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. 

 

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.