ࡱ> ikfgh#` Bbjbj\.\. f >D>Dd $ W W WP\W\W zPY(xY"YYY^^^$h~~A d]^ddAYYAVhhhd^Y Yhdhh߄ ^ YDY &# Wd" l0fD ^K`:hab ^^^AAg^^^^dddd   M W   W      American Indian COMMUNITY SUICIDE PREVENTION ASSESSMENT TOOL Contents: Page Community Identification History of the Reservation Life on the Reservation Population data Government Land Environment Reservation Water System Tribal Economy Recreation Activities Medical Facilities Housing Education Mortality Data Community Cohesion Family Integration Factors Identification of the Current Status of the Community Healing Process Review of Community, Tribal, Social and Mental Health Service Delivery Community Self-Helping Process Identification of Community Infrastructure Issues Review of Self-Continuity Factors Community Treatment Plan  Developed by R. Dale Walker, MD (2005) Adapted from SAMHSA at  HYPERLINK "http://www.sprc.org/library/catool.pdf" http://www.sprc.org/library/catool.pdf and Acting on What We Know: Preventing Youth Suicide in First Nations (Canada)  HYPERLINK "http://www.hc-sc.gc.ca/fnihb-dgspni/fnihb/cp/publications/preventing_youth_suicide.pdf" www.hc-sc.gc.ca/fnihb-dgspni/fnihb/cp/publications/preventing_youth_suicide.pdf INSTRUCTIONS: This Microsoft Word document is designed as a TEMPLATE for use by a variety of American Indian organizations. It is a combination of two separate instruments designed for Community assessment of suicide prevention components of the community. How to use this document: Open this document and Download it to your computer using the Save As drop down option of File on your word processor tool bar. Select the File Folder of your choice (example: tool kit) and hit Enter (or click Save). (Example: File/Save As/Tool Kit/Filename: American Indian Community Suicide Prevention Assessment Tool) The document contains text in RED/Plum and automatic font colors. The Automatic font is the tool outline with sample text to guide you. RED/Plum text signals information that varies from community to community and is included as an example. Make the RED/Plum font examples reflect specific information for your community. REMEMBER: When finished, change the font from RED/Plum to the color used in the rest of your document. Suggested uses of this tool: Internal program assessment and planning Background material for grant applications Extract selected sections and include in grants Use the entire tool as an Appendix in grant applications Please let us know your experience with this tool. Also, you may contact us for information or questions. Phone: 503.494.3703 Fax: 503.494.2907 Email: oneskycenter@ohsu.edu AMERICAN INDIAN COMMUNITY SUICIDE PREVENTION ASSESSMENT TOOL NOTE: Dark Red or Plum Ink is used to highlight phrases that differ across organizations. Text included in this assessment tool is an EXAMPLE of content that can be revised to fit specific tribal or organizational needs. 1. COMMUNITY IDENTIFICATION Original _____(Insert Tribe(s) Name_____________ Lands  The ___(Insert Tribe(s) Name _____ Reservation or Community  2. HISTORY OF THE RESERVATION (Community) The terms of the _(name)______ Treaty of _(Date)____ placed the __(tribe)_______ on one large reservation that encompassed parts of _(State)_________, and _(#)___ other states. After the United States defeated the Indian (tribe's name) the US Government broke the _(name tribes)_____ original reservation into several smaller ones. Not only did the U.S. government reduce the Indians acreage, it also splintered the Tribe. In _(year)____ the United States reclaimed ____ million acres of the ___(tribes)___ and moved the _______ to the ________ Reservation. Although the Reservation originally occupied ____ million acres, subsequent land confiscations by the government reduced the Reservations size to ____ million acres. 3. LIFE ON THE RESERVATION (IN THE COMMUNITY; NATION) The main economic activities on the ______________ Reservation are ______________. The Tribe has established various industries including a fairly successful casino and some light industry. Despite these efforts to establish greater economic activity on the Reservation, tribal members still face high unemployment and poverty. As a matter of principle, the __________ tribes never complied with the Indian Reorganization Act of 1935 and therefore do not receive their full share of government funding. This lack of government dollars, meager per capita income, and high unemployment intensify the housing and health problems on the Reservation. Many residents live in remote areas, far away from medical care and healthy food. Housing, both in remote areas and in towns, is in short supply, forcing many families to live in overcrowded conditions. Two out of three tribal members are jobless and residents annual income averages only $______.  