2016

In June, Lisa Tyndall joined the Foundation as a technical assistant for the NC Center of Excellence for Integrated Care (COE). With over fifteen years of experience, she will help to provide technical assistance for integrated care program development to a variety of medical practice settings. We asked Lisa a few questions to get to know her better.

Q: Where are you from and how did you end up in North Carolina?

A: I am originally from Florida, but I have lived in North Carolina since I was in elementary school. I have spent most of my time in eastern North Carolina, with my undergraduate education taking me to Chapel Hill and have also spent some time in Raleigh with my husband.

Q: What drew you to the Foundation?

A: I love the idea of being a part of helping shape health policy at the state level. Even in the short time I have been on board I have been able to be a part of conversations that have given me huge light bulb moments of understanding how system wide change occurs. I love that the vision of the Foundation is geared towards helping all of those in North Carolina have access to quality healthcare.

Q: What types of organizations have you worked for in the past?

A: The majority of my employment time has been spent in an academic setting teaching, conducting research, service, and administration. I have also had experience in administration at two independent schools, as well as working in a local nonprofit family violence prevention agency.

Q: What are you most excited for in this position?

A: I think two things excite me the most about this position. First, as a Marriage and Family Therapist, I love building relationships and I am excited about building relationships with our various sites across the state in an effort to help them advance along the continuum of integrated care. Second, I am excited to continue to be involved in the advancement of integrated care across our state as a whole. I have always believed people are more than the sum of their parts and I am excited that our healthcare system is beginning to acknowledge this as well.

Q: What do you like to do for fun/in your free time?

In my free time, my most favorite thing is playing a game with my family. We will pick up a game of kickball, wiffle ball, or most recently monopoly, usually at the urging of one of my boys. While my husband and I may be tired, within a few minutes we are so glad we said yes to the request. Of course, I also love my personal quiet time through running and walking with my dog and time spent on the back porch in the early evenings with my husband.

Irina In May, Irina Kolobova joined the Foundation as a technical assistant for the Center of Excellence for Integrated Care (COE). With years of experience and a passion for improving health, she will help to provide technical assistance for integrated care program development to a variety of medical practice settings across North Carolina. We asked Irina a few questions to get to know her better.

Q: Where are you from and how did you end up in North Carolina?

A: I was born in St. Petersburg, Russia and grew up on the west coast, spending 6-8 years each in San Diego, Seattle, and Portland. I moved to North Carolina to pursue my doctoral studies in 2013. When I finished my PhD this May, I decided to stay and call North Carolina my new ‘home’.

Q: What drew you to the Foundation?

A: Working for the Foundation with the Center of Excellence for Integrated Care provides me an opportunity to apply everything I learned through my educational training while also being true to my passion of supporting marginalized communities and increasing access to high quality healthcare. Working alongside the multiple programs within the Foundation, I get the opportunity to be part of the systemic approach to improve the health of our community.

Q: What types of organizations have you worked for in the past?

A: A significant portion of my work history has been in research, starting with my earliest experiences at the University of Washington. During college, I was a research assistant for Drs. John Gottman and Jessica Sommerville. Following my love for research, after college I worked as a research assistant for a NIDA Clinical Trials Network protocol that evaluated a manualized 12-step program at an outpatient treatment center in Portland, Oregon. Later and until I moved to North Carolina, I worked as a research coordinator in the department of Endocrinology at Oregon Health & Science University (OHSU). In the position, I managed a large NIH-funded randomized-controlled study that looked at the effects of thyroid function on metabolism and cognition. During my doctoral studies, I worked as behavioral health provider at a Federally Qualified Health Center in Eastern North Carolina. Beyond these longer work experiences, I’ve also worked with a variety of other organizations including Cascade AIDS Projects, The Parry Center for Children, the Knight Cancer Adolescent and Young Adult Cancer Psychosocial Program, and the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.

Q: What are you most excited for in this position?

