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RIMROCK IN THE NEWS

Rimrock Foundation marks 40 years of battles, successes
Treatment center started when few options - if any - existed for alcoholics, drug addicts

By ED KEMMICK
Of The Gazette Staff

The Rimrock Foundation, a nationally known addiction-treatment business, came by its 130 employees and $7 million budget the hard way, by "pushing a boulder up a mountain for 40 years."

That's the analogy used by Mona Sumner, a Billings native who has been with the foundation since its modest beginnings in the summer of 1968. The intervening years have given her a career that has been satisfying but never easy.

One continuing difficulty has been working with people whom society at large would rather ignore or throw in prison - people addicted to alcohol and drugs, people with eating disorders and gambling problems.

Over the course of four decades, there have been bruising fights with the medical community, insurance providers, state lawmakers and state agencies, with city government and unwelcoming neighbors.

"There's always going to be a need for advocacy, and you have to be willing to fight for the right thing," Sumner said. "You've got to put on your armor and go do it."

Billings attorney Bill Lamdin, president of the foundation's board of directors, said Sumner has never shied away from a confrontation.

"She's brutally honest," he said. "I like that directness. The people we serve have no voice. Mona Sumner and Dave Cunningham (Rimrock's CEO) speak for them. If they didn't, who would?"

Despite the difficulties, there has been progress. When Sumner returned to her hometown in 1964 with a social-work degree from Washington State University, she was amazed at the lack of treatment services for alcoholics in Billings. She worked with troubled children at the Billings Youth Guidance Center, and in almost every instance parental alcoholism was involved, yet it was hardly even talked about.

"Nobody was diagnosing it, and nobody was treating it," Sumner said. "The stigma was horrific. Drunks were the people down on Montana Avenue in the gutter."

She did a little research and learned that there were only two Alcoholics Anonymous groups in all of Billings. But she also met the Rev. Gene Robinson, a Lutheran minister who, having had some training as a counselor, offered his services to alcoholics.

The Rimrock Foundation began to take shape at a breakfast table. Robinson eventually put together a group of people, including Sumner, who wanted to expand those services in Billings, and they began meeting over meals to talk about what they could do. After two years of talking and planning, Rimrock Foundation was formed in 1968. A hospital administrator from Ekalaka was hired to run it and the organization opened its doors in June 1968.

Forty years later, it is "really one of the key players on both the state and national levels," in the words of Joan Cassidy, chief of the Chemical Dependency Bureau of the state Department of Public Health and Human Services.

Jeffrey Kushner, who has headed alcohol and drug abuse prevention and treatment programs for three other states and is now the drug court coordinator for the state of Montana, said Rimrock ranks with the best-known addiction-treatment centers in the country.

"I can tell you that if I had a family member that I needed to send to treatment, I would have no hesitation to send a relative to Rimrock. I would put it on the same level as the Betty Ford Center or Hazelden. ... I think it's probably less costly, but I think the results would be just as good or better at Rimrock."

'Far-out' notions

The foundation merged with Sumner's agency in 1972 and became, for a time, the Rimrock Guidance Foundation. The merger brought together people with mental-health backgrounds and alcoholism counselors trained in 12-step programs.

Sumner said the result was that Rimrock became one of the first, if not the first, agencies in the country to offer family-oriented treatment, which she described as "a far-out notion at the time." It was as far out as the notion that alcoholism might be more than a failure of will.

"I remember talking to service clubs about the disease of alcoholism, and people would look at me like, 'You've got to be kidding,' " she said.

As members of the foundation struggled with raising awareness, they also struggled for funding.

"We spent two years beating the streets to raise enough money to keep it going," Sumner said.

The foundation was accepted into United Way in the early 1970s, and in 1974 it opened the first medical detoxification unit in Montana. The detox unit was operated in partnership with what was then Deaconess Hospital, now known as Billings Clinic, in the hospital's former nurses residence. Deaconess provided nursing and support services under a state grant, and Rimrock provided the counseling staff. Sumner looks on that accomplishment as "the start of our real professionalism."

