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

https://clinicaltrials.gov/ct2/show/NCT04524767

Sponsor:

Columbia University

Collaborator:

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.

SUD and Beyond: Schools Use NIATx To Improve Youth Suicide Prevention Efforts

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

The NIATx model for process improvement was initially based on the question: Could the strategies used to improve processes in manufacturing and other industries be used to improve services in other fields, such as in substance use disorder (SUD), mental health, and educational settings? For the past 20 years, many organizations from a diverse range of professional fields have successfully used NIATx to implement change and streamline work processes. One recent success story comes from an intensive technical assistance (ITA) learning collaborative, Building Capacity for Effective School-based Suicide Prevention, sponsored by the Great Lakes Mental Health Technology Transfer Center School-based Supplement (SB-MHTTC) and the American Foundation for Suicide Prevention.

October 13, 2021, was the official start date of the four-month ITA learning collaborative. Comprised of 12 participating school districts, the overarching aim of the project was to implement effective school-based suicide prevention efforts within the schools of each district. Many team projects focused on creating or revising suicide prevention policies, establishing protocol review schedules, creating suicide crisis manuals, and increasing staff awareness of suicide prevention policies. The incorporation of the NIATx Change Leader Academy curriculum within the prolonged learning collaborative training schedule allowed the districts more time to fully develop and implement their change projects according to NIATx principles.

Learning collaborative participants Susan Kennedy and Laura Vanderheyden of the Racine (WI) Unified School District reported that throughout the October 2021–January 2022 training schedule, they were able to complete a full inventory of their district’s current suicide prevention resources, create the first draft of their Response Manual for Suicidal Crisis, and establish sustainability best practices for using and reviewing newly integrated resources and protocols in their schools.

Ms. Kennedy and Ms. Vanderheyden recommend other schools and organizations use NIATx to make significant and lasting process improvements, commenting “[NIATx] helped define a direction and provide guidance on how to achieve our goal.”

For those interested in learning more about the Building Capacity for Effective School-based Suicide Prevention learning collaborative, additional testimonials and details from the participating districts’ final presentations will be shared in upcoming blog posts. In the meantime, check out the NIATx website to discover other success stories and learn how you can use NIATx in your own work.

A Glimpse of New York State’s Program to Address Hepatitis C and SUD

Public health officials in New York State have launched a new learning collaborative aiming to integrate Hepatitis C testing and treatment into Opioid Treatment Programs. 

One of the ATTC Network's products, Guide to Integrating HCV Services into Opioid Treatment Programs, played a key role in helping launch the collaborative.

Here's our Q&A with Mehvish Bhatti, project coordinator at the New York State Department of Health's Bureau of Hepatitis Health Care, on how the program started, and how the ATTC Network was able to help.

NY State Hep C Collaborative logo
Q.  Give us a brief overview of the new learning collaborative you are launching. What are the objectives? Timeline?

A. The New York State (NYS) Hepatitis C Learning Collaborative is a two-year initiative designed to build the capacity of substance use disorder (SUD) treatment programs to provide on-site HCV testing and linkage to care activities for clients living with hepatitis C. This will be accomplished through completion of an organizational readiness assessment to identify areas for tailored technical assistance and additional training that will be supplemented by monthly collaborative calls to discuss challenges, identify solutions, and share best practices and resources. Six SUD treatment programs have been selected to participate in the Collaborative. Each program will receive $50,000 each year for two years. The Collaborative began on April 1, 2022 and will end March 31, 2024.

Q. Why is the Learning Collaborative so important?

A. Hepatitis C is a major public health problem in the United States. Many people living with hepatitis C do not know their status. Hepatitis C can be cured. Many people with hepatitis C also have co-occurring SUDs. Among new hepatitis C cases reported in 2019, in NYS (excluding NYC) 72% of those with known risk factors reported injection drug use as a risk. The NYS Hepatitis C Elimination Plan identified people who use drugs and substance use disorder treatment programs as priority populations and settings in the work towards eliminating hepatitis C in NYS by 2030. Providing services to thousands of individuals in NYS each year, substance use disorder treatment programs are particularly well positioned to play an important role in eliminating HCV. A 2018 survey of the hepatitis C infrastructure in NYS SUD treatment programs found 60% of SUD treatment programs do not provide HCV testing onsite and only 8% offer HCV treatment onsite. This Collaborative will help prepare these programs to screen and diagnose people for hepatitis C and link them to curative treatment.

Q. Your office found the ATTC Network's Guide to Integrating HCV Services into Opioid Treatment Programs useful. How are you using that resource in this new venture?

