APT Prez Promises Change

Thomas Breen photoChristopher Peak photoDowntown neighbors criticized a controversial methadone clinic for consistently snubbing the community, while the clinic’s president argued that substance abuse treatment programs should be supported, not attacked, as an opioid epidemic rages nationwide.

Those competing narratives dominated a half-hour conversation about the APT Foundation during the regular monthly meeting of the Downtown-Wooster Square Community Management Team (DWSCMT) on the second floor of City Hall.

Lynne Madden, the president and CEO of the New Haven-based methadone clinic and healthcare nonprofit, pitched the merits of the APT Foundation’s medication-assisted treatment programs to a group of 40 Downtown and Wooster Square residents.

“There is a lot of misinformation and confusion and fear in the community” about what APT does and how it works, Madden said.

Attendees listened patiently as she explained the scope of services that APT provides and the measures it has taken in the past year to curb patient loitering outside of its Congress Avenue clinic, which Hill neighbors have long criticized as creating a dangerous and unwelcoming environment at the heart of a residential neighborhood.

But they didn’t hold back in criticizing Madden for APT’s prior refusals to engage with the community and participate in honest, public conversations about its clinics’ impacts on surrounding neighborhoods.

“It feels like the APT does not understand its role as a good neighbor,” said Hope Child Development Center Director Georgia Goldburn.

“A Lot Of Mythologies”

Thomas Breen PhotoMadden spent the first 15 minutes of Tuesday night’s conversation outlining APT’s history, its breadth of services, the number of patients it treats each year, and the role it plays in addressing opioid addiction.

“There are a lot of mythologies about the work we do,” she said. By opening up about the organization’s past, present, and future, she said, she hoped to demonstrate that APT is both a responsible neighbor and a critical medical and social service provider.

APT was founded in New Haven in 1970 by the Yale School of Medicine’s Department of Psychiatry and by addiction treatment pioneer Herbert Kleber.

The nonprofit currently operates out of five locations: one on Congress Avenue in the Hill, one on Long Wharf, one in Westville, one in West Haven, and one in North Haven.

 

Its substance abuse services include outpatient medication-assisted treatment in the form of methadone and buprenorphine, as well as intensive outpatient services that require patients receive at least nine hours of treatment per week. APT also provides housing for female patients and their children through a residential services program, as well as primary care services, mental health counselling, and vocational training.

Madden said APT treats 8,000 patients every year, and that 4,500 of those patients receive some kind of medication-assisted treatment for opioid abuse. She said the nonprofit employs 354 people, 271 of whom live in the Greater New Haven area, and 100 of whom live within New Haven city proper.

The clinic’s minimum starting salary is $14.20 an hour, she said, and APT provides ample tuition support for employees pursuing higher education.

“We are really committed” to our employees and to the community, she said.

Madden said that APT had a much smaller connection to patients involved in the wave of downtown non-opioid-related K2 poisonings in August than many community members may think.

Of the 47 people poisoned during this summer’s frenzied outbreak on the Green, she said, only seven were APT patients. Two of those seven were only getting mental health treatment at APT, she said, while the remaining five were getting some form of substance abuse treatment.

“The idea that somehow all the people were getting APT Foundation services is simply not the case,” she said.

But what is the case, she said, is that this country, and this state, are still in the throes of a public health emergency that does not look like it is going to lighten anytime soon.

She said 110 people die every day in this country due to opioid-induced overdoses. In Connecticut alone, she said, a recent survey found that 3.2 percent of residents aged 12 to 17 reported at least one non-medical use of pain relievers in the past year.

“That’s a big number” for such a young demographic, Madden said. What that number tells her, she said, is that “there’s more to come,” and that now is the time to invest in substance abuse treatment clinics like APT.

As for its efforts to be a better neighbor, particularly at its Congress Avenue clinic, Madden said that APT recently opened a new clinic on Front Avenue in West Haven that has allowed it to transfer 900 patients from New Haven to West Haven. “Some of our patients call it the ‘country club,’” she said about the brand new West Haven facility.

