In September 2019, when Colleen O’Neil stepped into the role of chemical health prevention specialist for the Anoka-Hennepin Schools, she knew she’d have her hands full. With 38,000 students attending 26 elementary schools, six middle schools and nine high schools, Anoka-Hennepin is the largest district in the state: As her title suggests, O’Neil is in charge of monitoring the chemical health of enough young people to make up a small city.
She knew it would take some time just to get a lay of the land.
“My first thought was,” O’Neil said, “‘How am I going to do all this?’ I spent much of my first year doing a needs assessment, figuring out what needs to be done.”
While her careful assessment didn’t turn up any glaring addiction issues — O’Neil learned that district students reported “pretty average” rates of substance use on the 2019 Minnesota Student Survey, for instance — it only took a few close conversations with students for her to discover that there actually were larger issues that needed to be addressed going on just beneath the surface.
“You can collect data all day long,” O’Neil said, “but I don’t know if it is as accurate as what we actually see and know from working directly within the schools, from listening to students who are willing to be open and honest.”
What O’Neil learned from her conversations with Anoka-Hennepin students is that an overarching sense of shame and discrimination connected to mental illness and addiction meant that many young people were hiding their chemical use — and maybe even using it as a kind of self-medication to cope with stress, anxiety and depression. With rates of common mental health issues on the rise among young people across the state, O’Neil could only predict that as the pandemic wore on, the number of students in her district using drugs and alcohol to cope was going to rise.
“You have to wonder what it is going to look like when we finally get back into the buildings and COVID is no longer highlighting our every day,” she said. “I’m fearful of the impact that substance use will have had on young people because of the mental health challenges we’ve all been facing.”
If schools want to open lines of communication and avert an addiction crisis among their students, O’Neil said, “Something’s going to have to be done. We have to be there for them when they need us.”
This desire to provide students with support and possibly connections to affordable treatment options inspired O’Neil to develop a new partnership between the Anoka-Hennepin school district and Hazelden Betty Ford, the Minnesota-based provider of addiction treatment services.
Through conversations with colleagues in other districts, O’Neil learned about School-Based Supportive Services, a program offered by Hazelden Betty Ford, where the nonprofit assigns a licensed clinical professional to conduct school-based screenings and assessments of students who may be experiencing issues related to substance use and mental health.
“I knew that Hazelden Betty Ford was offering this program,” O’Neil recalled. “So last January I reached out to some colleagues and said, ‘How can I connect with them?’” After a few phone calls, she reached Cindy Doth, Hazelden Betty Ford youth and outreach manager.
“We clicked right away,” O’Neil said of Doth. “Her ability and professional experience in the schools was a real selling point.”
While Doth, a licensed alcohol and drug counselor (LADC) soon to be certified as a licensed professional clinical counselor (LPCC), brings a unique skillset to the job, O’Neil said that she was particularly excited about the possibilities offered by a partnership with Hazelden Betty Ford.
“Cindy’s qualifications are amazing,” O’Neil said, “but it wasn’t so much what she can bring that thrilled me. It really is more what her organization can bring to a district. They’re world-renowned. There is a wealth of information and other resources at Hazelden Betty Ford that we can tap into as a district and a community. I’m super-excited about this collaboration.”
Hazelden Betty Ford isn’t the only organization that Anoka-Hennepin has invited to speak with students about substance use. For the last five years, the district has had a partnership with Know the Truth, a peer-led substance-use prevention program for youth sponsored by Minnesota Adult and Teen Challenge.
“They come into the schools and they do prevention work,” O’Neil explained. “They bring in graduates from the program and they share their stories with students.”
While the Know the Truth programming is a “great partnership that fills an important need,” O’Neil said, it is run by peer recovery specialists. Peer support is a central part of recovery and addiction treatment, but peer recovery specialists are not trained in clinical assessment and are therefore not qualified to make recommendations or referrals to treatment or recovery programs.
Doth agrees that peer support plays a key role in recognizing and recovering from addition. “Peer support is awesome,” she said. “I fully support it as an important part of addiction treatment. However, a peer-support person isn’t a licensed professional who is able to identify when a young person needs a higher level of support. Those qualifications make clinical professionals like me or Colleen stand out.”
O’Neil, also an LADC, explained that both she and Doth are trained in clinical assessment, a process that determines if an individual would be best served by an outside addiction-treatment program. With her years of experience and knowledge of the state’s providers, Doth is equipped to make treatment recommendations and to help students get connected to inpatient and outpatient centers.
Having clinical assessment services available in schools means that students and their families have access to addiction support without having to find help on their own, O’Neil added.
“School districts should have the ability to remove the barriers for students who might benefit from assessment or screening or individual support,” she said. “We want to get them and their families to a place of recognizing their need for additional help, be that residential, outpatient or whatever.”
