A Storied Career: Interview with 2021 NAADAC Enlightenment Award Winner, Mark Sanders

 
Mark Sanders, LCSW, CADC, is the Illinois State Project Manager for the Great Lakes ATTC, MHTTC, and PTTC. Mark is a published author, trainer, educator, and mentor, as well as the founder of the Online Museum of African American Addictions, Treatment, and Recovery and the co-founder of Serenity Academy of Chicago, the only recovery high school in Illinois. 

If you have never attended a training hosted by Mark Sanders, you're missing out. Mark has a unique ability to be at once both energizing and reassuring. His presentations are equal parts inspiration and intellect – a captivating mix of stories, memoire, and facts. He has motivated and educated countless members of the SUD workforce throughout his nearly 40-year career. For these reasons and many more, Mark Sanders, LCSW, CADC, has been selected as the recipient of the 2021 NAADAC Enlightenment Award, the 2021 Community Behavioral Healthcare Association of Illinois Frank Anselmo Lifetime Achievement Award, and the Illinois Association for Behavioral Health’s 2021 Lawrence Goodman Friend of the Field Award.   

The Great Lakes ATTC, MHTTC, and PTTC congratulate our colleague, Mark Sanders, on these well-deserved awards for his many years of exemplary service and leadership. In celebration of his accomplishments, we asked Mark to share his thoughts on the field of SUD recovery services and how he has achieved success throughout his career.

Lawrence Goodman Friend of the Field Award

Frank Anselmo Lifetime Achievement Award

    

What inspired you to enter the fields of social work and substance use disorder recovery services? 

I graduated from my undergraduate program at 21 years old with a bachelor’s degree in social work and sociology. It's January and I'm standing at a bus stop with no job, a diploma underneath my arm, and I see a blinking neon sign that says, “Youth Center.” So, I walked in. As I waited to speak with someone, I noticed some books stacked in the corner of the room. I figured I may as well read while I wait, and the book I picked up was Another Chance [sic] by Sharon Wegscheider-Cruse. She talked about addiction, alcoholism, and families with roles like those of my own family members. I came from a family with lots of alcohol use disorder and substance use disorder, and I saw my family in that book. 

Eventually, I spoke with a member of the adolescent substance use disorders program at this youth center. I asked if they had any openings for counselors. They said they needed a strong male counselor, and I thought to myself, I don't know how strong I am, but I am a male counselor. And so, I was hired. For 39 years, I've been in this particular industry, helping individuals with their recovery. What’s kept me going is seeing the many clients over the years who have achieved recovery. I often think of the famous saying, “The flap of a butterfly's wings in Brazil can cause an earthquake in Texas,” and what I've come to realize is each time a client recovers, they go on to help others. The work never ends, and the results are magnified.

How have you seen the substance use disorder field change over time?

When I first became a counselor, we had one technique with clients: confrontation. Early in my career, I learned that a good substance use disorders counselor should be like a prosecuting attorney, like Perry Mason, and our job is to cross examine clients to get them to confess it all. What we’ve learned years later is that approach doesn’t work. The field has transitioned to using evidence-based practices, such as motivational interviewing and multiple pathways of recovery, and this has greatly improved our clients’ ability to achieve positive outcomes.

Another big change that occurred is in our language and the way we talk about substance use disorders. There is a Native American phrase that says, “If you want to appreciate something, call it a flower. If you want to destroy it, call it a weed.” Practitioners began using fewer stigmatizing words and phrases and doing so helped reframe our understanding of substance use disorder as a chronic condition, like cancer and diabetes, and not a moral failing. We’ve discovered that more and more people are seeking help because we are reducing stigma through language alone.

Is there one expert or scholar who's inspired you or guided you?

Yes – my mentor, William White.  He's known by many as a substance use disorders professional historian, but when I first met him, he was a trainer. Decades ago, I told my friends and colleagues that I wanted to be a trainer. Everyone said, if you want to be a trainer, you need to meet William White. He’s so charismatic – amongst the best trainers in our field.

One Friday night, William was hosting a workshop. I showed up, shy and nervous to approach him because of his reputation, but eventually, I introduced myself to him. He was so approachable and easy to talk to. We had lunch and he shared his knowledge with me and answered all my questions. He inspired me to become a mentor myself. One of the greatest lessons he passed down to me is that people who are truly grateful for what they've learned from this profession freely give it away. They pass it forward to the next generation.

What advice would you give to future social workers and counselors? 

Many people who enter this profession feel they’ve been called to do this work. You may be so busy working, trying to save human souls and help people recover, that you forget to take care of yourself. My advice for you is to take a break every day. Take your whole lunch hour. Treat your evenings and weekends as sacred time. Rest and replenish yourself so you can continue helping people without sacrificing your own wellbeing. 

Another piece of advice that I’d offer to future professionals is that it’s important you understand the history of what happened before you entered the field. You will be more successful in building up this profession if you understand its history. 

What are some things that you do for your own self-care?

I enjoy quiet time. I listen to music. I take walks. I like to relax and watch Netflix. I spend time with friends –  that's really, really important to me. You see, at my age now, if I live as long as most African American men, I only have about 450 weekends left. I need to enjoy the time I spend with my family and friends, and my weekends have to count. 

