Unifying different worlds together: Developing

a culturally appropriate approach to

comprehensive mental health services
evaluation in tribal communities
Betsy Lopez, Sushama Rajapaksa, M.A., Chandria Jones, Ph.D., M.P.H., Craig Love,
Ph.D.,
Joselin Bravo, B.S., Affoue A. Sara Ayemonche, B.S., June Crandall, M.A., Carol Hagen,
Ph.D., and Abram Rosenblatt, Ph.D.

Funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) through
the Child, Adolescent and Family Branch, Center for Mental Health Services

Kirstin Painter, PhD, SAMHSA Contracting Officer Representative

Emily Lichvar, PhD SAMHSA Alternate Contracting Officer Representative
Disclaimer

The views, opinions, and content expressed in this

presentation do not necessarily reflect the views,
opinions, or policies of the Center for Mental Health
Services (CMHS), the Substance Abuse and Mental
Health Services Administration (SAMHSA), or the
U.S. Department of Health and Human Services
(HHS).
 Acknowledgements of the
Tribal Workgroup

Gary Bess Candace

Holly Echo- Fleming
Hawk Brenda
Puneet Sahota Freeman
Dan Foster Craig Love
 Focus of this Presentation

Provide an overview of the Childrens

Mental Health Initiative National
Evaluation
Describe the participatory approach
the National Evaluation Team is using
to engage tribes and Tribal
Communities in evaluation efforts
Present preliminary outcomes of this
collaborative process
 Overview of the Childrens Mental
Health Initiative National
Evaluation
Being conducted by Westat
Designed to:
Assess whether system of care (SOC) services and
supports are expanded
Compare how expansion was implemented to how it was
planned
Explain how expansion changed in response to external
barriers or facilitators
Assess the impact of SOC services on health and
behavioral health outcomes, educational attainment,
living environment, social connections, and quality of life
Assess whether expansion and impacts varied by type of
award (state or local)
Describe factors that are associated with successful
expansion
Framework for National
Evaluation
 Instrumentation and
Measures
Instrumentation Analytic Dimension State Timing
or
Local
Key Partner Interviews Policy/Partnerships; Both Years 2 & 4
Training/Workforce; Financing;
Strategic Communications
Financial Mapping Financing Both Years 2 & 4
Benchmarking Financing State Years 2 & 4
System of Care All Both Year 2 start &
Expansion and annually
Sustainability Survey
(SOCESS)
Child and Family Services/Supports Local Years 1-4; at 6
Outcome Study month
Intervals
(while
receiving SOC
services) and
at discharge

Network Analysis (Across Policy/Partnerships Both Years 2 & 4

State and Local Levels
 History of Evaluation in
Tribal Communities
Recognize the need for program
evaluations to help reduce behavioral
health challenges in tribal
communities
Many examples of challenges in the
data collection and use process
Need for research and evaluation to
be conducted in a collaborative and
respectful manner
SAMHSA Supports for Tribal
Evaluations
National Tribal Behavioral Health
(NTBH) Agenda
Center for the Application of
Prevention Technologies (CAPT)
Tribal Training and Technical
assistance (TTA)
CMHI National Evaluation Tribal
Workgroup
 Process for Collaboration
Developed a Tribal Work Group consisting
of Native Professionals who specialize in
childrens behavioral health
Facilitated meetings in which Tribal
Workgroup members reviewed current
National Evaluation instrumentation
Discussed how instrumentation could be
adapted for effective use in tribal
communities
Worked with the Tribal Workgroup to
identify challenges and solutions for
Tribal Workgroup Activities
 Challenges related to SOC
Implementation and
Evaluation
Mistrust
Forced adaptations
Diversity across tribal
communities
Often tense relationship between
Tribal Communities and states
Local tribal capacity
 Instrumentation Review

1. Suggested language
improvements
2.Recommended addition of
culturally
specific services
3. Encouraged the use of open
ended questions to create an on-
going dialogue
 Instrumentation Review

1. Suggested language
improvements
 Instrumentation Review
2.Recommende
d addition of
culturally
specific services
Recommendations for Data
Collection Efforts
Make sure to get buy in
Emphasizes the value of
participating in the National
Evaluation to the local community
Connect National Evaluation to local
evaluation efforts
Create opportunities for tribes to
connect with each other
Recognize challenges to electronic
Finding the Balance
 Moving Forward

An on-going process, but with hopes

to positively influence participatory
approach in tribes and tribal
communities
Draft instruments and forms
specifically relevant for tribes to
engage child, youth and families in
the process
Provide continuous support and
services to better assess the needs
 Conclusions
Facilitate engagement among tribes
and tribal communities members in
SOC evaluation
Examine data collection instruments
to better address culturally specific
health issues in the lives of tribal
families and improve services in
communities
Document the collaborative process
so that it can be replicated in other
 Contact information

Betsy Lopez
E-mail: BetsyLopez@westat.com
Website: http://westatbl.weebly.com

For more info on CMHI National

Evaluation
E-mail: CMHIeval@westat.com