Understanding Recovery and Substance Use Disorder Better

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Would having a better understanding of how the recovery process works for people with substance misuse disorders make you more supportive of the services they need? Are you open to learning a new way to think about addiction and what people need for recovery?

As an intern for the Public Health Council, Hattie Kahl conducted an assessment to explore the need for more recovery housing in the Upper Valley of New Hampshire and Vermont.  According to Hattie’s research, the Upper Valley offers numerous substance misuse treatment options and supportive services; however, housing that supports an abstinent lifestyle is hard to find – or afford.

Recovery Housing Report

You can review Hattie’s full report here: Upper Valley Recovery Housing Assessment 2024. Read on for a few summary bits of information she pulled together that give us insight into both the recovery process and the addictive process.

Recovery Capital

Recovery Capital describes a set of resources necessary to sustain recovery (Best and Laudet). Chances of sustained sobriety increase as one’s recovery capital increases. The growth of personal recovery capital has ripple effects for families, others in recovery, and the community.

  • Physical capital is defined as assets, like money or housing, that may increase recovery potential – for example, being able to live away from friends who engage in substance misuse or affording residential treatment.
  • Social capital is the resources from personal relationships, such as family or support groups.
  • Human capital is skills, good physical health, positive outlook, etc.
  • Cultural capital includes “values, beliefs, and attitudes” that move a person away from the social conformity of drug culture and toward societal behaviors.
Protective Factors for Recovery

Self-efficacy: The belief that someone can perform the behaviors needed to achieve a specific goal. It’s a measure of how confident someone is in their ability to control their motivation, behavior, and social environment.

  • Steady and stable post-treatment employment and an employer who supports one’s recovery.
  • Living in an environment like a recovery residence and having peer support.
  • Maintaining a good and stable relationship with family and friends who are not in recovery (Alemi et al, 2009).

For more information please review Hattie’s supplementary report: Predictors of Substance Misuse Recovery and Relapse: A Literature Review.

2024 PHC Flu Vaccine Clinics Are Coming!

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Flu vaccine clinic at the Enfield Community Building in Enfield, N.H., on Thurs, Oct. 12, 2023. (Photo credit – Alex Driehaus)

Once again, partner organizations across the Upper Valley are coming together to provide seasonal flu vaccine to our community members. And because COVID-19 transmission is ticking up, protecting people from seasonal flu illness is very important.

There are numerous options for vaccination. Please use the information below to find the right vaccine option for you and your family.

This list DOES NOT include school-based flu vaccine clinics offered in many of our New Hampshire schools. This is because these clinics are reserved only for students of those schools. If your child has the opportunity to get a vaccine in one of these school-based clinics, we encourage you to sign them up.

Public Health Council & Dartmouth Hitchcock Hosts Series of Community Flu Clinics

Starting on September 26th, the Public Health Council, Dartmouth-Hitchcock, Geisel School of Medicine and other partners will host free seasonal flu vaccine clinics in communities around our region. Clinic details are below:

*All PHC clinics are walk-in only, free to all, and there are no registrations required. See other guidance below.

Thursday, September 26th
4pm to 7pm
Plainfield Elementary School (92 Bonner Rd, Meriden, NH)

Thursday, October 10th
4pm to 7pm
Enfield Community Building (308 US Route 4, Enfield, NH)

Saturday, October 12th
10am to 1pm
Orford Congregational Church (617 NH Route 10, Orford, NH)

Wednesday, October 16th
4pm to 7pm
Oxbow High School (36 Oxbow Dr, Bradford, VT)

Wednesday, October 30th
4pm to 7pm
HealthFirst Family Care Center/Mascoma Community Health Center
(18 Roberts Rd, Canaan, NH)

Saturday, November 9th
10am to 1pm
Windsor Welcome Center (3 Railroad Avenue, Windsor, VT)

PHC Vaccination Clinic Guidance

  • No registration required. No insurance needed.
  • Offering regular dose vaccine and enhanced vaccine for people 65+. We will NOT be offering COVID-19 vaccines at these clinics.
  • If you have symptoms of illness, we will ask you to wear a mask.
  • Please do not arrive more than 15 minutes prior to the start of the clinic.

Other Flu Vaccine Options in the Upper Valley

Dartmouth Health

Dartmouth-Hitchcock will also be offering numerous flu vaccine clinic options for Dartmouth Health patients at various locations at the Medical Center this year. Please go to their Lebanon Flu Clinic Schedule webpage for details. Reservations are required. If you are a DHMC patient and use myD-H.org to make an appointment. If you do not use myD-H, you may call the Flu Hotline a 603-653-3731.

When you schedule your appointment, please have your insurance card ready. If you carry health care insurance, we will bill your carrier at no cost to you. For individuals who do not have any health insurance, we will be providing flu vaccines free of charge. Please contact the Flu Hotline for more information.

