FINAL DRAFT

Fallon Paiute-Shoshone Tribe

Community Readiness Assessments

Date: December 30, 2018

Cheri Bowen – Project Manager Cynthia Wachsmuth – Community Coordinator

Dylan Merrick – Social Marketing/Public Education Coordinator Submitted by: Kevin Crowe – Evaluator

Susan Mears – Evaluator

FINAL DRAFT

Submitted by: Cheri Bowen – Project Manager Community Readiness Assessments

Introduction The Fallon Paiute Shoshone Tribe’s (FPST) Circles of Care (CoC) project conducted Community Readiness Assessments for each of the Tribes within the service area of the Fallon Tribal Health Clinic, Fallon, Lovelock and Yomba. The primary purpose of this document help in understanding what a Readiness Assessment is, show what the process used to gather and analyze information, explain the outcome as well as describe the next steps. SAMHSA Native Connections’ “Community Readiness Model” was the tool selected to measure the stage of 1

readiness to change within the tribal communities. The questions were adapted to be specific to children’s and young adult’s mental health and reviewed with the TA providers. The Assessments were conducted with each of the Tribes to help accurately identify where each Tribe is in the areas measured. For the FPST CoC it is important that each Tribe’s unique strengths and challenges be honored and plans that are created help to reflect both the commonality and diversity within these areas. The CRA helps show where each community is in regards for its readiness to change. Understanding the current stage of change allows for better program planning as it meets the community where it is at and respects the progress the Tribes have made in making improvements in their communities. This also allows the community to gain understanding of the current issues and help to create plans on how to address the problems and barriers for children’s and young adults’ mental health needs and improve on protective factors. Method In order to help ensure reliability and validity of the assessments, the format suggested was followed. For Fallon and Yomba, Circles of Care staff selected participants as there is familiarity with the people in these areas and staff was able to determine who would be best to interview. For Lovelock, we request help from the Social Services department in choosing people to interview as they are most familiar with their community. CoC was able to bring on two summer youth workers who were trained to assist with these interviews and the collection of data. Each interview was conducted by 2 people, typically 1 staff and 1 youth, with all answers hand recorded, interviews were tracked by number, no names were recorded. Answers for each interview were typed and reviewed by the interview team for accuracy. After the interviews were all recorded, 2 evaluators, not involved with the interviews, reviewed the responses. These were scored separately then the evaluators came together to discuss and agree upon final scores for the individual interviews. All scores for the dimensions were averaged then rounded down and recorded on a final score sheet for each Tribe.

1 Jumper-Thurman, P, Plested, B.A.. Community Readiness Part 2: Interviewing Methods and Scoring Process. The National Center for Community Readiness, Colorado State University, Fort Collins, Colorado

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FINAL DRAFT Areas Measured There were 6 areas that were measured during this assessment that were designed to gauge the following questions: 2

2 Edwards, R., Jumper-Thurman, P, Plested, B.A. Community Readiness Manual,. Community Readiness Model.. The National Center for Community Readiness, Colorado State University, Fort Collins, Colorado

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FINAL DRAFT The answers to each section were measured on a 1-9 Readiness scale:

STAGE DESCRIPTION

1. No Awareness Children’s and young adults’ mental health is not generally recognized by the community/leaders as an issue (or it may truly not be an issue.)

2. Denial / Resistance

At least some community members recognize that children’s and young adults mental health is a concern but there is little recognition that it might be occurring locally.

3. Vague Awareness Most feel that there is local concern but there is no immediate motivation to do anything about it.

4. Preplanning There is clear recognition that something must be done and there may even be a group addressing it. However, efforts are not focused or detailed.

5. Preparation Active leaders begin planning in earnest. Community offers modest support of efforts.

6. Initiation Enough information is available to justify efforts. Activities are underway.

7. Stabilization Activities are supported by administrators or community decision makers. Staff are trained and experienced.

8. Confirmation/ Expansion

Efforts are in place. Community members feel comfortable using services and they support expansions. Local data regularly obtained.

9. High Level of Community Ownership

Detailed and sophisticated knowledge exists about children’s and young adult’s mental health prevalence and consequences. Effective evaluation guides new directions. Model is applied to other issues.

