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Meeting Archives: Meeting # 3

September 4, 2026

Index

To go to a specific meeting material, click one of the links below to be taken to where the text begins on this page.

Agenda

Task Force on the Intersection of Tribal and State Forensic Behavioral Health

Public Notice and Meeting Agenda
  • Task Force on the Intersection of Tribal and State Forensic Behavioral Health
  • Friday, September 4, 2026
  • 9:00 am - 12:00 pm
  • Remote Location: Public Webex Link (opens Webex meeting)
  • Welcome and Roll Call
  • Presentation on Recognition of Tribal Court Orders in Washington State 
    • Heather Erb, Lead Policy Advisor, American Indian Health Commission
    • Kathryn Akeah, Tribal Health Consultant, American Indian Health Commission
  • Questions for consideration: 
    • What prompted the need for having the state recognize tribal court orders?
    • What governance tools were used with non-tribal entities to recognize tribal court orders?
    • What adjustments have you taken or recommend to increase positive outcomes?
  • Discussion and Q&A on Presentation
  • Hold for summary of tribal-state models for recognition of tribal court orders: Arizona, North Carolina
  • Break
  • Discussion on Indian Law Section-Full Faith and Credit Proposal
  • Work Session
    • Include recommendation for Indian Law Section-Full Faith and Credit Proposal within Task Force Report Due December 15, 2026
  • Public Comment
  • Homework and Next Steps
  • Adjourn
Chair
  • Hon. Naomi Stacy, Judge, Confederated Tribes of the Umatilla Indian Reservation
Vice Chair
  • Hon. Denise Keppinger, Judge, Columbia County Circuit Court
Members
  • First Lady Aimee Kotek Wilson, MSW
  • Lisa Nichols, Manager, Intensive Forensic Services, Oregon Health Authority, Behavioral Health Division
  • Leslie Wu, Policy Advisor, Department of Justice
  • Kimberly Lindsay, Executive Director, Community Counseling Solutions
  • Hon. Karen Costello, Chief Judge, Confederated Tribes of Coos, Lower Umpqua, and Siuslaw Indians
  • Hon. Gayleen Adams, Chief Judge, Confederated Tribes of Warm Springs
  • Hon. Melissa Cribbins, Chief Judge, Coquille Indian Tribe
  • Hon. Ronald Yockim, Chief Judge, Cow Creek Band of Umpqua Tribe of Indians
  • Hon. Patrick Melendy, Chief Judge, Confederated Tribes of Grand Ronde
  • Sharon Stanphill, Chief Health Officer, Cow Creek Band of Umpqua Tribe of Indians
  • Cindy Cecil, Clinical Director of Behavioral Health, Yellowhawk Tribal Health Center
  • Adrea Korthase, Indian Child Welfare Act Analyst, Office of the State Court Administrator
Additional Agency Support
  • Angie Butler, Siletz, MEd, Senior Tribal Policy & Program Analyst, Tribal Behavioral Health Continuum of Care Advisor, Oregon Health Authority
Staff
  • Channa Newell, Senior Staff Counsel for Government Relations, Office of the State Court Administrator
  • Kiely Lyons, Analyst, Office of the State Court Administrator

Materials

Full Faith and Credit (FFC) Recognition of Tribal Court Orders Forensic Behavioral Health (civil commitment/aid and assist criminal defense)

  • Alt. Text: A table shows three columns (state, statute/case, and notes) of nine states as described below:
    • State: Oregon
      • Statute/Case: ORS 24.105
      • Notes: Excludes FFC for civil commitment ORS 426.180
    • State: Colorado
      • Statute/Case: CRS 27-65-132
      • Notes: SB 25-009 (2025)
    • State: New Mexico
      • Statute/Case: NMSA § 32A-6A-29 (children)
      • Notes: New Mexico Supreme Court Order 18-8300-011/Form 4-490 , applies to recognition of tribal court orders for involuntary commitment of Adults - State sends copies of orders of guardianship or continued treatment of person subject to previous tribal court orders - copy sent to tribal court; Tribal State Consortium project 2015-2020. Then worked on NMSA Statute for children.
    • State: Oklahoma
      • Statute/Case: 12 Okl. St. § 728
      • Notes: 12 Okl. St. § 728 Legislature delegated authority to Supreme Court; Okla. Rule 30(B)
    • State: Kansas
      • Statute/Case: KSA § 60-3020
      • Notes: None 
    • State: Nebraska
      • Statute/Case: NRS § 71-964
      • Notes: Nebraska Public Health laws under NRS Chapter 71. Significant work from their Tribal-State Consortium
    • State: Maine
      • Statutes/Case: 30 MRS §§ 7208; 6209 A-C
      • Notes: Statutes separately (but consistent) for each of Maine's tribes
    • State: North Carolina
      • Statute/Case: NC Gen. Stat § 1E-1
      • Notes: None
    • State: Washington 
      • Statute/Case: RCW 71.05, 71.34, 71.24, 70.02 via SB 6259
      • Notes: SB 6259, HB 1877 American Indian Health Commission support w/ tribal governments and WA Health Care Authority; CR 82.5

