What's New This Week in the ATTC Network

May 24, 2016

Maureen Fitzgerald
ATTC Network Coordinating Office

The ATTC Network brings the addiction treatment and recovery services field a range of new publications, webinars, and training resources each week. This week, for example, brings you a new resource on integrating substance use disorder treatment with other health care, a webinar on teen use of e-cigarettes, vaping, and dipping, and easier access to ATTC bilingual resources.

Advancing Integration of Substance Use Disorder Services and Health Care

Integrating substance use disorder services with other health care remains a high priority in today's changing health care environment. The ATTC Network offers a range of tools and training expertise to facilitate efforts to integrate substance use disorder services with health care.   Building Capacity for Behavioral Health Services Within Primary Care and Medical Settings, the  second white paper in the ATTC Network's Advancing Integration white paper series, explores ways that organizations can build workforce capacity to treat patients in integrated care settings. Download a PDF of the paper here.

Webinar: Teen Smoking, Vaping, and Dipping: How Should Providers Respond? 

According to the latest Monitoring the Future 2015 Survey results, in 2015 e-cigarettes continued to have higher use among teens than traditional tobacco cigarettes or any other tobacco product. Find out what this means for treatment providers in this week's new webinar from the Build Up Your Teen Treatment IQ (TTIQ) project: 

Teen Smoking, Vaping, and Dipping:
How Should Providers Respond?
Wednesday, May 25
12:00pm ET, 11am CT, 10am MT, 9am PT
Register today! 

Buscando recursos en espaƱol? (Looking for resources in Spanish?) 

We've just updated the Products and Resources page on the ATTC website for easier access to the Network's bilingual and Spanish-language resources. You can see what's available with just one click. Visit the page to view the array of resources produced by the National Hispanic and Latino ATTC, the Pacific Southwest ATTC, and the Mid-America ATTC. Check out the list of bilingual Fact Sheets (Hojas Informativas) produced by the National Hispanic and Latino ATTC. These fact sheets accompany the Center's monthly webinars (in English).  All webinars -- like the May 2016 webinar, "Developing Culturally Centered Interventions for Hispanic and Latino Populations," are recorded and available for viewing anytime on the National Hispanic and Latino ATTC web page.

Want to stay up-to-date with ATTC Network news, trainings, webinars, and publications?  Check out our website, join our mailing list, like us on Facebook, follow us on Twitter--and of course, follow the ATTC/NIATx Service Improvement Blog!

Myth buster: Change Takes Time. A Lot of Time.

May 16, 2016

Thomas F. Hilton, PhD

One process improvement myth that resurfaces regularly like a sighting of the Loch Ness monster is that change takes time. A lot of time. Because trying out new procedures takes so long, staff might be convinced that change is just not worth the effort. And they'll quietly go back to doing things the comfortable old way.

But I'm here today to bust the myth that change takes time.

There are two related issues here. The first is trial-and-error.  The second is tried-and-true.

An overly long period of trial-and-error drains momentum for change. That's why NIATx change teams using PDSA cycles as their structure for trial-and-error have the freedom to abandon a change after a short period of time, especially if the data show it just isn't working.  (More about data later.)

We've seen change teams revert to the tried-and-true practice when the trial-and-error phase drags on too long. The whole point of trial-and-error is to identify a "better" tried-and-true that everyone in the organization is happy to embrace.

Process improvement always involves trial-and-error. However, what gets tried should be guided by common sense and experience derived from living with the problem. In other words: NIATx Principle #1: Understand and Involve the Customer!

Another common mistake many organizations make is to tackle complex problems too soon. It's always a good strategy to take on a few simple changes first. An initial success can go a long way towards showing staff that change can happen quickly. Here's an example. Do a quick walk-through of the intake process at your agency. Go ahead and call your agency as if you were a client seeking services. Go on, dial the number. Did someone answer the phone after the first ring? Or did you have to listen to a long recorded spiel? How soon could you get in for an assessment?  One phone call to your agency might be all it takes for you to get ideas for a few things you could change quickly to improve your customers' experience.

Keep it simple.