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FINAL DRAFT Results

Dimension Fallon Tribe Lovelock Tribe Yomba Tribe Total Average Total Average Total Average

A. Community Efforts 3.99 3 2.83 2 3.26 3 B. Community Knowledge of the

Efforts 3.60 3 3.29 3 3.19 3

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FINAL DRAFT C. Leadership 2.89 2 3.05 3 3.08 3 D. Community Climate 2.48 2 3.35 3 2.83 2 E. Community Knowledge About

the Issue 2.39 2 2.84 2 1.86 1

F. Resources for Prevention Efforts 3.21 3 2.19 2 2.19 2

Based on the above information, all communities identify Community Knowledge about the Issue as an area that needs to be addressed. As stated throughout all three Readiness Assessments, most people do not know about Policies and Procedures that address mental health, data about mental health, how data is used to develop programs or what the signs and symptoms of mental health issues might look like. Responses from Fallon included, “We don’t have the greatest outreach. It is in the Numa News but not everyone reads this,” “I think a couple of years ago it was a 0 but Programs have been putting things out like Domestic Violence has done stuff and the Substance Abuse program. It’s time to start looking at it, not sweeping it under the carpet” and “People know just about the basic services like they know we have Mental Health and Substance Abuse programs but they don’t know much more than that.” Lovelock comments included, “I don’t think the community is well informed because of the lack of communication. They just handout flyers but don’t talk to people about what they say,” “No awareness because there are no programs” and “The community knows about services offered at the tribal building and come in

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FINAL DRAFT regularly, sometimes just to chit chat and sometimes to check in to see what’s going on or look for help.” The responses from Yomba included, “Some people know mental health issues and when they present themselves but most of the people do not know where to go beyond the tribal hall to speak with the ASAP Director,” “People somewhat know about services, people know to call in or ask, potential is higher than reality” and “All have presentations for different departments as part of the grant requirements. We hand out flyers, the person that does trash pickup will drop off flyers while they do the pickup. Off reservation presentations are rare. We have a website and Facebook page.” Community Climate, how the community views or support mental health, was the second primary area identified, especially in regards to Fallon and Yomba. Some of the comments in Yomba included, “The ones that care, care and those that don’t care, don’t. There are a lot more that don’t care” and “I don’t hear people talk about it, they are pretty private about that and there is nothing geared towards mental health. They talk about diabetes but not mental health.” With Fallon, comments included, “In a lot of ways they are a close knit community but also very judgmental, there is always that stigma and very clear battle lines drawn between families and individuals” and “They are closed, fear of being labeled as ‘crazy’ they think you are either sane or crazy and don’t understand. They are worried about the stigma and concerned about privacy, they don’t want people to know their business.” Lovelock also had responses such as, “It is unhealthy, we have Substance Abuse as an issue, Domestic Violence, Elder Abuse, Child neglect. We need more presentations, information and well people” and “I think it is really closed off due to being judgmental and they don’t want to be looked at differently.” All tribes reflected concerns with being labeled, issues with stigma and difficulty establishing dialogue. Resources for Prevention Efforts, what is currently available in their community, is the third primary area that was noted which includes current mental health services offered. The Fallon Tribe reflects that they have more resources with a score of 3, versus a 2 for Lovelock and Yomba, but also states that these resources are not sufficient. “I think they are open to it as long as there is food. I think no one knows where to start. Natives are more in-house and soldier-on,” “Collaboration with workers and others, maybe a team here and more people trained. I would assume people would not donate money, there is a core group that attend, set-up and are dedicated but mostly people don’t want to volunteer time or money” and “Everyone likes the idea but no one wants to do the work.” Within Lovelock comments included, “Volunteers are always available but financially everyone here is struggling,” “There is no awareness because there are no programs” and “I am not aware of any plans to create programs.” In addition, Yomba responses stated, “People would show up out of curiosity if something was offered, Tribal staff will help out,” “There is little to desire there” and, “I am not aware of any data or plans to create programs.”

