NIATx in New Places: RHRP

By: Mat Roosa, LCSW-R

“How can we improve our workforce?”

In a human service environment filled with open positions, understaffed programs a low rates of worker retention this seems like a perfectly reasonable question. 

As NIATx has continued to explore new places, we have turned our attention to trying to support the workforce challenges of health and human service organizations. The critical need for this support emerged from the experience of attempting to support programs in implementing NIATx based change projects, but finding that the change leader supervisors were struggling to keep enough staff to operate the program, and had little energy for improvement. Some consultants and providers of technical assistance have been struck by the level of stress related to workforce concerns that supervisors are experiencing. Too many supervisors express a high level of stress and moral injury, as they find themselves unable to pursue the mission that they care deeply about, because they do not have the staff to do it. 

So, we decided to use our improvement model to help organizations to answer that question: “How can we improve our workforce?”  And upon further inspection we found that this might not be the right question to ask.

One of our NIATx principles is to get ideas from other industries, and so we found ourselves thinking about how a similar question might play out in another environment. What if a customer went into a grocery store and asked the front-end manager, “Where can I find the dinner food?” We all know why this would not be an appropriate question. It is just too generic to be meaningful. The response would likely be some version of “It depends on what you want to eat.”  

The work of Deming teaches us that everything we do can be defined as a process. And workforce issues are no exception. It became clear that any effort to support workforce improvements needed to use our NIATx tools to break down the issue into the specific processes. These included recruitment, hiring, retention, and promotion (RHRP). The NIATx tools of the walk through and flow charting could then be used to understand the potential applicant or interviewee’s experience associated with that specific process. Nominal group technique brainstorming could then help to define specific strategies for recruitment, or hiring that could be tested using the PDSA (plan, do, study, act) change model. 

We have begun to use this approach to train supervisors and managers to make specific changes and to measure the results to see if they can recruit more diverse candidates, get more people to apply for positions, enhance the interview experience, etc. In addition to the NIATx model, we have also included other key factors, including cultural responsiveness, wellness, and coaching/ mentoring to provide additional support to the workforce improvement effort.

There is certainly no single fix to the complex economic drivers of workforce challenges. But the use of focused data driven change projects can help an organization or a broader system, to find strategies that can make a difference. Harnessing the wisdom of a change team to find new paths forward is a key part of NIATx. Using PDSA change cycles is helping leaders to impact these workforce challenges in simple and powerful ways. 

Mat Roosa, LCSW-R

Mat Roosa is a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant and trainer in the areas of process improvement, evidence-based practices implementation, and organizational development and planning. Mat’s experience also includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human services agency administration.

Addiction Technology Transfer Center (ATTC) Network: Celebrating 30 Years of Empowering Professionals

By Greg Grisolano, for the ATTC Network

Technology transfer is in our name, but do you really know what it is?


Even though the Addiction Technology Transfer Center (ATTC) Network has been a leading expert in the field of substance use disorders since 1993, we realize there are still some folks who don’t know who we are and what we do.


We provide professionals with free training, tools, and support to help those in recovery and facing substance use disorders. The ATTC Network offers evidence-informed education, technical assistance, and custom resources aimed at strengthening the skills of practitioners. By listening to the needs of local, regional, and national partners, the ATTC ensures it stays relevant and effective, working to empower professionals and foster a thriving, recovery-oriented system of care.

Recently, we launched a new series of explainer videos that provide an overview of the organization’s mission and services. The videos are available in both English and Spanish and are designed to be accessible to a wide range of audiences.

What is the Addiction Technology Transfer Center (ATTC) Network? - Full Length from ATTC Network on Vimeo.

In addition to these explainer videos, the ATTC Network recently celebrated its 30th anniversary. As part of this celebration, we released a timeline highlighting significant accomplishments over the past 30 years. The timeline includes information about how the organization has grown over time and how it has adapted to meet changing needs in the field of substance use disorders.

Our 30th anniversary celebration also included a virtual event that featured remarks from SAMHSA Assistant Secretary Dr. Miriam Delphin-Rittmon and Dr. Yngvild Olsen, director for the Center for Substance Abuse Treatment (CSAT). During this event, attendees had the opportunity to learn more about the organization’s history and its plans for the future.

Watch the ATTC Network’s 30th Anniversary Celebration


The ATTC Network is helping to empower practitioners and foster a thriving, recovery-oriented system of care. 

NIATx in New Places: Insights on Using NIATx in Prevention

By Erin Ficker, Prevention Manager, Great Lakes PTTC, and Maureen Fitzgerald, Communications Manager Great Lakes ATTC, MHTTC, PTTC

Erin Ficker, CPRS, MPAff, has over 18 years of experience in substance use prevention, helping communities adopt evidence-based strategies and data-driven processes for prevention planning and execution. Since 2019, Erin has teamed up with NIATx coach Scott Gatzke to conduct NIATx Change Leader Academies for prevention professionals. An August 2023 CLA for prevention included four 90-minute weekly virtual sessions over four weeks.