What are you most excited about as you go forward in this part of your career?

Part of my legacy is the Online Museum of African American Addictions, Treatment, and Recovery. I intend to keep building that website so that clinicians coming into the profession will have culturally relevant information about working with African Americans with substance use disorders. 

I’m also really passionate about the importance of quality clinical supervision. You can’t implement evidence-based practices unless there's quality clinical supervision. 

Finally, I’m excited about welcoming the next generation of professionals to the field and making sure we leave them the tools and information they’ll need to be able to move the field forward. 

Change Project 911: Unable to sustain a change

Mat Roosa, LCSW-R
NIATx Coach

“It’s easy to quit drinking. I’ve done it a thousand times.”   W.C. Fields

Change is easy. Sustaining change is not so easy. This is true for personal changes like quitting smoking, exercising more, driving slower, or keeping the house more organized. It is also true for workplace systems changes, such as implementing new policies and procedures. Too often, despite our best intention, we end up like Sisyphus, doing our best to roll the change up the hill, only to see it slide back down.  

The NIATx rapid-cycle PDSA change model emphasizes making changes that you can measure and implement quickly. Sometimes, change teams think of the process as a quick sprint to change. But sustaining a change (sustainment) is more like a long-distance run. So here are a few things you can do to pace yourself to sustain your change project gains. 

Create a sustain plan

Sustainment rarely happens without a clear sustainment plan. Just as inpatient hospital care should include discharge planning at admission, change projects should start sustainment planning at the beginning of the change. Build the sustainment conversation into the change project planning, and use the elements below to ensure sustainment success. 

Keep meeting

NIATx change teams meet frequently when developing and implementing a change project. Too often, these teams disband prematurely at the end of the change implementation. Schedule ongoing—but less frequent—change team meetings to monitor the successful change. 

Track the data

Many successful change sustainment teams develop a data dashboard for tracking key change metrics. Periodic review of the data helps decision-makers take action when the data reflects a drift from the new practice. Teams can set parameters that will trigger actions: If metric x drops below level Y, we will do Z, etc.

Engage new staff

Staff turnover poses a primary challenge to sustainment. Initial implementors leave, often replaced by staff who have no knowledge or investment in the new practice. Offset this issue and sustain the new practice by building it into your organization’s policy and procedures and new staff training. In addition, learning the history story of successful change projects helps new staff to appreciate the work that has come before them and will motivate them to sustain the improvements.

Assign a Sustain Leader

A key role in the NIATx model is the Change Leader. Teams are also encouraged to assign a data coordinator, who gathers and presents the change project data. The Sustain Leader plays another key role for Change Teams. Assigning a  Sustain Leader responsible for creating a sustainment plan is the clearest path to making sustaining the change a priority for your team.

Focus on ROI

Change teams feel frustrated when they see the progress of a successful change project fading—or worse, reverting to the old way. Backsliding leaves the team right back where they started, with little to show for their efforts. Instead, motivate teams to sustain successful gains by celebrating progress. Announcing the successful change and honoring the change team's effort in an office newsletter or other communication can also motivate the team to sustain the improvement.

Recognize the challenge of turning the new into the norm

Most people and teams are better at starting new things than they are at sustaining new things. Humans evolved to notice risk and make rapid decisions to increase safety. Appreciating this innate wiring can help us feel greater empathy for ourselves and our team members as we work to monitor changes and enhance sustainment. 

Using the strategies above can help you to succeed in turning new changes into norms of practice. However, continuous quality improvement is not just about the implementation of change. CQI also requires an ongoing effort to sustain the changes you have already made. 

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

About our Guest Blogger

                                                 

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at matroosa@gmail.com.

AMERSA People & Passion, Episode 10: Initiating Medications for Opioid Use Disorder—There’s an App for That?!?

To support the utilization of Medications for Opioid Use Disorder (MOUD), the Office Based Addiction Treatment Training and Technical Assistance (OBAT TTA) team will be releasing a mobile application that will guide healthcare providers through the initiation of buprenorphine and naltrexone for OUD (including injectable buprenorphine) and pain management for patients on these medications via interactive clinical algorithms. This is one of the only apps of its kind for addiction care. This podcast will interview key members leading the development of the app to learn more about its development, what gaps it is addressing, and feedback on initial utilization and impact.
Web Access to the App: https://www.bmcobat.org/quick-start/

Find the app in the Apple Store and on Google Play

Elizabeth M. Oliva, PhD, received her PhD in Developmental Psychopathology and Clinical Science from the University of Minnesota where her graduate work examining the etiology of substance use from adolescence to early adulthood was funded by a National Science Foundation Graduate Fellowship. She completed her pre-doctoral clinical psychology internship at UCSD/VA San Diego and is currently the VA National Opioid Overdose Education and Naloxone Distribution (OEND) Coordinator. Dr. Oliva also conducts research on VA OEND implementation as an Investigator at the VA Center for Innovation to Implementation (Ci2i) at the VA Palo Alto Health Care System. She is a Senior Evaluator for the VA Program Evaluation and Resource Center (PERC; one of three VA Office of Mental Health and Suicide Prevention evaluation centers) and supports implementation of VA’s Stratification Tool for Opioid Risk Mitigation (STORM). Dr. Oliva is also an Associate Editor for the Substance Abuse journal.

