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Fall 2016 Issue

FRONT COVER Magazine Urban Minority Alcoholism & Drug Abuse Outreach Program we will

the moving past pain CONFERENCE SPEAKER ADDRESSES MENTAL HEALTH ISSUES down &

STATE CONFERENCE FOCUSES ON build GROWTH, UNITY

MENTORING PROGRAM HELPS YOUTH SUCCEED strong guidance

A LOOK AT THE OPIOID EPIDEMIC

growing community PROVIDING SUPPORT TO BABIES, MOTHERS

investing in the future PREVENTION EFFORTS PAY OFF

• Agency Programs • Politics • Society • Culture • Incarceration • Poverty • Re-Entry Topics ofDiscussion

theinfluence.org is an online platform to have a voice in the national discussion on addiction and recovery.

BY 2020, MENTAL AND SUBSTANCE USE DISORDERS WILL SURPASS ALL PHYSICAL DISEASES AS A MAJOR CAUSE OF DISABILITY WORLDWIDE.

CONTENTS INTERESTED IN MORE FROM UMADAOP? To learn more about our resources for living a healthy lifestyle, contact one of our many locations throughout the state of Ohio:

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Akron UMADAOP

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8 TEENSTAKE CHARGE Youth-led group provides a space for teen perspective on addiction 10 OLD SCHOOL, NEW PROGRAM Former school repurposed for UMADAOP activities 12 TACKLING AN EPIDEMIC Legislation would tackle opioid problem in our four areas 14 GROWING COMMUNITY Mansfield UMADAOP puts focus on parents and young children 18 INVESTING IN THE FUTURE UMADAOP proactively helps kids to steer clear of drugs and alcohol 20 UP AND DOWN While prescription opioid doses decrease in Ohio, deaths from fentanyl rise 22 REVEALING AN IMPOSTER Dayton UMADAOP seeks to educate those on ‘the great imitator’ 28 SAVING OHIO’S YOUNGEST African American infant mortality rate soars in Ohio 30 21 ST CENTURY After school program helps at-risk kids get ahead 32 RESERVING A PLACE IN HISTORY UMADAOP builds bonds that foster recovery

36 SUPERWOMEN IN RECOVERY Unique challenges require unique treatment 40 FROM SMOKINGTO DRINKING Marijuana users are more likely to develop an alcohol abuse disorder 44 STARTING YOUNG Insight into adolescent addiction comes as new guidelines urge early prevention 46 FIGHTING FORTHE BRAIN DISEASE MODE Model can complicate messaging in treatment plans 48 LASTING IMPACT UMADAOP leaders look back on how the state conference has evolved 50 BOOMING PROBLEM Elderly substance abuse issues expected to grow 52 THE MISSING LINK Integrated treatment works best for victims of sexual abuse 54 RECOVERY U More college campuses are dedicating housing to students in recovery 56 LEARNINGTO DRINK Study finds alcohol changes the brain

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Lorain UMADAOP

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Copyright 2016 by The Influence. No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher, excepting brief quotations in connection with reviews written specifically for inclusions in magazines or newspapers, or limited excerpts strictly for personal use. Printed in the United States of America. All rights reserved.

from the very first drink 58 ARE VACCINES THE ANSWER?

A new vaccine has been shown to prevent overdoses and stop opioid “designer drugs” from affecting the brain 60 THETURNING POINT New study looks to pinpoint transition from prescription opioids to heroin

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Lima UMADAOP is a Recovery Oriented System of Care Organization ( ROSC) a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems.

(419) 222-4474 www.limaumadaop.com

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information from a teen perspective to the community, King says. King has worked with the Lima UMADAOP for around 15 years; he attends these youth meetings, but he’s only there to sometimes help nudge kids in the right direction. “e adult is just there to guide them if there’s a situation or if they get stuck,” King says. Being selected to participate in the Village Youth Led Community Coalition somewhat resembles being chosen as a captain on the basketball team.

e youth recruited have a history with UMADAOP, King says. In some cases, the youth have worked at UMADAOP over the summer. In other cases, teens recruit additional members. King says the casual environment suits the kids. He says it’s a setting where kids have the opportunity to show leadership, have discussions and disagree, if necessary. “ere’s not the negativity that most people would think young people would bring to a setting,” King says. “ey dialogue things out and come to a conclusion.”

Every Wednesday, a group of approximately ve kids gathers to discuss drug and alcohol prevention strategies. But there’s something dierent about this group. Here, at the Village Youth Led Community Coalition, the young adults take charge of leadership. e students, ages 15 to 18, draft the itinerary, take notes and keep meeting minutes, assistant director Marcell King says. e groups provide youth a voice and allow teens the opportunity to bring drug and alcohol addiction

