Bringing Hope to Rural Communities

[Upbeat Guitar Music]

Mike: Welcome everybody. This is Avoiding the Addiction Affliction, a series brought to you by Westwords Consulting, the Kenosha County Substance Use Disorder Coalition, and by a grant from the state of Wisconsin's Dose Reality Real Talks, reminding that opioids are powerful drugs and that one pill can kill.

Mike: I'm Mike McGowan.

Mike: My guest today, Tania Reindl is a mental health navigator in a small rural school district in Wisconsin. She's worked as a county social worker and has also worked with the Department of Corrections, and all of those jobs have unique challenges. But today we're gonna talk about the challenges of meeting the mental health and substance abuse needs in a small, rural community.

Mike: There's a lot of 'em across the United States. Welcome Tania.

Tania: Hello, Mike. Nice to see you again.

Mike: It's great to see you too. So tell us what the role of a mental health navigator is, especially in a school district.

Tania: Sure. And my role is a little unique because my current position as a mental health navigator is part of a SAMHSA Project AWARE grant.

Tania: So my position currently is a temporary position. And my tasks are essentially to create some sustainable mental health systems, policies, procedures, resources with students and staff in the community, in the very small community of the Wabeno School district. This grant position does not provide direct service to students or their families.

Tania: Again, because this is a temporary position. However, there are some school districts in, not only in Wisconsin, but throughout the nation that have embraced a mental health navigator role. That does work directly with families and students to connect them to referrals and interventions that are available to them, not only in the school, but in the community.

Mike: Since you've mentioned it in your first response since you said the magic word SAMHSA. And we're, by the way, we're recording this a week after the federal government sent out a letter eliminating all grants, and then reinstated the next day. What happened last week?

Tania: Last week was extremely chaotic for us.

Tania: My coworker and I have had the the ability to work with grants either directly within them or aside or in essentially working aside them through some of our other positions in our careers. So we know that a grant position is always subject to some additional scrutiny and potential for early termination, those kinds of things.

Tania: However, under our current administration. Last January, we already saw some of the writing on the wall, and we were a little worried about some of the things that were within our national platform with SAMHSA that didn't necessarily align with the current administration. So we've taken every single day that we've been offered within this grant as a gift.

Tania: So we have always worked to make sure that whatever we are providing to the district is going to be sustainable tomorrow if something happens to our grant. Last week all of that hard work that we continue to put into people's heads about sustainability, what happens if we're not here?

Tania: That kind of thing came to fruition. On Tuesday of last week at around 4:27 Wisconsin DPI received a letter from SAMHSA saying that the AWARE grant had been terminated immediately. So we actually I received notice of that actually from a press person from Milwaukee Journal Sentinel.

Mike: Wow.

Tania: Who had reached out to our district, or reached out to me personally and said, Hey, I hear that you have lost your grant. Can you make a comment? Obviously, I was not going to comment. I directly sent that to the state AWARE director. The next morning we actually had received a voicemail from that person saying that they were in with their legal team.

Tania: They were trying to work out some of the parameters to decide what's going on, et cetera, et cetera. On Thursday at 10:15 AM, so it was essentially Tuesday evening to Thursday morning. We still hadn't heard anything until we received another call from the director who said. Oops, SAMHSA just sent us an email saying, disregard the termination everything's been reinstated.

Tania: So it was 48 hours of chaos, not only for our project, but for so many other community projects that are boots on the ground in these small and larger communities that, you know, and we're just one little piece of it, but we're a pretty big piece for our school district and for our county.

Mike: Actually, that's why I wanted to do this podcast 'cause I'm all over the place. And when I go into small communities, it is a blessing to have something like what you're doing in place. And not every place does, but think of that tens of thousands of positions across the country, all of a sudden we're in flux.

Tania: Absolutely.

Mike: Okay, if you go away. And you will eventually, right? What do you hope is in place when your position is no longer funded?

Tania: Part of being in this position is really taking a close look at what can this district, what can these smaller schools and communities be able to absorb whether or not there's a, with the least amount of dollars, let's just put it that way, with the least amount of dollars for sustainability. What can we put into place that we know is going to be able to be there, whether or not there is a thousand dollars in the budget or whether or not there's $0 in the budget. So we knew very quickly that our district and even some other districts within our county would be, it would be really hard pressed to have another position added. Another actual mental health coordinator or navigator position added, or even for, reality reasons, a school social worker position or a school navigator position be added at a cost of, if you're talking benefits and wages, over $50,000 a year at least.