Andrea Caputo, DNP, FNP-BC, CARN-AP, is a Nurse Practitioner and Clinical Nurse Educator for the OBAT TTA+ program at Boston Medical Center with expertise in women's health, individuals experiencing homelessness, and chronic disease management. She is committed to serving vulnerable populations and works per diem at Boston Health Care for the Homeless Program; Andrea has also conducted international healthcare work in Haiti. She is a term lecturer and preceptor for nurse practitioner students at the MGH Institute of Health Professions (MGH IHP). Andrea received her Masters of Science in Nursing in 2011 and her Doctorate of Nursing Practice in 2018, both from the MGH IHP. She is board certified in addictions nursing through the Addictions Nursing Certification Board.

Annie Potter, MSN, MPH, NP, CARN-AP is a Nurse Practitioner and Clinical Nurse Educator for the OBAT TTA+ program at Boston Medical Center. Annie educates and supports health care providers on best practices in the treatment of substance use disorders and serves as Medical Director for BMC’s Massachusetts OBAT ECHO. Prior to joining BMC, Annie practiced at a community health center in Baltimore, MD, where she established and served as the clinical lead for the city's first walk-in HIV treatment and prevention program. She is board-certified in addictions and holds specialty certifications for the treatment of HIV and Hepatitis C. Annie earned her Masters of Nursing and Masters of Public Health from the Johns Hopkins School of Nursing and Bloomberg School of Public Health, respectively.

AMERSA People & Passion, Episode 9: History of AMERSA with Sid Schnoll

Sid Schnoll, one of the founders of AMERSA, discusses with Paula Lum the origin of the organization out of the Career Teacher Program of the early 1970s. The desire by the federal government to cultivate experts in substance use disorders into health professional schools has resulted in a vibrant, growing organization that helps health educators provide cutting-edge information to their students.

Sidney H. Schnoll, M.D., Ph.D., is an internationally recognized expert in addiction and pain management who has recently applied his experience of over 30 years in academic medicine to the issues of risk management of controlled substances. Sid was a member of the team that developed the Tramadol Independent Steering Committee (ISC), and he was the principal investigator on the health care professional surveillance project to determine rates of use of tramadol among health professionals. Sid also developed the RADARS® System to study the use and diversion of prescription opioids, which was cited by the FDA as a model risk management program. With over thirty years in academic medicine, Sid has published over 150 research papers, book chapters and educational materials. His areas of research include both addiction and pain management with special emphasis on perinatal addiction and prescription drug use.

 

Sid Schnoll on 1971 Philadelphia Magazine Cover

Paula J. Lum, MD, MPH is an HIV primary care physician, addiction medicine specialist, and Professor of Medicine at the University of California, San Francisco.  Board certified in internal medicine and addiction medicine, her research, clinical, and teaching activities for the last 25 years have focused on evidence-based and patient-centered care to improve the health and wellness of the urban poor.  After attending her first AMERSA conference in 2008, Dr. Lum “felt the love” and knew she had found her professional home.   She enjoyed reviewing abstracts for the conference so much, that she went on to co-chair the Abstract Committee in 2012 and 2013, and to co-chair the Conference Program Committee in 2014 and 2015.  Encouraged by AMERSA colleagues and other giants in the field, she established the first accredited Addiction Medicine Fellowship Program in the University of California.  In 2019, Dr. Lum received AMERSA’s W. Anderson Spickard, Jr. Excellence in Mentorship Award and began her current tenure as President of the AMERSA Board of Directors.  At the Annual National Conference, pestering Sid Schnoll for stories about the Summer of Love has become one of her favorite traditions. 

AMERSA People & Passion, Episode 8: Key Conversations: Dismantling Racism Against Black, Indigenous, and People of Color Across the Substance Use Continuum

The Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) released a solidarity statement and a position paper articulating racism’s deadly effects on persons who use alcohol, tobacco, and other drugs. This cascade of negative effects, compounded with the social determinants of health results in higher rates of incarceration, increased risk of overdose, fewer employment options, multi-generational poverty and economic disadvantages for Black, Indigenous, and People of Color (BIPoC).

The AMERSA Board of Directors (BOD) proposes an initial set of strategies to promote diversity, equity, and inclusion using a framework that speaks to four key AMERSA experiences: engagement, education, mentorship, and leadership. Please join Dr. Holly Hagle, Marlene Martin, and Miriam Komaromy in this podcast for a discussion on how AMERSA commits to promoting equity and inclusion to dismantle the individual, institutional, and structural racism that has pervaded the United States for centuries. Through these actions we stand in solidarity with BIPoC and all persons who use substances across the spectrum of harm reduction, prevention, intervention, treatment, and recovery; committing to promoting equity and inclusion. The AMERSA BOD cannot achieve this alone. We invite our members to join us in building an inclusive, multidisciplinary professional society equitable for all. Please visit us at AMERSA.org

Holly Hagle, Ph.D. is an Assistant Research Professor at the Collaborative to Advance Health Services, at the University of Missouri-Kansas City’s School of Nursing and Health Studies. Dr. Hagle is a proven leader and educator with over 18 years’ experience developing educational programming, curricula for traditional face-to-face and online education, supervision of staff and consultants, and the management of multi-million dollar federal grant budgets. She is the Co-Director of the National Addiction Technology Transfer Center (ATTC) Network Coordinating Office (NCO) and Principal Investigator (PI) for the Prevention Technology Transfer Center (PTTC) NCO. In addition, she is the UMKC PI, and Co-Director on behalf of the ATTC Network for the Opioid State Targeted Response Technical Assistance (STR-TA) grant. Dr. Hagle has been actively working with medical and behavioral health providers for more than 20 years on the integration of behavioral health interventions, including educational programming on intercultural sensitivity. Her area of expertise is in adolescent co-occurring disorders, screening, brief intervention, and referral to treatment, and the application of evidence-based practices in community settings with a special focus on qualitative research methods.