A. The Guide to Integrating HCV Services into Opioid Treatment Programs provided us with helpful information that we used as a foundation for the resources created for the Collaborative. It served as a guide for the Organizational Readiness Assessment created to assess the readiness of the SUD treatment programs to integrate hepatitis C services. Furthermore, the components in the guide provided a strong foundation for us and will serve as a resource when providing technical assistance to the programs in the Collaborative. This guide will also be shared with our programs so they can use it as a resource when needed.

Q. Is this the first time NYSDOH has used an ATTC product? If so, how did you find it? If not, what other resources has ATTC provided that you found useful in your efforts?

A. ATTC has several useful Hepatitis C resources that have been used by NYSDOH staff and shared with community partners. The Motivational Interviewing to Address Hepatitis C resource was shared with trainers and curricular developers who are delivering Motivational Interviewing training for NYSDOH funded programs. HCV Snapshot: An Introduction to Hepatitis C for Health Care Professionals was disseminated by the NYS Technical Assistance Center for State Viral Hepatitis Coordinators – a 2007- 2015 CDC-funded project. SAMHSA’s TIP #53: Addressing Viral Hepatitis in People with Substance Use Disorders is a foundational document for working with SUD treatment programs and will be used for the Collaborative.

Mehvish Bhatti
Mehvish Bhatti is the Project Coordinator at the New York State Department of Health, Bureau of Hepatitis Health Care. She joined the Bureau in November 2021 to lead the HCV Learning Collaborative. 

Prior to joining the NYSDOH, Mehvish was the Public Health Planner at the Albany County Department of Health, Division of Emergency Preparedness. She has a Master’s in Public Health from the University of Albany.



Alcohol is STILL a Drug

April was first designated as Alcohol Awareness Month in 1987 to increase public awareness about the prevention and treatment of alcohol use disorder—which remains a tenacious public health concern in the U.S. 

For decades, substance use disorder (SUD) treatment focused on alcohol use disorder (Kinney, 2021). 

“Gradually, other substances such as freebase cocaine, crack cocaine, methamphetamines, heroin, oxycontin, and fentanyl surpassed alcohol as the primary focus,” said Mark Sanders, program manager for the Great Lakes ATTC, MHTTC, and PTTC. “We learned that SUD progresses much more quickly with these drugs than with alcohol. To use an analogy, ’Alcohol destroys your house slowly, like termites. Crack, methamphetamines, and heroin destroy your house quickly like a fire. Fire grabs everyone's attention!’" 

Thus, the media, the court system, the criminal justice system, the child welfare system, hospitals, and Hollywood shifted their attention from alcohol to other drugs, even as alcohol continued to kill 95,000 Americans every year, making it the third-leading preventable cause of death in the United States

Alcohol Awareness Month ribbon

Alcohol misuse often co-occurs with other SUD: a majority of individuals who die of opioid overdose are found to have alcohol in their system at the time of death (Hart, 2022). 

And recent data indicate that alcohol-related deaths increased 25 percent from 2019 to 2020. See the CNN news item: Alcohol-related deaths in the US spiked more than 25% in the first year of the pandemic, study shows

To shift the focus back to problem alcohol use, The Great Lakes ATTC, MHTTC, and PTTC launched the “Alcohol is STILL a Drug” webinar series to kick off Recovery Month in September 2021. 

“When we set about planning this series, we felt that it was important because alcohol, while still the most commonly abused substance, maybe less lethal in people's minds as other drugs take center stage,” said Laura Saunders, program manager for the Great Lakes ATTC, MHTTC, and PTTC. 

The 30-minute sessions air on the first Tuesday of the month at 10 a.m. CT. Series topics have included: 

View the “Alcohol is STILL a Drug” playlist on the Great Lakes Current YouTube Channel. 

Upcoming sessions include: 

Please join us in the months ahead as we continue to examine alcohol and its impact on individuals, families, and communities. 

Related Resources

SAMHSA

Talk, They Hear You: Underage drinking prevention campaign 

CDC 

Alcohol Use and Your Health 

NIAAA

NIAAA Alcohol Treatment Navigator 

Selected Resources from across the ATTC Network:

Great Lakes ATTC: 

Alcohol Awareness Card 

Infographic: Pharmacology for Treatment AUD 

Alcohol is STILL a DRUG YouTube Playlist

Mountain Plains ATTC 

National Hispanic and Latino ATTC

Alcohol Use and Abuse During Covid 19 (Available in English, Spanish, and Portuguese)

Northwest PTTC

References

Hart, C. Drug Use for Grown-Ups: Chasing Liberty in The Land of Fear. Penguin Books. (2022). New York, NY

Kinney, J. Loosening the Grip: A Handbook of Alcohol Information (Kindle Edition, 2021). Outskirts Press, Parker, Co.

