Q & A with DMH

Q & A with DMH

The Treatment Services Team at University of Missouri Saint Louis-Missouri Institute of Mental Health reached out to Tim Rudder from the Missouri Department of Mental Health to get some perspective on what was successful under STR, what's new on the horizon under SOR, and for some encouragement for the future.

Stories of Success

Originally published to the February, STR/SOR Newsletter Mon, Mar 04, 2019 2:16 pm

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The following is a story of recovery from an individual who received rehabilitative services through Bridgeway Behavioral Health--Preferred Family Healthcare. This individual shares how STR helped turn his life around, his experience with medication assisted treatment, and on rebuilding himself, one day at a time.

"Hi. I am a 51 year old black male. I grew up in St. Louis. I first got started using when I was 13 years old. I went to prison at the age of 24 and served a 25 year sentence. When I came home, I moved in with my sister and I tried to pick up where my life had left off.

In trying to cope with life on the outside, I started smoking crack and picking up street-walkers, which turned into heroin and meth use. I had a good job that I lost due to my use. I decided I had reached a limit and wanted to get clean. But I knew I couldn't take those early first steps while living with my sister. It would have been impossible. I told her I would rather live on the streets than live with her. So I started living on the streets.

I was on the streets for three months before a friend told me that I could go to MoNetwork for assistance. I told the staff there I wanted to get clean. They got me into Gateway who sent me to Bridgeway. At Bridgeway, my recovery started.

I did a short stint in St. Mary's Psych ward after telling Bridgeway staff that I wanted to commit suicide. I'm glad I said something, I was finally able to get on the right medications for the first time in my life.

Leaving St. Mary's, I went back to Bridgeway. I was staying in an old abandoned house that I had been living in for the past three months, but Bridgeway helped get me into recovery housing were I am still currently living. I also started an outpatient program. I go to Bridgeway from 9 to 4, Monday through Sunday. Bridgeway helped me get on Medicaid. The staff is really helpful and kind. At first, I thought that they wouldn't care about me, but they have helped me more than I could have hoped to ask for. Since I've been with Bridgeway, I've been working my program and going to the groups and I've benefited from both. I am learning how to be more responsible with myself. Recovery housing is giving my life structure. I'm slowly getting my life back and I couldn't be more grateful."

Stories used with permission. Specific authorship and identifying details redacted to protect anonymity. Editor reserves right to redact content involving coarse language as well as content that could be triggering to readers in recovery from Substance Use Disorder. Additional edits made to grammatical choices to provide cohesion of text.

Article By Aaron Ruiz. Treatment Support Staff. SOR. UMSL-MIMH. 2019

Positive Actions, Brighter Futures

Since the 1860s, the Boys & Girls Clubs of America has been synonymous with excellence in care for growing and inspiring the future. Boys & Girls Clubs has seen generation after generation of Americans work to not only overcome the obstacles facing lower income families, but to learn how to thrive. Since its inception, Boys & Girls Clubs has maintained a heart for encouraging creativity, and a passion for developing integrity, responsibility, and good citizenship in children growing up in areas of economic need.

Bringing Faith and Braiding Funding

Founded in 2001 by Bobbi Jo Reed, the Kansas City based recovery juggernaut, Healing House, has set an example for Missouri on how to create a sustainable model for transitional housing for individuals in recovery. The Recovery Services team at UMSL-MIMH reached out to Healing House for a closer look into the secrets of their success…

SOR and Technology: uMAT-R

Dr. Patricia Cavazos-Rehg from Washington University leads a team of innovators as they bring access to resources for neonatal care and opioid treatment providers right to your phone. 2019 welcomes the launch of a new application for tablets and smartphones that combines technology and MAT in a new, SOR-funded, mobile app that helps women navigate pregnancy, parenthood, and recover.

