Jun. 19—JOHNSTOWN, Pa. — Five years ago, Cambria County Drug and Alcohol Program Administrator Fred Oliveros sat down with recovering substance users to identify unmet ways to address the region's drug issues.

Time after time, he heard a similar response.

Each person said that if they'd had the right support to address their own personal issues when they were young, they probably wouldn't have self-medicated with drugs and alcohol to escape those issues, he said.

But as local stakeholders looked across Cambria County at the pool of mental health counselors available to support today's young people, they found waiting lists hundreds of patients long, Oliveros said.

"Those who were in long-term recovery attributed the source of their drug problems to unresolved mental health issues and unaddressed trauma," Oliveros said, "but we realized that, even when kids are seeking help, the opportunities for support just weren't where they should be."

Over the past year, Cambria County has been working to change both trends — using its initial funds received through settlements with opioid companies to hire and place full-time counselors and support teams in schools countywide.

Long-term response

The Cambria County Drug and Alcohol Program rolled out the Cambria County Rise Project during the just-completed school year, assigning master's degree-level mental health counselors to the county's public and private schools.

With its latest hire this month, the program now is set to reach its initial seven-clinician goal — one clinician for every two school districts, Oliveros said.

As designed, each clinician serves as a site supervisor for paid interns from Indiana University of Pennsylvania's master's- and doctoral-level clinical mental health counseling programs, giving them a team of support staff.

The goal is to give teens 14 and older accessible, face-to-face access to counselors with whom they are comfortable when times get tough — and to develop a pipeline of talent in the mental health field who will develop relationships with schools, communities and the county system.

At this point, three interns have been hired for the fall, a number that Oliveros hopes will grow to at least six by fall.

Cambria County partners in the program are also hopeful that some of them will find jobs in the region once they graduate, helping to fill the local shortfall in counselors.

The county's struggle with substance abuse wasn't born overnight, and it'll take long-term approaches to address it, Oliveros said.

"The goal was to focus on sustainable solutions ... that will have an impact over the long term," he said.

Cambria County, which ranked among the state's hardest-hit by the opioid epidemic, is projected to receive more than $12 million over 18 years through a settlement that involved Johnson & Johnson and three major drug distributors, including AmerisourceBergen, Cardinal Health and McKesson.

'Dollars back in the community'

Somerset County is set to receive a total of $2.9 million over 18 years, Somerset Single County Authority Director Erin Howsare said.

Somerset County officials formed an advisory committee in 2022 to talk to those on the drug epidemic's front lines — human services agencies' employees, treatment providers and emergency responders among them — to identify support needs before deciding how to spend their opioid settlement dollars.

Somerset County's commissioners have used some of the county's funds to support reentry program-related mental health services at Somerset County Jail and a separate county program that enables groups to apply for funding assistance to lead drug prevention, education and treatment initiatives, Commissioner Pamela Tokar-Ickes said.

The county turned to its Single County Authority to oversee the funds and the application process, she said.

"This was a chance for us to get these dollars back in the community — not only through county government, but also hospital programs and nonprofit (initiatives)," she said, adding that they've continued to focus on evidence-based strategies.

Howsare said several have already been funded, including a healthy outdoors program for youth, portable life-saving devices — including distribution of the anti-opioid overdose drug naloxone — for Uptown Somerset events, and $5,000 for the Somerset Recovery Walk.

Additional applications are being reviewed this month for likely awards, Howsare added.

Fixing shortfalls

Oliveros recognizes that Cambria County's approach is somewhat different than many county peers, but it has been a goal for years, he said.

Counseling shortfalls were identified in 2018 through a state-required "needs assessment" as part of a broader strategic plan focused on identifying areas in which Cambria County's support system capacity didn't meet local demand for services, Oliveros said.

Relying partly on data from the Pennsylvania Youth Survey and other sources, state drug and alcohol officials, a Penn State University think tank, Cambria County drug and alcohol officials and other Cambria County Drug Coalition members met with focus groups to discuss the results, Oliveros said.

Those groups included Cambria County residents in long-term recovery, school officials, guidance counselors, police chiefs and then-Cambria County District Attorney Kelly Callihan, among others.