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Greater Understanding

e group handles a variety of tasks, including presenting information during parent’s night. In one such meeting, they focused on mental health and drug addiction from a teen perspective. In passing conversations, King says he makes sure to give credit where credit is due. “Some adults in the community spoke to me, and said they heard we were doing a presentation,” King says. “I said ‘No, our youth are putting on this event.’’’ Youth Led Prevention Program Coordinator Jessica Mays also helps oversee the group. A mental health professional will be present at the youth-led meeting, in the event an adult asks a question the group…nds di†cult to answer. While still in its early stages, the group is also working to organize funds to help provide water, or other resources in Flint, Michigan. King says working with the youth also generates new and useful information. When a new drug or activity happens in the community, the teens will often bring it to King’s attention. King says this will often trigger him to do more research. “I’m able to start addressing it before it hits the community hard,” King says. e Lima UMADAOP is part of a larger federation of UMADAOPs throughout the state of Ohio. All UMADAOP locations focus on serving the needs of urban minorities. Similarly, the Lima Village Youth Led Community Coalition works with other youth led groups at UMADAOPs throughout the state of Ohio. Each youth alliance group looks a little di’erent. All together, the youth led group collective is known as QUAAD, or Quality Urban Alliance Approaching Destiny. “Now, we realize the bene…t of the federation, to be able to publically move as an Ohio urban unit,”Mays says. In total, UMADAOP operates 11 locations in urban areas throughout the state of Ohio. Stronger Together

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A space reimagined The children who attend UMADAOP services might have a past littered with abuse and neglect, or a learning disability. UMADAOP engages youth in prevention through a variety of strategies. In the evenings, kids in the community outreach center practice Tae Kwon Do. “It’s prevention because it has the ability to reduce the risk of diabetes, or heart disease — all because they’re moving,”Davis says. The Tae Kwon Do program isn’t aliated with any schools in the area, Davis says. It’s an activity that UMADAOP oers for the community. “We tried to think outside the box, outside of board games, to provide prevention in a dierent way,” Davis says. Recently, Davis says 10 of those kids participated in the Amateur Athletic Union’s State Tae Kwon Do Championship. Of those 10, ve won a medal. Two were awarded gold. The Manseld UMADAOP is gearing up to provide more services. This summer, Baker says the Manseld UMADAOP expects to oer a summer camp for approximately 150 kids. Overall, 65 kids participate in the Tae Kwon Do program at the Manseld UMADAOP, Davis says.

Early this year, the Manseld UMADAOP celebrated the ribbon cutting of a new community outreach center. Youth Development Coordinator Benjamin Davis says he remembers feeling a big sense of relief at the ribbon cutting ceremony. “We purchased the building in December 2014,” Davis says. “Just over a year later, we had the ribbon cutting.” In an earlier life, the facility functioned as a school. Now, the Manseld UMADAOP will use the space to hold activities for kids, such as summer camp. Dennis Baker, executive director at the Manseld UMADAOP, emphasizes how the UMADAOP has always worked to serve kids. Still, the new facility provides something dierent. “It’s an opportunity to separate kids from our main facility,” Baker says. “They have dierent challenges, so we thought it was best not to have them in the same facility that treats addicts.”

The summer camp is set to be held in the new community outreach center.

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Dollars and sense The Manseld UMADAOP used funds from a variety of sources to nance the renovation of the new center. The Manseld UMADAOP receives funds from a variety of sources, including from the Ohio Department of Mental Health and Addiction Services. The Manseld UMADAOP also secured loans from banks to nance the acquisition.

Davis, along with other prevention sta members, work in the new community outreach center.

In some cases, renovations were as simple as applying a fresh coat of paint. Other areas, such as the gymnasium, received all new basketball hoops and new padding along the walls. About 90 percent of the ooring in the building is new, Davis says.

“The building was built a long time ago,”Davis says. “There was a lot of work to get it up to today’s standards.”

Davis says the community outreach center is located along one of the main streets in Manseld, on Trimble Road. The center is within 20 minutes of other schools in the area, Davis says. 11

Born Into Addiction UMADAOP looks to protect infants and expecting mothers from opioid abuse Between the years 2004 and 2013, the number of babies in Ohio who were born addicted to opioids has increased nine times, according to the Ohio Department of Mental Health. Neonatal abstinence syndrome (NAS) occurs when infants are born to mothers who were taking opioids or other drugs. A variety of symptoms can be associated with neonatal abstinence syndrome, including low birth weight, breathing problems, tremors, excessive or high pitched crying, vomiting, diarrhea, or sweating, according to the Ohio Department of Mental Health.

In addition to the symptoms stemming from withdrawal, babies who suffer neonatal abstinence syndrome are also more likely to suffer birth defects, premature birth, seizures or a lack of fetal growth while in the womb, according to Stanford Children’s health. Babies suffering from severe symptoms may be prescribed medication. Babies might also require a higher calorie formula to compensate for additional activity, according to Stanford Children’s Health. Women identified as positive for drug abuse or dependence should also be screened for Hepatitis C and HIV due to a high rate of comorbidity, according to the Ohio Department of Health. “Prevention is everything, it’s the key to success.” - Sharon Gallagher LPN, Mansfield UMADAOP

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“Not only are we wanting you to become healthy, but we want your baby to be as healthy as possible too.” - Sharon Gallagher

Prevention is key Staff at the Mansfield UMADAOP make sure to offer screenings to every pregnant woman who comes through their door, saying they also put an emphasis on holistic prenatal care. But they say there’s only so much you can do once a baby is born, or if a woman is unable to abstain from substance use while pregnant.They say the real focus is on prevention and education. “The prevention is everything, it’s the key to success,” says Sharon Gallagher, a licensed practical nurse (LPN) at the Mansfield UMADAOP. “Not only are we wanting you to become healthy, but we want your baby to be as healthy as possible too.” Neonatal abstinence syndrome is entirely preventable. Mothers who learn they have become pregnant should stop using drugs and alcohol immediately, according to Stanford Children’s Health.

