Lakeland Currents, your public affairs program for north central Minnesota.

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Welcome to Lakeland Currents, I'm your host Todd Haugen.

Our show is about Oshki Manidoo in Bemidji.

We have the CEO with us, his name is Jeremy Syverson and also from Oshki Manidoo the Outpatient Manager her name is Juanita Reopelle.

Welcome to Lakeland Currents to you both.

Thank you for having us.

Oshki Manidoo is something that people might have heard the name locally and may not be aware of what it is.

What is Oshki Manidoo?

So Oshki Manidoo is well it stands for New Spirit Center so it a lot of people recognize it as the old Gilfillan Center in town and White Earth, White Earth Nation, purchased the land and property back in I believe 2007 with the idea of going forward and having it continue with our youth inpatient residential program on there.

So we operated that program for I think it was until 2012, 2013, around that area is when we expanded and brought our inpatient residential women's program, it's called the women's well-briety program.

So currently we operate two residential facilities one for male and female adolescents as well as our adult female residential for women.

One thing that really makes us unique across the state is that we are able to have women bring their children with them to treatment.

So we have our two residential programs and then I think around 2016, 2017 we kind of expanded, we wanted to keep that continuum of care and open outpatient we're having individuals who would come to residential treatment, they would graduate and they wanted to continue to work with our program, they wanted to stay in the community and so we expanded to add outpatient treatment on there.

We've had some individuals with us for years that continue to seek services and have that relationship with us.

Along that time too is when there started to be more of an uptick with you know heroin opiate abuse.

We've had a opiate epidemic for many years.

Indian country is generally hit pretty hard with that as well so we expanded, met with some partners and kind of piggybacking off of one of the programs that White Earth started on the reservation over there the mom's program, it was maternal outreach and mitigation services, they started to offer buponorphine treatment for opiates for pregnant women.

So they started off of that and being that we, you know, service a lot of females who are pregnant themselves, have children, you know, we began to explore offering that within our treatment setting too in an outpatient setting.

Jeremy you said Oshki belongs to the White Earth Nation, White Earth tribe, but is anybody eligible to come there for services?

So we are open to everyone.

We do probably 99% of our individuals we serve our relatives that we serve we call them are, you know, of Native American or have ties to Native American communities.

We are culturally based treatment services, you know, but once again, you know, we've had individuals who are non-Native American but they have close ties to the community but we're generally open to everyone.

And you said when the facility was purchased by White Earth the facility and the land and I was reading about it online there's more land there than I thought how much land do you have there?

Yeah so we do have 40 acres right in the middle of town.

Yeah it's kind of, you know, a lot bigger than you'd think.

You know you kind of see the buildings there but it expands pretty good you know.

We have some trails in the back, you know, have some woods, we have wildlife, we have a pond, you know, so it's a nice almost wildlife setting within an urban, you know, area.

Convenient and beautiful.

And beautiful it is.

Juanita what do you do as director or manager of outpatient services is that it?

Yes that's what it is.

So within our outpatient services we, as Jeremy mentioned, we have the opioid treatment, so people come and engage in getting medication for opioid use disorder but we also have a program where you don't have to be an opioid user, you can just have a substance use disorder and still engage in outpatient programming.

So my role is to focus on the direction of the program and ensure that we are meeting our mission by helping individuals recover or on their recovery journey and I supervise the clinical staff, meaning our counselors, treatment coordinators, and some additional staff that aren't considered medical staff.

About how many people do you serve generally, outpatient?

Right now we have about 120 in our program.

That seems like a lot.

Yes and we're open for more.

Really?

Yes we're positioned to serve additional individuals who could benefit from outpatient services.

A lot of our individuals who come we have some that come on a daily basis to engage in outpatient services, some for medication, some for groups and one to ones with addiction counselors and some for both.

And the ones that keep coming back are ones that seem to be benefiting from the community that's created there.

Is it generally people that many of us would consider young people, you know people under 25, or are there older people?

That's an excellent question and we serve everybody.

You walk in the door you may see someone, a fresh 18 year-old, and you may see a seasoned 65 year-old all seeking services so we run the gamut.

I think that some people might have the misconception that this is a problem that just young people experience.

And so I'm thankful that you're bringing it out because that is absolutely a myth.

Addiction has no favorites, anyone can fall prey and so we're just here to support.

So what kind of it's drug addiction counseling that you do, that's that's your primary mission.

Yes.

Okay and do you provide any other kinds of services, health services for people?

So that is an area we are looking to kind of expand in.

You know it's kind of one of those things that when you have an individual come in you know there's a lot of issues that are you know whether they would be the primary issue that leads you know it's always been the one thing what leads to addiction you know kind of like the chicken before the egg you know what you know is it a mental health issue, is there trauma, you know, so there's a lot of things, you know, that affect that individual.

We do have the ability to work with a lot of co-occurring individuals.

We're not a co-occurring facility but we operate as closely to one as possible.

We have outpatient mental health services through White Earth located on site so individuals are able to you know get a diagnostic assessment.

We do have the ability to do medication management for mental health medication.

