Meeting Notes: Bridge Coalition Meeting on November 25th
Opening Comments (Jim):
- A broad overview of NorthStar Advocates Mission and purpose was discussed,
- Focusing on return to community: safe housing, relationships, and supporting young adults facing unaccompanied homelessness interests and passions.
- Invited the guests to look for the joy and gratitude that exists during the holiday season.
The Bridge Scope and Vision (Mayauna):
- High rate of return to homelessness for young people exiting inpatient care,
- Cross-system information sharing and training,
- Developing Return To Community Plan,
- Developing opportunities for systems reform.
SHB 1929 Bridge Housing Updates
Friends of Youth – Bridge Pointe (Blanca Gonzalez, Manager of Youth Haven & Bridge Pointe Housing)
- Since the Friends of Youth Ribbon Cutting Ceremony, there has been a high demand for services. The program is currently at capacity with a waitlist, and they are conducting screenings to ensure best fit.
- They have connected with additional inpatient and mental health facilities for referrals.
- Expansion is planned within the next few weeks for the second house with an ADA-accessible room. When this second house opens their capacity will go from 5 to 10 beds.
- Blanca highlighted the importance of the Return to Community Plan, noting that one of the largest barriers is documentation (ID, Social Security cards, driver’s licenses, etc.). They have implemented a strategy to address identification and documentation immediately upon entry, but this continues to be a trend.
- Documentation that proves the young person is in fact homeless remains a barrier with Coordinated Entry.
- Structure, routine, and consistent support were flagged as critical protective factors for success.
- Staff report that many residents have cycled for months or years between facilities, which impacts:
- Peer engagement
- Life skills development
- Conflict resolution
- Emotional regulation remains a significant challenge; however, consistent support and predictable environments are helping residents regulate more effectively.
- Despite the difficult days, Blanca shared that there have been more good days than bad, and that client feedback is actively integrated into programming decisions.
Excelsior Wellness – East Side (Lauren Zunker, Executive Director of Transitional Aged Youth & Malecka Nachtsheim, Care Coordinator)
- Lauren echoed the success of the recent Ribbon Cutting, highlighting it as both a team bonding experience and a major milestone.
- She expressed appreciation for the targeted training and technical assistance (TA) from NorthStar Advocates, and shared her excitement for the upcoming intensive training that NorthStar Advocates will be providing the first week of December. She emphasized deep gratitude for the supportive team environment NorthStar has helped build.
- Referrals have been slower than expected, so they are conducting targeted outreach to increase capacity and are also working with Friends of Youth regarding their waitlist.
Resident Trends (Malecka):
- With only two residents currently enrolled, staff are seeing how fluid Return to Community Plans become as youth are exposed to more options.
- Initial goals leaned toward independent living, but both residents are now exploring sober living environments to stay focused on recovery.
- It has been powerful to watch them gain clarity on the skills and supports they need.
- Because of the small cohort, staff are able to focus deeply on individualized Return to Community Plans.
- The biggest challenge and growth opportunity has been only having two clients.
- A new referral is scheduled for January, and coordination is underway with the referring provider to ensure strong support at intake.
Dr. Layton & Dr. Gardiner – Non-Pharmacological Approaches to Substance Use Disorder & Sleep
Dr. Layton – Research Overview
Matthew Layton, MD, PhD, FACP, DLFAPA is a Clinical Professor in the Department of Translational Medicine and Physiology at Washington State University. His work focuses on the intersection of substance use disorder, sleep physiology, and non-pharmacological treatment approaches. Dr. Layton has led multiple clinical research studies examining opioid-related sleep disorders and innovative interventions such as hyperbaric oxygen therapy to support methadone dose reduction, improve sleep, and enhance patient agency in recovery. His work bridges clinical practice, translational research, and systems-level innovation in opioid treatment.
- Dr. Layton opened by emphasizing that his work is meant to offer hopeful, non-pharmacological approaches for people with substance use disorders, especially around sleep.
- His interest in this connection started about 12 years ago with a sleep and smoking study at WSU with a graduate student of his, Amy Bender.
- They brought people who smoked into the sleep lab for a baseline night of polysomnography.
- Participants then quit smoking and returned for two more nights in the lab.
- They found that those who had better, deeper slow-wave sleep were able to refrain from smoking longer.
- Amy published these findings, and this was Dr. Layton’s first clear look at the link between sleep and substance use.