American Indian Health Commission Washington Tribal Behavioral Health Model Presentation

Slide 1: Washington State Tribal Behavioral Health Model
Slide 2: About Us
  • American Indian Health Commission
  • Pulling Together for Wellness
  • Established in 1994, we are a Tribally-driven, non-profit organization providing a forum for the twenty-nine tribal governments and two urban Indian health programs in Washington State to work together to improve health outcomes for American Indians and Alaska Natives.
Slide 3: Land Acknowledgement
  • I would like to begin by acknowledging that as we gather today, we are all on the ancestral homelands of indigenous people. Today we are meeting across the lands of hundreds of Tribes.
  • Indigenous people, despite being removed from the lands where they lived, hunted, gathered, practice ceremonies and cared for their community members. Indigenous people and Tribes, whether “official” recognized by the United States Government or not, continue to care for these lands and their community members. As health professionals, it is important that we also acknowledge the impacts of the removal from traditional lands, of children stolen to boarding schools, of the oppression of cultural and traditional ways of life on the health of indigenous people throughout the country and in Washington State.
  • As we work to improve health across the Northwest, it is imperative that we address the inequities of the past by understanding their impact of the present. I invite each of you to learn about and understand the true history of the indigenous lands where you reside on.
Slide 4: Presentation Overview
  • Part I: Tribes and Indian Health Care Providers (IHCPs): Integral Components of State Behavioral Health Systems
  • Part II: The Need for Legislation Reform
  • Part III: 6 Key Reforms
  • Part IV: Tribal and State Governance Tools
  • Part V: Outcomes and Adjustments
  • Part VI: Resources
Slide 5: Part I
  • Tribes and IHCPs: Integral Components of State Behavioral Health Systems
Slide 6
  • 29 Tribal Nations
  • 2 Urban Indian Health Organizations
  • 3 (Federal) Indian Health Service (IHS) Service Units
Slide 7: Indian Behavioral Care Health Providers: A Key Component of the Washington State Behavioral Health System
  • Washington state citizens, both native and non-native, benefit from a multitude of Indian Health Care Providers (IHCPs) that provide behavioral health services to Washington state citizens including outpatient mental health, outpatient substance use disorder (SUD), inpatient BH programs, and BH crisis response services.
  • Tribes, through use of Tribal designated crisis responders, Tribal courts, Tribal law enforcement, Tribal corrections, and Tribal behavioral health staff, are expanding resources to meet the needs of more Washington state citizens including those who reside in rural areas where state resources are limited and those who have been historically underserved.
  • Alt. Text: Outside of the Lummi Nation Wellness Center; Source: Cornerstone CGI, Lummi National Wellness Center (opens link to external website)
Slide 8: IHCPs are Critical in AI/AN BH Crisis Response
  • Trusted and familiar relationship between the Tribal member, families, and the IHCP.
  • IHCPs serve their members Birth to Death.
  • IHCPs are culturally sensitive.
  • Continuity of care. IHCPs are familiar with wrap around services and what is available in the community. Those serves will always be more culturally appropriate than services outside the community.
  • Stronger follow-up care with Tribal member experiencing crisis.
  • Alt. Text: Front of the outside of Tulalip Tribal Health Clinic
Slide 9: Tribal Courts are Critical in AI/AN BH Crisis Response
  • Tribal members and their family are more likely to share critical information with a Tribal Court than a State Superior Court or Commissioner.
  • Tribal Courts are culturally sensitive.
  • Continuity of care. Tribal Courts are familiar with wrap around services and coordination.
  • Stronger follow-up care with Tribal member experiencing crisis.
  • Alt. Text: Front of the outside of Colville Tribal Court
Slide 10: Part II
  • The Need for Legislation Reform
Slide 11: State OF EMERGENCY AI/AN Suicide and Opioid Crisis
  • AI/AN between the ages of 10 and 29 account for 63% of Washington State AI/AN emergency department visits for suicide attempts in 2020. Footnote 1
  • AI/AN were 1.6 times more likely to have a suicide attempt than non-AI/AN. Footnote 1
  • Nationally, the highest suicide rates among (AI/AN) are for adolescents and young adults. Footnote 2
  • Since 2001, the suicide mortality rate for AI/AN in this state has increased by 58% which is more than 3x the rate of increase among non-AI/AN. Footnote 2