According to Erin, prevention has always involved elements of process improvement. “During the implementation phase of prevention programs, it’s very common to review data and make  mid-course corrections," says Erin. “But a structured approach to this process has been the missing piece. NIATx provides a great framework for addressing this gap."

In the August prevention CLA, Erin and Scott revamped the language and presentation to resonate with the prevention audience. For example, NIATx Principle #1: “Understand and involve the customer,” was fine-tuned to “Understand and involve the participant,” with prevention participants identified in multiple settings: community, schools, government, and families.

Erin and Scott also work to reframe the concept of  “process” within the context of prevention work. "Prevention professionals don’t typically view their work as process-driven. We used the flowcharting tool to help participants identify their prevention work as processes, while integrating quality improvement concepts."

She continues, "Processes in prevention are less obvious than, say, the daily routines in hospitals dealing with new mothers and babies, which are straightforward to define. In areas such as recruiting coalitions and implementing policy, it may not always be apparent that there are well-defined processes at play.”

NIATx Tools
Photo of three people working together with the caption, "Let's elevate prevention together with NIATx

Erin cites the Plan-Do-Study-Act (PDSA) cycle as one of her favorite tools for streamlining the change process. She explains, "Prevention efforts often require ongoing adjustments and enhancements. The PDSA cycle enables a coalition to make gradual, incremental changes to their strategies and interventions and then assess the impact of those changes.” 

The training offered sample prevention-focused aim statements to guide a prevention-focused PDSA Cycle:

  • Increase number of schools using Project Towards No Drug Abuse program from 7 to 11 by April 
  • Increase number of parents completing 80% or more of Strengthening Families sessions from 20 to 50% by May
  • Increase coalition meeting attendance from 50 to 85% by March

Another favorite NIATx tool for Erin is the Nominal Group Technique (NGT). "The NGT has been a game-changer for engaging participants in structured idea generation,” she says.

“Aha!” Moments

“Participants saw the potential for these tools to enhance their work, even though they had not yet identified a specific change project,” says Erin.

“For the next iteration of the prevention CLA, we’re planning to embed activities in the sessions that will give attendees the skills to apply what they’ve learned immediately.”

The Great Lakes PTTC will offer a NIATx Change Leader Academy for Prevention Professionals again in 2024.

Photo of Erin Fickers

Erin Ficker, CPRS, MPAff, serves as a prevention manager for the Great Lakes PTTC. She has worked in substance use prevention for more than 18 years, supporting communities to use evidence-based strategies and data-driven processes in substance abuse prevention planning and implementation. Erin works with community-level prevention practitioners and schools to develop, implement, evaluate, and sustain prevention interventions.





NIATx in New Places: Empowering Teams in Recovery Community Organizations with NIATx

 By Kris Kelly, PR COE and Great Lakes ATTC, MHTTC, PTTC Project Manager, and Maureen Fitzgerald, Great Lakes ATTC, MHTTC, and PTTC Communications Manager

For recovery advocate Kris Kelly, the NIATx model helps tackle a long-standing question: 

“How can we support grassroots recovery organizations that are typically underfunded, under resourced, but continuously over-delivering?”

Kris joined the team at the Great Lakes ATTC, MHTTC, and PTTC in 2018 as a project coordinator, bringing experience in helping people discover and maintain recovery as director of programs for the Minnesota Recovery Connection, Minnesota’s most longstanding recovery community organization (RCO). In 2020, she became the team lead for the Recovery Community Organization Capacity Building Arm of the Peer Recovery Center of Excellence (PR-CoE). 

After attending her first NIATx Change Leader Academy, Kris quickly saw the potential for NIATx tools to help RCOs drive positive change, improve processes, and empower individuals and teams. 

A group of smiling people standing in a circle with each person extending one hand into the center, overlapping each other's hands in an expression of camaraderie and celebration.

A tool for empowerment

For Kris, the true power of the NIATx approach lies in empowering teams.

“The NIATx approach doesn’t  involve an authority figure swooping in to do something for you,” adds Kris. “Instead, it teaches teams to use a process like flowcharting that helps them understand what it’s like to be a customer in their organization.The flowchart tool can uncover both the strengths in a process and surprises about what’s not working well—like asking someone the same question four times!”

The NIATx walk-through also helps teams understand the challenges people face when seeking services from an RCO. “The walk-through exercise is easy and approachable and makes complete sense once you give it a try,” adds Kris.

Another participatory process that RCOs find valuable is the Nominal Group Technique (NGT). “We can use the NGT in staff meetings to decide on practically anything,” comments Kris. “The NGT brings in all voices to decide on a way to move forward. This really aligns with the RCO philosophy.”

Validating lived experience

“RCOS are frequently staffed by people who come into the work because of their lived experiences navigating the confusing and complex system of care for people with substance use challenges,” explains Kris. “They come to the field with a passion to expand and change the available options and provide care that authentically meets the wants and needs of the recovery community.”

