NIATx in New Places: Empowering Teams in Recovery Community Organizations with NIATx

 By Kris Kelly, PR COE and Great Lakes ATTC, MHTTC, PTTC Project Manager, and Maureen Fitzgerald, Great Lakes ATTC, MHTTC, and PTTC Communications Manager

For recovery advocate Kris Kelly, the NIATx model helps tackle a long-standing question: 

“How can we support grassroots recovery organizations that are typically underfunded, under resourced, but continuously over-delivering?”

Kris joined the team at the Great Lakes ATTC, MHTTC, and PTTC in 2018 as a project coordinator, bringing experience in helping people discover and maintain recovery as director of programs for the Minnesota Recovery Connection, Minnesota’s most longstanding recovery community organization (RCO). In 2020, she became the team lead for the Recovery Community Organization Capacity Building Arm of the Peer Recovery Center of Excellence (PR-CoE). 

After attending her first NIATx Change Leader Academy, Kris quickly saw the potential for NIATx tools to help RCOs drive positive change, improve processes, and empower individuals and teams. 

A group of smiling people standing in a circle with each person extending one hand into the center, overlapping each other's hands in an expression of camaraderie and celebration.

A tool for empowerment

For Kris, the true power of the NIATx approach lies in empowering teams.

“The NIATx approach doesn’t  involve an authority figure swooping in to do something for you,” adds Kris. “Instead, it teaches teams to use a process like flowcharting that helps them understand what it’s like to be a customer in their organization.The flowchart tool can uncover both the strengths in a process and surprises about what’s not working well—like asking someone the same question four times!”

The NIATx walk-through also helps teams understand the challenges people face when seeking services from an RCO. “The walk-through exercise is easy and approachable and makes complete sense once you give it a try,” adds Kris.

Another participatory process that RCOs find valuable is the Nominal Group Technique (NGT). “We can use the NGT in staff meetings to decide on practically anything,” comments Kris. “The NGT brings in all voices to decide on a way to move forward. This really aligns with the RCO philosophy.”

Validating lived experience

“RCOS are frequently staffed by people who come into the work because of their lived experiences navigating the confusing and complex system of care for people with substance use challenges,” explains Kris. “They come to the field with a passion to expand and change the available options and provide care that authentically meets the wants and needs of the recovery community.”

Many employees of RCOs come from outside the clinical addiction treatment field. While learning about the work of an RCO, people may be hesitant to bring forth their ideas.

"This is where NIATx steps in as an empowerment tool for people who may not yet see themselves as leaders and changemakers," says Kris. "It shows people that there is a process for trying out their ideas, and that it’s perfectly OK to abandon a change if it doesn’t work. In the end, you have some data that supports your reason for continuing with a change in a process.”

What’s more, says Kris, NIATx also mimics how recovery coaches work with people new to recovery.

"Recovery coaching can be similar to doing a flowchart of your life and doing a walk-through of your recovery journey," explains Kris. In recovery, we follow Plan-Do-Study-Act cycles, trying out different strategies and refining our approaches for example, finding a mutual support meeting that works best for you. A coach might tell someone to try one meeting for a few sessions, then decide to continue or try a different one that works better.”

Building the peer recovery support workforce

An exciting prospect for Kris is the potential impact of the NIATx model on the future of RCOs and the peer recovery workforce. 

“What really interests me is the idea of moving NIATx upstream,” says Kris. “By including NIATx in program planning, organizations can ensure that they assess whether a program is working as intended. It provides a way to constantly evaluate and improve upon initiatives.”

The PR CoE will provide two NIATx CLAs focused on recruitment, retention, and leadership in RCOs in the coming year.

“The field of peer support is rapidly evolving, and for RCOs seeking funding to embed peers, including the NIATx approach can make a winning proposal,” she adds. “NIATx provides a blueprint for incorporating peers into organizations and with a built-in tool for collecting valuable data to showcase the success of a project.”

Photo of Kris Kelly

Kris Kelly is a Project Manager for the Peer Recovery Center of Excellence and Great Lakes ATTC, MHTTC, and PTTC, at the University of Wisconsin–Madison,  and a subject matter expert on peer recovery support services. Kris has developed best practices for integrating peer recovery supports into a wide variety of systems and services.

ATTC/NIATx’s Top 10 Posts From Our First Decade

 Compiled by ATTC/NIATx staff and directors

This month marks a decade of partnership and collaboration between the ATTC Network and NIATx on our shared blog. In that time, we’ve published more than 300 articles, including multiple series, from the pearls of wisdom we’ve learned over the years, to all the many new places you can implement the NIATx process.

Together we have compiled a list of 10 of our favorite posts from the last 10 years.

November 2022: Embracing Change: Providing Program Specific Harm Reduction Technical Assistance

The goal of the Embracing Change series was to showcase the ways each of the regional and population-specific ATTCs had found to survive, adapt, and thrive during COVID-19.

June 2021: The Treatment Challenge in Jail Settings: Detox and Withdrawal or Continuing Medication?

