The Oglala Sioux Tribe (OST), headquartered in Pine Ridge South Dakota in partnership with the OST Attorney General's Office, Courts, Child Protective Services (CPS), Department of Corrections, Tribal Educational Department, Housing (Prevention), Rapid City mental health providers, youth and family consumers, and many others, proposes to implement a Circle of Care initiative in Pine Ridge, South Dakota. While our reservation's population is constantly influx, the total OST enrollment is about 38,332, with 19,639 living on the reservation. In Oglala Lakota County, labeled the "poorest" county in the nation, the per capita income of our residents is $8,768. Fueled by poverty and addiction, the unemployment rate hovers around 80%.
Addiction is endemic. In addition to opioid and meth problems, for years 11,000 cans of beer a day were poured into the Pine Ridge reservation (liquid genocide), causing untold damages. Up to two-thirds of adults live with alcoholism. While progress has been made since 1990 when one in four newborns was affected by prenatal alcohol exposure, Pineridge newborns are still at a disproportionately high risk for Fetal Alcohol Spectrum Disorders (FASD). The suicide rate for South Dakota young people, ages 13 to 30, is four times the average rate in the nation and in 2014, the Reservation declared a state of emergency after 14 youth killed themselves. These and other health disparities informed the selection of our population of focus: OST children, youth and young adults (Y/YAs) up to 25-years of age, and their families (300 or more in Yr. 3 pilot).
Despite incremental improvements to both access and quality of health and behavioral health care for our OST members, the continued development of mental health and co-occurring (COD) infrastructure is essential in order to keep pace with growing demand. We must rely on the limited resources of our current systems which include the department of public safety, tribal courts, IHS, Anpetu Luta Otipi (a comprehensive alcohol and substance abuse prevention and treatment program for the OST), and other tribally operated social service agencies which continue to experience respective service challenges. In too many cases, mental health service access for children, youth and young adult (Y/YA) necessities up to a two-hour drive to Rapid City.
While we have many strengths on which we continue to build, we have many challenges, gaps, and infrastructure needs: Behavioral health myths. An increasing volume of clients. Misunderstanding about treatment and treatment processes. Limited resources stretched over many sites and large geography. Workforce (esp. licensed) recruitment, retention, and mentoring challenges. Bureaucracy which threatens our agility and autonomy.
Our overarching goal is: Develop our own capacity and infrastructure to plan, design, pilot, evaluate, and sustain an effective system of care (SOC) to improve the mental health/COD, and wellness of our Y/YAs up to age 25 and their families (300 in Year 3 pilot). Our process and outcome evaluation will involve data collection that will be utilized to manage, monitor and enhance this important initiative.