Three wishes for 2015

January 5, 2015
Kim Johnson, PhD
Co-director, ATTC Network Coordinating Office
Deputy Director, NIATx

Instead of giving you my resolutions, I am going to tell you what I hope for and what in my own way I intend to work for in 2015. It’s a mishmash of things that I  wish I could wave my magic wand and make happen right now—instead of waiting for the evolution that will someday lead us to fixing these problems. 

In no particular order, my top three:

Evidence-based practices: What are the essential elements of the evidence-based practices that you use? Do you know?  Research has done kind of a lousy job of teasing out the essential from the non-essential aspects of the EBPs that we employ. There is an entire debate about common versus specific factors that gets at the question, but I think maybe some new research techniques are in order. For example, practitioners might find it useful to know why treatment following the manual is more effective  than treatment without the manual, and which modules you can skip with certain clients. I’m hoping that NIH’s increased interest in implementation research will help us start to thinking about the essential elements for treatment and how to best help people incorporate these essential techniques into their practice.

Technology:  I’ve written about privacy and how we need to figure out how we maintain it. Today I want to write about what gets automated and what doesn’t. Wouldn’t it be nice if we automated the tasks that take too much time away from direct service? What if we automated writing notes from visits?  Or discharge summaries? How about automating the process for getting prior authorization or continuing care authorization from insurance companies? In other industries, automation focuses on the most tedious and bureaucratic tasks. In health care, we keep automating direct service— the one thing we want to do ourselves. There are good reasons for that in terms of trying to eliminate variation and ensure quality, but wouldn’t it be nice if technologies like EHRs actually made your job easier? I’m hoping this is the year that tech firms start thinking about how to add value by automating the tedious tasks that keep clinicians from seeing patients. What would you automate to free up more time for direct service?

Stigma and shame: I’m hoping that this is the year that someone comes up with the ribbon, bracelet, headband, color—something to symbolize recovery from an SUD. I remember when my grandmother had breast cancer and it was too embarrassing to discuss.  I remember when AIDs was shameful.  We had massive campaigns to reduce stigma for these diseases because it helped people get diagnosed and treated. I want to be able to say the same thing for addiction before I retire or die.  What is the symbol that we can rally around? And then, how are we going to make that symbol be seen everywhere with pride, not shame? I’m ready for the campaign to begin. 

Also, this is the year for the addiction treatment providers to let go of their own shame and the stigma they may inadvertently put on patients. Just for example, we need to alleviate symptoms as we help people change attitudes and behavior. You know what that means.  If you are still anti-medication, you are facilitating stigma. Let it go, already! Can we figure out how to decriminalize treatment?  Right now it seems like the only way to get treatment is to be on probation.  How stigmatizing is that? That’s just a couple of examples, but we need to really look at addiction treatment as a field (and behavioral health overall, because I am afraid the treatment for serious mental illness is headed down this same path) and how we create and reinforce the stigma we so desperately claim to wish to eliminate.

These are my rants for the start of the New Year.

Who is with me and wants to get started making these changes?  What would you change about the delivery of behavioral health services if you could?

Kimberly Johnson, NIATx Deputy Director and ATTC Network Coordinating Office Co-Director, served for seven years as the director of the Office of Substance Abuse in Maine. She has also served as an executive director for a treatment agency, managed intervention and prevention programs, and has worked as a child and family therapist. She joined NIATx in 2007 to lead the ACTION Campaign, a national initiative to increase access to and retention in treatment. She is currently involved in projects with the ATTC Network and NIATx that focus on increasing implementation of evidence-based practices, testing mobile health applications, and developing distance learning programs for behavioral health.

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