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FINAL DRAFT Leadership, how leadership supports or addresses mental health, rates low for Fallon with a score of 2 and is at a 3 for Lovelock and Yomba. Fallon comments regarding leadership included, “They have a lot of priorities, mental health is not at the top. I think if they had a role to play they would be more involved,” “They have a lot on their plates, they are informed and see the problem but they have a lot on their plates. Program Directors, most of them see it and are interested but they are overwhelmed” and “I think if they were educated on mental health and how it’s impacting our community they would be more supportive, the issue is funding.” Lovelock responses included, “Mental Health just doesn’t seem like too much of a priority on a daily basis,” “I don’t see the leaders really participating in thing but lately they’ve been doing things with the kids” and “I am sure they would be supportive of new programs, they are here for us.” For Yomba, responses were “Addressing Mental Health hasn’t been addressed even though this is a problem for the whole country. The problem is accountability and having infrastructure for the people to return to their homes with a support system,” “10 for the Administrator, 1 for Council as I’ve never heard them talk about it, 4 for elders, cultural engagement is medicine others aren’t cultural and culture helps to heal on a deep level” and “Admin is highly supportive of mental health, Council will support.” All three Tribes noted that their Councils would be supportive but they are not seeing very many active efforts from community leaders. Community Efforts, what programs there are and understanding of what services the programs offer, ranked as a 3 for Fallon and Yomba and a 2 for Lovelock. Fallon interviewees stated, “Our substance abuse program is knowledgeable, they are determined to reduce and prevent use with teens,” “The Psychologist always responds, listens and is willing to work with the families on kid’s mental health” and “Several times kids have been referred to mental health, the Psychiatrist refuses to see them and the Psychologist is hit and miss. They know it is a problem but they are not looking for ways to change it.” Yomba responses regarding leadership included, “There are some people that feel very passionate and want to pass on the culture and language. We have an elderly community and a lot of focus is on them,” “I’m not even sure, they don’t really reach out and the program has been down more than it’s been up. I don’t really know what they do there other than they did a presentation on Adult Children of Alcoholics and they do crafts with kids” and “Recovery and Mental Health are very important. There are a few people with experience in AA, Alanon and Alateen that are open to help.” Lovelock responses stated, “I see a lot of substance abuse and there are a lot of tragedies that happen that no one talks about so they turn to substance abuse to cover up issues, self-medicating,” “Services have always been here but not always staff in place to work them, we lack consistency and resources because of funding” and “We need more presentations, more awareness on mental health to let people know what resources are out there.” Community Knowledge of the Efforts, what the community knows about the efforts or programs, their purpose and their policies, ranked as a 3 for all three tribes. Fallon respondents answered, “We don’t have the greatest outreach. It is in the Numa News but not everyone reads this,” “I

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FINAL DRAFT think a couple of years ago it was a 0 but Programs have been putting things out like Domestic Violence has done stuff and the Substance Abuse program. It’s time to start looking at it, not sweeping it under the carpet,” “People know just about the basic services like they know we have Mental Health and Substance Abuse programs but they don’t know much more than that.” Lovelock responses included, “I don’t think the community is well informed because of the lack of communication. They just handout flyers but don’t talk to people about what they say,” “No awareness because there are no programs” and “The community knows about services offered at the tribal building and come in regularly, sometimes just to chit chat and sometimes to check in to see what’s going on or look for help.” Yomba interviewees stated, “Some people know mental health issues and when they present themselves but most of the people do not know where to go beyond the tribal hall to speak with the ASAP Director,” “People somewhat know about services, people know to call in or ask, potential is higher than reality” and “All have presentations for different departments as part of the grant requirements. We hand out flyers, the person that does trash pickup will drop off flyers while they do the pickup. Off reservation presentations are rare. We have a website and Facebook page.” All three tribes use flyers as a primary means of communication. All three tribes also have websites but these are not updated often and do not offer much information. Approvals The individual Community Readiness Assessment was reviewed by the current Evaluation Workgroup and presentations were offered for review in Fallon, Lovelock and Yomba to people that participated in the interviews. Participants in Fallon opted to review theirs individually and either gave email feedback or called to discuss their thoughts. Lovelock participants chose to review the presentation with members of their Tribal Council and Yomba participants opted not to review the presentation for input before further approvals. The Community Readiness Assessment presentation was reviewed in Lovelock first, with both interviewees and Tribal Council. The Tribal Council approved to have the presentation done publically. There was a closed session with the Fallon Business Council where the presentation was shown and discussed. The Fallon Business Council provided their input and approved to have the presentation shown publically. The presentation was taken to the Yomba Tribal Council, they chose not to view the presentation but we did discuss the content and goals, Yomba Tribal Council approved this to be shown to the public.