- Around the same time, he became Medical Director at the Spokane Regional Health District’s Opioid Treatment Program. There, his attention shifted from nicotine to opioids and sleep:
- They discovered that many people taking opioids—whether for addiction treatment or for pain—had significant sleep-disordered breathing, often along the lines of central sleep apnea.
- Opioids suppress the brain’s respiratory drive, so people were losing oxygen repeatedly throughout the night.
- Around the same time, he learned of a WSU Pullman colleague who had developed a mouse model using hyperbaric chambers to ease withdrawal symptoms in morphine-dependent mice. This raised the question: could hyperbaric oxygen help people get through withdrawal and into treatment?
- This led to the first human hyperbaric study he spoke about:
“Hyperbaric Oxygen to Assist Adults with Opioid Use Disorder in Reducing Methadone Dose.”- Many people on methadone fear they will never be able to taper without relapsing and were voicing their desire to be off of it.
- Around 46% of the individuals had opioid sleep induced apnea.
- The goal of the study was to test whether hyperbaric oxygen could provide a non-pharmacological clinical pathway to safely reduce methadone doses.
- They found that many participants did reduce their baseline doses, and that hyperbaric oxygen not only helped with withdrawal symptoms, but also with pain and sleep.
- Building on that, the team conducted a second human study:
“Nighttime Sleep and Respiratory Disturbances in Individuals Receiving Methadone to Treat Opioid Use Disorder.”- Participants with OUD who were in methadone treatment were often doing well in many areas—housing, family, education—but were still struggling with poor sleep and low oxygen levels at night.
- Some were using methamphetamine to counteract the sedation and sleep disruption caused by methadone.
- In this study (about 20 participants), they split people into two groups:
- Those with a positive UA for illicit substances at the start
- Those with a negative UA at the start
- All participants went through hyperbaric sessions, and over 90 days, the combined group reduced their methadone doses by about 25%.
- Both the positive and negative UA groups reduced their doses over time and reported better sleep, particularly those receiving full hyperbaric treatment.
- Dr. Layton underscored that methadone remains a gold-standard medication, but not everyone wants to stay on it, and it can be very hard to taper. His takeaway:
- Roughly half of patients want to stay on methadone, and half strongly prefer not to.
- These findings suggest there may be a real, clinical, non-pharmacological pathway to help people safely lower methadone doses, improve sleep, and increase patient choice and agency in recovery.
Dr. Gardiner – Patient Voice & Advocacy
Poppy May Gardiner, PhD is a Postdoctoral Research Associate in the Department of Translational Medicine & Physiology at the Sleep and Performance Research Center within the Elson S. Floyd College of Medicine at Washington State University. Her work centers on substance use disorder, sleep, and patient-centered research, with a strong emphasis on patient voice, recovery pathways, and non-pharmacological interventions. Dr. Gardiner conducts in-depth interviews with adults in treatment to better understand lived experience, motivation, and recovery goals, helping bridge clinical research with real-world impact.
- Dr. Gardiner emphasized the central role of patient voice in their work and shared a quote from a study participant:
“If there can be something that’s not pharmacological to help [with OUD], it’s just amazing, and so that’s why I’m so excited to be part of it too, to help [others].”
- She interviews participants about:
- Where their journey began (first use)
- Progression into active addiction
- Their recovery pathways
- The age range is generally 20s through 50s, with clear themes emerging across stories:
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- Prescription pills after injury or surgery
- Many became dependent after medically prescribed opioids.
- A common pattern: providers “drop the ball” on follow-up, tapering, and support.
- Domestic violence, childhood abuse, and trauma
- Early exposure to violence or abuse often pushed them toward substance use as a coping mechanism.
- Mental health & co-occurring disorders
- Anxiety, depression, PTSD, and other conditions were very common.
- Many participants were very aware of “why” they were using.
- Motherhood & caregiving
- While there were fathers in the group, many stories centered on mothers and caregiving roles.
- One story she has shared in other talks:
- A mother who was suicidal was stopped when her child found her and said,
- Prescription pills after injury or surgery
“Mom, I can’t live without you. I can’t do this without you.”
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- Methadone clinic support & counseling
- Participants consistently valued the peer support and counseling environment.
- They emphasized how critical it was to feel connected and not alone.
- Methadone clinic support & counseling
- Future directions of their research include:
- Applying for funding to expand studies to youth and young adults (16–25) and identify their unique themes and experiences.
- Expanding to Portland and other Northwest sites.
- Exploring TMS (Transcranial Magnetic Stimulation):
- Uses magnetic fields to stimulate specific brain regions
- Already used for depression, OCD, and addiction
- They plan to look at studies specifically targeting opioid use disorder and alcoholism to see how they can contribute.