Inpatient treatment

It was also in 1978 that Rimrock hired Cunningham as chief executive officer. Sumner, who had been on the board since the organization's founding, was the board president that year and was tired of the turnover in directors. She asked authorities at Deaconess to help the foundation find a director who would be a good fit and who would be around for a while.

They found Cunningham in Minnesota, where he had recently left a job as assistant director at Hazelden and was then in charge of publishing for another health care business.

In the mid-1980s, Rimrock split from Deaconess. Sumner said the break was spurred by a hospital CEO who urged the Deaconess board to offer on its own the services that it had been providing with Rimrock. After Deaconess essentially evicted Rimrock, Sister Michel Pantenburg, the administrator of St. Vincent Hospital (now St. Vincent Healthcare), came to rescue. In a much-criticized decision, she allowed Rimrock to move its operations into Marillac Hall.

"Nobody wanted us there," Sumner said, but Pantenburg stuck to her guns. It was also Pantenburg who later suggested that Rimrock buy what had previously been a building occupied by doctors behind the hospital, at 1231 N. 29th St. The asking price was $1.6 million and the foundation had only $10,000 in the bank, but a bond sale and the signing of a lot of bank notes got the foundation into the building. The sale took place in 1981, and Rimrock took occupancy in 1983. The building still serves as its headquarters.

"She really saved the foundation," Sumner said of Pantenburg. "There's no question about it."

It was also in 1983 that Cunningham persuaded Sumner, who had been a counselor and board president, to take over as clinical director for the Rimrock Foundation. Her decision to do so was partly prompted by reading a book that Cunningham had published in his previous job. It was by Drs. Robert and Mary McAuliffe, who advanced the novel theory that all addictions begin with a psychological dependence.

Sumner was eager to put those theories into practice, to begin treating all disorders in the same setting, since they all had the same psychological basis. With the hiring of Rimrock's first certified psychiatrist in 1985, the foundation began treating what are called co-occurring addictive and mental-health disorders, a radical concept that is now universally accepted.

Fight for survival

Sumner didn't mince words in describing managed care, which she said was "pretty well ravaging" inpatient treatment programs. The insurance companies argued that people with drug and alcohol addictions didn't need to be treated as inpatients.

"That's like saying a disease like cancer can be treated in outpatient," Sumner said. "How stupid."

All over the country, addiction-treatment centers were forced to close, but in Montana, the Rimrock Foundation led a lobbying effort that resulted in the passage of a law, in 1991, that established something known as utilization review.

That meant the managed-care companies had to abide by national standards in establishing types and levels of care and could not make cuts willy-nilly to reduce expenses.

"That was huge," Sumner said. "We were the first state in the nation to pass a utilization review law."

Rimrock also battled with the state health department in 1991 over obtaining a certificate of need, without which it could not have offered most of its services.

The battle - Sumner called it "a community dog fight" - was over the definition of the foundation's services. Providers of acute-disorder services, like the Deaconess Psychiatric Center, argued that Rimrock should have to meet the same standards as the psych center to receive its state-issued certificate of need. Rimrock, however, was treating sub-acute disorders, which was then a new concept, and it argued that its certificate was for an entirely different kind of treatment.

"That's one of the hazards of pioneering everything," Sumner said, that people don't understand what you're trying to do. Rimrock eventually won the fight and received its certificate of need. Cunningham said one benefit of all the disputes was that the public gradually became better educated about the nature of addiction and about Rimrock's aim.

A new kind of treatment

A more important addition was the opening of Michel's House in 2001. The fourplex on Alderson Avenue, named in honor of Sister Michel Pantenburg, became home to mothers and their children while the mothers were being treated for drug addiction. They also received parenting education and training in life skills and job skills.

Michel's House was closely aligned with the first Family Drug Court in Montana, which started in 2002, largely as the result of lobbying by the Rimrock Foundation. The court became the model for other communities in Montana.

Lamdin, president of the foundation board, said the success of Michel's House, the first residential treatment center operated by Rimrock, pushed the organization in a new direction.

