The Center for Health Care Strategies (CHCS) has identified promising cross-system collaborations that support integrated prevention planning and implementation, and focus increasingly on upstream approaches. Following a document and literature review, CHCS interviewed 46 stakeholders from four states (California, Kentucky, New Jersey, and Ohio) and one tribe (Salt River Pima-Maricopa Indian Community in Arizona), including representatives from child protection agencies, behavioral health, Medicaid, community-based organizations, youth and families with lived expertise, as well as other experts in child and family well-being. These geographically diverse jurisdictions deliver prevention services through a range of collaborative structures.

This document profiles cross-system collaboration efforts in the Salt River Pima-Maricopa Indian Community.¹ For detailed information on the other jurisdictions, see: California, Kentucky, New Jersey, and Ohio. For an overview of lessons learned across all five of these collaboration efforts, see: How can child protection agencies collaborate to prevent foster care and support family well-being?

 

Salt River Pima-Maricopa	2017	2018	2019	2020	2021
Total CPS removals	65	43	61	44	33
Total population in foster care	273	227	207	187	147
Percentage of children removed	1.61%	1.03%	0.86%	1.14%	0.82%
Percentage of children in care	6.75%	5.44%	5.26%	4.83%	3.68%
Source: Salt River Pima-Maricopa Indian Community Social Services

 

Background and structure

In the Salt River Pima-Maricopa County Indian Community, the Social Services agency is responsible for child protection as well as several other key programs for children and families, including in-home services, public assistance, family resource centers, job programs, the food bank, and advocacy related to the Indian Child Welfare Act. Since 2014, the Salt River Community has made significant efforts toward preventing child welfare system involvement, highlighted by the implementation of Circles of Support, an intensive in-home service that includes clinical assessment, Structured Decision-Making, and evidence-informed interventions.

Social Services collaborates closely with another tribal agency, Health and Human Services, which oversees behavioral health, school and community relations, a Family Advocacy Center, juvenile justice, and law enforcement. An assistant community manager, reporting to the tribal council, oversees both Social Services and Health and Human Services, which helps ensure inter-agency coordination. Directors from both agencies meet at least quarterly to identify service gaps and opportunities for improvement, including in the area of prevention, and have the flexibility to interact and meet more frequently as needed.

Key initiatives and collaborations

The Salt River Community submitted a Family First Prevention Plan, which was approved in 2022. In developing its plan, Social Services brought together a range of tribal departments, administrators, the court system, community members, and the tribal council. The plan supports several programs and services, including: Circles of Support; Structured Decision-Making; SafeCare®; motivational interviewing; behavior coaching; Positive Indian Parenting; Nurturing Parenting; Nurtured Heart Approach; and concrete supports. Salt River also administers fatherhood, motherhood, and healthy relationships programs.

The community’s Family Advocacy Center exists to provide a safe, secure, and healing environment for families involved with a child abuse or neglect investigation. The center provides prevention-related services through a multi-disciplinary team across Social Services, behavioral health, the police department, domestic violence advocates, and legal representatives. This collaboration is supported through the co-location of services within one building. To facilitate care coordination, the center has an agreement with the Health and Human Services department to share information about the families served, if the families give consent.

Family and community engagement

Salt River prioritizes building strong partnerships with families and leads with cultural awareness and respect. Based on this commitment, Salt River engages families in many different ways in order to guide the improvement of prevention services and strategies. The Social Services department strives to treat the families it serves as customers instead of clients, and actively seeks their feedback. The department developed a formal questionnaire about its services and families were given incentives encouraging them to fill it out. Social Services also has used social media to solicit feedback from community members, which resulted in the addition of grief as a key topic in their Life Enhancement and Resource Network (LEARN) program. Salt River also is working on a strategy to report child welfare-related data back to the community and is in the process of creating an app to provide the community with key updates from government departments.

Financing

Salt River’s prevention services are funded through several sources. Services offered through the Social Services department are funded primarily through Title IV-E, Medicaid, federal and state grants, and tribal funding. The Family Advocacy Center is funded through a combination of tribal funding and a federal grant from the Office of Victim Services. Behavioral health services are largely covered through Medicaid and Indian Health Services, including compact funding. These supplemental funding sources are particularly useful to pay for services not typically covered by an individual’s health plan, such as respite care. Concrete supports, such as housing assistance, are funded primarily through the tribal council.

1 Agencies/Organizations interviewed: Social Services; Life Enhancement and Resource Network; Health and Human Services; and Family Advocacy Center.

2 Data on total child population and children in foster care from the Salt River Pima-Maricopa Indian Community’s Family First plan.