The waiting room is cozy.
There is a smiling receptionist, a desk with stacks of papers and family photos. Homey plants are arranged around the surrounding offices. A small dog named Sampson nuzzles those passing by.
A woman stands just to the right of the intersecting hallway, grazing her hand over the brick walls and voicing her displeasure about them. These walls are the only features in the building that hint at the secrets and memories that have been divulged among the inspirational posters and hand-drawn pictures.
Within these white walls, residents are offered a shot at redemption: a second chance.
Nancy Wilson-Hintz’s holds the title of executive director, but her office is kept simple. Her passions do not lie in extravagance, but rather with NOVA, the non-profit treatment community she works for.
Her window overlooks a stretch of white fence and a small patch of lush trees. Sitting amid the 110-acre Cooper Farm in Omaha, Nebraska, this place is a small patch of green, tucked away among endless rows of cookie-cutter houses.
NOVA was founded in 1984, and Wilson-Hintz has been at the helm since 2012. It’s the only Public Residential Treatment Facility in Nebraska that handles both mental health and substance abuse cases simultaneously, providing help to a population others simply can’t.
Its uncommon status has made it an oasis in a desert of dilapidated health care laws and depleted funding.
As of 2014, according to a report by the Nebraska Center for Rural Health Research, 78 counties in Nebraska displayed an unusually high need for mental health services. Sixty-nine of these counties were either rural or frontier counties. Despite this growing necessity, only three of Nebraska’s 93 counties weren’t state designated as shortage or partial-shortage areas for psychiatry and mental health.
The counties that have escaped the deficiency are largely metropolitan ones, such as Douglas County and Lancaster County, encompassing Nebraska’s two largest cities: Lincoln and Omaha. Those living in other parts of Nebraska, particularly out west, are mostly left ignored.
With the majority of its adolescent patients coming from rural areas, NOVA’s extensive set of services has proven to be the exception, within Nebraska’s treatment of its rural inhabitants.
Monday through Friday, children attend classes starting at 8 a.m. and ending at 2 p.m. The hope is to keep those in treatment caught up with the school they’re missing. The curriculum is flexible, and individual planning is used for each student. The end goal is to help them earn their high school diploma, should they choose to pursue it.
About half of the adolescents also take part in a 4-H program, which is held on a farm adjacent to the facility, in collaboration with Omaha Home For Boys. April 5 marked the start of the program’s fourth year.
Each child is paired with a lamb or calf. He or she grooms it, washes it and eventually shows it in Dodge and Sarpy county.
“It’s something they can be proud of and see from start to finish what their hard work can lead to,” Wilson-Hintz said. “I think it lends itself to the future so they can know when they really do put their mind to something, it can be accomplished.”
Wilson-Hintz said the program tries to use the surrounding nature as much as possible, and that its location lends itself to an experience that isn’t so intimidating.
But the facility’s location in one of Nebraska’s easternmost cities makes it a lengthy drive for many, as is the case with most of Nebraska’s better equipped communities. Proper treatment for those ages 13-18 often requires traveling well beyond one’s own county, sometimes necessitating going across the entire state to find a facility that properly meets each individual’s needs.
“We just got a kid today from Scotts Bluff, and they had to transfer him,” Wilson-Hintz said. “It took nine or 10 hours to get (him) here, and he was transported by security in handcuffs the whole way. The kids who come from rural areas, the services just aren’t in those communities.”
The choice for some rural residents has become a decision between sending their child off alone, up to seven hours away, for proper care, or choosing to fend for themselves in their own area’s depleted healthcare bubble.
And many don’t even get to make that choice. Wilson-Hintz estimated that about nine out every 10 children they treat is coming while on parole, meaning a court order is deciding their fate rather than their family.
Many children come bearing years of trauma, often leading to alcohol or drug abuse as a coping method. Sexual and physical abuse, as well as neglect, are not uncommon criteria for those who enter through NOVA’s door.
“I think it takes a lot of courage for someone to get uprooted, come here, live here for six months and have their whole lifestyle get changed,” Wilson-Hintz said. “For a young person to come into treatment is huge. But we’re here to help them through that process.”
