Project ECHO LGBT: Making System Change to Address a High-Risk Population

Artist/photographer: Lavinia Solano
June 27, 2017

How can you effectively treat a high risk population without knowing which patients make up the population? The answer is: you can’t. 

To treat the complex needs of LGBT patients, it is necessary to remove the veil hiding this population from their health care providers. This removes stigma and increases the availability of treatment options based off of the specific needs of this population.

In collaboration with the Centers for Disease Control (CDC) and the National Association for Community Health Centers (NACHC), Dr. Wanda Montalvo of the Weitzman Institute at Community Health Center, Inc. led an initiative entitled “Transforming Primary Care for LGBT People” to improve the quality of care LGBT patients receive at 10 Federally Qualified Health Centers (FQHCs). 

This initiative took place over the course of a year, beginning in March of 2016. The primary focus of this initiative was the identification of the Sexual Orientation and Gender Identity (SOGI) of patients and the integration of this information into the electronic health record (EHR). Through the documentation of SOGI in the EHR, health care providers can make informed decisions about how to provide much needed care. 

Project ECHO LGBT 

The 10 FQHCs engaged in the initiative were provided access to Project ECHO LGBT and a Practice Improvement Collaborative (PIC) hosted by the Weitzman Institute’s online learning network. Project ECHO LGBT featured expert faculty from the Fenway Institute, who provided didactic presentations and facilitated and addressed case-based questions from providers attending ECHO. Project ECHO LGBT didactics addressed the full scope of relevant clinical topics to improve the knowledge and competency of providers.
  • Within one year, the 10 FQHCs engaged in the initiative were able to implement system change and identify the SOGI of 50.8% of their patient population (205,738). 
  • Of the 10 FQHCs, nine were able to integrate SOGI into the EHR. 
  • Throughout the year, each FQHC was able to improve risk-based screening and STD and HIV screening rates within this population, due to the increased visibility of at risk patients. 
This initiative yielded insight into how the engaged sites were able to make system change within the elaborate environment of an FQHC. The lessons learned across the 10 FQHCs provide an accurate account of the necessary steps and tools needed to unveil and begin population-specific treatment of LGBT patients. 

Culture First, Data Second

While documentation and data are critical to the big picture treatment of this population, the necessary first step is to consider the culture of your staff and patient population. The FQHCs found that alienation of both providers and patients was more likely if system change was disseminated without first considering the culture of staff and patients. 

It Starts at the Top

All FQHCs endorsed that the most important factor in the success of organization-wide system change was buy-in from leadership. Regardless of how important the work was to staff, patients, or the community, it was difficult to make change without the support of key leadership members. These include the CEO, CMO, and departmental heads in key departments like Human Resources, Communications, and Business Intelligence. 

Let’s Get Behavioral (Health, that is). 

Considering the societal stigmatization of LGBT people, it was not surprising to find that many of the case presentations on Project ECHO LGBT surrounded the behavioral health needs of LGBT patients. Whether the patient struggled with suicidal ideation, substance abuse, or sex addiction, it was evident that it’s necessary to treat each patient as a whole person and not only focus on their physical health through screening for STDs and HIV. System change cannot only accommodate physical health, but must address the mental health of patients to reduce incidence of chronic disease and other long-term health conditions that create poor quality of life for the patient.

The efforts of the 10 engaged FQHCs, with the guidance and assistance of the CDC, NACHC, the Weitzman Institute, and the Fenway Institute, cumulated in a critical understanding of how to make high-level system change to improve access and quality of care to an at-risk population. 

For more information on this work, please visit You can also contact Agi Erickson, Director of Project ECHO, at or (860) 347-6971 ext 3741.

