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NH Initiative Led By Family: Teaching Self-Care to Workforce Touched by Opioid Crisis

Stories in the newspaper about an overdose death are more than just stories to those who are touched every day by the opioid crisis. The entire team including physicians, nurses, first responders, social workers, and even teachers and others in the community etc. are left devastated, and quite often have little training or skills to deal with the aftermath.

Angela T. Jones, LCMHC, MLADC, LCS, RYT and Cynthia Thomas, MSN, RN, are sisters who are working together with the “Opioid Response Network (ORN)” to create the North Country Task Force, which aims to address the mental health issues that often arise when dealing with the stress and devastation working in a field touched by the opioid crisis. The ORN initiative was created to address the prevention, treatment, and recovery of opioid use disorder and funded through the STR-TA grant, by the Substance Abuse and Mental Health Services Administration.

In 2018, New Hampshire, with 397 opioid overdose deaths—mostly from fentanyl—had the second highest opioid overdose death rate in the nation, and while the numbers of deaths are leveling off, it remains a major issue throughout the state.

Needs Assessment

Before the task force was formed, the sisters conducted a needs assessment by sending out a survey to providers, first responders, educators and others to determine how the opioid crisis was affecting their work and their mental health. The results were striking. Ninety-six percent of respondents met the at-risk criteria for Compassion Fatigue, a term used to describe burnout and moral dilemmas often faced by those in the helping professions. Nearly half of the respondents were not SUD treatment providers, and included police officers, correctional workers, and school counselors and educators. The sisters realized they needed to broaden the scope of the task force to include more than behavioral health and addiction treatment providers. The task force has expanded to include members from throughout the state, including representation from the state Department of Health and Human Services, Education, Public Safety, and Administrative/Policy makers.

During its first task force meeting, Dr. Sanchit Maruti, an addiction psychiatrist and the local ORN consultant working with task force, gave a Substance Use Disorder 101 presentation, which Ms. Jones said was well received. The presentation was developed by Providers Clinical Support System clinical experts in an effort to explain the science behind addictions to the general public. “Dr. Maruti was able to communicate the intricate details of this complex chronic disease in a way that everyone in the room found very compelling,” Ms. Jones said.

Dr. Maruti has also helped keep the project on track and guided the sisters on creating actionable items as well as measurable outcomes. “That’s really been key, in terms of his consultation with organizing this project,” Ms. Jones said.

The task force is modelling its efforts after the National Academy of Medicine’s guidelines on this subject:

• Raise the visibility of clinician anxiety, burnout, depression, stress, and suicide
• Improve baseline understanding of challenges to clinician well-being
• Advance evidence-based, multidisciplinary solutions to improve patient care by caring for the caregiver.

The Goal

The task force wants to provide a tool kit to identify evidence-based coping mechanisms specific to each professional group targeted. Ultimately, they hope that by addressing wellness and providing evidence-based coping skills for the workforce, patient care will improve along with the mental health of the workforce. Their plan is to identify core competencies that would become a standard of practice. “Many professionals have received little training in self-care and yet it is a principle in many professional groups code of ethics,” Ms. Thomas noted. “We want to help professionals articulate what self-care is, incorporate it as a daily routine, understand it is an important factor of resilience, produce change in work environments and professional organizations to provide ongoing self-care education and support.”

This is an initiative close to the sisters’ hearts, both of whom respect the challenges for those living with chronic conditions complicated by mental health and substance use disorders. “I know for myself and my colleagues, all of us are feeling the pressure of working without enough resources to meet the need for effective treatment. For the first time many of us are experiencing patients die in our case load,” Ms. Jones said. The stresses are many, she said. “Having a constant waiting list of people wanting to have the treatment, of admissions having to turn them away or put them on a waiting list. It is a complex moral dilemma of saying, ‘I’m sorry, I can only treat so many people.’ Knowing that the majority of people who need it aren’t getting any help and also reading in the newspaper, hearing on the radio, about these overdoses.”

Both women share lived experience and professional experience dealing with suicide related to substance use disorders and mental health conditions. Ms. Thomas’ work in chronic disease and population health is well-suited for her efforts with the task force. “I began to see that my experience in chronic care certainly applied to substance use disorders,” Ms. Thomas said. “My experience helped me see it’s an entire community, it’s not just agencies, it’s not just one professional group that has an impact for a problem as large as what we are experiencing now with the opioid overdose epidemic.”

Bringing in all areas touched by the opioid crisis is critical, they agreed. “The public safety participants, their testimony was incredibly moving. Having their perspective in the (project) brings another element of recognition that this experience that everyone is going through is reaching well beyond the hospitals or mental health centers,” Ms. Jones said.

Contact ORN@aaap.org to learn how you can develop a similar task force in your community.