ATTC’s Pearls of Wisdom: Innovative partnerships + hard work help tackle stimulant use in the Western U.S. & beyond

By: Beth A. Rutkowski, MPH, co-director, Pacific Southwest ATTC

I’ll never forget the first time we met Tom Donohoe back in spring 2004. Tom is a colleague from the UCLA Department of Family Medicine and Director of the LA Region of the HRSA-funded Pacific AIDS Education and Training Center (PAETC). UCLA Integrated Substance Abuse Programs had become the administrative home of the Pacific Southwest ATTC (PSATTC) in 2002, and many potential community partners were requesting meetings with us to see how we could collaborate and share PSATTC resources.

But Tom Donohoe was different. He said he had resources to share with us, and he meant it. This initial meeting marked the beginning of a nearly 20-year collaboration that has impacted thousands of HIV and SUD clinicians throughout Region 9 and beyond.

Tom Freese and I had been conducting dozens and dozens of trainings on methamphetamine throughout Region 9 (and beyond) and had established a recurring educational series called the California Addiction Training and Education Series (CATES). The first several rounds of CATES trainings focused on the many different facets of methamphetamine use. We had more material than we knew what to do with, and we were constantly updating our training slides to make sure we were teaching others the latest science-based information for providing services to people who used methamphetamine.

Similar to the PSATTC, the PAETC had been working to develop training curricula and resources on the topic, and when Tom Donohoe received supplemental funding through the PAETC to work on the U.S./Mexico border, he immediately contacted us to help conduct needs assessments and deliver trainings. The first series we co-sponsored was “HIV, Methamphetamine, and Women along the U.S.-Mexico Border.”

A few years after the PAETC and PSATTC initiated the U.S./Mexico Border Training Series, we were encouraged to expand our partnership to encompass the other Region 9 Federal Training Centers, including the Curry International Tuberculosis Center, California STD/HIV Prevention Training Center, and Cardea Services. The resulting product was the development and delivery of multiple one- and two-day training events focused on the treatment of HIV, STDs, TB, Hepatitis C, family planning, and substance use. Each event also featured simultaneous English/Spanish translation. All were held along the U.S./Mexico Border in California, Arizona, and New Mexico. In each of these endeavors, the focus was on the provision of high quality, up-to-date data, and best practices on how to treat people with HIV, TB, STIs, and substance use. We made a lot of amazing friends along the process, and trained hundreds of clinicians.

Traveling and training with the PAETC and PSATTC faculty not only improved our respective knowledge of substance use disorders and HIV, but it helped us all sharpen our skills as trainers and content developers. We were cross training each other as much as the bi-national participants who came to our trainings. In addition, the four-city tour of the border was fun. Often, the events that most shape us as trainers are learning and having fun with other experts in our respective priority areas. One of the most impactful results was the development of a “Methamphetamine TIP sheet” for HIV clinicians. The tip sheet has been revised a few times over the years, and is one of the most downloaded products from the AETC National Resource Center website.

Flash forward to 2019, when the ATTC Network received a request from SAMHSA leadership to establish a national workgroup on stimulants. While so much recent attention had been focused on the opioid epidemic that was killing Americans at record rates, drug poisoning deaths related to cocaine and methamphetamine were on the rise, as well. It was only natural for me and Tom Freese to volunteer to co-chair the newly established work group, and we were lucky to have Jeanne Pulvermacher agree to be our third co-chair. Little did we know in fall 2019 that a global pandemic was on the horizon that would challenge us to adapt our in-progress curriculum development efforts and pivot to create a national product that would be immediately useful to the SUD treatment and Recovery workforce and not sit on a shelf in someone’s office waiting for the return to in-person training.

The Stimulant 101 National Core Curriculum is a comprehensive set of training materials focused on the latest evidence related to the impact of stimulants on brain and behavior and best practice approaches for effective treatment and recovery. More than 50 ATTC-affiliated trainers participated in a modified training of trainers process in summer 2020, and to this day, these trainers are delivering the curriculum around the country. The National Core Curriculum features the following components:

• Daylong Face-to-Face Curriculum (with a fully articulated Trainer Guide & Reference List)
• Three-Hour Live Virtual Overview
• 70-minute Keynote Presentation
• Seven Supplemental Video Modules and Reference Lists
• Considerations for Families in the Child Welfare System Affected by Stimulant Use
• Gender Differences and Stimulant Use
• Methamphetamine Use and HIV among Men Who Have Sex with Men
• Polysubstance Use among Stimulant Users
• Overview of Recovery and Recovery Supports
• Stimulant Use in Rural and Remote Areas
• Stimulants and HIV
• Three Video Cultural Modules and Reference Lists
• Stimulant Use among African Americans
• Stimulant Use among the Latinx Population
• Stimulant Use among the American Indian and Alaska Native Population

The stimulant-focused work that we’ve had the privilege and honor of conducting through the PSATTC, and by extension, through our partnership with the PAETC represents one of the most challenging and fulfilling experiences of my career. This experience has taught me that you should never say no when someone new reaches out to you with an idea to collaborate, because who knows, that initial conversation can blossom into a decades long innovative partnership, with a lot of hard work making a huge difference in the quality of training/TA services provided to the community-at-large.

