Radical Healing: A Viable Response to Racial and Ethnic Inequities in Behavioral Health


Maxine Henry, MSW, MBA

Co-Director
National Hispanic and Latino ATTC


Ethnic and racial inequality has been present in our landscape for generations, yet the COVID 19 pandemic seems to have put a spotlight on the disparities felt by people of color and other minority groups. In a time where the entire world is experiencing overwhelming stress brought on by a virus that has changed our everyday lives, the National Hispanic and Latino ATTC decided to bring together powerful voices to spark conversation and activate positive change in our communities across the nation.

September is a busy month for many in the behavioral health field, as we celebrate National Recovery and Suicide Prevention Month our calendars and social media fill up with important events and inspiring messages of hope, healing and transformation. In many ways it has been a bright spot in the pandemic.

For Latinx community members September also kicks off Hispanic Heritage Month (September 15-October 15), providing us with additional opportunities to commemorate and celebrate our diverse communities. The 2020 theme for Hispanic Heritage Month is “Hispanics: Be Proud of Your Past and Embrace the Future”. In honor of this year’s theme our team decided to host a 4-part Virtual Learning Series titled “The Intersection of Acculturation, Assimilation, and Substance Use Disorder in Latinx Communities: Risk and Resiliency Factors”.

Different from a webinar format, this virtual learning community consists of a returning panel of four subject matter experts who are well respected in the areas of focus: Hector Adames, Psy.D.; Lorraine Moya Salas, PhD; Anna Nelson, LCSW; and Mr. Javier Alegre. The experts spend a short time providing an insight into the research and theories covered in our sub-topics and then have open dialogue with the same small audience of professionals, paraprofessionals, peers, students and leaders from across the U.S. This event is focused on providing a safe space for key stakeholders to gather to discuss the topics of race, disparities and strengths in the Latinx communities they come from and/or serve in the behavioral health space. The goal was to secure engagement in order for the participants to return to their communities and begin to manifest positive change.

Throughout all of our four sub-topics one theme that is consistent is radical healing as a key component to not only coping with racial and ethnic inequities and long-standing collective trauma that is the exacerbated by the pandemic, but to thrive despite the disparities that our communities have felt and, in some instances, contributed to. On its surface radical healing might sound far-fetched or hard to obtain, but once you take a closer look it is a natural strength of many communities. It is based in fundamental tenants often found in the deeply rooted Latinx culture. “Advancing beyond individual-level approaches to coping with racial trauma, we call for a new multisystemic psychological framework of radical healing for People of Color and Indigenous individuals. Radical healing involves critical consciousness, radical hope, strength and resistance, cultural authenticity, self-knowledge and collectivism. (French, Lewis, Mosley, Adames, Chavez-Dueñas, Chen, & Neville, 2019).”

Under this premise we can look back on what our ancestors have taught us, that in times of need we employ familismo, our larger family unit consisting of relatives, friends and community. To heal, recover and thrive from trauma and/or substance use disorders we look to traditional healing, connection and collectivism to take care of ourselves and others. When we face inequities, we rely on our resilience taught to us by our ancestors and family, stand in resistance to racism, and work together to push our families into the future.

Our goal with this event is not only to unpack issues of historical trauma, racism and intersectionality but also to highlight the strength, resiliency and power of our diverse communities. Furthermore, we aspire to use this dialogue as the catalyst for community and systemic change to heal and push forward into a brighter, healthier, more equitable landscape.

REFERENCE:

French, B. H., Lewis, J. A., Mosley, D. V., Adames, H. Y., Chavez-Dueñas, N. Y., Chen, G. A.,

& Neville, H. A. (2020). Toward a Psychological Framework of Radical Healing in Communities of Color. The Counseling Psychologist, 48(1), 14-46. https://doi.org/10.1177/0011000019843506.


Connecting Community and Faith in a Troubled World: The Southeast ATTC’s Faith Leadership Academy

By Pamela Woll, MA, CPS 
and Dawn Tyus, LPC, MAC, NCC
Southeast ATTC

Six months ago, when the world started grinding to a halt, it looked like travel and gathering restrictions might get in the way of the Southeast Addiction Technology Transfer Center’s highly interactive “Let’s Have the Conversation” Faith Leadership Academy, due to start its Immersion Training on April 27. Far to the contrary, the Academy has adapted well to Zoom, and the effects of COVID-19 have many times underscored the urgent need for and importance of the Academy, its lessons, and the leaders it inspires.