By simple, I do not mean easy, but changes that everyone agrees should make things better and that you can try in-house. Does everyone in your agency dislike the current intake form because it's so lengthy? Does everyone want to reduce wait times? Try introducing a new intake form to see if it can shorten wait times. Give it a fair trial -- no more than a couple of weeks. Is the new form reducing waiting times? If not, adapt the form( don't throw it overboard just yet) and give it another trial.

What do the data show? 

What often sets the ship of change adrift in the Waitn'See is ambiguous data. Staff might expect the data to trend up or down, but it might instead be bobbing up and down after a couple of weeks. This can be a good indication that it's time to adapt the change and start a new change cycle. The data will help you determine if the problem is in the new practice itself or in its implementation.  Ask the following questions:
1. Is everyone on board? Is it possible that not everyone is capable and motivated to try the new way of working?
2. Is data being collected reliably?
3. Are you seeing all the data?
4. Are some staff seeing improvements, while others are not?
5. Are some staff returning to the old tried-and-true way now and then, because they have to?

If the answer to all question is NO, then the problem is probably not due to poor implementation.  What's more likely is that the new practice isn't working--the error part of trial-and-error. Altering course to try a new implementation altogether is the only sure way to sail out of the doldrums and get your process improvement back on course.

What is the quickest change your agency has been able to test and implement, using the NIATx approach?  Share your story in the comments section below. 

Looking for ideas for your next change project?  Check out the Promising Practices on the NIATx website.

Tom Hilton is a retired NIH science officer and NIDA program officer now in private practice. Tom has over 40 years of experience studying and conducting large-scale organizational change initiatives in publicly-traded corporations, DOD and other large federal agencies, as as general-medical and addiction health services organizations.

Read other posts by Tom Hilton:
Mythbusters: Staff don't want to help find solutions
Factors influencing organizations' use of NIATx

Hepatitis Awareness Month and Hepatitis Testing Day

Holly Hagle, PhD

Leslie Cohen, BS
New England ATTC

May 10, 2016

The month of May is designated as Hepatitis Awareness Month in the United States, and May 19 is Hepatitis Testing Day. During May, many public health partners will work to shed light on this hidden epidemic by raising awareness of viral hepatitis and encouraging priority populations to get tested (CDC, 2016).

See the May 2016 press release from the CDC: Hepatitis C Kills More Americans than Any Other Infectious Disease

ATTC Network HCV Current Initiative

HCV Current is a national initiative developed by the ATTC Regional and National Focus Area Centers and funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) to increase hepatitis C (HCV) knowledge among medical and behavioral health professionals--specifically, staff at federally qualified health centers.

To disseminate the latest on the rapidly evolving field of HCV, and to address the HCV epidemic in the United States, this initiative provides comprehensive resources for health professionals, including:
  • Online and in-person curriculum and training
  • Downloadable provider tools
  • Region-specific resources 
Click here to view the HCV Current infographic.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) 

As defined by SAMHSA, SBIRT is a comprehensive, integrated public health approach to the delivery of early intervention and treatment services for people with substance use disorders, as well as those who are at risk of developing those disorders.
  • Screening quickly assesses for the presence of risking substance use, follows positive screen with further assessment of problem use, and identifies the appropriate level of treatment. 
  • Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavior change.
  • Referral to treatment provides those identified as needing more extensive treatment with access to specialty care. 
A Public Health Approach to Health and Wellness 

Bringing this public health approach together with the silent epidemic of hepatitis C makes sense, since persons with mental health and substance use disorders face an increased risk for the infection. As noted in the cross-agency Action Plan for thePrevention, Care, and Treatment of Viral Hepatitis 2014-2016increasing the proportion of persons who are aware of their hepatitis C virus infection by improving the frequency, availability, and acceptability of hepatitis testing is critical to addressing this leading infectious cause of death.
  • Hepatitis C, a viral disease that destroys liver cells, is the most common blood-borne infection in the United States.  See the CDC Press Release: Hepatitis C Kills More Americans Than Any Other Infectious Disease
  • There has been a nationwide increase in HCV infection occurring among young (20 year old) people who are using and injecting opioids. 
  • Testing for HCV and connecting health outcomes to substance use through the application of SBIRT can get people into treatment earlier.
Coming Soon: SBIRT & Hepatitis C Video Vignette Series