Tania: And that's the minimum probably. So everything that we've created, we've always asked ourselves, is this something that we can create with little or no dollars. That can be sustained, not necessarily by a staff person and maintained, and keep the momentum going. So that is really what we have entered every intervention and project with.

Tania: We know that, and we've had early discussions early on with our district administrators that another position was likely not going to be in the works. So we have stayed on the sidelines. We have not provided direct service. We have complimented whatever positions are there already, and whatever champions of mental health are there already within their own staff and really help to give them their support that they need to create a couple of new programs. To bring in some new resources that are from the outside that really no one knew that it would be free to bring them to the table for the students and the families. And that's what we've really worked hard on. So again, if we were not there and last week was a true reality, again, what do we have available? What can we continue to help those that district move forward?

Mike: I've been in places where the staff and the community have not embraced initiatives like yours.

Tania: Yes.

Mike: How has the staff and community accepted, embraced, or not embraced what you're doing?

Tania: There were a lot of questions. Both myself and my coworker are not necessarily directly from this community.

Tania: Someone else coming in and saying, Hey, we think you could do this a little bit better or a little bit different, can be intimidating for the recipients. So we really had to give a lot of initial information to them. This is what our grant is really about.

Tania: These are what our efforts are about. This is why we're here. And it really it was a little eye-opening for some of our district staff and families to realize that part of the reason our grant was brought to Forest County in particular in this little tiny hub of Wisconsin was that some of the last data and statistics showed that out of 72 counties in Wisconsin, Forest County was number 71 for health condition.

Tania: We ranked lower than Milwaukee County, which is our largest metro county in the state. So just educating our staff and our families a little bit about why we're here and that we're not here to say, you're doing this wrong or that wrong, or whatever. But let's bring some other things to your district that you may not be aware of, that your students may not know you know, anything about.

Tania: Or if they don't have all the information. And let's share that out there so that you have a little bit more support and we can add a little bit more value to the education system and to the community. And it was a little hard sell at the beginning. They don't see us regularly.

Tania: We're more behind the scenes. But when we launched something that we'll talk about, as far as like when we launched our mental health resource page for the district, people were like, holy cow, we didn't know that all this stuff was out there. And now it's at their fingertips and it gives them everything that they really could need to start a process of getting some help and support.

Mike: It's ironic when I work in larger districts, Tania you know this from working in several. You don't even know if kids are accessing outside help somewhere. But in small districts, the school is often the first place that kids and families turn to.

Tania: Absolutely. And so one of the things that we talked often and we still do, about communication and collaboration. Communication and collaboration and normalizing the conversation. Our initial, like boots on the ground efforts were, let's bring 988 here. Let's show the students what 988 is really about.

Tania: Let's educate them a little bit about, who they can reach out to. Because 988 has changed their platform a little bit too. They used to be just a, and I shouldn't say just a, but they used to be a suicide hotline.

Mike: Yeah.

Tania: They now have blossomed into, it's not just about if you're having some self-harm or self hurt conversations or thoughts.

Tania: It's also about if you're struggling with day-to-day living and challenges. And so they really opened up the eyes of many of our students and our staff who stopped by the table. So we brought them to our little school, so the kids could see that firsthand and talk to their call center folks firsthand as well.

Tania: We brought NAMI here so that the kids knew a little bit about what does that mean and what does that, those kinds of things. And then when we created, like I had said, the website. We created on there a pathway so that parents or students could get on there. And not only does it list our guidance counselors, but it lists our therapists who are available and it lists other resources available in our area that they can just click on a link and immediately be in contact with someone to be able to get some help at two o'clock in the morning or eight o'clock at night when they're sitting there. And they may feel isolated and alone.

Mike: And that happened, right? I think I remember that.

Tania: Yes.

Mike: Was it over a weekend that you actually got a call and were able to intervene?

Tania: Yes.

Mike: That's the beauty of a small, connected rural district.

Tania: That is exactly what we want and really embrace the students and the staff and the families to feel comfortable enough to reach out to those resources.

Tania: And it did happen in our school. We're fortunate enough to create a group of peer-to-peer led suicide prevention students who were trained in how to be connectors to trusted adults and how to be connectors to other students. So that if students were feeling challenged or frustrated or felt like they needed to have an outlet and be able to speak to someone that they could connect with those peers or connect with those trusted adults to be able to have a conversation and be able to find the resources that they need.

Tania: And that did happen specifically with a younger group in our middle school. And we were able to pull our groups together fairly quickly. And with your assistance, of course and you were fantastic 'cause we called and you were there. And the kids, you could just see the calmness come over in the room.

