health

Kids with mental health challenges eventually grow up and become adults. So how do caregivers and communities help them as they make this major transition? And, since many psychological conditions begin in early adulthood– how can parents, friends and even, colleges, help them understand and learn to manage their own mental health?

•••

IN-STUDIO GUESTS: Joining us from Alaska's mental healthcare community we have two guests in the studio with host, Shana Sheehy.

• Barry Andres is a Licensed Clinical Social Worker and Clinical Manager of the Child and Adolescent Outpatient Department at Anchorage Community Mental Health Services where one division, theTransitional Aged Youth Program, helps young people move from one form of care to another.

• Georgia DeKeyser is a Psychiatric Nurse Practitioner and the Associate Director of the University of Alaska Anchorage Student Health and Counseling Center. 

LINKS FROM THIS PROGRAM:

• Anchorage Community Mental Health Services - Transitional Aged Youth Program
• UAA Student Health & Counseling Center 
• National Network on Youth Transition
• "Helping Youth with Mental Health Needs Avoid Transition Cliffs: Lessons from Pioneering Transition Programs"
• National Collaborative Workforce & Development - Youth
• UAA Student Survey on Drug & Alcohol Use (opens as PDF)
• State of Alaska Division of Behavioral Health 
• State of Alaska Mental Health Resource Guide (opens as PDF)
• American Academy of Child & Adolescent Psychiatry

WHERE TO FIND HELP:

• Statewide Careline Crisis Intervention 24 hour hotline
• Anchorage Area Mental Health Service Providers
• Juneau Mental Health Directory
• Statewide Mental Health Facility Search
• Statewide Substance Abuse Treatment Facility Search

FEATURED STORIES:

- Parents Talk About Change - We asked a few parents how they deal with transition; we've gathered their answers into a collection of community voices.

- Covenant House Helping Youth in Transition - Young adults who experience mental illness are more likely to be homeless at some point.Covenant House Alaska serves homeless youth through age 20; about 40% of the youth they serve have been in residential treatment for behavioral and mental health issues. Twice as many qualify as beneficiaries of the Alaska Mental Trust Authority, meaning they have a substance abuse problem, mental health issue, traumatic brain injury and/or a developmental disability. Our contributor Jessica Cochran visited Covenant House to learn how the organization helps serve those youth.

- UAA's "AN-CAP" Program Attracts Alaska Native Providers -One new program at the University of Alaska is aimed at increasing the number of “home-grown” mental health care providers in rural Alaska - to help people of all ages. The program is called the AN-CAP program; that stands for Alaska Native Community Advancement in Psychology. It’s a re-tooling of the previous Alaska Native Psychology Program. Contributor Jessica Cochran spoke with Professor EJ David and student Tina Woods to learn more about it.

This series is supported by funds from the Alaska Mental Health Trust Authority and is a copyrighted production of the Content Producers Guild.

Listen to the whole series here.

Report no. 12: Growing Up Around Alcohol Abuse

Reporting from: Kotzebue, AK (pop. 3,294)

HOST INTRO: Rates of alcohol abuse in Alaska are some of the highest in the nation and communities across the state regularly suffer from domestic violence, abuse, suicide and other related issues because of it. This is the final installment of the special reporting series, “Being Young In Rural Alaska” from the producers of Kids These Days.

Traveling and reporting in rural Alaska, it’s impossible to miss the signs of alcohol abuse, and yet people often don’t talk about it: it’s such a part of life that it’s almost taken for granted. So what’s it like to be a kid growing up around heavy alcohol use in small-town Alaska? Sarah Gonzales heads to Kotzebue to find out.

Kotzebue is located just north of the Arctic Circle. The community recently voted to have a liquor store in town - the first in a generation. 

SARAH GONZALES: Teens in the youth leader program in Kotzebue have some strong opinions about alcohol: 

[Teen voices montage] “I grew up here seeing people drink I’ve heard stories of people dying from overdrinking and I’ve seen what drinking can do to a person and I don’t like it… It hurts the family, too…Drinking can affect the family emotionally, physically and mentally…Fighting and don’t remember the family times and stuff like that…The alcohol and the abuse that I don’t like about this town…” 

Teen Leaders in Kotzebue.

