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? 
 I have always found an organization’s climate to be a ready indicator. When people are “burning out” and moving to another clinic or leaving the field altogether, it is usually a reaction to a toxic climate.

Both directors and clinic staff can contribute to a toxic climate by externalizing organizational problems. It is easy to blame overwork on insufficient community support, dwindling third-party reimbursements, and simply too many people seeking help. The resulting exhaustion derived from a toxic climate and culture enables that sort of rationalization. “I know how to swim, but I am still drowning here.”  That sort of thinking often blinds incumbents from noticing how simple changes can help to turn things around. In the swimming metaphor, it can be as simple as allowing yourself to drift into shallower waters.

In the field of addiction recovery, organizational inertia is especially common because so many provider organizations are small in size and resources, and many have a long history of struggling to find resources to support their work. The role overload that once was due to external factors gets mistaken for role overload now emanating from internal factors that are creating barriers to efficiency and effectiveness.

So, unless the organization perceives that it has some extra resources, it is unlikely to perceive that it has the “luxury” of exploring change, much less believe that it has the energy to engage in change. This is the same vicious circle as the revolving door metaphor for addiction relapse. Cruelly ironic is the likelihood that if you do not fix the organization, you are not likely to slow the addiction revolving door for clients either. So, I guess a big challenge for NIATx is finding a way to educate providers about the need for change.

As I mentioned, a fairly reliable barometer of organizational health is organizational climate. And a bellwether sign of a deteriorating climate is staff exhaustion. Being tired after a busy workday is normal. Feeling exhausted on most days signals organizational decline, a decline that risks taking staff and patients down with it.

Maybe offering a checklist of climate indicators of decline might stimulate interest in change. I have a million of ‘em, but these five seem most germane to addiction:

1. Staff members frequently complain of feeling exhausted.
2. Clients are dropping out in greater numbers than the past.
3. No-shows are becoming more common.
4. Employee turnover is diverting resources to recruiting and training.
5. Most of staff members feel that things would improve if only external factors like funding would improve.

Any one of these symptoms signals a need for continuous improvement troubleshooting. More than one symptom usually indicates the need to stop and assess the entire organization’s health. This is the sort of activity that NIATx was designed to help addiction health service providers accomplish.

How does your organization identify the need for change or the need to improve your processes and systems? Let us know in the comment section below.

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 www.facingaddiction.org 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.

Marijuana Lit: Even more resources for SUD providers

Marijuana Lit: Fact Based Information to Assist you in Providing SUD Services launched in January this year with a goal: to supply SUD providers with the straightforward, accurate information about marijuana from trusted sources. The team at the ATTC Network Coordinating Office has  been busy adding new information and resources! 

Here's a quick recap of the most recent additions to the Marijuana Lit site, along with other ATTC activities related to marijuana use:

The changing healthcare landscape: tools for states and treatment providers

Todd Molfenter, PhD

Senior Scientist, Center for Health Enhancement Systems Studies

Co-Deputy Director, NIATx

In this time of health system reform, states have had to plan for and implement dramatic changes, particularly in the way they purchase and provide addiction treatment services. The unprecedented amount of change has compromised states’ abilities to provide the full spectrum of technical assistance that addiction treatment programs may need to adapt to the changing environment (see Andrews et al., Health Affairs, 2015).

For the past several years, NIATx has led a range of SAMHSA-funded projects designed to help states make the transition to this new landscape. Lessons from earlier NIATx projects such STAR-SI and Advancing Recovery have helped inform these state-based initiatives. A recurring theme in the earlier projects was the key role that state purchasers of addiction treatment services play. That remains true with our current efforts. What we’re finding in our work is a set of competencies that states can develop to increase the viability of their publicly-funded addiction treatment systems.

Some states and treatment providers are focusing on administrative operations through SAMHSA’s BHBusiness Plus and other programs. The Strategic Provider Partnerships collaborative that we're now working on as part of BHBusiness Plus is helping three states (Texas, Louisiana, and Mississippi) look at ways to strengthen their addiction treatment systems at both policy and service delivery levels. Other states (like Ohio and Missouri, to mention just two)  are focusing on use of evidence-based practices such as medication-assisted therapy to reduce the impact of opioid misuse. Through these efforts, it’s become increasingly clear that states want evidence of improved treatment access and clinical quality, regardless of their ACA status or how they pay for substance use disorder (SUD) services.

At the provider level many efforts are, or should be occurring, that states may or may not be able to support with technical assistance. These efforts start with better access to treatment for SUDs. As a recent news stories reported, people seeking help for an SUD continue to encounter barriers to treatment. With improving access, we’re talking about reducing wait times and adding weekend and evening hours, or open access. Improving access also involves helping people get connected to health insurance that will cover their treatment.

Another driving quality indicator within the context of the ACA is documented use of evidence-based practices that are supported by better retention and completion rates.

Ultimately, ensuring treatment agency viability will likely rely on their ability to engage third-party payers to pay for treatment services. This, in turn, is driving treatment agencies to hire staff who meet requirements for insurance reimbursement. Earning accreditation from organizations such as The Joint Commission or CARF International has also become a quality improvement priority for many treatment organizations. 
There are many instances of states supporting the adoption and proliferation of these competencies that improve access and quality. At the same time, providers are also pursuing these capabilities on their own through the many training and technical assistance tools that NIATx and the ATTC Network offer.

What has your state or treatment organization been doing to adapt to the changing healthcare environment?  Let us know in the comment section below. 

Todd Molfenter, PhD, is Deputy Director of NIATx and a Senior Scientist at the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. He is currently a principal investigator for an NIH study focused on increasing use of buprenorphine in Ohio. Todd has led a variety of statewide projects designed to improve addiction treatment access and quality through system and organizational change efforts.  You can reach Todd at 

Naitonal Hepatitis Testing Day: Ask the Expert, Corinna Dan

National Hepatitis Testing Day in the United States is part of an educational initiative of CDC's Division of  Viral Hepatitis and the U.S. Department of Health & Human Services' Combating the Silent Epidemic of Viral Hepatitis: Action Plan for the Prevention, Care & Treatment of Viral Hepatitis, Updated 2014-2016 .

Corinna Dan, R.N., M.P.H., is Viral Hepatitis Policy Advisor, Office of HIV/AIDS and Infections Disease Policy, U.S. Department of Health and Human Services. In this role, she is working to implement the the Viral Hepatitis Action Plan, which aims to build awareness of new hepatitis C screening recommendations and treatments, as well as prevention, diagnosis, care and treatment for viral hepatitis now available under the Affordable Care Act. 

Here, Ms. Dan responds to questions about hepatitis C as part of our observation of Hepatitis Awareness Month, the launch of our the new ATTC resource, HCVCurrent, and  National Hepatitis Testing Day.