  • Footnote 1: "Trends in Suicide-Related Emergency Department Visits among American Indians and Alaska Natives in Washington During COVID-19,” Northwest Indian Health Board. https://www.npaihb.org/wp-content/uploads/2021/05/WA-Suicide-ED-fact-sheet.pdf.(opens link to external website)
  • Footnote 2: SB 6259.
Slide 12: Disparities in Premature Deaths
  • 2022 Opioid related Years of Potential Life Lost per 100,000 in Washington:
    • 4 Times the rate for AI/AN population vs. Total Population 
      • Source: Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2022, Community Health Assessment Tool (CHAT), November 2023.
  • Alt. Text: Bar graph
    • AI/AN only-NH: 2,685.30
    • Total Population: 683.71
    • RATE = years of potential life lost relative to age 65 per 100,000 population. (Count = number of YPLL65)
      • Source: Washington State Department of Health, Center for Health Statistics, Death Certificate Data, 1990–2021, Community Health Assessment Tool (CHAT), October 2022.
Slide 13: Tribal-State BH Coordination Legislation
  • HB 6259 (2020)
    • Improving the Indian Behavioral Health System 
  • HB 1877 (2024)
    • Coordination and Recognition with Indian Behavioral Health System
  • Recognized and included Tribal courts, Tribal law enforcement agencies, and Indian behavioral health systems to better serve AI/AN Washington state citizens as well non-AI/AN state citizens
  • Removed Jurisdictional Barriers to ensure Tribes can fully participate in the crisis process and increase access to care that meets the unique needs of AI/AN.
  • Increased access to culturally appropriate behavioral health care.
Slide 14: HB 6259 and HB 1877 Bill Contributors
  • Tribal Representatives including Tribal leaders, Tribal behavioral health providers, Tribal judges, Tribal law enforcement
  • American Indian Health Commission
  • State Medicaid agency (HCA)
  • Representatives from Washington Designated Crisis Responder Association
  • Alt. Text: 2SHB 1877 Behavioral Health/Tribes 3/19/24, Tulalip Resort, Governor Inslee Bill Signing
Slide 15: Part III
  • 6 Key Reforms
Slide 16: 6 Key Reforms
  • 1. Recognition of the Indian Behavioral Health System
  • 2. Notification Requirements to Tribes and IHCPs
  • 3. Recognition of Tribal Right to Conduct Crisis Response
  • 4. Tribal Right to Intervene in State Court
  • 5. Acceptance of Tribal Court Orders by Facilities
  • 6. Increased Sharing of Behavioral Health Information
Slide 17: 1. Recognition of the Indian Behavioral Health System
Slide 18: Recognition of Indian Health Care Provider in State Law
  • "Indian health care provider" means a health care program operated by the Indian health service or by a Tribe, Tribal organization, or urban Indian organization as those terms are defined in 25 U.S.C. Sec. 1603.
Slide 19: Inclusion of Tribes in Behavioral Health Service Provider Definition
Slide 20: 2. Notification Requirements to Tribes and IHCPs
Slide 21: Notification to Tribes and IHCP re Their Tribal member patients
Slide 22: 3. Recognition of Tribal Right to Conduct Crisis Response
Slide 23: Tribal Government Authority to Provide Behavioral Health Services
  • Tribal governments have the “sovereign authority…to act as public health authorities in providing for the health and safety of their community members including those individuals who may be experiencing a behavioral health crisis.”*
    • *Washington Health Improvement Act, SB 5415 (codified at RCW 43.71B.901); See also COHEN'S HANDBOOK OF FEDERAL INDIAN LAW § 5.01 (Nell Jessup Newton & Kevin K. Washburn, eds., 2024); Aila Hoss, Toward Tribal Health Sovereignty, 2022 Wis. L. Rev. 413, 419 (2022)(“Protecting the public's health, safety, and welfare is among the core powers and duties of sovereign governments.”).
Slide 24: Designated Crisis Responder (DCR)
  • "Designated crisis responder" means a mental health professional appointed by the county, by an entity appointed by the county, or by the authority in consultation with a [T]ribe or after meeting and conferring with an Indian health care provider, to perform the duties specified in this chapter.
Slide 25: Tribal Designated Crisis Responder
  • Tribes and their behavioral health programs can employ or contract with a State-Certified Tribal Designated Crisis Responder to respond to Tribal community members experiencing behavioral health crisis and conduct involuntary commitment process in BOTH state court and Tribal court.
Slide 26: Tribal Designated Crisis Responder Models in Washington
  • Alt. Text: Sliding scale from left to right State Control to Tribal Control. There are four spots on the scale evenly spaced out from left to right. 
    • County [State] DCR
      • Petitions State Court
      • Follows state code
    • Tribal DCR
      • Chosen by the Tribe and appointed by the HCA
