On Wellness in WV

I wrote a story for today’s paper about a mindfulness training to be held in the fall for first responders from Kanawha, Putnam and Cabell counties. We have limited space in the paper, but I wanted to share more about the research being conducted on the training, and what agencies that don’t operate in Kanawha, Putnam or Cabell counties can do.

Richard Goerling, a police lieutenant in Oregon who developed a training on first responder resiliency and performance, will be leading the two-and-a-half day training. He says it’s about noticing emotions as they arise, and not spending unnecessary energy trying to control or ignore the emotion. He also says it’s about learning to pay attention to stress-related changes in the body. Goerling said participants will learn “how do we be present and create space for performance with the emotion that arises.”

“Ignoring emotion actually makes us more weak,” he said. “Typically today we wait until first responders are broken and then we try to fix them.”

Organizers have not announced where in the region the event will be held, but it is planned for late fall.

Dr. Michael Brumage, executive director and health officer for the Kanawha-Charleston Health Department, and Brittany Canady, a health psychologist at Marshall University, applied for a $49,000 grant to get the training. West Virginia Clinical and Translational Science Institute will conduct research on it, based on standardized self-assessments, and will test the presence of stress hormones in a person’s saliva before the training and then again weeks after it’s over. Researchers will measure participants’ baseline emotional physical and mental well-being through questionnaires and also measure salivary cortisol level (an indicator of stress). They predict changes in mindfulness, physical health, mental health and stress, and that those changes will be reflected in salivary cortisol levels at 4 weeks and 90 days after the intervention.

The grant application says that results “will be shared with the first responder community.” But only about 70 people will be trained.

“Our hope is that we can test out this intervention, hopefully find out that it’s helping people, and then be able to relay those results to others so the word can get out,” Canady said. “There’s really nothing that we know of that’s been done with first responders in Appalachia.”

Here’s what organizers told me about what other counties with fewer resources could do:

Goerling suggested that West Virginia agencies that lack funds to hold similar trainings could look for local yoga trainers. He also noted that in early 2018, Pacific University Graduate School of Psychology in Oregon and the University of California San Diego Center for Mindfulness will launch a peer coach training. West Virginia agencies could send representatives, who could then come back and train staff. He also recommended pooling resources with other local and regional agencies.

Brumage also noted that there are meditation and tai chi groups in the region.

“I think our best advocates for this kind of training will come from the first responder community themselves,” he said.

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Sometimes you can can learn a lot about someone by what they don’t say.

On July 15, we published a story I wrote about how a plan the U.S. Senate was considering to repeal and replace the Affordable Care Act would cause West Virginians to lose access to addiction treatment.

The story noted that the bill would end Medicaid expansion in West Virginia and make deep cuts to traditional Medicaid. It noted that in 2016, about 50,000 of those covered by Medicaid expansion in West Virginia had substance-use disorders, according to the Department of Health and Human Resources.

From the story:

The Congressional Budget Office hasn’t released an estimate for the newest version of the bill. But it estimated the similar previous version would cut Medicaid by $772 billion over 10 years, based mainly on ending the extra funding for states that expanded Medicaid under the Affordable Care Act and setting per-capita-based caps on traditional Medicaid payments to states. It estimated 15 million fewer people would have Medicaid in 10 years.

Medicaid is the single largest payer of substance abuse and mental health treatment in the country. Nationwide, Medicaid covered three in 10 people with opioid addiction in 2015, according to the Kaiser Family Foundation. West Virginia has the highest overdose death rate in the nation, mainly due to opioids.

The newest version of the bill could also make obtaining coverage harder for people who have been addicted to opioids to find coverage on the private market because it would allow insurers to sell plans that discriminate against people with pre-existing conditions by charging higher rates.

Dr. James Berry, addiction psychiatrist and medical director at West Virginia University’s Chestnut Ridge Center, said the bill would be “devastating to the people who don’t have the financial resources in order to take advantage of programs such as ours.”

