Workplace Learning: Helping Practitioners Work Wiser

Nancy Roget, Joyce Hartje & Terra Hamblin 

CASAT, University of Nevada Reno 

Pacific Southwest ATTC

After 25 years of conducting training workshops, translating research into bite-size pieces for curricula or stand-alone products, and creating opportunities for performance feedback to enhance skill development, the Addiction Technology Transfer Centers (ATTCs) are ‘upping their game’ to offer novel training/technical assistance (TA) options that include multiple learning components in new delivery formats focused on changing practices. ^{1, 2, 3} Leading these efforts in 2017-2018, the Pacific Southwest ATTC, which includes three partnering institutions: University of California at Los Angeles (UCLA); University of Nevada Reno (UNR); and Arizona State University (ASU), recently began implementing new training models for workforce development. Specifically, the Pacific Southwest ATTC based its new model on two of the principles derived from the work of Flexner⁴ and others ⁵:

1. Learning is competency-based and embedded in the workplace
2. All workers learn; all learners work

Typically, training for behavioral health professionals and recovery support specialists has been conducted offsite with staff traveling to the learning event (e.g., workshop or conference) rather than embedded within the workplace. While many behavioral health practitioners liked being out of the office to receive training, administrators frequently complained about loss of revenue (billable hours), which is a valid concern especially with many more complex EBPs requiring three- and four-day training events. Unfortunately, administrators used this rationale in some instances to decrease the amount of training practitioners could attend. However, limiting or eliminating training paid for by organizations in order to reduce costs and increase revenue is not a viable answer since training/TA can enhance the quality of service delivery and improve client-level outcomes. Workplace-embedded training is feasible and, like all ATTC-sponsored training, competency-based.

In 2018, the Pacific Southwest ATTC piloted several sequenced learning events delivered online during regular work hours over an extended period of time (4 to 8 weeks). Initial feedback showed that participants liked the format, although some still struggled with the technology. The Pacific Southwest ATTC is currently revising its sequenced workplace learning events to match lessons learned from the business and healthcare fields regarding increased team building and providing a context for the new skills.

Another significant contributor to this new method of delivering training/TA in the workplace is the work of Aaron and colleagues. ^{6, 7} These researchers found that administrators possessed significant influence (positive or negative) regarding the adoption of EBPs by their organizational staff. One concrete way administrators showed organizational support of workplace learning was by allowing employees to count the learning sessions as part of their work day schedule.

The Pacific Southwest ATTC is committed to making workplace learning a reality in the region by designing learning events that: are delivered online using easy and inexpensive or free learning platforms; include instruction/support on how to use the online learning platforms; are conducted during work hours; include team building exercises/assignments; use workplace-specific real life scenarios in case studies; include near-peer performance feedback; and ensure there is administrator support. Making workplace learning a routine practice for delivering competency-based training similar to other Fortune 500 businesses is the goal, culminating in the creation of innovative delivery of training events that increase access, decrease costs, and help practitioners and recovery support specialists work wiser.

References

1. Edmunds, J.M. et al. (2013). Dissemination & implementation of evidence-based practices: Training & consultation as implementation strategies. Clinical Psychology: Science and Practice, 20, 152–165.
2. Powell, B.J. et al. (2014). A systematic review of strategies for implementing empirically supported mental health interventions. Research on Social Work Practice, 24, 192–212.
3. Herschell, A. D. et al. (2010). The role of therapist training in the implementation of psychosocial treatments: A review & critique with recommendations. Clinical Psychology Review, 30, 448–466.
4. Flexner, A. (1910). Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching. Bulletin No. 4. Boston, MA: Ubdyke.
5. Miller, B.M. et al. (2010). Beyond Flexner: A new model for continuous learning in the health professions. Academic Medicine, 85(2), 266-272.
6. Aarons, G.A. et al. (2014). The Implementation Leadership Scale (ILS): Development of a brief measure of unit level implementation leadership. Implementation Science, 9(1), 45.
7. Aarons, G.A. et al. (2016). The roles of system & organizational leadership in system-wide evidence-based intervention sustaniment: A mixed-method study. Administration and Policy in Mental Health, 43, 991-1008.

