Welcome to the New National Hispanic and Latino Addiction Technology Transfer Center

Pierluigi Mancini, Phd, MAC
Director, National Hispanic and Latino ATTC
National Hispanic and Latino ATTC

Welcome to the New National Hispanic and Latino Addiction Technology Transfer Center, (National Hispanic and Latino ATTC) the latest member of the Addiction Technology Transfer Center network (ATTC). The National Latino Behavioral Health Association (NLBHA), the grant recipient, was established to fill a need for a unified national voice for Latino populations in the behavioral health arena and to bring attention to the great disparities that exist in areas of access, utilization, practice-based research and adequately trained personnel. (www.nlbha.org)

The Latino population in the United States combines very diverse populations. The major groups are Mexican Americans (who constitute 63.0% of Latinos), mainland Puerto Ricans (9.2%), and Cubans (3.5%). The Census Bureau's code list of subgroups other than the major groups contains over 30 Hispanic or Latino subgroups, including Brazil, South America’s largest country.

There are also individuals who were born in the United States of America who identify themselves as Hispanic or Latino.

The various Latino groups concentrate in different regions of the U.S. and they constitute a large proportion of the foreign-born population, slightly more than half (53.1%) of the total foreign-born population is composed of immigrants from Latin American and Caribbean nations.

Latino groups also differ in nativity status. About one-third (36%) of Hispanics of Mexican origin are foreign-born, as compared with more than half of Cubans and Dominicans (59% and 57%, respectively). Among Puerto Ricans living in the United States, one-third (31%) were born on the island. In addition, there is substantial heterogeneity across Latino groups in terms of immigration history and patterns.

The National Hispanic and Latino ATTC will be addressing the diverse needs that this heterogeneous community faces when it comes to seeking and finding addiction treatment, prevention and recovery services. Besides country of origin we will be addressing issues of acculturation, limited English proficiency, health literacy, or the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions.

We plan to train the behavioral health workforce that will be serving Hispanic/Latino communities and developing and/or adapting the evidence-based practices and services that these professionals will be using in order to bring meaningful change to the lives of these individuals.

We will serve individuals and organizations who provide behavioral health services to Hispanic/Latino populations throughout the United States. The center will provide training and technical assistance to a wide range of public, nonprofit and private organizations in culturally and linguistically appropriate practices and programs effective in serving Latino populations including evidenced based, community defined evidence, and other best or emerging practices.

Finally, we will make sure that the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS Standards) are recognized. Training and hiring protocols will be implemented to support the culture and language of all subpopulations (English, Spanish or Portuguese), with a focus on the diverse Hispanic/Latino populations.

For additional information, please don’t hesitate to contact Project Director, Pierluigi Mancini PhD, MAC, at pierluigi@nlbha.org or at 678-883-6118

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REFERENCES
Acosta, YD., De la Cruz, GP. Brief ACSBR/10-15. US Dep. Commer., Econ. Stat. Adm., US Census Bur; 2011. The foreign born from Latin America and the Caribbean: 2010. http://www.census.gov/prod/2011pubs/acsbr10-15.pdf

Ennis, SR., Rios-Vargas, M., Albert, NG. Brief C2010BR-04. US Census Bur; 2011. The Hispanic population 2010. http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf

Brown, A., Patten, E. Hispanics of Puerto Rican origin in the United States, 2011. Pew Res Cent, Hisp Trends. 2013 Jun 19. http://www.pewhispanic.org/2013/06/19/hispanics-of-puerto-rican-origin-in-the-united-states-2011/



Great Lakes ATTC: Process Improvement Focus Helps Organizations Implement Evidence-Based Practices


Todd Molfenter, Ph.D.
Director, Great Lakes ATTC

The mission of the ATTC Network includes “accelerating the adoption and implementation of evidence-based and promising addiction treatment and recovery-oriented practices and services.”

At the Great Lakes ATTC, we’re applying our background in implementation science and process improvement to help accelerate the adoption and implementation of EPBs in our region and beyond.

Implementing EPBs can be challenging for organizations of any size. Emerging research from implementation science tells us that successful EPB implementation needs:
  1. more than training alone,
  2. coaching and feedback; and
  3. standardized improvement model.
See related article, Water into Sand: OUD Pharmacotherapy and Implementation Science: Why Training on Evidence-Based Practices is Never Enough

The NIATx Model

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. A seminal article written by McCarty et al. in 2007 described the impact of the NIATx model on access and retention in addiction treatment settings. 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.