They are outspoken among their peers on the issues of drinking, smoking, using drugs - trying to both educate and set a good example for younger students.  They’ve grown up surrounded by a lot of alcohol: 

[Teen voices montage cont…] “I’ve seen my mom and relatives drinking…My dad and uncle and them and I’ve seen the way they act and I don’t wanna act like they did…After they’ve been drinking how they were, their behavior and in the morning they’d be grouchy and I don’t wanna be like that…It really saddens me to see the people – MY people I grew up with – acting like that….It makes me feel like I’m the adult and they’re the children.” 

Meritha Cappelle is now a young adult in her 20’s. She grew up Kiana, a small village outside Kotzebue; she’s now an administrator within the borough. 

[Meritha Capelle] “A lot! There was a lot of drinking growing up. I mean, it was just the social norm.” 

Capelle says that for her growing up in a place where alcohol was restricted, where people struggled with alcoholism, made it difficult to form any sort of so-called “normal” view of drinking. 

[Capelle] “I would say it wasn’t until I left Alaska that I realized, ‘Oh they have liquor on the shelves here,’ it wasn’t locked up in a whole separate store. There was a different way to drink responsibly or even a healthy way to drink, you know, to be able to stop at a drink or two rather than finishing a bottle in fifteen minutes.” 

Kotzebue voted three years ago to allow alcohol and two years ago the package store and distribution center opened in town. Purchasing liquor is legal in limited quantities and only after paying the city for a permit and a background check.  The system brings in revenue for the city, and allows for pretty strict regulation.  That’s won the support of many community members, including law enforcement. Police Chief Craig Moates says the opening of the store hasn’t made much of an impact on the number of alcohol-related calls that they respond to. 

[Chief Moates] “We respond to a number of calls ranging from theft to assaults. (Sarah: Do you have any way of knowing if the assaults or anything else are related to alcohol?) Well, generically here we say it’s the anomaly when the calls aren’t alcohol-related.”

The "liquor store" in Kotzebue is adjacent to the police station.  

Those who want to get drunk will find a way to get their booze one way or another – bootlegging, homebrew, at a store - which is why some think that teaching youth how to have a healthier relationship with alcohol through moderation could be a more valuable message than the total abstinence one.

Scotty Barr grew up in Kotzebue, he’s now a health educator with Akeela: 

[Scotty Barr] “If we can as parents teach them to stay healthy and not scare them off – you know, alcohol is bad for you, tobacco is bad for you – it’s like you’re fueling them and they say, you know, I’m gonna try this.”

A truck hauling a liquor shipment from airport to package store. Those with a permit are allowed 1 liter of hard liquor, 2 liters of wine and 1 gallon of beer per day.  

But, there’s enough stigma about alcohol abuse, that many moderate users don’t want to engage in any sort of public, alcohol-related behavior says Meritha, like buying a bottle of wine at the local package store... 

[Capelle] “I won’t go there, you know, and that’s the thing – it’s not that I won’t have a drink but I won’t go there…there’s definitely a stigma.”

(From Left) Reporter Sarah Gonzales, Merithe Capelle & reporter Anne Hillman in Kotzebue. 

And while so many people still struggle with alcohol abuse, that stigma may remain. Maniilaq Association is trying new methods in its treatment and recovery programs to try to bring those numbers down.  

Bree Swanson is the Administrator for Social Services there. She says it used to be that the way those services were offered wasn’t successful – helping people get better away from their families and villages meant they often returned to the same harmful environment from before; recovery support groups were often canceled due to lack of participation. Turning that around all came down to dependable facilitators, establishing trust and implementing Inupiaq values. 

[Swanson] “We started out with nobody showing up and now we have 24 in a group, so we had to add more hours just recently.” 

Swanson says their training of Village-Based Counselors helps people where they live - and Maniilaq's starting to implement telemedicine capabilities, too - so providers in the hub of Kotzebue can remotely connect to outlying clients in the villages. 

But turning a life around from alcohol abuse isn’t just quitting the drink, she says, it’s about having work, feeling useful, being surrounded by supportive family and friends, managing everyday stressors. It's really about getting the entire community well. 

[Swanson] “You know you go back into the same community with the same people doing the same things and it’s really easy to get pulled back into that same cycle.” 

Breaking the cycle is a frequent topic of conversation among the teen youth leaders and their advisor, Michelle Woods, is no-nonsense when it comes to discussing this topic with them. 

[Woods] “If you’re gonna stay in the village then you make it a good village. If you don’t like the fact that you can’t walk down the street because you got a bunch of drunks being ass****s then YOU change it and you change it now by your attitude and by what you say to the little kids.”

