NH recovery centers model how to treat recovering employees

By Annmarie Timmins

When Ryan Fowler, a recovery specialist in long-term recovery at Granite Pathways in Manchester, lost a friend to an overdose death last year, he was encouraged to take time off to grieve and got a card of support from co-workers when he returned.

At his prior recovery jobs, Fowler would have kept his loss hidden, he said, because that support wasn’t there. “Because I’ve had such great support (at Granite Pathways), my job is a strength for my recovery,” Fowler said.

An estimated 30 percent to 50 percent of addiction professionals are in long-term recovery themselves, said Dr. Dorothy Saxon Greene of East Tennessee State University, who studied this population in 2014. She found a 14.4 percent relapse rate but two prior studies found a 38 percent relapse rate.

Read more at our partner site NH Business Review.

North Country task force gives support to addiction counselors

Sheryl Rich-Kern

Behind the deluge of the opioid epidemic lies a tenuous line of addiction counselors trying to restrain the swell of overdoses and deaths.

Too often, they don’t have time to lean on each other for support.

But last year, on a muggy August morning, a group of these counselors recessed from the summer heat in an air-cooled space backdropped by the White Mountains and babbling brooks.

The setting was a Best Practices Waterville Valley conference room, where they assembled for six hours to discuss stories of substance misuse, alcoholism, grief, irreparable family dynamics and suicide.

These counselors weren’t disclosing details about their patients. They were exchanging their own life struggles, professional goals and turnaround moments. They also discussed what some call “vicarious traumas” — the result of watching patients suffer — and strategized how to mitigate the strain for their own psychological health, especially when faced with patients who don’t improve or refuse to follow recommended protocols.

Cynthia Thomas of Littleton, a registered nurse and faculty member of the Graduate Nursing Informatics at the nonprofit, online Western Governors University, participated in the 12-member panel at the Waterville workshop. She says the goal was to help raise awareness of clinician anxiety and burnout.

Thomas says that providers are taught to put their personal issues aside, yet when managing agitated or aggressive patients, that’s often difficult to do. She recalls working in a large medical and surgical unit in Virginia where patients with substance use disorders came in to detox medically or treat wounds from their addictions.

Many of the nurses, unless they received psychiatric training, weren’t familiar with anti-addiction medications and didn’t know how to respond to patients desperate for a fix.

“We don’t have the type of [mental health] services that people in our country need,” says Thomas. “Everybody [the provider] is trying to patchwork-quilt everything together in the moment for every single patient.”

An inadequate insurance system, she says, impedes the response to crisis scenarios. That leaves healthcare workers feeling less than satisfied about their job performance and emotionally exhausted. Ultimately, this impacts the quality of care, allowing medical mistakes to occur, often with tragic results.

Read the full story at our partner NH Business Review.

This story was produced by The Granite State News Collaborative as part of its Granite Solutions reporting project. For more stories, follow us on Twitter @Newsgranite and like us on Facebook @collaborativenh.

Piece of the Puzzle: Drug Courts Expand Across State

By Anna Berry

It was a Monday afternoon in Concord and Christopher Ruggles was sitting in a familiar place — in front of Judge John Kissinger at the Merrimack County courthouse. But after more than a year of regular appearances in court, this visit was cause for celebration.

Once one of Concord’s most-wanted men, Ruggles was graduating from the Merrimack County Drug Court — and he was the first to cross the finish line.

Wearing a collared sweater and a close-cropped beard, Ruggles looked younger and healthier than in the mugshots posted in news reports over the years.

Nearly 100 people had crowded into the courthouse for the January 28 ceremony, a mix of current participants, healthcare workers, police officers, and public officials in suits and ties.

“Every cop in the room had literally arrested me at one point or another,” Ruggles, 46, said later.

Read the rest of the story at our partner NH Bar News,

This story was produced by The Granite State News Collaborative as part of its Granite Solutions reporting project. For more stories, follow us on Twitter @Newsgranite and like us on Facebook @collaborativenh.

Road Work Ahead: Treatment providers get creative with transportation for patients

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By Annmarie Timmins

Correspondent

Granite State News Collaborative

The state promises this to anyone who walks through “The Doorway” for opioid use disorder treatment: “Help is less than an hour away.” It is a lot of the time. But that’s tough to guarantee because New Hampshire’s public transportation options are limited, and the state hasn’t yet handed out Doorway grant money intended to bridge gaps.