Currently in post-production, the National SBIRT, New England, and Northeast & Caribbean ATTCs have collaborated on an educational video vignette series. This video vignette series highlights six health scenarios in which SBIRT and Hep C screening is discussed in relation to the patients' presenting health condition. We are excited to present these sneak peeks: 

Meet Henry - Henry is an active 66-year old African American professional male. He is a healthy older man, who recently lost a great deal of weight and is working on being physically fit, exercising daily, and working out at the local gym. He is also proud of the fact that, except for the year when he was a marine helicopter pilot in Viet Nam, Henry has never used drugs. While in Viet Nam, Henry smoked marijuana, and after seeing some of his friends killed in action, injected heroin with the guys in his unit for the remainder of his overseas tour of duty. 

Meet Eddie - Eddie is an 18-year old suburban male who began abusing opioid pain medication when he was 14 years old and crossed over to intravenous heroin abuse two years later. Eddie frequently shared works with drug friends and sometimes with the dealers who sold him drugs. Between the ages of 14 and 17, he had numerous admissions into both out-patient and in-patient drug-free substance abuse treatment programs, quickly relapsing after completion of each program. Five months ago, while he was driving under the influence, he had a near-fatal car accident. During his surgery, he received two blood transfusions. Eddie was significantly impacted by the distress the accident caused for his family. After he was released from the hospital, Eddie enrolled in a Suboxone program and has abstained from abusing all drugs for the last four months. 

All six vignettes are designed to portray a health encounter in which risks of Hep C are discussed and feedback on alcohol and/or drug use (SBIRT) are given in the context of the presenting health condition. These educational videos can be used with the Increasing Hepatitis C Knowledge for Behavioral Health and Medical Providers curriculum available through HCV Current, and will be available in fall 2016

For more information, visit the HCV Current page on the ATTC Network website.

Related blog posts:
"Know More Hepatitis" with HCVCurrent
Recovery Month 2013: Sharing Stories from People in Recovery Who Also Have Hepatitis C

Collegiate Recovery Programs: New program at UMKC meets campus need

May 2, 2016

Gabrielle Rodriguez

President, RooCovery
University of Missouri – Kansas City

In April, the Association of Recovery in Higher Education (ARHE) hosted their 7th National Collegiate Recovery Conference  in Atlanta, Georgia.
With much gratitude I was able to attend the conference as a student in recovery, President of RooCovery, a newly formed Collegiate Recovery Community at the University of Missouri – Kansas City (UMKC), and a representative of the ATTC Network Coordinating Office

The conference provided information regarding Collegiate Recovery Communities (CRC) and Programs (CRP) by inviting experts from all fields relevant to education, addiction, and recovery to offer their expertise and support. The workshop topics focused on building a CRC/CRP, collaboration, leadership, sustainability, and inclusion. (Click here to view the presentation slides.)

The results of the 2015 National Collegiate Recovery Program Profiles Study (Jeff A. Jones, Ph.D., Emily Eisenhart, M.S.S.C., Brianna Charles, B.S., & Nathan Walker, B.A.) were discussed in a workshop. A few key points:  
  • CRCs and CRPs are part of a recovery movement that has been active since 1983, but has shown a growth spurt in the last six years. 
  • From 1983 – 2009 only 1 or 2 programs started each year. 
  • 4 new programs began in 2010.
  • 14 new programs began in 2012.
These numbers prove that recovery works and community is needed on campuses across the states. There are also two  programs located in states that mandate running a CRC.  In my opinion, that is a huge step in the right direction.

As president of a newly organized CRC, my goal at this conference was to engage with as many members of CRCs around the U.S. to ask questions and raise concerns about my own university. My two main concerns are earning administration buy-in and support.
Why "RooCovery?" Ask Kasey the Kangaroo,
the UMKC mascot.
The positivity and encouragement I received from clinicians, counselors, directors and members of established CRCs/CRPs was incredibly inspiring. They encouraged me to never give up, to "build it and the people will come." The best advice given was that the CRC is not about me, but for that one person that the program might help.