Valley News

Many of these clinics will be posted to the Valley News Calendar, available online and in the print edition.

We wish all our Upper Valley neighbors a healthy and safe fall and winter!

Measles Cases on the Rise

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Update on July 10, 2024: The Upper Valley of New Hampshire and Vermont continue to see a small number of measles cases, with 2 more cases reported in just the past few days. Please be aware of your risks, whether you are vaccinated or not. Additional information is available at:

 

 

Original Post

Measles cases are rising in the United States (US), and Vermont recently had its first case of measles since 2018. As of May 3, 2024, there have been 131 cases of measles in the US this year, already more than double than in all of 2023. Measles is one of the most contagious viruses and can cause serious illness in some people, like babies, young children, and people with weakened immune systems.

Reversing an Historic Public Health Achievement

According to the US Centers for Disease Control and Prevention, “Measles was officially eliminated from the United States in 2000†, meaning there is no measles spreading within the country and new cases are only found when someone contracts measles abroad and returns to the country. Achieving measles elimination status in the US was a historic public health achievement. The below figure illustrates how common measles was before vaccines and how vaccine policy enabled elimination.”

Source: https://www.cdc.gov/measles/cases-outbreaks.html
*2023 data are preliminary and subject to change.
†Elimination is defined as the absence of endemic measles transmission in a region for ≥ 12 months in the presence of a well-performing surveillance system.

No Longer at Herd Immunity Levels in All Places

The risk of widespread outbreaks in Vermont and the US is low because of high vaccination rates, but communities with less than 95% vaccine coverage rates are at higher risk for outbreaks.

The 95% number is important because when more than 95% of people in a community are vaccinated, most people are protected through community (or herd) immunity. This includes protection for people who are unable to be vaccinated for medical reasons and/or are medically vulnerable to even mild cases of measles. However, vaccination coverage among U.S. kindergartners has decreased from 95.2% during the 2019–2020 school year to 93.1% in the 2022–2023 school year, leaving approximately 250,000 kindergartners at risk each year over the last three years.

  • Vermont’s Kindergarten MMR Vaccination Rate for 2022/2023: 93.1%
  • New Hampshire’s Kindergarten MMR Vaccination Rate for 2022/2023: 89.4%

What Happens If my Child is Not Vaccinated

There are a few reasons why a child may not receive vaccinations like the MMR; these include medical exemptions and religious exemptions. No matter the reason, people who have not been vaccinated are at increased risk of disease and/or spreading the measles virus if they are exposed.

In Vermont, the Department of Health has asked School Nurses to proactively let parents of children with exemptions or provisional admittance know that their children will need to quarantine for up to 21 days if there is an outbreak in the school. This can help parents prepare for the potential disruption of keeping their unvaccinated children home for 3-weeks. Such steps have also been part of New Hampshire rules; however, it is unclear what the State guidance may be at this time.

For more Information about Measles Vaccination, Health Impacts, and Outbreaks:

To Get Vaccinated

Both New Hampshire and Vermont offer vaccines free to children. The links above will provide information about how to request a free vaccine, though in both states you generally start with your regular health care provider or a federally qualified health center or free clinic.

In Vermont, if you do not have health insurance and are under the age of 65, you can also make an appointment at your Local Health Office to get vaccinated. Local health offices do not charge a fee for giving the vaccine.

Promoting Youth Engagement and Advocacy

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Andrea Smith facilitating a panel discussion with Senator Prentiss, Representative Sullivan, and Representative Damon.

In 2022, the NH Charitable Foundation announced a pilot grant opportunity available to the 13 Regional Public Health Networks (RPHN) in New Hampshire that focused on public health community engagement and advocacy. According to the Foundation, they had come to understand that “community-based partners working to advance public health and behavioral health equity are often challenged by funding restrictions, which can prevent meaningful, and needed, participation in policy and advocacy efforts (New Hampshire Charitable Foundation, 2022).”

The purpose of the grant is to support community engagement, advocacy and lobbying efforts on a broad range of public health topics. Areas of interest include substance use, mental health, children’s behavioral health, childhood immunizations, early childhood development, and other relevant public health issues. This was a direct result of legislation introduced in the 2022 Legislative Session to reduce public health’s infrastructure. The Upper Valley and Greater Sullivan County RPHNs both applied and were awarded this grant.

Youth Advocacy Event

On October 27th, 2023, RPHN staff, Andrea Smith and Deryn Smith, hosted a Youth Advocacy Event in partnership with New Futures, and the New Hampshire Charitable Foundation. At this event, high school students from each of the Upper Valley and Greater Sullivan County Regions earned what advocacy is, why it is so important, and how youth can be involved in life changing advocacy work. The students participated in a panel discussion with local legislators, including Senator Prentiss, Representative Sullivan, and Representative Damon, to hear firsthand why youth voices are so impactful, best practices for youth to participate in advocacy work, and ask questions of the panelists.

