ATTC's Pearls of Wisdom Podcast Series, Episode 4: The Next Decade (2023 and Beyond)

In celebration of the 30^th anniversary of the Addiction Technology Transfer Center Network, we're taking stock of where we've been, and looking ahead to where we are going. We invite you to listen to our Pearls of Wisdom podcast series. Each episode examines a different decade in our network's history, and features conversations with the people who shaped and are shaping the field. In this series, hosts Laurie Krom and Maxine Henry of the ATTC Network Coordinating Office will talk with ATTC staff – past and present – about the history, challenges, and evolution of the network.

Featured guests include: Nancy Roget, Mountain Plains ATTC co-director; Denna Vandersloot, Northwest ATTC co-director; Pat Stilen, former director of the Mid-America ATTC; Lonnetta Albright, former director of the Great Lakes ATTC; Maureen Nichols, South Southwest ATTC director; Todd Molfenter, Great Lakes ATTC co-director; Andrew Wilson, Central East ATTC co-director; Estela Besosa-Martinez, project coordinator of the Northeast and Caribbean ATTC in Puerto Rico; and Abby Roach-Moore, technology transfer specialist with the Opioid Response Network. 

In the fourth episode of our series, host and ATTC NCO co-director Maxine Henry talks with Andrew Wilson, Central East ATTC co-director, Estela Besosa-Martinez, project coordinator with the Northeast and Caribbean ATTC, and Abby Roach-Moore, technology transfer specialist with the Opioid Response Network (ORN), about what the next decade holds for the network and the field.

In the coming decade, Abby Roach-Moore said she expects to see harm reduction continue to be normalized as part of the continuum of care.

“Education is power, and that’s all harm reduction is,” she said. "You meet people where they are, but you're not going to leave them there."

Another area the panelists expect to see peer support specialists and people with lived experience making a significant impact and contribution to the work of the ATTC Network's mission.

“Peers are what was missing in this process of recovery,” Estela Besosa-Martinez said. "The clinician, or counselor, or social worker may possibly understand them, and have amazing tools to guide them... but the peer brings something that the clinician can't." 

Listen to the entire series here.

ATTC's Pearls of Wisdom Podcast Series, Episode 3: The Previous Decade (2013-2022)

 In celebration of the 30^th anniversary of the Addiction Technology Transfer Center Network, we're taking stock of where we've been, and looking ahead to where we are going. We invite you to listen to our Pearls of Wisdom podcast series. Each episode examines a different decade in our network's history, and features conversations with the people who shaped and are shaping the field. In this series, hosts Laurie Krom and Maxine Henry of the ATTC Network Coordinating Office will talk with ATTC staff – past and present – about the history, challenges, and evolution of the network.

Featured guests include: Nancy Roget, Mountain Plains ATTC co-director; Denna Vandersloot, Northwest ATTC co-director; Pat Stilen, former director of the Mid-America ATTC; Lonnetta Albright, former director of the Great Lakes ATTC; Maureen Nichols, South Southwest ATTC director; Todd Molfenter, Great Lakes ATTC co-director; Andrew Wilson, Central East ATTC co-director; Estela Besosa-Martinez, project coordinator of the Northeast and Caribbean ATTC in Puerto Rico; and Abby Roach-Moore, technology transfer specialist with the Opioid Response Network.

In the third episode of our series, host and ATTC NCO co-director Maxine Henry talks with Maureen Nichols, South Southwest ATTC director, and Todd Molfenter Great Lakes ATTC co-director, former executive director of the Great Lakes ATTC, about the growth and change of the network during its third decade.

Maureen Nichols joined the network in 2017, becoming director of the South Southwest ATTC in 2018.

She ne of the most significant challenges in the past decade has been the COVID-19 pandemic and its impact on the behavioral health workforce. One of the biggest changes has been the rapid rise in telehealth services. But an ongoing impact remains among the workforce. 