About the author

Maureen Fitzgerald is communications manager for the Behavioral Health Excellence-Technical Assistance Center (BHE-TAC), based at the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. She also oversees communications activities for the Great Lakes ATTC, MHTTC, PTTC, and NIATx.

Five Obstacles to Providing Substance Use & Mental Health Services for Black Americans

Black people in the United States have rates of mental health conditions and substance use comparable to the general population. Yet outcomes for Black/African American people are poorer overall compared to the general population.

A recent study found that older Black men were dying of opioid overdose at a rate four times greater than the overall opioid overdose fatality rate. 

In partnership with the African American Behavioral Health Center of Excellence, the National Council for Mental Wellbeing has developed a white paper to assist with understanding the health disparities that exist in the access, engagement, utilization and outcomes for B/AAs seeking specialty mental health and substance use treatment services.

Located within the Morehouse School of Medicine’s National Center for Primary Care, the AABHCOE will use innovative, evidence-based, culturally aligned systems-change, workforce development, technology transfer and collaborative national partnerships to eliminate disparities and promote mental health and substance use treatment and health equity for African Americans. 

Five obstacles to providing substance use and mental health services for Black Americans report cover

The white paper focuses on five key findings that emerged from focus groups, as well as potential solutions. 

Challenges facing Black/African Americans in Mental Health/Substance Use Treatment:

1. Lack of Resources/Social Determinants of Health

2. System/Financial Barriers

3. Lack of Focus on Prevention and Education

4. Lack of staffing

5. Trauma

Lack of resources

“The B/AA community is disproportionately impacted by issues such as poverty, incarceration, transportation, underserved schools, environmental exposures, insurance coverage, adequate housing and other social determinants of health,” the white paper states. 

The lack of resources makes accessing and maintaining mental health and substance use services more difficult and lead to poorer outcomes. The effects can be even worse in rural areas.

The white paper suggests prioritizing building grant-writing infrastructure, as well as increasing use and capacity for telehealth services. It also proposes working with and embedding mental health and substance use providers in existing community organizations, like faith-based institutions.

System/Financial Barriers

“Structural barriers exist both in the financing of mental health and substance use services and the location of services which can have significant effects on access to care,” the white paper states. 

Solutions should include greater incentives for the provision of care in under-resourced communities, and expansion of substance use and mental health services in non-traditional settings.

Lack of focus on Prevention/Education

“The importance of prevention and early intervention before the exacerbation of symptoms was emphasized by all participants,” the white paper stated. “This lack of prevention and early intervention services can lead to B/AAs accessing care in in the most expensive and trauma inducing ways such as emergency rooms, hospitals and criminal justice settings.”

Solutions include prioritizing prevention and education efforts, as well as screening for mental and substance use challenges in non-traditional settings. Find out more information about the latest in prevention research and education at The Prevention Technology Transfer Center’s website.  

Lack of staffing

“The failure of service providers to bridge this cultural divide can contribute to discontinuation of treatment among B/AAs,” the white paper stated. “Engagement of patients during treatment can be a difficult task and the lack of well- trained professionals skilled in working with diverse populations certainly contributes to this problem.”

Solutions include increasing investments in recruiting and retaining B/AA providers in the mental health and substance use field, greater use of peer support specialists, and better supervision around cultural competencies.

Trauma

“Historical trauma and current-day injustice can affect perceived psychological safety in treatment and impact long-term recovery,” the white paper stated. “Addressing historical trauma was a solution mentioned during the interviews as many cited examples of racial trauma having detrimental psychological effects on people and their communities.”

Solutions include providing additional training on trauma-informed approaches to care, and utilizing family-centered treatment models. 

You can read the full white paper here. Additional resources and TTA may be obtained from the following organizations:

By Greg Grisolano, for the ATTC Network.

Recruit-Hire-Retain: Navigating COVID-19 staffing challenges in behavioral healthcare

Mat Roosa, LCSW-R
NIATx Coach

“Our program is fully staffed with a diverse and skilled team. Our team members usually stay for a long time, but when a staff member does leave, we are able to quickly hire a qualified replacement.”

How many of today’s leaders in behavioral health can make such a claim? 

Could this assertion become your reality in today’s challenging environment?

High demand for services, macro-economic factors, and staff burnout have left supervisors scrambling to fill open positions and pulling double shifts to cover the holes in the staffing schedule. I spoke recently with a residential program supervisor about these challenges, and she quietly began to cry over the futility of her daily efforts to deliver the care she felt so committed to providing. 