Tania: They're carrying a lot of emotions and stress with them. And you could see that in their faces, in their eyes when we were talking to them. And that is exactly why we are doing the work that we do, so that they feel comfortable enough to be able to come forward. And it's been a really, it's been something very exciting to see.

Tania: And it's been it's in, in my career, which has been over 35 years as a social worker. I'd love to see that in our kids and empowering them to know that there's help and resources out there for each other and for themselves.

Mike: One of the, this is so gratifying when I do this, but one of the things that struck me, and it strikes me all the time, is while these kids were really concerned about a peer.

Mike: When we met with them it didn't take long before they were mentioning all of the stressors in their lives and needing support. And as adults, you look around going, holy cow, there's a lot going on underneath the surface.

Tania: There is. And the ability for them, the strength for them to feel as though they can come forward and just discuss that as a normal conversation.

Tania: That's a huge win for our community, for our district, for students all across the United States if we continue to normalize those conversations. I like to have conversations with older adults as well, because we often hear I went through a lot of things when I was a student too, and, X, Y, and Z. And I'm like, things they look a little different today. And when we had that conversation with those students, you knew immediately they were so concerned, genuinely concerned for their fellow student that they were willing to put it aside even though some of their things that they were talking about were fairly traumatic.

Tania: And big things going on. They wanted to lend that helping hand. And their resilience showed through that event, alone. But it also helps for them to, heal together. And that's exactly what I think we saw a little bit of that just with that one event as well.

Mike: You talked about outside help, and we've talked about it here, the cuts to Medicaid, the lack of insurance that some families have. So what are the resources that are available and have you noticed when something happening with Medicaid cuts or lack of insurance, like what outside help can they access?

Tania: And at this point our district is fortunate to have two partnerships within our school-based mental health services that do have a sliding fee scale, that do accept Medicaid. Wisconsin at this point still has some school-based mental health funding that is available at the district levels that they could attach to mental health services for a student, should the need arise and there be an assessment done. And there's no other funding source. There is some ways to navigate around the funding. We've been fortunate to not have had any situations where a student has not been able to access services and have funding for that.

Tania: We work for Forest County Potawatomi. We actually have two tribes within Forest County here in the state of Wisconsin. One is the Potawatomi Tribe and the other is the Chicagoan tribe out of Mo Lake. We partner with Forest County Potawatomi Behavioral Health. They offer services in-house, so in our school and in their clinic in Cranden.

Tania: And then we also have services with North Lakes Clinic, which is out of another small town in our district, Lakewood. They provide in-house, in-school services and in their clinic as well. Not only for the students, but for their families if they would choose to do a family therapy session. And again, they offer sliding fee scales.

Tania: They offer Medicaid assistance. They're pretty broad and they're pretty creative with how they find funding for those services. We have not had a situation, and knock on wood, we have not had a situation where we have had to send a student or offer a student outside of those two providers to receive services unless they are for emergent psychiatric services, which then we're limited to go to a couple of metro areas. And that would be coordinated through our county health department, human services department.

Mike: I'm on a block where I know my neighbors who are right on either side of me, but the one on the side of my neighbor who's next to me, I don't know their name. That is not I've only been here 20 some years. That is not the case in a rural district. And so do you think that sometimes that perception that everybody's gonna know keeps people from seeking help or asking questions?

Mike: I find oftentimes, Tania, that the kids are healthier than the adults.

Tania: Absolutely. And again, even through some of the conversations we've had with students, we know that students are more worried about their family and their uncle and their aunt and their grandparents than they are about themselves sometimes.

Tania: There is some stigma, animosity, those kinds of things when you talk about living in a county that has some tribal relationships and things like that. There is a lot of historical trauma and historical opinions about working together and being cohesive in support for one another.

Tania: We have really worked hard. The district even prior to our grant coming, the district has worked hard to continue their partnership with our tribal nations and also with our clinic that we are work with in Lakewood that we've also worked with the tribe to bring in talking circles, which is very powerful in their population. And they have opened that up to not only tribal students, but also to all other students. And we've worked really hard to encourage other students to learn and to support one another in beliefs and history. That has gone very well so far this year. Sometimes we hit a few bumps in the road about, systems and just procedures and things like that.

Tania: But we've worked really hard with some of their directors to make sure that those services are available for all students and not just siloing students into particular groups and. We've really seen some change in opinions and some conversations to make sure that we are not doing anything that might look like it might be discriminatory or might have a stigma attached to it and that kind of thing.

