Embracing Change: Leading Through Change - Essential Skills for Managers in Behavioral Health Settings

 By Beth Rutkowski, MPH, and Michael Shafer, Ph.D.

Behavioral health and recovery support professionals operate within interdisciplinary, multi-professional teams of providers. Behavioral health professionals frequently find themselves serving as site managers, team leaders, shift leads, clinical supervisors, and other middle-management positions. In these positions, behavioral health professionals are often called upon to perform tasks and functions for which their clinical training program did not provide adequate preparation. 


Among these roles is that of team leader. In these capacities, team leaders serve as facilitators of team development, cohesion, and action, including the implementation of new practice routines. Facilitators help others get things done. Effective team leaders work best by promoting inclusive engagement in team decision-making and team responsibilities among all members of the team.


The PSATTC developed and pilot tested an intensive technical assistance model designed to enhance internal change capacity within substance use disorder treatment and recovery support organizations. 

A bunch of white arrows pointing to the right, while a single red arrow in the middle points to the left.


For the past three years and amid the COVID-19 pandemic, 77 individuals representing 32 agencies participated in intensive training on change management facilitation and effective facilitation skills. Participating agencies launched change teams and engaged in a series of actions designed to identify and prioritize issues in need of improvement. The teams then designed and carried out a series of implementation steps while ensuring executive sponsor engagement and support. 


Drawing upon traditions of group work and systems theories, while integrating elements of process improvement, including NIATx, the Organizational Process Improvement Initiative (OPII) was designed to develop internal change facilitator(s) and internal change capacity within organizational units or teams, as opposed to deploying an external facilitator/consultant technical assistance model. In this approach and as we emphasized to our participants, we were "change agnostic." In contrast to more narrowly focused process improvement or EBP implementation-focused technical assistance approaches, the OPII provided teams with the skills and a structure for launching and sustaining changes they had prioritized with executive leadership endorsement.


The beginnings of the COVID-19 pandemic occurred a month after launching our second cohort as 37 individuals completed three days of in-person training on the OPII and change facilitation. Learning lessons from our first-cohort experiences, teams left with PSATTC faculty site visits scheduled within the next 45 days to ensure the launch of local agency change teams and the beginning of a 9-12-month structured change plan process.


Remarkably, most of these participating agencies ultimately returned to their change efforts and engaged in the OPII change model to varying degrees of success. 

For the next two years, our PSATTC team made radical changes in our approach and the platforms and tools available to us to provide intensive technical assistance.


As we approached the launch of our third cohort, we did so with a recognition that everything that the PSATTC provided had to be delivered virtually and that every agency participating in the cohort would be doing their local change facilitation work virtually, as well. We threw out our tried and true "three-day, in-person, intensive training workshop," and replaced it with a five-week, eight-session, 21-hour virtual training Academy. We planned for local agency change teams to be convening virtually, with some agency personnel working from home while others were in the clinic. We required participating agencies to purchase (a cost of ~$200) and utilize MIRO, a virtual collaboration application, for local change team meetings. We utilized MIRO as our instructional delivery platform and pre-populated numerous pages and templates for use during the training that change facilitators could copy and use with their team.


The pandemic served as a major innovation disruptor to our team, causing us to pivot to the new realities that COVID-19 brought, not only in how we engaged with agencies to deliver intensive technical assistance but also how change was occurring within these agencies and the types of changes that they prioritized to address. Recognizing that the participating agency-based teams, like our PSATTC team, were living and breathing Zoom, we came up with a whole suite of no- and low-cost options for facilitating team meetings virtually. Jamboards, Mentimeter, Zoom polling, Google Docs, and Sheets replaced Flipcharts, masking tape, and Sharpies.


We discovered as a team and with our participating agencies that these virtual-mediated team facilitation tools provided, in many instances, more effective, inclusive, and efficient platforms than traditional and in-person devices.


As we emerge from the pandemic, we find ourselves challenged with integrating our newfound tools and experiences in virtually mediated technical assistance with some of our more traditional tools and devices. Supplementing our technical assistance “toolbox” with Jamboards and Zoom are perfect compliments to flipcharts and Sharpies in this post-COVID hybrid world within which we live!