4. POPULATION Total Population: _________ Residing On Reservation: _________ Registered: _________  Reservation: (insert Number) Districts and District Population: Insert District names & Population Data District NamePopulationDistrict NamePopulation 5. TRIBAL GOVERNMENT The Tribal Council consists of a ______, _________, a _____ and ____ additional Council people who are elected by the tribal members. The Tribal Council Chair is the head of administration of the Tribe. The Tribal Council Chair and Council serve a term of four years, six of them without regard to residence in any district or state. Each of the remaining members is elected from their District. The At-large Council members are elected by the Tribe. Statistics at a Glance Tribal/Agency Headquarters: (Insert name of town/city )Counties: (List Counties) Federal Reservation established: (List Year)Population of enrolled members: ____#______Reservation Population:____#__Density:______ persons per square mileLabor Force:___#____Unemployment percentage rate: (#%)Language: _____________ and English__________ Bands (or Clans): (give names of bands/clans) 6. LAND The ____________ Tribal members are descendants of the ____________. The Reservation is __(name non-rez city or town & state)______________. The ________ River runs along the _________ of the reservation and __________Creek in the ___________. The reservation ends at the __________ County lines in the west and the __________ on its east side. The southern line of ___________ Reservation ends with the ___________ line. The total land area of the _______________ is ___________ million acres and of that _______________ million is tribally owned. The land is an important part _________ peoples life. ____(insert other pertinent facts)_____. Land Status:AcresTotal Area ###,### Tribal OwnedTribal Owned AllottedTotal tribal ownedNon-Indian OwnedReservoir Taken area 7. ENVIRONMENT The following infrastructure (exists or was lost) to _____________ Tribes due to __________(insert treaty, Act, other reasons for loss of land)___________________: _#_ domestic water systems # acres of waterbed# rodeo arenas# ranch water systems# miles of main roads# race tracks# acres of land# housing units# sawmills 8. WATER Water is the key to increasing the quality of life and promoting full economic development on the ____________ Reservation. An adequate supply of good quality water is needed by many of the ___ ( # ) __Indians and __( # )__ non-Indians living on the reservation. Problems with water quality and inadequate supply are common throughout the reservation and have a detrimental effect on health and quality of life as well as deterring economic growth. The availability of a plentiful and high quality water supply is vital to the health and well being of those living on the ___________ Reservation. The level of health and quality of life of the general population is directly related to the quality of their domestic water supply. Many residents currently depend on poorly constructed or low capacity individual wells or have water hauled to __(underground cisterns, Other locations)___. These sources are often contaminated with bacteria or undesirable minerals, provide an inadequate quantity of water, and are costly to maintain and operate. _(Surface; Ground)_______ water is the major water source for the reservation with the __(Water source)______ providing by far the largest part of the surface water supply. Other reservation streams have extremely variable flow patterns and are not reliable enough for a year-round water supply. Groundwater is not as abundant as surface water and where available it is usually adequate for only small-scale use. For these reasons, __(Name)__ is the obvious sources for a reservation water supply system. There has been a serious water shortage over the past three years with drinking water being imported. The US and the tribal government are trying to resolve the difficulties using _____________(insert information as appropriate)________. 9. TRIBAL ECONOMY The _________________ Tribes major economic occupation is _____________. _____________ Tribe established various industries for the Tribe on the reservation (in the Nation) and plans to develop more enterprises. In the area of economic development, the Tribe currently operates the ______________________(name economic enterprises)_____. The district also operates businesses such as the _______________________________their local districts. __________ has a grocery store, ___________ has a convenience store/gas station, ____________ has a trading post and _________ has a laundromat. Enrolled members of ___________ own their own businesses: ___(name business owned by tribal members)_________________________. There are non-Indian owned businesses throughout the reservation, primarily in ________________________________. _(Agriculture? , list type of industry)____________is the primary industry on the ____________ Reservation and the key to the full development of this industry is water. Surface water in small streams, lakes, and dugouts is scattered throughout the area. Surface water, however, is an unreliable year-round supply and generally available only during the wet periods of spring. During drought periods, these sources of ten dry up, and livestock must be sold or moved off the reservation. Shallow groundwater is scarce and unreliable and deep groundwater, while generally more plentiful, is highly mineralized and of poor quality. This lack of an adequate water supply has also reduced the livestock production on the reservation. The grazing lands cannot be fully utilized and valuable resource is wasted. The lack of stability in the production of feeder-cattle also discourages related industrial development such as packing plants, cattle feeding and canneries. Hydrologic Setting: Shallow groundwater is not obtainable on much of the ______________________Indian Reservation, and where it is found, it is often of poor quality. Surface water, with the exception of the _____________ Rivers, though valuable and widely distributed resources, are undependable because of scanty and erratic precipitation. Artesian water from deeply buried bedrock aquifers underlies all of the