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.