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.

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