The ATTC/NIATx blog is a place where we sometimes invite our friends and collaborators to share their thoughts on issues affecting our industry, like this guest editorial from the Justice Community Opioid Innovation Network (JCOIN).

July 2020: Addressing the Syndemic of Addiction, COVID-19, and Structural Racism by Strengthening the Workforce

Our Tech Transfer In Action series focused on ways the ATTC Network delivers to the communities we serve. This article looks at the syndemic approach deployed by the New England ATTC to address addiction, COVID-19, and structural racism.

May 2019: Great Lakes ATTC: Process Improvement Focus Helps Organizations Implement Evidence-Based Practices

“A fundamental tool in the Great Lakes ATTC’s effort to accelerate EPB implementation is the NIATx model, developed in 2003 as a demonstration project supported by the Robert Wood Johnson Foundation and SAMHSA… Since then, more than 50 peer-reviewed articles have documented the use of the NIATx model in adopting evidence-based practices in addiction treatment, mental health, HIV treatment, child welfare, criminal justice, and other human services settings.”

December 2018: Building Rural and Technology Literacy Skills

The Mountain Plains ATTC provides an update on its efforts to strengthen the behavioral health workforce in rural communities.

February 2017: PPW Project Echo: Building capacity to provide care for pregnant and postpartum women with substance use disorders

The ATTC Network often gets TA requests for materials and resources targeted to specific populations, like this effort to utilize Project ECHO to provide care for pregnant and postpartum women with substance use disorders.

June 2016: Are we leveraging digital technology in addiction treatment?

Then-NIATx director David H. Gustafson provides an update on their A-CHESS app, a smartphone app for recovery support.  

November 2015: A Seminal Study Asks: Should our paradigm for treatment be expanded? Are we doing enough?

Another guest post, this time from a quartet of researchers who published “An Interpretive Phenomenological Analysis of Secular, Spiritual, and Religious Pathways of Long-Term Addiction Recovery” in Alcoholism Treatment Quarterly. The study explores 64 shared themes over three distinct stages of recovery.

October 2014: Integrating SUD Services with Health Care: the ATTC Network's Role

Here’s a post about the ATTC Network’s role in integrating behavioral and physical health care services.

August 2013: Better Together: Welcome to the ATTC/NIATx Service Improvement Blog!

The post that started it all!

NIATx in New Places: Implementing MOUD Programming in Criminal Justice Settings

By: Jessica Vechinski, MSW, Client-Based Researcher & Project Manager, Justice Community Opioid Innovation Network (JCOIN),Center for Health Enhancement Systems Studies, UW–Madison, and Kristina Spannbauer, MA, Communications Specialist, Great Lakes ATTC, MHTTC, PTTC Center for Health Enhancement Systems Studies, UW–Madison

Coaching is a favored strategy for the implementation of medications for opioid use disorder (MOUD), yet research has not adequately tested or assessed coaching dosages and mediums for overall effectiveness, nor has coaching been widely used or studied within criminal justice settings (CJS).

The University of Wisconsin’s Center for Health Enhancement and Systems Studies (CHESS) in partnership with the Justice Community Opioid Innovation Network (JCOIN) funded by the National Institute on Drug Abuse (NIDA) was provided the opportunity to implement a pilot program and research study using the NIATx learning collaborative model within jails and community treatment provider sites around the country where recent policy mandates for the provision of MOUD have been handed down to jails. 

Illustrations of a buprenorphine molecule, a naltrexone molecule, and a methadone molecule. All are medications use to treat opioid use disorder.

Over the last three years, 50 sites in 14 states have participated in the study and utilized NIATx coaching in their jail systems. As of July 2023, 32 sites have completed the two-year study and the remaining 18 sites will be completing the study by January 2024.

In the initial steps of the pilot, a NIATx coach worked with each site to identify one or more process improvement aims to focus on during the 12-month intervention phase by flow-charting and conducting a walk-through of their MOUD processes. These steps not only provided NIATx coaches with a greater understanding of the operational environment of CJS, but a few reoccurring themes related to the existing barriers of offering MOUD treatment presented themselves. One theme was the stigmatization of providing MOUD to incarcerated individuals. This was a monumental barrier that needed to be addressed before any changes could effectively be made. Another predominant theme was that each correctional setting is a complex system with processes that are structured around standard operational procedures as well as guidance from multiple different key stakeholders—and there is often little direct correlation or communication between the two!

The Role of Stigma

The stigmatization of MOUD in CJS is the greatest barrier preventing many of the sites from implementing a successful MOUD program. For some sites, leadership was in support of MOUD; however, the staff was not, and protocols would be skipped. On the flip side, other sites would have medical teams pushing for change and the leadership would be resistant. These examples highlight the importance following the NIATx principles, because if staff and leadership are not on board with the MOUD programming, change cannot occur. This unique dynamic created the ultimate barrier for NIATx coaches and was ultimately addressed by dedicating multiple coaching sessions to educating staff and leadership about the benefits of MOUD and how MOUD programs improve CJS conditions and outcomes.

