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08/29/2018 08:30 AMAs someone who makes it her job to assess and address the public health of East Haven, Branford, and North Branford, Barbara Naclerio was tuned in more than most when an outbreak of at least 76 overdoses hit drug users on the New Haven Green in a single, 24-hour period earlier this month.
As a public health educator for East Shore District Health Department (ESDHD) covering approximately 72,000 residents, Barbara is constantly assessing the district-wide community to determine what risks residents face from disease, addiction, environment, mental health, and other issues—and how ESDHD can help.
“Part of our job is always to assess the community and what’s going on,” says Barbara. “So we are hyper-aware of what took place in New Haven, and we’re waiting for the data from the [state] health department and the DEA to come from this to see what we should be looking out for.”
She wants to be able to share with citizens any information she can gather on the synthetic drug known as K2 (sometimes referred to as “synthetic marijuana”) that’s responsible for the New Haven overdoses.
“So now, we should be getting materials to talk about this synthetic marijuana. I know nothing about it, but it’s our job to educate ourselves so we can educate other people,” says Barbara.
In her work, Barbara also knows it’s important to ask the next question, which, in the case, includes “with the way the state is going and the way the states are going with legalizing marijuana, is this going to be a bigger problem?”
Add that question to the mountain of information and outreach on the many public health topics Barbara gathers to create resources for residents available at www.esdhd.org. She’s also often out and about in all three towns, giving talks on the latest topics.
As part of her work for ESDHD, Barbara is also leading the department’s multi-year effort to earn its first accreditation. The opportunity to receive national public health accreditation has been available for only 10 years or so, and involves peer-reviewed assessments and reams of documentation to determine if a department meets the top standards of its service.
As part of the effort to build ESDHD into one of the state’s top public health departments, Barbara founded the Community Health Improvement Planning (CHIP) board, which includes representatives of public sector and agency programs across all three towns and also includes New Haven agency and health representatives.
When the CHIP board met after the New Haven overdose situation, one issue raised centered around emergency responders’ use of Narcan (naloxone) to revive overdose victims.
“The question was if using Narcan won’t make people feel more free to take these drugs like they did on the New Haven Green,” says Barbara.
As someone who joined ESDHD as a health educator in 2008 after leaving a 17-year career in bio-med research (a wife and mom to three, she went back to school while her kids were young to earn her master’s degree in public health), Barbara took a data-driven approach to find an answer to the CHIP board’s question. She found it in a study from the National Institutes of Health [NIH].
“The NIH study said Narcan saves lives in communities and does not increase the amount of drug use,” says Barbara. “Though, on the flip side, a couple of those people on the New Haven Green had to get resuscitated and went out again and overdosed again. Because I’m not addicted to drugs, I can’t understand the mentality, so I don’t know everything. So I think there is some reasoning behind the question of does it enable people to take risky behavior because they know it’s saving lives.”
Narcan, and how it is used, first became familiar to Barbara through her research on Connecticut’s opioid crisis. Barbara found some unsettling statistics in the district that also led to ESDHD earning some state grants to help combat issues related to opioid abuse.
“We have an area of the state that prescribes a lot of opioids, right here in this district,” she says. “It’s shocking. We’re not Bridgeport, we’re not New London. The challenge we have is helping people find alternatives and getting people to be able to talk about addiction, while also educating the community.
“It’s not the skinny teenager in the corner shooting up,” she continues. “There are functional addicts around you every day, and you have no idea who they are.”
With others on the ESDHD team, Barbara applied for an opioid-crisis grant from the state that has allowed ESDHD to hire a nurse educator. The nurse is versed in the latest information, such as new state laws related to opioid prescriptions, which she then relates to area practitioners, explains Barbara.
“Her full-time job is educating doctors on using the system to report prescriptions they order. But she’s also doing a lot more, like talking to real estate agents,” says Barbara. “Why real estate agents? Because people will go to open houses looking for drugs in the cabinets. There are all these different arms of that problem.”
Barbara is helping ESDHD facilitate action against another arm of the opioid problem, by leading education in the district about Narcan.
“We did a Narcan training session in April,” she says. “We had 24 people show up of different ages, races, and circumstances. We had some seniors who were just curious, and some younger people who may be in a situation where they know somebody [at risk]. They had the ability to get a Narcan kit from us, and the state paid for that. We’re hoping to be able to do that a lot in the area, because it saves lives. And we are public health, and we should be saving lives.”
Risk-Taking
When Barbara gives a talk, she generally starts out with the same message.
“Everybody takes risks, whether it’s driving a little too fast on the highway or eating a donut in the morning,” she says. “But take smart risks. Use the information you know about yourself to do the best that you can to live a healthy life, but also to have a quality of life.”
One information area that she’s especially targeting these days is stress. Barbara says stress in our lives can lead to physical and mental health issues. Unhealthy ways of dealing with stress can be further compounded by escaping with illegal use of drugs and prescription medications.
One way to help is ESDHD’s public campaign for the safe storage of medications and safe disposal of unused and outdated prescriptions.
“All summer, we’ve been at the fairs, and out giving talks, and talking to people about properly disposing of your drugs or locking up your drugs,” says Barbara. “A lot of people get these prescription drugs from neighbors and friends, and that’s how they start. And some can have surgery and be given prescription opioids for their recovery and be hooked—and that’s horrible, because now they’re suddenly in this world where the only way they can get these drugs is illegally or by taking them from friends or family. They’re suddenly seen as a criminal, when what they have is an illness.”
Stigma-Busting
Another important revelation Barbara is working to share with the greater community is the importance of talking about issues of mental health, especially when it comes to recognizing it affects all ages and can start at a very young age.
“Robin Comey of [Branford Early Childhood Collaborative] screened a documentary in Branford in April called Resilience, about adverse childhood experiences causing stress, which can also lead to public health problems. That’s when I first saw the documentary,” says Barbara.
The award-winning documentary delves into the science of adverse childhood experiences (ACEs)—such as abuse, trauma, and neglect—and the “toxic stress” induced that can shorten lives through violence, addiction, and disease.
“I was so moved by this film, I brought it to the CHIP board, because we’re always trying to think of where public health falls in this world, and how can we make a difference,” says Barbara. “Everybody needs to at least see this movie to understand we all have stuff we carry. And people need to get help, and not say, ‘I’m fine.’ It’s that whole stigma of mental health. So one of the things we’re trying to do is reduce the stigma.”
To that end, Barbara is now leading ESDHD’s effort to show the documentary district-wide.
“Within the next six months, we’re going to do showings of the film at libraries in our three towns,” she says.
“We all wear a lot of different hats,” Barbara says of her ESDHD colleagues. “We try to give a lot of help and direction with updates and information on our website, and our other social media. We get a lot of phone calls where we’re the last bastion people are turning to for help. By this time, they’re frustrated, angry or sad. We let them talk about it and we let them know we’ll do what we can to help.
“I’m not ever going to hang up the phone with you without giving you a place to go or helping in some way,” she adds. “That’s kind of our motto here. We try to make sure no one leaves without information, and if we don’t have an answer, we’ll get one for them.”