Students and an advisor from the Sunapee Middle/High School learn about advocacy.

“It was clear that the students are passionate about making a difference in their school, community, and nation, and providing them with information on how they can enact positive change with their own voices was extremely impactful. Every New Hampshire resident can advocate for what is important to them, so I am excited to see how these students take the information they learned and advocate for what they are passionate about.” – Deryn Smith, Substance Misuse Prevention Coordinator, Greater Sullivan County Regional Public Health Network.

Special thank you to Lebanon’s Kilton Library for generously allowing us to use their Community Room to hold this event.

— Submitted by Andrea Smith, Senior Community Health Partnership Coordinator, Dartmouth Health

Workforce Crisis Needs Policy Solutions

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Kate Luczko of HealthForce NH, discusses healthcare workforce programs in New Hampshire.

The Public Health Council of the Upper Valley (PHC) hosted the Upper Valley Bi-State Legislative Breakfast on Monday, November 6, 2023. The purpose was to provide state-level legislators from the Upper Valley region with information, stories, and policy guidance on the many levels and layers of workforce challenges impacting health and wellbeing in our region. Goals included:

Develop relationships with legislators.
Educate about policy related issues.
Promote cross-border awareness/collaboration on issues.
Help legislators become more responsive to the needs of constituents.

The agenda included presentations by leaders in education, housing, childcare, and local health care from both NH and VT.  We had 31 people in attendance, including five NH Representatives, two VT Representatives, and two VT State Senators.

Report of Proceedings and Recommendations

The PHC recently released a report from the event, including a summary of the issues discussed and the policy recommendations that emerged: PHC 2023 Legislative Breakfast Report.

Through presentations and discussion, the meeting highlighted a few key messages for policymakers relative to the health care workforce crisis. These include:

  • the healthcare workforce is struggling, even more so after the pandemic, and with the aging of our populations, the crisis will only worsen;
  • current and potential healthcare workers at all levels need ready and affordable access to (continuing) education, childcare, and housing if they are to do this critical work; and
  • all of these required supports face real barriers right now that must be addressed together.

As speakers and panelists laid out challenges and opportunities for policymakers to consider, a general understanding of the workforce crisis emerged.

Healthcare Workforce Struggles
  • Job openings in healthcare have grown consistently since 2019. Both job postings and hiring have increased, particularly in nursing positions. However, the skilled healthcare workforce is aging, and younger workers are not stepping up to fill the gaps. This is happening at a time when our populations are aging and in need of more healthcare.
Workforce Education & Training
  • Higher Education must be allowed and supported to adapt to meet current and future workforce needs.
  • For nursing-related professions, universities struggle to recruit professors to teach as travel and per-diem jobs pay much more than universities can. Many people who work in the field and have been willing to teach part-time are no longer able to due to shortages in their own workplaces.
  • Clinical placements are an essential part of preparation, but the workforce shortage means that potential preceptors do not have the capacity to mentor students.
  • This is a vicious cycle. Lack of time to teach leads to fewer students graduating, which leads to a lack of staff to hire, which leads to a lack of time to teach.
No Place to Live
  • One reason healthcare employers are struggling to recruit and retain employees is the difficulty in finding affordable housing near enough to work. Our region needs 10,000 more housing units by 2030 to keep up with current demand. The current pace of building is nowhere near this level.
  • Many younger people, who are critical for our workforce, cannot find “middle ground” housing such as townhouses or condos when they want to start a family. They are forced to move to other areas to find a balance of work, housing, and childcare.
  • Lack of housing is limiting the vibrancy and diversity of our area.
Who Cares for the Caregivers’ Children?
  • The importance of early childhood care and education has been neglected. The childcare crisis is not new. but has worsened since the pandemic. There were thousands of childcare job vacancies prior to COVID-19 and that number has only grown.
  • Childcare serves two vital roles in our communities that must be respected and supported: 1) we need the younger workers who need childcare to work and 2) young children need the jump start in education and social-emotional skills to be ready to succeed in kindergarten and beyond.
  • We must shift our thinking away from childcare being an option or a luxury for families. Most families cannot survive, much less thrive, without safe, quality, affordable care for their children.
It Will Take All of Us to Fix This
  • To address these inter-connected challenges, collaboration between all stakeholders is critical. This includes businesses, state policymakers, municipalities, educational facilities, and non-profit organizations.
  • When businesses help fund degrees, they are guaranteed employees to fill positions, and graduates are guaranteed a job.
  • The PHC also encourages all residents of the Upper Valley to advocate for legislation that addresses the issues of most concern here in the Upper Valley. To learn more about organizations that specialize in advocating, please use the PHC resources available on our Advocacy Page.

PHC and members of the Planning Committee wish to thank all the elected officials who joined us for this event and the many local experts who came to share their wisdom and experience. We hope this report will provide a guide for our policymakers over the next year of legislative activity.