“There are many fewer people available to provide services in behavioral health then there were at the beginning of this decade that we're talking about," she said. "And that still continues to be a huge challenge for the field. And the folks that are still doing the work are struggling to fill the positions.”

Todd Molfenter became the co-director of the Great Lakes ATTC in 2018. He said a significant focus for the ATTC network during the previous decade has been the evolving opioid crisis in the U.S.

“There’s been a lot of focus around (Medications for Opioid Use Disorder), getting buprenorphine, injectable naltrexone out more… and creating access around that,” he said. “As that improved, the evidence-based practices really began to evolve, the TTC network has been able to really contribute a lot to.” 

Listen to the entire series here.

Empowering Change with NIATx: Expanding Peer Support Services in Wisconsin’s Comprehensive Community Services Program

 By Maureen Fitzgerald, Communications Manager, Great Lakes ATTC, MHTTC, and PTTC

Comprehensive Community Services (CCS) is a unique Wisconsin Department of Health Services (DHS) program designed to provide a wide range of community-based, recovery-oriented, and person-centered mental health and substance use disorder services to eligible individuals across the lifespan. The program, part of the DHS Division of Care and Treatment Services Bureau of Prevention Treatment and Recovery, works to help individuals with mental health and substance use challenges receive the care and support they need in their communities, rather than in institutional or residential settings.

CCS began in 2005 through an administrative rule and grew to include half of the state’s counties. To increase the use of CCS statewide, Wisconsin leadership changed the funding structure of the program and encouraged tribal nations and counties to work in regional models. In 2014, under the leadership of the BPTR Integrated Services Section Manager Kenya Bright, DHS started a statewide expansion. CCS now operates in 70 of Wisconsin's 72 counties and three tribal nations. CCS programs offer an array of 13 service components to over 15,000 individuals across the lifespan each year.

With this expansion winding down, CCS staff have shifted their focus towards enhancing the program's quality and stability as one of DHS’ few truly integrated behavioral health programs.

 “The Division of Care and Treatment Services has a history of collaborating with NIATx on quality and process improvement projects,” says CCS Coordinator Heather Carlson. “At the end of 2021, our Bureau of Prevention Treatment and Recovery colleagues with the Coordinated Services Teams (CST) Initiatives hosted a NIATx Change Leader Academy, which served as a nice reminder of the NIATx process and how it could be applied to our psychosocial services realm."

Heather is now leading a NIATx initiative with her fellow CCS coordinators Mike Van Sistine and Danielle Graham-Heine. Their goal is to increase the number of CCS programs providing certified peer specialist services.

Peer support services are an integral part of the CCS recovery-oriented model and person-centered care service array. They contribute to the overall well-being and recovery of individuals with mental health and substance use challenges by offering support, hope, and empowerment through peer relationships and shared experiences.

The change team

Kenya Bright serves as the executive sponsor for the CCS change team, with Heather and Mike serving as co-change leaders. Joining them on the team are Danielle Graham-Heine, BPTR peer coordinators Lynn Maday-Bigboy and Marguerit Galindo, and BPTR data specialist Laura Gebhardt. The team meets monthly, while the change leaders hold weekly meetings.

“We’ve also actively engaged other interested parties, including peer recovery workgroups, to build support at different levels within our division,” says Mike.

A system-level walk-through to define the big aim

Working with NIATx coach Scott Gatzke, the CCS change team recognized the need to adapt the NIATx walk-through exercise.

"Our team had to adopt a unique approach for our walk-through, given that we were assessing the CCS statewide system as a whole, rather than focusing on individual agencies," explains Mike. "To accomplish this, we leveraged the insights from our comprehensive annual survey. The survey consists of 71 questions administered to every CCS program and includes several questions pertaining to peer services.”

The 2022 survey showed that not all CCS programs were offering certified peer services, even in areas where state workforce data showed they were likely available. Thirty of the CCS certified programs did not use a certified peer specialist; of those, 27 appeared to have a certified peer specialist available in their county or tribe.