Marlene Martin, MD, is an Assistant Clinical Professor at UCSF and a hospitalist at San Francisco General Hospital. She is driven to improve care for populations in the safety net.

Marlene was born and raised in Los Angeles and is a first-generation college graduate. She attended college and medical school at Stanford prior to completing Internal Medicine residency at UCSF. Her bilingual and bicultural Mexican immigrant background influenced her to serve socially oppressed populations.

Marlene is board certified in addiction medicine and founded and directs the Addiction Care Team, a novel interprofessional consult service that delivers compassionate, evidence-based care for hospitalized people with unhealthy substance use. She is interested in alcohol use disorders among LatinX populations as well as eliminating the inequities faced by persons with substance use disorders.

 

Dr. Miriam Komaromy is an addiction medicine physician who is medical director of the Grayken Center for Addiction at Boston Medical Center, where her work focuses on all aspects of substance use disorders and the intersection between addiction and health equity. In the past she led the development of the ECHO model for education of clinical teams about how to treat substance use disorders in primary care. She currently leads a federally-funded program studying the best way to treat co-occurring addiction and mental health disorders in primary care settings.

Change Project 911: Customers don’t notice improvements

Mat Roosa, LCSW-R
NIATx Coach

How do we know if a change is an improvement?

Change teams and change leaders ask this question frequently. It often refers to the measures and data they’re using to monitor change results.

But there is another and perhaps more meaningful way to ask this question: How do our customers know that a change is an improvement? 

The number one NIATx Principle asks us to understand and involve the customer. The most important way to involve customers is to make sure that they are experiencing the improvements resulting from a change.

Collecting quantitative data on the change is essential, but collecting qualitative data about the customer/client/ patient experience is also essential. For example, do the results of the change create a real impact that the customer feels? Does the change make the service process more satisfying, comfortable, or useful to the people we are trying to serve?  

Quality customer experience by design

Most of us try to gather customer feedback to help us to improve our services. Surveys and focus groups of service recipients can be excellent strategies for determining the impact of a change that we have implemented. Typically this feedback is gathered after the implementation to support efforts to improve a flawed process further. 

Wouldn’t it be better to design the process to ensure quality in the customer experience from the beginning? 

Wouldn’t it be better to gather customer experience data before developing change projects? 

The best way to ensure that the customer feels the change is to engage the customer on the front end of the change development process. So what can we do to ensure that we include the customer’s values from the beginning of the change process?

Include customers on the change team

“Nothing about us without us” has been a powerful refrain in the behavioral health peer recovery movement. These words underscore the importance of including people who are receiving services or support in all decisions related to that service. Perhaps the best way to do this in a change project is to include customers on the change team.  Many organizations that have adopted the NIATx model have found that a change team that consists of both service recipients and service providers generates change ideas with greater impact. 

Use the “So What?” test

The history of product design is filled with clever products that excited designers but left customers saying, "So what?” Again, if we return to the NIATx principle number one, we need to know and understand the customer to develop services or make service improvements that create a strong positive customer response. 

Use customer impact criteria to select a strategy

In the NIATx model, we often use Nominal Group Technique (NGT) to brainstorm change strategies to address our chosen aim. Typical NGT uses a simple return on investment criteria to select a strategy from the list generated: 

What is the level of resource required to implement the strategy, and what are the expected results? 

We can add to this criteria a question about customer impact to ensure that the selection process includes these critical elements: Which of these strategies will have the greatest desired impact on the customer's experience? As described above, including customers on the change team is a great way to ensure that the change project addresses customer values and priorities. In addition, customers participating in the NGT process will generate ideas that focus on customer experience. 

To believe that the customer is “always right” is to believe that the customer is the first and best source for improvement ideas. Regardless of the industry or service type, customers/ clients/ patients vote with their feet. If you engage customers in building and improving your service, they will keep coming back, and you will be able to deliver the services, care, and supports that will make a difference in their lives.  

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

About our Guest Blogger

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at matroosa@gmail.com.

AMERSA People & Passion, Episode 7: Palliative Care: Bridging the Gap for Addiction Treatment in People with Serious Illness

Substance Use Disorders are common in people with serious illness and contribute immensely to suffering and poor quality of life. People with addiction and serious illness are an underserved population with unmet and complex medical and psychosocial needs. In this episode, Palliative care clinicians will discuss the overlap between both fields, educational initiatives, patient cases, and innovative models of collaboration to bridge the gap.