Interprofessional Communication Gaps

Conducting the CJS walkthroughs were “eye-opening” experiences for everyone involved. Sites asked a variety of different staff and stakeholders to describe their current processesfrom intake, to screening, to the administration of medication, and the warm-community handoff. For many of the sites, it was the first time their staff had sat down together and created a process flowchart based on input from a diverse cross-section of site staff and leadership, and they discovered that often the processes were not occurring as described by their team. The NIATx coaches used team coaching calls to help the participating sites improve gaps in communication that may be affecting the follow-through of their processes. As the study progressed, many of the sites commented on the helpfulness of the NIATx coaching calls in keeping them on track, bringing key players to the table, facilitating fruitful discussions, and maintaining accountability. There was also the added bonus of having a coach to guide them through MOUD process improvement! 

A doctor handing medication to a patient.

NIATx Keeps Evolving

This pilot program and study is not only testing the efficacy of the NIATx model in CJS, but also assessing the optimal amount of coaching needed to successfully implement or increase MOUD programming. Although the jails enjoyed the coaching calls, most of them stated that they wish they would have had more one-on-one coaching time. Some sites received four hours of coaching while others received twelve hours of coaching of the course of a year. Based on preliminary findings, there was a need for more communication between the sites and the coach. A small pilot is underway to develop and test a web based NIATx Coaching Extender Platform (CEP) that will allow asynchronous communication between the coach and jail staff. The platform will include a running agenda, all rapid-cycle PDSAs, MOUD data, a message board, and an "ask the expert" feature. All these features will include email and/or phone notifications so that communication can happen in a quick, timely matter.

We've learned so much from this unique and intensive pilot. Although the study has concluded for many of the participating sites, several of those facilities have continued their monthly team meetings and remain committed to maintaining MOUD programming in their facilities.

Want to learn more?

Read Jessica's 2021 blog post, The Treatment Challenge in Jail Settings: Detox and Withdrawal or Continuing Medication? for additional insight on JCOIN's research and the aims of this pilot program during the early stages of the study.

Discover additional evidence-based information about medications for OUD by downloading SAMHSA's TIP 63: Medications for Opioid Use Disorder.

Stay tuned for updates on the NIATx CEP next year!

Image of Jessica Vechinski

Jessica Vechinski is a member of Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin. She serves as a client-based researcher and project manager for a five-year study with the Justice Community Opioid Innovation Network (JCOIN), an initiative funded by NIDA/NIH. The study is testing the combination and dosages of two evidence-based strategies to implement or improve medications for opioid use disorder (MOUD) programming within justice settings around the country. You can reach Jessica at

ATTC & NIATx: After 10 years – Still Better Together!

By Todd Molfenter, director of Great Lakes ATTC & director, NIATx, Laurie Krom – ATTC NCO co-director, and Maxine Henry, ATTC NCO co-director

In August 2013, the ATTC Network and NIATx launched the ATTC/NIATx Service Improvement blog with a welcome post by Laurie Krom and Kim Johnson, aptly titled "Better Together." The inaugural post celebrated the ATTC Network and NIATx collaboration and shared vision for the behavioral health field. Ten years and more than 300 blog posts later, we’re even better together!

Our "Better Together" collaboration continues to evolve and grow. The ATTC Network was established 30 years ago to promote technology transfer and bridge the gap between research and real-world application. NIATx entered the scene 20 years ago, focused on evidence-based process improvement and systems change practice. The magical combination of technology transfer and process improvement has helped to fuel transformative change in prevention, treatment, and recovery practices—now more important than ever as we face the intersecting epidemics of HIV, hepatitis, substance use disorders, mental health issues, and pregnancy-related morbidity and mortality.

ATTC NIATx 10 year anniversary logo

The ATTC/NIATx approach that has emerged from combining technology transfer (or translational science), process improvement, and implementation science offers several guiding practices that can help tackle health challenges and drive the adoption of effective, evidence-based solutions:

1.      Identifying implementation brokers: Both NIATx and ATTC recognize the importance of key individuals in scaling up practices. The NIATx model includes the key roles of Executive Sponsor and Change Leader. The ATTC Network’s seminal product, The Change Book, also promotes the use of a Change Leader. These roles are implementation brokers. They can help accelerate the implementation process. For example, in implementing medications for opioid use disorder (MOUD), we’ve learned that payers, administrators, clinical champions, and recovery community leaders play integral roles.

2.      Translating knowledge: A key element of the ATTC Network’s Continuum of the Diffusion of an Innovation is translation. ATTC’s define translation as “explaining the essential elements and relevance of an innovation, then packaging it to facilitate dissemination.” Examples could include lay-language newsletter articles describing an innovation or training curricula. In the NIATx model, the voice of the customer highlights the importance of translating research into accessible, culturally responsive language for people outside the scientific community. Incorporating input from those receiving services has long been part of ATTC and NIATx practice, resulting in numerous products and technical assistance knowledge translations.

3.      Aligning implementation strategies: Leveraging implementation science, NIATx tools such as the PDSA cycle, and the practical experience of ATTCs, we understand the value of selecting strategies to enhance the implementation process. For example, in community health or criminal justice settings with multiple systems components, a learning collaborative with coaching may be the perfect solution for building MOUD capacity. In contrast, implementing Narcan distribution at ED discharge may require a less intensive strategy, such as step-by-step instructions provided in a quick podcast or YouTube video.