Straight-talking Teen Leaders advisor, Michelle Woods

And the young people want that change. Fifteen-year old Lorena Gephardt wants to go away to college to become a pharmacist and then come back to Kotzebue to live, work and raise her own family. She hopes to do all that in a healthier environment. 

[Gephardt] “With that stuff gone – no more drunks, no more smoking or just a healthier diet – could really make a difference in this community. (Sarah: Do you think you guys can help that happen?) I DO think that because WE are the next generation, we’re the VOICES and we DO make an impact.” 

And they most likely will - if they receive the support they need to make those healthier decisions - for themselves, their families and the community as a whole. 

Reporting from Kotzebue, I’m Sarah Gonzales.

The "Being Young in Rural Alaska" reporting series airs statewide Mondays on Alaska News Nightly at 5pm or 6pm depending on your location. Go here to find your APRN station & schedule.

This series is supported by funds from the Association of Alaska School Boards' Initiative for Community Engagement program.

Report no. 8: Efforts to prevent tobacco use among rural Alaskan youth. 

Reporting from: Kotzebue and St. Mary's, Alaska

HOST INTRO: Statewide, Alaska’s tobacco use rate hovers around 20%; it’s gone down significantly over the last decade or so, and is only slightly above the national average. But among Alaska Natives the rate is much higher – in some places, more than double - and often kids begin using tobacco at young ages. Jessica Cochran has more, in the next installment of our series “Being Young in Rural Alaska” from the producers of Kids These Days.

Posted outside the Maniilaq Health Center in Kotzebue, Alaska

JESSICA COCHRAN: Samantha Lindeman began smoking when she was seven; she grew up in Quinhagak in Southwest Alaska.

[Samantha Lindeman] "My mom kind of smoked, she’d go on and off, but everyone else around me in town smoked. And it was a small town, thirty people."

JC: Not that the adults condoned the kids using tobacco.

[Lindeman] "We’d go to the store and get candy and have someone else get us cigarettes, and then we’d have to wait hours before we could go home. So that was never fun having to wait, especially in the rain." 

JC: They’d wait until they no longer smelled like smoke. At some points, Lindeman craved cigarettes so much, it was all-consuming.

[Lindeman] "It’s just like taking care of an infant to me; that’s how it feels."

JC: Bethel Alternative Boarding School helped Lindeman quit; they require students to stop smoking and keep pretty close tabs on them. Having a son clinched the deal: diapers and formula are expensive in Bethel. People around Lindeman still smoke, and the temptation is always there, but she’s determined not to start again.

• LEARN MORE! State of Alaska Tobacco use statistics

Much of the tobacco use in rural Alaska isn’t smoking: it’s chewing tobacco, snuff, or an extra-potent homemade blend of tobacco and punk ash fungus called iqmik, or blackbull. It’s a little easier to hide chewing than smoking– except at your dental check-up. In Saint Mary’s, dental health aide Bernadette Charles has seen signs of kids as young as 8-years old chewing tobacco products.

[Bernadette Charles] "Most times they say no, no they don’t, but you can notice how that tobacco pouch is in the mouth, it’s been there for quite some time. It’ll have some sloughed up tissue or be red and wrinkly."

JC: Charles says patients argue that they have relatives who have used it for years, with no problems; but she tries to remind them tobacco use is linked to many forms of cancer – and cancer is the leading cause of death for Alaska Natives in the region.

Laura Ellsworth is manager for the nicotine control and research program at Yukon-Kuskokwim Health Corporation. The program used to focus primarily on helping people quit, but she’s trying widen that effort to include more education and prevention efforts across the region. Tobacco use hasn’t been at the forefront of community conversations, maybe because, as Ellsworth says, it doesn’t fit with the culture to judge others, to tell them how they should live. She’s trying to break through that barrier.

[Laura Ellsworth] "I like to get local community members, people who have lived here a long time, who are Alaska Native to bring that message back to their peer group. So to say, I am Alaska Native, I value our culture very highly. Here are some things I know about tobacco, these are the reasons I don’t use it, these are the reasons I quit."

• LEARN MORE! Laura Ellsworth’s You Tube video on why she works to reduce nicotine use.