 

Julie W. Childers, MD, graduated from the University of Pittsburgh School of Medicine in 2005 and completed residency training in internal medicine at the University of Rochester in 2008. She completed fellowship training in palliative care in 2009 and obtained a master’s degree in medical education in 2010. She began treating opioid use disorder in 2010, and in 2018 became board certified in Addiction Medicine. In addition to her work as a palliative care specialist, she attends on the inpatient Addiction Medicine Consult Service, has an active outpatient practice treating substance use disorders, and developed a new ACGME-accredited addiction medicine fellowship. She has written and taught nationally in the areas of teaching communication, motivational interviewing, medical ethics, and managing addiction in patients with serious illness.

Katie Fitzgerald Jones, BSN, MSN, APN, is a Palliative Nurse Practitioner at VA Boston Healthcare System and PhD student at Boston College Connell School of Nursing. Her clinical and research interests improve pain management, quality of life and enhance opioid safety in individuals with cancer and substance use disorder. Past clinical experience includes developing a sustainable Palliative Care Nurse Practitioner Fellowship at Dana Farber Cancer Institute and Brigham and Women’s Hospital, serving as the Palliative Nurse Director, and creating an innovative Palliative Care Program for older adults at Hebrew Senior Life. Ms. Jones has been an active member of the Palliative Care Academic Community. Over the past years has been an invited speaker at the Harvard Center for Palliative Care, the Harvard Inter-Professional Palliative Care, and the Harvard Geriatric Fellowship. Ms. Jones is a co-leader of the national hospice and palliative care buprenorphine clinical mentorship support group and research group. In her early research work- she has examined biopsychosocial factors associated with long-term opioid use in cancer survivors, parallels between Palliative Care and Substance Use Disorder Treatment, and Buprenorphine prescribing practices in Palliative Care clinicians. Her research is currently funded by the Foundation of Addiction Nursing and the National Institute of Nursing Research Predoctoral Fellowship Award (F31). She has authored several manuscripts and book chapters on the intersection between palliative care and substance use disorders and has spoken nationally on various related topics.

Dr. Janet Ho is a board-certified palliative medicine and addiction medicine physician at the University of California, San Francisco. She completed internal medicine training and chief residency at Yale, a masters in public health at Harvard, and fellowships in health services research, palliative care, and addiction medicine at Harvard, Dana Farber Cancer Institute, and Massachusetts General Hospital in Boston, MA. Her clinical and research interests lie at the intersection of serious illness, addiction, pain, and chronic cancer pain. Dr. Ho is dedicated to improving provider knowledge and confidence in primary palliative care and addiction medicine; improving disparate quality of life and care for patients with life-limiting serious illness and addiction; understanding the role of buprenorphine in palliative care; and challenging stigma against patients who use drugs. She has been invited to teach with the Harvard Center for Palliative Care, the Harvard Inter-professional Palliative care fellowship, the UCSF Division of hospital medicine, the UCSF palliative care fellowship, and has presented at several national conferences. She is a co-leader of the national buprenorphine peer mentorship support group for palliative and hospice providers and has contributed to several book chapters and manuscripts on addiction and serious illness.

AMERSA People & Passion, Episode 6: Leveraging Media and Medicine to Reduce Stigma and Improve Access to Addiction Treatment

The COVID-19 pandemic is distinct from other catastrophic events because of massive population exposure to ongoing trauma. Illness, death, loss, grief, job- and food-insecurity have led to increased substance use, return to use/relapse, overdose and death. In the face of widespread misinformation, accurate and engaging health messaging matters NOW more than ever. Health messaging should target stigma of SUD, myths about MAT/MOUD and stress reduction (without using alcohol/drugs) and other pandemic-related health issues. We also know that physician and other healthcare professionals' voices matter: amid the coronavirus pandemic, Americans have a high level of trust in their doctors. Media - traditional and social - are effective ways to educate and empower the public about key issues about SUD/addiction.

 

Dr Stefan G. Kertesz is a physician in internal medicine and addiction medicine with a long-term commitment to fostering better care for populations whose clinical care is affected by social challenges such as homelessness, and clinical concerns like chronic pain. He is currently a researcher and clinician at the Birmingham Veterans Affairs Medical Center and Professor at the University of Alabama at Birmingham. He has engaged in national advocacy on how changes in national policies on opioid prescribing affected the care of patients with long-term pain, recently winning the David Calkins award in Health Policy Advocacy from the Society of General Internal Medicine. He also is cohost of the podcast "On Becoming a Healer" with Dr. Saul Weiner.

Dr. Lipi Roy is an internal medicine and addiction medicine physician, keynote speaker and sought-after media medical commentator who has appeared on MSNBC, NBC News and CNN. A Forbes Contributor, she has been featured in The New York Times, Wall Street Journal and Boston Globe, and her articles have been published in STAT, Psychology Today and The Huffington Post. Dr. Roy currently serves as the Medical Director of COVID Isolation and Quarantine Sites at Housing Works in New York City. She also serves as clinical assistant professor at NYU Langone Health. Dr. Roy’s work spans academia, clinical medicine, media, homeless health, social and criminal justice and public speaking. As the former Chief of Addiction Medicine at Rikers Island, Dr. Roy oversaw substance use treatment and recovery services at the nation’s 2nd-largest jail complex. Dr. Roy completed her medical and master’s in public health degrees at Tulane University, followed by residency training in internal medicine at Duke University Medical Center. Follow Dr. Roy on Twitter, Instagram and YouTube.