Interview with a Certified Peer Specialist

One of the primary and most significant tenants of the Medication First Model is the provision of Medications for OUD (MOUD) without psychosocial services. Some providers have expressed concern that if such services are not mandatory, that clients may only come to get medication.
The UMSL-MIMH Treatment Support team met with St. Louis resident and Certified Peer Specialist, Miles Hoffman, to get a clearer perspective of the role and benefits of peer support and maybe an answer to that ever-persisting question:

UMSL-MIMH Spotlight

UMSL-MIMH Spotlight

The Opioid STR/SOR Evaluation Team is led by Claire Wood, PhD, and Alex Duello, MPH. The Evaluation Team works to analyze and disseminate data on the effectiveness of STR/SOR program implementation, with a specific focus on the impact of treatment protocols (i.e., The Medication First Model) on clinical and cost-related outcomes (e.g., medication utilization, treatment retention, monthly price of treatment). The Evaluation Team also monitors and assesses state-level and regional opioid-related data to support grant initiatives, assists grant partners in standardizing and improving data collection, tracks training data across grant initiatives, and manages the Opioid STR/SOR website. Reports produced by the evaluation team also focus on highlighting opioid-related disparities and the ever-changing landscape of the opioid crisis in Missouri (e.g., naloxone distribution, treatment admissions, opioid-involved overdoses and overdose-deaths). Support for evaluation activities is also provided by a number of other team members including Paul Thater, Claire Ward, MSW, Bridget Coffey, MSW, Keith Eldridge, and numerous wonderful interns from UMSL and WashU.

Gateway to Better Health Trainings

The Opioid STR/SOR Training Team is partnering with the St. Louis Regional Health Commission to provide educational sessions for St. Louis area Federally Qualified Health Centers (FQHCs) on the new Gateway to Better Health Substance Use Disorder (SUD) benefit and medical treatment for Opioid Use Disorder (OUD). Sessions are being held for medical providers and general staff audiences.

Stories of Success

Originally published to the December, STR/SOR Newsletter Tue, January 29th 1:10 PM

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The following is a story of recovery from an individual who received rehabilitative services through Bridgeway Behavioral Health--Preferred Family Health. This individual shares how STR helped turn his life around, his experience with medication assisted treatment, and on rebuilding himself, one day at a time.

“I got here from mostly from Fentanyl use. Although sometimes meth. Sometimes marijuana. I got myself into legal trouble. I kept hearing from former addicts that told me their stories and how their lives were different now. I was tired of being dopesick all the time.

I have been through Bridgeway several times in the past. This time when I called to get on the waiting list, I told them I wanted to do residential this time. I got here around May 5th 2018. Of course like a [redacted], I took my Subutex ® too early so I was sick as [redacted] for like three days. They gave me medicine to help me detox off the Fentanyl. Still, I tried walking out but my Dad would not come get me. I’m really grateful for that now. To be honest, I didn’t think I could do this and I didn’t really know what I was doing here. I thought I was just wasting everyone’s time again. But as days passed and I was listening to other addicts’ stories, I found I could relate to what they were saying. I started thinking that maybe I did have a chance of making it after all.

At first all I wanted, all I could think about was going back home. That changed when one day I was meeting with my counselor, and we were in the middle of doing a treatment plan, and he asked if I wanted to make a phone call home. So I called my Dad. When he answered, he was all [redacted] up and that’s when I knew I couldn’t go back home. That is when I made the biggest decision I’ve ever made in recovery and that was to move into a sober house. My counselor sent an e-mail to the sober house director and got me into the STR program.

I worked with a counselor for a plan on what to do after my discharge date. We had made a plan for housing and a plan for me to go to meetings from 9-4, Mondays through Fridays. So I’ve been going to meetings even though I really don’t like talking in meetings or groups. But I am slowly starting to share more often. My main support are the other addicts that I talk to. Also the staff has been great.

In the past I had tried inpatient and outpatient; I was even on Suboxone ® for a while. But I never changed anything or worked a recovery program. It was time to try something different if I wanted to stay sober. This is the first time I’ve been on Vivitrol ®. It’s helping me. Vivitrol ® is kind of like a safety net. But I know I still need to work a program if want this to last.

I just want to be like most normal people and have a job, a car, a house—just be successful. My health has improved by not putting [fentanyl] into my body. I now eat regularly. And I haven’t started yet, but I’m going to start running and working out. I love going to the races, fishing, and hunting—I now look forward to doing sober activities.