Lois Vance, addiction care coordinator at Kanawha City Health Center, said “If they lose their insurance, the whole world is going to be looking down on them again.”

And from a previous story:

Medicaid expansion money spent on substance abuse treatment, including services and prescriptions, increased from about $25 million in 2014 to $111,767,057 in 2016.

In 2013, 5,827 people with opioid abuse diagnoses were covered by Medicaid, according to the DHHR. Medicaid paid for $6.8 million in opioid abuse-related claims that year. By 2016, the number had increased to 14,808 patients. Medicaid paid for more than $17 million in opioid abuse-related claims that year.

All three members of the U.S. House of Representatives — Reps. David McKinley, Alex Mooney, and Evan Jenkins, all Republicans — voted for a bill that would have similarly resulted in a loss of coverage among the opioid-addicted population in West Virginia. It would have cut Medicaid by an estimated $834 billion over 10 years, resulting in 14 million fewer Medicaid enrollees by 2026, the Congressional Budget Office found. States would also have been allowed not to require insurers to cover certain conditions, including mental health and substance abuse problems.

Spokesmen for Mooney and McKinley have not responded to requests for comment on how their votes could have affected the opioid-addicted population in West Virginia. Those requests were sent July 17, following the release of the latest story.

A spokeswoman for Jenkins responded to the initial request, but never sent a statement or set up an interview as requested.

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Before Tom Price came to town to “listen”

Remember when U.S. Health and Human Services Secretary Tom Price visited Charleston in May for a “listening tour” on opioid addiction? Of course you do. West Virginia made national news when journalist Dan Heyman was arrested after attempting to ask Price a question, about whether domestic violence would count as a pre-existing condition under the GOP plan to replace Obamacare.

I found the description of the event as a “listening tour” a bit strange, because I knew from a previous open records request that state officials had already told GOP leaders supporting the bill, in letters, that it would “negatively affect the ability of West Virginians with mental, behavioral health and substance use disorders to access needed services,” and that the president’s budget would have a “dramatic impact on substance abuse and mental health services.” “Federal funding must be maintained or West Virginia’s health care infrastructure will collapse,” both Governors Jim Justice and Earl Ray Tomblin have said.

So I wanted to know more about who, exactly, thought the tour was a good idea, what the Trump administration had to say when they contacted state officials, and the planning that went into it.

If you’re interested, here are the 155 pages of emails DHHR was required to send me under state law. Some of the highlights include:

Laura Trueman, of HHS, emails the governor’s office, saying Price wants to come on Tuesday, May 9 to “highlight work being done on opioids by the states.” The email also says he wants to perhaps “meet with the Governor and his Advisory Council, and then go see something in the community – perhaps first responders, hospital visit, or a rehab place or drug court.” The governor did not attend.

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HHS officials also insisted that press not be able to attend the roundtable discussion (although we were able to attend a four-question “press conference.” Most of my time at that event was spent listening to prepared statements by various officials, not on questions.) According to emails, Butch Antolini, a spokesman for the governor, asked about making the event open to press. Trueman gives reasons why not:

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HHS was apparently concerned about “losing control of the message,” which conflicts with its stated goal of a “listening tour.”

They also stated that “Candor might be compromised.” This is confusing to me, because we at the Gazette-Mail regularly speak to most of the roundtable participants about the opioid crisis.

More concerns about press:

press

Trueman sends suggested language for the invitation to the event. It begins:

suggested-language

Butch Antolini, the governor’s communications director, responds:

butch

And on May 9, the day of the event:

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There’s more here, if you’re interested. Seems like there was a lot of confusion leading up to the event, and that Congressman Evan Jenkins, who is running for Senate, was not originally supposed to be standing alongside Conway and Price at the press conference. I’m going to get back to a story I’m working on about how the GOP bill would affect the opioid epidemic killing my friends and neighbors.