AMERSA People & Passion, Episode 5: Are Peer Counselors the Missing Link in Addiction Care?

This episode of the AMERSA People & Passion podcast highlights peers in an acute care setting engaging with vulnerable patients suffering from active substance use disorder, with a focus on the intersection of lived experience, evidence-based treatment, and harm reduction strategies. Discussion centers around the safe space a peer creates in an environment that is traditionally unwelcoming toward populations encountering substance use disorders. Peers are the conduit to potentially change the trajectory of engagement during an emergency room visit.

Paul Bowman is an At Large member of the NIDA MA-HEALing Communities CAB. He serves as the HCS-MA national Steering Committee CAB representative. Paul has 30 years of experience working for the Commonwealth; he has lived experience, and he has been an advocate for people with substance use disorder (SUD) and stigma reduction. Paul has been the regional supervisor at the MA Department of Housing, served as the Chapter Director of MA National Alliance for Medication Assisted (NAMA) Recovery and NAMA Board of Directors member. Paul was Vice Chair of MA Department of Public Health’s Bureau of Substance Abuse Services (BSAS) Consumer Advisory Board. He is a Certified Methadone Advocate.

Colleen LaBelle, MSN, RN-BC, CARN is the Director of the OBAT TTA program and the founder and director of Boston Medical Center's OBAT Clinic. She also serves as the Program Director of many related projects, including two Opioid Addiction Treatment Extension for Community Healthcare Outcomes (ECHOs) at BMC. Ms. LaBelle has over 30 years of experience treating HIV and addiction and over a decade of experience advising health care organizations on incorporating addiction treatment into their programs. She is a member of the Massachusetts Board of Nursing and Governor Charlie Baker's Opioid Working Task Force. In recognition of her work to improve and expand treatments for patients with addiction, Colleen received the 2017 Betty Ford Award from the Association for Medical Education and Research in Substance Abuse (AMERSA) and the 2016 Lillian Carter Exemplary Acts in Nursing Award from Modern Healthcare and the Lillian Carter Center for Global Health & Social Responsibility at the Emory University School of Nursing, among many others. She also received an honorable mention for the Gage Award from America's Essential Hospitals in 2016. Ms. LaBelle is board certified in addiction nursing and pain management, and she earned both her BSN and MSN from Grand Canyon University, in addition to a Diploma in Nursing from St. Elizabeth's School of Nursing.

Nicole O’Donnell is a Certified Recovery Specialist, recognized by the Philadelphia Inquirer for excellence in patient care for her work at Penn Medicine’s Center for Addiction Medicine and Policy, which includes expansion of opiate use disorder treatment and engagement initiatives at Penn Presbyterian, Pennsylvania Hospital, and the Hospital of the University of Penn.

AMERSA People & Passion, Episode 4: A Path for Substance Use Disorder Content in the Education Setting

Join AMERSA and ATTC in celebrating a journey through AMERSA time with Marianne Marcus, in conversation with Sid Schnoll.

This podcast summarizes Dr. Marianne Marcus’ career as a nurse educator and researcher, and the role AMERSA played in developing her understanding of substance use disorders. Her career included sequential faculty positions in Herman H. Lehman College and Columbia University in New York and the University of Texas Health Science Center in Houston, Texas. A serendipitous opportunity to open a primary care clinic in a residential substance use treatment facility led her to increase substance use content in nursing curricula and research. She sought out the support of like-minded health care faculty through her involvement with AMERSA.

AMERSA People & Passion, Episode 3: Barriers to Treatment for Opioid Use Disorder: Why Aren’t Pharmacists Stocking Buprenorphine?

Patients with opioid use disorder must be able to obtain prescribed buprenorphine from a pharmacy promptly to reduce risk for a recurrence of use and subsequent morbidity and mortality. However, phone-based secret shopper surveys indicate many pharmacies do not consistently maintain an adequate stock of buprenorphine and qualitative surveys show some pharmacists refuse to dispense it altogether. The underlying reasons for this problem are complex and will require innovative collaborations between pharmacists, buprenorphine prescribers, policymakers, and other healthcare team members.

Jeffrey P. Bratberg, PharmD, Clinical Professor at the University of Rhode Island, studies community pharmacists' roles play regarding opioid safety, opioid overdose, harm reduction and opioid use disorders. He is a consultant or co-investigator on two federal grants, a randomized controlled trial of pharmacists’ use of a CPA to manage medications for opioid use disorder and a multi-state, randomized control trial testing the effectiveness of a pharmacist and pharmacy focused intervention to improve naloxone provision, nonprescription syringe access and buprenorphine dispensing in community pharmacies.

Lucas G. Hill, PharmD, BCPS, BCACP serves as PhARM Director, The University of Texas at Austin. Dr. Hill graduated from the UMKC School of Pharmacy and completed a combined residency/fellowship in the UPMC Department of Family Medicine. He is now a clinical assistant professor at The University of Texas at Austin College of Pharmacy where he founded the PhARM Program and led implementation of Operation Naloxone. Dr. Hill is the principal investigator for a five-year, $25 million TTOR grant which seeks to address the opioid crisis in Texas by educating health professionals and the public while conducting pragmatic research. 