reservation. These aquifers are not, and probably will not become highly developed sources of water because of the high-to-very-high salinity of artesian water in most of the area. 10. RECREATION ACTIVITIES The ______________________ Tribe has __#___ Casinos, the ____________ Casino located near ______________ and the _________ near ____________. Give information about when recreational facilities were developed. They are developing plans to build an _____________. Hotel and motel accommodations are located in __________________, the ___________ largest towns nearest the reservation. The Tribe District (Pow Wows (or major cultural events) DateType of event/NameLocation2nd Weekend in JuneMemorial Day Pow WowAny town, State ______________________College sponsors a Graduation Powwow ________. Chemical Prevention Program Annual Sobriety __________ Elementary School ________________ Veteran's Day _______________ Tribal Days _________________ Other recreational and honoring activities that have special meaning: _________ in _________ in memory of __________ _________ in _________ in memory of __________ Annual _________ events are held in the surrounding _________ Annual ______________at __________ (when)________ _______________________________ During the year, other sports activities such as basketball, softball, volleyball and horseshoe tournaments are also held in the districts. Water sports such as boating and fishing are popular along _______________________________ River. 11. MEDICAL FACILITIES The reservation is located in the U.S. Indian Health Services __________ Area. The I.H.S. operates a hospital at _________ and smaller clinics in the __________________________ districts. The Tribal Health Department provides a number of health services including the Community Health Representative Program, health education, eye examinations, eyeglasses, and Emergency Health Care including ambulance services. The Tribe also provides an elderly nutrition program and youth recreational activities. ______________________Reservation Hospital: The 12-bed hospital at ____________, has a staff of ________ physicians and a ________ unit that opened in ____________. Dental care is provided in the main hospital clinic by ________ dental officers, and in a mobile clinic by one dental officer. There are three LPN nurses and 13 registered nurses. An outpatient health center at ___________ has ___________staff physician. There are also health stations at _________________________. The health stations provide minimal outpatient care and are staffed by a physician's assistant, a public health nurse, and a community health representative. The health stations are visited at least once per week by a physician from the _____________ hospital. 12. HOUSING The ______________________Housing Authority constructs and manages over 650 homes for Tribal members living on the reservation. This includes homes on scattered sites built through the HUD Mutual Help home ownership program on individual land or Tribal land leased for home sites. The other housing in the districts is low-income HUD Low Rent for individual Indian residents in reservation communities. As private housing stock is limited, some of the ______________________members own their own homes in the rural areas through other private financing. The Bureau of Indian Affairs and the Indian Health Service have some housing available in __________ and ____________ for their employees. The Tribe plans to build a number of apartment complexes in the future. The need for housing is great on _________________. The Tribe is looking into Habitat for Humanity homes and the government Home Grant project. The average number of persons per household in the ______________________Service Area is __________ compared to _________ for ___(name state(s) or counties as appropriate)_____________. The average number of persons per household for all races in the U.S. is __(obtain data from Census Bureau)___________. 13. EDUCATION Schools providing K-12 educational services are located in every community on the reservation. The Bureau of Indian Affairs operates elementary and secondary schools in __________________. The Tribe also provides preschool education through the Head Start program. Public schools located in __________________________. A private parochial school, ____________, provides K-6 education in ___________. Post secondary education is available on reservation at _____________, which offers Associate Degrees including ___________________. A Bachelors Degree in Teacher Education is also offered in conjunction ____________ on the ___________________ Reservation in South Dakota. Four year colleges include:_____________________ For the __________ school year, there were _______ students enrolled in K 12 schools on the ______________________ reservation. Of this group, _________(__%) are American Indian students. Three elementary schools (_________________________-) and one high school (________ High School) have a student population that is ____% American Indian. Two school districts (_____________ and ________- Public Schools) have school populations that are ___% American Indian. On the other end of the spectrum, one school district (____ Public Schools) has an American Indian enrolment of ___%. Within all the schools on the ______________________ reservation, for the 200_ 200_ school year, there were _______ teachers. There were _______ American Indian teachers, or ______% of the total faculty. ______ schools had no American Indian teachers. _______ schools have _______ American Indian teacher. The greatest number of American Indian teachers was found in the Bureau of Indian Affairs School that has _____American Indian teachers in a faculty of ____________. DistrictsFunding SourceType of SchoolNameNumber TribalFederal (BIA)StateChurchElementaryMiddleHighState or County 14. MORTALITY DATA Descriptive information is provided _____ of the ____ completed suicides on or at the ______________. 