Please use the application - ATTC Addiction Technology Transfer

AMERICAN INDIAN
& ALASKA NATIVE
LEADERSHIP
ACADEMY
2015-2016
Participant
APPLICATION
National American Indian and Alaska Native Addiction Technology Transfer Center . University of Iowa . 1207 Westlawn . Iowa City, IA 52242
Phone: 319-335-5564 . Fax: 319-335-6068 . Email: americanindianalaskanative@attcnetwork.org . Website: attcnetwork.org
STRATEGIC
LEADERSHIP
DEVELOPMENT
A unique leadership development opportunity for
behavioral health and addiction professionals
The National American Indian & Alaska Native ATTC would like to
offer support to future American Indian and Alaska Native leaders in the
behavioral health and addiction service fields by inviting participation
in a comprehensive leadership preparation program which provides a
balance of traditional training seminars, distance education, and field
education.
Many leaders of tribal behavioral health programs in both urban and tribal communities
have expressed concerns about the graying workforce, especially among the leaders of
substance abuse, mental health, prevention, and treatment programs. These are very challenging
times, and our American Indian and Alaska Native leaders are concerned about who will lead these programs into the
future, particularly given the substantial changes in health care, the introduction of the Affordable Health Care Act, and the
integration of behavioral health into primary care. The need for leadership development and support is imminent.
Your agency, among many others, may already be faced with a shortage of adequately prepared leaders in supervisory and
administrative positions. Though experience is important, many leaders find themselves lacking vital skills - such as business,
administrative, or formal leadership training - needed to successfully guide an agency in this increasingly demanding field. The
American Indian & Alaska Native Leadership Academy is addressing this need by building a network where leaders can obtain
these skills through support and guidance using a holistic approach. This program addresses the urgent need to make available
thoughtfully developed, comprehensive training that is founded on the latest research in all relevant fields, and delivered to
those who will benefit the most: future administrative and supervisory leaders.
Why participate in the American Indian & Alaska Native Leadership Academy?
This program will provide opportunities to:
• Develop individual leadership skills
• Learn more about your personal leadership styles
• Receive individualized attention for leadership development
• Earn a Certificate of Leadership to validate hours of training and
project completion
• Meet other developing leaders
• Gain practical experience for the “real world”
What will the Leadership Academy offer?
The American Indian & Alaska Native Leadership Academy offers an exceptional opportunity for behavioral health and
addiction professionals to be mentored by current leaders in the field, as well as empowerment, support, and professional
networking on a local, state, regional, and national level, which will play a vital role in strengthening the healing community.
The program provides a balance of traditional training seminars, distance education, and field experiences. This nine-month
experience takes commitment on the part of the participant, mentor, and the agency in which the participant is employed.
The primary goal of the Academy is to cultivate new leaders within the behavioral health and addiction field through the
enhancement of knowledge and development of competencies among emerging leaders. The program incorporates a fourphase design that will lay a foundation in developing leadership, as well as some management skills:
Phase 1: Assessment – Participants are required to undergo a formal assessment of their leadership and management
interests, values, and skills, which should include participation of their supervisors, peers, and persons who report to them.
Phase 2: Training Experiences – Participants are required to attend in a five-day Immersion Training that provides the
conceptual framework and an appropriate body of knowledge for understanding the theory and practice of leadership and
management. It is recommended each participant take at least 20 hours of additional continuing education training based
on the applicant’s individualized development plan which will be made available through various educational venues.
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Phase 3: Experiential Learning – This phase moves the participant from the “classroom” to relevant settings (likely their
own organization) to hone their leadership competencies. Participants will be paired with a mentor who will help guide the
choice of topic and planning of an individualized leadership project relevant to their work and career goals. Examples: client
recovery mentoring or advocacy plans, community case management and referral development, counselor self-care, processes for reducing stigma,
or cultural competency. Participants will have an opportunity to present on the progress of their project and receive feedback
during the Enhancement Session in Winter 2016, which will also include continued training on various leadership skills.
Phase 4: Recognition – The program culminates at the end of the nine-month training when all participants and their
mentors gather to acknowledge accomplishments. Participants will present their individual projects and participate in a
special ceremony where they will be awarded a formalized certificate of proficiency.
How do I apply?
Please use the application included in this packet to submit to the National AI & AN ATTC office. The application deadline
is June 22, 2015. Please keep in mind that space is limited; only ten candidates will be selected to participate. Applications will be screened
and selected for the program through a committee process by the Leadership Steering Committee. The selected candidates will
be notified by July 1, 2015.
Send to:
National AI & AN ATTC Leadership Academy
1207 Westlawn, Iowa City, IA 52242
or email to:
Kate Thrams: kate-thrams@uiowa.edu; Mandy Conrad: mandy-conrad@uiowa.edu;
or Sean Bear: sean-bear@uiowa.edu
What are the costs?