This personal toll on staff leads to the economic challenge of high-cost staff turnover, as systems spend resources on the constant cycle of hiring, training, and lost productivity. 

The NIATx Answer


For almost 20 years, behavioral health providers have used the NIATx model to tackle a wide array of challenges. Our signature training, The NIATx Change Leader Academy (CLA), has trained thousands of individuals to use NIATx tools to increase client access and retention, build cultural intelligence, strengthen peer recovery services, and adopt and implement evidence-based practices. 

In 2022, we are focusing the NIATx CLA training lens on special topics, including the COVID workforce challenge. 

The NIATx Change Leader Academy-COVID Workforce Challenges (March 8-29) will address the three core workforce challenges of staff recruitment, hiring, and retention. In addition, participants will learn how to develop change projects to test improvements related to key staffing questions:

1. What can we do to increase the number of eligible applicants who apply for positions?

2. How can we ensure that the desired candidates accept our employment offers?

3. What actions can we take that will increase the length of employee service? 

Join us!

The NIATx process improvement tools you’ll learn in the CLA work for any quality improvement needs. Many organizations report that simply engaging staff members on NIATx change teams—regardless of the change topic—helps retain staff. Team members experience increased job satisfaction and engagement with their peers as they work together to achieve measurable improvements in service delivery.  

Now is the time to explore how NIATx can aid your recruitment, hiring, and retention efforts. Join us to learn how to use rapid cycle PDSA testing to find the best staffing strategies for your organization.

Learn more and register for the NIATx Change Leader Academy Special Focus: COVID Workforce Challenges

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. Mat also serves as a local government planner in behavioral health in New York state. 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 at matroosa@gmail.com.


Change Project 911 In Review

Thank you for coming along on this Change Project 911 journey with Mat Roosa, the guest blogger for the series. Below you will find a list of all the Change Project 911 NIATx series with a short blurb. Select the title to read the full content of each blog.


Help! My Project is Dragging on Too Long

Posted December 29, 2020

Change projects are not meant to be open-ended. They’re meant to move quickly and efficiently to extract the maximum benefits. Dave Gustafson, who developed the NIATx model, recommends limiting change projects to no more than a few weeks. Some change projects can be completed successfully in as little as a day. If you find your team in the middle of a never-ending project, try to diagnose the root cause that’s derailing the project.
Any one of these underlying problems could make a change project drag on. . .


Help! My Change Team has lost its energy!

Posted February 10, 2021

Sometimes a change team can feel like a phone with only 2 percent battery life left. Some teams start with a full charge that drains through time. Other teams get started with a lower level of energy and go downhill from there. The challenge of COVID-19 and other competing priorities and stressors can quickly diminish a change team’s energy and divert attention from the change project. The fix. . .


Help! Our change project is unmanageable!

Posted March 15, 2021

Basket or cart?

It’s the first decision we usually make when we enter a large grocery store. When I am just buying a few items, I usually pick up a basket so that I can move more easily through the store. Often I find myself with a gallon of milk in one hand, an overflowing too heavy basket in the other, and wondering why I did not get a cart in the first place. So, what can we do to keep from overloading the process?. . .


What to Do When the Idea Well Has Run Dry

Posted April 8, 2021

Generating change ideas requires time and energy. Teams lose momentum when initial change efforts don’t succeed, and then struggle to develop option B (or C) to continue their improvement efforts. As teams attempt to move multiple priorities forward, they lose energy to exploring new ideas. Worst case scenario? They feel like just giving up and tolerating the problematic status quo.

So what is a busy team with limited resources to do? How can your team develop a new vision? The five ideas that follow can help organizations to generate new ideas to get the change process moving again. . .

 

The Incomplete Walk-through

Posted May 24, 2021

Understand and involve the customer.

This is the first and most important of the five NIATx principles. Much of our NIATx work involves working to understand the customer/client/patient experience—because the customer experience is the critical factor in all service delivery. Strategies to understand and involve the customer can include client interviews, focus groups, or including clients on a change team. . .


Counting what Counts: Addressing the challenge of incomplete data collection

Posted July 23, 2021 

“Help! We don’t know if our change is an improvement!”

At the foundation of all quality improvement work lies data.

Imagine driving down a twisty road at night and having your headlights turned off for a portion of the journey. That’s what happens when we try to manage a change project without consistent data access. It can be helpful to think about the data needed to steer a change in three stages:. . .


When Your Rapid-cycle PDSA is Not Working

Posted August 26, 2021 

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. . .


Help! How do we deal with change project interruptions?

Posted September 17, 2021

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. . .


