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. 

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 processes—from 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! 

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!

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 jvechinski@wisc.edu.

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.

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.