Top 10 Blog Posts of 2017

December 27, 2017

The ATTC/NIATx Service Improvement Blog covered a variety of topics in 2017, ranging from cultural competence and technology to the opioid epidemic, marijuana legalization, and process improvement.

We thank the many guest bloggers and ATTC Network staff who contributed posts and shared their unique perspectives and views with our audience— which now includes readers on six continents!

Here's a list of our Top 10 Posts of 2017,  ranked by number of page views:

1. African American History Month and Addictions Recovery: Featuring the Online Museum of African American Addictions, Treatment, and Recovery  "The museum offers the historic and current context of treatment and recovery for African Americans seeking recovery," write guest bloggers Mark Sanders and Gabriel Perez.

2. Marijuana legalization is a process and we haven't reached the midway point: "Some people used to think legalization meant the same old same old, just without the arrests. We’re far enough into legalization to realize how naïve those beliefs were, but we’re not yet far enough in to have much of an inkling of where this movement will take us," wrote guest blogger Jon Caulkins, Professor of Operations Research and Public Policy at Carnegie Mellon University.

3. Responding to the opioid epidemic: "We should be marching in the streets over the state of opioid use disorder treatment," wrote Ned Presnall, Executive Director of Clayton Behavioral in St. Louis, Mo.

4. Cultural competence and organizational change: Meet the researcher, Dr. Erick Guerrero:  "Any essential quality for working with those that have been underserved is empathy," said Dr. Guerrero in this interview-based blog post.

5.  What do med students and prescribers need to know about opioid use disorders? Caroline Miller, Director of Wisconsin Voices for Recovery, wrote about a survey of med students' and their training related to substance use disorders. The survey found that one of the top things med students want to know is how to talk to patients about addiction.

6. Marijuana policy: Science matters: Susan Weiss, NIDA's Director of the Division of Extramural Research, wrote: "Science, not emotion, needs to guide our thinking as society implements new policies related to marijuana."

7. Changing the world's relationship with alcohol through mobile technology: Chris Raine, Founder of Hello Sunday Morning, an online community focused on changing they way people use (or don't use) alcohol, wrote about Daybreak, a new online tool that he and his team have created. The goal: to support 300,000 high-risk drinkers in changing their relationship with alcohol.

8. The quickest way to reduce time to treatment: NIATx coaches agree: Offering walk-in appointments or same day service helps organizations reduce time to treatment and increase revenue.

9. Introducing The BASIS: Your portal to addiction science and resources: Heather Gray of Cambridge Health Alliance announced this new weekly resource that brings research to the real world.

10. PPW Project Echo: Building capacity to provide care for pregnant and postpartum women with substance use disorders: Sarah Knopf-Amelung, Senior Project Manager for the ATTC Center of Excellence on Behavioral Health for Pregnant and Postpartum Women and Their Families shared info on this telehealth tool that's changing the way healthcare providers deliver best practice care.

Which 2017 blog post(s) were your favorite(s)?

Let us know in the comment section below—and be sure to tell us what topics you'd like to see in the ATTC/NIATx Service Improvement Blog in 2018!

Best wishes for a Happy New Year! 

How do you spell EKG?

December 12, 2017

Maureen Fitzgerald
ATTC Network

The story behind the NIATx walk-through

If you've done a NIATx change project, chances are it started with a walk-through

It's is one of the essential tools that change teams use to experience their organization’s services exactly as a customer would. NIATx Director Dave Gustafson says that his experiences taking on the role of a customer in other systems improvement projects are what inspired him to include the walk-through in the NIATx Process Improvement Toolbox

“I was working with a hospital to find out ways to improve its cardiac surgery program. So, I took on the role of a patient and checked in to the department. The first thing I was told to do was to go and get an EKG. The person behind the desk told me to just follow the signs. When I got to the EKG department, I asked the staff person there what could be done to make her job easier in terms of helping patients through the process. She said, “Change the signs that people are supposed to follow to get here.”

Gustafson asked her to explain, because he hadn’t had any trouble getting to the EKG department.

"She asked me to look again, and that's when I noticed that none of the signs said ‘EKG.’ They all said ‘Electrocardiogram.’”

Gustafson also used the walk-through to get a better understanding of the substance use disorder treatment field as he and the research team were preparing to launch the first NIATx project back in 2002.