JC: In Kotzebue, a group of teen leaders have taken on tobacco use as one of their main causes. They’ve focused on enforcing the no-smoking- or-chewing rules at school – and teaching younger kids about the health risks, and general yuckiness of tobacco use. Fourteen-year old Nyla Ivanoff:

[Nyla Ivanoff] "Like this morning, I saw somebody spit on the gym floor. And the gym floor is new. Smoking is not only bad for the air but for the communities, for the families."

Youth Leaders Nyla Ivanoff (L), Levi Foster and Lorena Gephardt teach other kids about making healthy choices, not smoking...

JC: Members of the group have performed plays for younger kids, trying to spread the message. Michelle Woods of Maniilaq Association says kids need to get these prevention messages at school, because they don’t always get them at home: parents didn’t grow up with anti-tobacco messages and some don’t understand the health risks to their kids. 

[Michelle Woods] "We’ve had reports back that parents will use chew tobacco as a reward for good behavior; if a toddler is crying, they’ll use it and put it in their gums to calm them."

Maniilaq Health Center in Kotzebue, Alaska

JC: Iqmik has come to be associated with Alaska Native traditions; one study showed people who use it are more likely to participate in subsistence activities, to be actively engaged in their Alaska Native culture. But as anti-tobacco advocates see it, since tobacco was introduced to Alaska Natives by westerners, none of its forms are truly traditional. Elmer Howarth Junior is a tobacco cessation counselor for Maniilaq. 

[Elmer Howarth Junior] "It isn’t in our culture but it kind of got adopted in, you know you go hunting you see your dad chew or smoke a cigarette and you start too. So we’re trying to break that tradition - that non-tradition - and restore who we are as Alaska Natives."

• LEARN MORE! Anchorage Daily News article on Iqmik

JC: It’s a message he hopes will catch on. Two-thirds of underage users report they get their tobacco from others in the community.  So successfully reducing tobacco use isn’t just about individual habits, it’s about addressing the social norms of entire communities.

With help from Sarah Gonzales and Anne Hillman, I’m Jessica Cochran.

The "Being Young in Rural Alaska" reporting series airs statewide Mondays on Alaska News Nightly at 5pm or 6pm depending on your location. Go here to find your APRN station & schedule.

This series is supported by funds from the Association of Alaska School Boards' Initiative for Community Engagement program.

COULD LAUGHTER REALLY be the best medicine? To find out how laughter and positive emotions can effect the body and mind, we spoke with one of the leading researchers on humor in the medical community who is quite serious when it comes to laughter.

Dr. Lee Berk spoke with KTD producer Sarah Gonzales from his office at Loma Linda University School of Medicine.

Students in Chugiak ProStart class prepare Alaska grown produce for students to sample

IN DISCUSSIONS ABOUT childhood obesity, sooner or later, the topic of school lunches seems to come up. School lunches are designed to meet federal nutrition guidelines, but plenty of parents consider them far from healthy. Lots of the ingredients are shipped, pre-processed, from the Lower 48. Across the state, efforts are underway to try to get more fresh, local food incorporated into school lunches – to up the health value, the taste – and the market for local food producers.

KTD contributor Jessica Cochran has more.

Links from this story:

• Alaska’s farm-to-school strategic plan 
• School District Caught Between What's Good, What Kids Will Eat (Julia O'Malley, ADN.com)
• KCAW-Sitka radio story on local fish
• Sitka fish in schools website

Image via HealthyFuturesAK.org

YOUR KIDS MAY have brought home exercise logs at some point during this last school year - students from all over the state were recording how much exercise they got each week and then turning in their progress in exchange for prizes. It's all part of the Healthy Futures Alaska program and although the school year is wrapping up, we found out that they are keeping up the activities all summer long (see their community events here).

KTD Producer Sarah Gonzales spoke with the Healthy Futures Program Director, Cindy Norquest to find out how Alaskan kids can stay active all summer long...

Child obesity is a heavy problem in the country and  our state is no different - one in three children in Alaska enter kindergarten overweight. Kids who are fat can have serious, even fatal, health conditions, they get picked on and they don't feel good about themselves. Sick and teased with low self-esteem - that's no way to be young! That's why this time we're talking about preventing childhood obesity and overweight, plus we'll look at eating healthy in the bush and staying active throughout the year.

IN-STUDIO GUESTS: Joining host Shana Sheehy in the studio are two guests this time. 

• Dr. Gary Ferguson serves as the Director of Wellness and Prevention at the Alaska Native Tribal Health Consortium (ANTHC). He also is a staff doctor at Avante Medical Center. He obtained his doctorate in Naturopathic Medicine in 2001, and has been working in the Alaska Tribal Health System for the past 11 years.