The NIATx Change Leader Academy

To teach the NIATx model, we offer the NIATx Change Leader Academy (CLA): a one-day, face-to-face workshop followed by three months of peer networking and support from a NIATx coach. The CLA teaches organizations how to use the NIATx model of process improvement to lead change projects that focus on improving systems or implementing EBPs.

Based on customer feedback (and applying NIATx Principle #1: Understand and Involve the Customer), we continue to refine this training session to make it focused, team-based, and interactive. Participants leave the skill-building workshop with tools they can use to start a change project as soon as they get back to the office.

Available in our region and beyond

During our first year as the Great Lakes ATTC, we conducted NIATx CLAs in each state in our region. These events were a great way to build relationships with our stakeholders and to introduce more behavioral health providers to the NIATx model.

Organizations in our region are using the NIATx approach for a wide range of change projects, including implementation of medication-assisted treatment for opioid use disorder and Screening, Brief Intervention, and Referral to Treatment. NIATx tools are helping to build Recovery-Oriented Systems of Care in Ohio, Indiana, Illinois, and soon, we hope, in other states in our region. Organizations can use the NIATx approach to implement other EPBs, such as those listed in SAMHSA’s Evidence-Based Practices Resource Center.



Photo: NIATx Change Leader Academy, MARRCH, April 3, 2019

The NIATx model also provides a framework for making changes to administrative processes. In Minnesota, a recent NIATx CLA marked the launch of a strategic initiative by the Minnesota Associations of Resources for Recovery and Chemical Health (MARRCH): a statewide Change Leader Learning Community that will help Minnesota providers adapt to policy changes coming to the state.

Read the related news story: NIATx Change Leader Academy Launches Minnesota Learning Collaborative

We offer the NIATx CLA regularly in the states throughout our region; check the Great Lakes ATTC calendar for info on upcoming offerings. And if you are interested in hosting a NIATx CLA in our region, give us a call!

Why Understanding and Involving the Customer Matters in Behavioral Health

Mat Roosa, LCSW-R
NIATx Coach





Treatment organizations continue to face the challenge of improving access to and retention in treatment. NIATx (originally known as The Network for the Improvement of Addiction Treatment) was developed specifically to help treatment providers make simple, powerful changes that can improve service delivery.

NIATx is based on five principles. The first principle, Understand and Involve the Customer, is number one for a reason. According to the research that was foundational to NIATx, this principle has more impact on the success rates of change implementation than all of the other four principles combined!

Listening to the voice of the customer
Everyone has heard the old business adage, “the customer is always right.” Many of us struggle with this concept. While a shoe store might take back a pair of shoes with half the sole worn off, do we really think that the customer is “right” to ask for the refund? Principle #1 helps us to understand just how right the customer always is.

There is no more important vision and voice than that of the customer. The customer is the only one who can tell us what they feel and what they want. The customer is always right about their perceptions of their experience, and that perception is the most important concern when we are trying to engage and help them. The best product or service will not be successful unless it is embraced by the customer.

So, what steps can we take to engage and involve the customer better?
I recall being at a meeting during which a veteran administrator was asked how recipients of services would feel about a major change. As he waxed on about a number of variables, I could see a supervisor of peer services, a woman with a great deal of lived experience as a service recipient, growing more and more frustrated. When he took a breath, she simply said, “Why don’t you just ask them?”

Why don’t we spend more time “just asking them”? The asking of customers requires that we treat them as partners at the table of service development and service improvement. While most would say they are willing to ask, fewer are willing to invest the time and ready to relinquish the control that is required for genuine asking. The walk-through, the Empathy Map and the Nominal Group Technique are three tools that will help teams to build a culture that values customer input.

The walk-through
One essential NIATx tool is the walk-throughThis role play exercise in which staff walk through the client experience is typically conducted at the beginning of the change project and helps teams see treatment barriers and process problems that are often hiding in plain sight. Walk-through exercises have uncovered issues such as an incorrect phone number listed as the agency contact information, poor directions to the treatment location, confusing signage at the facility, unwelcoming waiting areas, and lengthy intake sessions that require excessive or duplicative paperwork.

Here are a few tips for ensuring a successful walk-through:

1. Inform your staff: The team should be prepared for the experience. You want to see the process at its best, and then consider how it can be improved.

2. Stay in your role: complete the process in an authentic fashion.

3. Note the details of the process, and your emotional experiences

4. With each step of the process ask two questions: Is this necessary? If yes, Is it the best that it can be?

The Empathy Map
What do your customers say, think, feel, and do? What are their goals? Draw a large version of the Empathy Map grid, and ask your team members to write single ideas on sticky notes to be placed in the five sections of the grid. This tool will cultivate empathy for your customers’ experiences. It can serve as a way to gather all of the wisdom that customers have shared with administrative and treatment staff over time, and can help to identify key themes that will lead toward improvements. These questions are also an excellent structure for asking customers for feedback through interviews or focus groups.

