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Recovery treatment changes with pandemic

By Ben Rodgers

GREEN BAY – Those with court-mandated treatment as a result of crimes involving intoxicants have a little more flexibility during the COVID-19 pandemic.

As part of sentences, judges may require either an operating while intoxicated/driving under the influence assessment or an alcohol and other drug abuse (AODA) assessment for offenses like driving under the influence or domestic assault where intoxicants played a part.

Judges also require the recommended treatment be completed to do things like get a driver’s license back.

For example, a person convicted of DUI is ordered by the court to complete an assessment where a licensed professional determines the best course of treatment.

For Barbara Jordan, owner of AdvantEdge Executive Recovery Coaching, and other addiction specialists, the American Society of Addiction Medicine (ASAM) criteria help determine the needs of a person going through addiction treatment.

According to the ASAM, a person will need a certain level of care, and if that care is not available, generally people are able to seek more intensive treatment.

But Jordan said providers can now go a step lower as long as adjustments are made, thanks to flexibility with the Wisconsin Department of Health Services and public health departments during the pandemic.

“Providers can go to the next lower level of care until COVID restrictions are lifted and supplement residential care with their arrangements,” she said. “For example, intensive outpatient programming (IOP) is usually done in a group, in person. Some programs are having IOP, but over virtual meetings.”

However, privacy during virtual meetings can prove difficult in regards to the Health Insurance Portability and Accountability Act or HIPAA, which keeps people’s medical information confidential.

“Connection is important, but so is confidentiality and anonymity,” Jordan said. “That’s a huge challenge to balance those two. Even though the state is being flexible and waving some strict requirements for HIPAA, there still is a lot we consider in flexing these services and providing a client that same level of confidentiality that is safeguarded and protected.”

Restricted until June 15

Virtual meetings are a necessity because in-person services for everything from group meetings to inpatient care are generally on hold, except for extreme situations.

“We paused our residential intakes, but we plan to resume it on June 15,” said Larry Connors, CEO of the Jackie Nitschke Center. “We have plans in place with social distancing and the safety of our clients in mind.”

The Jackie Nitschke Center offers the full gamut of programs, but the next closest facility accepting inpatient referrals is Pathways To A Better Life in Kiel.

Connors said other programs at Jackie Nitschke are operating virtually until June 15.

“We have implemented and are continuing to explore other ways we could be available to the community essentially on a virtual basis until we can get more clear guidance,” he said.

However, to get to the point where inpatient residential treatment is required is an extreme case.

“A lot of the court systems will opt, if somebody hasn’t had treatment before, they’ll generally go with the least intensive level of treatment first,” said Tina Baeten, clinical supervisor with the Jackie Nitschke Center, who oversees the clinical team and programs.

She said those include outpatient offerings one time a week, individual sessions, therapy, or group therapy three times a week, a day treatment program, between three and five days a week, where patients go home to sleep at night, and finally residential, which is 24/7 usually over 30 days, but is not medically managed.

Baeten said medically managed care is administered in hospitals when a person’s life is in danger due to detoxification.

“This isn’t about getting them in trouble, it’s about providing them some help so they don’t suffer legal consequences and getting help for their issues,” she said.

Other options

Brown County is also home to five treatment court programs for offenders to apply to for various offenses.

For crimes related to drugs, heroin, DUI or for offenders who have mental health issues or are veterans, offenders are given the ability to apply for a treatment court, where the requirements aren’t as stiff as the regular judicial system.

“We by and large have case workers and then we’re connected with the Community Treatment Center on a lot of issues,” said Judge Don Zuidmulder, Brown County Circuit Court Branch 1 and lead judge for the treatment courts. “We don’t really have (inpatient treatment) to the extent our budget doesn’t allow us to do a lot of inpatient services.”

Zuidmulder said it’s the responsibility of the offender to pay for any addiction recovery services that would be required as part of a sentence, but options exist for those who can’t afford it.

The Jackie Nitschke Center, for example, has the Jackie’s Legacy Financial Assistance Program for people who are unable to pay for treatment.

Brown County also has funds budgeted for mental health and substance use treatment services, which can include county provided services and contracted services.

Unclear numbers

Though Baeten completes assessments for the courts, she said it’s not possible to determine how many people are referred to residential inpatient treatment at any given time.

Ian Agar, behavior health manager at the Brown County Community Treatment Center Outpatient Clinic, also has difficulty putting a number on this problem.

“At our agency, we only see a certain portion of people,” Agar said. “You could go to another agency, you could go to Bellin or Prevea, and you could see either a therapist or drug counselor there, and they could require residential treatment. A lot of people could access treatment in many different ways. They don’t all require contracts with Brown County.”

He said a typical month sees probably five to 10 people referred to residential treatment.

However, the recently-lifted social distancing guidelines with the pandemic are a double-edged sword.

“Because people’s activities in general have been severely hampered… a lot of people are hunkered down at home,” Agar said. “I would say our volume of referrals for alcohol and drug treatment is currently lower than it typically would be.”

At the same time, those in need of addiction treatment are currently more vulnerable than before, Connors said.

“There’s definitely a potential for more relapses, which is why it’s really important for people to reach out in the virtual world,” he said. “Whether it’s a friend support network, virtual meetings, it’s absolutely essential, because isolation can definitely be a trigger for people in terms of their substance-use disorder and/or recovery. It’s going to take intentional efforts on their part to really stay connected. Physically distancing is what’s required, social distancing is not. Stay connected. It’s important for the recovery.”

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