I guess that’s it. Just wanted to thank Bridgeway. None of this would be possible without them.”

Stories used with permission. Specific authorship and identifying details redacted to protect anonymity. Editor reserves right to redact content involving coarse language as well as content that could be triggering to readers in recovery from Substance Use Disorder. Additional edits made to grammatical choices to provide cohesion of text.

Article by Aaron Ruiz. Treatment Support Staff. SOR. UMSL-MIMH. 2019

Healing, Housing, Hope

Healing, Housing, Hope

In 2001 Ms. Bobbi Jo Reed of Kansas City residence made a decision to purchase a house. Not just a mere real estate investment, Ms. Reed had a vision to turn this small piece of property into a transitional living facility for women with substance use disorder. The framework she established for her endeavor involved a threefold set of goals to meet for each resident: provide research based recovery resources for all our residents, create a safe, supportive home environment where residents can focus on recovery, and equip residents with the life skills necessary to become self-sufficient, productive members of the community.

New Prescribing Guidelines Released by Missouri Health Organizations

Effective at the end of November, a big revision came to the opioid prescription recommendation guidelines. These guidelines, put into place to inform and instruct hospital-based physicians’ utilization of opioids in pain management, were suggested as a joint effort by the Missouri Academy of Family Physicians, Missouri Association of Osteopathic Physicians & Surgeons, Missouri College of Emergency Physicians, Missouri Dental Association, Missouri Hospital Association, and Missouri State Medical Association back in November 2015. This November, a revision to the guidelines has been put into effect. These revised guidelines stress the importance of thorough assessment of pain before prescribing narcotics, shortening the length of prescription for new conditions requiring narcotics, not refilling prescriptions that have been claimed lost or stolen, and suggests non-narcotic modalities of pain management in lieu of opioid prescription.

An EPICC Opportunity

The EPICC program serves those who recently overdosed on opioids, and within hours of admittance to the hospital, pairs the patient with a peer support specialist. Peer support specialists are individuals in long-term recovery from substance use disorder who act as living testament that recovery is possible. The peer support specialist is able to build a unique connection to the recently overdosed patient as someone who has likely been through the same pains of physical withdrawal and felt the same fears and reservations associated with seeking rehabilitation. But by bringing lived experience, encouragement, and a proverbial game plan for treatment, peer support helps the patient choose a rehab path that is right for them.

The ABC’s of STR   

Since 2009, Generation Rx has been a practical and straight-forward curriculum focusing on early prevention of pharmaceutical abuse. Offered in both English and Spanish this free, online curriculum has helped youths and adults alike learn the importance of taking medications only as prescribed by physicians. Generation Rx’s vision is to reinforce the importance of proper storage and disposal of medications, to explain the importance of not sharing pharmaceuticals with others, and how to carry the Generation Rx message out into the community.

Stories of Success

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Two individuals who received rehabilitative services through Southeast Missouri Behavioral Health share their stories of how STR helped turn their lives around, on getting clean time, and rebuilding their lives one day at a time.
The first story we received comes from an individual with a self-described all-consuming addiction to opioids and methamphetamine, and where they are today.

“I had no place to lay my head at night. Jobless, broke, and withdrawing from drugs but all I could do was focus on the cravings. Everything in my life revolved around the cravings.
I had tried to getting clean before, but I was unsuccessful. Medicine helps me stay stable and kill my cravings so I can focus on life. The place I had gone to wouldn’t allow me to take any kind of prescription medicine.
The treatment that ended up working for me was buprenorphine. That and counseling. I was able to mark my progress and I started getting more involved with social services and vocational rehabilitation.
Today I am clean of communicable diseases. I have been cured of Hepatitis C. My weight has improved. My mental health has improved. I have a nice house that I keep clean and a cat. I get to enjoy life and feel real feelings of joy, gratitude, and love. I can have meaningful conversations now. I’m not running from my problems anymore.”

Our next story comes from an individual who describes them self as having a severe addiction to Oxycodone, battling their severe anxiety, and how they wanted to get clean for their kids.

