Change, Test, Repeat: Using NIATx to implement SBIRT

Catherine Ulrich Milliken
Director, Addiction Treatment Program
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

Introducing a new practice like SBIRT can be a challenge in any setting. In the Dartmouth Hitchcock Medical Center (DHMC) Perinatal Addiction Treatment Program (PATP) we faced the added challenge of implementing a new practice across three departments and two institutions. 

That’s where my previous experience with the NIATx model came into play. I was fortunate to be a part of a NIATx STAR-SI grant in Maine while working for Crossroads for Women ( Over three years beginning in late 2006, the ten state-provider partnerships used the NIATx diffusion model to accomplish four goals: build state capacity to improve access and retention; build payer/provider partnerships that drive the improvement process; implement payer improvement strategies; and implement performance monitoring and feedback systems.

Integrating care and improving birth outcomes with SBIRT: An update from the field

Catherine Ulrich Milliken
Director, Addiction Treatment Program
Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire

It’s hard to believe that almost two years since I first wrote in this blog about the Dartmouth Hitchcock Medical Center (DHMC) Perinatal Addiction Treatment Program (PATP).

The PATP is a joint, multidisciplinary, and interprofessional venture that spans two institutions, (Dartmouth Hitchcock Medical Center and The Geisel School of Medicine at Dartmouth College), three departments (Psychiatry, OB/Gyn and Pediatrics) and the inpatient and outpatient environments. 

Turning 2 and Our Top Ten List

Maureen Fitzgerald
Communications Coordinator, ATTC Network
Senior Editor, NIATx

The DipR is the ultimate cookie spoon.
It was almost exactly two years ago that we launched the ATTC/NIATx Service Improvement Blog with our first post: Better Together. In that post, ATTC co-directors Laurie Krom and Kim Johnson wrote about the true innovation that comes from collaboration. They announced the main goal for our blog: to publish regular posts featuring information, tools, and techniques to help behavioral health professionals manage programs and provide services.

Over the past two years, we've published, on average, three times each month, on a wide range of topics. Our blog writers have included ATTC and NIATx staff along with guest bloggers representing research, clinical care, state and national organizations, and people in recovery.

Factors influencing organizations' use of NIATx: Dr. Tom Hilton responds

Tom Hilton is a retired NIH science officer and NIDA program official now in private practice. Tom has over 40 years of experience studying and conducting large-scale organizational change initiatives in publically-traded corporations, DOD and other large federal agencies, as well as general-medical and addiction health service organizations. In this blog post, Dr. Hilton comments on a recent study published in the Journal of Behavioral Health Services Research that discussed the factors influencing use of NIATx. That study found that larger organizations with more administrative resources that treat more patients and participate in national associations and in NIDA’s Clinical Trials Network are more likely to use the NIATx model.
Organizations change in response to one of two things: being oriented towards continuous improvement, or crisis. Both are usually rooted in leadership.

Organizations in crisis suffer from emotional blindness caused by fear, panic, and role overload. As far as leaders of declining organizations can see, exploring changes in policies and practices is an impediment to immediate mission accomplishment. That lack of foresight too often leads to the organizational equivalent of a massive coronary that usually puts the organization out of business.
How does one overcome such thinking? The real challenge in change involves overcoming inertia. Usually that inertia emanates from the widely accepted values, beliefs, and practices that determine what and how work gets done (i.e., organizational culture). Some cultures facilitate productivity and quality outcomes. Other cultures unwittingly undermine it. So how can one determine if their culture is in need of peaks and tweaks or complete overhaul? 

How to Integrate Addiction Services with Primary Care: The Integration Institute

Kathy Reynolds, MSW, ACSW 

Principal, Reynolds Associates

With all of the state Health Home amendments that include addiction treatment being approved by CMS under Section 2703 of the Affordable Care Act, the time has come for addiction treatment providers! In the new healthcare environment, specialty treatment providers can extend services to millions of people who now have health insurance that covers addiction treatment. Many of those clients will be seeking care in integrated health care settings.

