Hungry Heart Community Conversation, Part II: 12/17/13

Our goal tonight was to learn what is working and what is not; we
continued the Circle format. We reviewed what has led up to this point in
time, what is being done, and the beginnings of identifying the gaps and
some solutions. We will meet again Jan. 14 at 6PM at North
Congregational Church. Tentative plan is to do short review, and then
break into smaller groups to delineate what steps we as a community
should take.

Sue Cherry, our moderator, opened by having Nancy Bassett and Paul Bengtson
discuss DART (Drug Abuse Resistance Team), the Kingdom Recovery Center, and
the new DART 2.0.
Nancy mentioned how DART and KRC began
Paul gave an overview of how St. Johnsbury and Rutland, among other areas,
had issues with heroin and the beginnings of gangs in the late 90s, and that the
prevalence of heroin and prescribed opioid drug misuse has seesawed back and
forth several times since then. DART was formed after the community showing of
The War on Drugs, and our actions and plans led to Bess OBriens
documentary Here Today, which drove efforts on the regional, state and local
levels for a number of years, and is still being shown today.
The success of this movie in raising awareness and DARTs continued efforts
helped lead to the development of the KRC, a peer-operated Substance Abuse
Recovery Center, and the Aerie House, a Half-Way house for women in recovery
entering from incarceration and treatment. Pam Smart, who helped develop and
was the first supervisor, and Nancy, who was one of the first on-site
coordinators, agreed that Aerie has about a 50% success rate in assisting
women in their transition. (Covered Bridge, a faith based way house for men,
actually preceded Aerie, but was certainly enabled by the awareness-raising
success of DART and Here Today)
Another initiative, little-noticed at the time and coordinated by KRC in
partnership with Community Coordinating Council, Youth Advisory Council, State
police, St. Johnsbury police, Caledonia County Sherifs Department, NKHS, state
and local health departments, St. Johnsbury Academy, Probation & Parole, and a
group of recovering addicts, was the Meth Initiative: we gathered info, educated
merchants and local orgs: we slowed the spread of meth into our community by
about 5 years.
Paul then mentioned that heroin is now becoming prevalent once again as
current efforts and pricing are having an effect on RX misuse.

(My note: this continuous drug swing just highlights the need for an approach which
stresses the societal drivers that contribute to the perceived need for an addiction to
deal with trauma, loneliness, and above all, Poverty).

Now we are using the awareness wave of Besss new documentary The Hungry
Heart, to again find community-wide ways to address medication misuse and
the larger issues of a compassionate society.

Next, Nancy discussed what at KRC is working well. These include:

Collaborations, visitor and volunteer participation (specifically decision-making
at the weekly open work meetings). Also, annual events such as the Sober
camping Trip, Recovery Day at the Statehouse, Recovery Month March &
Candlelight Vigil, and many educational workshops. The Healthy Lifestyles
Initiative (co-sponsored by NVRH) has been a success in informing the
recovering population on healthy food and physical/mental/spiritual health. The
Recovery Coach Program assists many recoverees in navigating the shoals of
early recovery, and a representative of the center is involved with the Family
Treatment Court. There is a new, in-house Medication Assisted Recovery Pathway
Guide & Advocate, and several new meetings that expand the scope beyond 12
step/AA types. Gaps are detox beds and immediately available treatment beds.
As several in the group made note of, when the addict is ready, then is the time
to get him or her to treatment; we will lose them with a wait of any time length.
Karrie Taylor, state Hub Manager next spoke at the invitation of Justin BartonCaplin, who could not be there. She spoke to many of the things we are now
doing that may be lacking in other parts of the state, such as the Blueprint, of
which we are the pilot. Karrie spoke to the need for treatment beds when
needed, treating the organic, whole person and the necessity for determining
what is the best medication if needed. She states that when the Hub opens here
and in Newport January 1st Bupe can be kept on the premises and administered
in the same protocols as methadone. Prescribing physicians will be able to send
their patients to the Hub for counseling, and Prevention, recovery and Treatment
will all share the same vision. Recovery can be a lifelong process: the Hubs can
help address that with smaller caseloads and a larger team.
Next Sue Taney, NP, who will be a Hub team member, spoke on how important it
is to support prescribing Physicians, who have felt left-out and underserved to
date. The Blueprints first go-around was lacking but now there is to be more
support, with one full-time LADAC and p/t nurse for each 100 patients in addition
to present staffing levels (?). The LADAC/Nurse team will cooperate with
Physicians and coordinate support from the Hub.
Sue discussed the different needs of diverse areas, with Clara Barton in Bradford
as an example of a different model under the Blueprint; and, the need to better

2.

connect with other services in each distinct area. PCPs care most about
monitoring their patients for compliance.
24-48 hour window for Methodone/Suboxone treatment admission is planned. In
the past there were not enough placements for Long Term treatment and it was
not adequate, so patients were detoxed for 7 days and discharged, a sure recipe
for failure.
With the new Hub treatment availability for simple opioid use residential wait
lists should trend down, and there will be pilot residential programs
Deb Bach, NVRH ER Charge Nurse and Paul discussed treatment of those
suffering from addiction in the ER. Some hospitals hold those needing SA or NH
placement in their ERs for quite some time, but NVRH does not due to resource
allocation. It can be very hard to find placement, and Deb states that Social
Services can spend hours trying. There are 1200-1400 ER visits per month, and
consults from NKHS are called in 21-25 times: this # does not include those
seeking drugs. Deb states that getting consent for the ER to be able to consult
with BAART and other involved parties as a matter
3.

of course will make a difference, and there is an ongoing pilot of Care Plans to that
effect. Consent to speak with the ER during an emergency could be part of the consent
a patient signs when they enroll with BAART or prescribing physicians.