“I didn’t know anything about addiction treatment when I came into the field, so I got myself admitted for heroin addiction. I figured it was the only way that I could get a feeling for what the field was like, and so with the help of two treatment agencies in Madison and New York City, I created a fake persona. I let everybody know ahead of time I was coming in. The persona I created was one of being a heroin addict for 30 years. Finally, my wife had gotten rid of me, I had lost my job, and I desperately needed help. I went through the admission process, and I lay in the detox facility for several hours to feel what that would be like, and so on.
Many rich experiences came out of that, but one of them was that after two and a half hours of interviewing me and collecting information they said, “You do need to be admitted into residential treatment. But we do not have a bed now. I tell you what. Call back once a week and let us know if you are still interested.” My reaction was that if I really were a heroin addict, I don’t think I would been motivated to call back once a week until a bed was ready for me.”

It turns out that the walk-through wasn’t a new concept in process improvement, Gustafson says—Toyota had been using it as part of kaizen, its approach to continuous improvement. Union Pacific Railroad had also used the concept in designating a Vice President of Tracks, whose job was to ride all 52K miles of track in the U.S. and live the life of a train.

“We thought that the walk-through was so effective that we made part of the grant application process for our first NIATx project,” explains Gustafson. “Then using the knowledge gained through the walk-through, each organization had to carry out a rapid-cycle change project that addressed one problem uncovered in the walk-through.”

From its beginning with a few dozen treatment centers, NIATx has grown into a network of providers and payers in multiple fields including substance use disorder treatment and recovery services, mental health, public health, criminal justice, and child welfare. The walk-through continues to yield valuable information to both novice and expert NIATx change teams.

Is it time for another walk-through in your organization? Visit the NIATx webpage for information and examples.

Treatment and Recovery News Roundup

November 28, 2017

Maureen Fitzgerald
ATTC Network Coordinating Office

Did your recent holiday include a holiday from the news?  Get caught up with these links to breaking treatment and recovery headline stories:

The Health 202: This hotel CEO thinks he can fix America's opioid abuse problem, Washington Post: "Gary Mendell, the chairman of HEI Hotels & Resorts who lost his son to drug addiction six years ago, has convinced four of the five major U.S. insurers – Aetna, UnitedHealth, Cigna and several of the Blue Cross plans – and a dozen smaller companies to sign onto eight principles of care for patients struggling with addiction."

In Ads, Tobacco Companies Admit They Made Cigarettes More Addictive from NPR:  Tobacco companies launched a series of ads warning about the health effects of smoking and the dangers of second-hand smoke.

Where is the Prevention in the President's Opioid Report? New York Times: The report mentions some evidence-based prevention programs, but does not recommend any.

Scientists explore drug's value in treating both alcoholism and PTSD, from Baltimore Sun: Dr. Bankole Johnson of the University of Maryland School of Medicine, is leading a team launching a five-year study of the effectiveness of a drug called pregablin for treating alcoholism and PTSD together.

White House report: Cost of opioid crisis over $500B from UPI:  A report by the White House Council of Economic Advisors adjusts for underreporting of opioids in overdose deaths and incorporates nonfatal costs of opioid misuse.

Veterans help spur use of medical pot for PTSD from The American Legion is pressing VA doctors to recommend medical marijuana where it's legal.

Should Hospitals be Punished for Post-Surgical Patients' Opioid Addiction? From NPR:  Some doctors and hospital administrators are now asking if opioid dependence is a medical error "along the lines of some hospital-acquired infections."

How Opioids Started Killing Americans, from Bloomberg: A Columbia University study analyzed clinical diagnoses and prescriptions for more than 13,000 adults in the Medicaid program in 45 states who died from an overdose from 2001 to 2007.

Follow the ATTC Network and NIATx on Twitter and Facebook to stay caught up with treatment and recovery news.

What are other ways that you keep informed of what's happening with treatment and recovery? Share your comments below. 

You Don’t Have To Be a Latino to Provide Services to Latino Populations: Enhancing Transcultural Mental Health Care

December 4, 2017

Emily Maynard, PhD
Post-doctoral fellow
University of California, Santa Barbara

Three facts you need to know about Latinos and mental health care in the United States:

  • Eighteen percent of the U.S. population is Hispanic or Latino (56.6 million) (US Census Bureau, 2016)
  • Only 5% of American psychologists are Hispanic or Latino (American Psychological Association, 2015).
  • Approximately 3% of American social workers are Hispanic or Latino (National Association of Social Workers, 2003).
See: How the U.S. Hispanic population is changing/Pew Research Center

With the number of Latinos in the United States at a high and growing, and after recent natural disasters that have impacted Latino populations in the Caribbean and Gulf areas, we may see more Latinos than ever accessing mental health services. Therefore, it’s likely that many non-Latino clinicians will be asked to work with Latinos, especially in border states and the Gulf region. Some familiarity with this group is helpful to provide appropriate, cross-cultural mental health services to Latinos.