Treatment requires months of therapy and group work to get to the core of each individual’s issues. There is no set formula, no handy “10 guaranteed steps to cracking your substance abuse” guide. Wilson-Hintz said each person responds differently, and that NOVA adapts their procedures to match the individual.
But the distance doesn’t help make the process any easier.
“They’re removed from their family,” Wilson-Hintz said. “So, (even) if their parents are involved, they probably aren’t going to come visit very much. We have to do therapy over the phone or Skype, and that’s hard. It’s much easier to do it face-to-face, in the moment. It’s much more personal, you know? So those children that come from far away, we do what we can to make it work, but we have to get creative.”
For others, the luxury of phone calls and Skype sessions just isn’t available. With a sizeable chasm placed within families already teetering on neglect, and patients receiving treatment hundreds of miles away, sometimes the calls home to mom don’t last long.
“It’s a lot,” Wilson-Hintz said. “A lot of kids get homesick. Sometimes you have kids come in and their families are not engaged. It’s hurtful if a parent says, ‘Yeah, I’ll come visit you,’ and then they don’t show. Here you have a kid who’s trying to get through treatment, (and they) don’t have that outside support.”
It’s a painful, but recurring truth for those taking the leap into rehabilitation. But, Wilson-Hintz said it’s the staff who becomes a family to the patients. NOVA helps residents build their own support system, both within and outside the facility.
“Whether it’s case professionals or trying to help them find an AA sponsor, we try to give them a system for when they leave,” Wilson-Hintz said. “Otherwise they won’t succeed.”
* * *
The sheet is starkly white. There aren’t any frills or intricacies. Its inquiries are simple and straightforward.
The third question asks, “Have you remained free from the use of alcohol and other drugs?”
Each resident receives a copy of this survey 30 days after completing his or her stay at NOVA. For those who have moved on, it’s a chance to reflect on their time spent since discharge.
This piece of paper is the only form of data NOVA is legally allowed to collect. With residents heading back to their homes, often hours away, there simply isn’t enough of a return rate to learn much from. Wilson-Hintz said that the amount of forms they get back varies, but it hangs around the 30 percent mark.
However, even the questionnaires that are returned aren’t of much use.
“(Of) course, most of the ones who send back say ‘yes’ because they’re proud of it,” Wilson-Hintz said. “But not everyone sends back a questionnaire, so it’s hard to gauge from that. (They) really just don’t give the whole picture.”
Wilson-Hintz said she believes a patient’s confidentiality should never be compromised, but wishes in-house research could be done.
The regulations leave facilities in the dark about the effect of their work beyond immediate results. It’s an additional risk factor in a system that is already underserving a large geographic area of the state.
“Everybody’s always trying to figure out a way to stay engaged with folks after they leave so we can find out how long they stay sober and perhaps what their triggers are once they (leave),” Wilson-Hintz said. “It’s really difficult. With the substance abuse laws and HIPAA, the restrictions have just escalated. It does protect that person’s confidentiality. But it does make it hard to gauge how many out there really are sober.”
Because of NOVA’s status as a dual treatment facility, the guidelines it falls under are much broader. Both state and national conduct must be followed. The facility is responsible for keeping up to date with new laws and rules; there’s no government watchdog sending out updates to clinics.
“I definitely understand that if we’re going to get funding from the state (and) from the government, then we better prove to them that we’re doing what we say we’re doing,” Wilson-Hintz said. “I don’t have any problems with that. It makes me proud to know that we’re doing what we’re supposed to be doing. But the guidelines constantly change for each program, so you have to keep abreast of that. People don’t really tell you when they (change), you just have to monitor it on your own.”
Funding put a ceiling on the scope of what the center can achieve. With a finite number of beds and staff members, waitlisting is sometimes necessary. Fourty-eight Nebraska counties in 2014 were already devoid of a mental health practitioner, according to the NCRHR’s report. But NOVA’s ability to service rural adolescents is not a factor when it comes to the money they receive.
“Most of our funding is from the government, and I think the government is aware that there is an issue and a need for our programs,” Wilson-Hintz said. “But what I’d like them to be aware of is that we always need more money. More money (means) that we can serve more children and more adults. There is money blocked out for this particular (service), but we just need more of it.”