Building a CRC at UMKC has been a dream of mine for a few years. In 2010 I was a transfer student to UMKC from a junior college and at the beginning of the end of my dependence on alcohol. In 2011 I dropped out following a summer study abroad program. In 2012, I found a twelve-step program and have been sober ever since. It was twice as hard to establish a group on campus without being a currently enrolled student, so I re-applied to UMKC. In the fall semester of 2015 I returned to complete my Bachelor’s in Spanish Language and Literature. In September, I received an email from our Counseling Center asking students if there was any interest in starting a CRC. I immediately and enthusiastically replied yes! In that moment I realized that I am exactly where I need to be. Also in the fall, I was able to connect with ATTC Network Coordinating office,  which has become a part-time student worker position. This semester RooCovery was approved and recognized as an official student organization at UMKC. We have weekly meeting(s) and are collaborating with other student organizations. We are working to gain visibility and support from our administrators and community.

For more information on CRPs/CRCs, check out http://www.collegiaterecovery.org
where you may
also find information on the 7th Annual Collegiate Recovery Conference, future events, resources, and membership.

Related Resource: The Bridge, Fall 2015:  Collegiate Recovery Programs 

Does your community have a Collegiate Recovery Program?  Tell us about it in the comments section below. 

Gabrielle Rodriguez is a student at the University of Missouri-Kansas City and president of the newly formed Collegiate Recovery Program there, RooCovery.  

Recovery from a faith-based perspective

April 27, 2016

Rev. David Martins
Interim Director
Rhode Island Communities for Addiction Recovery Efforts (RICARES)

"Everyone has inside of him a piece of good news. The good news is that you don't know how great you can be! How much you can love! What you can accomplish! And what your potential is!
These words are taken from The Diary of Anne Frank. While they were not intended for the Recovery Community, they certainly apply. As one of the 23 million Americans in recovery, I can tell you firsthand the truth that it is indeed good news--in fact, it's incredible news, to continue to discover the latent potential of how great life is, and how much we can love. The journey to recovery is strengthened by the knowledge that we are part of a community, and not trying to get through this experience of rebirth alone.

For the person of faith, this experience we describe as "Recovery" should sound familiar. For the Christian, the phrase "good news," brings to mind the word "Gospel": the good news of Jesus Christ, risen from the dead, and Easter the promise of rebirth. For the Jewish community, "good news" is the promise of a Messiah that will inaugurate a world of peace and justice, where "the lion will lie down with the lamb." For the adherents of Islam, the Uawn al-Qiuamah, is "the Day of Religion" or "the Last Hour," when the judgement of Allah will come upon the earth, rewarding the just with eternal life.

We could go on and on about the experience of rebirth as it is understood by the major religious denominations. We could likewise identify the countless ways that some form of rejuvenation drives the spiritual paths of those who identify as "not religions," but none the less in pursuit of some form of transcendental peace. It would seem that the goal of faith, and the goal of recovery, is more or less the same: serenity, joy, and renewal...and being able to engage the pathway to it, is certainly "good news."

It is for this reason that the creation of FIRE (Faith Infused Recovery Efforts) seemed so natural. As folks journey down the road of their own recovery, we discover quickly that it is not merely a physical experience of some form of abstinence; rather, recovery is about engaging in the spiritual side of ourselves. It is about satisfying the needs of the intangible part of ourselves. It is about discovering that love, greatness, and potential that Anne Frank wrote about. For anyone of any faith expression, that life of faith is intrinsically bound up in this spiritual journey; and a strong program of recovery requires spiritual wellness.

FIRE is a grassroots alliance within the Recovery Community Organization for the State of Rhode Island (RICARES) charged with providing support, resources, and service to those who seek to engage in recovery from a faith-based perspective. Through a partnership between FIRE and the New England Addiction Technology Center (ATTC) a video titled Addressing Addiction and Supporting Recovery Through Faith was produced. The video, designed to start a conversation, contains interviews with faith-based leaders in which they describe their role in the light of the addiction epidemic. In March 2016, FIRE and the New England ATTC held a premier of the video, followed by a panel discussion with some of the faith-based leaders who appeared in the 16-minute video and moderated by Dr. David Lewis, founder of the Center for Alcohol and Addiction Studies at Brown University.