A: I get to show people how to integrate physical health and behavioral health and why this is important to improving population health. I enjoy getting them exciting about the work!

Q: What do you like to do for fun/in your free time?

A: As my colleagues would say, I have a life-long case of ‘wanderlust’. I love to travel near and far and do so with just about every minute of my free time. I enjoy exploring different cultures, trying new foods, finding treasures, and embracing different ways of being. I also enjoy nearly all outdoor activities including hiking, kayaking, paddle boarding, and snowboarding.

The table below from the CDC illustrates what we hear all the time on the news and in our communities: drug overdose deaths are on the rise. It’s both heartbreaking and shocking! Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving opioids. Escape from chronic pain, caused by a myriad of physical ailments, often initiates the journey to overuse and addiction.

Rather than focusing on the enormous and incredibly complicated routes to opioid addiction, this newsletter will take this opportunity to shine a light on some of the people, communities and projects that are working to make a difference. Once again, our mantra at the Foundation, “it’s a whole-person, whole-community thing,” holds true. Solving this issue is not possible by a single person or a single agency/institution; it’s about how we all can work together.

Rural communities are particularly vulnerable to this issue for a variety of reasons. Access to care, access to pain management, and the number of heavy labor occupations inherent in the economy of these communities have all been linked as reasons for increased opioid use. Research has also shown that prescription drug use in some rural areas is an embedded part of the culture, as they are often prescribed them to maintain a steady workflow in heavy labor occupations.

The Foundation houses The NC Rural Health Leadership Alliance, a group that works closely with the National Rural Health Association (NRHA) on a variety of issues. In February, NRHA provided testimony to the United States Senate Committee on the Judiciary regarding mental health and substance abuse issues in rural America. The following is a summary of the comments and recommendations from NRHA:

Rural Americans in need of substance abuse treatment services and behavioral health care will find that access to care can be limited.
Even with rural telemedicine services improving access to mental health care, 60 percent of rural Americans live in a mental health professional shortage area.
Rural Americans are forced to travel significant distances for care, especially specialty services such as mental health services and pain management.
With rural hospital closures, rural Americans are farther away from emergency care, as well as options for the ongoing treatment that is essential for successfully treating substance abuse.
The differences between rural and urban settings, culture and resource availability means the solution for rural America must be uniquely tailored to this population.
Treatment programs must be available locally and should be tailored to the unique needs and characteristics of rural Americans. Treatment programs must be able to leverage the health care providers in the community while using tele-health and other resources to bring new providers into the community.
The implementation of models to engage rural communities in addressing opioid issues must be supported. Broad community coalitions, including schools, law enforcement and medical providers need to be a part of the rural solution.
Evidence-based prevention programs tailored to the needs of rural communities must be identified and developed.
Implementation of harm reduction strategies must increase. Harm reduction is an essential part of dealing with the existing problem and will require training of both law enforcement and first responders. It will also require administering interventions known to reduce the harm of drug use including needle exchange and naloxone.
Use of evidence-based prescribing guidelines need to be promoted. Pain management is an important component of health care. However, measurement of hospital and physician quality must balance the need to address patient’s legitimate pain with the need to avoid misuse and diversion of pain medications.
State prescription drug monitoring programs (PDMPs) must be strengthened.
Use of substance abuse treatment as an alternative to incarceration for opioid users must expand. Those facing substance abuse or mental health crisis may wait years before seeking treatment from a professional, especially in rural America where the stigma discourages people from seeking treatment and views addiction as moral failure.

For the complete testimony from NRHA to the U.S. Senate Committee on the Judiciary, visit: http://connect.nrharural.org/blogs/erin-mahn/2016/02/22/nrha-submits-testimony-on

An enormous thank you to all the people engaged in this work every day. At the end of the day, success comes from the work done by communities, their citizens and the people who need their help.