• Karol Fink is the program manager for the State of Alaska Obesity Prevention and Control Program. She has been a Registered Dietitian for almost 20 years and has a Master of Science degree in nutritional science from the University of Washington. She started her public health career 16 years ago at Providence Seward Medical Center. 

CHILD OBESITY LINKS:

Alaska-specific resources -

• Alaska Obesity Prevention & Control Program
• ANTHC - Wellness & Prevention
• ANTHC - Nutrition 
• AK Traditional Knowledge & Native Foods Database - find the nutrituional value, calories, in foods native to Alaska
• 'Childhood Obesity: Beyond Baby Fat' (Ak Baby & Child magazine)
• Ak Grower's School (UAF Extension)
• Ak Farm-to-School Strategic Plan
• Sitka's Fish-to-Schools program
• Healthy Futures Alaska
• State of AK P.E. Requirements
• Get Out and Play Every Day (AK Dept. Health & Human Services)

National resources -

• Institute of Medicine's 2011 Child Obesity Report
• American Academy of Pediatricians Child Obesity Prevention Pages
• AAP Obesity Prevention - 'What Families Can Do at Home'
• 10 Tips for Parents for Talking to Kids About Weight (WebMD)
• ChooseMyPlate.gov - USDA's new, daily dietary recommendation that replaces the food pyramid
• CDC's Physical Exercise Recommendations - 60 minutes/day for kids
• Shape of the Nation report - P.E. requirements by state
• Why P.E. is Important infographic
• CDC's ReThink Your Drink Campaign - 1 in 5 calories consumed is from beverages
• Childhood Obesity in the US Map (Save the Chidren)
• HBO mini-series: The Weight of the Nation - the public is invited to a screening on May 23 in Anchorage and June 4 in Juneau, for more information visit Play Everyday. 

Articles/Studies -

• 'Obesity-related Type II Diabetes Harder to Treat in Children' (NY Times)
• 'More Mothers Unaware of Overweight Children' (YNN)
• 'Parents Don't Like to Hear "Fat" From Pediatrician' (Time)
• 'Losing Weight Doesn't Help Teen Girls Love Themselves' (Time)
• 'Why the Campaign to Stop the US Obesity Crisis is Failing' (Newsweek)

FEATURED STORIES: 

- Farm-t0-School Changing Lunchtime in Alaska - School lunches are designed to meet federal nutrition guidelines, but plenty of parents consider them far from healthy. Across the state, efforts are underway to try to get more fresh, local food incorporated into school lunches, increasing the health value, the taste and the market for local food producers. KTD contributor Jessica Cochran has more.

- Healthy Futures Alaska is Active this Summer - Your kids may have brought home their exercise logs at some point during this last school year - it's all part of the Healthy Futures Program and although the school year is wrapping up, we found out that they are keeping up the activities all summer long. KTD Producer Sarah Gonzales spoke with the program director, Cindy Norquest.

- Chef KTD: Lighter Mini-Cheesecakes - We asked our Chef KTD Liz Madsen for a "healthy version" of a kid-friendly dessert recipe and she showed our producer, Sarah Gonzales, how a few key substitutions can make for a healthy mini-cheesecake with berry compote - with less fat and minimally-refined sugars. [Recipe, photos + audio here]

LAST MONTH, NEWS about teens becoming mothers made headlines - the number of teen pregnancies in the United States dropped to a record low for the US. According to a CDC report, teen birth rates for 15 to 17 year olds fell 12% from 2009 to 2010; birth rates for 18 and 19 year olds dropped 9 %, though rates in the US are still significantly higher than in other industrialized countries. 

In Alaska, teen birth rates have been on the decline since the early 1990's, dropping by 42% for younger moms, and 24% for older moms over a 15 year period. Older teens have almost four times as many children as younger teens, and Alaska Native teens have children at about 2.5 times the rate of non-Natives. 

For many of those younger teens who become pregnant, finishing high school is the biggest challenge. In Anchorage, some of them attend Crossroads - a high school just for pregnant and parenting teens. Some of them are also enrolled in Kids Corps Early Head Start program. The program has an in-home program that offers child development information, developmental screening - and just general support to those young moms. 

KTD contributor Jessica Cochran spoke to the woman who does those home visits -- Tundra Paulson.

Links from this story: Alaska Teen Pregnancy Fact Sheet