"It really kind of inspired the board, and it really kind of opened our eyes to benefits of the residential treatment model," he said.

The foundation soon began expanding its array of residential treatment houses, opening the Freedom House on Ash Street. Originally designed as sober-living housing for up to six male veterans, it is now used as a women's sober house. Rimrock later opened sober-living houses for men on Eighth Avenue North and in two locations on North 23rd Street. Two other sober houses opened later on North 19th Street, next to a residential treatment program that housed eight people.

All those moves were uneventful and hardly even noticed by the neighborhoods they went into. That would not be the case with a group home for up to six teenage boys with addiction problems that Rimrock had hopes of opening in a house on Locust Street.

For a variety of reasons, the foundation's intention, which became public knowledge in the spring of 2005, ignited opposition in the neighborhood surrounding the "tree streets." Opponents circulated petitions, put up yard signs and took out a full-page ad in The Gazette.

They also lobbied - Lamdin would say they harassed - members of the board. He said he had just become president of the board and hadn't even chaired his first meeting when the storm hit. Board members were inundated with angry phone calls, and several of them ended up quitting over the dispute.

Neighborhood concerns

In fact, according to the state Department of Public Health and Human Services, there are at least 35 group homes in Billings, and the only one between North 27th Street and Pioneer Park is Rimrock's Freedom House on Ash Street.

Gene Jarussi, one of the leaders of the opposition, said he and the other opponents were aware of the need to offer treatment in group homes, but they did not want to see health care providers moving outside the "well-defined medical corridor" into their neighborhood.

"Any organization wants to be a good citizen," Jarussi said. "Just because you can do something - sometimes you want to use good judgment." And in this case, he said, the foundation board realized that and made the right decision.

That decision was to buy another house, on Poly Drive, where it opened its New Choices Center for adolescent boys. Even though Rimrock had the legal right to buy the Locust Street house, the controversy apparently became overwhelming. The foundation, in explaining its decision, also mentioned unspecified problems with the Locust Street house.

Lamdin still maintains that the concerns raised by the neighborhood amounted to "a made-up-after-the-fact justification." What he and other board members heard in the first days after the controversy began, Lamdin said, was that "they did not want those adolescent males in treatment in their neighborhood."

"Until people get schooled, they tend to say what they think," he said.

Lamdin said opponents also tried to make a claim that the neighborhood around Locust Street was somehow special and needed to be preserved. The same argument has been made hundreds of times around the state and nation when group homes are proposed, he said, and that's why there are laws protecting group homes.

In Montana, the law granting automatic approval for any group home for eight or fewer people was introduced in 1973 by then-Rep. Tom Towe, D-Billings. Towe, who later served in the state Senate, called the bill "one of the most significant pieces of legislation I've ever gotten through."

There were "horrendous fights" over the location of group homes in Montana, he said, and it always came down to the fact that "people didn't like to have people who were strange or different in the neighborhoods."

One early opponent of the Locust Street site was Jim Gainan, who lived close to the house. But as he looked into the proposal and spoke with people at the Rimrock Foundation, he changed his mind.

When it became obvious to him that the proposed home was not a medical facility and yet opponents clung to their belief that it was, "that's when things started to unravel," he said. "... At that moment the mob mentality had started."

Gainan's investigation of the foundation made him a strong supporter of the organization.

"Treatment works - of that, there is no doubt," he said. "Consequently, I will tender my support in the future in whatever way I can - whether it be in my own backyard or not."

A new fight

The argument again was that the project represented an incursion by the medical corridor into a residential neighborhood. Some residents worried that the treatment complex was so large that it would almost be a separate campus of the foundation.

The opponents' arguments, however, were undercut by their own written statements. A petition they circulated made no mention of medical-corridor expansion. Rather, it said the proposal "would allow a housing development for low income and drug abuse. Allowing housing for people with low income people (sic) with drug addictions into our neighborhoods."

The City Council got involved by denying Rimrock's application for special review, which would have allowed the foundation to build two fourplexes on the North 17th Street site. The council vote ran contrary to the advice of the city attorney, and Rimrock filed suit against the city.

