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Will’s Corner Newsletter
Volume 13, issue 2
Serving the Disability Community in Oklahoma
Addiction in Oklahoma: A Disease That Leaves No One Untouched
By Terri White
Commissioner, Oklahoma Department of Mental Health and Substance Abuse Services
Stories about substance abuse have been featured both prominently and frequently in the news lately, and for good reason. Addiction is a complex illness that crosses over societal boundaries, affecting areas ranging from physical health to social issues to public safety concerns. It is a disease that impacts hundreds of thousands of Oklahomans, either directly or indirectly.
As a state, Oklahoma now ranks number one in the nation for prescription drug abuse, for all age categories above age 12, with an estimated 300,000 Oklahomans abusing painkillers. Although there is undoubtedly overlap, an estimated 245,000 Oklahomans above age 12 also abuse or are dependent on alcohol or illicit drugs such as marijuana or methamphetamine.
Even though prescription drug abuse and methamphetamine addiction get a majority of the news coverage, alcohol still remains Oklahoma’s most abused substance, as it has for decades, with an estimated 35.7 percent of adults receiving treatment services through the Oklahoma Department of Mental Health and Substance Abuse Services in fiscal year 2011 listing alcohol as their “top drug of choice.”
Rounding out the top four were marijuana at 19.3 percent; methamphetamine, 19.1 percent; and prescription drugs, 14.3 percent.
Regardless of the substance involved, it is obvious Oklahoma has a problem. Virtually no one remains untouched by the disease of addiction, whether it be their own addiction, the addiction of a family member or loved one or, as taxpayers paying for consequences associated with untreated addiction, such as higher incarceration rates and increased numbers of children entering the foster care system.
Budget Cuts Have Affected Access to Treatment
The sad reality is that, although nearly a quarter of a million Oklahomans need substance abuse treatment, ODMHSAS was only able to provide services to about 19,000 Oklahomans (adult and youth) during the past fiscal year, the vast majority of whom received outpatient services. On any given day, there are 600-900 Oklahomans who are in need of a residential treatment program, but who cannot get in because every bed is full.
In Oklahoma, an estimated 78 percent of adults and 80 percent of youth who need substance abuse treatment are not receiving appropriate care. Access to care has always been a problem, but it has become even more difficult in recent years. Since 2009, state and federal funding to the agency has been cut by more than $36.6 million—from $326.3 million to $289.8 million.
Service cuts have drastically reduced access to care statewide. They have impacted community services, local hospitals, all aspects of our criminal justice system, children in state custody, our schools, and the overall health and well-being of our state. The cost of not responding early means a heavier price to pay on the back end. This threatens our ability to treat others in need, because our resources have been drained responding to the needs of those who have reached a crisis state, and leads to an even greater number becoming more ill and more costly to the system and state.
The effect is felt far beyond that person. It is felt by families and by communities—costs that manifest in a variety of ways.
From a public health perspective, lack of access to services is directly related to many of the problems we face as a state—including high incarceration rates, scores of children neglected or abused by parents with an untreated mental or addictive disorder, uncompensated care at hospitals and social issues. The medical costs associated with untreated addiction and/or mental illness are staggering. One in four of all hospital admissions is directly related to untreated mental illness and/or substance abuse disorders.
Most Oklahomans, in general, can expect to live to be about 72 years of age. However, for a person with an untreated addiction, life expectancy drops by nearly 30 years—to an average of only 43.2 years.
As part of this year’s budget request, we are asking for an additional 100 residential substance abuse treatment beds. Funding of this request would restore residential substance abuse services to pre-cut levels, which would help offset some of the tremendous need for filling the treatment gap.
Access to treatment services must be a priority if we are going to help these individuals and their families, but early intervention and prevention efforts to help stop the disease before it starts must be, as well.
Tremendous need still exists in our state, as rates of prescription drug abuse continue to rise; waiting lists to obtain services continue to grow; and our state remains historically above the national average for its rate of incarceration.
As an agency, we have responded by implementing programs that are making a difference today and laying the foundation for a better tomorrow. Significant progress has been made in the areas of alternatives-to-incarceration, use of technology to expand treatment options, and advancing programs to assist children and families.
Reducing stigma, emphasizing prevention, and increasing access to care are all necessary if we are to progress in treating addiction. Additionally, integration with physical healthcare—particularly within primary care and emergency room settings—to implement screenings for substance abuse, depression and suicide risk, are essential.
Addiction is a disease that can, and should, be treated. Thousands of Oklahomans are living testaments to this, yet thousands more still need help. If 600-900 Oklahomans were on a waiting list to receive life-saving services for cancer, there would be public outrage. Treatment for addiction should not be viewed any differently.
In my search for comprehensive social services with a hand up rather than a hand- out, I landed in Cushing, Oklahoma of all possible places. No offense Cushing, but your 2010 population only registered 7826 people. It seems I should be going to Tulsa or Oklahoma City, but it appears bigger cities could learn from you.
LoveInc. is a national organization with 155 affiliates in 30 states. So far the only affiliate in Oklahoma is in Cushing with a catchment area of ten miles in all directions of town.