John Burns, director of SOS Recovery in Dover and Rochester said it can take a Somersworth client four hours to travel two miles to the Rochester site because the public bus takes such a circuitous route. The risk, Burns said, is that kind of hassle can zap a person’s motivation to stick with recovery.

Treatment providers have had to get creative.

Staff at Harbor Homes in Nashua pool their money to cover clients’ cab fare to treatment when there are no other options. Burns relies on volunteers willing to drive their own vehicles. Manchester’s Safe Station is using a city grant to pay Lyft drivers.

“The (Doorway’s) hub and spoke system, I like the design of it honestly,” said Burns, “but we don’t have the capacity at the spoke level.” And that’s with only 916 people using Doorway services since January - a fraction of the 5,000 expected by 2021, the end of the two-year grant.

On paper at least, the transportation challenge looks solved.

The state Department of Health and Human Services envisions Doorway clients without transportation using one of the state's existing public transportation services like Advance Transit in the Upper Valley, COAST on the seacoast and North Country Transit at the top of the state to get to treatment.

There are nearly a dozen providers. All have set routes but some will take a rider to a specific location with advance notice. Many charge a fare but some don’t. And, the rides are always free for Medicaid clients when arranged ahead of time through CTS, the company that coordinates non-emergency medical transportation for Medicaid clients. CTS also contracts with almost 65 taxi companies that can transport Medicaid clients to appointments, but again, it requires a one- to two-date notice.

Health and Human Services spokesman Jake Leon said the department does not know yet how many current Doorway clients are insured by Medicaid and thereby eligible for free transportation because the program began fewer than three months ago. For the same reason, Leon said he does not know how many Doorway clients have used public transportation to reach services.

The state also thought about non-Medicaid clients who don’t have their own transportation, can’t afford the bus fare or are uninsured or underinsured.

For this group, the state built a $450,000 “flexible needs fund” into the grant to cover non-reimbursable expenses necessary for recovery such as transportation, housing and medication co-pays. Each of The Doorway’s nine hubs are to receive $50,000, but it’s not clear yet how much spending discretion they will have or whether some portion of the fund must be dedicated to transportation.

That money has not yet been given to the hubs. And Leon said the department is still finalizing a policy for using the flex money.

In reality, there are still significant transportation barriers, said those who rely on public options for themselves or their clients.

Melbourne Moran Jr., director of Integrated Care and Population Health at Harbor Homes, said CTS’s required one- to two-day notice for a ride doesn’t work when he has a client that needs  medication-assisted treatment today. That’s when Harbor Homes staff pay a client’s cab fare out of their own pocket. “They are motivated for change while they are here,” Moran said of clients. “Just a five minute delay, then we lose them.”

Alyssa Seidenberg of Rindge used a taxi arranged by CTS to get to counseling and other treatments for several months last year. She said the taxi was unreliable - often late or a no-show - and inflexible if she needed to change her route. Seidenberg had a much better experience after staff at her drug court suggested she contact a nearby church that was offering free rides. Seidenberg said the driver called her over the weekend to set the week’s travel schedule and showed up when she said she would - every time.

But that ride service is limited to only females who have been in the criminal justice system and are working toward their recovery. That’s a small group of Doorway clients. Other local ride services are similarly limited, often to seniors and people with disabilities.

“Overall (buses and taxis) are helpful when they go the way it should,” Seidenberg said. “But at the same time, it’s a huge pain.”

Several treatment providers said the limited hours of public transit services can also be a challenge. Most run Monday through Friday, during the day. Yes, those hours work for most doctor appointments, counseling sessions, and medication-assisted treatment. But those hours don’t work for evening support groups or peer-to-peer sessions. And if a client needs to get to treatment across the state, the local transit services isn’t an option because it can’t leave its designated route.

Asked what would help, Burns of SOS in Rochester and Dover suggested a cooperative system between hubs and other spokes, although he acknowledged creating it would be a “logistical nightmare.”

This story was produced by The Granite State News Collaborative as part of its Granite Solutions reporting project. For more stories, follow us on Twitter @Newsgranite and like us on Facebook @collaborativenh.