That suit was settled this spring - though a final agreement has not yet been signed - when the city offered to pay the foundation $400,000 and to allow the project to be built as originally proposed.

Sumner said the North Park fight was one that Rimrock could not afford to lose. When opponents of the Locust Street home took the battle to the North Side, "that said to us, that is enough of this," Sumner said. Other group home operators, she added, privately urged Rimrock to file suit, believing it was their fight, too.

"I don't think there is any place in this city we could build it if we couldn't build a fourplex in North Park," she said.

Sumner also disputed claims that the project was merely a business and would take in lots of out-of-state residents. The proposed units were essentially residences, she said, and though in recent years 30 to 40 percent of Rimrock's clientele has been from out of state, nearly all of those people use the inpatient services at Rimrock's main building. Sumner said she could think of only two out-of-staters who had ever spent any time in the foundation's residential treatment programs.

Former city councilwoman Shirley McDermott, who moved with her husband to Laurel last year after having been residents of the North Side for decades, said they left partly because there is so little neighborhood feeling on the North Side anymore.

As for the fight against Rimrock, she said, "the point to me was that they were trying to build a commercial project in a residential neighborhood."

In addition to group homes, McDermott said, the neighborhoods around North Park also are home to the Head Start program, the Tumbleweed runaway program and many units of federally subsidized housing.

"Let's face it," she said. "North Park is just loaded with them."

Also in the North Park area is one of Rimrock's most innovative programs, the Silver Leaf Center. The center, which opened in 2006, provides daytime addiction-treatment programs to inmates of the Yellowstone County jail. The low-risk inmates are taken to the center from jail to take part in the programs.

Whatever the merits of each particular program, McDermott said, clustering them on the North Side has resulted in gradual reduction in property values, which encourages longtime homeowners to leave, replaced by renters or other projects similar to what was proposed by Rimrock. It's already a neighborhood in distress, and as more nonprofits move in with projects, "it's making it happen much more quickly," McDermott said.

Lamdin, naturally, disagrees. He said the dispute in North Park was fanned by a handful of people and "we never had the opposition in the neighborhood our opponents pretended we had."

The community treatment model works, he said, and all the troubles of the past few years have only strengthened the resolve of the board members who hung on.

"This is about the people we serve, not how we're perceived in the community," he said. "We want to get back to being low-key members of the community."

More Info

By the Numbers

Number of beds in 2007: 119 total, including 55 beds at Rimrock headquarters.

Adults treated by the foundation generally stay for 28 days. Adolescents and residents being treated for eating disorders typically stay for 35 days.

For adolescents being treated for drug and alcohol addiction, the inpatient per-diem rate is $410; for adults, the rate is $385. For eating disorders, the inpatient per diem rate is $470. Other charges are: medical detox per diem, $395; individual family therapy, $80 an hour; aftercare, $540 for 12 sessions; individual therapy through the intensive outpatient program, $70 per session.

Patient breakdown by payment source in 2007: self-pay, 44 percent; Blue Cross, 15 percent; other third party, 23 percent; grants and contracts, 11 percent; Medicaid, 5 percent; miscellaneous income, 2 percent.

Current salary for Rimrock CEO David Cunningham, $83,616; for Chief Operations Officer Mona Sumner, $81,806.

In 2007, the Rimrock Foundation provided a little more than $500,000 worth of community care, including $295,968 in subsidized detoxification services; $128,965 in charity care; $40,320 through services provided by the Rimrock Foundation Library; $24,276 in college internships; $21,740 in community education; and $6,522 for teachers in residence.

As part of its outreach efforts, the foundation sent out 54,398 fact sheets in 2007 to counselors, legislators, schools and the general public.

The foundation library had 6,184 contacts in 2007 and sent out material to organizations and individuals all over the country.

At foundation headquarters at 1231 N. 29th St., a 500-kilowatt generating system provides power in the event of an outage.

The foundation employs 130 people, including its own construction, maintenance and landscaping crews, reducing the cost of renovation, upkeep and development.