"This initial survey laid the groundwork for our change project," Mike explains. "To gain deeper insights into peer services, we decided to send out a focused survey to programs that do not presently provide peer services or that just began to offer them in 2022."

The team set a change project aim to increase the number of CCS programs offering certified peer specialist services in areas where those services appear to be available (based on 2022 workforce development data) from a baseline of 42 programs to a goal of 52 programs by December 31, 2024.

Change team strategy

"We've sent targeted surveys to 27 CCS programs that meet our change project's inclusion criteria: CCS programs that are not currently offering certified peer support services in areas where the services are available,” says Mike. “Our goal was to find out more about the specific hurdles they’re facing when it comes to offering certified peer specialist services.” Targeted surveys were also sent to six programs that began providing peer support services in 2022, to help gain insight into the factors that led them to provide these services.

The survey questions were designed to uncover whether the hurdles were related to a lack of awareness about the availability of peer support specialists, a misunderstanding of the potential roles these specialists can play, or if there were other barriers preventing them from providing these services.

 “One-third of respondents cited a lack of availability of peer support specialists in the area, which doesn’t align with some of our existing data,” adds Heather. Other reasons cited for not providing certified peer support services included a lack of knowledge or awareness about peer support specialists, perceived lack of need, challenges in sustaining peer services, and a lack of understanding about the certified peer specialist role.

NIATx Principle #1 in Action

The change team has organized a series of focus groups with CCS programs that completed the targeted surveys.  

“Information from the focus groups will further inform our discussions with our peer colleagues and CCS change team members to help us craft the initial interventions for our upcoming pilot phase,” adds Mike. “At the same time, we will also identify the 3-5 pilot programs where we can test these interventions.”

“The change team has done a great job in adapting the NIATx approach to a system level change goal,” says Scott Gatzke. “Their statewide walk-through using survey data and the follow-up focus groups are a great application of NIATx principle 1, “Understand and involve the customer,” he adds. “The focus groups also offer a unique opportunity to tap into customer insights on solutions that will help meet the change project goal.” 

New Framework Released to Reduce Opioid Overdose

By: HEAL Connections

The Opioid-Overdose Reduction Continuum of Care Approach (ORCCA): A Policymakers Guide to Implementing Evidence-Based Strategies that Address Opioid Overdose aims to help policymakers, communities and key stakeholders to develop comprehensive, multi-system strategies that address the opioid crisis. The science and evidence behind the framework was published in the Drug and Alcohol Dependence and outlines 19 essential evidence-based interventions to reduce opioid overdose deaths.

The 19 evidence-based interventions recommended in ORCCA across five domains include:

Prioritize Individuals at heightened risk for opioid overdose death: 

To prevent overdose deaths, a primary focus should be on reaching populations with the highest risk, especially those who do not currently engage in treatment or prevention services. Recommendations include:

●      Prioritize delivery of services to those who need them most in criminal legal settings and other venues

●      Implement field-based population detection methods

●      Use data sources to target intervention to those who need services

●      Engage individuals with lived experience in decision-making process

Opioid-Overdose Prevention and Naloxone Distribution (OEND) programs encompass training on recognizing and responding to overdoses, administering naloxone, and providing rescue kits. Recommendations include:

●      Implement active overdose education and naloxone distribution (OEND) programs for people who use opioids and their social networks

●      Implement active OEND at venues where overdoses are more likely to occur

●      Include passive OEND strategies

●      Build OEND capacity among first responders   

Enhance Delivery of Medications to Treat Opioid Use Disorder: 

Improved access to evidence-based Medications for Opioid Use Disorder (MOUD) significantly reduces the risk of overdose death. These medications stabilize brain chemistry, reduce opioid effects, and relieve cravings. Recommendations include:

●      Expand medications for opioid use disorder (MOUD) capacity in healthcare, criminal legal settings, and through telemedicine

