Policymaker Role and System-Level Challenges
I had the opportunity to interview Jonathon Holth, who serves as North Dakota’s Commissioner of Recovery & Reentry. In this role, Holth works across state agencies, local governments, and communities to improve outcomes for individuals experiencing addiction and those transitioning back into society after incarceration. His position was created to elevate recovery and reentry as key priorities within the state.
Holth described his role as collaborative and evolving, with a focus on advancing policies that reduce barriers to care. His work includes engaging with local communities, participating in policy discussions, and coordinating efforts across systems to improve behavioral health access. A major theme throughout the interview was the challenge of limited resources. He explained that no community has enough behavioral health services, providers, or funding to meet demand. Workforce shortages, particularly among addiction counselors and treatment providers, remain a significant barrier. The state has explored strategies such as improving licensure reciprocity to help attract providers. Funding constraints also present challenges, especially given North Dakota’s reliance on factors such as oil revenue.
Access to care in rural communities was another key issue. While larger cities have more available services, much of North Dakota is rural, where access to providers is extremely limited. Holth emphasized that policymaking must address the needs of smaller communities, not just urban areas. These challenges are consistent with research showing that rural populations face significant barriers to healthcare access, including workforce shortages, geographic distance, and limited resources (Coombs et al., 2022).
Policy Impact and Advocacy Approaches
Holth highlighted several policy initiatives that have been implemented during his time in this role. One of the most impactful developments has been the passage of reentry-focused legislation aimed at reducing barriers for individuals leaving incarceration. These policies address practical challenges such as ensuring access to identification and continuity of healthcare upon release.
North Dakota has also implemented deflection programs that allow law enforcement to connect individuals experiencing behavioral health crises with treatment services rather than incarceration. These programs improve access to care, reduce incarceration rates, and lower costs for the state.
A key aspect of Holth’s advocacy approach is the inclusion of individuals with lived experience in policymaking. As someone in long-term recovery, he emphasized the importance of ensuring that those directly affected by addiction and reentry challenges have a voice in decision-making processes. This approach aligns with research demonstrating that incorporating lived experiences and personal narratives into policymaking can strengthen policy development and lead to more effective outcomes (Fadlallah et al., 2019).
Implications for DNP Practice and Policy Engagement
Holth also provided valuable insight into how healthcare providers can become involved in policy and advocacy. He emphasized starting at the local level through community meetings, public health initiatives, and local advisory groups. He noted that meaningful change often begins within communities and can expand to influence broader policy decisions.
His perspective reflects broader evidence that nurse practitioners and healthcare providers play a critical role in shaping health policy through advocacy, collaboration, and engagement in decision-making processes (Carter et al., 2025). This interview provided valuable insight into the complexities of behavioral health policy and the challenges of implementing meaningful change. Holth’s work demonstrates how policy, advocacy, and community engagement intersect to improve outcomes for vulnerable populations. His emphasis on lived experience, rural access, and local involvement highlights the importance of a practical and comprehensive approach to policymaking. This experience reinforced the important role that healthcare providers, particularly those at the doctoral level, can play in advancing policy and improving access to care.
References
Carter, K. D., et al. (2025). Nurse practitioners as policy leaders: The art and strategy of advocacy. The Journal for Nurse Practitioners. https://doi.org/10.1016/j.nurpra.2025.105468
Coombs, N. C., Campbell, D. G., & Caringi, J. (2022). A qualitative study of rural healthcare providers’ views of social, cultural, and programmatic barriers to healthcare access. BMC Health Services Research, 22, 438. https://doi.org/10.1186/s12913-022-07829-2
Fadlallah, R., El-Jardali, F., Nomier, M., Hemadi, N., Arif, K., Langlois, E. V., & Akl, E. A. (2019). Using narratives to impact health policy-making: A systematic review. Health Research Policy and Systems, 17(1), 26.
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Comments
Your interview with the Commissioner of Recovery & Reentry was an unexpected but relevant contribution to your topic of limited tribal behavioral health treatment programs. Tribal communities face similar access to care problems in Arizona as you explored in North Dakota. In Arizona, the Division of Developmental Disabilities (DDD) Tribal Health Program (THP) is a fee-for-service program that allows eligible members to receive services at any Arizona Health Care Cost Containment System (AHCCCS) registered fee-for-service provider accepting THP (Arizona Department of Economic Security, n.d.). An additional barrier here is that tribal members must apply and qualify for DDD services to be able to enroll in THP. Tribal members may seek healthcare and mental healthcare locally but still occasionally find themselves in non-tribal operated Emergency rooms, treatment centers, and law enforcement situations. Holth's efforts to improve outcomes for individuals experiencing addiction and those transitioning back into society after incarceration is exactly the bridge in care needed for at risk populations with limited access to services. I especially appreciate Holth’s advocacy for inclusion of individuals with lived experience. Policy making and driving change in general is heavy on conveying the "so what?" or "why?" of a problem to different stakeholders. Incorporating those who are affected into the advocacy process is one of the most effective ways to get your problem heard.
Reference
Arizona Department of Economic Security. (n.d.). DDD Tribal Relations. https://des.az.gov/services/disabilities/developmental-disabilities/individuals-and-families/ddd-tribal-relations