LoveInc. is Christian churches working together to show love to the poor and needy. The mission statement of the Cushing LoveInc. is to “mobilize local churches to transform lives and communities.” That statement is high sounding, but how does it translate into meeting real human needs?
Let’s talk about that. I can go to LoveInc. in Cushing to assist me with food, clothing, shelter, budgetary problems, utility bills, furniture—just about any need you can think of. But, lots of places do these kinds of things. What’s so different about LoveInc.?
What is different is that LoveInc. is not a handout. It is a hand up. They’re going to help you to help yourself. They’re not just going to pay that delinquent utility bill. They’re going to explore with you how you got delinquent in the first place and get ahead of the game through prevention. Most places—perhaps no others in Oklahoma—do not provide this kind of service.
LoveInc. is going to follow up on any service they provide to verify if you really did pay that delinquent utility bill. They may help you with other needs like prescriptions and groceries after they see the electricity is back on at your house.
Then there’s the Back-to-School program to outfit needy kids with clothing and school supplies to start the school year. This is a big need in Cushing as a whopping 62% of all school children qualify for free school lunches because of poverty.
So how does this all work? You call LoveInc.’s clearinghouse for a quick phone interview. They’ll ask simple questions like your name, address, family, work, a guestimate of typical expenses and your insurance if you have it.
If you’re having financial problems, they may ask you to bring your bills to the office and any letters from collection agencies. Staff will work with you on a plan to solve all your financial concerns—not just that one delinquent bill.
LoveInc. has a resale shop in their building where they sell donated clothing at a huge mark down. All tops may be a dollar. All shoes may be two dollars. The resale shop has been a great success since opening in the fall of 2011. Clothing is affordable to the consumer, and sales have been higher than projected.
As we said, LoveInc. benefits from a large number of volunteers from 45 local churches. It also encourages individual churches to develop their own ministry to the community.
The local Methodist church sponsors a monthly free meal in the community to feed the hungry. The great thing about that ministry is that the volunteers to cook and serve the dinner come from several different churches.
The First Assembly of God sponsors a furniture ministry. Volunteers pick up items for donation and repair them. They then take that furniture to the homes which need it. Right now LoveInc. provides storage space for the donated furniture.
Volunteers from local churches supply staff for in-house social programs as well as volunteers for LoveInc. itself. Only two paid staff work with approximately 70 volunteers to provide comprehensive social services in the Cushing area. It is amazing.
Amy McCracken is the Executive Director of the Cushing LoveInc. She is an amazing person in her own right who believes in what she does and loves doing it. Amy comes armed with lots of 2010 census statistics which point to some of the serious needs in her area. She and her volunteers work to meet some of those needs in the present while empowering their clients to meet future needs themselves.
If you would like to find out more about establishing a LoveInc. in your area of the state, go to the national website at www.loveinc.org. Read their statistics that fully 14.3% of all Americans live in poverty.
The Americans with Disabilities Act (ADA) is the federal law which provides civil rights for people with disabilities. It was signed into law July 26, 1990 by President George Bush (the father). Among many other things, the ADA deals with service animals.
There has been some confusion as to what a service animal is and where the service animal is permitted. There has also been some confusion on whether or not a service animal is required to have certification of specific training that the animal has had.
The U.S. Department of Justice (USDOJ) has published revised final regulations implementing the ADA. These regulations went into effect March 15, 2011. Here is some general information on those final regulations as they affect service animals.
First, let us note that the USDOJ defines SERVICE ANIMAL as dogs or miniature horses individually trained to do work or perform tasks for people with disabilities. Only these two animal species are recognized by the USDOJ as meeting ADA requirements to be considered a service animal.
In the past monkeys and other species of animals have been accepted as service animals. This is no longer the case according to this narrower definition of the ADA. However, it should be noted that other laws such as the Fair Housing Act which applies to people with disabilities in public housing and the Air Carrier Access Act which applies to people with disabilities traveling the airways have their own definition of service animal.
Let’s talk a little about what type of tasks that service animals may perform. They may guide people who are blind or alert people who are deaf. They may alert a person with a seizure disorder that a seizure is about to take place. They may remind a person with mental illness when to take medication. Animals whose sole function is to provide comfort or emotional support do not qualify as service animals under the ADA.
As a rule of thumb, service animals must be permitted in establishments of state and local government, businesses and nonprofit organizations open to the public. For example, a hospital has waiting rooms, patient rooms and cafeterias open to the public where service animals should be welcome. However, operating rooms or burn units may exclude a service animal because the animal’s presence may compromise the sterile environment.
According to the latest interpretation of the ADA on service animals, the animal owners do not have to present certification of training on demand. They may legitimately be asked if the animal is a service animal required by a disability and what work or task the animal has been trained to perform.
This does not mean that an animal may disrupt a public place in any way. Animals must be housebroken. They should not be either too friendly nor threatening in their working environment. They are present to work on behalf of a person with disabilities. When there is a legitimate reason to ask that a service animal be removed, staff must offer the person with disabilities the opportunity to obtain goods or services without the animal’s presence.