Making a change For pregnant women and new mothers struggling with substance use, discussing possible birth defects and complications can be an extremely difficult conversation to have. And while it may be unpleasant, Gallagher encourages women to use those emotions as a motivating force in their recovery. “To me, it’s good when I see emotion,” Gallagher says. “I know that you’re caring, maybe it’s hitting home, maybe all this information is making a difference in changing your behavior and drug use.” Mansfield UMADAOP staff offer their full support to new and expecting mothers, opening lines of communication between medical and treatment staff to make sure all of a client’s needs are being met.They will also make referrals to outside organizations when they don’t offer a particular service in house. While opioid abuse continues to negatively impact the lives of people across the country, UMADAOP staff know it’s the smallest citizens who may be the most vulnerable. As they continue to address the root causes of opioid abuse in all clients, they will pay particular attention to new and expecting mothers, and will continue to push for increased education and prevention measures. “Education and knowledge is power,” Gallagher says. “Hopefully they have more of that, then they’ll be able to make better decisions.” 

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Growing Community Mansfield UMADAOP puts focus on parents and young children

The birth of a child can bring as much joy and excitement as it can fear and anxiety, especially for new parents.That’s why the Mansfield UMADAOP is doing everything it can to help new mothers and fathers overcome the challenges of parenthood. As part of Ohio’s Help Me Grow initiative, the Mansfield UMADAOP regularly sends a staff member out into the community to do home visits with new parents and expecting mothers.The staff person provides information on a wide variety of issues, including health and development, educational activities, and even how to play with a child in a safe and constructive way.The staff person will also conduct simple screenings to help ensure the child is happy and healthy while helping the parent lay a foundation for the child’s future. “The whole idea is to try to improve that child’s health and development,” says Carol Payton, Mansfield UMADAOP’s prevention and outreach director. “These are new moms and a lot of times they’re very young, and we want to make sure they’re focused on getting the right information and doing the right things during those critical years of a child’s life.”

“You suddenly have a friend who’s non-judgemental, who’s giving you the kind of support you need.” - Carol Payton prevention and outreach director Mansfield UMADAOP 14

A friendly face The program will see pregnant women and their children up through three years of age.They also work with a number of single dads and will provide the same services to fathers in need of assistance.Their goal is to help 25 families per year, but because of a large need for services, Payton says they often help far more. While the parenting tips and information are invaluable, Payton says it’s the social aspect that helps make the program so successful. She says many parents can be uncomfortable around doctors and visiting clinics, so getting them to interact with a community health worker in a safe and familiar environment helps ease concerns and allows parents to open up about the challenges they’re facing. “You suddenly have a friend who’s non-judgemental, who’s giving you the kind of support you need,” Payton says. “It makes people think, ‘I’ve got somebody that I can call for even the smallest questions.’”

“It’s a very holistic approach that we’re taking, it’s a family approach.” - Carol Payton

Future growth Payton says the overall goal is to help new mothers and fathers become more confident and competent in their parenting skills. She says that competency can lead to a reduction in abuse, and helping parents with small things like arranging doctors appointments can have bigger benefits as well. By eliminating the stress of everyday tasks, parents have more freedom and confidence to pursue other positive activities to improve their situation for themselves and their children. “We look at things growing one step at a time. Our goal is to assist them in managing those barriers,” Payton says. “We’ve had women who have gone back to school. We’ve managed to remove enough barriers in their lives that they’ve been able to pursue higher education.” The program has seen many success stories over the years, and Payton says she is looking to expand services in the future to help more families in need. Payton hopes to make a positive impact on the community as a whole by helping new parents improve their skills to give children the best possible start in life. “It’s a very holistic approach that we’re taking, it’s a family approach.”

Pictured: Dennis Baker, CPS, Executive Director of Mansfield UMADAOP 15

PRIMARY PREVENTION & EDUCATION TO HISPANIC/LATINO CHILDREN

(216) 459-1222 Residential treatment services are available 24-hours a day.

HISPANIC UMADAOP

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UMADAOP Of Dayton Location 1 Elizabeth Pl RT-1, Dayton, OH 45417

Our programs are designed to encourage positive African-American cultural and social values, leadership skills, and appropriate communications skills.

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INVESTING IN THE FUTURE

UMADAOP Proactively Helps Kids To Steer Clear Of Drugs And Alcohol

Prevention Education Specialist Nereida Diaz has been working at the Hispanic UMADAOP for 21 years. A typical day involves travelling to one of her six assigned schools, and talking with students about drug and alcohol prevention. Her colleague, Prevention Education Specialist Roberto Colón does much the same work. How- ever, their first meeting was not in the workplace, rather, it was when Roberto was young and still in school.

“I remember when I was in school, Nereida would give me classes,” Colón says. “I always thought it was something I’d like to do.” In reflecting back to fifth grade, when Colón listened to Diaz’s presentation, he says the passion Diaz brought in sharing prevention information with the class is what sparked his interest in the field.