We have the ability to do tele-health with psychiatrists, various psychiatric nurse providers, and our nursing staff within our outpatient and we have nursing staff within our inpatient too that are able to do minor minor health things.

You know we have a lot of individuals with, you know underlying health conditions, diabetes, chronic health disease, you know, the hepatitis out there, so we do a lot of education, we do a lot of care coordination, getting them set up with, you know, providers in the area.

You know there's not enough hours in the day, you know, sometimes to try to fulfill all the needs but we do our best, you know, and one of the reasons I wanted to bring Juanita to this conversation too is she's served in various different functions throughout the years.

Both her and I have been with Oshki back since, she's been longer than myself, but I started with Oshki back in 2015 and throughout there you know we've evolved and, you know, like I said we're looking to kind of expand on the needs.

You know it's the needs of our relatives we serve that kind of steer us into what we can do.

Would you be able to do that right now if you could, I mean if you had the patients do you have enough people or do you need more space?

Space is always an issue, office space is always an issue.

We're actually completing a renovation for our outpatient building right now to add more offices.

We're looking to expand upon peer support more and looking at bringing in some more nursing.

We're recruiting, you know, addiction professionals, nursing staff as well too.

It's pretty cutthroat out there for nursing to get nursing staff in right now, you know, ever since covid kind of hit you know covid did change kind of the landscape of a lot of things.

There was a lot of good things that came out of it, tele-health is a big thing we take advantage of, it opens up a lot more possibilities to provide for the needs of our individuals.

Did you have something you wanted to add to that?

I do.

Your question was focused on medical and medical needs and Jeremy answered that very well.

I also want to add since our model looks at individuals as whole people, not just people with addictions, but people with addictions who have lots of other areas that they could use support in in order to create the groundwork for healing and in that we have treatment coordinators on campus that do needs assessments to take a look at some of those other areas.

What are the gaps in services, what are the gaps in things that I need in order to stabilize and so we add into their treatment plan some of the things that would help them stabilize, such as getting social security cards, identification, looking for employment, looking for housing, you know, so some of those are the things that sometimes keep people from being able to focus well on their recovery because there's so many other things that are off balance.

So we try to create help support and create balance.

There's a lot of socioeconomic factors too that, you know, can inhibit somebody's ability to, you know, get well, you know, fulfilling some of their basic needs, you know.

Stability in life is important isn't I mean a lot of people of us that, you know, we have stable lives generally places to go home to, not everyone has that and that probably makes it more difficult to recover.

Yes, definitely.

What determines if someone's going to be an outpatient, use outpatient services, or be inpatient at the facility, is it a room question?

There's a couple of things.

One is we do something called a comprehensive assessment and the assessment looks at a person's the whole person, what they're using, how much they're using, how long they're using, the problems that are associated with using, and there's a scoring criteria that comes out that is actually matched with DSM5 okay for substance use and outside of that comes recommendations and so we look at the person and see how chronic is the illness or how much support the person needs and the recommendation is the level of care which is like residential, outpatient, or even withdrawal management.

The recommendation comes out of their expressed need during that evaluation period and so if the person's situation, circumstance, addiction is presenting as very chronic we may make a recommendation that they go into inpatient treatment in order to stabilize and so it really depends on the level of care that the person is needing at that point of contact.

Another thing that comes into play is client choice.

There was a time in this field that the person who does the evaluation they make the recommendation and like it or not you're going to inpatient treatment this is our recommendation.

Now we may say this is what we believe would benefit you best and the client will say "Yeah, but I'm not going."

Yeah but I have barriers, yeah but who's going to take care of my six children at home, so it's a combination of what is presented and what the client is needing at that time.

And you said earlier Jeremy that there is room at the facility for children to come with people if people have custody of their kids.

That's correct.

So right now we have the ability to house 20 women based on our various room sizes and the guidelines that we follow will be dependent on how many children they can have with them as well as we do operate a tribally licensed daycare on site.

So depending on the availability in our daycare, the physical space that we can allow would be dependent on, you know, how many children can come with the mothers.

We like to kind of laugh and be happy, you know, cuz we have we call them Oshki babies cuz we've had individuals with us that, you know, have been pregnant they've been with us we've seen births coming back with new babies.

You know our goal is to keep that reunification with the mothers, you know, and that's always one of the things that puts a smile on my face is seeing those little ones with their mothers cuz the love they have for their mothers.

You know the disproportionate rate of out of home placements with, you know, within the Native American community, you know, we try to put a dent in that, you know, keeping mothers having those children part of their journey to wellness is a big thing, you know, because there's that, you know, just ultimate love that the family has and, you know, working, you know.

It's hard being a parent, you know, and, you know, whatever we can support, you know, and I mean it's hard being a parent especially going through, you know, addiction struggles, you know.

I want to ask you more about the cultural component there but first I wanted to ask about mandated drug counseling, when a court tells people they have to get counseling, they have to get services to try to beat their addiction, does that work very well or do people have to want it?

Excellent question, Todd.

Okay so here's how I've seen it play out over the years.