The costs for the American Indian & Alaska Native Leadership Academy are largely offset by funding provided to the
National AI & AN ATTC, Substance Abuse and Mental Health Services Administration, and Center for Substance Abuse
Treatment (SAMHSA/CSAT), and is available to helping professionals across the nation. The National AI & AN ATTC
requests a one-time fee of $1000 (on a sliding scale) payable by the applicant’s agency, with remaining costs covered by the
program, including: hotel accommodations, travel, and per diem during the face-to-face meetings.
Where and when do the face-to-face meetings take place?
AUG
17-21
Immersion Training
Meskwaki Casino and Hotel,
Tama, IA
JAN
2016
Enhancement Session
Miami, FL
MAY
2016
Graduation
Portland, OR
Required face-to-face meetings include: a five-day Immersion Training in Tama, Iowa, August 17-21, two-day Enhancement
Session in Miami in January, and two-day Graduation in Portland in early May.
The American Indian & Alaska Native Leadership Academy Committee is asking for your application if you hope to
be a future leader in the behavioral health, addiction treatment, or helping professional field. Any questions about this program
may be directed to kate-thrams@uiowa.edu, mandy-conrad@uiowa.edu, or sean-bear@uiowa.edu.
Sincerely,
Anne Helene Skinstad, PhD, Project Director
Sean Bear Sr., BA, CADC, Meskwaki Tribal Member, Senior Behavioral Health and Training Coordinator
Mandy Conrad, BS, Doctoral Trainee, Graduate Research Assistant
Kate Thrams, BA, Research Support Coordinator
Jacki Bock, Fiscal Manager
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LEADERSHIP ACADEMY PARTICIPANT APPLICATION
Candidates for the program must apply with the support of the agency director within their treatment
agency. It is critical that the agency agree to allow the candidate the time needed to complete all
requirements, and provide opportunities to test new skills. Forms are included in this application to be completed
and submitted by an agency supervisor or director who works closely with the applicant.
Candidates should show potential for management and leadership, a willingness to learn, grow, and meet the following criteria:
• Identify as Native American, American Indian, or Alaska
Native.
• Have no certification violations.
• *Verify passing of criminal background check or fingerprint
clearance
• Are a tribal leader interested in behavioral health.
• Are employed in behavioral health, addiction treatment, or helping
professions field.
• Provide verification that the agency is also committed to the personhours required to learn and apply the leadership model/training
(forms included).
• Are supervisors/administrators (preference will be given to those
who have substance abuse certification or licensure).
*Options are listed on the following page
• Have supervisory or administrative experience. Additionally,
clinical experience will be taken into account.
Applicant Information
Name:
Agency:
Title:
Address (agency):
City:
Telephone (day):
State: Zip:
Email:
Highest academic level:
Years in behavioral health/addiction/helping professions field:
Current Position:
Is this position supervisory or administration?
Yes
No
Tribal Affiliation:
The following fields are OPTIONAL. This information is included on the nomination form to help assure balanced participation.
Gender: Race/Ethnicity:
Male Female American Indian or Alaska Native
Multi-racial
Other
NOTE: With the complete application, please also submit:
1. An autobiographical overview or resume.
2. A letter of commitment describing your interest in this program, professional growth goals and objectives, and areas of
interest within your field including potential topic(s) for your individual project.
3. Completed forms on the following pages and letter of support from supervisor/director (may be included with applicant’s
materials if enclosed in a confidential signed envelope, or submitted directly).
OPTIONAL – Is there any additional information that you would like to include which would assist the selection committee in
making their decision?
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CERTIFICATION AND AGREEMENT
The purpose of the American Indian & Alaska Native Leadership Academy is to enrich the experience of a wide range of
promising individuals at an optimal point in their career to help them prepare for greater responsibilities and contributions to
the agencies in which they work, and to the behavioral health and addiction field in general. By signing below, the applicant agrees
to commit to the requirements for the 2015-2016 program if accepted, and will initiate steps to have results of a criminal background check or
fingerprint clearance sent to the review committee, choosing one of the following options:
My organization has conducted a background check. I consent for the results to be sent to the review committee of
the Leadership Academy.
I would like to pay for a background check myself. I consent to have the results of the background check sent to the
review committee of the Leadership Academy.
I will obtain a copy of my fingerprint clearance card. I consent for the copy to be sent to the review committee of the
Leadership Academy.
Signature of Applicant:
Date:
I certify that the information included in this application is correct.
ALL APPLICATION FORMS MUST BE POSTMARKED OR RECEIVED ON OR BEFORE:
June 22, 2015
Send to:
National AI & AN ATTC Leadership Academy
1207 Westlawn, Iowa City, IA 52242
or email to:
Kate Thrams: kate-thrams@uiowa.edu; Mandy Conrad: mandy-conrad@uiowa.edu;
or Sean Bear: sean-bear@uiowa.edu
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LEADERSHIP ACADEMY APPLICATION: AGENCY SUPPORT FORM
CONFIDENTIAL
Note to person completing this form: It is important that in completing this form of support that you believe the applicant
has realistic potential to become a leader in your agency, and also demonstrates commitment to both your agency in particular,
the behavioral health and addiction field, or other helping professions such as mental health and problem gambling in general.
