Introduction

An important part of the overall grant process is the gathering of factual information. Gathering information helps you to understand which grants to pursue in order to fulfill your goals and to know that your applications are as complete and compelling as possible.

In community-based situations, focus groups are a good tool for canvassing a community for information. In this simulation, you will assume the role of a grant writer for Turtle Bend Recovery (TBR), a nonprofit on the Standing Bear Ridge Reservation outside of Riverbend City which focuses on treatment programs.

A recent string of deaths from opioid overdoses has thrown the Standing Bear Ridge Reservation community into crisis mode, and TBR is hoping to pursue grant funding to deal with the crisis.

Briefing Text

Email from Gena Mason

From: Gena Mason, Director, Turtle Bend Recovery

Subject: Opioid Task Force Focus Group

Before we head into tomorrow night’s focus group, I wanted to touch base with you about parameters, what we’re hoping to accomplish, etc. And thanks again for your help with all of this!

This focus group was scheduled by Roger Chaska, the Tribal Chair, at our request; we’ve been pushing for some sort of concerted effort to deal with the opioid problem on the Reservation for a while now, only to run into a lot of inertia. I think Roger’s always been on our side, but he wasn’t able to muster a lot of political action until we had that day three weeks ago with 6 overdoses in one day.

That was terrible, but at least it got things moving for us to face the situation and take action. Roger and I have reached out around the community – both on and off the reservation – to try to bring together people involved in the crisis, so that we can share perspectives, consolidate information, and do all of that “get on the same page” stuff.

What I’d like you to do there is to pay attention, keep your ears open, and do your best to get a sense of what underlying issues you see that we could possibly address with grant funds. And once you see some angles of attack, maybe start thinking about what specific grants you’d pursue and how you might make your case.

I hope this helps- thanks again, and I’ll see you at the meeting tomorrow night!

— Gena

Focus Group

Standing Bear Reservation

Gena Mason

Executive Director, Turtle Bend Recovery

I’d like to thank everybody for coming this evening.

As you can imagine, TBR has been doing our best to deal with the opioid crisis here at Standing Bear Ridge for years. But it has just overwhelmed our ability to keep up. We’re doing the best we can – we’re working at rates that to be honest I don’t think we can sustain – and we’re still not keeping up.

I wanted to start out by sharing some hard statistics with everyone in the room. Last year, we had 817 ambulance runs on the Reservation, with that number spiking in the past couple of years and a growing share dedicated to OD calls. In the past 15 years, we have 53 deaths from OD… that we know about. I think everybody in the room knows that’s probably an underestimate. As for what people have been overdosing on, we’ve seen a mix of misused prescription drugs (OxyContin especially, but also Vicodin and Fentanyl) and, increasingly, street heroin.

TBR has done the best we can in the face of this, but we’ve been a lot more reactive than I like. We haven’t been able to conduct any outreach or coordinate with any other tribal organizations. And we can’t get ahead of this thing – or even catch up to it – if we don’t.

Frank Stevenson

Chief, Standing Bear Ridge Tribal Police Force

This breaks my heart. This breaks all of our hearts.

Everyone on the force, we just hate all the calls we’ve been getting. This is a small community. These aren’t strangers we’re getting OD calls about, these are our neighbors, our friends, our family members. There’s nothing in the world worse than getting a call, getting there before the ambulance, and not being able to do anything until the EMTs get there.

We started the year with a handful of Naloxone kits that we sent out with some squads. Naloxone, it’s an antidote, you can give it to someone who’s ODing and it can save ’em. We burned through those kits inside the first month, though. And some of my guys, they were nervous using them even when we had them. There’s two types of those kits, one you inject into a muscle and one you spray up the nose. Nobody on the force felt too comfortable with the injection kits.