Trainer Development Efforts to Build a Competent Behavioral Health Treatment and Recovery Workforce in the Pacific Jurisdictions

Beth A. Rutkowski, MPH

Co-Director, Pacific Southwest ATTC

In the 2012-17 funding cycle, the Pacific Southwest Addiction Technology Transfer Center (Pacific Southwest ATTC) region was expanded to encompass HHS Region 9. Formerly serving only California and Arizona, the Pacific Southwest ATTC now also serves Nevada, Hawaii, American Samoa, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, Guam, Republic of the Marshall Islands, and Republic of Palau.

One strategy employed to service the unique and varied needs of the Pacific Jurisdictions was to join forces with the SAMHSA-funded Pacific Jurisdictions Workforce Development Initiative. This initiative began in 2011 to develop local expert trainers, grooming to provide the on-the-ground training and technical assistance to local behavioral health providers.

Topics were determined by each jurisdiction to address local needs (e.g., Matrix Model treatment, SBIRT, adolescent treatment, culturally responsive treatment and prevention). During the first year of the project, participants visited host sites in the mainland United States to gain experience from organizations providing services in their chosen focus area.

In March 2013, the Pacific Southwest ATTC, in partnership with the Pacific Behavioral Health Collaborating Council (PBHCC), conducted a conference attended by 27 individuals from the six Pacific Jurisdictions, along with representatives from the SAMHSA’s CSAT, CSAP, CMHS, and the Regional Administrator, HHS Region 9 (Dr. Jon Perez).

Participants engaged in meetings that focused on developing participants' skills in training and technical assistance. Each participant provided training on their focus area to peers and invited guests, and received individual coaching to improve skills. Participants heard from Drs. Thomas Freese (UCLA ISAP) and Steve Gallon (Oregon Health & Science University) on effective training and technical assistance strategies. Participants were also invited to UCLA ISAP to hear from ISAP's principal investigators about domestic and international research activities. The four-day conference ended with a recognition ceremony.

Access to local training and technical assistance experts is essential for the Pacific Jurisdictions. These island nations span an area of ocean larger than the continental United States. Their total land mass (669 islands and atolls spread across 5 million square miles of ocean) is smaller than the five states of New England. The total population of the Pacific Jurisdictions is approximately 451,000, and 19 languages are spoken. The island populations self-identify predominantly as native to their island, although segments of the populations are Filipino (5%-26%), Chinese (2%–5%), "other" Pacific Island background (2%–8%), and 2%–6% Whites or “other.”

Since 2013, the Pacific Southwest ATTC has visited Hawai’i and five of the six Jurisdictions on more than 15 occasions. The days are long, but the relationships developed and impact made is most satisfying. Recently, with supplemental funding from the PBHCC, Drs. Thomas Freese and Chris Rocchio and Mr. Alex Ngiraingas, an expert trainer from Palau, traveled to Pohnpei, FSM, to conduct a weeklong Alcohol and Drug Certification (ADC) Academy, to prepare providers to challenge the IC&RC certification exam. Because of this intensive weeklong training experience, eight people achieved regional certification, and one person achieved international certification. This increase in certified counselors represents a huge improvement in building a larger, more competent behavioral health workforce in the Pacific.

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Northwest ATTC & Tri-County Behavioral Health Providers Association Motivational Interviewing Teaching & Coaching Collaborative

March 27, 2019

Meg Brunner, MLIS

Northwest ATTC

Motivational interviewing (MI) is the number one training request the Northwest ATTC receives from our region. Providers are embracing this evidence-based practice and, at the same time, are also struggling to access training and on-going coaching to promote staff proficiency.

The challenge leaders report is: how do we build internal staff capacity to support this evidence-based practice and fully implement it in our organizations?