Sometimes that intervention is exactly what is needed and a person's mandated time out creates the space for a person to take advantage of that opportunity and seek their healing and some have done that have watched it play out, never turn back.

Others will elope same day of intake, within five days of intake, or realize that all right I'll just play the system and go ahead and do my time, start counting down the time right away in order to avoid incarceration but never necessarily take it seriously.

So it really depends on the individual.

There has been some success with that and there has been some failures with that is you know a person ultimately will need to have internal desire to pursue their wellness, otherwise it will not work.

Right because they probably would have never got addicted in the first place if they didn't find some enjoyment of some kind, I mean at least at first right when they start becoming a drug user.

I mean isn't that why people start?

It's a hard one, I know, but that's I mean because most people want to say "Oh no that's it's just that you can't help it or whatever."

But I mean people that's why people drink, that's why they use some kinds of mind-altering drugs right?

Well the motivation for using varies from individual to individual.

No one as a child wakes up one day and says "When I grow up I want to be a drug addict or a person addicted to substances."

There's a lot of other things that happen that can cause a person to go from experimenting or trying drugs whether that's for peer pressure or for a relief or because they see that it seems like it benefits someone in some way to being desperately in need of supportive services in order to arrest their addiction and those could be things like biological traits, historical trauma, profound childhood trauma or something people call ACE's, adverse childhood experiences.

There's a list of childhood traumas that sometimes can lay that groundwork for someone.

Things change in our bodies sometimes when we're using like chemically and so let's say I'm going to use Jeremy cuz he's at my right elbow.

He and I could probably try something same day, same time, same substance and for something the key opens something up in me that's different from him and he can be like done with that, walk away tomorrow and I have years of struggle, it all depends on that individual and so many other factors biologically, economically, socially, that can determine someone's outcomes when it comes to addiction.

So there's no hard and fast no rules there's no do this do that and then do this and then the problem's fixed.

Exactly and treatment is going to look different for everyone, what works for someone, someone might go well you know I quit cold turkey and that worked for me so it will work for you, and some others might go I need to go to it's a group and be around like-minded people who are all pursuing the same thing and some might say, you know what, all I need it needs to be me, God, the woods and a bicycle trail.

It's going to look different for everybody.

I think that's one of the things that's kind of a fallacy is that there is no cure for addiction.

You know addiction is it's a disease, it's a chronic disease and it's something that you're never going to be cured of, you're going to have to, you know, manage it, you know, much like a chronic disease like diabetes or something, you know, and I think that's one of the things, you know, I've seen over my years is that, you know, there's a lot of different factors as to why people use, you know, loss of identity, you know.

And you mentioned bringing up the cultural component, you know, but that's a big thing, you know, loss of identity, the traumas, you know.

I would say a majority of our individuals we serve have some type of, you know, trauma in their life they've experienced that they medicate.

It can come down to as simple as I can't quit because I don't want to get sick.

You know if you've ever seen somebody in opiate withdrawal it is not a pretty sight, you know, and that's the biggest fear that I've seen for somebody who has a opiate use disorder is I don't want to be sick, you know, and that was kind of one of our things with implementing our medication for assisted treatment is to help people with that withdrawal do whatever mitigation we can for those withdrawal systems, you know.

Unfortunately we just have a few minutes left of our show but Jeremy how does the cultural component of what you do at Oshki work, do I assume we're talking about Native American culture?

Yes definitely.

So we kind of have the the mindset of trying to use culture as treatment, you know, getting our individuals back to their roots.

Myself I've learned so much over the years not growing up traditional but having that stuff come naturally to learn, you know, our various ceremonies what their meanings are, our respect for the environment, our you know just overall kind of family dynamics and things.

You know we try to implement that into our daily life and treatment.

We have weekly ceremonies, teachings.

We work very closely with the White Earth Behavioral Health cultural department and you know people getting their Native American names.

We offer sweat lodge and things and just connecting with that spirituality.

Is this, are these kinds of things that these people might not have been familiar with before they came to Oshki Manidoo?

Yeah, you know, and I bring that back to that kind of loss of identity, you know, not knowing who you are, where you came from, what things mean, you know.

But to be able to learn, you know, hey this is a beautiful culture, you know, I can learn these things, you know, it helps healing, you know, healing with self-healing spirit things.

Right and does that seem to work for the outpatient people as well?

It does.

It is not uncommon to hear people say I did blank for the first time while I was at Oshki and really appreciate that cultural thread, the ceremonies that are offered, and incorporating, you know you can see somebody starting to stress out a little bit or the energy shift in a space and someone says we should smudge.

They may have done it 20 minutes ago but feel like it's time to do it again so we keep things around so people can grab and incorporate in their daily lives and if they want medicine to take home we send medicines home with them.

And so a lot of people express the benefit of leaning into their culture as part of the healing.

Well, we're running out of time.

How do people find out more about Oshki Manidoo?

So if they visit whiteearth.com there is a page under our behavioral health division, we're part of White Earth Behavioral Health.

They can call us 218-751-6553, that's our main number, that'll connect you to any one of our programs.

Thank you much.

Thanks for joining us for Lakeland Currents.