"I came here with a pill-addiction and learned that I had an anxiety. I was using Oxycodone daily and it was a significant drain on finances. My relationship with my kids was damaged. And I had so much anxiety. When I was younger, I was in an inpatient program that helped get the chemicals out but they never addressed the anxiety and the chemical imbalance.
The MAT approach was different. It worked for me in that they addressed the anxiety. I had no idea I had so much anxiety. They gave me Suboxone which helped me get balanced and then the anxiety was no longer at the forefront. It was no longer overwhelming. I had a clearer head.

My family was my main reason for seeking help. Today I can say that our life is amazing. I live with my girlfriend and our two girls. We have a home. We try to make positive progressions every day. My day to day life is far less stressful, or at least, I am able to handle things with less anxiety. And I get to spend more quality time with my kids. I have grown closer to my family."

Stories used with permission. Specific authorship and identifying details redacted to protect anonymity. Edits made to grammatical choices and to provide cohesion of text.

Article by Aaron Ruiz. Treatment Support Staff. SOR. UMSL-MIMH. 2018

Live Through This

Located on the bulls-eye of one of St Louis’ most at-risk neighborhoods, the Missouri Network for Opiate Reform and Recovery is bringing back hope to the hood. Open seven days a week, MoNetwork tackles the opioid epidemic head on by fusing a radical empathy for their clients with street outreach, compassionate peer support, naloxone education, harm reduction services, and connections to care.

Overdose Education and Naloxone Distribution Efforts

Overdose Education and Naloxone Distribution Efforts

Overdose education and naloxone distribution (OEND) efforts through STR/SOR are continuing to rapidly expand! To date, the grant has provided training to over 6,000 individuals and distributed over 8,200 naloxone kits. The Mo’ Heroes project aims to expand overdose education and naloxone distribution into criminal justice settings (primarily city and county jails and treatment courts) where individuals are at particularly high-risk of experiencing an opioid overdose post-release.

Updating the Medicine Cabinet

The Overdose Education and naloxone Distribution efforts through STR/SOR have recently helped expand the definition of “child safety” to foster parents at Angels’ Arms with a training on crisis response to an opioid overdose.

“Foster children deserve the chance to be children, to be part of a family, and to live up to their potential,” is the heart-felt mantra of the Saint Louis based foster-care agency, Angels’ Arms. Ensuring that the children that enter the care of their program are going to be kept supported and safe through any contingency until they can be placed in a forever home has been their mission since they first opened their doors back in 2000. But in the wake of the opioid epidemic that has swept Missouri, new factors have to be taken into consideration on how to keep children safe. According to the SAMHSA National Survey, between the years of 2014 and 2015 around 12,000 individuals aged 12 or older had admitted to using heroin. (SAMHSA National Survey, pg.6)

The Heart of Ground Zero

Better Family Life has been serving the greater Saint Louis Metropolitan area since 1983 with compassion and a big heart for the underserved populations of the city. Their mission statement, “to plan and establish social… cultural, and educational programs that help to promote positive and innovative changes,” shines through in their recent initiatives aligning themselves with STR/SOR.

Researching Trauma Informed Care

“My name is Anusha Challa and I am a clinical psychology graduate student at University of Missouri- St. Louis. My research interest in trauma and its intersection with substance use drew me to the work done at MIMH on Missouri’s response to the opioid overdose epidemic. It is striking to me that opioids, compared to other substances, are associated with experiencing earlier traumas. It is unfortunately very common for individuals misusing opioids to have extensive trauma histories. In the past few months, I’ve been lucky enough to present on the opioid overdose epidemic to the State Trauma Roundtable. As a current Roundtable member, I am working on developing trauma-informed guidelines in the context of substance use with the help of other experts in the field. We are hoping that such guidelines can raise awareness of the high trauma rates in opioid misusing populations to enhance a cultural change in the way we view, discuss, prevent, and treat opioid misuse. The goal is for such a cultural shift to affect consumers and providers alike, as providers witnessing overdose are at high risk for burn out. Working at MIMH on a team with others dedicated to saving lives during this difficult opioid overdose epidemic has been a very rewarding and inspiring experience, and I urge others to also lean on each other as we fight this epidemic.”