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FINAL DRAFT Action Plans The below is the list of preliminary action plans based on community discussions. It is expected that the goals and objectives will expand as more discussions occur. Action Plan to Improve Community Knowledge of Mental Health and Improve Community Climate Regarding Mental Health Issues Communities of Focus: Yomba, Fallon, and Lovelock Overall Readiness Score Fallon 2 Lovelock 2 Yomba 1 Goal One: To increase understanding of mental health 1. Arrange for trainings to understand signs and symptoms such as Youth Mental Health First Aid trainings. Who is Responsible : Project Manager Target Date for Completion: September 2019 Dates of Completion: Fallon Lovelock Yomba Goal Two: Reduce stigma regarding mental health issues. 1. Gather information and have small group discussion within communities focused on understanding and reducing stigma. Who is Responsible : Project Manager Target Date for Completion: September 2019 Dates of Completion: Fallon Lovelock Yomba Goal Three: Increase suicide and crisis prevention and intervention skills. 1. Arrange for trainings that address prevention such as ASSIST trainings. Who is Responsible : Project Manager Target Date for Completion: September 2019 Dates of Completion: Fallon Lovelock Yomba Purpose: To improve understanding of mental health signs and symptoms and develop basic

skills for talking to people about mental health needs with a secondary purpose of

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FINAL DRAFT

reducing stigma. Elders should be invited to attend as they are identified as the ones people will talk to when they have problems especially in Yomba.

Evaluation Method: Participants will be asked to complete a pre and posttest as well as a satisfaction

survey. Results will be reviewed for effectiveness. Action Plan to Improve Community Knowledge Policies and Statistics Communities of Focus: Yomba, Fallon, and Lovelock Overall Readiness Score Fallon 2 Lovelock 2 Yomba 1 Goal One: Identify and review current policies and procedures. 1. Work with each Tribe to identify existing Policies regarding mental health. Who is Responsible : Project Manager & Community Coordinator Target Date for Completion: March 2019 Dates of Completion: Fallon Lovelock Yomba 2. Work with each tribe to develop a workgroup to review and improve existing policies and procedures. Who is Responsible : Project Manager, Community Coordinator Target Date for Completion: August 2019 Dates of Completion: Fallon Lovelock Yomba 3. Work with each tribe to develop new policies and procedures. Who is Responsible : Project Manager, Community Coordinator Target Date for Completion: August 2019 Dates of Completion: Fallon Lovelock Yomba Goal Two: Improve understanding of current issues 1. Work with local agencies to help collect data related to mental health. Who is Responsible : Project Manager, Evaluators Target Date for Completion: March 2019 Dates of Completion: Fallon Lovelock

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FINAL DRAFT Yomba 2. Arrange information for community presentations and information. Who is Responsible : Project Manager, Social Marketer Target Date for Completion: May 2019 Dates of Completion: Fallon Lovelock Yomba Purpose: To help identify current policies and procedures as well as to improve transparency

within the communities and share data to improve understanding of issues. Evaluation Method: Participants will be asked for input on presentations. Number of Policies will be

recorded. Action Plan to Improve Community Climate Communities of Focus: Fallon, Yomba and Lovelock Overall Readiness Score Fallon 2 Lovelock 3 Yomba 2 Goal One: To increase understanding of causes of mental health issues. 1. Arrange for training that explains factors that lead to family and community struggles such as Historical Trauma and Resiliency Who is Responsible : Project Manager & Community Coordinator Target Date for Completion: August 2019 Dates of Completion: Fallon Lovelock Yomba 2. Arrange for training that helps explain link between childhood events and later struggles such as an ACEs Training. Who is Responsible : Project Manager, Social Marketer Target Date for Completion: June 2019 Dates of Completion: Fallon Lovelock Yomba Purpose: To help identify some of the causes for mental health issues as a way to reduce blame

and shame and to help move towards understanding. Evaluation Method:

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FINAL DRAFT Participants will be given pre and posttests as well as satisfaction surveys. Results will

be reviewed for effectiveness. Action Plan to Improve Resources for Prevention Efforts Communities of Focus: Yomba, Lovelock and Fallon Overall Readiness Score Fallon 3 Lovelock 2 Yomba 2 Goal One: Identify current resources and strengths that may be utilized for prevention 1. Work with each Tribe to identify existing resources and assets Who is Responsible : Project Manager & Community Coordinator Target Date for Completion: March 2019 Dates of Completion: Fallon Lovelock Yomba 2. Continue to review and add this information into the existing Resource/Asset map and submit for public access. Who is Responsible : Project Manager, Community Coordinator Target Date for Completion: March 2019 Dates of Completion: Fallon Lovelock Yomba Goal Two: Identify possible partners/providers form mental health prevention services. 1. Work with local agencies to identify programs/people that may provide services. Who is Responsible : Project Manager, Community Coordinator Target Date for Completion: September 2019 Dates of Completion: Fallon Lovelock Yomba 2. Create MOU’s or contracts with identified partners as approved. Who is Responsible : Project Manager, Social Marketer Target Date for Completion: December 2019 Dates of Completion: Fallon Lovelock Yomba

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FINAL DRAFT Purpose: To help identify and improve access to prevention services or methods.

