'It's hard to let go of that': Grand Forks schools to go without addiction counselor

Apr. 20—GRAND FORKS — Cindy McMillan's new office in the back of Prairie Harvest Mental Health is still largely bare, save for some books on a shelf in the corner and the certificate naming her as a state-licensed addiction counselor tacked onto the bottom corner of the corkboard over her desk.

Until recently, McMillan was Grand Forks Public Schools' only addiction counselor — and quite possibly the only addiction counselor operating in a North Dakota K-12 school district.

She left last month after being told her position was

among the dozens expected to be cut next year

as the school district grapples with a projected budget deficit and attempts to boost its depleted operating reserves.

"I'm not angry at all. I get budget cuts," McMillan said. "But I'm just sad, mostly for the kids and how they're going to manage."

Local substance use prevention advocates say Grand Forks has lost a critical and unique foothold in addressing and preventing adolescent substance use disorder.

Grand Forks Public Schools is working to establish a position to take over some part of McMillan's role, and new funding from the state Department of Health and Human Services could offer an avenue to restore counseling services in the future, but McMillan's time with the district is likely finished.

McMillan joined the district as a licensed counselor in 2018. Administrators were concerned about rates of substance use among students, and used federal Title IV funding as well as a Drug-Free Communities grant Altru Health System received to bring on McMillan, who'd been working with adolescents since 1986.

"We had enough evidence ... that there were students showing signs of going down that path," said Catherine Gillach, associate superintendent of secondary education. "So we wanted to give them a resource that could intervene during school day hours, so that they had those services on campus."

Substance use starts young, Gillach notes. A 2014 report from the Substance Abuse and Mental Health Services Administration estimated 74% of those in treatment for substance use disorder began using at or before age 17.

McMillan essentially served a two-pronged role in the district. She lectured on substance use and addiction to health and medical career classes — particularly on vaping, a relatively new phenomenon in 2018 — hosted educational events for families, and worked on other prevention efforts sponsored by the Drug-Free Communities grant, which focused on tobacco, alcohol and marijuana use.

"It's hard for that type of information to set in with young folks," said Haley Thorson, a public health nurse who serves on the Substance Abuse Prevention Council, which McMillan regularly addressed. "It's more effective to have somebody identified inside the school to speak to these issues."

In her other role, funded first by Title IV and then out of several other pots, she also provided counseling services referred to her by teachers, social workers, school resource officers or other district staff — maybe a student who'd been caught vaping in the bathroom.

"I've got some insight into the disease concept, into when the abuse is starting," she said. "That's right where I could grab the kids."

Jeff McKinnon, regional director for the Northeast Human Services Center, said schools are an important part of substance use prevention for youth because it's where students spend most of their days.

Despite that, a 2018 report on North Dakota's behavioral health services found 0.1% of youth substance disorder treatment services were delivered in school settings during the prior year.

McMillan said most times she would only see a student for one session, but she had a few regular clients struggling with substance use who she would see on a more regular basis.

In more serious cases, she could refer students for outpatient treatment, with providers like the Northeast Human Service Center. If they were facing criminal charges, she'd talk with them and sometimes attend juvenile court.

She said a mellow attitude helped her connect with students — some nicknamed her "hippie grandma," she said — and she could relate her own struggles with substance use in her youth, which she's open about.

"I just know where they're at," said McMillan, who cleaned up when she was 20. "I was actually using in middle and high school, so I get it. There are a lot of other things going on."

McMillan estimates she spoke to upwards of 1,800 students for preventive services, and counseled another 400 individually.

Data collected from the Grand Forks Youth Survey, a biennial study of student substance use funded via the Drug-Free Communities grant, show rates of reported substance use dropped during McMillan's time with the district.

According to the 2022 survey, the number of Grand Forks students who reported having one or more alcoholic beverages in the last 30 days dropped from 13.9% in 2018 to 9% in 2022.

Reported rates of marijuana and cigarette use and prescription drug misuse also dropped.

Student vape usage remains a concern, however. The Youth Survey asked students about vape usage for the first time in 2022 and found between 8% and 9% of students reported using a vape in the past 30 days, while 9% reported ever using a vape to smoke marijuana. McMillan observed that vaping marijuana "skyrocketed" during her time in the district.

Older students reported vaping or vaping marijuana at higher rates. Gillach said the Youth Survey will include more questions about vape usage when it is conducted again this spring.

Altogether, though, Gillach said the data bore out the importance of McMillan's role in educating students on and preventing substance use.

"It seems like fewer kids are choosing to use those substances," Gillach said. "So that tells me that her role in that greater puzzle was making a difference."

Gauging the efficacy of McMillan's counseling work is more complex, since information about her clients was largely confidential and, Gillach noted, staying substance-free is a lifelong challenge.

Still, she believes McMillan helped students become more resilient and gave them a safe space to do so.

"I can assure you the work she did directly with students who needed that sort of specific counseling and support made an impact on those individuals," Gillach said. "It's hard to let go of that. It's hard to think that direct service won't be in place."

McMillan's departure means there are fewer resources available in Grand Forks to address substance use in adolescents.

According to a representative from HHS, there are only three treatment programs in the Grand Forks region licensed to provide outpatient substance use disorder treatment to adolescents — one in Grafton and two, Agassiz Associates, PLLC and the Northeast Human Services Center, in Grand Forks.

The Human Services Center, which covers four counties in northeast North Dakota and serves many low-income clients and Medicaid users, has had two open youth addiction counselor positions for months, according to McKinnon. One position has gone unfilled for over a year.

"In my 25 years, this has been the most challenging 18 months to two years regarding recruitment of addiction counselors," McKinnon said.

The agency has been working to recruit more licensed addiction counselors from Minnesota as well as training its current employees to fill those roles.

McKinnon said McMillan will be missed most for the wealth of knowledge she brought to Grand Forks for her decades working with adolescents.

"Cindy has such a long history, all that institutional knowledge about social work services," McKinnon said. "She really was such a go-to person, a point person for so many folks."

McMillan is continuing to work to address substance use in her new position at Prairie Harvest, she said, but her work is focused strictly on adults.

Gillach said substance use prevention efforts continue at Grand Forks Public Schools through health and medical career classes, and said she's asked Thorson to gather resources the district can provide to families to show them how connect with substance use treatment services in lieu of McMillan.

The district is working to create a new position within the district that will take on McMillan's prevention work as well as serve in a leadership role with the SAPC. That position would be entirely funded by the Drug-Free Communities grant.

Gillach said the district also is applying for the latest round of behavioral health grants from HHS and the district's proposal could include a funding request for another licensed addiction counselor.