In a better world, I’d like to be able to do more about this than react to calls. But it’s a heck of a thing to start up against. We can try to crack down, especially on heroin making its way to the Reservation. But Standing Bear Ridge is a mighty big place and I’ve got a small force and we can’t be everywhere all the time. And anyway, Riverbend City’s not too far away, and there’s not much we can do about people heading down there. I don’t know. If I could figure out how to stop a drug crisis just with enforcement efforts, I’d be the first one to do it and they’d have a big parade for me.

Edward Noah

Director, Standing Bear Ridge Tribal Clinic

At the clinic, we’ve been at ground zero for this epidemic. Actually, we get it on two sides — people OD and an ambulance gets sent out, they come to us and we help them. But way upstream, we also get people coming in trying to get prescriptions or samples out of their doctors.

I… look. I feel like some of this started at the clinic. In health care, we heard a lot for years about how important pain management was. There was all this talk about pain as one of the main vital signs we had to keep an eye on. And at the same time, we were getting the hard sell from pharma companies, they had this pill or that pill that were just wonder drugs for managing pain, here are some samples, see what they do. And I know that folks here at Standing Bear have it mighty hard, lots of the work that people have really takes a toll on your body, leaves you with a lot of chronic aches and pains.

I like to think we’re getting somewhere with fixing this. It’s a top priority at the clinic to get all of our staff to take a harder line on prescribing opioids. I guess part of my problem is figuring out how to turn that top priority into action. I can only stand up and lecture people at staff meetings so often.

I also know that we need to get Naloxone kits to people faster. We need them in the Tribal police squad cars, and we ESPECIALLY need them in the ambulances. Reliably. We need the EMTs in the ambulance to be trained in on how to use them. Just knowing for sure that there was a nasal-spray Naloxone kit in every ambulance, that’d save a bunch of lives every year.

Roger Chaska

Tribal Chair, Standing Bear Ridge Reservation

First off, I’d also like to thank everyone for coming.

I think we can all agree that something needs to be done. I’d be surprised if there was anyone in this room who didn’t have someone close to them who has been touched by this problem. We’ve talked a lot about deaths and ODs. That spike in deaths a couple of weeks ago really got everyone’s attention. And god knows that we need to reduce those. But I also think we need to keep in mind that the crisis goes a lot further than overdoses. We’ve got, I don’t think anyone knows the exact number, but hundreds of people on the reservation whose life is severely disrupted by their need to figure out where the next fix comes from. We’ve had petty crime rates rising like flood water for the past few years as more and more people get desperate for money for pills. Or heroin.

I guess what I’m saying here is that yeah, we absolutely have to do something about overdose victims, because that’s going to save lives. But we also need to do something to stop overdoses from happening. And we need to do something to stop people from picking this crap up to begin with, because lives are getting wrecked way before people get to the overdose stage.

Sherman Morrison

County Attorney

I’d like to thank you all for inviting me to this meeting. I may not live on the reservation, but I feel like a part of the Standing Bear Ridge community, and I certainly would like to work with everyone on a way to mitigate this crisis.

Much like the medical, treatment, and law-enforcement resources here in Standing Bear Ridge, my office has been completely swamped by opioid-related problems. Directly-related drug offenses, of course, but also a big old pile of secondary crimes. And of course, since we’re countywide, it’s not just Standing Bear Ridge- we’ve got the same thing going on in Riverbend City and Brown Trout Bay.

I’m spending a lot of time arguing for more resources for my office. I know that you hear a lot of theorizing about alternative approaches that we can try, new ways to treat addiction, yada yada yada. But I’ve been a prosecutor for a long time, and I can tell you that only one thing works: aggressive prosecution. Maybe not on demand side, although I think there’s a deterrent value there, too. But heavy, aggressive prosecution on the supply side. If people know they’re going to get the book thrown at them, maybe even get assets seized, they’ll think twice about sneaking some Fentanyl out of the clinic to sell it.

I know it’s a hard thing. But sometimes the hard thing winds up being the right thing. The law’s the law, and it’s here to protect us.