Kelly Gagnon graduated from Hobart and William Smith Colleges in 2013 with   Bachelor of Arts degree in Psychology and French. During her undergraduate career, she conducted research on how to improve the quality of life of adolescent mothers and their children. This inspired her interest in research in sexual health. The needs of these mothers also opened her eyes to the needs of a widely underserved population. Her goal is to continue to work with these underserved populations to improve health disparities. Kelly is currently enrolled in a Master of Public Health program at Southern Connecticut State University. Kelly joined the Weitzman Institute in 2016 to assist with the LGBT ECHO and Pain research projects. She hopes that through working on these projects and others she can gain valuable research experience. After graduating from her Master’s degree program, she plans on continuing her education and pursuing a PhD program.

Honoring Pride Month 2017: YMSM + LGBT Webinar Series

June 20, 2017

Brandy T. Oeser, MPH
Project Director
YMSM+LGBT ATTC Center of Excellence 

LGBT Pride Month is celebrated each year in the month of June to honor the 1969 Stonewall riots in Manhattan. As part of the Center for Substance Abuse Treatment's recognition of LGBT Pride Month, the YMSM+LGBT Center of Excellence would like to encourage you to visit our archived webinars, where you can learn more about the LGBT Community. We have webinars available on many topics, including:
  • Creating an LGBT Affirming Organization
  • Supporting Change for LGBTQ Young Adults
  • Working With and For Two-Spirit Individuals

Special two-part series: Model programs 

We are also proud to present a two-part webinar series featuring four model programs serving YMSM of color. The programs are SAMHSA Targeted Capacity Expansion (TCE) HIV grantee award winners, who will share their successes and lessons learned providing substance use disorder treatment and HIV prevention services.

June 23, 2017: We'll hear from Jorge Diaz from the Nuevo Amanecer/New Dawn program at Bienestar Human Services, and Wendell Glenn from the Alcohol & Drug Advocacy for Young Men (ADAM) Project at Behavioral Health Services. 

July 28, 2017: The second webinar features Donald Powell and Sean Underwood from Project Aspire at Exponents and Anthony Contreras from Getting OFF! at Tarzana Treatment Center. 

To learn more and register, please visit:

This post is cross-posted from the YMSM+LGBT CoE blog.

Related Resources 

National Park Service: Stonewall, National Monument, New York

Related Resources from SAMHSA

Related ATTC/NIATx Service Improvement Blog Posts 

Cannabis News Roundup: June 2017

June 14, 2017 
Maureen Fitzgerald
ATTC Network Coordinating Office

The cannabis news deluge continues, with no sign of letting up.  Here's a roundup of some of the latest: 

Do medical marijuana laws promote illicit cannabis use disorder? (Science Daily, April 26, 2017)
"Illicit cannabis use and cannabis use disorders increased at a greater rate in states that passed medical marijuana laws than in other states, according to latest research."
Older Women and Medical Marijuana: A New Growth Industry (New York Times, May 25, 2017):
"Inspired partly by their own use of the drug for pain relief, or by caring for others who use it for their own aches, these women see viable business opportunities and view their work as therapeutic for their customers."
Teen cannabis use and illicit drug use in early adulthood linked (Science Daily, June 7, 2017)
"Researchers from the University of Bristol have found regular and occasional cannabis use as a teen is associated with a greater risk of other illicit drug taking in early adulthood."
More people are voluntarily seeking help for marijuana addiction (Washington Post, June 12, 2017)
"With fewer people landing in court for using marijuana, it follows that fewer would be sentenced to treatment for it. But while mandatory treatment is falling, evidence suggests that the number of people voluntarily seeking treatment is rising."

Vermont expands medical marijuana plan (CNN Money, June 12, 2017):
"Vermont has had legal medical marijuana since 2004. It applies to patients with a list of serious conditions that are typically found on state plans, including cancer, HIV, multiple sclerosis and glaucoma."

 New Mexico's Contentious 'Pot Powwow' (The Atlantic, June 12, 2017):
"A cannabis company believes the pot industry could save tribal nations from poverty. But many argue it would only make a drug problem worse."

Science Calls Out Jeff Sessions on Medical Marijuana and the "Historic Drug Epidemic" (Scientific American, June 14, 2017):  "Rolling back protections from federal interference in state legalization laws could worsen the opioid overdose crisis." 