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“When they’re incarcerated, they have to find someone to leave their children with so they can serve time,” Diaz says. “Sometimes there are complications, because their children are taken away.” Diaz leaves her business card with the inmates. After being released from jail, Diaz says she encourages women to stop by her office if they need assistance. For example, in the past, one woman was working to get custody of her children. The woman requested Diaz write her a letter of support, saying the woman had been attending the group Diaz hosts. Diaz says some might be surprised to notice the age range of the inmates. “You’d think these are older ladies, but they are beautiful young girls that are serving time,” Diaz says. “The majority of times the problem they have is connected with alcohol and drugs.” Hispanic UMADAOP receives funding through the Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board of Cuyahoga County and the Ohio Mental Health Addiction Services (OMHAS). “I thought it was always something I’d like to do.” -Prevention Education Specialist Roberto Colón

Prevention works Diaz teaches in each class one day per week; in total, she sees approximately 580 middle and high school students. Sometimes this involves going to two schools per day. In addition, Colón provides prevention education to about 500 elementary school students. “I’m also in the after school program,” Diaz says. The Hispanic UMADAOP is specifically valuable for the Spanish-speaking population in schools. Classes with younger students often give out bilingual permission slips to better communicate with parents at home. Colón says one portion of his job involves adapt- ing to different classrooms, as each can be slight- ly different. “Some kids are mischievous, some are nice, some are controlled,” Colón says. “You just have to figure out in what way you can adapt to them.” Colón says if he works in a classroom with talkative kids, he might build in more elements of participation. If children are quiet, he might try other approaches that increase the students’ enthusiasm for learning. Colón says one of the most impactful parts of his job is seeing how the children digest the information. “They tell me stories about how they go and talk to their parents about how smoking is bad for you,” Colón says. Within four walls Diaz has also worked in a program for incarcerated women for the past 20 years. UMADAOP offers services for children and families. Diaz says ladies are often interested to hear more about the services UMADAOP offers.

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While prescription opioid doses decrease in Ohio, deaths from fentanyl rise

While fewer prescription opiate doses were dispensed in Ohio, deaths related to drug overdose continue to rise. Overdose deaths related to fentanyl significantly contributed to the rise of drug addiction-related deaths, according to the Ohio Department of Health. In 2014, fentanyl contributed to 502 drug overdose deaths, whereas one year earlier, it contributed to just 84 overdose-related deaths, according to the Ohio Department of Mental Health. In 2014, drug overdose deaths, including both opioids and heroin, reached record levels in the United States, according to the Centers for Disease Control and Prevention (CDC). Like many states, Ohio saw an increase in the number of deaths related to drug overdose; deaths attributed to drug overdose in Ohio increased by 17.6 percent, to 2,482 in 2014. Fentanyl is up to 50 times more potent than heroin, and 100 times more potent than morphine, according to the CDC.

“We are right in the middle of this epidemic, as an organization, and as a treatment center.”

- Nelson Ramirez executive director at Hispanic UMADAOP

Growing addiction In tandem with the growing number of deaths associated with fentanyl, the number of illicit fentanyl drugs confiscated by the Drug Enforcement Administration has increased as well, according to the CDC. Ohio led the nation with the highest number of fentanyl drug seizures in 2014, at 1,245 illicit drugs seized, according to the CDC. More than 80 percent of drug seizures were concentrated in 10 states. California, the most populous state in the nation, meanwhile, had less than 20 seizures of illicit fentanyl in the second half of 2014, the CDC reports. “Fentanyl has been a huge concern,” Nelson Ramirez, executive director at the Hispanic UMADAOP says. Fentanyl use can include a variety of side effects, including dizziness, dry mouth, weakness or severe constipation, according to WebMD. “Cautiously Optimistic”

“Fentanyl has been a huge concern.” - Nelson Ramirez,

A decrease in the number of prescribed opioids represents a shift in opioid addiction in Ohio. At this decrease, Ramirez says he is cautiously optimistic. Ohio patients received 42 million fewer prescribed opioid doses between 2012 and 2014, according to Ohio Governor John Kasich’s office. “That’s very encouraging,” Ramirez says. “I think doctors are getting the message, and are understanding the root cause of this opioid epidemic.” In 2006, the State of Ohio Board of Pharmacy established the Ohio Automated Rx Reporting System (OARRS) to help target the misuse of prescription drugs.The system collects information on all outpatient prescriptions and allows prescribers to avoid potentially life-threatening drug interactions, as well as identify individuals who might be ‘doctor shopping,’ according to the OARRS website. Also, the Hispanic UMADAOP has built relationships with local organizations, such as the Cleveland Free Clinic.Through these, UMADAOP has been able to partner with needle exchanges, organizations that provide naloxone treatment for those suffering an overdose, and other treatment centers. “We are right in the middle of this epidemic, as an organization, and as a treatment center,” Ramirez says. Doctors are becoming more aware of the problem, and are not prescribing opioids as openly and freely, says Marketa Robinson, executive director of the Dayton UMADAOP. “Everyone is accountable to help fix this,” Robinson says.

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DAYTON UMADAOP SEEKS TO EDUCATE THOSE ON ‘THE GREAT IMITATOR’

e Dayton UMADAOP has received a $15,000 mini-grant from the Directors of Health Promotion and Education (DHPE) LEAP National Program to provide lupus education and awareness in the community. Lupus, a dicult disease to diagnose, is more prevalent in African-Americans than in Caucasians, according to the Lupus Foundation of America.