In response to this need, the Northwest ATTC, in collaboration with the Tri-County Behavioral Health Providers Association in Oregon, is providing a year-long Motivational Interviewing Teaching and Coaching Learning Collaborative. Eighteen clinical supervisors from fifteen behavioral health organizations are participating in this intensive technical assistance project aimed at developing their MI teaching and coaching skills. The goal of the project, which is funded by Washington and Multnomah County, is to increase internal staff capacity for teaching and coaching staff in MI.

Participant selection included nomination by each organizations’ CEO and submission of a written application and sample MI audio-session. The project kick-off included a 1.5-day training on teaching and coaching MI and securing organizational buy-in and support.

At monthly learning collaborative meetings, participants receive a 90-minute module focused on a specific MI skill such as reflective listening, developing discrepancy, or eliciting change talk, along with all the necessary handouts and materials for them to subsequently present the skill module to a select group of staff at their organization between learning sessions. Staff members are encouraged to practice each MI skill between sessions and report back on their experiences.

Participants report deepening their own MI skills through this process as well as seeing significant MI skills development in staff members.

The value of this project is evidenced in these comments from participants:

The training series has helped me advocate for integration of the practice and spirit of MI varying levels of our office. Beyond that, it’s been really amazing to comb through my own understanding of the practice and better support clinicians that I supervise to help people change by being able to teach the principles more effectively and confidently. – Participant from Morrison Kids

This training brings MI to the fore as a process oriented, respectful form of therapy, and highlights the cooperation between provider and client that makes for a great treatment bond. –Participant from Cascadia Behavioral Healthcare

The Northwest ATTC plans to replicate this project in the future across Region 10 and is excited to be able to support this training and technical assistance need in our region!

For more information, or to find out how you can be a part of one of our MI technical assistance projects, visit our NWATTC Motivational Interviewing website.

Improving Substance Use Prevention and Treatment: International Efforts

March 20, 2019


Kim Johnson

Executive Director

ICUDDR 

Did you know that there is an international effort to improve the quality of substance use prevention and treatment through workforce and infrastructure development? The Department of State Bureau of International Narcotics and Law Enforcement Affairs (INL) supports a series of efforts in developing countries to do work much like the ATTC does in the United States. They are helping developing countries create infrastructure for certification and licensure, develop education and training systems for workforce development, and link people who work in the field all over the world through engagement in education and social networks that cross national boundaries.

Global Center for Credentialing and Certification 

First, there is the Global Center for Credentialing and Certification (formerly ICCE) that provides testing and credentialing services for individuals and countries that want to establish standards of care. The treatment certifications have reciprocity with NAADAC. You can find more information about them at: NAADAC.ORG/Colombo-plan and at the ISSUP page, The Global Centre for Credentialing and Certification. People with a NAADAC credential can have deemed status and receive the comparable ICAP credential. Find out more at the ISSUP page, Credentialing and Certification Examination. 

International Society of Substance Use Professionals (ISSUP)

Second, there is the International Society of Substance Use Professionals (ISSUP) that is designed to be a place to link to other people who work in any aspect of substance use prevention, treatment, recovery, research all over the world. ISSUP will soon be linking the ATTC HealtheKnowledge portal  of online training and education to a global audience. ISSUP membership is free and it links you to other people who are trying to solve the same problems that you are in countries in Asia, Africa, Latin America, the Middle East and Europe. The goal is to support evidence-based practice in addressing substance use issues and mutual problem solving by international peers.

International Consortium of Universities for Drug Demand Reduction (ICUDDR) 

Finally, there is the project that I am now heading up: The International Consortium of Universities for Drug Demand Reduction (ICUDDR). ICUDDR brings together universities to develop and improve upon their degree programs or courses in what is internationally called drug demand reduction. We have 160 member universities from countries in every part of the world. Many of them are using and adapting curricula created by international researchers and educators including ATTC leadership. The curricula are called the Universal Prevention Curriculum and the Universal Treatment Curriculum (UPC and UTC).