A stepping-off point for much more, this video gave clergy the opportunity to declare their commitment to help stop the stigma and stereotype that surrounds the recovery community. What was the conversation?

How can we help?
What are we doing now?
What can we do differently?

The overwhelming response was that we need to come together across the many aisles, dogmas, and details that separate us, and work together towards this common goal. More than that, the common responsibility of all religious leaders to shepherd and love the people entrusted to our care was also a point of discussion. There is not a single faith expression that does not demand attention and care to our neighbor, and the sad truth of addiction is that our neighbors are dying. 

Where will FIRE go next? The sky's the limit! Everything from support groups, worship services oriented toward recovery, and the use of facilities are all things that are happening already; and FIRE is eager to walk together into a future that is saturated with recovery and spiritual wellness. Do you want to learn more about FIRE and how you can introduce a faith-based recovery into your community? Contact Dr. David Martins at dmartins@ricares.org, and be part of this dynamic aspect of the recovery community! 

Does your organization work with an interfaith community to support people in recovery?  Share your story in the comments section below. 

Related resources: The Mid-America ATTC produces faith-based community bulletin inserts for Problem Gambling Awareness Moth (March) Alcohol Awareness Month (April), and Hepatitis C Awareness Month (May). You can view them all on the Resources page of the Mid-America ATTC website.

SAMHSA also offers the following resource:
Preventing and Addressing Alcohol and Drug Problems: A Handbook for Clergy

Guest Blogger Father David Martins serves as Pastor of St. Therese Old Catholic Church in West Warwick, RI. He has also worked at Youth Pride, Inc., The Family Care Community Parthernship, and Anchor ED program. He studied at Providence College/Our Lady of Providence Seminary, Mount Mary Seminary and University, and Creighton University. 

Mythbusters: Staff don't want to help find solutions. Or do they?

April 4, 2016

Thomas F. Hilton, Ph.D. 

A frequently-mentioned myth NIATx coaches encounter is the perception by managers that their staff do not want to help find solutions to the organization’s problems. That impression may seem valid to managers because they tend to focus on matters external to daily operations while staff, on the other hand, have to live with annoying redundancies, conflicting demands, and other inefficiencies that the boss seems to ignore at their, and the clients’ expense.

Past attempts at change within the organization – or past resistance to change by managers – may have built a culture of suspicion and indifference in the workforce. When this is the case, management initiatives often flounder in the "Wait’n Sea" unless there is clear evidence that the staff are empowered to change how they do things.

Problem or Opportunity?

March 28, 2016

Disruption is a word often used to describe what's happening in health care today.  And providers are encouraged to "think outside the box" to adapt to this disruption.

But have you ever wondered just how to "think outside the box?"

In this five-minute video, Andrew Isham, research scientist at the Center for Health Enhancement Systems Studies (which also houses NIATx), offers a strategy: opportunity based thinking. It might be one way to think different and identify solutions that are sometimes so obvious they're easily overlooked.

For example, how did Steve Jobs found the solution to the problem of the stylus that was once ubiquitous with mobile devices?  Literally, at his fingertips.

This video was part of Isham's presentation for the BHBusiness Plus Innovator's Network at the National Council Conference, NatCon16.

How do you use opportunity based thinking in your organization? Has letting go of assumptions given you insight into opportunities?  Share your story in the comment section below.

Andrew Isham, M.S.,  is a researcher at the Center for Health Enhancement Systems Studies, based at the University of Wisconsin-Madison. His focus is on the innovative adaptation of information technologies to support behavior change in people with chronic health conditions. Isham has a BS in mechanical engineering, a minor in psychology, and an MS in industrial and systems engineering, with a specialization in health systems engineering. In both the academic research and commercial realms, Andrew has experience and knowledge of many of the links in the health IT chain, including testing, implementation, patient/clinician engagement, and sustainability.

Other posts by Andrew Isham: Mobile Health: A Brave New World