-Maggie Sauer

CEO & President

Through a series of regional briefings held this month, the NC Rural Economic Development Center (Rural Center), a partner of the Foundation, released its rural advocacy agenda titled “Rural Counts: 10 Strategies for Rural North Carolina’s Future”.

The agenda promotes “stabilizing and transforming rural health” as an essential strategy for providing rural communities with a foundation for success. Regarding this strategy, the Rural Center specifically advocates to “strengthen local, state, and federal efforts to reduce opioid and methamphetamine drug addiction” recognizing addiction and substance abuse as a national crisis and supporting programs from various sectors and government levels designed to address this issue.

Learn more about the Rural Center’s recommendations regarding rural health and its comprehensive strategies for realizing the “economic potential for our rural communities and citizens” from the #RuralCounts download center on the Rural Center’s homepage: http://www.ncruralcenter.org/

The date is set! Please reserve October 6, 2016 from 6:00-9:00pm for the 11th Annual Jim Bernstein Health Leadership Fund Dinner supporting the Jim Bernstein Health Leadership Fellows Program. This premier event convenes health professionals and stakeholders from across North Carolina to network and learn from one another and to celebrate and honor past, present, and future contributions in our state’s health sector.

For years, the country’s opioid crisis has quietly escalated. From 1999 to 2012, deaths from common opioid medications increased by 400 percent. Additionally, accidental drug overdose is currently the leading cause of injury-related death in the country for people between the ages of 35 and 54.

North Carolina is no exception. In 2014, more people in North Carolina died from drug overdoses than car accidents.

Some blame decades of overprescribing opioids for the epidemic. Others blame law enforcement for not controlling the influx of cheap heroin. But according to community health advocate Anne Thomas, the “blame game” isn’t helpful. “Everyone is part of the problem. And everyone is part of the solution.”

Anne Thomas
Consultant for Chronic Pain Initiative and Project Lazarus

Anne Thomas is the current Chair of the Foundation’s Board of Directors and a consultant for the Chronic Pain Initiative and Project Lazarus. She supports communities in over 30 North Carolina counties who are building capacity to address the opioid epidemic and manage chronic pain effectively.

“Communities are best poised to solve their community health problems because they know their resources, they know their own culture,” said Thomas. “They know what things are possible, where there’s support, and where there’s resistance.”

The Chronic Pain Initiative and Project Lazarus is a two-year project funded by the Kate B. Reynolds Charitable Trust. The Foundation partners with the NC Office of Rural Health and Community Care of North Carolina to administer this statewide collaborative around opioid prescription management.

Project Lazarus is based on a successful model developed in Wilkes County aimed at preventing overdoses and meeting the needs of those living with chronic pain. The model includes the use of toolkits for clinical and community training. The toolkits are a range of guidelines for community action, education and for assessing pain and prescribing medication safely.

Thomas’s work is with community engagement. She provides technical assistance to help communities create and maintain local coalitions. She assists them with developing locally identified needs and locally tailored drug overdose prevention programs and connects them with state and national resources. This work includes identifying stakeholders who need to be at the table, leveraging resources or providing educational materials to boost awareness. “Many times they have the resources right there in their community, it’s just helping them explore and navigate them,” said Thomas.

One of the premises of the project is that change is possible with community engagement. Thomas says this means engaging with traditional and nontraditional partners. “We try to bring everyone together and engage the entire community,” said Thomas. Many coalitions are made up of parents, school systems, law enforcement, public health, businesses, churches, pharmacists and the medical community.

Thomas said that regional alliances can have a big impact. A cluster of seven counties in the northeastern part of the state have a coalition called the Albemarle Region Project Lazarus Coalition. The coalition includes Currituck, Camden, Pasquotank, Perquimans, Gates, Chowan and Bertie counties. Because of their shared resources, the alliance distributed effective messaging around safe opioid medication use and disposal.