If we had any doubts about the complexity of the global pandemic of substance use disorders (SUD), the global pandemic of COVID-19 has wiped out those doubts. The social isolation and unemployment that coronavirus prevention measures created have proved powerful complicating factors for SUD.
  • Substance use has escalated, often to “self-medicate” loneliness, stress, and distress.
  • Access to treatment and recovery support has been reduced, or at best complicated.
  • Overdoses have skyrocketed, due to increases in use and decreases in the human contact that sometimes leads to life-saving measures.

Faith Leaders

The under-resourced SUD field has begun to recognize that engaged, knowledgeable faith leaders and faith communities can be excellent collaborators, “force multipliers,” and bridges between recovery and community life. For many individuals and families, welcome and support from faith leaders, congregations, and faith-based programs can be a catalyst for recovery, a source of referral/resources, and—for some—a primary source of ongoing recovery support.

But even before COVID-19, it wasn’t as simple as opening the doors and carrying a message of faith, hope, and redemption. The stigma, misconceptions, judgmentalism, and shame attached to SUDs:
  • keep many individuals and families away from faith communities,
  • prompt many people to hide or deny their afflictions long after they’ve joined faith communities, and
  • sometimes provoke subtle and not-so-subtle expressions of disapproval that can drive people away from faith communities—sometimes away from faith itself.
Well-prepared faith leaders can seed recovery-friendly cultures within their organizations/congregations, but that’s not simple either. Religious education offers little information or training about SUD, stigma, intervention, referral, or recovery support. Beyond that, it seldom prepares leaders to develop the larger vision, mission, and calling that would help them reach out to surrounding communities and collaborate in transformative efforts to find and help the many individuals and families in desperate need.


The Faith Leadership Academy
Southeast ATTC Director Dawn Tyus and Developer/Facilitator Le’Angela Ingram, MS built the Academy to address just these challenges. Components include:
  • “360 Assessments” synthesizing feedback from superiors, peers, staff, and congregants;
  • one-to-one coaching with the facilitator;
  • a collaborative immersion training for this cohort of 10 faith leaders;
  • webinars with field leaders presenting best practices and emerging trends, followed by discussion sessions within the cohort;
  • extensive reading (e.g., Robert Greenleaf’s Servant Leadership, James Collins’s and Jerry Porrass’s “Building Your Company’s Vision,” Peter Senge’s The Fifth Discipline, John Kotter’s “Leading Change,” and Derron Payne’s The Art of the Pivot);
  • collaborative results-based projects;
  • a booster session; and
  • graduation.
With the inspiration of their individual and collective values, visions, and missions—and the energy and synergy of their collaboration—participants are finishing their projects, including:
  • a regional gathering of faith leaders, a committee to discuss options for linkage to treatment/recovery support, and a multidisciplinary forum on the SUD needs of men in the criminal justice system;
  • training programs (e.g., understanding/identification of SUD, stigma reduction, trauma-informed services, faith leader peer support, forging connections with community resources, starting an SUD ministry, Mental Health First Aid, Wellness Recovery Action Planning, and Resilient Congregations Framework for Ministry) for other faith leaders;
  • a project to establish wraparound services in an impoverished community, a mentoring/support relationship with an under-resourced congregation to establish a Celebrate Recovery program, and a movement to prevent arrests and recidivism; and
  • two video projects, one using personal recovery and faith community experience to educate faith leaders/communities on becoming more welcoming and connecting; and one on empathy, with an accompanying journal/discussion guide for faith communities.

Facilitator Ingram has fond memories of many moments from the Academy, but her favorites are the moments when participants came to her saying things like, “Le’Angela, this is deep!” “This is not lightweight stuff!” and “I have to take more time to be reflective!”

NIATx Principle # 4: Getting Ideas from Outside the Field …Or From Inside Track and Field


By Mat Roosa, LCSW-R
NIATx Coach






The United States has consistently produced some of the best track and field sprinters for decades and decades.

And the United States 4x100 relay teams have been disqualified from a painfully large number of World Championship and Olympic races as a result of dropped batons or botched handoffs.

Why have these best-in-the world sprinters failed so often?

Because relay success requires both speed and the effective management of a multi-step process. In sprint relays, it's all about the handoffs.