Information overload, a little?

With this flood of daily news, sorting out what we actually know vs. what we think we know, or what we've heard, or think we've heard about cannabis can lead to some serious information saturation.

That's why The National Council, Advocates for Human Potential, and the ATTC Network, are hosting The 2017 National Cannabis Summit (August 28-30, Denver). 

The Summit focuses on six key themes:
  • The science of cannabis 
  • The impact of emerging research and epidemiological data on legalization
  • Public health and public safety
  • Prevention
  • Governance, federal law, and emerging best policy practices
  • Regulatory issues

Workshops will offer insight into everything from cannabis use disorder among older adults and the impact of medical marijuana dispensaries to youth prevention and implications of legalized marijuana for drugged driving. For the preliminary program, visit:

Who should attend? 

You should. The 2017 National Cannabis Summit is designed for addiction treatment and recovery specialists, community-based leaders, health care providers, researchers, policy makers, and public health and prevention professionals. Anyone interested in learning more is welcome to join this forum focused on cannabis science, policy, and best practices. 

See you in Denver? Register today! 

Dryhootch: Coffee shops and technology-based peer support for Veterans

May 29, 2017

Bob Curry is a Vietnam veteran who founded to provide support for veterans returning to their communities after deployment. He was inspired to launch the project after his own experience with PTSD and a substance use disorder.  In 2012, the Obama White House recognized Curry as a Champion for Change.

Today, Dryhootch has seven brick and mortar coffee shops/ community centers across the U.S.  Curry has combined his understanding of veterans' needs with his expertise in technology to create virtual supports like the digital Forward Operating Base, or "FOB."  He's also partnered with IntheRooms to test virtual support meetings for veterans in recovery.

No More Excuses: Implementing Technology to Improve Substance Use Disorder Services

May 23, 2017

Terra Hamblin, M.A., NCC, DCC
Project Manager
National Frontier and Rural ATTC

  • Seven billion people (95% of the global population) live in an area covered by a mobile-cellular network. (Bhuyan et al., 2016) 
  • By 2018, an estimated 50% of the more than 3.4 billion smartphone and tablet users will have downloaded mHealth apps. (Kuersten, 2010) 
  • Use of online and mobile technologies is increasing as consumers rely on Internet and smartphone-based tools for health information and tracking. (Ramsey et al., 2016) 
  • 80% of providers want to be alerted if their client is at risk of relapse; only 8% would want an immediate alert (Muench, 2015).  Current evidence demonstrates patients use and are interested in using technologies as part of their treatment or continuing support. Understanding how technology can be implemented is a critical first step towards successful adoption of technology-assisted care.
Technology can be a powerful partner in helping people manage their health conditions. Are you prepared to offer technology-based services? 

Marijuana Legalization is a Process and We Haven't Reached the Midway Point

May 11, 2017

Jonathan Caulkins, PhD
H. Guyford Stever University Professor of Operations Research and Public Policy
Carnegie Mellon University, Heinz College

On August 28, 2017, the National Council for Behavioral Health, Advocates for Human Potential (AHP) and the ATTC Network are partnering to host the  2017 National Cannabis Summit in Denver: An objective national forum for changing public policy, public health, treatment and research. In today's blog post, drug policy researcher and National Cannabis Summit plenary speaker Jon Caulkins muses on how marijuana legalization might evolve over the next 25 years. 

Colorado and Washington State legalized large-scale commercial production and marketing of cannabis for non-medical use in November, 2012. Almost immediately reporters started asking: “How has legalization turned out?”

I try to answer helpfully. Some results were predictable, such as declining prices. Others were less anticipated and so are truly news. My top three might include the proliferation of extract-based products, consumption increases coming largely from increased intensity of use rather than increased prevalence, and industry lobbyists replacing do-gooders as the drivers of liberalization.

Yet such comments, though true, are woefully incomplete.