“THE SIGNS AND SYMPTOMS HAVE BEEN WITH HER SINCE SHE WAS 13.” - DAYTON UMADAOP EXECUTIVE DIRECTOR, MARKETA ROBINSON

The Great Imitator Lupus has been referred to as “the great imitator,” because its symptoms so closely mimic those of other diseases, according to the Lupus Foundation of America. Symptoms of lupus can include inammation, meaning pain, heat, redness, swelling, or loss of function at a particular part of the body, according to the Lupus Foundation of America. Dayton UMADAOP Executive Director Marketa Robinson has experience with lupus. Her nearly 40-year-old sister was recently diagnosed with lupus. “e signs and symptoms have been with her since she was 13,” Robinson says. Robinson’s sister would often experience a buttery type rash across her nose as well as unexplainable fatigue. Robinson says she thought the rash was a birth mark.

After learning more about lupus, however, Robinson says they learned a buttery type rash — especially across the face — can be a sign of lupus. Lupus occurs when a body’s immune system attacks its own organs, according to the Mayo Clinic. Inammation can aect dierent types of body systems including joints, skin, kidneys, blood cells, brain, heart and lungs, according to the Mayo Clinic. Substance use/misuse can become a factor due to self medicating to relieve recurring symptoms and can make lupus even more dicult to diagnose, Robinson says. A patient might notice they often feel fatigued or suer hair loss. A client might attribute these symptoms to their substance abuse, not realizing the underlying cause. e Lupus Foundation of America estimates that 1.5 million Americans live with lupus.

Educating Community, Providers & Professionals As a part of the grant, the Dayton UMADAOP disseminated information to Montgomery County residents, providers and professionals to increase knowledge and awareness surrounding lupus. “We sought out dierent rheumatologists in the Montgomery County area, did information booths and oered a support group so that we can be able to oer more information,” says Prevention Educator and Program Lead Dominique Dixon. In the search to educate service providers, UMADAOP didn’t have to look far. e Dayton UMADAOP holds its oce in an old hospital. “We found out there is a rheumatologist in the same building that we’re in,” Dixon says. Robinson says so far, she’s received a positive reaction from the physicians she’s spoken with in the greater Dayton area. Learning About Lupus e Dayton UMADAOP held a lupus education and awareness conference May 13 at Central State University-West, James Elam Hall. Hetlena Johnson, a renowned circuit speaker living with lupus, spoke at the event. Dr. Temeaka Gray, who is also a professor at the University of Toledo, also spoke at the event. e conference provided workshops to educate community members, professionals and providers about lupus as well as included a discussion around lupus from a patient’s perspective. e conference included a panel session where people asked questions related to lupus.

UMADAOP Sta from left-right- Michelle Turner, Marketa Robinson- Ex. Director, Carl Mitchell, Dominique Dixon, Antheny Petty and center: Ethel Munlin

From left-right- Steven Gregory-Wright State Univ. Evaluator, Marketa Robinson, Hetlena Johnson-Keynote Speaker, Dominique Dixon, Dr. Steve Owens- Director of Health Promotion and Education (DHPE).

THE NUMBER OF AMERICANS LIVING WITH LUPUS, AS ESTIMATED BY THE LUPUS FOUNDATION OF AMERICA 1.5 MILLION

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Lupus Survey Do you have symptoms of Lupus? Please take a moment to complete and return the following survey.

YES

NO

1. Have you ever had arthritis or rheumatism for more than three months? 2. Do your ngers become pale, numb or uncomfortable in the cold? 3. Have you had sores in your mouth for more than two weeks? 4. Have you been told that you have low blood counts-anemia, low white cell count or low platelet count? 5. Have you ever had a prominent rash on your cheeks for more than a month? 6. Does your skin break out after you have been in the sun (not sunburn)? 7. Has it ever been painful to take a deep breath for more than a few days? 8. Have you been told that you have protein in your urine?

______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______

______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______ ______

9. Have you ever experienced rapid loss of hair? 10. Have you ever had a seizure, convulsion or t? 11. Have you ever been diagnosed as having Lupus or a related disease? 12. Do you know someone who has these symptoms?

Please Note: It is important not to diagnose yourself

If you have answered, “YES” to three or more questions, please complete the following:

Ethnic Group : Caucasion ___ Hispanic ___ Black ___ Asian ___ Other ___

Sex : Male ___ Female ___

Age: _____

Date of Birth: ____/____/____

Name: __________________________________

Address: _________________________________ _________________________________

Phone Number: __________________

Email Address: ____________________________

Emergency Contact Name: __________________________________

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Signs & Symptoms of Lupus For each symptom listed, write “yes” next to the ones you have experienced in the past, or are currently experiencing. If you are unsure, write “don’t know”. 1. Achy, painful and/or swollen joints for more than three months: _______ 2. Fingers and/or toes become red or blue, or feel numb or painful: _______ 3. Sores in your mouth or nose that lasted more than ve days, or sores on your skin that would not heal: _______ 4. Anemia, a low white blood cell count, or a low platelet count: _______ 5. Redness or rash in the shape of a buttery across your nose and cheeks: _______ 6. A fever over 100 degrees for more than a few days: _______ 7. Photosensitivity, a reaction to sun or light that causes a skin rash to appear or get worse: _______ 8. Chest pain while taking deep breaths: _______ 9. Protein in your urine, or swelling in your legs and ankles on both sides at the same time: _______ 10. Persistent, extreme fatigue and weakness for days or weeks at a time; even after plenty of sleep: _______ 11. Seizures or unexplained confusion that lasts more than an hour: _______ 12. Blood clot(s): _______ 13. Heart Attack or Stroke: _______ 14. Miscarriage(s): _______ 15. Sudden, unexplained hair loss: _______ Risk Factors for Lupus Gender, ethnicity, age, and family medical history may all contribute to your risk for Lupus. Nine out of 10 people who develop Lupus are women, and most women develop Lupus between the ages of 15 and 44. Hispanic, Asian, Native American and African-American women are also two to three times more likely to develop Lupus than Caucasian women. 1. Age: _____ It is important for you to know the warning signs and symptoms of Lupus. Complete this simple checklist to help you recognize the symptoms and risk factors for Lupus. Answer each question in terms of your current and past health status. If you have had symptoms like these, especially if you have had several, talk to your doctor about Lupus. e checklist is only meant to help you recognize the signs and symptoms of Lupus, and as a guide for you and your doctor to discuss your possible risk for developing Lupus.

2. Ethnicity: ____________________ 3. Gender: Male____Female____

4. Does your family have a history of autoimmune disorders such as rheumatoid arthritis, Sjogren’s syndrome, type 1 diabetes, Raynaud’s Phenomenon, Scleroderma, mixed connective tissue disease, multiple sclerosis (MS), or “over-“ or “under-“ active thyroid?

For more information, please visit www.lupus.org

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African American infant mortality rate soars in Ohio

Ohio also ranked as the state with the third highest infant mortality rate for babies of Hispanic origin, at 6.9 per 1,000 live births. “at was shocking to me,” Youngstown UMADAOP Executive Director Darryl Alexander says. “It was just disturbing.” e United States has a national average infant mortality rate that lags behind 27 other wealthy countries, including Sweden, Czech Republic and Slovakia, according to the Centers for Disease Control. Nationwide, babies of non-Hispanic black origin faced the highest rate of infant mortality.

When it comes to the infant mortality rate of African American babies, Ohio ranks as the third worst in the nation.is statistic comes from the most recent data available in the Centers for Disease Control National Vital Statistics Report. e infant mortality rate for non-Hispanic black babies (13.6 per 1,000 live births) stands at nearly double that of non-Hispanic white babies (6.3 per 1,000 live births), according to the Kaiser Family Foundation.

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HEALTH DISPARITIES A variety of factors contribute to Ohio’s signi cant infant mortality rate.e Ohio Department of Health examined the infant mortality rate between 2009 and 2013.e biggest factor driving Ohio’s infant mortality rate during that time period was premature births, which contributed to 46.7 percent of infant mortality. Another set of causes related to Ohio infant mortality were sleep related causes, such as Sudden Infant Death Syndrome (SIDS), asphyxia, or undetermined causes, which contributed to 16.2 percent of infant deaths. Smoking also likely stood as a contributing factor to some of the aforementioned categories, including 23 to 24 percent of SIDS deaths, the report indicated. While health disparities exist in rates of infant mortality, Alexander says greater health disparities also exist in other areas of wellness measurement. People of color tend to experience higher rates of asthma, prostate cancer, and other issues, Alexander says. While people of all races experience health problems, some problems are more concentrated in populations of color. “ey’re dying at an earlier age,” Alexander says. “So these are health issues that are unique in terms of their intensity for people of color.”is underscores a great opportunity and a great need for prevention tactics, Alexander notes. “If we invest early, I think we will save lives in the future, and also reduce some of our healthcare costs,” Alexander says. UMADAOP RESPONSE From its foundation in 1980, UMADAOP has worked with urban minorities, according to the Akron UMADAOP’s website. “We’re part of the community,” Alexander says. Alexander says UMADAOP is positioned to help heal communities, and works to provide culturally competent services to its clients. A culturally competent treatment environment is one in which clients feel welcomed. “It’s almost like home,” Alexander says. “You don’t have any hesitancy. No barriers are there.” One way to increase culturally competent services is to increase the racial, ethnic, and gender identi cation diversity of service providers, Alexander says. According to the United States Census Bureau, in 2010, 45.2 percent of the Youngstown City population surveyed identi ed as Black, or African American alone. Additionally, 9.3 percent surveyed identi ed as Hispanic or Latino. Part of the work UMADAOP does relates to prioritizing policies which address the needs of urban minorities. “We have a lot of work to do in order to get quality outcomes in a variety of areas,” Alexander says. “I think there is a need for a lot of progress.” “We’re part of the community.” -Darryl Alexander 29

After school program helps at-risk kids get ahead 21st Century

“For elementary, homework completion is key,” McIntyre says. “If they’re turning in homework and doing it correctly, then it follows they’re going to do well on their tests, and their grades will go up.” The Elementary School 21st Century Community Learning Centers exist in communities with poverty rates exceeding 95 percent. In addition to academic support, the 21st Century Community Learning Center provides youth leadership development programs, career/college readiness, and recreational activities, such as field trips, McIntyre says. The program also works to engage parents.

Four days each week, around 30 elementary school students gather after school to continue doing what they’ve done all day — learn. The Youngstown UMADAOP is one of many schools across the nation that operate 21st Century Community Learning Centers. After School Program Director Beth McIntyre oversees two elementary school sites under the 21st Century Learning Center program. According to the U.S. Department of Education, the 21st Century program is designed to create spaces for children to learn outside of school hours; the program specifically targets high-poverty and low-performing schools. Kids arrive after school and typically begin by enjoying a snack or meal, McIntyre notes. Then, the elementary school kids devote one hour to their homework.