Many employees of RCOs come from outside the clinical addiction treatment field. While learning about the work of an RCO, people may be hesitant to bring forth their ideas.

"This is where NIATx steps in as an empowerment tool for people who may not yet see themselves as leaders and changemakers," says Kris. "It shows people that there is a process for trying out their ideas, and that it’s perfectly OK to abandon a change if it doesn’t work. In the end, you have some data that supports your reason for continuing with a change in a process.”

What’s more, says Kris, NIATx also mimics how recovery coaches work with people new to recovery.

"Recovery coaching can be similar to doing a flowchart of your life and doing a walk-through of your recovery journey," explains Kris. In recovery, we follow Plan-Do-Study-Act cycles, trying out different strategies and refining our approaches for example, finding a mutual support meeting that works best for you. A coach might tell someone to try one meeting for a few sessions, then decide to continue or try a different one that works better.”

Building the peer recovery support workforce

An exciting prospect for Kris is the potential impact of the NIATx model on the future of RCOs and the peer recovery workforce. 

“What really interests me is the idea of moving NIATx upstream,” says Kris. “By including NIATx in program planning, organizations can ensure that they assess whether a program is working as intended. It provides a way to constantly evaluate and improve upon initiatives.”

The PR CoE will provide two NIATx CLAs focused on recruitment, retention, and leadership in RCOs in the coming year.

“The field of peer support is rapidly evolving, and for RCOs seeking funding to embed peers, including the NIATx approach can make a winning proposal,” she adds. “NIATx provides a blueprint for incorporating peers into organizations and with a built-in tool for collecting valuable data to showcase the success of a project.”

Photo of Kris Kelly

Kris Kelly is a Project Manager for the Peer Recovery Center of Excellence and Great Lakes ATTC, MHTTC, and PTTC, at the University of Wisconsin–Madison,  and a subject matter expert on peer recovery support services. Kris has developed best practices for integrating peer recovery supports into a wide variety of systems and services.

ATTC/NIATx’s Top 10 Posts From Our First Decade

 Compiled by ATTC/NIATx staff and directors

This month marks a decade of partnership and collaboration between the ATTC Network and NIATx on our shared blog. In that time, we’ve published more than 300 articles, including multiple series, from the pearls of wisdom we’ve learned over the years, to all the many new places you can implement the NIATx process.

Together we have compiled a list of 10 of our favorite posts from the last 10 years.

November 2022: Embracing Change: Providing Program Specific Harm Reduction Technical Assistance

The goal of the Embracing Change series was to showcase the ways each of the regional and population-specific ATTCs had found to survive, adapt, and thrive during COVID-19.

June 2021: The Treatment Challenge in Jail Settings: Detox and Withdrawal or Continuing Medication?

The ATTC/NIATx blog is a place where we sometimes invite our friends and collaborators to share their thoughts on issues affecting our industry, like this guest editorial from the Justice Community Opioid Innovation Network (JCOIN).

July 2020: Addressing the Syndemic of Addiction, COVID-19, and Structural Racism by Strengthening the Workforce

Our Tech Transfer In Action series focused on ways the ATTC Network delivers to the communities we serve. This article looks at the syndemic approach deployed by the New England ATTC to address addiction, COVID-19, and structural racism.

May 2019: Great Lakes ATTC: Process Improvement Focus Helps Organizations Implement Evidence-Based Practices

“A fundamental tool in the Great Lakes ATTC’s effort to accelerate EPB implementation is the NIATx model, developed in 2003 as a demonstration project supported by the Robert Wood Johnson Foundation and SAMHSA… Since then, more than 50 peer-reviewed articles have documented the use of the NIATx model in adopting evidence-based practices in addiction treatment, mental health, HIV treatment, child welfare, criminal justice, and other human services settings.”

December 2018: Building Rural and Technology Literacy Skills

The Mountain Plains ATTC provides an update on its efforts to strengthen the behavioral health workforce in rural communities.

February 2017: PPW Project Echo: Building capacity to provide care for pregnant and postpartum women with substance use disorders

The ATTC Network often gets TA requests for materials and resources targeted to specific populations, like this effort to utilize Project ECHO to provide care for pregnant and postpartum women with substance use disorders.

June 2016: Are we leveraging digital technology in addiction treatment?

Then-NIATx director David H. Gustafson provides an update on their A-CHESS app, a smartphone app for recovery support.  

November 2015: A Seminal Study Asks: Should our paradigm for treatment be expanded? Are we doing enough?

Another guest post, this time from a quartet of researchers who published “An Interpretive Phenomenological Analysis of Secular, Spiritual, and Religious Pathways of Long-Term Addiction Recovery” in Alcoholism Treatment Quarterly. The study explores 64 shared themes over three distinct stages of recovery.

October 2014: Integrating SUD Services with Health Care: the ATTC Network's Role

Here’s a post about the ATTC Network’s role in integrating behavioral and physical health care services.

August 2013: Better Together: Welcome to the ATTC/NIATx Service Improvement Blog!

The post that started it all!