"After talking with all of them, one of our goals was to try to increase access and engagement in school-based mental health services," Oliveros said.

Given the caseload volume overwhelming local mental health providers, "it was just a matter of how," he said.

The initial round of settlement dollars "made it easy" to revisit that possibility because community stakeholders already knew it was a serious need, Oliveros said.

Project entering 2nd year

This marks the Cambria County Rise Project's second year in operation.

Initially designed with a $666,710 budget for the 2023-24 school year, the county is partway into a two-year contract with REACH Inc. to provide counseling services to 13 public and two private schools, enabling the agency to oversee staff recruitment and placement through 2024.

According to a funding schedule sent to the county by the state Office of Attorney General, Cambria County was projected to receive a combined $1.3 million from the settlement funds in 2022 and 2023 to reimburse those costs.

A big part of the Rise Project's expenses involves salaries for master's-level clinicians, which were set at $50,752 each as well as benefits, according to Cambria County Drug and Alcohol Program figures.

Health care costs were projected to add another $4,000 for each clinician, while master's-level IUP interns are contracted to earn $15 an hour for their service, Oliveros said. For 600 hours of work, each would earn $9,000 at that rate.

The county purchased screening software to ensure that every student is screened the same way, regardless of who is handling the process or the student's age or district, while also flagging if a student might benefit from other resources.

Efforts are made to place mental health clinicians in schools in which they are good fits and live nearby to make them accessible to students year-round, regardless of weather or whether school is in session, Oliveros added.

"These counselors are seeing students in the cafeterias, engaging with them in the hallways, so they are building relationships with them," he said.

Oliveros said the county still isn't certain what money could be received through separate drug settlements, including a deal with CVS and Walgreens that is currently being finalized, but future funds could enable the county to expand the Rise Project further to add a clinician for each school, rather than split duties, he said.

To Cambria County Drug Coalition project coordinator Natalie Kauffman, it's money well-spent.

Studies have proven that "unresolved childhood trauma" has a devastating effect on people as they transition into adulthood, she said, cutting their lives on average by 20 years and leading to far greater chances of developing substance use disorder and a list of other "preventable diseases" such as obesity, depression and diabetes.

Whether it's sexual, physical or emotional abuse, domestic violence, the loss of a parent or the fallout from living in a household where substance abuse is rampant, it often leaves behind mental or emotional scars that impact a lifetime of decisions if not addressed early, Kauffman said.

"The (Rise Project) is going to give these children across Cambria County the mental health support they need to deal with these experiences," she said. "It's about helping address their pain and turmoil so they don't turn to drugs to cope."

Kauffman understands better than most. She's an abuse survivor who turned to alcohol before facing her issues years ago.

"Fortunately, I had the support system I needed to help me get into therapy ... before things got worse," Kaufman said, "but a program like this would have helped someone like me sooner ... when I was a child."

Today, Kauffman leads a county-wide effort formed by community leaders to battle the drug epidemic through education, treatment, faith-led efforts, prevention programs and law enforcement efforts.

Over the years, they've supported millions of dollars in results-based education designed to reach young people before they experiment with drugs, worked to break down barriers in the path to recovery for current drug users — with or without assistance from medication — and marketed programs in place to enable them to seek help.

Naloxone has been deployed to law enforcement agencies and other groups across the county, while a collaboration with Conemaugh Health System developed a program assisting women who are struggling with drugs while pregnant to get the support that their children need.

Those are all necessary programs, Kauffman said, but the most cost-effective way to battle the problem is by investing in efforts that stop people from ever getting hooked on drugs and alcohol in the first place.

And to do that, mental health must be addressed, she said.

Oliveros said the Rise Project's first year in operation led counselors to screen 240 teens across the county — many of whom already indicated they'd tried drugs or alcohol. A total of 51 told counselors that they've attempted suicide.

Some area schools had already attempted their own efforts to expand counseling services prior to the Rise Project's launch. Through the Rise Project, they no longer have to foot the bill — but still work as partners with the county and REACH Inc. counselors.

Area school leaders praised the move earlier this year.