4.      Leveraging partners: Scaling up evidence-based practices requires collaboration and coordination. Our long-standing relationships with regional partners create effective channels for disseminating implementation products and services. For example, each ATTC Regional Center utilizes a robust Advisory Board comprised of key partners and SAMHSA and state officials.

As the ATTC Network and NIATx grow better together, we look forward to sharing our successes in the ATTC/NIATx Service Improvement Blog. Stay tuned for more inspiring stories as we shine a spotlight on the incredible innovations and achievements of our colleagues. Here's to another 10 years of transformative change as we address today’s most pressing healthcare challenges together. 

ATTC’s Pearls of Wisdom: Using the Science to Service Laboratory to bridge the gap between research and practice

 By Rosemarie Martin, PhD and Sara Becker, PhD, New England ATTC

The New England ATTC at the Center for Alcohol and Addiction Studies of Brown University has been continuously funded since the ATTC network’s inception in 1993. The mission of the Center for Alcohol and Addiction Studies is to promote the identification, prevention and effective treatment of addiction and its problems through research, education, training, and advocacy.  Having a home in a world-class addiction research center, the New England ATTC fills a unique niche that sets us apart. Our role as technical assistance purveyors, paired with our home in a center dedicated to advancing science, makes us ideally suited to advance the study of implementation science. We are well poised to close the lengthy gap between the development of research-based addiction health services and their adoption to clinical practice. 

The New England ATTC has leveraged our academic partnerships with community providers to improve the standard in the field for rolling out evidence-based practices (EBPs).  The centerpiece of the New England ATTC’s training efforts for the past two decades has been the Science to Service Laboratory. The SSL is a comprehensive, state-of-the-art multi-component implementation strategy that facilitates technology transfer. 

What is unique about the SSL is the inclusion of three key implementation strategies designed to better support the broad process of technology transfer: didactic workshop, performance feedback, and external facilitation. 

The SSL has strengthened the New England ATTC’s capacity for providing intensive technical assistance through ongoing immersive experiences that help infuse EBPs into real world settings.  As a result, the New England ATTC provides a higher proportion of intensive technical assistance relative to the rest of the network: a network-wide analysis in 2020 suggested that 4% of TTC events were classified as intensive technical assistance during COVID, whereas for the New England ATTC this proportion was 30% over the same time period. Early evaluation of the SSL showed that 96% of agencies that completed all of the SSL components ultimately adopted an EBP.

Using contingency management as test case, our ATTC first applied for funding in 2008 to evaluate the SSL strategy compared to the standard at the time, didactic workshop delivered by a national expert, Nancy Petry. 

We offered the SSL multi-component implementation strategy to seven opioid treatment programs within our region and compared that to 11 opioid treatment programs outside of our region that received a didactic workshop. Opioid treatment program staff in both conditions reported on their delivery of contingency management every two weeks for a year. We found that those organizations trained with the SSL model had higher odds of adoption (odds ratios up to times higher than the didactic workshop), higher speed of adoption, and higher overall frequency of adoption.

Still, we thought there was room for improvement. Could we help accelerate the uptake of contingency management in clinics?  Could we help sustain its use? We asked opioid treatment providers from 11 programs in our region how we could more effectively help them to integrate contingency management into their treatment approach and used their feedback to enhance the SSL. With R01 funding from the National Institute on Drug Abuse, our ATTC is partnering on a large-scale cluster randomized trial with 28 opioid treatment programs throughout the region to test our standard SSL strategy versus an enhanced SSL strategy that layers in provider incentives and external facilitation targeting sustainment. 

This five-year project is wrapping up and we are excited to share the results soon.

In the meantime, we are using the lessons learned to partner with the Rhode Island Department of Health to help them rollout contingency management to opioid treatment programs state-wide. Our SSL model has also informed the multi-component implementation strategy currently being used across California in their rollout of contingency management as a Medicaid-reimbursable service.

The SSL continues to evolve as we integrate new scientific findings in behavior change at both individual and organizational levels.  The science to service influence is bidirectional: we learn from scientific research to improve our technical assistance, and we learn from our work in the field providing technical assistance to improve our science.

In recent years, the most popular EBPs for which the New England ATTC receives intensive technical assistance requests include contingency management, motivational interviewing, and Screening, Brief Intervention, and Referral to Treatment. We look forward to continuing to apply the SSL to help organizations implement EBPs and improve the quality of care offered to persons with or in recovery from substance use disorders.

About the authors:

Rosemarie A. Martin, PhD, is Director of the New England ATTC.  Dr. Martin is an Associate Professor at the Center for Alcohol and Addiction Studies at  the BRown University School of Public Health.  

Sara J. Becker, PhD is Co-Director of New England ATTC.  Dr. Becker is the Inaugural Director of the Center for Dissemination and Implementation Science at the Northwestern Feinberg School of Medicine. 