Beth Rutkowski, MPH, has been associated with UCLA Integrated Substance Abuse Programs (ISAP) since December 2000, and currently serves as the Director of Training and Co-Director of the SAMHSA-funded Pacific Southwest Addiction Technology Training Center. In addition, she organizes and conducts conferences and trainings throughout the Pacific Southwest region, and has co-authored and edited several peer-reviewed research articles, book chapters, special issues, and technical reports on a variety of topics related to the treatment of substance use disorders.


Michael S. Shafer, Ph.D., is a Professor of Social Work at Arizona State University. Dr. Shafer has been associated with the Pacific Southwest ATTC for over 20 years, in addition to serving as Principal Investigator on multiple federally- and state-funded studies of implementation and inter-organizational collaboration. Shafer has published extensively in peer-reviewed journals, book chapters, asynchronous learning modules, and curricula.

NIATx Model Featured in Newly Released Classroom WISE Training Discussion Guide

By: Kristina Spannbauer, Great Lakes ATTC, MHTTC, and PTTC Communications Specialist

The Great Lakes Mental Health Technology Transfer Center School-based Supplement (SB-MHTTC) recently published a companion discussion guide for the Classroom WISE training program. Classroom WISE is a free, self-paced online course for educators and school staff that focuses on increasing mental health literacy in schools and developing robust and sustainable supports for students experiencing mental health distress and adversity. The Classroom WISE Discussion Guide is a supplemental training resource based on NIATx principles. The guide offers users a framework for integrating the Classroom WISE strategies in schools by applying evidence-based process improvement methods such as the nominal group technique (NGT) and PDSA (Plan, Do, Study, Act) rapid-cycle testing.

CLassroom WISE instructional material cover.
Recently, the Great Lakes SB-MHTTC also utilized the NIATx model as part of a school-based intensive technical assistance program (ITA) aimed at improving youth suicide prevention efforts. The educators who participated in the ITA reported how valuable NIATx was to the success of their initiatives. This positive feedback was, in part, the inspiration for creating the Classroom WISE Discussion Guide. The Great Lakes SB-MHTTC team recognized a unique opportunity to pair the NIATx model with the Classroom WISE curriculum to enhance the outcomes of the Classroom WISE strategies for educators and their students. 

The blending of both models provides more specific instruction on the steps required to successfully implement the training and how to measure change accurately and effectively over time as users complete the Classroom WISE training modules.

The NIATx model relies on implementation science and uses evidence-based practices to assist organizations through times of change in a collaborative manner that supports the organization’s goals and strengthens its infrastructure throughout the process. Furthermore, NIATx offers guidance on creating and facilitating work groups using nominal group technique—an approach emphasizing the equal representation of ideas, prioritizing organizational needs, and using data-driven decision-making to effect positive change. The inclusivity and equitable participation promoted by the nominal group technique is a vital component of successful process improvement as it explicitly includes the thoughts and opinions of everyone in the group—from the “executive” or those in leadership to the on-the-ground workers.

The Classroom WISE Discussion Guide is available for download on the Great Lakes Mental Health Technology Transfer Center’s products and resources website.  

The Classroom WISE training program was developed by the Mental Health Technology Transfer Center (MHTTC) Network and the National Center for School Mental Health (NCSMH) with funding from cooperative agreements with the Substance Abuse and Mental Health Services Administration (SAMHSA).

For more information about Classroom WISE, and to access the brand new Cultural Inclusiveness and Equity (CIE) WISE companion training series, please visit classroomwise.org.

Related Content:

Check out the June 2022 ATTC/NIATX Service Improvement Blog, “SUD and Beyond: Schools Use NIATx To Improve Youth Suicide Prevention Efforts” to read more about applying the NIATx model to school-based programs and services.


Embracing Change: The Fluidity of Evidence-Based SBIRT

 By Diana Padilla, CLC, CARC, CASAC-T, on behalf of Northeast & Caribbean ATTC 

The SBIRT Framework 

Screening, Brief Intervention and Referral to Treatment, also referred to as SBIRT, is an evidence-based practice designed to intervene with people who are at risk of health and psychosocial consequences stemming from their risky levels of alcohol consumption and/or other substance use.