One frequent disclaimer that people with disabilities who have service animals hear in a restaurant is that health codes prohibit animals on the premises. This is not a legitimate reason to bar entry to a service animal. Again, staff may ask if an animal provides a service to the person with disabilities and what that service is.
Service animals are not pets. They are an extension of the person with disabilities which permits them to function more efficiently in the community. Because of this, people with disabilities may not be charged deposits or fees which patrons with pets may be charged.
Miniature horses are considered one species meeting the definition of service animal according to the ADA. They generally range in height from 24 to 34 inches at the shoulder and weigh between 70 and 100 pounds. Miniature horses should be housebroken and under owner control. The facility should be able to accommodate the size of the miniature horse, and the animal’s presence should not compromise legitimate safety concerns of the facility.
For more information about ADA interpretations of service animals, go to www.ADA.gov. You may also call 800-514-0301 or 800-514-0383 (TTY) M, W, F 9:30-5:30, Th. 12:30-5:30 (Eastern Time) asking to speak to an ADA Specialist.
Will’s suggestion on service animals:
As we reported earlier, the ADA does not require a person with disabilities to carry documentation on training of a service animal. It is my suggestion that if you do have documentation of training that you make multiple copies and freely distribute them where appropriate. If your doctor has ordered you to have a service animal, make copies of that order as well. If you get specific information about service animals from the United Stated Department of Justice, copy that information as well. People with disabilities continue to inform me that there is a lot of misinformation about what the Americans with Disabilities Act requires.
United We Ride
United We Ride (UWR) is a council appointed by the Governor of Oklahoma to provide a comprehensive assessment of existing state and federal human service transportation funding programs. UWRs mission is to evaluate and recommend the most effective and efficient use of human service transportation resources across Oklahoma. The council consists of public and private agencies, Oklahoma Tribes, and persons who are transportation disadvantaged.
The UWR vision sees the creation of a transportation system that supports the needs of all Oklahoma citizens including older adults, people with disabilities, and low-income individuals. The purpose of United We Ride is not only to see expanded public transportation but to explore ways to form collaborations that will more efficiently use available resources.
One element of assessing transportation is to identify barriers to transportation. Sometimes there may be no bus within walking distance of your house. Sometimes your need doesn’t fit within transit hours of operation. Sometimes a person may qualify for public transportation because of their age or ability, but not meet income guidelines.
Another step in evaluating the efficiency in our public transportation system is to identify gaps in service. One transit agency may provide service within the city limits of one small town while another agency offers trips across regions of the state. Saturday service may be the exception rather than the rule. Public transportation services may only be available in narrow corridors while vast areas are left uncovered. Many small providers only serve the residents of one particular nursing home, while other providers serve an entire metropolitan area.
Getting up-to-date and accurate information on providers of public transportation statewide is necessary to fine tune the efficiency of the transportation system. In 2011, the Oklahoma Department of Transportation (ODOT) and UWR collaborated to conduct a public transit/human service transportation survey to develop a comprehensive database of agencies that purchase and/or provide transportation services within the State of Oklahoma.
That survey helped identify gaps and issues related to providing health and human service transportation and aided ODOT in developing strategies for transportation providers to work together to create a more efficient and effective transportation system. This information provides the big picture we need to encourage better coordination of services. Survey results were integrated into ODOT’s Oklahoma Locally Coordinated Public Transit / Human Service Transportation Plan released in January 2012.
As we speak, United We Ride is working to complete its two-year Strategic Action Plan which will culminate in a report of recommendations for the most appropriate and cost-efficient service that can be accomplished through the coordination or consolidation of human service transportation resources. The findings and conclusions in the updated ODOT Plan, as well as analysis of best practices in Oklahoma and other states, are being considered in the UWR final recommendations. The report is scheduled to be presented to Governor Mary Fallin at the end of May.
Preliminary data suggests that regional and/or statewide mobility management may be a means to unify all regional transportation services for potential transit patrons. The implementation of a mobility manager service at the state level may require significant time and resources to implement, according to the ODOT Plan. The United We Ride Council agrees. Wouldn’t it be wonderful to have one regional, or even a statewide number, to call asking for a ride from Miami to Tulsa on May 1 leaving mid-morning and returning by 5 p.m. Someone at the other end of the line puts you in touch with a provider that meets your needs and their requirements. The benefits to the consumer could be enormous.
We’re not there yet, but United We Ride will be suggesting ways to get there in its recommendations. Meetings are always open to the public. The next quarterly meeting will be held May 17, 2012 from 10:30 a.m. till 12:30 p.m. at the Oklahoma Library for the Blind and Physically Handicapped, 300 NE 18th Street, in Oklahoma City. At that meeting the Council will sign off on the final plan to be given to the Governor.
Visit the website at www.okunitedweride.org to view the Strategic Action Plan. If you wish to be added to an email list to receive Council updates and announcements, you may also call Irene Martin at 405-521-3899 or contact her at email@example.com. Better coordination of all public transportation in Oklahoma is important to us all.