Tania: It's a work in progress, but it's come a ways in my opinion.

Mike: Trust is so important in opening up and seeking help. And as you mentioned earlier, I don't know how many headstones you have to have in the cemetery before you're considered part of the long-term community.

Mike: But how do you go about establishing that trust so that people go, oh, okay, I'm gonna reach out.

Tania: Being visible and being consistent is what we've tried to really portray since we've come on as these grant positions. Again, not only within our district, but even within the community, people would look at us and say, so who are you and where do you come from?

Tania: And once we talk about the platform and what we're really trying to accomplish. Again, for that sustainable work. Really, people start to understand that this isn't just a one, we're gonna do this one project and we're done. We literally are putting things into place that anyone can use moving forward.

Tania: And again, that dollar sign is a big thing to make sure that it isn't gonna cost the district or the community anything more. Once people start to hear some of those, what I would call buzzwords, then they start to understand, okay, this isn't just another fly by the seat of the pants kind of program.

Tania: Let's really see if we can partner together. And partnering has been very successful. Like I said, not only with... there's a couple of other school districts within our county, so we try to be consistent with what we're providing in one school district to another because we do have transient students who move from one district to another. And it's fairly easy in today's world to be able to do that. So if we provide one resource and intervention at this school, we'd like to provide it at the other two school districts. And so we talk often and have regular partnership meetings with those other two districts and with our outside providers, whether or not that be the tribes or that be NAMI or that be the health department, so that everyone knows what's going on and how we can support one another even in community events that come up.

Mike: I always ask this because it's just been a interest of mine in my entire career about substance abuse. What drugs are you dealing besides alcohol, which is the big Wisconsin, I think what are you dealing with?

Tania: Alcohol still remains to be one of the biggest concerns even in our student population.

Tania: And when you're in a rural area there's access and availability and it's part of the culture, unfortunately, it is just forever there. Our county in particular has seen a huge uptick in opioid use, which again is nothing different than the trend throughout the entire United States. And we have had some of our partner resources that have really embraced the Narcan vending machines and Narcan resource or opioid resource at vending machines that are available throughout our county. Trainings, Narcan trainings or other trainings related to substance use have gone on and are available to the community as well. There's talking circles, parent cafe circles that are being offered so that parents can get a little bit more information about safety, security, those kinds of things. And then we did, as I had mentioned previously, the talking circles. One of the new things that's being offered right now through our Forest County Potawatomi Partners is to have some of their trained coaches. They're substance use coaches come in and these are, peer recovery coaches, essentially, that are coming in to be able to provide the students with an opportunity to sit down and talk about day to day, not only to help prevent them from use, but what do they do if their family members are using. How can they support those individuals?

Tania: Or what do they do in a crisis or emergency situation? Who can they go to? Who can they call for help? And those coaches come in four to five times a week. They are also working off a grant, might I add, through their tribe. But those coaches are coming in consistently and meeting with multiple students.

Tania: Some talking about, again, not only what's going on in the community, but what's going on nationwide. What's going on in social media? What are they hearing? What are they seeing? Those kinds of things related to substance. And also, we always like to touch a little bit on the vaping issues as well, because we have had some THC vaping situations this year that have resulted in some pretty big student suspensions, those kinds of things as well.

Mike: That's when law enforcement gets involved, especially if they're at school right?

Tania: Exactly. And we are really trying to steer people in more of a restorative justice type path. What are some of the services that we can offer?

Tania: How can they reach out to their own physicians and their own care providers to say, how can I get help for this? That kind of thing. And that takes some time though. And it also, there's a culture not only in Wisconsin, but through all of our partner states as well, that it's okay to utilize THC as a coping mechanism.

Tania: And that is, we're starting to see an uptick in that on a regular basis.

Mike: Yeah. You're close to where it's legal. Yes. Within driving distance. And we're still Wisconsin, for those of you listening in other parts of the country, we're surrounded by THC legality. We're still not, we're not, but I think it's only probably a matter of time.

Tania: We are literally within an hour, essentially to the Michigan border for access.

Mike: Which is of course illegal to transport it back, but I don't, I haven't heard of anybody being stopped.

Tania: Exactly.

Mike: Back in the day, way, way back in the day. When I first started this I did training and schools had these things called concerned persons groups.

Mike: These were kids who were concerned about somebody in their family. And when I go to a small district and do a presentation, if I simply mention my own history with my family afterwards, there is a huge line of kids wanting to do the me toos. Me too. Me too.