Customers don’t notice improvements

Posted October 18, 2021

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? . . .


Unable to sustain a change

Posted November 19, 2021 

“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. . .


No Time for a Change Project: Finding Time vs. Making Choices

Posted January 3, 2022

Why do so many good change ideas end up at the bottom of the pile? Why do most teams struggle to find the time, energy, and people to implement change projects? Many teams are convinced that they cannot control the urgent needs, staffing and fiscal resource demands, and other obstacles that get in the way of change implementation.  This might be because they are asking the wrong question. . .


About our Guest Blogger

                                                 

Mat Roosa, LCSW-R 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.

Change Project 911: No Time for a Change Project: Finding Time vs. Making Choices

Mat Roosa, LCSW-R
NIATx Coach

“The change seems like a good idea, but we just don’t have the time to do it. Let’s come back to this next year when we have more resources."

No time for a change project:
Finding time vs. making choices

Why do so many good change ideas end up at the bottom of the pile? Why do most teams struggle to find the time, energy, and people to implement change projects? Many teams are convinced that they cannot control the urgent needs, staffing and fiscal resource demands, and other obstacles that get in the way of change implementation.  This might be because they are asking the wrong question.

 

Instead of asking, “Do we have the time to take on this new project?” teams and leaders should be asking, “Which projects should we choose?”.

 

While we may be short on time, we can choose how we’ll spend it. The four steps below can help you choose which project to pursue. Apply these strategies to both current and potential projects periodically to ensure that you create time for the critical projects and let go of the rest.  


  1. Consider the return on investment of a potential change project before implementing the change.
  2. Prioritize a manageable number of activities for action to ensure that you have the resources to complete the change project successfully.
  3. Cultivate urgency within your team to foster focus and action.
  4. Use tested practices to unite the team and sustain action to implement the project.

ROI: Understanding pros and cons and the value of the change

In keeping with a motivational Interviewing model, we are all ambivalent about most of our decisions. This includes decisions to invest in change projects. It can be helpful to use a decision balance exercise with your team regarding the pros and cons of moving forward with the change project. How valuable will this change project be for our team?

"Why should we do the change?" and "What will we lose if we fail to do this change?" balanced with "Why should we avoid the change?" and "What will we lose if we do the change?"


Priority: If everything is a priority, then nothing is a priority.

Once you have determined a strong ROI for completing a change, then you need to find a way to make it happen. Most of us have too many priorities and struggle to move them forward in a timely fashion. There are only so many projects that you and your team can complete successfully, and that number is probably smaller than you think it is. To succeed with a change implementation, we need to decide what we want to do. We also need to decide what needs to come off our list to ensure that the priority projects are completed.  


Urgency: the burning platform

Most of us, most of the time, have a bias toward the status quo. Unless there is a convincing reason to change, we tend to favor options that we know over those less familiar. Known things are more comfortable, even when they are not useful, or even dangerous. New and unknown things are stressful, even when they are likely to provide us with great benefits.

Change requires a felt sense of urgency. Many have used the story of the burning platform to understand the importance of urgency. Imagine that you are on a platform in the ocean, a mile from the shore. You are told that you need to jump into the water and swim to shore. You will likely hesitate and consider all the risks related to this swim. Will you be hurt jumping off the high platform? Can you swim that far? Is there a current? Are their sharks in the water? Etc.

Now imagine that the platform is on fire, and flames are spreading toward the edge where you stand. You may pause briefly, but then you will jump and do your best to swim toward the shore. 

The challenge of urgency is that most of us do not experience the clear danger of a burning platform. The need for change is rarely as obvious as when the window of opportunity to make beneficial changes has closed. Leaders need to understand the risks of inaction and the rewards for action and communicate these in a way that cultivates urgency for the team. Leaders should never “light a fire” to get their team to jump, but they need to be able to point to the obvious risks of inaction.  


Tested Practices: Do what works to find the time. 

Once you have found a project with a high ROI, and have cultivated urgency for this new priority, you are ready to implement the change. Effective team implementation requires that you:  

  • Collaborate with the team to harness the energy and skills of a diverse group. 
  • Delegate elements of the project to ensure team engagement and to spread responsibility so that the project is more manageable. 
  • Use existing infrastructures such as staff meetings and supervisory processes to steer the change project. This prevents the need to find additional time to work on the project. 

There is always time for the most valuable priorities. Hopefully these ideas will help you define priority changes and then take action to get them done.


Planning a change project in 2022? 

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.

Join an upcoming NIATx Change Leader Academy! View the complete 2022 NIATx Change Leader Academy Training Schedule.


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.