As a comprehensive, integrated, public health approach, the components of the SBIRT model include screening for substance use, and when warranted, a brief intervention (dialogue using Motivational Interviewing core communication skills) and referral to treatment. An array of non-substance use disorder treatment settings provide opportunities to identify and reduce harmful levels of consumption with people who generally don’t meet the criteria of a substance use disorder but are experiencing adverse effects as a result.  

Adapting SBIRT

The NeC-ATTC has provided technical assistance and implementation support to organizations seeking to integrate SBIRT in HIV programs, prevention and recovery support organizations, state agencies, and community peer-based initiatives. As such, SBIRT has been adapted to meet specific community needs. 

Based on the focus of programs and target populations, we have helped providers learn to use SBIRT to screen and address problematic behavior related to specific health issues. Creating an atmosphere that is physically and cognitively conducive to helping people feel comfortable and likely to engage is key. Validated screening tools specific to the identified health concern are used as required within the context of the SBIRT model.

A brief intervention dialogue using motivational interviewing core communication skills allows for a person-centered interaction that can help clients consider options for addressing behavior that may impede them from meeting their identified goals. A brief intervention that is effectively delivered helps to build receptivity to a referral for further assessment and possible treatment.  We have found that the components of the SBIRT intervention can be adapted to fit a variety of specific health issues beyond just problematic substance use without compromising the fidelity of the evidence-based practice.  

Expanded Application of SBIRT: Case Study
A black person holds their head in their hands and appears visibly depressed.

While major depression and general anxiety disorders are the most diagnosed mental health disorders in the US, they are severely underdiagnosed among the Black community. 

Although socio-economic, cultural, and contextual factors contribute to health disparities for people of color, stigmatizing beliefs about mental illness lend to the underdiagnosing of these disorders for African American populations. As such, the SBIRT model has the potential to enhance the identification of mental health issues within diverse communities.  

Currently, the NeC-ATTC is providing technical assistance support to Dr. Sidney Hankerson, Columbia University’s pilot study, “Depression Screening in Black Churches,” a clinical trial testing the viability of using SBIRT with African Americans versus the traditional mental health referral process. 

The study recognizes that African Americans have the highest rates of church attendance among all racial/ethnic groups in the U.S., with over 60% attending church several times per month. Approximately 72% of African Americans with serious personal problems, including depression, seek help in Black churches.

The pilot program recruits members of church congregations, (30 churches involved in the study) to train as Community Health Workers (CHWs) in the facilitation of SBIRT. It is hypothesized that using SBIRT may bridge the gap between depression screening and access to treatment. Part of the cultural framework for initiating SBIRT includes CHWs representative of the diverse communities who also attend the churches where the study is piloted. This offers both the faith-based and racial-cultural affiliations that can help increase the likelihood that community members will participate in the study, get screened, and possibly link to mental health care.  

Cultural Benefits of SBIRT Adaptation 

With health care disparities reported as extremely high amongst diverse populations, the flexibility of SBIRT model provides opportunities to reach diverse populations who struggle with conditions that may not necessarily be identified and treated in traditional health care processes.  

The Depression Screening in Black Churches is an ongoing study. But the hope is that data will show that SBIRT can help increase access to care for African American communities burdened with a high prevalence of depression and possibly other mental illnesses.  If so, it can open the door for more studies as well as training for clinicians and providers to help meet the needs of culturally diverse individuals and advance equity in care.

Depression Screening in Black Churches



Columbia University


National Institute of Mental Health (NIMH)

Information provided by (Responsible Party):

Sidney Hankerson, Columbia University

Author bio: Diana Padilla, is a Research Project Manager, at the New York State Psychiatric Institute, Division of Substance Use Disorders, Columbia University Medical Center. She is a curriculum developer and senior trainer for the Northeast & Caribbean Addiction and Prevention Technology Transfer Centers. She is certified by the New York State Office of Addiction Services and Supports (NYS OASAS) as an SBIRT trainer.

Embracing Change: How Northwest ATTC is Helping Programs Enhance Their Co-occurring Disorder Services – A Model for Success

By Denna Vandersloot, co-director, Northwest Addiction Technology Transfer Center

Many clients seeking care for their substance use disorder also have co-occurring mental health disorders – and vice versa. Treating both types of conditions at the same time by providing quality integrated services is more effective than treating each disorder separately.