Tania: Exactly.

Mike: This is a huge concern for kids when they come to school every day and they're worried about what they'll go home to at night.

Tania: Exactly. And that's one of the things why we try to have events on a more regular basis so that they have that release ability. They have that ability to talk about it. And not just to their staff, or not just to their peers, but also to some outside individuals. Because kids, we can talk till we're boo in the face, as the adults that they see on a day-to-day basis, they're like, yeah, I've talked to you before.

Tania: And they might not feel like sometimes we are always listening or being able to give them the time or the space that they need. But when we have other individuals come into the school, they embrace that. They are feeling more and more comfortable with being able to do that.

Tania: And our goal is that if they become comfortable. They will take that extra step when they're alone to reach out to someone to be able to have that conversation. And it's not that they have to accept what is going on at home or what's going on with their loved one, but it is really about what can they do about it?

Tania: How can we empower them so that they have the ability to do something for themselves and for that other individual.

Mike: As you move forward and look towards transitioning the end of the grant, what do you hope stays in place or that you've put the ball going downhill.

Tania: Our goal and I know I've probably sound like a broken record, has always been sustainability.

Tania: So our peer-to-peer suicide group, Sources of Strength, which has taken place and has really exploded across the entire United States is really again, that peer-to-peer student to student arming them with the tools that they have available and can offer to one another and to themselves in a time of need.

Tania: That's probably been, and those kids are like I had mentioned before, they're so resilient and they're so creative and they're doing newscasts and their own little segments to be able to show. Not only they talk to staff and they talk to students.

Tania: They make it fun, they make it normal. They make it, as if you don't have to be fearful to reach out. These are the things that we can provide to you. And that momentum has not stopped and we want that momentum to continue. We are confident that group will continue beyond because they've taken ownership of it now.

Mike: That's the key, right?

Tania: The district has taken ownership of it. The mental health resources, putting together the mental health wellness page was actually pretty easy peasy, to be honest with you. And just to have a one stop shop, not only for our staff, but for our students and our community members, we're getting anywhere from three to five hits a day, which some people would be like, Ooh, that's not... In this small community that's huge!

Mike: Yeah!

Tania: That's huge. If it's there for one person even during the month when they need it, that is exactly what we're striving for. And that's there, that's been created. It was easy. Collaboration and communication. We have given the district a few tools to say, Hey, talk to your therapist and get some updates. Make sure that we are, if there's a potential harm to a student or there's something that's going on with that student that we can communicate and collaborate out a little bit more clearly so that their teachers can, maybe handle with care a little bit differently for the day or for the week or something to that extent.

Tania: We have created pathways for teachers to communicate with one another. We've created pathways that and we had a tragic student death last year. We realized through that death that we needed to do a much better job with communicating with our community partners, our EMS, our law enforcement, to make sure that we were supporting one another in a very strategic planned way for a very tragic event.

Tania: And so we created a collaboration guideline so that our district administrator is available by phone 24 hours a day. At first was not really thrilled about that, but he has embraced it.

Mike: (Laughs)

Tania: So law enforcement and EMS, 'cause we have all volunteer first responders up here for emergency services.

Tania: Those individuals all know exactly who to contact, whatever time of day or weekend it is. If something does happen and they feel as though a student may need some extra care for the next week, or a family may, they know how to reach out, and then that district administrator will make sure that information gets brought down to the correct individuals.

Tania: Just, again, making sure, we also trained our staff and some youth mental health first aid resources. These are some of the things that you are going to see. Let's have regular conversations about how we can support one another and support kids in our classroom, and who we can make those referrals out to.

Tania: So it's just making things a little bit more clear and concise. It again, it helps to empower people and to put people at a sense of being able to help one another and make sure that they're giving the right resources at the right time, at the right dose.

Mike: Awesome. And that is probably all of those reasons is probably why the phones last week and the emails in Washington blew up. 'Cause if that goes away, then you have tens of thousands of communities that are struggling and it's not that expensive either in the grand scheme of things.

Tania: Exactly.

Mike: Tania, I can't thank you enough for taking the time. It's chilly in Wisconsin today, folks. It's below zero.

Tania: Yes, it is!

Mike: I know we're inside. We're not doing this outside, but still it's gives you, speaking of mental health.

Mike: For those of you listening and watching, you have the link to the opioid information on the podcast blurb. Tania, thanks for your experience, the support that you offer. For those of you listening, please be safe, please be healthy, and understand what's going on.