What do non-Latinos need to know to work effectively with Latinos?

Nine things to keep in mind.

1. Latinos are diverse! Just like the United States, Latin American countries have long histories of colonization, conquest, slavery, and immigration. There are individuals of European, African, indigenous, Asian and Middle Eastern descent across Latin America. Don’t assume that someone is or is not Latino because they look a certain way or have a certain name.

2. Take the time to learn about the recent history of the countries/regions where your patients come from. A professional-class patient fleeing Venezuela may have a very different background than a Puerto Rican laborer or a Chilean graduate student. Newspapers, magazines, films, novels, and even Wikipedia are great sources of information about your patients’ countries of origin.

3. If you speak Spanish, seek out professional opportunities to train and receive supervision in Spanish.
Have you ever taken any Spanish classes? Spanish is by far the most-taught second language in the United States, with more students enrolled in Spanish than in all other foreign languages (Goldberg, Looney, & Lusin, 2015). If you have even a passing familiarity with Spanish or with Latin American cultures, use what you know of it to inform your work with patients. (For example, use the formal usted form of address unless your client invites you to use the informal tú.)
4. Be willing to acknowledge your own racial/ethnic identity. If you speak Spanish and are not Latino, patients will have curiosity about how you acquired it. To not answer questions about language acquisition or race/ethnicity may be perceived as hostile, strange, or may invoke paranoia. Be prepared to give a brief explanation, e.g., “I lived in Chile and Argentina for a few years,” and move on. 

5. Be on the lookout for complex trauma and trauma-related disorders when working with Latinos. Latin America is now considered the most violent region in the world, with the highest homicide rate (U.N. Office on Drugs and Crime, 2013). Latinos endorse high rates of exposure to violence, including political violence (Fortuna, Porche, & Alegria, 2008). 

Day of the Dead shrine in guest blogger's office
6. Distinguish between psychopathology and culturally-normative behavior. For instance, a person who appears to be paranoid may be in fact behaving very adaptively if they were raised under a dictatorship (as, for example, in Chile, Argentina, Brazil, Dominican Republic, Cuba, to name just a few). Signs of anxiety/panic/nerves must also be considered in the context of recent changes to immigration policy and raids on immigrants across US.

7. Interpersonal boundaries are different, but still exist with Latino patients! Don’t be fooled into thinking that a more affectionate style among Latinos means that they don’t respect interpersonal boundaries. I have found that Latinos are often keenly aware of professional hierarchies and are very respectful when working with therapists. They will also expect a similar level of professionalism and respect from their clinicians.

8. Family is important. Most Latino cultures have a greater focus on family functioning rather than on autonomous individualism (Cauce & Domenech-Rodriguez, 2002; La Roche, 2002). Some ways to acknowledge family role in therapy:
  • Routinely ask about significant family members.
  • With children/teens: “Mándale saludos a tu mamá”/“Say hi to your parents for me.”
  • Allow parents of infants or small children to bring children into psychotherapy with them.
9. Show up. For non-Latinos, it is important to demonstrate an ongoing commitment to working with Latinos. Linguistic and cultural knowledge are markers for commitment, but so is showing up!
  • Be present at public events in the Latino community; let yourself see and be seen. 
  • Take university-level classes in Spanish, or courses on Latin American history and culture.
  • Visit Spanish-speaking neighborhoods.
  • Acknowledge important holidays and traditions with patients: Día de los Muertos, December 12 (Day of the Virgin of Guadalupe) and quinceañeras for Mexican patients

About our guest blogger

Emily Maynard received her Ph.D. in clinical psychology from Fordham University. Her pre-doctoral internship was conducted at NYU-Bellevue Hospital Center in New York City, where she completed rotations in medical psychology, substance abuse treatment, and inpatient psychiatry. Dr. Maynard received her undergraduate degree in Spanish and Portuguese from Princeton University, with a minor in Latin American Studies, and she was later a Fulbright Fellow to Brazil. Dr. Maynard is bilingual in Spanish and fluent in Brazilian Portuguese.

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