Almost 9 percent of children in Nebraska have emotional behavioral health issues, and just over 7 percent have a dependence on alcohol or illicit drugs, per the 2015 Mental Health Associations Parity or Disparity report. Just less than 30 percent of children in need of mental health services didn’t receive any treatment at all.
Wilson-Hintz said the mountains of paperwork the facility has to go through every week is frustrating when considering the lack of funding. Nebraska was one of seven states in 2014 that actually reduced its funding to behavioral health services, according to the National Alliance on Mental Illness report on state activity.
The non-profit struggles in particular with employee retention, mirroring one of the overarching problems in the state in terms of salary.
“A lot of times people come to start and work for us, and they get some experience, and then they move on to find something that pays more,” Wilson-Hintz said. “But when you work for a nonprofit, that’s kind of what you expect. We’d just like to be a little bit more competitive.”
According to the 2014 Nebraska Center for Rural Health Research report, more than 14 percent of licensed and independent mental health care professionals said they had an intention to relocate outside of Nebraska.
Almost 30 percent of addiction counselors also said they plan to follow suit.
But 2015 did show some optimistic signs of change for Nebraska. Funding to behavioral health services increased slightly after the steady skid following 2008’s financial collapse. A bill was passed last May that requires a mental health evaluation for all children in primary care. There’s also an increasing wave of scholarships and grants to fund students who will go on to practice inside the state, hopefully alleviating the attrition rate.
It still remains to be seen whether Nebraska will continue on this trend or simply slide back into old habits of budget cutting. The question left is whether or not any funding will be significant enough to affect the lives of Nebraska’s rural inhabitants, and if they’ll see a single penny of it.
“You never know,” Wilson-Hintz said. “You never know when it comes to money and government because sometimes they have to take money from one area to support another area.”
Her hands rest on the table, and there is a pause. She nods her head briefly, and a wave of optimism follows in her body language.
She said with more funding smaller towns could start getting services that are at least comparable to NOVA’s, meaning less traveling, easier transitions back into their own communities and more immediate service for those in need. But she said it takes somebody who has an idea and is willing to put in the work for a nonprofit.
“(What) we’re doing collectively as a group in Nebraska is (talking) to the legislature about our situation,” Wilson-Hintz said. “We can talk to the senators and get them to advocate on our behalf for more funding. I think if we collectively keep asking as a group, and we keep bringing it up in the government, that’s the best way to get more funding and money that (we) need.”
For Wilson-Hintz, her work is ever-changing and constantly growing. The road ahead is tumultuous, and no funding seems guaranteed until it’s actually been used. Between hours of paperwork and meticulously triple-checking regulations, she stays grounded through those she serves.
“It’s challenging, and it’s difficult, but what keeps me going is seeing the progress we make when these people walk through the door,” Wilson-Hintz said. “When they first come in, we take a picture. It’s so interesting to compare their before and after pictures. You can actually see the physical transformation that they make. It’s amazing.”
The journey through NOVA’s program for each child ends after months of group sessions, therapy and classwork.
“It’s exciting for them, but it’s also nerve wracking,” Wilson-Hintz said. “Most people who leave successfully are scared to leave.”
But the residents do leave. Once treatment is finished, they gather the few possessions they have in their rooms and make their way to the exit.
Two lines form outside of the door. Discharged residents take their final walk in between those they’ve struggled alongside and the staff who has been by their side throughout.
Some will continue to carry addiction. Some will relapse. The beatings, the abuse and the neglect will never truly leave them. They only hope to learn to live and cope.
But all who return back to their home or forge ahead to a new one have taken a step toward getting clean.
Among all the demons they carry and stories they exchanged with others, they also carry out a single teddy bear, called a Nova Bear. Its fur is shiny and brown. They name it themselves.
Positioned at the end of their symbolic walk is Wilson-Hintz, who will lean in and whisper her final goodbye.
“I always tell the children when they leave, ‘Have a wonderful life,’” Wilson-Hintz said. “Because that’s what I want for them. Whatever that is for them, that’s what I want.”