Learning made fun The 21st Century Community Learning Center seeks to enroll kids who have grades below a “C,” who have had difficulty passing state testing, or have other at-risk factors, such as a short attention span, McIntyre says. The program works to make learning fun. McIntyre says the students are fortunate that the elementary school kids are permitted to use the laptop cart. Students also have access to the computer lab. The learning center attempts to incorporate technology when possible, McIntyre explains. “We try to avoid doing worksheets,” McIntyre says, instead, the center focuses on fun learning games. Students play games that also enforce learning to keep them interested, McIntyre says. The program monitors the grades of students in the program. The center monitors both language arts and math grades; all sites saw grade increases of at least 12 percentage points by the end of January this year.

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School administration tracks the grades of all students enrolled in the 21st Century Community Learning Center program. After School Program Director Beth McIntyre supervises learning centers at two elementary schools, Martin Luther King Jr. Elementary, and Williamson Elementary Schools. Within the first few months of this school year, the number of students passing each subject area with a “C” grade or better has seen the following improvements:

% Passing with a “C” or better

% Passing with a “C” or better by January, 2016

33% 51%

33% 66%

Math

64% 76%

69% 83%

Language Arts

Williamson Elementary

M.L.K. Jr. Elementary

Creative funding In addition to focusing on improving academics, the 21st Century Community Learning Centers also work to provide nutritious meals to families when possible. “This is necessary,” McIntyre says. “Because sometimes you don’t know a family’s situation.” The section of the 21st Century Community Learning Center program that focuses on kids in grades 3-6 receives funding from a Community Development Block Grant, as well as other funding sources. The 21st Century program also offers a parallel program for kids in grades 6-8. While in its origin, this portion of the program for older kids was supported by a federal grant of $200,000 per year, funding from this grant tapered off in the last two years. McIntyre says she works to receive support from the community. When McIntyre hosts families, she uses caterers that typically discount their costs as a way of supporting the program and meeting the needs of the families. With these funds, McIntyre says she’s able to serve parents a nutritious dinner, such as chicken and salad. “ For elementary, homework completion is key. ”

When her program wasn’t able to have a space in the school gym due to after school sporting events, McIntyre says she found a nearby church that allowed students in the program to use their gym once per week. The local church even provided kids transportation to and from the church. “Our expenses were minimal,” McIntyre says. Transportation represents one of the biggest costs for the program. The elementary school students require door-to-door transportation. “Our transportation cost is $100 per day, per bus,” McIntyre says. “And my sites typically have one to two busses.” Staffing represents the other significant expense for the program. McIntyre says the program has partnered with Eastern Gateway Community College to allow students to work as tutors, using federal work study dollars. “That’s wonderful because the student and college are committed to work with the kids. This has resulted in expenses that we did not have to incur,” McIntyre says. McIntyre says she plans to continue the 21st Century Community Learning Center program with different sources of funding when the current grants end.

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-After School Program Director Beth McIntyre

African-Americans, Native Americans and Hispanics. Lee-MChunganji says these groups of people experience oppression, which can involve trauma and not having access to services. The term trauma encompasses more than just a physical injury. Both African-Americans and Native Americans have had their contributions left out of history, Lee-MChunganji says.

The institution of slavery, in relation to how it is collectively remembered and impacted the identity formation of a group of people, can be referred to as cultural trauma, according to Dr. Ronald Eyerman, professor of sociology at Yale University. History is often written from a

Recovering from drug and alcohol addiction encompasses much more than helping someone stop using. Clinical Services Manager Terehasa Lee-MChunganji says the process is like helping people nd their roots. “If your roots don’t go down very deep, and the storm comes, you get knocked down,” Lee-MChunganji says. UMADAOP works specically with urban minorities, including

European perspective, Lee-MChunganji says. “When you give people their history back, what you give them back is their pride and dignity,” Lee-MChunganji says.

“WHEN YOU GIVE PEOPLE THEIR HISTORY BACK, WHAT YOU GIVE THEM BACK IS THEIR PRIDE AND DIGNITY.” -Clinical Services Manager Terehasa Lee-MChunganji

Treating the Traumatized UMADAOP works with clients who have spent time in prison. Some of the clients UMADAOP serves have spent most of their lives in prison. “We really work to reconstruct their thinking and behavior in a way that allows them to be more successful,” Lee-MChunganji says. While UMADAOP strives to help people, Lee-MChunganji says it’s valuable to look at a client’s life within the bigger picture. A client could experience a signicant amount of high quality treatment — but if afterward, a client returns to a toxic environment, the treatment might not be as successful. “Not everyone is going to be fortunate enough to buy a new house in the suburbs,” Lee-MChunganji says.

Lee-MChunganji says UMADAOP helps clients learn survival skills for when obstacles and barriers arise. The 12-step community is an important partner with UMADAOP, Lee-MChunganji says. UMADAOP works to nd culturally inclusive 12-step groups. “They’re part of a group of people that have successfully navigated their way out of criminal behavior,” Lee-MChunganji says. Recovery coaches who work in UMADAOP’s treatment facility are also involved in 12-step meetings. Lee-MChunganji says clients can sometimes be reluctant to attend 12-step meetings because it’s new and there’s also a lot of stigma associated with being an addict.