In my work as executive director of ICUDDR I have traveled to Thailand to host a meeting of 13 universities from 11 Asian countries; Brazil to meet with universities developing prevention education programs, Kenya to meet with 40 universities from all over Africa to organize a continental effort to develop education programs, and to the Philippines to talk to universities there about how to adapt curricula to be more culturally appropriate. If you want to see where I am next, follow me on Twitter: @icuddr

Cusco, Peru

Interested in joining a global workforce?

If becoming part of a global workforce to address substance use and addiction excites you, please check out the websites in this blog post, become a member of ISSUP or ICUDDR and perhaps attend one of our conferences. ISSUP will hold a conference in Vienna July 1-5 and they are still accepting abstracts! ICUDDR will host its annual meeting in Cusco, Peru July 21-23. It will be high season for visiting Machu Picchu, so if you want to come to the ICUDDR meeting, register soon.  I would love to see more of you engaged in this very exciting global effort.

About our Guest Blogger

Kimberly A. Johnson, is the executive director of the International Consortium of Universities for Drug Demand Reduction and an associate research professor at the University of South Florida. Prior to her move to Florida, she served for two years as the Director of the Center for Substance Abuse Treatment, a U.S. federal government agency.

Dr. Johnson has worked as an associate scientist at the University of Wisconsin, Madison where her projects included studies on mobile apps for behavior change, quality improvement in care development and acting as the co-director of the national coordinating office of the Addiction Technology Transfer Centers and as co-deputy director of NIATx. She received funding from multiple NIH centers, AHRQ, SAMHSA and several foundations. She has also served as the state of Maine single state authority for substance abuse, and as the executive director of a substance abuse treatment agency. In her early career, Dr. Johnson was a child and family therapist and managed treatment and prevention programs.

The Healing of the Canoe: Community Pulling Together

March 14, 2019

Meg Brunner, MLIS

Northwest ATTC 

The Healing of the Canoe began as a collaborative project between the Suquamish Tribe, the Port Gamble S’Klallam Tribe, and the Alcohol & Drug Abuse Institute at the University of Washington, now the home of the Northwest ATTC. 

Suquamish and Port Gamble S’Klallam identified the prevention of youth substance abuse and the need for a sense of cultural belonging and cultural revitalization among youth as primary issues of community concern. 

Port Gamble S'Klallam

In response, the Healing of the Canoe partnership sought to address these issues through the development of a community-based, culturally-grounded prevention and intervention life skills curriculum for tribal youth that builds on the strengths and resources in the community. 

The Culturally Grounded Life Skills for Youth Curriculum, created through this collaboration, is an adaptable curriculum for Native youth focused on substance abuse and suicide prevention. It uses the Canoe Journey as a metaphor, providing youth the skills needed to navigate their journey through life without being pulled off course by alcohol or drugs – with tribal culture, tradition, and values as compass to guide them and anchor to ground them. 

Suquamish

The Northwest ATTC is proud to offer a range of different training and technical assistance options for the Healing of the Canoe, and has worked with several regional tribes already. At a recent summit of American Indian Health Commission Tribal Leaders, Steve Kutz, the chair of AIHC and Cowlitz leader, expressed his thanks to Leonard Forsman, chairman of the Suquamish Tribe, for his role in the development of the Healing of the Canoe project, “a program that so many tribes in Washington and in the country are now implementing in their communities.” 

The NWATTC offers individual or multiple tribe training workshops, in-person/webinar/phone technical assistance, ongoing involvement in learning collaboratives, booster sessions, and consultation for funding opportunities to support implementation and sustainability. If you are interested, please contact the Northwest ATTC at northwest@attcnetwork.org

For more information about Healing of the Canoe, please watch this “digital story” from Nigel Lawrence of the Suquamish Tribe: 

And be sure to check out the NWATTC’s web page about the Healing of the Canoe project!