NIATx in New Places: Building Capacity for Effective School-Based Suicide Prevention

 By: Maureen Fitzgerald and Sarah McMinn

Sarah McMinn, LCSW, joined the Great Lakes MHTTC team in 2018 to lead the School-Based Mental Health Supplement. In her previous work as clinical program manager for a Colorado agency, Sarah had worked with homeless families and mental health clinicians. She had also helped launch a family and child clinical program at the agency’s early childhood education center. Sarah grew up in Madison, Wisconsin, and earned her undergraduate and graduate degrees at UW–Madison. The school-based mental health program manager position was an ideal match for Sarah's skills and background, with the bonus of being based at her alma mater. 

During the first year of the supplement, Sarah’s work focused on training and promoting school-based mental health across the Great Lakes region (HHS Region 5: IL, IN, MI, MN, OH, and WI) and launching the best practice modules developed by the MHTTC Network. In addition, Sarah organized a suicide prevention learning collaborative with suicide prevention expert Tandra Rutledge. 

“School-based mental health gained additional attention as a national issue in spring 2020 with the advent of COVID as school-based mental health providers struggled to meet their students’ needs,” comments Sarah. “We recognized that schools have a lot of resources and information on suicide prevention but lacked a concrete set of guidelines on how and where to start implementing those policies and procedures.”

The NIATx model offered a potential solution to meet this need. “We recognized that NIATx could provide a simple framework to help guide school districts that needed to update and implement their suicide prevention policies.”  

Identifying gaps

Sarah and Tandra, with assistance from NIATx coaches Scott Gatzke and Mat Roosa, developed an intensive learning collaborative that was structured around the NIATx Change Leader Academy (CLA). Schools and school districts applied to participate in the initial learning collaborative, and it was so successful that it has been repeated with a new cohort.

“To date, we have worked with 28 school districts across two cohorts embedding the NIATx CLA into intensive technical assistance efforts,” says Sarah.

Two NIATx tools that helped participating schools immediately were the walk-through and rapid-cycle PDSA testing.  

“For a lot of our schools, doing the walk-through as an eye-opener,” adds Sarah.

“The walk-through allowed schools to determine how new staff were introduced to, trained on, and kept updated on current suicide prevention policies and procedures at the school,” explains Sarah. “It allowed them to find the gaps in knowledge and training that needed to be addressed to have fully available and implemented suicide prevention strategies.

For example, one school did a walk-through as a new employee was called upon to help a student expressing suicidal ideation. The change team went through the process step-by-step to identify the resources a person would need and who they would need to contact to get the whole picture of what's required to appropriately respond to a student in crisis. The walk-through helped identify where additional training and directive was needed so that both current and new staff were better prepared.

The NIATx flowcharting tool helped another school’s change team identify the need to create a suicide crisis team. “They used flowcharting to determine what needs to happen from start to finish to create safety for the student, the provider, and the school," says Sarah. "This exercise also identified gaps in school staffing that community stakeholders could fill. As a result, they're now drafting a manual for prevention, intervention, and postvention."

NIATx: Easily adaptable to school settings

The school-based NIATx CLAs identified three areas where change teams can focus their efforts: 

• Increasing staff awareness of the district suicide prevention protocol 
• Increasing the use of a universal screener 
• Increasing number of staff trained in suicide prevention training (QPR, ACT, ASIST, etc.)

In addition, the CLAs have demonstrated how the NIATx approach can benefit school settings.

“Educators, student support staff, and school administrators are busy. They often have little time to commit to projects outside of immediate student needs and educational requirements. Furthermore, they often must weave through heavy bureaucracy to make significant changes. The NIATx process gives education teams the opportunity to identify a problem and try small, measurable changes quickly so they can support students efficiently. It also gives them data to show leaders that small changes building upon one another are necessary, important, and have the potential to create significant change.”