Passing the baton around the track is an excellent representation of many handoffs that we see in health care and other industries. Whether we’re talking about products on an assembly line, information, or patients receiving care, the handoff can make or break the product's quality and the customer experience.

The secret of winning sprint teams

Sprint relay teams who have succeeded in winning championships—despite having slower runners than the other teams—have excelled because they have mastered the baton handoff. Contrast this with the American teams, who have been criticized for too much focus on team members' raw speed and inadequate focus on the baton handoff process.

By dissecting a complex process into its component parts and making focused adjustments to enhance efficiencies, you can achieve some amazing results.

Perhaps the less-than-speedy teams have used tools similar to the NIATx method to understand and improve their relay effectiveness:
  • Conducting a Walk-Through (or…a Run-Through) to identify the elements of concern
  • Flowcharting to understand the strengths and weakness of the process, and to identify potential ways to fix those weaknesses
  • Nominal Group Technique brainstorming to identify specific changes to prioritize for action
  • And using Rapid-Cycle PDSA changes to test specific adjustments to the race process

The NIATx model has worked for many organizations in diverse fields making a wide range of improvements.

Not that we are suggesting a NIATx coach for the American sprint relay teams, but maybe ….

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 quality improvement, organizational development and planning, and implementing evidence-based practices. Mat 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

Responding to Needs: Collaborations for Broad Impact




By Thomasine Heitkamp, LCSW
PI and Co-Director of the Mountain Plains ATTC and MHTTC


The Mountain Plains ATTC collaborated with the Mountain Plains MHTTC to create a shared product entitled Depression, Alcohol and Farm Stress: Addressing Co-Occurring Disorders in Rural America, [Co-occurring Disorders] April 2020 (M. Shogren, R. Landwehr, D. Terry, A. Moore and A. McLean). This blog discusses the rationale for product development, a brief description of the product, end-user comments, and collaborations with organizations, localities, and states. The topic of co-occurring disorders (substance use and mental health concerns) was identified as a significant training and technical assistance (TA) need in recent formal assessments conducted by the Region 8 ATTC and MHTTC shown below.


In response to this identified need, Region 8 offered training/TA activities and developed products related to treating co-occurring disorders. Given the rural and frontier nature of Region 8, the issue of treating co-occurring disorders requires an examination of this topic in the context of farming families and their communities. 


The Co-occurring Disorders product was produced to assist Region 8 behavioral health providers to improve and enhance their skills in treating co-occurring disorders. Users of this product are provided a fictitious case scenario that walks them through applications regarding use of screening tools (AUDIT-C, PHQ-2, PHQ-9, Health Leads, SIREN) to determine the needs of a farmer who is ultimately diagnosed with an alcohol use disorder and depression. The Co-occurring Disorders product also underscores the importance of family supports, referral to treatment, provider flexibility, and addressing compassion fatigue. The 66-page product includes evidence-based resources (81 references and 26 resources) and colorful photos to provide a narrative regarding screening and intervention related to co-occurring disorders.


“It was easy to understand, and one of the parts that I really liked was that we followed John through the entire process, from the initial start to the emergency room. I liked that because it was easy to see how it would work into a practice; the storyline and how it is incorporated into patient care and practice.”

“It reminds me that as a primary care provider, you might get a little numb to all the barriers that people are facing.”



Following publication and dissemination of the Co-occurring Disorders product, the Mountain Plains ATTC assessed end-user perceptions, including feedback by advanced practice nurses and APRN students who suggested incorporating this document into health career curricula, especially to prepare primary care providers. All feedback was positive, with a note regarding the informative nature of the product and the practical approach to assisting providers in expanding their capacity to address co-occurring disorders among farmers and rural residents. In less than three months, this product has served as the backdrop for additional training/TA activities provided by both the Region 8 ATTC and MHTTC. This includes:

  • Collaboration with Great Lakes MHTTC and the American Psychological Association to offer two trainings - (1) Approaching and Treating Co-Occurring Mental and Substance Use Disorders in Farming and Rural Communities and (2) Co-Occurring Mental and Substance Use Disorders in Farming and Rural Communities: Assessment, Ethics, and Preventing Compassion Fatigue;
  • Co-authoring a companion piece in June 2020 with Mountain Plains MHTTC and Mid-America ATTC and MHTTC, entitled Farm Stress Facts, Impact of Covid-19, Resources, and Training Needs of Mental Health Care Providers (S. Schroeder, T. Heitkamp, B. Clark, E. Holiday, A. Breigenzer, & S. Johnson);
  • A Mountain Plains ATTC Enhanced Professional Learning series that establishes a learning community to expand treatment capacities on co-occurring disorders.
The Co-occurring Disorders product has been accessed and marketed by multiple organizations, including the RHI hub, the National Rural Health Association, and the National Organization for State Offices of Rural Health, which provided a review in their monthly newsletters. Representatives of the United States Department of Agriculture (USDA) lead offices in the Region 8 states (CO, MT, ND, SD, UT, WY) have received the product and are critical collaborators in working on the topic of addressing farm stress through their numerous office locations. USDA has participated in past trainings and is more readily accessing TTC resources, given this collaboration. This effort reflected meaningful and ongoing collaborations among the TTCs and other behavioral health partners to increase awareness and enhance expertise on how co-occurring disorders are addressed in rural areas.


Thomasine Heitkamp, LCSW, is the PI and Co-Director of the Mountain Plains ATTC and MHTTC. She is a Chester Fritz Distinguished Professor at the University of North Dakota with more than 30 years of experience in behavioral health workforce development.




Technology Transfer and Organizational Resilience in the age of COVID-19



Michael S. Shafer, Ph.D.
Pacific Southwest Addiction Technology Transfer Center
Arizona State University

February 4-6, 2020, 39 behavioral health professionals representing 13 agencies throughout HHS Region 9 gathered in Oakland, California for three days to participate in the PSATTC’s Organizational Process Improvement Initiative (OPII) Change Facilitator Academy, launching a 10-month, long-term intensive technical assistance program. Each agency’s group of newly trained facilitators returned home with a plan to brief their Executive Sponsor (who had previously provided a letter of commitment for staff to attend) and hold an organizational change team kick off meeting within 30-45 days. Schedules were coordinated to ensure that I could travel to and attend each of these meetings; no small feat considering sites were located in two states (CA & AZ) and two Pacific Jurisdictions (RMI & CNMI) half a world away. This wordle, captured at the conclusion of the 3-day Academy, denotes the spirit and emotion of the participants.

These are agencies that were ready for change and innovation; they had applied to the PSATTC OPII program to enhance their ability to do so. Selected agencies were required to survey their staff using the TCU Organizational Readiness to Change Assessment. Academy participants had to view three hours of asynchronous video modules before arriving in Oakland. CEOs had to provide a letter of commitment with specific deliverables and action items associated with the OPII model.

And then COVID-19 happened. Site visits were cancelled, kick off meetings were put on hold and change teams suspended, as agencies responded with immediate crisis management actions to protect staff and patients and begin to reimagine service engagement with clients in a physically-distant manner. One agency executive director approved $80,000 in expenditures related to ramping her agency’s telehealth capacity in the two weeks following implementation of her state’s stay at home order. In late March and early April, however, the most important thing these agencies had to focus on changing and innovating was protecting their staff and patient’s safety.

In the four months since the onset of the COVID-19 pandemic, six of the 13 teams have resumed meeting regularly, virtually, and advancing in the 4-phased OPII model. Two of the agencies withdrew their participation, while one agency postponed their change team launch until July. Our ATTC team pivoted our TA procedures. We launched a series of group and individual agency email and zoom meeting communications encouraging agencies to consider altering their improvement change goal to address agency-pressing COVID related issues (such as telehealth adoption). In lieu planned site visits, I began holding Zoom check-ins with each agency every 4-6 weeks. Using Zoom’s recording and transcription capacities has proven a great innovation for documentation and evaluation purposes! We launched a monthly 1-hour Community of Practice (CoP) Zoom session to introduce virtual facilitation tools and skills (such as Zoom and Mural; this portion of the CoP is called the “spark session”) to support facilitators’ virtual team facilitation skill development. These virtual CoP sessions also afford an opportunity for agencies to check-in on their team progress in the OPII change model, while sharing facilitation successes and struggles. These communications are providing insights into the organizational resilience of these agencies in the face of massive short- and yet-to-be-defined long-term changes, and the impact of an ATTC-mediated technical assistance model on strengthening their capacity for technology transfer and innovation.