They also organized drop boxes for unused prescription medication and purchased two incinerators for disposing them. They organized training in naloxone—a drug that reverses opioid overdoses—for emergency first responders. The alliance has partnerships with the school system to train school resource officers and school staff in providing prevention education. They work with community colleges to provide addiction education in the health curriculum as well as with law enforcement and the public health department.

“Rural communities have scarce resources,” said Thomas. “So creating economies of scale and scope by sharing resources and getting more people at the table is really effective.”

Thomas says communities can accomplish a lot by setting goals, assigning roles and developing strategy. “People don’t want to come to the table to just talk about something,” she said. “They’d rather be doing something. And when the doing starts to happen, people get involved.”

To learn more about the Chronic Pain Initiative and the Project Lazarus model, visit:
https://www.communitycarenc.org/population-management/chronic-pain-project/

For more information on North Carolina’s opioid epidemic, read “Policy for the Use of Opiates for the Treatment of Pain”.

Erin Hultgren, a Bernstein Fellow and Program Manager at Gaston Family Health Services (GFHS) is currently assisting with a behavioral health initiative that will improve and expand the delivery of substance abuse services and Medication-Assisted Treatment (MAT) to underserved populations with opioid use disorders. This initiative is funded by the Health Resources & Services Administration (HRSA) through their recent Substance Abuse Service Expansion, which awarded a total of $94 million in funding to health centers across the United States. GFHS was one of seven centers in North Carolina and one of 271 centers across 45 states to be awarded.

The additional grant money will enable GFHS to expand behavioral health and substance abuse services to serve its patient panel as well as extending services to both pregnant women and people living with HIV/AIDS and opioid addiction. Through its history of collaborative work with the Gaston County Health Department (GCHD), GFHS will work with GCHD and other community partners to identify pregnant and parenting women and HIV+/AIDS patients who need a more integrated approach to their opioid addiction including primary care, behavioral health, MAT and counseling services. Identification is only the first step. The ultimate goal of GFHS is to not only identify these patients, but also provide them with the integrated care they need to achieve and sustain recovery.

Additionally, GFHS will enhance their existing integrated model by:

Increasing the number of patients screened.
Connecting identified patients to treatment.
Hiring additional behavioral health providers to connect patients with access to MAT treatment.
Providing training and education for providers on best practices for opiate prescription.
Working with patients and community members on the availability and use of opioid antagonists.

As the HIV program manager for GFHS, Erin’s primary role in this initiative is to increase screening and education regarding the availability of testing and treatment for patients with or at risk of HIV/AIDS and Hepatitis C, both associated with opioid use disorders. Erin will work with behavioral health staff to update risk assessments to include questions regarding sexual health, HIV and Hepatitis C risk. Since integration and coordination of services is key to success, Erin will coordinate services between GFHS and health departments in the area to ensure patient’s have access to HIV testing and clinical services regardless of ability to pay. Although she’s new to the work of opioid addiction, she believes that an integrated care approach is the best way to provide support for these substance abuse issues.

“As we move forward, I think collaboration and communicating between partners will be our largest challenge and biggest asset,” she says. “Education will be critical – educating primary care providers, working with ERs, changing protocols, etc. Opioid addiction has far-reaching consequences and it will take all players at the table to conquer this public health crisis.”

For more information about Gaston Family Health services and their unique integrated care approach, visit http://gfhs.info.

Just this month, Monica Harrison joined the team as Technical Assistant for the Center of Excellence for Integrated Care. With years of experience and a great deal of passion, she will provide tools, techniques, training and technical assistance to organizations and healthcare professionals that will help them implement best practices for integrated care. We asked Monica a few questions to get to know her better.

Q. Where are you from and how did you end up in North Carolina?
I was born in New Orleans, LA. However, I’ll say I’m from everywhere, as I am what they call a “military brat.” Both of my parents were in the army and we moved to Fayetteville (Ft. Bragg), NC in 1991. I decided to attend college at the University of North Carolina at Greensboro for my Bachelor’s Degree in Human Development and Family Studies, and then attended NC A&T for my Master’s Degree in Social Work.