Madden also said that APT has worked with the New Haven Police Department for over a year, hiring off-duty officers to patrol outside its Congress Avenue clinic.

Furthermore, she said, the Hill location recently bumped up its opening time to 5 a.m. and its closing time to 2 p.m., so that its patients can get in and out of treatment without overlapping with student arrivals and departures at the adjacent John C. Daniels School.

Madden added that APT is currently building out an interior waiting space at its Congress Avenue clinic, so that patients waiting to receive treatment will no longer have to wait on the sidewalk outside of the building. She said that interior waiting room should be finished by Dec. 31.

In response to a question about whether APT ever kicks patients out of its substance abuse programs, Madden said it tries as hard as it can to keep people who need treatment in treatment. However, she said, all patients are required to attend a minimum of one hour of counselling per month, and that those who do not meet that requirement cannot receive methadone or buprenorphine.

In response to another questions about APT’s finances, she said the nonprofit has an annual budget of around $36 million, and ended this year with a $700,000 operating margin.

“We Never Even Got A Response”

Despite Madden’s sharing of APT data and operating details on Tuesday night, many neighbors in the room argued that the clinic president was doing too little, too late after years of allegedly ignoring community complaints.

Goldburn, who recently moved her daycare to Wooster Square, described the APT Foundation as a negligent and negative neighbor when she operated the center out of 1 Long Wharf Dr. She said APT allowed its patients to do whatever they wanted outside the mixed-use building, including defecate, engage in oral sex, and do drugs.

“It is just depressing to come into that space and to deal with those behaviors,” Goldburn said.

Worst of all, she said, whenever she tried to contact APT about her concerns with their Long Wharf facility, she consistently got “zero response.”

Madden responded that she was not aware of Goldburn’s repeated attempts to make contact with the nonprofit. She said that APT has recently worked closely with the Long Wharf building’s contracted security to ensure that APT patients do not engage in such behavior outside of the building.

But, she said, since APT leases space in the Long Wharf facility and doesn’t own it outright, she said she can’t kick patients out of the building if they decide to leave the clinic and then swing by the pharmacy or any other business operating out of 1 Long Wharf.

Carmen Mendez, Downtown’s Livable City Initiative (LCI) neighborhood specialist, said the activities Goldburn described at Long Wharf also take place on the Green. She said she frequently sees and hears about people hanging out on the Green, getting high, sitting at bus stops when they’re not taking the bus, and disturbing passerby.

“You have to think about other law-abiding citizens,” she said.

She said APT should provide some kind of transportation for its patients so that out-of-town residents do not have to linger on the Green as they wait to pick up a bus after they’ve finished treatment for the day. She also asked APT to provide a larger waiting room within its Congress Avenue facility so that patients do not have to line up on the street outside, and to provide education for its patients on what behavior is unacceptable in public spaces.

“It’s impacting the city and the quality of life for everybody here,” she said.

Madden said that the vast majority of people who spend extended periods of time on the Green are not APT patients. She said city police provide APT with arrest information for people picked up for drug-related charges on the Green, and that only a small fraction of those arrested are connected to APT.

She said that, instead of blaming APT, New Haveners should pressure city and state officials to prioritize treatment, housing, and employment initiatives for people who suffer from opioid abuse disorders.

New Haven Urban Design League President Anstress Farwell remained skeptical, particularly considering the Downtown management team’s prior, futile attempts to get APT to one of its meetings.

For four years, she said, the management team has invited APT representatives to address the community. “We never even got a response,” she said, until the fallout from the August K2 poisonings spurred APT to the table.

Madden said she has been meeting with Mayor Toni Harp for years to discuss how the APT Foundation can be a better neighbor in the Hill.

“We’re the people on the ground,” Farwell said about the community management team. She said APT should have prioritized talking to everyday residents as much as it apparently prioritized private conversations with the mayor.

Farwell added that the nonprofit should consider moving its clinic from Congress Avenue to somewhere in the city’s medical center near Yale-New Haven Hospital.

