Stout, who has led broad efforts to address and treat substance use in the greater Orange County Indiana area, has spearheaded efforts to elevate the quality of healthcare available to those facing substance use. Instead of treatment only being available through substance use and other treatment centers, Stout and Southern Indiana Community Health Care now increasingly integrate substance use treatment into family healthcare services.

This includes the local administration of MAT (medication-assisted treatment) options, where people facing substance use can be prescribed Suboxone or Vivitrol without having to travel to a specialty clinic (MAT treatment also typically includes a combination of counseling and behavioral therapies).

Properly administered, Suboxone can blunt intoxication from using drugs like heroin, oxycodone and other opiates, reducing cravings and allowing people an opportunity to transition away from a life of substance use. Injectable Vivitrol is also available through a MAT program, which use blocks euphoria or ‘high’ that alcohol and opioids produce. Vivitrol has also proven effective in helping people with substance use issues recover.

“There is still a stigma around substance use, and this stigma serves as a barrier to seeking treatment for those who need it,” Stout said. “By integrating MAT options within family medical treatment, this provides several advantages, including helping those facing substance use issues with improving their general health and also addressing issues like diabetes.”

(Recognizing that physical health and mental health go together, Southern Indiana Community Health Care utilizes an integrated care model. For more information, please visit https://sichc.org/mental-health/)

People with substance use issues can go to a typical facility like SICHC’s Valley Health clinic in West Baden Indiana and confidentially receive treatment. “My MAT patients sit in the same lobby as patients seeking healthcare for other reasons,” Stout said. “They don’t have to drive a long distance to a specialty clinic or face the stigma of publicly going to that clinic.”

With the federal removal of certain data waiver requirements, MAT treatment became a viable option to integrate within more typical medical services. This is now more important than ever, according to Stout, as new illegal drugs in pill form that “look like” opiates are becoming more available on the street. “Dealers mix up illegal and highly dangerous combinations of fentanyl, heroin and other drugs, and illicitly press them in pill form to ‘look like’ oxycodone or other opiates,” she said.

The dangerous illegal and increased use of fentanyl has tragically resulted in additional deaths by overdose, Stout explained said. When prescription opiate availability decreased, people who used opiates turned to heroin as a substitute, opening the door for dangerous fentanyl.

Southern Indiana Community Health Care began exploring MAT treatment options in 2018, when tests showed opiate use among the obstetric population. Initial success of the program promoted SICHC to roll out integrated treatment options to the general public in 2019.

Stout noted that overdoses still tragically occur often. She emphasized that free opioid rescue kits are available without prescription or social contact. Life-saving Naloxone can be administrated by nasal spray or other means in an emergency overdose situation.

“There are many Naloxone Boxes and free distribution points around Indiana,” Stout explained, encouraging any with an opiate issue (or anyone with a family member or friend with an opiate issue) to secure a free, confidential supply at NaloxBoxes around the area. (NaloxBox locations and distribution points can be found at https://www.overdoselifeline.org/naloxone-indiana-distribution/). Several churches, public libraries and facilities, and recovery centers are host to free and accessible opioid rescue kits.

Recovery from substance use takes time and can include complications. In addition to seeking quality medical care, people with substance use are encouraged to take advantage of local peer support groups and 12-step recovery programs like Alcoholics Anonymous and Narcotics Anonymous. Safe Haven Recovery Engagement Center in Orange County offers several options. Interested people can also visit https://www.indianarecoverynetwork.org/

Together with a patient in recovery, Stout presented details about the MAT program and its integrated value during the recent Indiana Rural Health Associations annual state conference in French Lick.

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Already a focus in helping to address personal issues resulting from an unhealthy accumulation of Adverse Childhood Experiences (ACEs), self-care is being positively put into practice by providers and medical staff at Southern Indiana Community Health Care. 

Susie Benham, office manager of the English office of Community Health Care, has been taking part in a collaborative training process to help the organization become more trauma-aware and trauma-informed, including measures to address trauma results created by sustained stress and other factors. The training and awareness, coordinated by the Indiana Department of Health, involves formal training and information sharing, which is being presented to professional staff and employees at Community Health Care offices.

Recent university research by George Mason University and other institutions shows that burnout and exhaustion rates experienced by providers and professionals in primary care are increasing at twice the level of other medical professionals. Medical professionals working many extra hours and consistently foregoing self-care in order to serve others at all times can experience challenges. Recognizing that continuous sacrifice can actually produce trauma symptoms over time is important.

“Our staff has participated in presentations that explain what being trauma-informed looks like, how it can impact people, and how staff can better practice self-care,” said Ms. Benham. “Recommended self-care measures have already been put into place and staff are responding very well.”

What does self-care look like? These include the institution of special days off where professional staff are encouraged to do things they enjoy – read a long-neglected book, work in the garden, take a short trip – instead of working 10-12 hour days. The Community Health Care staff also are also given options to reduce stress through exercise programs, expressive art therapy, financial planning, yoga classes, and supportive weight management programs.

Rested and resilient medical staff are generally more effective, and they also can pass on their personal experiences to patients, encouraging patients to avoid burnout and exhaustion by practicing self-care measures.

Southern Indiana Community Health Care has recognized how untreated and unresolved Adverse Childhood Experiences (ACEs) can directly contribute to current and later emotional and physical challenges. Research has shown how ACE scores of four or higher can directly result in later substance abuse, hypertension, and even cancer.

Community Health Care has successfully partnered with area schools and businesses to offer mindfulness and other trauma-reducing techniques for students and employees. Fore more information about this successful community initiative, read the online Limestone Post story “Public Schools in Orange County Reply on Unique Health Partnerships” here. https://limestonepostmagazine.com/rural-indiana-schools-unique-health-partnerships/ 

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Ready to have a great summer with your kids? When it comes to enjoying life, many can remember their fathers or mothers saying, “Health is your greatest wealth.” As a long-time practicing physician in the area, I know that if you are blessed with good health, your options are many, including having summer fun.