Q. What drew you to the Foundation?
Talk about the universe smiling down on me. I was eager to learn all I could about integration and making sure my agency participated in continuing our integration efforts in the most concise and evidence-based way possible. I’ve been on this endeavor since 2010. When I met the Center of Excellence staff in 2011, I thought, “wow it would be great to have had a blueprint to build off of and follow.” I’ve kept pushing forward ever since and have hoped I would have the opportunity to help others in their journey. Now I get to do just that.

Q. What type of organizations have you worked for in the past?
Believe it or not my first career was as an educator/teacher so, I hold a Birth Through Kindergarten Teaching License. Since then, I’ve held multiple positions with the Guilford County Head Start/Early Head Start program (teacher, education specialist, professional development coordinator, consultant). I’ve worked for Wake Forest Outpatient Dialysis Centers as a Nephrology Social Worker and Social Worker Manager in which I traveled to facilities in different parts of North Carolina as a part of an interdisciplinary team. I’ve worked for Win-Win Resolutions where we focused on character education, mentoring, bullying and conflict resolutions for the school system as well as juvenile justice led family programs. I’ve been the clinical lead for a residential home (group home) conducting clinical groups, and I’ve also worked at a pediatric primary care office to consult with other pediatric offices to work on integrative efforts. Lastly, I transitioned to working in a Federally Qualified Health Center as a part of and manager of their integrative endeavors.

Q. What are you excited for in this position?
I am excited to get the opportunity to spread my love and joy of integration and to be able to assist others to be successful in their integration efforts.

Q. What do you like to do for fun?
Well if not running around crazy to my children’s sporting events (I have five boys who all play a different sport, some of which travel constantly – and yes I am the loudest yelling mom on the team) then you will find me out with my husband trying out a new or favorite restaurant – we are “foodies.”

Jessica_Pikowski In February, Jessica Pikowski joined the Foundation as the new Communications Coordinator. In her role, she brings expertise in strategic communication that she will utilize to assist the Communications Team in setting and implementing strategies that help build the Foundation’s brand and visibility. We asked Jessica a few questions to get to know her better.

Q. Where are you from and how did you end up in North Carolina?
I grew up in Connecticut, but ended up in North Carolina when I decided to attend High Point University for my undergraduate degree. I fell in love with the state (and the weather) and ended up staying around to attend UNC Chapel Hill for graduate school. I think it’s safe to say I won’t be leaving North Carolina any time soon.

Q. What drew you to the Foundation?
I studied strategic communication as an undergraduate, but I’ve always had an interest in working for health-related nonprofits, which is why I am now pursuing a master’s degree in Health Communication. I’ve found that I enjoy doing work for organizations that make a difference (especially in health), whether it’s at the community level or nation-wide, which is one of the main reasons I was initially drawn to the Foundation.

Q. What type of organizations have you worked for in the past?
I went right from undergraduate to graduate school, so I don’t have a ton of experience in the work-field, but many of my undergraduate and graduate courses have involved working with clients in the surrounding community, so I’ve done work for a variety of clients like: the High Point Community Foundation, Kozzy’s Grille, Solar Head of State, and the UNC Volunteer Doula Program. I also worked for a small public relations agency called Creative Services, where I worked with mostly university clients, including High Point University and Davidson County Community College.

Q. What are you excited for in this position?
The Foundation’s message is an important one, and one that doesn’t always get the attention it deserves, so I’m looking forward to helping with the communication of these messages and being able to help get the word out to others about the great work they do.

Q. What do you like to do for fun?
I love to run, go hiking, biking, basically anything that gets me outdoors. I also love to read. With all the academic reading I have to do for school, sometimes it’s hard to find time lately to read for pleasure, but I’m trying to fit in at least 2-3 books a semester.

New Staff Feature: Lisa Tyndall Joins the Center of Excellence for Integrated Care.