NIATx in New Places: The International Impact of the NIATx Model: Ukrainian healthcare providers increase access to treatment during war

 By: Lynn Madden, PhD, MPA
       Kristina Spannbauer, Communications Specialist for Great Lakes ATTC, MHTTC, & PTTC

In 2003, the NIATx model was first used by 39 providers, each managing their own pilot project as part of the grant-funded Paths to Recovery and Strengthening Access to Treatment and Recovery programs. Dr. Lynn Madden and her team at the APT Foundation managed one of these pilot projects, and she has been a NIATx coach ever since. In honor of the 20th anniversary of NIATx, we asked Dr. Madden to share how NIATx has grown over the years and the impact it has had on an international scale.   

Thinking back to 2002 or 2003, when your organization first heard about NIATx, what inspired you to apply to be one of the first grantees?

I was at Acadia Hospital, which is a psychiatric hospital in Bangor, Maine that serves people for both substance use disorders and other mental health issues. We were at the beginning of what was clearly a growing issue with opioids and yet our substance use treatment programs were empty. So, when I saw the call for proposals, I thought, [NIATx] is exactly what we need to try to reduce waiting time, increase admissions, and ultimately increase continuation.

As it turned out, we were awarded the NIATx grant, and Dr. Dave Gustafson became our coach. In our first change project, our team's approach to reducing wait times was pretty straightforward — if someone qualifies for this program, just let them in. At the time, we had ample staff and resources, so we tried it and it really worked. Our waiting time decreased, and we had three times as many patients as we did before using NIATx.

I am personally highly invested in practical solutions, so within 12 months after I was introduced to this approach, I became a coach and consultant. I've been able to contribute to the development of NIATx as it has grown over time.  

Team members brainstorming by writing and sharing ideas on sticky notes.

It's pretty amazing how NIATx has evolved over the past two decades. Since you first became a NIATx coach and consultant, you've expanded the use of NIATx throughout the US and internationally, as well. What is it that allows this process to be so adaptable and successful in different environments?

One of the key ideas of NIATx is that you select an aim, and the aim is related to improving the customer's experience. It's not implementation for implementation's sake. There is also this amazing parallel process that I think is what fundamentally distinguishes NIATx from other kinds of implementation frameworks. That is the way NIATx allows us to improve service delivery and client outcomes while increasing the strategic advantage of the organization overall.

A NIATx change team is designed to include the voices, thoughts, and experiences of folks working at all levels of an organization as well as the needs of the customer. How has this concept translated when applying the model on a larger scale or in international settings?

We started working in Ukraine in 2014. I was requested to lead a NIDA grant funded NIATx collaborative of Ukrainian chief physicians and stakeholders representing communities across the country with the aim of addressing opioid use disorder. One of the first things we did was a series of nominal group technique exercises, which was something they had never done before. A key feature of the nominal group technique is everyone has a voice. Everyone has an opportunity to speak. The result of our team using the nominal group technique was that we were able to create a series of public health priorities related to the treatment of substance use disorders, and these priorities were shared with the Ministry of Health in Ukraine.

One of the most valuable long-term outcomes of this NIATx collaborative is the network of practice they built with each other and maintain to this day – even throughout the extreme challenges and widespread public health crises caused by the war in Ukraine. This group adopted NIATx tools. They used the findings from nominal group technique to focus their efforts. Thanks to their continued work, today approximately 70% of Ukrainians who use medications to treat opioid use disorders (MOUDs) have access to take-home medications. In 2014, before the initial NIATx change team convened and offered their recommendations to the Ministry of Health, the number of people with take-home MOUDs was zero.

We are still working with them, by the way. Something I would really like to share is that this collaboration of physicians has continued to increase the number of patients receiving treatment throughout the war. They go to work in places that are not very safe. None of them have stopped working unless their entire facility has been bombed, which has happened in a couple of places. In which case, they move to another part of the country, and they keep working. They consider providing their patients with the healthcare they need to be well as their national duty. That is an amazing demonstration of dedication and fortitude.

Do you have any final thoughts or advice you'd like to share?

Participating in that first NIATx grant and developing a working relationship with Dave Gustafson has profoundly impacted my life and career. I think he is a transformational person, and the NIATx model has been transformational to my professional experience and to those who I've coached since I first learned about it.

I also want to mention that I recently co-wrote a grant with some folks in Lima, Peru that is heavily focused on using NIATx in a learning collaborative setting. Lima was awesome, and it's exciting that we keep finding new opportunities to share this approach to process improvement with organizations and communities who are eager to make a difference.

