MUSC student brings new approach to rural opioid crisis

March 30, 2021
studio portrait of a woman
Nikki King has been working on new ways to reach those addicted to opioids in her rural Indiana community, all while earning a DHA at MUSC. Photo provided

When Nikki King graduates from the College of Health Professions at the Medical University of South Carolina this spring and can officially add “doctor” to the front of her name, she’ll already have made a mark on the people of Ripley and Franklin counties in Indiana.

King works as the manager of Behavioral Health and Addiction Services at Margaret Mary Health in Batesville, Indiana, population 6,686. There, she has built an innovative opioid addiction treatment program that accounts for the unique challenges of rural areas. And she’s done it while traveling to Charleston every semester for the in-person element of the Doctor of Health Administration program.

The addiction treatment program features a partnership between the hospital and local courts, probation offices and the Department of Child Services. People who find themselves in trouble are often referred by a judge to participate in the program, which meets for nine hours each week and incorporates court oversight of individuals to include home visits, random drug screens and administrative sanctions and incentives.

Court involvement is critical to the success of the program, King said.

“It's really difficult to maintain people in early recovery and treatment. I think that’s something we’ve run into nationally,” she said. “When you talk about people in early recovery, these are inherently people who are struggling with mental illness. They're not really capable of making good decisions when they’re in that place, so the people who need treatment the most, we tend to lose them repeatedly in that first month without some kind of outside incentive.” 

“It takes creative thinkers like Nikki to bring solutions to make it work.”

Tim Putnam
President & CEO, Margaret Mary Health

Suburban and urban areas circumvent this problem with residential programs and sober houses for people experiencing homelessness, but those resources are less likely to exist in rural areas, she said.

Tim Putnam, DHA, president and CEO of Margaret Mary Health and an MUSC alumni, said biases against people with substance use disorder can prevent health systems from trying new approaches.

“Traditionally, community hospitals don’t touch addictions or mental and behavioral health, let alone reach out to court services,” he said. “Hospitals focus on pneumonia and broken bones, and that’s what they think they’re responsible for. But when you really look at our mission statement, and the mission statement of every community hospital out there – especially the rural hospitals that are the only game in town – it can’t stop there.”

He’s backed King’s innovations, including having the hospital utilize space in the county courthouse – pre-pandemic – so participants could walk directly from court to the program.

“It takes creative thinkers like Nikki to bring solutions to make it work,” he said. Unlike other diseases, there’s no one-size-fits-all approach that they could easily adopt, he said.

Putnam also backed King’s decision to apply to the DHA program. Although she already held a Master of Health Services Administration degree, served on state and national boards focused on rural health and was breaking new ground with the treatment program, if she really wanted to affect policy and funding decisions, then she needed the skills that would come from a doctoral-level program, he said.

Putnam was guiding her from experience. Currently, he chairs both the Indiana Graduate Medical Education Board and National Rural Accountable Care Consortium and serves on the White House COVID-19 Health Equity Task Force.

“I don’t know that I encouraged it so much as I was there when it became self-evident that ‘Dr. King’ needed to come out,” he said.

King joked that she was attracted to the program because she’s a “big research nerd.”

“I really wanted a good excuse to read a lot of articles and think critically about ways to apply them,” she said.

King is exactly the type of person that the DHA program is aimed at, said Jillian Harvey, Ph.D., the program’s director.

“She’s very determined to make changes and improve outcomes for rural populations,” Harvey said.

The program takes 20 to 30 people in each cohort. They’re all working professionals within health care who are interested in change, and the program gives them the applied research skills to explore and identify problems – and to implement evidence-based solutions.

Although there’s plenty of individual work, interacting with the other cohort members is a huge part of the program, Putnam said. 

“So much of the DHA is about the connection to other people who are a little bit dissatisfied with health care delivery and want the system to be better, and that connection comes from really strong opinions, debates, discussion and after-hours sessions,” he said.

As King winds up her time at MUSC, she’s examining the effectiveness of the opioid treatment program for her doctoral project. She’s looking at a variety of factors to see how they correlate to success within the program, examining such markers as insecurity related to food, transportation and housing as well as age, gender and whether there are minor children in the home. She’s also looking at LGBTQ status, as there are more LGTBQ participants than would be expected, based on the numbers within the overall population.

Additionally, King is looking at whether participating in the program helped to rebalance the number of emergency room visits that could have been handled by primary care providers and whether participants were better about staying on psychiatric medication.

The pandemic forced some changes to the program, moving many of the sessions online. That has its pros and cons, King said.

“It's probably a lot less fun. When we’re in person, we can do lots of things. We go on hikes. We go on nature walks. We do art therapy and music therapy. It’s hard to do that stuff online,” she said. “On the other hand, transportation is a traditional bugbear of the rural experience. It never seems to really go away, and so this has helped mitigate a lot of transportation issues. It’s helped mitigate a lot of childcare issues.” 

She expects to move toward a hybrid model as the pandemic eases up.

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