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UMADAOP BUILDS BONDS THAT FOSTER RECOVERY

“A recovery coach can go with them to introduce them to someone who might be very benecial,” Lee-MChunganji says. The recovery coaches stay with clients until the client is able to build a peer-network for themselves, Lee-MChunganji says.

UMADAOP also refers clients to White Bison meetings, a group centered on addiction recovery specically for Native Americans

“NOT EVERYONE IS GOING TO BE FORTUNATE ENOUGH TO BUY A NEW HOUSE IN THE SUBURBS.” -Terehasa Lee-MChunganji

A recent past Lee-MChunganji notes that some might see slavery as a product of the distant past; something that occurred more than one hundred years ago. But this isn’t the case. “We’re 140 years away from slavery,” Lee-MChunganji says. “Two grandmothers back were slaves.” Lee-MChunganji notes some African-Americans spend time trying to nd their roots. In other words, they want to nd out about their heritage and where their family was distributed in the U.S. upon arrival. “You expect people to be balanced, when they were cut off at the root,” Lee-MChunganji says. Lee-MChunganji says drug treatment in Ohio now has a greater emphasis on treating the mental health of clients. Although, Lee-MChunganji says, a lot of times when patients receive culturally specic treatment, underlying issues of depression and anxiety can go away on their own. “Despite the changes in the state of Ohio, we continue to grow and thrive,” Lee-MChunganji says. “It’s largely due to the commitment to what we do.” In short, Lee-MChunganji says her goal is to help people, individually, and as a community, reach their highest potential and their greatest good. 33

THE LORAIN UMADAOP provides life skills, family

strengthening, violence, alcohol,

tobacco and other drug

prevention services, utilizing

evidenced based curriculums.

UMADAOP o f Lo r a i n , I n c .

UMADAOP of Lorain, Inc

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HELP IS ONE CLICK AWAY

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“I was relieved to hear that addiction was a brain disease that doesn’t discriminate.” - UMADAOP of Cincinnati client Superwomen in Recovery Unique challenges require unique treatment Specialized groups, like UMADAOP of Cincinnati’s women’s recovery group, allow women to address these issues without the burden of additional shame and guilt. It also allows women to receive the supportive help from one another they would not otherwise receive. One UMADAOP of Cincinnati client described her experience, saying, “I was relieved to hear that addiction was a brain disease that doesn’t discriminate. I am a highly successful woman and I felt guilty for being an addict because I didn’t have an excuse for my addiction. I didn’t come from a broken home, I wasn’t molested as a child, I didn’t live in poverty and I wasn’t abandoned by my father or husband.” She reported that shame kept her pretending as if no one had noticed she was an addict, and her guilt kept her out of treatment. She is not alone. When a woman is emotionally and spiritually bankrupt, she feels hopeless and helpless, which is contrary to how women are socialized. Women in America are socialized to be mothers, wives and superwomen, therefore, the aforementioned is out of the question.

The female clients of UMADAOP of Cincinnati are working to restore their families and their lives. UMADAOP of Cincinnati’s women’s recovery group is viewed as a “MUST DO” for the female clients if they are going to maintain sobriety. Nine out of 10 female clients serviced at UMADAOP of Cincinnati are in treatment due to opioid-based drug use.The female experience differs vastly in the drug culture than that of males, therefore the road to recovery is different. Women are usually saddled with a tremendous amount of guilt and shame associated with their addiction.They also deal with enormous loss, such as loss of self-esteem, dignity, children, spouses, employment, housing and self-respect.

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Addiction: superwoman’s kryptonite The superwoman complex can be harmful to women who have never had an addiction, and it can be even more devastating to her sense of self once she begins to use. These women did not just fail themselves, but their children, parents and mate. They often feel as if they have compromised the future of the entire universe and they believe they could never be forgiven. Women often develop symptoms of post-traumatic stress disorder. They become depressed, distressed, numb, they have flashbacks, recurrent nightmares and panic attacks, as well as feelings of hopelessness and helplessness. Addiction affects the brain’s reward circuit, otherwise known as the limbic system. This area of the brain responds to pleasing stimuli by releasing the neurotransmitter, dopamine, which creates feelings of pleasure.

Most drugs of abuse directly or indirectly target the brain’s reward system by flooding the circuit with dopamine. Dopamine neurotransmitters present in regions of the brain and regulate systems that control movement, emotion, motivation and feelings of pleasure. When a person takes an addictive substance, the limbic system releases chemicals that make the user feel good, and once someone develops an addiction, their brain is rewired to use drugs, despite the consequences.

Hope prevails The overwhelming need to use a substance, regardless of the harm it may cause, is due to the changes which have occurred in the brain’s reward system. The number one priority in an addict’s life becomes the addictive substance. When you couple the superwoman complex with an addiction, what you get is a very difficult time trying to arrest the disease. UMADAOP of Cincinnati is fortunate to have skilled staff and supportive sponsors to help address this overwhelming and paralyzing illness.There is hope for the hopeless and UMADAOP of Cincinnati welcomes everyone.

“I am a highly successful woman and I felt guilty for being an addict because I didn’t have an excuse for my addiction.” -UMADAOP of Cincinnati client

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