Because they offer support and connections, peer-led conversations can be a key part of the process of acknowledging a need for help treating addiction, but figuring out the best next step, O’Neil added, “is best done by someone in a clinical position.”
‘The earlier the intervention the better’
When Anoka-Hennepin schools opened this fall, classes were held in a hybrid format, with students taking in-person classes three days a week, and online at home on the other two. Doth said that this part-time approach was a challenging way to start a new job — but she and her colleagues adapted.
When district schools are back in person, Doth will be given private meeting space where she will office two days a week. Because Hazelden Betty Ford also has contracts with other school districts in the state, she will have to spend a lot of time on the road.
When a district student is identified as having a likely substance-use issue, school counselors offer them and their parents and guardians the option of individual support and or group support. If they select individual support, Doth reaches out to them. They then schedule a meeting — post-pandemic many may be conducted in person, but while face-to-face school is not an option, the meetings are scheduled virtually.
During these meetings, Doth said, “We talk with students about what is going on around their substance use and their life from many different angles. Then we determine if a referral is needed. I help figure out if they need substance use support, mental health support, family therapy, individual therapy.”
Though she craves in-person contacts with students and families, having an option to meet from a distance has its advantages, Doth said: “One thing I really like about the virtual services is that rather than being tied down and having to dedicate one day to each school, waiting for someone to get in trouble or identify that they need help, I have the flexibility to meet with the students and their family members whenever they are in crisis. And students are comfortable with this format, so it works for them.”
Because she does not have to find a time when everyone can get together in one room, meeting students and families virtually has helped to speed up the intervention and assessment process, Doth said. This is a good thing: “We know that the earlier the intervention the better. If we can reduce that time between a school violation and my ability to meet with them, the better the outcome for the student, the parents and the school.”
If a student does not have the technology at home required for remote meetings, Doth can make space for them to meet her in person. “If a student is struggling and needs Wi-Fi or needs more in-person support, they can go to the school. We all mask up and meet in person. I’m fine with that. It depends on what the student needs.”
Another important part of Doth’s role is confirming that students have the means to pay for treatment services. Because her position is funded through Hazelden, she does not have to charge for her services. And she can help families make their way through the maze of paperwork required by insurance providers.
For the first five years of the program, grants from the F.R. Bigelow Foundation, the Medica Foundation and the F.T. Weyerhaeuser Family Fund made it possible for School-Based Supportive Services to be offered free of charge to schools. When those funds ran out, Doth said, Hazelden decided to continue funding the program.
“We made a commitment to continue the program as part of Hazelden Betty Ford’s nonprofit mission to be a force of hope and healing for individuals, families and communities,” she said. “It’s an investment in our community that we’re passionate about.”
Though her position is funded by Hazelden, Doth said that when she refers students for treatment, she makes a point of picking programs that work best for the individual student and their family. This means that many have no connections to her employer.
“Some Hazelden Betty Ford programs may be appropriate for students in the plethora of services we offer. But I also have referred many, many students to other organizations. My role is to find the best fit for them.”
O’Neil is concerned that when students are finally able to come back to in-person school, she and Doth may be overwhelmed. The district’s delayed hybrid rollout meant that Doth wasn’t able to start meeting with students and families until October — and within a few weeks, schools across the state had to go virtual.
“Cindy has met with some students and has connected with several of our families,” O’Neil said. She’s guessing that post-pandemic, when Doth is able to be a regular in-person presence in the district’s high schools, demand for her time will only increase: “When we get back into the buildings, Cindy will be spread pretty thin.”
The pandemic has forced young people to change their lives in ways that may have lasting psychological impact on their generation, O’Neil said. She is concerned that some of that impact may come in the form of substance use. She believes that treatment professionals like herself and Doth won’t see the full extent of this psychological damage until later, when the world’s attention finally turns away from fighting the crisis at hand.
“I’m more worried about the back end of all of this,” O’Neil said. Not being able to see students face-to-face feels limiting and frustrating: “All of us that provide any support for students are facing the same challenges that teachers are facing. It is very difficult to get students to interact and connect when it comes to substance use. There is still a huge stigma around it.” Add to that the limitations of virtual communication, and you have a recipe for a treatment logjam.
Doth points to research showing that COVID has taken a serous toll on the collective mental health of young adults. She predicts that at least some of that toll will be seen in a rise in chemical use and addiction.
“Nearly 50 percent of youth report experiencing major depressive symptoms during COVID,” she said. “When young people are facing mental health challenges, oftentimes they will self-soothe through chemicals. They don’t like the loneliness. They don’t like not being able to see their friends. They are going to use because they don’t like the feelings they are having. This is where I will be able to step in and help.”