●      Initiate on-site MOUD in community-based settings

●      Create linkage programs and protocols

●      Enhance MOUD engagement and retention

Remove Barriers to Critical Resources: 

Improving outcomes and treatment retention for individuals with OUD involves addressing the availability of external resources that support recovery and enhance treatment retention. Recommendations include:

●      Expand peer recovery support and peer services

●      Remove barriers to housing services

●      Expand transportation initiatives for patients with opioid use disorder (OUD)          

●      Address barriers to needed resources, including insurance coverage, food security, childcare, and employment

●      Remove barriers to supplemental behavioral health services 

Safer Opioid Prescribing, Dispensing, and Disposal Practices: 

These strategies aim to reduce excess opioid supply, prevent access by vulnerable individuals, and improve overall opioid prescribing safety. Recommendations include:

●      Ensure safer opioid prescribing

●      Implement safe and effective opioid disposal

The HEALing Communities Study, a multi-site research study, tested the impact of ORCCA, an integrated set of evidence-based practices across healthcare, behavioral health, justice, and other community-based settings. HEALing Communities is funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative®. To download the ORCCA Guide for Policymakers, click here.

HEAL Connections

The HEAL Connections Center was created by the NIH HEAL Initiative® to translate HEAL research into action. Learn more here.

ATTC's Pearls of Wisdom Podcast Series, Episode 2: The Second Decade (2003-2012)

In celebration of the 30^th anniversary of the Addiction Technology Transfer Center Network, we're taking stock of where we've been, and looking ahead to where we are going. We invite you to listen to our Pearls of Wisdom podcast series. Each episode examines a different decade in our network's history, and features conversations with the people who shaped and are shaping the field. In this series, hosts Laurie Krom and Maxine Henry of the ATTC Network Coordinating Office will talk with ATTC staff – past and present – about the history, challenges, and evolution of the network.

Featured guests include: Nancy Roget, Mountain Plains ATTC co-director; Denna Vandersloot, Northwest ATTC co-director; Pat Stilen, former director of the Mid-America ATTC; Lonnetta Albright, former director of the Great Lakes ATTC; Maureen Nichols, South Southwest ATTC director; Todd Molfenter, Great Lakes ATTC co-director; Andrew Wilson, Central East ATTC co-director; Estela Besosa-Martinez, project coordinator of the Northeast and Caribbean ATTC in Puerto Rico; and Abby Roach-Moore, technology transfer specialist with the Opioid Response Network.

In the second episode of our series, host and ATTC NCO co-director Laurie Krom talks with Pat Stilen, former director of the Mid-America ATTC, and Lonnetta Albright, former executive director of the Great Lakes ATTC, about the growth of the network during its second decade.

Lonnetta Albright spent 17 years as executive director of the Great Lakes ATTC, including the last five years as Principal Investigator. She is an executive director of the John Maxwell Leadership Certified Team.

In reviewing the impact of the ATTC Network during that timeframe, Albright emphasized the value of education and transformation provided by the network, particularly from its seminal product, The Change Book: A Blueprint for Technology Transfer.

“I think the greatest gift the ATTCs brought to the field, and continues to, is to tell the truth and give facts,” she said. “And I’m not just talking about evidence-based practices but helping people to think. So that Change Book… helped us articulate what technology transfer is all about.”

Pat Stilen first became familiar with the ATTCs as a consumer, when she was working for a managed care company, before becoming a consultant and then joining the network full-time when it was still known as “The Addiction Training Center.” She retired from Mid-America ATTC in March 2022.

For Stilen, one of the most significant contributions of the ATTC Network during that time period was creating and developing core competencies to help with professional development in treatment and recovery services.

“We were still struggling with competencies as substance use counselors,” she said. “So I really knew from a personal standpoint, having been a substance use counselor myself and then trying to do training, that we really needed those competencies. And that would not have happened without the ATTCs.”

Listen to the entire series here.