Read more about Dr. Madden's work:

·       Collaborative learning and response to opioid misuse and HIV prevention in Ukraine during war (The Lancet Psychiatry, 2022)

·       Extending a lifeline to people with HIV and opioid use disorder during the war in Ukraine (The Lancet Public Health, 2022)

·       Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine (Journal of Substance Abuse Treatment, 2021)

·       The development and initial validation of the Russian version of the BASIS-24 (Addiction Science & Clinical Practice, 2022)

·       Using nominal group technique among clinical providers to identify barriers and prioritize solutions to scaling up opioid agonist therapies in Ukraine (International Journal of Drug Policy, 2017)

Lynn M. Madden, PhD, MPA

Dr. Lynn Madden
Dr. Madden’s work focuses on identifying treatment gaps in substance abuse/mental health treatment and improving both access to services and retention in treatment, with an emphasis on inclusion of marginalized persons and integration with primary care/treatment for infectious diseases such as HIV/AIDS and HCV. She is affiliated with Yale School of Medicine, Internal Medicine - AIDS. Since 2006, she has served as Chief Executive Officer of APT Foundation, a non-profit agency founded in 1970 by members of the Yale School of Medicine Department of Psychiatry.  Under her leadership, APT has grown from serving 1,300 persons to over 8,000 persons every year regardless of ability to pay.  Dr. Madden is also a consultant and NIATx Coach working throughout the United States since 2004, Ukraine since 2014, and Central Asia since 2021, specializing in improving treatment access and program outcomes through the use of implementation science frameworks.


Altice, F. L., Bromberg, D. J., Klepikov, A., Barzilay, E. J., Islam, Z., Dvoriak, S., ... & Madden, L. M. (2022). Collaborative learning and response to opioid misuse and HIV prevention in Ukraine during war. The Lancet Psychiatry9(11), 852-854.

Altice, F. L., Bromberg, D. J., Dvoriak, S., Meteliuk, A., Pykalo, I., Islam, Z., ... & Madden, L. M. (2022). Extending a lifeline to people with HIV and opioid use disorder during the war in Ukraine. The Lancet Public Health7(5), e482-e484.

Madden, L., Bojko, M. J., Farnum, S., Mazhnaya, A., Fomenko, T., Marcus, R., ... & Altice, F. L. (2017). Using nominal group technique among clinical providers to identify barriers and prioritize solutions to scaling up opioid agonist therapies in Ukraine. International Journal of Drug Policy49, 48-53.

Madden, L. M., Farnum, S. O., Bromberg, D. J., Barry, D. T., Mazhnaya, A., Fomenko, T., ... & Altice, F. L. (2022). The development and initial validation of the Russian version of the BASIS-24. Addiction science & Clinical Practice17(1), 65.

Meteliuk, A., de Leon, S. J. G., Madden, L. M., Pykalo, I., Fomenko, T., Filippovych, M., ... & Altice, F. L. (2021). Rapid transitional response to the COVID-19 pandemic by opioid agonist treatment programs in Ukraine. Journal of Substance Abuse Treatment121, 108164.

ATTC's Pearls of Wisdom: Saving Lives and Advancing Behavioral Health Equity, Diversity, & Inclusion

 By: Dr. Susie Villalobos, National Hispanic Latino Addiction Technology Transfer Center

SAMHSA Addiction Technology Transfer Centers

In the realm of behavioral health, access to effective treatment and support services is crucial for individuals facing mental health challenges or substance use disorders. The Substance Abuse and Mental Health Services Administration (SAMHSA) has taken significant strides in promoting behavioral health equity, diversity, and inclusion through its Addiction Technology Transfer Centers (ATTC). Let’s explore the vital work of SAMHSA ATTC, highlighting its efforts to save lives and foster a more inclusive and equitable approach to behavioral health.

The ATTC is a national network comprising 10 regional centers, and two national centers focused on specific populations – the American Indian/Alaska Native ATTC, and the National Hispanic and Latino ATTC. Each center is tasked with disseminating evidence-based practices and fostering workforce development in the field of substance use disorder treatment and recovery. 

ATTCs collaborate with various stakeholders, including treatment providers, policymakers, and community organizations, to improve the delivery and accessibility of behavioral health services.  The network also  recognizes that behavioral health disparities disproportionately affect marginalized communities. To address this issue, the centers prioritize initiatives aimed at achieving behavioral health equity. They focus on increasing access to care, reducing stigma, and improving cultural competence among service providers. 

By equipping professionals with the necessary knowledge and skills, the ATTCs contribute to reducing disparities and ensuring that all individuals, regardless of their background, receive equitable care.

Diversity and inclusion are vital components of effective behavioral health systems. The ATTC Network actively promotes these principles by fostering a culturally responsive approach. The centers work to create an environment that respects and embraces diverse perspectives, acknowledging the unique needs and experiences of individuals from various backgrounds. By facilitating cross-cultural understanding, the ATTCs empower providers to deliver person-centered care that accounts for cultural, linguistic, and other relevant factors.

National Hispanic/Latino ATTC

Recognizing that a one-size-fits-all approach may not be effective, the National Hispanic/Latino  ATTC provides tailored technical assistance to organizations and providers working with Hispanic/Latino populations. This assistance includes guidance, resources, and support to help these entities develop and implement culturally competent policies, practices, and programs. By addressing specific needs and challenges, the National Hispanic and Latino ATTC empowers organizations to enhance their services and improve outcomes for the communities they serve.

Our center places a strong emphasis on engaging community stakeholders, recognizing that collaboration and community involvement are essential for achieving behavioral health equity. We work closely with community-based organizations, advocacy groups, and grassroots initiatives to understand the unique needs and challenges faced by Hispanic/Latino communities. By fostering partnerships, our center ensures that our training and technical assistance efforts are informed by lived experiences and community insights.