Jane Loudsinger

Tribal Elder

Like everyone else, I’d like to thank Roger for getting this group together.

And also like everyone else, I have lots of stories from what this stuff has done to people I know. Stories that’ll break your heart. We’ve all known people in the past who drank too much and ruined their lives. And those are terrible stories, but I think maybe these are worse.

There’s my nephew down in Rock Creek. He was 17 when he overdosed and spent six hours unconscious on the floor. The circulation got cut off to his legs and there was nerve damage. We don’t know if he’ll ever be able to walk.

Or the little girl who lives a couple of houses down who was playing at a table where her mom was grinding up pills, and wound up getting Fentanyl powder on her hands. That stuff can go through the skin, and she was legally dead for a couple of minutes before the EMTs brought her back. Thank god they had Naloxone, and thank god they knew how to use it.

I’ve seen all kinds of hard times here at Standing Bear Ridge, but I’ve never seen anything like this. I do know one thing. Communities fight things like this best when they work together. More people die if they’re afraid to call for help because they might get arrested.

Rose Perkins

Concerned Mother

I wanted to be here to tell the story of how my family got sucked into this. I know everybody here knows people who’ve been affected. But still. I figure it always helps to put a face on things.

My daughter Heather, she’s a good girl, she’s always had a real tight focus on doing well in school and going to college. She did well in classwork, but I also encouraged her to go out for sports to help her chances. So she went out for basketball and I was really happy.

Last fall, it was the middle of the season, and she got bumped while she was up in the air shooting, and she came down hard on her knee and wrecked it. They had to take her down to the big hospital in Riverbend City to fix it up. While she was down there, they gave her OxyContin for pain.

And I think everybody here knows where the story goes from there. She stuck with that prescription while she rehabbed her knee. Then that prescription ran out. Before too long, I get called into the school, and the Principal tells me that Heather got caught buying pills in the girl’s bathroom.

Since then, it’s just been awful. We try to detox her — god knows she wants to — but it doesn’t stick. Her grades are shot, her whole life is shot. I don’t know what we’re going to do or how we’re going to put our lives back together.

Thank you for listening.

Michael Fox

Tribal Court Judge

I am as frustrated and heartbroken as everyone else. And like a lot of you, I can say that I’m just organizationally overwhelmed. Our court system here on Standing Bear Ridge is absolutely clogged with these cases. Possession cases, distribution cases, other crimes people are doing to support their habits, turf wars over sales territory, it all goes through my courtroom and it crowds out our ability to deal with anything else. And it isn’t like we had a lot of capacity to deal with things before this.

I’ll say this. I’m getting less and less convinced that this is a problem that we can prosecute away. Especially going after demand— the whole problem with addiction is that it makes you act in irrational ways, so it’s not like fear of prosecution is any kind of rational deterrent to people once they’re hooked. I don’t know. I’d love to look into an approach that’s more oriented towards harm reduction, maybe in partnership with some agencies here on the reservation. But I don’t know exactly what that approach would look like, or even how much flexibility we’d have as an office to pursue something like that.

Barbara Longley

Human Services Director

Everyone has really helpful information and perspectives, but I think what we need to do is focus. We absolutely cannot do every possible thing that seems like it might be helpful. I wish we could. But we don’t have enough resources as it is.

People say that we need to look at the wider circumstances that make addiction a problem. That’s right, of course, but that’s such a bigger thing than we can handle even if we all work together. That’s asking us to fix centuries of injustice. And we all know that this opioid problem is trouble in lots of other places off of the reservation, too.

I try to be a practical person. I have to be. I think the question we have to be asking ourselves is, “What have we talked about tonight that could start saving lives in a day? In a week? In a month?” I mean, that’s our goal, right? To find practical things that save lives.

That’s my perspective, anyway. I’ve learned it the hard way from years of trying to help people. You look for ways you can actually do something, not at all the things you just wish you could change.