Finding New Ways to Connect During Isolation

Jeff Ledolter
National American Indian & Alaska Native Addiction Technology Transfer Center

When COVID-19 was declared a pandemic in March 2020 and services began shutting down, many clinics were at a loss for what to do. Facing an unprecedented challenge, health providers had to make tough decisions with incomplete information on how they could best help their patients. They had to weigh the possible effects of exposing their patients to an unknown infectious disease against the behavioral health problems that they knew could cost their patients their lives. It’s been commonly said that addiction is the opposite of connection. How could a counselor advocate for their patients to socially distance when they knew it would put patients at greater risk of relapse and overdose?

Health providers were not alone in facing this decision. Almost every organization, including our three American Indian and Alaska Native technology transfer centers, was forced to adapt to the new normal of isolation and severing of connections. We’ve long been an advocate of hosting in-person training sessions and events. The relationships and trust that we have with our network of providers are based on face-to-face interactions. It not only embodies the harm reduction approach of meeting people where they are but acknowledges their tribal connections with their lands and shows that we are committed to helping improve their communities.

After some consideration, each of our centers began a series of listening sessions. Every week, we would invite providers to our Prevention, Mental Health, and Addiction TTC listening sessions to hear what was happening in their communities and allow them to connect to a world they were no longer permitted to attend. Originally, these sessions were an opportunity for grantees to vent their frustration and compare their situations with others. Over time, as people got used to the new format and began seeing familiar faces on these calls, they began opening up and sharing more about their individual and community challenges. They began comparing strategies that they’d found useful when faced with an unprecedented challenge and began accepting help from each other. Connecting these virtual neighbors allowed them to improve their practices by comparing the relative effectiveness of different treatment and prevention approaches in native communities.

Telecommunication events are still imperfect and may never match up to the connection found in face-to-face interactions. I’m sure that most professionals are too familiar with the audio/video problems and awkward delay problems that come with teleconferencing. Still, keeping that connection alive during these stressful times is more important than ever.

Unfortunately, 8 months since it was declared, the pandemic is still not over. Even worse, providers are already beginning to see the wave of mental health and substance use disorders that follow a period of stress, uncertainty, and isolation. To date, our centers have hosted over 100 of these listening sessions and we plan to continue them for as long as they are useful, perhaps even once we’re able to meet face-to-face again. Even through this virtual meeting space, we’ve seen once again the kind of resilience that Native communities display when relying on cooperation, empathy, and trust.

For an overview our listening sessions, please visit our webpage here:

Strategies for Addressing Stimulant Use Among Women: An ATTC Collaborative Project ECHO Series

Maureen Nichols
Director, South Southwest Addiction Technology Transfer Center
HHS Region 6


Pat Stilen
Director Mid-America Addiction Technology Transfer Center
HHS Region 7

Thomasine Heitkamp
PI and Co-Director
Mountain Plains Mental Health Technology Transfer Center Mountain Plains Addiction Technology Transfer Center
HHS Region 8

An overriding concern in the behavioral health field in HHS Region 6 in the past several years is the continued impact of stimulant use on individuals in our states and tribal communities, and the need to promote effective, evidence-based and holistic strategies for recovery and wellness for this population. Taking a focused approach on the specific needs of women who use stimulants, three regional ATTCs brought together their collective expertise to develop a Project ECHO series that the utilized case-based learning model to build community capacity to address this growing epidemic: Mid-America ATTC, a leader in evidence-based treatment for pregnant and post-partum women, Mountain Plains ATTC, with expertise in serving rural populations, and the South Southwest ATTC with experience in implementation of substance use peer recovery services. Each Project ECHO session included a didactic presentation followed by one or two de-identified case presentations related to stimulant use among women. All the case scenarios (required in an ECHO Model) had a stated goal of reunification of children with mothers who were struggling with a stimulant use disorder. This underscored for the cross-regional ATTC team the needs to work “hand in glove” with professionals with expertise in child welfare practice and encouraging cross-disciplinary efforts. The case reviews also underscored the limitation of resources to support mothers, especially in rural communities.

Results of this collaborative project advanced behavioral health service improvement in several ways:

Advancement of participant knowledge, skills and resources: The presentation of evidence-based approaches targeted to the specific target population of women who use stimulants and the productive discussion of specific, complex and challenging case presentations provided participants from across the primary and behavioral health care systems effective strategies and resources to meet the needs of their communities and patients. Didactic presentations remain available through the Mountain Plains ATTC website.

Implementation Strategies for the Project ECHO Model: The Project ECHO model, developed by the University of New Mexico, has effectively dispersed health care knowledge and services to underserved communities using a remote tele-mentoring model across the health care specialties. Implementation of the Project ECHO model in this setting revealed challenges in recruiting and supporting individual practitioners in the case presentation component. Time constraints on the part of practitioners and expert advice from our hub team caused the ATTCs to significantly streamline and modify the case presentation form and questions, focusing on patient strengths and immediate needs. Case presentations in front of hub team experts and a wide multi-regional audience could be somewhat intimidating, and mentoring from the ATTC staff members and local colleagues provided critical support to practitioners who volunteered to participate. Presentations by teams of service providers who were working together to meet the needs of the individual, rather than an individual presentation, also encouraged participation and lowered the barriers for practitioners.

Effective Collaboration between Technology Transfer Centers: The three regional ATTCs discovered effective strategies for collaboration between the regional teams that proved particularly meaningful in the subsequent transition online delivery of training and technical assistance as a result of the COVD-19 pandemic. The Mountain Plains MHTTC summarized these lessons learned in the publication 30 Steps for Cross-TTC Collaborations. Highlights include commitments on sharing expertise, evidence-based practice, agreement on evaluation/engagement on knowledge about outcomes, and practical considerations such as format and method of delivery, external communication and shared staff responsibilities.