As the ATTC White Paper Integrating Substance Use Disorders and Health Care Services in an Era of Health Reform points out, research shows that integrating addiction treatment and health care services improves patient outcomes. Yet, addiction treatment providers face a number of challenges in integrating services, including:

 “…needs to define and develop appropriate services, cultivate staff support, identify strategies for implementing change, train the SUD, mental health, and medical workforces, bring payers to the table, and transcend the currently bifurcated systems of SUD and mental health care. On the other hand, as integration moves forward, it creates opportunities for the current SUD workforce to work in new settings.”  
(ATTC White Paper, Integrating Substance Use Disorders, p. 6)

Technology Trends in Behavioral Health: Prepare for the Future at the National Frontier and Rural ATTC Summit

Nancy Roget, M.S., MFT, LADC
Project Director and Principal Investigator
National Frontier and Rural ATTC

Save the date for the the National Frontier and Rural ATTC's 3rd Annual Summit, September 2-3, 2015, in Austin, Texas!

Although behavioral health is considered an essential healthcare benefit, it is not always easily accessible to everyone who needs it, particularly in frontier and rural areas. This is especially true when talking about substance use disorder treatment and recovery, as access to these services is hindered due to workforce shortages and transportation issues. One way this gap in services is being bridged is by integrating the use of technologies into the behavioral health delivery system.

Break the silence: UNITE to Face Addiction

Pat Taylor
Community Outreach Coordinator
UNITE to Face Addiction

On October 4, 2015, tens of thousands of people representing organizations and families from the prevention, treatment, criminal justice, health and recovery communities will convene on the National Mall in Washington, DC. We’re grateful to the National ATTC Network and NIATx for standing up as one of the founding partner organizations for the UNITE to Face Addiction rally and for your help in mobilizing people to join us.

We are coming together to let policymakers, the media and our friends and neighbors know that addiction is preventable and treatable, that far too many of those affected have been incarcerated, and that people can and do get well.  As a member of the ATTC Network, you are needed to ignite and grow a movement that will demand solutions to the addiction crisis.

One of our nation’s best-kept secrets is that long-term recovery from addiction is a reality for over 23 million Americans. Regardless of the paths people choose to achieve recovery, their lives and the lives of their families, friends, neighbors, co-workers and communities are vastly improved. People in recovery and their allies are the living proof that there are real solutions to the devastation of addiction.

Although millions prove that recovery is real, more than 350 lives are lost each day to alcohol and other drugs – some 135,000 people each year – more than who die from either homicides or motor vehicle accidents. Another 22 million Americans are still suffering from addiction and the majority never receive any help.

Where is the national outrage about this needless loss of life, the costs to families and the economy, and more importantly, the demand for solutions? It’s time to speak up about the failed policies and poor care due to long-standing stigma and discriminatory public policies. For too long, a great majority of people connected to addiction have remained silent.

The time is now to break that silence.

Why 2015 and Why Washington, D.C.?
  • The grassroots constituency that has developed over the last 15 years is organized
  • To build on greater acceptance of treating alcohol and other drug problems as health issues
  • Too many Americans lack access to the individualized treatment and other recovery support services they need to get their lives on track
  • Introduction of the bi-partisan Comprehensive Addiction and Recovery Act (CARA) in Congress and other public policy initiatives to address addiction and discrimination
  • Across the political spectrum, there is an understanding that current rates of incarceration, including for alcohol- and other drug-related offenses, can’t be sustained
We’ve developed an array of resources that you can use to let other people know about UNITE to Face Addiction that can be downloaded from our web site. We also have a team of field organizers who are mobilizing people in communities across the country to get to Washington, DC for the rally on October 4 and for our Advocacy Day on Capital Hill on October 5. We’re going to make history when we demand solutions to the addiction crisis. Together, we can end the silence.

What you can do:
1. Go to and sign up to get updates and information about how you can get involved.
2. Contact the field organizer working in your state who is ready to help you mobilize.
3. Share your story about why you’re going to DC on our web page.
4. Follow us on Facebook and Twitter
5. Tell your friends that you’ll be in Washington, DC on 10.4.15 and ask them to join you!

See you in October!

Pat Taylor has over 40 years of experience developing and managing local and national public interest advocacy campaigns on a range of issues including healthcare, the environment, community development and philanthropy.  Most recently she served as Executive Director of Faces & Voices of Recovery from 2003-2014, where she led the development of the organization into the national voice of the organized addiction recovery community.