1) __(Give history of medical, mental health, substance use, family, academic achievement, previous attempts and method used. Completed through _(cause of death___. 2) 3) Aggregated Suicide Data ______________________Reservation Act Occurred: Jan 00, 2000 Feb 00, 2005 Age Range: 15-19 years Total: 54 Report Totals (N) (%) Self Destructive Act: Ideation with Plan __ __ And attempt __ __ Complete Suicide __ __ Data not Entered __ __ Event Logged by: Medical Social Worker __ __ Mental Health Tech __ __ Sex: Male __ __ Female __ __ Employed: No __ __ Yes __ __ Data Not Entered __ __ Community of Residence: _____________ __ __ _____________ __ __ _____________ __ __ _____________ __ __ _____________ __ __ _____________ __ __ _____________ __ __ _____________ __ __ _____________ __ __ Relationship: Single __ __ Data Not Entered __ __ Education: Less than 12 yrs __ __ Some College __ __ _______________ __ __ High School Grad/GED1 __ __ Data Not Entered __ __ Method: Gunshot __ __ Hanging __ __ Stabbing/Laceration __ __ Overdose __ __ Car crash __ __ Other __ __ Previous Attempts: None __ __ 1 __ __ 2 __ __ 3 __ __ 4 __ __ _______________ __ __ Data Not Entered __ __ Substance Abuse Involved: None __ __ Alcohol __ __ Drugs __ __ _______________ __ __ Location of Act: Home or Vicinity __ __ Other __ __ Jail/Prison __ __ Data Not Entered __ __ Contributing Factors: Suicide of Friend/ relative __ __ Death of Friend/Relative __ __ Victim of Abuse (current) __ __ Victim of Abuse (past) __ __ Occupational/education prob. __ __ History of Substance Abuse/Dep __ __ Divorce/Separation/Break-up __ __ Financial Stress __ __ History of Mental Illness __ __ History of Physical Illness __ __ _______________ __ __ Other __ __ Intervention (Ideation/Att): No Action Taken __ __ Inpatient (voluntary) __ __ Inpatient (involuntary) __ __ Outpatient __ __ Other __ __ Data Not Entered __ __ 15. COMMUNITY COHESION Number of high-risk individuals (e.g. previous attempts as identified by community workers): Please explain: (Example: With high unemployment, isolation and a fragile economy, the use of alcohol and drugs are a major problem). Number of "children in care", in community placements: _#__ reported from child protective services. Out of community placements: _#___ at a given point in time. Number of non suicide deaths in the past two years through non-natural means by type (i.e. vehicle crashes, accidents, violence): ___________ Percentage of youth/children with addiction issues: at least ___% Percentage of adults with addiction issues: __% Number of family units with more than one family member with addiction issues: ___% Anecdotal accounting by community workers of abuse indicators present (physical, sexual and emotional): _______ Number of reported sexual assaults in past two years: _____________ Number of reported physical assaults in past two years: _______________ Number of family violence reports in past two years: _______________ Traumatic events that have happened in and to community include: _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Loss of respected Elders, leaders or others: Loss is _______________, but there have been some ___________________________________________________________________________________________________________________________________________________________________________________ 16. FAMILY INTEGRATION FACTORS Role of Elders in extended family systems (advisors, counselors, healers)? ____________________________________________________________________________________________________________________________________________________________________________________ Interaction patterns (conflict, co-operation) between extended family systems/factions? ____________________________________________________________________________________________________________________________________________________________________________________ Familial instability (marital & family break-ups)? ____________________________________________________________________________________________________________________________________________________________________________________ Childhood separation and loss? ____________________________________________________________________________________________________________________________________________________________________________________ Interpersonal and inter-familial conflict? ____________________________________________________________________________________________________________________________________________________________________________________ 17. IDENTIFICATION OF THE CURRENT-STATUS OF THE COMMUNITY Community ownership over child-in-care decision-making, involvement in supporting "at-risk" families, role and functioning of social support systems. ____________________________________________________________________________________________________________________________________________________________________________________ Role of community Elders in community decision-making