Evaluation Method: Number of MOU’s or partnerships established. Action Plan to Improve Leadership Communities of Focus: Fallon, Lovelock and Yomba Overall Readiness Score Fallon 2 Lovelock 3 Yomba 3 Goal One: To improve leaderships understanding of the issues. 1. Identified who the leadership is within each community and invite them to meetings and trainings. Who is Responsible : Project Manager, Community Coordinator

and Social Marketer Target Date for Completion: May 2019 Dates of Completion: Fallon Lovelock Yomba 2. Work with identified leadership to establish roles and ways they may help promote mental health awareness. Who is Responsible : Project Manager, Community Coordinator

and Social Marketer Target Date for Completion: May 2019 Dates of Completion: Fallon Lovelock Yomba Goal Two: To enhance community cohesiveness. 1. Provide opportunities for engagement in social activities designed to help improve communication and senses of belonging such as talking circles, traditional crafts and other activities. Who is Responsible : Project Manager, Community Coordinator

and Social Marketer Target Date for Completion: February 2019 Dates of Completion: Fallon Lovelock

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FINAL DRAFT Yomba Goal Three: To enhance youth leadership roles. 1. Work with each Tribe to identify meaningful youth for leadership roles and youth advisory groups. Who is Responsible : Project Manager, Community Coordinator

and Social Marketer Target Date for Completion: February 2019 Dates of Completion: Fallon Lovelock Yomba 2. Provide Leadership trainings to interested identified youth. Who is Responsible : Project Manager, Community Coordinator

and Social Marketer Target Date for Completion: June 2019 Dates of Completion: Fallon Lovelock Yomba Purpose: To help educate leaders (Council, elders, adults and teens) in mental health issues and

help them find a role to play to help address mental health concerns. Evaluation Method: Agreements, Sign-in sheets, pre and posttest evaluations for trainings. Themes Through the assessment process and review many common themes were found within the interviews. These themes were summarized to help show some of the possible barriers, assets and concerns. Fallon

• People are afraid of being stigmatized or labeled. • Leadership does care, they are just too busy. • The community is divided, fractionated, too many old hurts still causing problems. • Open communication is needed but people seem to want to ignore the real issues or are

resistant to change. • People don’t know how data is being used, where to get statistics for the Tribe or if there

are Policies and Procedures. • People seem to lack a connection to the culture, a sense of identify and don’t know how

they can help. • Understanding, outreach and services are improving but there are still a lot of gaps.

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FINAL DRAFT Lovelock

• People are self-medicating with drugs or alcohol. • There is a lack of resources and consistency with programs. • A lot of people feel they can come to the Administration building for resources. • Most people do not want to talk about mental health. • We need more presentations/information to help understand mental health issues. • People are willing to show up to events and volunteer. • We want our community to be well.

Yomba • There are no real resources or programs to address mental health or substance abuse. • There is concern about confidentiality. • There are elders and leaders that are very involved and care about mental health. • The community is willing to come together to make change like they did with the

education issues. • There is a lot of lateral violence and oppression. • There is a desire to increase cultural activities and improve cultural awareness.

Conclusion A majority of the scores show the Tribes are at 2, denial/resistance, and 3, vague awareness. The above identified goals apply to all three Tribes to help them move along the stages of change and can be modified to meet the specific needs within the communities. The Social Marketing Plan also addresses some of these areas and plans will continue to be adapted as communities identify new goals and ideas. The Community Resource and Asset Map will help connect existing services to help meet some of these objectives. Additionally, the Needs Assessment will help give insight into areas that may need to be included in further planning, and the Local Evaluation Plan will help measure accomplishments and effectiveness. Local workgroups which include youth and community members will continue to help guide and shape program goals and objectives.

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