A significant barrier to accessing behavioral health services for Hispanic/Latino individuals is language. To address this issue, the National Hispanic and Latino ATTC ensures that their training and technical assistance materials are available in multiple languages. We prioritize linguistic competence, providing resources and training in Spanish and other languages commonly spoken within the Hispanic/Latino population. This commitment to language access helps bridge the communication gap and ensures that individuals can access and understand the information and support they need.

Beacon of progress

Promoting behavioral health equity, diversity, and inclusion requires intentional efforts and dedicated initiatives. The National Hispanic and Latino ATTC serves as a beacon of progress in this regard. Through our comprehensive Training and Technical Assistance, we work tirelessly to empower behavioral health professionals, organizations, and community stakeholders to better understand and address the unique challenges faced by Hispanic/Latino communities. By prioritizing cultural competence, linguistic access, and community engagement, we actively contribute to the development of a more equitable and inclusive behavioral health landscape.

These efforts serve as an inspiration for the field, highlighting the transformative potential of training and technical assistance in creating lasting change. The National Hispanic and Latino ATTC has proudly served the SAMHSA network since 2019. During that short time have produced a two-day, in-person national conference with a 98% satisfaction rate from 320 participants, a National Hispanic Latino Executive Leadership Academy with a 95% graduation rate, the Latinos Con Voz podcast series found on Apple and Spotify, and countless toolkits, webinars, short videos and technical assistance activities.

The ATTC Network’s commitment to saving lives and advancing behavioral health equity, diversity, and inclusion is commendable. Through training, technical assistance, and collaborative partnerships, ATTCs empower providers to offer high-quality care that meets the needs of diverse populations. By prioritizing cultural competence and reducing disparities, our network plays a pivotal role in creating a more inclusive and equitable behavioral health system, where every individual can access the support, they need to thrive.

About the author:

Dr. Susie Villalobos
Dr. Susie Villalobos is the director of the National Latino Hispanic Addiction and Prevention Technology Transfer Centers. Before joining the National Latino Behavioral Health Association, Dr. Villalobos worked with academic institutions and non-profits as a public advocate and researcher by implementing and managing clinical and socio-behavioral studies/programs. Her expertise in working with local, state and federal agencies stems from her associations with CBOs focused on activities committed to focusing on health disparities among Latino populations living and working on the U.S. – Mexico Border. She is a 2020-2021 graduate from the National Hispanic Latino and National Latino Behavioral Health Leadership Academy. She is particularly passionate about tackling issues faced by Latino populations across, age, race, gender, and biographical location. Her federal grant management experience includes the implementation of the SAMHSA Strategic Prevention Framework to communities focused on substance use prevention efforts in the four states of California, Arizona, New Mexico, and Texas. Dr. Villalobos was trained at the BNI ART Institute at Boston University School of Public Health, to integrate and apply Screening, Brief, Intervention and Referral to Treatment (SBIRT) to Latino individuals presenting substance use risk behaviors in an emergency room setting delivered by promotores. Dr. Villalobos received her doctorate in Educational Administration and Leadership from the Department of Education at the University of Texas at El Paso, and a master’s degree in educational psychology from the Department of Education at the University of Texas at El Paso.

Watch: ATTC Network's 30th Anniversary Celebration

Since 1993, the vision of the ATTC Network has been to unify science, education and service to transform lives through evidence-based and promising treatment and recovery practices in a recovery-oriented system of care.

The ATTC Network is an international, multidisciplinary resource for professionals in the addictions treatment and recovery services field.

Established in 1993 by the Substance Abuse and Mental Health Services Administration (SAMHSA), the ATTC Network is comprised of 10 U.S.-based Centers, two national focus Area Centers, and a Network Coordinating Office. Together the Network serves the 50 U.S. states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the Pacific Islands of Guam, American Samoa, Palau, the Marshall Islands, Micronesia, and the Mariana Islands. 

On June 6, we celebrated our 30th anniversary with a special presentation, highlighted by remarks from SAMHSA Assistant Secretary, Dr. Miriam Delphin-Rittmon, and Dr. Yngvild Olsen, director for the Center for Substance Abuse Treatment (CSAT).

We invite you to watch the celebration here. 


ATTC 30th Anniversary Celebration from ATTC Network on Vimeo.

We've also pulled out a few special highlights from the celebration, including this special video featuring photos and memories from our three-decade history. 

ATTC - 30 Years of Memories from ATTC Network on Vimeo.

We'd also be remiss if we didn't share with you these special messages of thanks and encouragement from around our network. An organization is only as good as its people, and our team is filled with amazing, passionate folks who are committed to making a positive difference in the fields of addiction science, treatment and recovery. Thanks team for all that you do for us! 

ATTC - 30th Anniversary Messages from ATTC Network on Vimeo.

Help us keep the 30th Anniversary celebration rolling, all year long, by visiting our Pearls of Wisdom landing page on the ATTC Network website, with more videos, a timeline, and links to all our special content. 