Since I see them in my practice, I think a lot about the kids in our area. Many different choices lie before them, especially the choices that promote good health. Here are some basic principles that can promote a great summer.

Summer is time for spontaneity, for surprise, for discovery and immersion into something special, a time for play and to have fun. Our young children and teenagers learn important lessons in this time: how to get along with others, to be a team, to share,  to create and experience special days, including day camps or summer camps, and in the family vacation. 

Sound health is key to enjoying all of them. 

How can your child  have a fun, safe, and healthy summer?

Sound sleep is fundamental

Here’s a surprise: number one on our list is good sleep. Set your child up for good and active days by helping them get a good night’s sleep, night after night. 

It takes planning, especially with daily work schedules, but keeping up a routine that features meals with healthy food and good snacks can give a child’s body the necessary nutrition to grow while they are pushing the limits of flat-out daylight to dusk high-energy activities. 

For many families, ensuring good nutrition can be challenging from both time and financial perspectives, especially in an era of rising food costs. Perfection is not the goal, but where possible, making a good, sustained effort is.

Eat healthy where possible

I know from experience that a child’s idea of a meal is often a double cheeseburger with a side of hot dog, washed down with a chocolate shake or mega-sized sugary drink. With a little planning, we as parents can substitute more healthy options, like yogurt with fruit for breakfast; a lunch with lean meat on good whole-grain bread (hold the chips), and some raw carrots or celery; and a dinner with plenty of vegetables and protein like fish, chicken (without the skin) or other lean options (including a bean dish). Think about having healthy snacks like unsalted nuts or seeds available in between meals to satisfy cravings (depending on their age, children can need anywhere from 1,200 to 3,200 calories a day).

Drink plenty of water

Related to good nutrition is a key point from the sports gurus: hydration. An important foundation of good health is drinking plenty of water (not sugar-dense sodas or over-sweetened fruit drinks). Encourage their children to drink a glass of water first thing in the morning and remind them to keep hydrated throughout the day. 

Stay active and have fun!

Summer is the time to be active! Turn off the TV and the cell phone and go outside. Go swimming, grab a ball and mitt, shoot some hoops, jump on a bike or skateboard, or take some old sheets and cardboard boxes and build a castle! 

The point? Summer is a time to get plenty of sunshine and fresh air where possible.

Sometimes during summer activities children can sprain an ankle or suffer an injury. Other times children can catch a summer cold. If that happens, always take advantage of the quality healthcare that’s available in our area.

Have a great, safe, and healthy summer!

A board-certified family physician, Dr. Curtis Thill has been practicing in the Crawford County region for more than 30 years. 

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It doesn’t have to be that way. Good options exist!

The truth is that doctors and hospitals would much prefer to find ways to help people find affordable healthcare long before something serious develops. 

Higher personal energy during the day, better sleep, and generally good health are often among the benefits of adopting a lifestyle that includes taking care of yourself. A regular checkup or seeing a health professional when symptoms first appear can resolve many potential problems – including crippling, life-threatening issues – that could appear later.

Hospital administrators know that when a patient presenting advanced symptoms of pain, trauma, or even life-threatening conditions shows up in an emergency room, it will likely be a much more challenging situation to resolve.

Federal and state laws require hospitals and doctors to treat patients and provide stabilizing treatment to people without insurance. But simply showing up in an emergency room is not the best way to resolve an issue.

Of course, securing commercial healthcare insurance through your employer, researching and purchasing healthcare at the federal website (https://healthcare.gov) during the signup period (now through December 15) or availing oneself of healthcare services available through Medicare or Medicaid are definitely preferred to not having traditional healthcare insurance.

But for a variety of reasons, sometimes finding and securing commercial healthcare may be perceived as a potential option. Unemployment issues, extra expenses incurred during this ongoing COVID-19 pandemic, or unexpected family issues can sap needed funds for healthcare premiums. Confusion about plans or anxiety about costs can lead to delays.

The good news is that many options exist for people who are concerned about potential high costs of medical services. Finding healthcare coverage should not be a stressful experience, and many options exist to help families. Financial subsidies are available through the Affordable Care Act (ACA), especially for those facing financial issues or who live at or below the federally defined poverty level.

In fact, in 2020, nearly 90% of the 10.7 million people who purchase health insurance through the federal government marketplace received money-saving subsidies to help pay for insurance premiums. Insurance premiums through options like this can be at a small fraction of typical premiums and pay for all sorts of standard healthcare – family healthcare services, OB pregnancy services, dental work, vaccines, behavioral health, and more.

Still, even applying for subsidies or securing healthcare coverage can be confusing. For some, plowing through paperwork or online options can just raise anxiety levels or create more confusion.

Thankfully, most hospitals and clinics – such as the Southern Indiana Community Health Care clinic where I work – provides free help through a certified insurance navigator. These professionals are called navigators because that’s exactly what they do – they help people navigate through potentially confusing insurance and coverage options to help find the best affordable coverage available. Many people in our southern Indiana area find good coverage through special programs offered by the Healthy Indiana Plan, Hoosier Healthwise or Medicaid. An insurance navigator can help you find and apply for coverage like this.

Still concerned about one’s ability to pay? Many physicians and clinics offer special discounts and payment plans. To find out specific options available in southern Indiana, you can visit the SICHC webpage at https://sichc.org/payment-options/ to review area programs. This includes the Community Health Assistance Program (CHAP) that offers a sliding fee schedule.

The bottom line? Many options exist to help you get good coverage. Don’t wait until a simple condition gets bad – go online or call your local providers for useful information about affordable coverage.

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