
• Identifies funding, expected size and number of awards
• Provides deadline
• Specifies eligibility, allowable activities,
evaluation/GPRA requirements.
Application and Submission
• Call for kit to be mailed,
– Mental Health: 1-800-798-2647
– Substance Abuse: 1-800-729-6686
• Download from www.samhsa.gov, “grant
opportunities”
• Download from www.grants.gov.
Infrastructure Grants,
Basic Expectations
• Allowable Activities
• Data and Performance Measurement:
Government Performance and Results Act of
1993, GPRA
• Grantee Meetings
• Evaluation
Application Requirements
• Application Kits contain the following and must
be used:
– PHS 5161-1 Application forms: face page, budget
forms, assurances, certification, and checklist
– Program Announcement (PA)
– Notice of Funding Availability (NOFA), as
published in the Federal Register, www.samhsa.gov,
and www.grants.gov .
Required Components
• Face Page: SF 424, part of PHS 5161-1.
– Including a Dun and Bradstreet (DUNS) number,
obtainable from www.dunandbradstreet.com, or 1-866705-5711
•
•
•
•
•
•
Abstract: 35 lines maximum, used in publications.
Table of Contents
Budget Form: SF 424A
Project Narrative and Supporting Documentation
Appendices
Assurances, Certifications, Disclosure of Lobbying,
and Checklist
Application Formatting Requirements
• Non compliance results in proposal being
screened out prior to review:
– Type size in narrative cannot exceed an average of
15 characters per inch. (excludes type size within
charts, graphs, footnotes)
– Text cannot exceed 6 lines per vertical inch
– White paper, 8.5inch by 11.0 inch
– Margins at least 1 inch
– 25 page limit for narrative.
Formatting Recommendations
• Type single space in black ink, one column per page
• Number pages including cover page #1, Abstract #2,
Table of Contents through the Appendices.
• 30 page limit for Appendices
• Send original and 2 copies to mailing address in
Section IV-6.1.
• No staples, paper clips, fasteners, heavy papers,
posters, CD-ROM’s, etc.
• Proposal must be easily copied.
Electronic Submission Option
• Use the www.grants.gov apply site
• Find application package by CFDA #
• Download copy of application package,
complete off line
• Submit via www.grants.gov, e-mail submissions
not accepted.
• Use Microsoft, font Times New Roman 12, or
PDF files.
Prior Requirements for Electronic
Submission (allow 2 wks+)
•
•
•
•
•
•
•
Obtain DUNS number
Obtain Central Contractor Registry (CCR)
Obtain Credential Provider registration
Obtain Grants.gov registration
User guide available at www.grants.gov,
Or e-mail: [email protected]
Or call 1-800- 518-4726, 7:00 am-9:00 pm, Eastern,
Monday through Friday.
Back Up Paper Submission
•
•
•
•
Label as “Back up for electronic submission”
Paper copy must meet “postmark” requirements
If both received, electronic version will be official
Automatic acknowledgement from Grants.gov with
Grants.gov tracking number
• Electronic signatures cannot be accepted now, so
signed paper originals of face page, assurances, and
certifications must be mailed, referencing the
grants.gov tracking number, within 5 business days of
the electronic submission.
Budget Form
• SF 424A, from the 5161-1
• Fill out Sections B, C, E.
• Follow the sample budget and justification from
Appendix D of Standard Announcement
• Include figures for each year of the grant
• Total budget will include direct cost and
negotiated indirect cost rate.
SAMHSA’s Guidelines for Assessing Cultural
Competence
• Experience with the
target population
• Training and staffing,
gender/age/cultural
competence
• Language
accommodations
• Materials appropriate for
target population
• Evaluation, methods and
instruments appropriate
for population
• Community
representation on boards
• Plan for implementation
Part II
• General Policies and Procedures Applicable to
all SAMHSA Applications for Discretionary
Grants and Cooperative Agreements.
• Used in addition to the Program
Announcement/NOFA and Standard Grant
Announcement
• Contains the Cultural Competence
Confidentiality, Participant
Protection, Human Subjects
Mary Phillips, M.A.
Kenneth M. Coll, Ph.D.
Brenda Freeman, Ph.D.