Lindsey J. Loera, PharmD is a PhARM Fellow at The University of Texas at Austin. Dr. Loera graduated from The University of Texas at Austin College of Pharmacy and is currently completing a two-year fellowship with the PhARM Program. In this role, she will develop an innovative clinical pharmacy practice at an outpatient medical home for SUD and conducts statewide research exploring the pharmacist’s role in addiction treatment. She previously served as President of the Student Pharmacist Recovery Network and co-founded the Addiction Medicine Advanced Pharmacy Practice Experience.

Change Project 911: Help! How do we deal with change project interruptions?

Mat Roosa, LCSW-R
NIATx Coach

Maintaining forward momentum on top priorities

Once your team has developed a change project and you have strong executive support, it might seem like things should be smooth sailing. But there are a number of ways that a strong project can be blown off course.

Competing priorities

Before the 1900s, the word “priority” was only used in the singular. The logic seems clear: there can only be one most important element. During the last 100 years, we have grown to accept the notion of multiple priorities and have then focused on strategies to juggle them. Most of us keep adding new elements until we experience failure. We keep adding balls to our juggling effort until we start dropping them. 

You’ve probably heard the adage, “If everything is a priority, then nothing is a priority.” It speaks to one of the most important roles of  executive sponsors, as they help the team to maintain a focus on the critical priority activity(ies). With leadership help, your change team can work proactively to limit elements that are not true priorities and to focus the team energy where it counts: on mission-critical work.  

Maintaining momentum

Even with effective prioritization, new challenges can emerge that threaten the team’s focus. COVID 19, and all of the related stressors that systems have experienced because of it, are powerful examples of challenges to even the best priority planning. 

So how can a team maintain forward momentum when new priorities or crises emerge that challenge the change effort? When we coach teams that encounter these challenges, we sometimes think about the simple act of riding a bicycle. Strong forward motion creates a high level of stability to the change project. While slowing the project down reduces some project stability, maintaining some motion will ensure project health. The change project, like a bike, falls over when it stops moving forward.

Coaches, executive sponsors, and change leaders can work to ensure that, regardless of emerging priorities and challenges to momentum, the change project continues to move forward. Circumstances may require that the project slow down to accommodate challenges, but steady motion will maintain change project stability and progress.  

Staying Focused

Try these four practical strategies to help a team stay focused on top priorities and maintain forward motion:

1. Provide regular “focusing” messages from leadership. Executive sponsors can set the tone by regularly reminding staff about the critical functions and goals. Accountability to leadership regarding progress on these priorities will also ensure proper priority focus and forward momentum. 
   
   
2. Meet regularly. This is a simple and often-neglected fix. One of the ways that teams can maintain focus and momentum is to maintain a disciplined meeting schedule to address next steps and sustain a change project. 
   
   
3. Use a checklist and check in. Using a checklist can add structure to ensure that the team addresses the key priorities when they meet. A short list and a timed agenda will aid the team in moving each priority forward in each meeting and will avoid the stalling of momentum that occurs when items are neglected.
   
   
4. Create a data dashboard. Each priority project should be managed with a simple graph or table that reflects the project’s key measures. Gathering these graphs together in a central and accessible location provides a highly useful dashboard for monitoring activities —and a motivating visual display of change team progress.  

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

About our Guest Blogger

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at matroosa@gmail.com.

AMERSA People & Passion, Episode 2: Stigma – The Not So Silent Killer

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The use of alcohol and other drugs is rising in the United States in the setting of Covid-19. In the 12-month period ending in May 2020, more than 80,000 people in the U.S. lost their lives to a drug overdose, the highest number ever recorded in a single year. Substance use and addiction affect millions of people across the nation as healthcare systems work to create innovative solutions related to prevention, early identification, treatment and recovery. One major barrier to accomplishing this monumental goal is the stigma experienced by people with substance use disorders. Stigma creates feelings of shame, limits access to care, and ultimately contributes to challenging and life-threatening cycles of addiction. While we know how to define stigma and how it impacts individuals and families, how we eliminate stigma specifically in healthcare settings to improve care and outcomes is poorly understood. In this podcast, we will describe the many barriers stigma forces on people with substance use disorders and how healthcare can support people with substance use disorders.

Cheyenne Johnson is Saulteaux (Ojibwe) and of mixed Settler ancestry and is a member of the Tootinaowaziibeeng Treaty 4 Reserve (Valley River) in western Manitoba. She is a Registered Nurse who works in addiction and substance use care in Vancouver. She is currently a member at large with AMERSA and the Co-Interim Executive Director at British Columbia Centre on Substance Use and an Adjunct Professor at the School of Nursing at University of British Columbia and actively collaborates with interdisciplinary clinicians, educators and researchers across Canada.

Dr. Deborah S. Finnell is a doctorally-prepared registered nurse, certified in addictions nursing and a Fellow in the American Academy of Nursing. She is currently AMERSA’s President Elect, an Associate Editor for AMERSA’s journal Substance Abuse, and led the publication of AMERSA’s substance use competencies for nursing.