processes? ____________________________________________________________________________________________________________________________________________________________________________________ Role of positive adult role models in assisting children/youth at-risk? ____________________________________________________________________________________________________________________________________________________________________________________ Extent to which the community embraces individual members as belonging to the collective (as opposed to "not belonging")? ____________________________________________________________________________________________________________________________________________________________________________________ Extent of customary healing practices within the community based on traditional customary practices? ____________________________________________________________________________________________________________________________________________________________________________________ Accepting responsibility for and addressing past sexual or physical abuse at the community level (e.g. healing circles)? ____________________________________________________________________________________________________________________________________________________________________________________ Identifying and supporting individuals with friends or relatives that have committed suicide? ____________________________________________________________________________________________________________________________________________________________________________________ 18. HEALING PROCESS Community ownership over child-in-care decision-making, involvement in supporting "at-risk" families, role and functioning of social support systems. ____________________________________________________________________________________________________________________________________________________________________________________ Role of community Elders in community decision-making processes? ____________________________________________________________________________________________________________________________________________________________________________________ Role of positive adult role models in assisting children/youth at-risk? ____________________________________________________________________________________________________________________________________________________________________________________ Extent to which the community embraces individual members as belonging to the collective (as opposed to "not belonging")? ___________________________________________________________________________________________________________________________________________________________________________________ Extent of customary healing practices within the community based on traditional customary practices? ____________________________________________________________________________________________________________________________________________________________________________________ Accepting responsibility for and addressing past sexual or physical abuse at the community level (e.g. healing circles)? ____________________________________________________________________________________________________________________________________________________________________________________ Identifying and supporting individuals with friends or relatives that have committed suicide? ____________________________________________________________________________________________________________________________________________________________________________________ 19. REVIEW OF COMMUNITY AND TRIBAL SOCIAL AND MENTAL HEALTH SERVICE DELIVERY Community relationship with the IHS: ____________________________________________________________________________________________________________________________________________________________________________________ State support and funding: ____________________________________________________________________________________________________________________________________________________________________________________ Mental health therapist contract: Community level: Tribal Council level: IHS funded: Is access to the IHS funded mental health therapist on a per client fee for service basis? _________ Access to State mental health services: __________ Alcohol and Drug Abuse Program: ________________________________________________________________________________________ Describe community recreation facilities or programming: ________________________________________________________________________________________ 20. COMMUNITY SELF HELPING PROCESSES Is there a linkage between suicidal behaviors and youth development processes: response from community workers to youth in crises; youth activities community inclusion and involvement? ____________________________________________________________________________________________________________________________________________________________________________________ Efficacy of current community worker resources in identifying and monitoring high-risk individuals; level of support proactively provided to high-risk individuals? ____________________________________________________________________________________________________________________________________________________________________________________ Worker or volunteer response to suicide attempts/verbalizations/gestures, organization of response strategy, allocation of resources, community education and outreach