Part of Section D of the NOFA:
Evaluation and Data
• “Applicants must document their ability to
collect and report required data”, including:
– Evidence of involving community key informants
(e.g., families, leaders) in the process
Such Involvement will include
• Descriptions of Plans for:
–
–
–
–
Data Collection
Data Management and Analysis
Data Reporting
Existing Approach to the collection of data
Data Collection
• Confidentiality and Participant Protection (of Human
Subjects) through:
– Informed consent from the Participant, including:
•
•
•
•
•
•
•
•
•
Purpose and background
Procedures for collecting the data
Description of risks/discomforts
Benefits
Costs
Payments
Questions
Voluntary consent (signed)
Participant Bill of Rights (Safety Monitoring Plan)
Data Management and Analysis
• Confidentiality and Participant Protection (of
Human Subjects) through
– Data entry person(s) signs a confidentiality
statement
– Works from a secure location and computer
– Trains in HIPPA guidelines
– Enters data without identifying information (e.g,
names, other identifications)
Continued
• Confidentiality and Participant Protection (of
Human Subjects) through
– Securely storing raw data in a locked file cabinet for
a specified period of time then shredded
Continued- Inclusion of Children
• Informed consent is needed from both the youth
(if at an age of understanding) and the
caregiver(s)
• SEE EXAMPLE
Data Reporting
• To Whom?
– Key informants (e.g., families, community leaders and
members, service providers)
• How often?
– Monthly
– Quarterly
– Semi-annually
• In what formats, venues?
– e.g., Radio, newspaper, executive summaries, newsletters
Existing Approach to the Collection of
Data
• Description of Current Management
Information System
Data Collection Instruments/Interview
Protocols?
• See examples
• Reliability and validity of evaluation methods
and instruments in terms of gender/age/culture
of the target population
– Community based-committee in development stage
– Focus groups
– Piloting
An Introduction to Logic Models
Kenneth Coll, Ph.D. and Brenda Freeman, Ph.D.
A Circles of Care Planning Logic Model
• A road map (or picture) of the planning process for your
program, highlighting overall how you plan to go about the
planning process, including:
– Some of the beliefs (conditions, assumptions, or background
factors) that will drive the planning process in your community
– The goals of the planning process (hoped for outcomes)
– Examples of the planning activities your community might engage
in to reach the goals
– The participants involved in the planning process
– Desired overall impact of the planning process itself
(adapted from W.K. Kellogg Foundation)
Definition of a Logic Model
• SAMHSA Infrastructure Grant Glossary:
– “A logic model is a diagrammatic representation of a
theoretical framework. A logic model describes the logical
linkages among program resources, conditions, strategies,
short-term outcomes, and long-term impact.”
– Logic Model Should Include:
• Identified need
• Proposed approach
• Outcomes
Logic Model for Circles of Care
•
A visual representation of answers to these
questions…
1. Based upon information gathered from other projects
or what you know from experience, what are some of
the needs of your community related to mental health
and related services for troubled youth and their
families? (Needs)
2. Keeping those needs from #1 in mind, at the end of
the three year planning process what is your overall
dream related to the planning of services for children
and families? (Impact)
Logic Model Planning Questions
3. What concrete changes will need to occur in
the community related to the planning of
mental health services for children and
families in order to reach your dream?
(Outcomes)
4. What are you going to do to bring about the
changes that are part of, or the result of, the
planning process? (Proposed Approach)
Logic Model Planning Questions
5. What groups would be impacted by changes in the
delivery system for mental health and related fields?
(Participants in the Planning Process)
6. How will others—and you--know if the outcomes in #3
above are being reached? (Measures)
7. Why do you believe the activities (#4 above) will lead
toward the outcomes (#3 above) you hope to
accomplish? (Change Theory)
Visual of a Logic Model
Needs
Assumptions About Change
Goals
Goal
Activities
Outcome
Activities
Outcome
Activities
Outcome
Activities
Outcome
Measures
Impact
Planning Form for a Circles of Care Logic
Model
Needs of
Community
Related to
MH &
Related
Services for
Children &
Families
Impact
What you
hope to have
accomplished
at the end of
the project.
Desired
Outcomes
(more
specific than
impact)
Proposed
Approach
(Activities
that will lead
to the
outcomes)
Strategies
If---Then
Assumptions
&Theory of
Why Change
Will Occur
Day 1 Wrap up
• Understanding Circles of Care
• The Basics of the Funding Opportunity
• Working Session on Developing a Logic Model
• Have a nice evening – see you in the morning!