The Nominal Group Technique
Using the Nominal Group Technique (NGT), another essential NIATx tool, is an excellent way to brainstorm with a team that includes customers, The structure of the process is designed to create inclusive participation among the team members. The four steps of the NGT process are intended to ask a powerful question and encourage listening to all of the answers offered. It can empower customers, and teach staff members about the value of the customer voice.

Four steps of the NGT



The walk-through, Empathy Map, and the NGT: three critical tools for understanding and involving the customer, and understanding just how right the customer is.



About our guest blogger:
Mat Roosa was a founding member of NIATx and has been a NIATx coach for a wide range of projects. He works as a consultant in the areas of quality improvement, organizational development and planning, evidence-based practice implementation, and also serves as a local government planner in behavioral health in New York State. His experience includes direct clinical practice in mental health and substance use services, teaching at the undergraduate and graduate levels, and human service agency administration.

You can reach Mat at: matroosa@gmail.com

ECHO-CMU for ATTC 25th Anniversary: SEA-HATTC’s expansion of new learning strategies


Behavioral health is a major problem while ongoing health workforce shortage is global issue. SEA-HATTC signed MOU with Missouri Telehealth Network, University of Missouri for utilization of ECHO® model and software to conduct virtual clinics via multi-point videoconferencing also extend behavioral healthcare knowledge and tele-consultation to primary care and community hospitals in the upper northern Thailand.

To promote the expansion of new learning strategies, SEA-HATTC mapped out an implementation of behavioral health ECHO® (Extension for Community Healthcare Outcomes) model as a guided practice strategy for transforming medical education and increasing workforce capacity to teach best-practice specialty care.Having been endorsed as a highly innovative strategy that produces improvements in the quality and efficiency of integrated care, ECHO is a low-cost yet high-impact intervention linking expert inter-disciplinary teams of practitioners through tele-education.

A regular monthly 60-minute tele medical education on ‘behavioral health’ under ECHO-CMU Project has been launched for doctors, nurses, psychologists and nutritionists.The goal is to manage and control of chronic disease through behavioral health interventions. ECHO-CMU has 4 sites in Chiang Mai, Chiang Rai, Lamphun and Lampang Provinces all are the provincial hospitals located in the upper northern region of Thailand. Hub is located at SEA-HATTC Office, Department of FamilyMedicine at Chiang Mai University. Spokes are residents of Family Medicine in in-service training program.

To date, there are 75 health professionals (excluding Hub team) participating. Sessions under behavioral health theme included ‘care for patients with EMCO stroke’; ‘multidisciplinary approach for self-management support’; ‘approach and management for delated development at child’; ‘MI and counseling’; ‘health behaviors and behavior change’; ‘caring past stroke patients’;‘depression’; ‘deconditioning’; ‘nutrition for patient with NCD’; ‘dealing with alcohol and smoking in chronic disease patient’; ‘ updating guideline for NCD’; ‘diet for DM’; ‘exercise for elderly with chronic disease’, and etc., as the model shown below.



The clinics are supported by basic, widely available teleconferencing technology. During teleECHO clinics, primary care clinicians from multiple sites present patient cases to the specialist teams and to each other, discuss new developments relating to their patients, and determine treatment. Specialists from Faculty of Medicine, Chiang Mai University and Mahidol University serve as mentors and colleagues, sharing their medical knowledge and expertise with primary care clinicians. Essentially, ECHO® creates ongoing learning communities where primary care clinicians receive support and develop the skills they need to treat a particular condition. As a result, they can provide comprehensive, best-practice care to patients with complex health conditions, right where they live.

Besides the behavioral health theme of the pilot ECHO-CMU, the upcoming theme will be provided on ‘Caregiver of NCDs Geriatric Patient’ targeted to primary care practitioners, co-health workers, village leaders and health volunteers.

Given the limited project budget and the vast geographic spread of the target countries, SEA-HATTC introduced ECHO model to the regional advisory board members as an effective multi-point videoconferencing platform in extending HIV/addiction technology transfer and tele-consultation to health and social workers in Tier 1 countries including Cambodia, Lao PDR, Myanmar plus India and Indonesia for workforce development within the Southeast Asia region.

Workplace Learning: Helping Practitioners Work Wiser

Nancy Roget, Joyce Hartje & Terra Hamblin 
CASAT, University of Nevada Reno 


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.