Dr. Caverly – Evidence-Based Practices for Youth Co-Occurring Disorder (COD) Treatment & Discharge
Introduction by Katie Joannes (NorthStar Advocates Parent Advocate):
- Katie introduced Dr. Caverly, sharing that she helped review her son’s treatment discharge notes after his death from overdose in 2021, just hours after leaving inpatient treatment.
- Katie shared a link to Jaden’s Community Fund, a legacy fund created in his honor.
Dr. Caverly – Executive Director, Columbia Valley Health
Her presentation was titled:
“Evidence-Based Practices for Youth Co-Occurring Disorders (COD) Treatment and Discharge Recommendations.”
She focused on three main themes:
- Framing the Issue – What is the Challenge?
- Best Practices for Youth/TAY COD Treatment
- Treatment Discharge Challenges
Framing the Issue & Challenges
- There are not enough resources for youth and young adults.
- Systems frequently try to fit youth into an “adult” treatment box, rather than providing developmentally appropriate care.
- Some best practices exist on paper, but they are not consistently implemented.
- Discharge planning remains an area where youth are still being failed.
- She highlighted a major data gap:
- Many surveys are conducted with youth who are still in school.
- Youth who are most impacted—those experiencing homelessness, system involvement, or dropping out—are often not included, leading to flawed data and underestimation of needs.
- She stressed that:
- The earlier youth start using, the more severe the consequences.
- Young people lose a lot in a short period of time, and early intervention is critical.
Cognitive Development, Risk-Taking & Engagement
- She discussed cognitive development and risk-taking in adolescence and young adulthood.
- Engagement is one of the most missed components in SUD treatment, especially with youth:
- There are too many rigid rules placed on them at critical developmental stages.
- Expectations are often skewed and unrealistic.
- Newer research shows:
- Youth with mental health conditions (anxiety, depression, ADHD) are more prone to substance use and isolation.
- We need better strategies to pull them back into connection, not push them away.
Best Practice Principles (2021 Study)
She referenced 2021 guidance on best practices for young adult SUD care, including that:
- Young adults should have timely access to care as soon as needs are identified.
- They should receive comprehensive assessments, psychosocial and pharmacologic treatments, harm reduction, and evidence-based recovery supports.
- Services should be individualized, strengths-based, and in the least restrictive environment possible.
- To maximize engagement:
- Youth should enter care voluntarily whenever possible.
- External leverage may be used strategically, but involuntary commitment should be a last resort and must be as good or better than non-coercive care.
- A core goal of care: continuous engagement, including during relapse.
- Substance use care should be held to the same quality standards as other chronic health conditions.
Assessment & Repeated Measures
- Most programs conduct one assessment at intake and do not repeat it regularly.
- She argued that if we want to promote progress, there needs to be repeated assessment:
- It builds buy-in when youth understand the tool.
- They become excited to see their own progress.
- It supports team-based alignment on what’s working and what needs adjustment.
Dr. Paula Riggs’ Treatment Proposal – Five Key Recommendations
- Integrate all assessment information, including the young person’s goals, into a clear problem list.
- Engage adolescents in treatment and collaborate on goals.
- Determine:
- Medication needs
- Weekly therapy frequency
- Motivational techniques
- Cognitive-behavioral interventions
- If there is no significant improvement after ~2 months:
- Reassess diagnosis
- Consider changing medications
- Increase treatment intensity or frequency
- From the very beginning, communicate the need for long-term monitoring of psychiatric conditions and ongoing attention to relapse risk factors.
Closing Discussion
Jim asked:
“What is the most important thing for a staff person who works at a Bridge Housing program to know?”
Dr. Caverly’s response:
- “You need to look happy they are there.”
- Many youth feel like they are being thrown away by systems.
- Staff need to celebrate their presence, not just tolerate it.
- Focus more on what the young person wants to get out of the experience, rather than solely what staff or systems want.
- Implement a universal assessment approach.
- Start discharge planning the day they arrive, not during the last week of treatment.
- The more we can intervene early, at the point where their difficulties begin, the more impact we can have.
- She closed by emphasizing a non-blaming stance:
- Everyone—youth, families, and providers—is trying to do the best they can within the resources and knowledge they have.
Community Updates:
- No updates
Closing Comments:
- Jim closed the meeting and thanked everyone for their support and active participation in this work, and reminded the group there will be no December meeting.
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