About the trainers

Sarah McMinn, LCSW is a program manager for the Great Lakes MHTTC in Madison, WI, part of a national network of SAMHSA technical assistance centers. She is responsible for coordinating training and TA to enhance the implementation of school-based mental health programming. Previously, Sarah was a therapist, clinical supervisor, and program manager working with homeless families and developing mental health services at an ECE and after-school program. She holds an MSW from UW-Madison.

Tandra M. Rutledge is a mental health and suicide prevention educator, advocate, and consultant. She is currently the Director of Healthcare Systems Initiatives for Project 2025, a national initiative of the American Foundation of Suicide Prevention to reduce the suicide rate by 20% by the year 2025. Tandra provides subject matter expertise on the Great  Lakes MHTTC school-based suicide prevention intensive technical assistance and has helped pilot the school-based NIATx Change Leader Academies.

ATTC's Pearls of Wisdom: Driving Integrated Knowledge Transfer and Implementation Via Collaboration

 By Oscar Morgan, Central East ATTC

Since joining the Addiction Technology Transfer Center (ATTC) Network in 2001, the Central East ATTC has endeavored to provide training and technical assistance (T/TA) that includes promoting gender, racial, sexual orientation equity, and cultural considerations. In addition to influencing people's experiences in the behavioral health system, these diverse identity markers also contribute to understanding the value of each individual.

We provide T/TA on evidence-based and promising practices for prevention, treatment, and recovery support services to substance misuse professionals and others in HHS Region 3 (Delaware, Maryland, Pennsylvania, Virginia, West Virginia, and the District of Columbia) according to identified regional needs. We use proven technology transfer strategies and practices to heighten awareness, disseminate information and promote the adoption and implementation of evidence-based practices that address substance use/misuse in real-time.

Methods include: 

• skills-based training; 
• targeted and intensive technical assistance; 
• development of handouts, guides, and toolkits; and 
• both virtual and in-person training.

Our center serves as a resource to collect, store, disseminate, and implement substance misuse disorders evidenced-based practices that emphasize a public health approach. The bedrock of our T/TA is the recognition that recovery is a process involving person-centered care, which improves health, and wellness resulting in an individual’s ability to thrive in communities of their choice. Our T/TA approach also recognizes the multi-faceted nature of substance misuse and the myriad of individual, social and environmental factors that influence substance misuse.

Throughout our history, we have prioritized collaboration as a crucial component of our mission to strengthen the capability, skills, and knowledge of professionals in substance use disorder treatment and recovery as well as the public health workforce as a whole in HHS Region 3. We engage with researchers, subject matter experts, behavioral health professionals and organizations, state and local behavioral health authorities, universities, consumers, peers, families, veterans and members of the military, community coalitions, social service groups, faith-based organizations, ethnic-minority-specific organizations, LGBTQ+ serving organizations, and other stakeholders.

A unique collaboration for our Center is with the Mid-AtlanticTraining Collaborative for Health and Human Services (MATCHHS), managed by the Office of Regional Operations- Region III. MATCHHS is composed of the HHS-Region 3-funded training and technical assistance centers with complementary missions. The Central East ATTC role within this collaborative is to ensure that the needs of people with substance misuse, substance use disorder or other behavioral health disorders are addressed in every health and human service setting through the implementation of evidence-based practices.

MATCHHS works to strengthen the capabilities of the public health workforce to support delivering high-quality services throughout our region. Collectively, we employ evidence-based and promising practices and data-informed solutions that focus on the adverse interactions between social conditions and diseases.  This fosters a better understanding of substance misuse prevention, treatment, and recovery.

Together, we work to reimagine, transform, and sustain health and human service systems in an equitable manner so that the needs of individuals with substance misuse and/or other behavioral health disorders in our region are met. Under the integration of behavioral health care into the public health system, we have trained over 8,100 providers.

About the author:

Oscar Morgan has more than 35 years of experience working with state behavioral health systems, organizations, and treatment practitioners. He has dedicated his work to strengthening their capacity,  skills, and knowledge in providing integrated culturally and linguistically competent behavioral health prevention, treatment, and recovery support services for children, youth, and adults who have and/or at-risk of developing serious emotional disturbances/serious mental illnesses and co-occurring substance use disorders. He is the project director of the HHS Region 3, Mental Health Technology Transfer Center, Prevention Technology Transfer Center, and the executive director of The Danya Institute, Silver Spring, MD.  Mr. Morgan is a former mental health commissioner for the state of Maryland. He has held senior-level management positions in a variety of state and national behavioral health organizations.  He obtained his Bachelors of Arts degree from the University of Colorado Boulder and Master’s Degree in Health Care Services Administration from George Washington University, Washington, D.C.