ATTC's Pearls of Wisdom: Flipping the Classroom to Improve Intensive Technical Assistance Efforts

By Bryan Hartzler, PhD, director, Northwest ATTC, director/research associate professor, Addictions, Drug & Alcohol Institute (ADAI), University of Washington School of Medicine

A convergence of technological advances and pandemic influences has resulted in an influx of asynchronous learning resources, or products the health workforce access individually and experience at their own pace. Examples include online training programs, webinar recordings, podcast series, and clinical demonstration videos—all included in the on-demand resource library availed by Northwest ATTC.

Today’s busy workforce members prefer, if not expect, such learning resources to be accessible when, where, and how is most convenient to further their continuing professional education.

As the depicted activities indicate, asynchronous learning resources serve many functions. These include: promoting awareness of useful treatment and recovery practices; increasing didactic or applied knowledge about a given practice; fostering insights about its personal/organizational compatibility; and informing adoption decisions. Within SAMHSA’s tiered rubric for technical assistance (TA), these are most consistent in intent with basic or targeted TA. In contrast, intensive TA efforts facilitate systems-level changes at health organizations to support coordinated implementation of a new practice—only in very rare circumstances would asynchronous learning resources suffice.

The synchronous learning activities depicted below are common features of intensive TA efforts. Among the functions served are: exploring organizational fit and readiness for a new practice; customizing it to local needs and resources; fostering requisite clinical skills amongst staff for its delivery to clients; preparing local systems for coordinated implementation; offering feedback and trouble-shooting during implementation; and creating a sustainment plan. The field of implementation science continues to scientifically test the utility of specific strategies intended to serve such functions. 

The pragmatic approach of the Northwest ATTC, as described elsewhere1,2, is guided by the phased EPIS framework3 and flexibly bundles and sequence such strategies in intensive TA efforts with community partners.

How may asynchronous learning resources augment intensive TA? If paired with or integrated into synchronous learning activities, they enable one to ‘flip the classroom’4—an educational philosophy that communal learning is less effective via passive instruction methods (i.e, didactic lecture, persuasion) than active ones involving higher-order, applied tasks (i.e, case formulations, skills-training with behavioral rehearsal). A blended learning approach is the result, of which the following Northwest ATTC-involved examples included use of:

  • A recorded webinar describing the Healing of the Canoe, a substance use and mental health intervention for tribal youth that draws on strengths of community identity. Asynchronous webinar viewing by a targeted group of tribal community members provided conceptual orientation that informed their subsequent participation in a multiday training workshop and longitudinal implementation support activities whereby the intervention was tailored to and later implemented by particular tribal communities.
  • Episodes of the Talking to Change podcast series, selected for weekly asynchronous review by pre-service MSW students enrolled in a 10-week Motivational Interviewing (MI) course. Acquainted with this weekly background on applying MI to unique clinical challenges and populations, instructor-led classroom activities each week then focused on corresponding skills-training involving peer coaching and performance-based feedback.
  • Contingency Management for Healthcare Settings, an online training with modules for four common personnel strata in health settings (i.e., leadership, supervisory, direct-care, administrative support). Initial asynchronous module completion enabled building of foundational knowledge of CM principles, exposure to clinical demonstrations of several empirically-supported CM paradigms, and tailored material aimed at preparing each personnel group for future CM implementation. At addiction treatment settings, this preceded expert-led synchronous activities recognized as core ingredients of successful CM implementation—namely, engagement of setting leaders in a collaborative design process to customize CM programming, assembly of a local implementation team to prepare setting systems, a coaching-to-criterion process for clinical staff to document readiness to deliver CM programming, organizational consultation and trouble-shooting during initial implementation, and eventual participation in a Community of Practice.1

Beyond the appeal and convenience that asynchronous learning resources hold, they offer cost- effective and inclusive means of reaching workforce members who may otherwise be missed by our collective ATTC network efforts. With increasing demands for equitable workforce access to professional education and shrinking budgets available for its provision, there is much to be gained by expanding the situations and circumstances in which intensive TA efforts of the ATTC network embody a blended learning approach. Perhaps the aforementioned trio of examples may stimulate further innovative ideas for such expansion. Such innovation may just reflect the ATTC network’s best and brightest opportunities to accelerate the adoption and implementation of useful treatment and recovery practices among the addiction workforce.


1 Hartzler, B., Gray, K., Marx, M., Kirk-Lewis, K., Payne-Smith, K., & McIlveen, J.W. (in press). Implementing contingency management to address stimulant use. Journal of Substance Use & Addiction Treatment.

2 Hartzler, B. (in press). It’s time to broaden dissemination of cognitive-behavioral therapy for substance use disorders: Charting pathways to ascend the remaining mountainside. Clinical Psychology: Science and Practice.

3 Aarons, G. A., Hurlburt, M., & McCue Horwitz, S. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services, 38(1), 4–23.

4 Bergmann, J., & Sams, A. (2012). Flip your classroom: Reach every student in every class every day. Washington, DC: International Society for Technology in Education.