efforts? ____________________________________________________________________________________________________________________________________________________________________________________ Frequency of community worker team meetings, effectiveness in identifying and serving high risk clients, case conferencing and management procedures, task assignment and monitoring, remedial mechanisms to improve service delivery? ____________________________________________________________________________________________________________________________________________________________________________________ Community worker team commitment to promoting positive mental health of high-risk individuals by connecting them to community social structure (individual home visits, assertive outreach, facilitating Elder involvement with high risk individuals)? ____________________________________________________________________________________________________________________________________________________________________________________ Strengths and weaknesses of community health and suicide service delivery system? Strengths: ________________________________________________________________________________________________________________________________________________________________________ Weaknesses: ________________________________________________________________________________________________________________________________________________________________________ 21. IDENTIFICATION OF COMMUNITY INFRASTRUCTURE ISSUES Number of homeless and near homeless (especially adolescents/young adults previously in -care): ____________________________________________________________________________________________________________________________________________________________________________________ Does the community resource team ensure that its team members carry out the work? ____________________________________________________________________________________________________________________________________________________________________________________ Are steps being taken to ensure the continuity of culture in the community? (e.g. assisting youth to feel connected to their traditional and cultural origins) ____________________________________________________________________________________________________________________________________________________________________________________ Existence of cultural facility, traditional customary practices, involvement of youth in community culture? ____________________________________________________________________________________________________________________________________________________________________________________ Community history: ____________________________________________________________________________________________________________________________________________________________________________________ Does the community have control over finances? ____________________________________________________________________________________________________________________________________________________________________________________ 22. REVIEW OF SELF-CONTINUITY FACTORS: Does the community have the ability to maintain and support a sense of self-continuity by adolescents? (e.g. help youth feel "rooted" in the customs of the community): ____________________________________________________________________________________________________________________________________________________________________________________ Does the community support, through individuals, transitional challenges - adolescence to adulthood? (e.g. sense of belonging/connectedness): ____________________________________________________________________________________________________________________________________________________________________________________ Self identify promotion within cultural context (degree of integration/traditional customs and practices exercised); is a cultural home provided? ____________________________________________________________________________________________________________________________________________________________________________________ Capacity of community culture to ground adolescents undergoing self-identity/transitional issues; how is this addressed? ____________________________________________________________________________________________________________________________________________________________________________________ Degree of loss of sense of connectedness to the future (e.g. multiple placements of children/youth in care? ____________________________________________________________________________________________________________________________________________________________________________________ Describe how well the current social and mental health delivery system is responding to the community problem situation: ____________________________________________________________________________________________________________________________________________________________________________________ 23. COMMUNITY TREATMENT PLAN What challenges need to be addressed? What strengths does the community have, that can be built on, to address the current situation? How can "cultural continuity" within the community be strengthened? What is the "treatment plan" for the community? What is the estimated duration - time line? What resources are needed based on effective use of existing resources? Please explain what outcomes, when, how measured.     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