Dr. Finnell has been a staunch advocate for vulnerable populations, seeking to address the bias, prejudice and discrimination that leads to stigma. She is a coauthor of the seminal publication , “Confronting inadvertent stigma and pejorative language in addiction scholarship,” has published her plenary address at the 2018 AMERSA conference on the neural basis of stigma, and has evaluated the impact of a substance use-related curriculum on students’ attitudes and perceptions.

Richard Bottner, DHA, PA-C is an Assistant Professor in the Department of Internal Medicine at Dell Medical School at The University of Texas at Austin and a physician assistant in the Division of Hospital medicine at Dell Seton Medical Center.

Bottner is also the Director of Support Hospital Opioid Use Treatment (SHOUT) Texas, a program seeking to increase access to opioid use disorder treatment in hospitals across the state and is the Co-PI on a grant from the Association of American Medical Colleges to develop and disseminate the Reducing Stigma Education Tools (ReSET) modules.

Introducing the "AMERSA People & Passion" Podcast, Sponsored by the ATTC Network

AMERSA is proud to announce a new podcast exploring the world of substance use education, research, care and policy! AMERSA People & Passion is a 10-episode series sponsored by the ATTC Network and hosted by executive director Doreen Baeder, featuring subject matter experts across a variety of topics, as well as special guests detailing their experiences as AMERSA members.

You can listen to new episodes of the podcast every week, beginning with today's episode, "Screening and Brief Intervention, AMERSA, and What You Should Do." Rich Saitz, former AMERSA president, is interviewed by his colleague, friend, and former mentee Nic Bertholet. We find out about whether screening and brief intervention are effective, and what the controversy is. We also learn about the evidence, what research should still be done, what we should teach, what we should do in practice, and how it has loomed large at AMERSA. Rich also shares how great it is to be very involved with AMERSA based on his experience with the organization, the value of colleagues met and friends made there, and by thinking about what other areas of research, education and care AMERSA plays big roles in.

Richard Saitz, MD, MPH is professor and chair, Department of Community Health Sciences at Boston University School of Public Health, professor of medicine in the section of general internal medicine at Boston University School of Medicine, and a primary care physician and addiction medicine specialist at Boston Medical Center and the Grayken Center for Addiction. He is editor in chief of the journal of Addiction Medicine, associate editor of JAMA, and a past president of AMERSA.

Nicolas Bertholet, MD, MSc is an addiction psychiatry and prevention and public health specialist, he is senior lecturer at the University of Lausanne, Switzerland.

Change Project 911: When Your Rapid-cycle PDSA is not Working

Mat Roosa, LCSW-R
NIATx Coach

Rapid-Cycle Plan-Do-Study-ACT (PDSA) is a powerful tool for improvement that can enable a team or organization to achieve its short-term goals and move toward long-term success. But sometimes, PDSA change cycles do not yield the desired results.

Here are a few questions to consider when your change project does not achieve the goal.

What are the lessons learned from “failure”?

Rapid-Cycle PDSA has been called a “no-fail” method. The lessons learned from change that does not achieve the desired result can yield as much information as a highly successful change project. Finding out what does not work enables a team to avoid future investments in ineffective strategies and focus on efforts with a high return on investment.

Was the goal realistic?

We often recommend a “stretch goal” for a project that pushes the team toward a result that might seem unattainable. Stretch goals can energize a team toward greater achievement. However, sometimes a lack of information or an overabundance of enthusiasm can result in an unattainable goal. Recalibrating the goal toward a more realistic expectation can clarify the level of success the change achieved. 

What does the early data tell us?

Some change teams make the mistake of waiting until the “Study” phase of PDSA to look at the data collected. However, an initial review of the data during the “Do” phase may uncover the need to restructure the change or reconsider the data plan. These adjustments can rescue some change projects from heading too far in the wrong direction.

Are we experiencing unexpected variables?

Confounding variables can have a big impact on change project results. Teams should conduct some form of environmental scan to consider factors such as seasonal events, economic trends, political or social events, changes in staffing, or other variables affecting the people being served or the people providing the service.

Was our aim statement hypothesis correct?

Increase A from B to C by date D through strategy E.

Teams can consider a number of assumptions related to this equation when a change project is not yielding the desired results:

• Is E actually a primary driver of A? Perhaps other strategies will have a better impact on the thing that we are trying to change.

• Is C too high? See our discussion of realistic goals above.

• Do we need more time? An adjustment to D may allow the change to unfold in a manner that creates better understanding of the impact of the change, or achieves greater results.

• Is A the key indicator of success? Are we measuring the right thing? Maybe there are better ways to understand the impact of strategy E. Maybe we are having an effect on a different goal.

• Is our data source valid and reliable? Is our chosen measure giving us accurate information about the thing that we are seeking to change? Are all participants following the measuring and reporting process consistently? Sometimes participants in the data collection process have a different interpretation of the data collection rules. (Oh, I thought we were only counting attendance for people who showed up on time…etc.)   

Rapid-cycle change projects should always yield valuable results, even when they do not achieve the desired goal. Taking some time to consider the questions above will result in more reliable results that can serve as a compass to guide your ongoing change project journey.  

 

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

About our Guest Blogger

Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in quality improvement, organizational development and planning, and implementing evidence-based practices. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration. You can reach Mat (Change Project SOS) at matroosa@gmail.com.