Yet while integrated care has been increasingly prioritized, it remains an often-elusive goal. An estimated 17 million adults in the United States live with co-occurring mental health (MH) and substance use disorders (SUD), yet only 5.7% of these individuals receive treatment for both disorders (NSDUH, 2020). 

So, what is getting in the way?

  • We have a divided system of care where MH and SUD services are often funded separately and governed by different administrative rules.
  • There is a long list of system-, program-, clinical-, and client-related barriers to integration of services.
  • “Integrated care” has become a buzzword and isn’t always clearly defined.
While the list of barriers to integrating SUD and MH services is long, providers remain interested in and committed to better serving this population, something evidenced by a group of Oregon SUD providers who signed up for a year-long Northwest ATTC and Oregon Council on Behavioral Health (OCBH) intensive technical assistance project aimed at enhancing their programs’ capacity to serve clients with co-occurring disorders.

The project was divided into phases aligning with Gregory Aarons and colleagues’ EPIS model for implementing innovative practices:

1) The Exploration phase involved securing leadership buy-in, assessing the programs’ existing co-occurring disorder services capacity using the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index, and providing a detailed summary report with program-specific recommendations for enhancing the level of integration.

2) The Preparation and Implementation phases involved leaderships’ participation in a NIATx Change Leader Academy featuring learning sessions and monthly coaching calls with an experienced NIATx coach.

The Sustainment phase: involved delivery of a final DDCAT site review to evaluate progress and document sustainability efforts.

Participating programs worked on a variety of change projects ranging from increasing mental health referrals, to matching treatment to stages of change for both MH and SUD conditions, to increasing the availability of co-occurring disorder group counseling.

Click to watch a video testimonial on this project, produced by Northwest ATTC and the Oregon Council for Behavioral Health

For example, Grants Pass Treatment Center (ORTC, LLC) increased their identification of mental health needs and referral to MH services within the first thirty days of treatment from 14% to 72% by increasing collaboration and coordination with mental health agencies, adding MH screening, and increasing the focus on mental health issues in case consultations.

The primary goal of this project was to improve co-occurring disorder services for clients by having program leaders engage in an intensive technical assistance process that combined the use of the DDCAT Index and the NIATx process improvement model. This goal was achieved with noteworthy results. The mean DDCAT score at the beginning (baseline) of the project was 3.21; this score had increased to 3.86 by the end of the project. Additionally, at baseline, just 30% of the programs were dual diagnosis capable, while at the final review, that figure had grown to 71%.

This suggests that future clients will be offered useful, integrated services to address their co-occurring MH and SUD challenges, a very exciting outcome for all involved.

A secondary goal of the project was to collect qualitative data on the system-level barriers standing in the way of providers’ integrating care. This data was used by the Oregon Council on Behavioral Health to help advocate for additional funding to support integrated COD care. House Bill 2086 was passed by the Oregon legislature allocating $10,200,000 in funding to support the development and implementation of payment structures/models that support integration of treatment and recovery support for individuals dealing with addiction and mental health diagnoses under one payment model.

Supporting the renewed interest in integration of MH and SUD services, this project provides a model for assisting programs to align policy, practice, and training efforts to support co-occurring disorder services.

For a comprehensive list of resources designed to assist providers and others in integrating behavioral and physical health care to better address the needs of individuals with co-occurring mental, physical, and substance use conditions, check out this guide from NWATTC. 

About the author: Denna Vandersloot is the co-director of the Northwest ATTC at the University of Washington. Her work with the ATTC Network over the past 20 years includes providing leadership, training, and technical assistance services to the Northwest region.

Embracing Change: Diversity Inclusion Project Showcase (DIPS) Promotes Recovery Community Organizations

Editor's note: This post is part of the ATTC Network's "Embracing Change" series.

The work to curb the impact of opioid use disorder and other forms of addiction is diverse and expansive. However, one fundamental portion of the effort comes via Recovery Community Organizations (RCOs), which deliver needed recovery support services to community members from historically marginalized, underserved communities. 