Paul and others wanted to know if there is a resource allocation vision in place
across the state. Karrie suggested that Evan Smith be contacted and that a
model such as Act Ones in Burlington could be useful. Pam and Paul reiterated
that stability in policy for healthcare allocation is needed: we need a needsbased plan for where beds should be located and where patients can be
directed.
Pam discussed the Opiate-Addicted womens Program, and the gap that exists
when the new moms need follow-up mental health services
Bess OBrien stated that ERs need available access to whatever services and
programs they require to immediately deal with a presenting addiction issue,
and that this is an issue across the state.

BREAK

Sue gave an introduction to this next segment, a discussion of the

issues brought up, and suggestions to go forward

Paul noted that the Hub and Spoke deals with medication-assisted
recovery and treatment and is a limited piece of the overall SA picture,
mentioning alcoholism as a larger issue. He suggested that we can make a
plan amongst ourselves, and suggest a state plan that fits our needs.

Rose Sheehan discussed the NVRH ATOD program (Alcohol & other Drugs)
that she directs. Tobacco is an addictive tool that is almost always
connected to SA, depression and many other MH issues. ATOD comes at
tobacco cessation from every possible issue, and the model can be
adapted to other SA/MH issues. She discussed education efforts around
junk food, sugar, tobacco and other health dangers. Store owners tell her
that tobacco doesnt generate much revenue, but that customers
purchase other items such as gas and milk when they stop by for tobacco
products. Rose stated that Prevention is paramount so that kids dont wind
up in the ER, and Bess and others seconded that statement. She uses the
Michigan Model in the schools and to train the trainers. Rose states that
she could use some help with the Second-hand Smoke campaign, and she
is applying for two new grants and will need support from the community.
She also mentioned new gender-based groups that are being developed
outside of the AA model
Sara Garey, Director of Health at St, Jay Academy stated that the Academy
now has many supports in place at the school, but that coordination and
support in the community could be improved, such as availability of IAP
programs. They do not use ER services for students needing addiction
treatment not of an emergency/overdose nature as Deb Lee arranges to
4.

send directly to Valley Vista Treatment Center in Bradford. The Academy

has three drug counselors.
Connie Sandahl, Director of NEKYS (Youth Services), spoke on the
population of kids who are homeless or precariously housed. She identifies
the problem in that they dont see themselves as an addicted population,
and are often coping by using drugs to dampen the trauma in their lives.
Connie mentions the Rap Program as a tool that identifies triggers, helps
put an action plan in place, and helps in facing a crisis.
Connie uses case managers to help kids stay involved with NEKYS, as it is
difficult to keep them engaged in wellness programs and to transfer to
formalized therapies when facing survival. When youth are ready we need
to have a response NOW! They dont identify with self-help groups in the
area because of the age difference and their needs are not recognized
Sue discussed her programs at the Community Restorative Justice Center.
They dont use case managers and focus on safety issues and link clients
with volunteers such as the COSA (Circle of Support & Accountability), a
program that successfully assists those who desire to reintegrate back
into the community after incarceration. They also operate the Reparative
Board, which has the offender face their victim and hold themselves
accountable. The CJC helps mobilize volunteers for many issues and can
always use more help.

Michelle Fay, our state representative and the Director of Umbrella,

discussed her time on the Judiciary Committee and the large amount of
time that was spent on opiates and treatment, and the new NARCAN
program to prevent overdose deaths. She asks us to continue to give her
as much input as possible.
Patrick Flood, Director of NCHC, mentioned that, while he was new to the
position he was invested in helping develop a vision plan for the Kingdom
and the state. He reiterated that his prescribing physicians have not felt
supported up to now.
Dennis Casey, an area counselor and original DART member, mentioned
gaps such as detox and crisis beds, the need for more IOP, and a fifty
person waiting list that will hopefully be addressed with the Blueprint/Hub
& Spoke. Also that people suffering from alcohol and other addictions are
left out of the HUB, highlighting the need for a more comprehensive
addiction plan.
Karrie mentioned a needed emphasis on discharge planning, with better
and more readily available options. It was pointed out that this has been
a long-standing problem in the Kingdom. Karrie also pointed out the need
for balance between Outpatient and Inpatient services, and that
providers and clinicians need a livable wage and better conditions, and
often leave the field.
Pam pointed to the lack of continuum of care except if a person is under
the care of Corrections.
Bess suggested that we need the same care plan for addiction as we
have for a disease such as cancer. If a doctor was to discharge a cancer
patient without needed services he would be liable for malpractice, and
SA/MH is now on parity with other diseases by law.
5.
She sees providers and clinicians around the state being overwhelmed by
lack of needed services. She sees that we need a major shift in societys
perception of and understanding of Addiction and its causes.
Patrick sees the need to track the total societal costs of SA and plan to
deal with them successfully.
Michelle reiterated that SA is treated differently than other medical
issues, especially when painted as a problem of the poor and
marginalized; it can then be dismissed as a marginal issue. She sees
the need for a compassionate approach, as others also mentioned, and
feels that Besss movies show that compassion.

We then adjourned until Jan. 14, when tables will be set up and
issues will be tackled. If anyone has suggestions please send them
on to Sue, Nancy, or myself. Please send corrections and additions
to these notes to me, at kline503@hotmail.com.

Steve Kline, NVRH/KRC