      • Petitions in State Court
    • Tribal or County [State] DCR]
      • Tribe recognizes Tribal DCR in Tribal Court
      • Follows state and/or tribal codes
    • Name TBD
      • Tribal Code grants mental health professional and/or substance use professional authority to petition Tribal Court for involuntary commitment
  • Alt. Text: The below stems from the Tribal DCR and Tribal or County [State] DCR portions of the sliding scale described in the previously section.
    • A Tribal DCR is a professional authorized to petition for involuntary treatment in the state system. 
    • Staffing 
      • Example 1
        • Works at one Tribe 
        • Wears state and Tribal hats depending on situation
        • Alt. Text: A person inside a circle. Within the circle the person is between 6 yellow balls on their left and 6 green balls on their right. 
      • Example 2
        • Primary counselor at one Tribe
        • Tribal DCR authority at several Tribes
        • Alt. Text: A person inside a circle. Within the circle next to the person are four yellow balls and one green ball. There is a smaller circle filled with three green balls to the right of the first circle. There is a smaller circle filled with one green ball to the right of the second circle. 
Slide 27: Support Tribal DCRs in State Court System
Slide 28: Tribal Right to Intervene in State Court
Slide 29: Tribal Right to Intervene in State Court Behavioral Health Proceedings
Slide 30: Tribes Added to Joel's Law
Slide 31: 5. Acceptance of Tribal Court Orders by Facilities
Slide 32: Acceptance of Tribal Court Orders by Behavioral Health Service Providers
Slide 33: 6. Increased Sharing of Behavioral Health Information
Slide 34: Dual Role of Indian Health Care Providers in Behavioral Health
  • Alt. Text: Flowchart of four boxes.
    • "Indian Health Care Providers (IHCPs)" at the top of the chart with "Providers of health services" and "Entities with Governmental Authority" stemming from it. The below two sub-bullets stem from the "Entities with Governmental Authority" box. 
      • Access to Mental Health Records in Crisis Response
        • Example: IHCPs can receive confidential mental health records without an ROI under certain circumstances such as when the IHCP needs the records to conduct crisis/involuntary treatment services. See RCW 70.02.230 (opens link to external website)
  • In, 2020, the Washington Indian Health Improvement Act, SB 6259, added Indian health care providers to the list of qualified professional persons who are allowed to receive confidential mental health records under certain circumstances.
Slide 35: Information Sharing with Indian Health Care Providers and Tribal Governments - Generally
Slide 36: Part IV: Tribal and State Governance Tools
Slide 37: Tribal Behavioral Health Reform in Washington State
  • Legislative: 
    • Tribal and state laws
  • Administrative: 
    • Agency regulations
    • Regional BH Agency contracts and subcontractor’s clauses
    • DCR Protocols, Mobile Team Guidance
    • Tribal Crisis Coordination Plans and MOUs
    • Facility agreements and guidance
  • Judicial: 
    • Court forms
    • Superior Court Judges Assoc. training
  • Funding: 
    • Tribal Portions of Crisis System $ (DCR, Mobile Teams)
    • Tribal Court reimbursement
    • Exploration of AI/AN BHASO for future coordination
Slide 38: Part V: Outcomes & Adjustments
Slide 39: Discussion Topics
  • Over Interpretation 
    • Not fulfilling notice req. doesn't mean the case is thrown out
    • Not having a coordination plan published is not a valid reason to not respond to crises at a Tribe
  • Still More Needed 
    • Dual certification of DCRs may become more used
    • New crisis system resources are standing up regularly and need to connect with Tribal systems
    • The narrowest interpretation of regulations sets everyone back
Slide 40: Part VI: Resources
Slide 41: Resources
Slide 42: Additional Resources
Slide 43: Thank You
  • American Indian Health Commission
  • Kathryn Akeah
    • Tribal Health Consultant
    • kathrynakeah@gmail.com
  • Heather Erb
    • Lead Policy Advisor 
    • Heather.erb@aihc-wa.com

Public Comment Submitted Via Task Force on the Intersection of Tribal and State Forensic Behavioral Health Online Contact Form

Public Comment Submitted August 19, 2026, by Suenia Villa:

"Hello, I would like to present on Mental Health Diversion and the need to have a more comprehensive program in the court system that is easily accessible, and what that would require. I am also happy to submit a paper I wrote for my doctoral program that explains this. Currently, I run a mental health diversion program in California and would like to advocate for and expand it in Oregon. I would also be happy to sit on the task force.”