On October 5, 2021, an array of addiction and recovery support professionals and representatives from four of the premier RCOs in Massachusetts and Connecticut joined for an event designed to spur innovative collaboration. The Diversity Inclusion Project Showcase (DIPS): Promoting Recovery-Oriented Organizations, co-hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the New England Addiction Technology Transfer Center (ATTC), was conceived as a platform to facilitate collaborations between RCOs serving historically marginalized communities, state leaders, policy makers, purveyors of technical assistance, and funders. The virtual meeting had an audience of more than 100 participants. 

Among the first to address the audience was Dr. Haner Hernandez, Senior Trainer for the New England ATTC. He established the tone of profound, personal connection that he and his colleagues have with their work. Hernandez noted the importance of RCOs, quoting renowned recovery expert William White, saying, “‘Recovery can be initiated in treatment, but recovery happens in community.’”

Dr. Haner Hernandez

The first two RCO representatives to speak were Louray Barton, Recovery Coach and Peer Specialist at STEPRox Recovery Center and Efrain Baez, Director of Stairway to Recovery. Barton emphasized the engagement and enthusiasm of STEPRox’s community members.

Baez discussed Stairway’s strides in offering an array of support services, as well as its enduring struggles and needs for support with obtaining adequate resources such as housing and multilingual health professionals.

Dr. Sara Becker, Director of the New England ATTC, spoke briefly about its mission and commitment to RCOs.

“We work to foster regional and national connections among diverse stakeholders,” she said.
Following Becker was Michele Stewart-Copes, Senior Trainer at New England ATTC. “To me, the opposite of addiction is connection,” Stewart-Copes said.

The next two CBO representatives to speak were Dr. Marie Spivey, Administrative Coordinator for Recovery Support Services, and Pastor Dana Smith, Director of New Life Ministries II. Each spoke about their RCO’s services, successes, and ongoing challenges.

“The Recovery Support Services is the first of this corporation (The Spott Unlimited Inc., a nonprofit service created by the Spottswood African Methodist Episcopal Zion Church in Connecticut) to launch a supportive program which is led by a recovery coach and eight to 10 recovery support assistants who are committed to work with individuals to help them find a pathway of recovery…”, Spivey said.
Smith followed her, saying, “Recovery is not a cookie-cutter kind of thing…All of us could be in the same accident, but its going to affect each of us differently.”

The DIPS Showcase, hosted by the New England ATTC and sponsored by SAMHSA, succeeded in highlighting the work of Massachusetts and Connecticut RCOs.

“(Community health workers) have been the unsung heroes of the pandemic, never giving up on their respective missions to save lives and lift up families,” said Nancy Navarretta, acting Commissioner of the Connecticut Department of Mental Health and Addiction Services.

Deidre Calvert, Director of the Bureau of Substance Addiction Services at the Massachusetts Department of Public Health, also recorded a personal message of gratitude for the leadership of StepRox, Stairway to Recovery, and other RCOs in her state.

“I would like to express the Commonwealth’s sincere appreciation for all of you who’ve been on the frontlines saving lives every day,” she said.

Having only introduced a few of the myriad of RCOs serving the 6-state region, the New England ATTC has plans to present similar showcase events in the future.

Encouragingly, collaborations have already occurred since the October 2021 showcase. In 2022, New Life Ministries II reached out to the New England ATTC to request intensive technical assistance to help members of the clergy learn and infuse harm reduction principles into the church community. Among the results of the collaboration were a harm reduction training workshop, production and analysis of graphic messaging, and iterative development of innovative recovery tools. The New England ATTC and New Life Ministries II are now partnering to develop a train-the-trainer curriculum focused on harm reduction in faith-based communities.

For agencies interested in participating in future showcase events, or in proposing any partnerships, please contact the New England ATTC at newenglandattc@brown.edu.

Author Bios
A native of Varnville, SC, Levell Williams considers himself a product of faith, family, and community. He gained his BA in Mass Communication from Tougaloo College in 2021. Levell is a Health Equity Scholar at the Brown University School of Public Health and is pursuing a Master’s in Public Health focused on science communication.

Dr. Kelli Scott is a clinical psychologist and Assistant Professor at the Brown University School of Public Health. Dr. Scott serves as the Evaluation Director for the New England ATTC, and works to assess the impact of ATTC training and technical assistance initiatives throughout the New England region.