Your candid assessment of the applicant’s talents, accomplishments, needs and potential will be very helpful to the academy’s
selection committee. Your comments are confidential, and will not be shared with the applicant. After completing this form, please
submit directly to the Leadership Academy, or enclose in a sealed, signed envelope for the applicant to include with their application.
PLEASE ANSWER THE FOLLOWING QUESTIONS.
Please submit a typed summary answering questions 1-4, not to exceed 2 pages.
1. How long have you known the applicant, and in what capacity?
2. What leadership qualities led you to recommend this person?
3. Please provide examples that describe the applicant’s leadership skills or potential.
4. What type of skills or training do you believe would benefit the applicant?
coordinating, teamwork, leadership/influence, managing
conflict, and planning/organizing.
Problem Solving and Decision Making – Demonstrates skills
through problem identification, insight, seeing things from new
angles, recognizing trade-offs, decisiveness, and action.
Communicating – Demonstrates effective oral and written
communication skills and active listening. Is persuasive and
influential in communications.
Building and Maintaining Relationships – Demonstrates skills
that build interpersonal relationships, negotiating, putting people
at ease, and showing compassion and sensitivity.
Mobilizing Innovation and Change – Demonstrates the ability to
conceptualize, inspire, act creatively to mobilize innovation and
change, risk-taking and visioning.
Managing Self – Demonstrates self-directed learning, personal
organization/time management, personal strengths, and
problem solving/analytical skills.
Personal Professional Demeanor – Demonstrates integrity and
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honesty, projects a professional image, and incorporates ethical
practices.
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Managing People and Tasks – Demonstrates such skills as
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5. Please rate the effectiveness of the applicant, to the best of your ability, in the following seven leadership competency
dimensions. Circle your numerical response using the 5-point scale provided.
CERTIFICATION AND AGREEMENT
The purpose of the American Indian & Alaska Native Leadership Academy is to enrich the experience of a wide range of
promising individuals at an optimal point in their career to help them prepare for greater responsibilities and contributions
to the agencies in which they work, and to the behavioral health and addiction fields in general. I understand that continued
agency support is imperative for the applicant’s successful completion of this six month program. If the applicant is accepted
to the program, the agency agrees to support the participant in the following ways:
• the time required for full participation
• the one-time registration fee of $1000 (on a sliding scale)
Agency Supervisor/Director Information
Name:
Agency:
Title:
Address (agency):
City:
Telephone (day):
State: Zip:
Email:
Signature of Nominator:
Date:
I certify that the information included in this application is correct.
ALL APPLICATION FORMS MUST BE POSTMARKED OR RECEIVED ON OR BEFORE:
June 22, 2015
Send to:
National AI & AN ATTC Leadership Academy
1207 Westlawn, Iowa City, IA 52242
or email to:
Mandy Conrad: Mandy-Conrad@uiowa.edu; or Sean Bear: Sean-bear@uiowa.edu
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AMERICAN INDIAN & ALASKA NATIVE
LEADERSHIP ACADEMY
Trainer
Brent Lierman, PhD, Member of Cherokee Nation
Curriculum Development
Brent Lierman, PhD, Member of Cherokee Nation
Mandy Conrad, BS, Doctoral Trainee
Sean Bear, Sr., BA, CADC, Meskwaki Tribal Member
Facilitator and Curriculum Writer
Pam Waters, MA
Task Force Members
Lisa Brunk, Lac Vieux Desert Band of Lake Superior Chippewa Indians
Julie M. Cain, BS, LAC, Blackfeet Nation of Montana
Arlene Kashata, Odawa enrolled with Grand Traverse Band of Ottawa & Chippewa Indians in Michigan
William Martin, Creek Nation
Richard Moreno, M Ed
Clyde B. McCoy, PhD, Eastern Band of the Cherokee Nation
Lenore Myers, Chippewa Cree Tribe of the Rocky Boy Reservation
Roger Dale Walker, MD, Cherokee Nation of Oklahoma
Kellie Webb, Eastern Shoshone/Cowlitz
Linda Woods, Odawa enrolled with the Grand Traverse Band of Ottawa & Chippewa Indians of Michigan
Marilyn Spoon, BS, CADC, Member of the Sac and Fox Nation of Oklahoma
Lakota R. M. Holman, M Ed, Rosebud Sioux tribe
Myron Lee Little Bird, AAS, CADC, NCEAC, Tribal Councilman for Northern Cheyenne tribe
National American Indian & Alaska Native ATTC
Anne Helene Skinstad, PhD
Sean Bear, Sr., BA, CADC, Meskwaki Tribal Member
Mandy Conrad, BS, Doctoral Trainee
Kate Thrams, BA
Jacki Bock
National Rural and Frontier ATTC
Terra Hamblin, MA, NCC, DCC