“It would transform the neighborhood so dramatically” if the APT Foundation’s current Congress Avenue clinic was an apartment building instead, she said.

“As long as you’re there, it’s going to have a detrimental impact on families,” Farwell concluded.

Madden pointed to the new interior waiting room, the collaboration with city police, the new West Haven clinic, and other initiatives she had discussed earlier as example of how the APT Foundation is trying to be a responsible neighbor in a residential neighborhood. She said that only a few dozen of the 8,000 patients who visit APT are the problem makers, and that those problem makers are likely the ones most in need of effective, medication-assisted treatment for their addictions.

“If I could do better,” Madden ended, “I would.”

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posted by: Patricia Kane on December 20, 2018  2:57pm

Where do Madden and Burgett live? I’ll bet it’s not next to an APT clinic.
  The neighbors have a right to live without fear or intrusion, so what can APT do?
  Farwell’s suggestion to move the clinic closer to YNHH makes a lot of sense. There’s a ton of security there and few residences to be disturbed by people hanging out.
  APT is a big money maker, so if a shuttle from the clinic to mass transit is needed, the money is there.
  APT has a great reputation as a treatment facility and I support its model completely. But that’s not enough. APT has not been a good neighbor. Wooster Square and other areas with strong citizen involvement would have acted years ago. Don’t wait for the pitch forks and torches.
    I’m sure the smart people at APT can improve in all the ways that people have suggested.
    What’s the timeline for change?

posted by: RealElmHavener on December 20, 2018  9:14pm

Too bad the NHPD was not at this meeting to correct Ms. Madden on her flat out “inaccuracies.” If it is one thing that law enforcement has been clear on in terms of the overdoses on the Green and the influx of addicts misbehaving in or neighborhoods is that they are mostly APT clients. APT is a bad neighbor and their impact and the way they engage with our city has been horrible. They need to move on.

posted by: Kevin McCarthy on December 21, 2018  12:00pm

RealElmHavener, did you notice the guy in the next to last photo? (He’s also on the left side of the first photo.) More seriously, the NHPD district managers have regularly participated in the DWSCMT meetings for years.

posted by: Noteworthy on December 21, 2018  12:39pm

Why ;must APT promise change? Why hasn’t APT been paying attention all these months and years to what’s going on right outside your door? Does it really need to become a crisis before executive management gets off their collective arse to quit hurting the neighborhood.

posted by: Pat Wallace on December 21, 2018  11:29pm

There are best practices that APT can follow to improve how it relates to neighborhoods in which it’s facilities are located. Having a social worker trained in community engagement who is responsible for creating and maintaining respectful relationships would signal a serious commitment to do so. That staff person should be accountable to upper management.  Change won’t happen without leadership and resouces.

posted by: Ben Howell on December 23, 2018  3:57pm

Good on Lynn Madden & APT for engaging in a conversation with the various community management teams, both here in Downtown & in the Hill-North recently. In the face of the ongoing opioid overdose epidemic, which killed over a 1000 of people in CT last year, APT is “the people on the ground” getting people in treatment and meeting them where they are at. I’m glad we don’t live in the counter-factual world where the 4,500 patients with opioid addiction do *not* get treatment overdose deaths (& HIV/HCV infections) are even higher. As a primary care physician who cares for some of their patients, I’m glad they exist.

I’m also glad she could dispell rumors about the range of services they provide (primary care, mental health, IOP, residential, etc), the jobs they create, & the benefits of their model, let alone myths about the problems that many people lay at their feet (K2 poisonings, all the problems on the green). We can’t blame APT for all the problems in the city or on the green.

I’d also push back at folks who would say the Congress Ave location should be “closer” to YNHH. It’s a block away on Congress Ave from other YNHH outpatient clinics & across the street from several YNHH offices & ancillary services. Also, many YNHH and other medical services are in the 1 Long Wharf building. It seems as if co-locating addiction services there (a medical outpatient clinic by any other name) with other medical services makes a lot of sense & what other people want.