Finding New Ways to Connect During Isolation

Jeff Ledolter
National American Indian & Alaska Native Addiction Technology Transfer Center

When COVID-19 was declared a pandemic in March 2020 and services began shutting down, many clinics were at a loss for what to do. Facing an unprecedented challenge, health providers had to make tough decisions with incomplete information on how they could best help their patients. They had to weigh the possible effects of exposing their patients to an unknown infectious disease against the behavioral health problems that they knew could cost their patients their lives. It’s been commonly said that addiction is the opposite of connection. How could a counselor advocate for their patients to socially distance when they knew it would put patients at greater risk of relapse and overdose?

Health providers were not alone in facing this decision. Almost every organization, including our three American Indian and Alaska Native technology transfer centers, was forced to adapt to the new normal of isolation and severing of connections. We’ve long been an advocate of hosting in-person training sessions and events. The relationships and trust that we have with our network of providers are based on face-to-face interactions. It not only embodies the harm reduction approach of meeting people where they are but acknowledges their tribal connections with their lands and shows that we are committed to helping improve their communities.

After some consideration, each of our centers began a series of listening sessions. Every week, we would invite providers to our Prevention, Mental Health, and Addiction TTC listening sessions to hear what was happening in their communities and allow them to connect to a world they were no longer permitted to attend. Originally, these sessions were an opportunity for grantees to vent their frustration and compare their situations with others. Over time, as people got used to the new format and began seeing familiar faces on these calls, they began opening up and sharing more about their individual and community challenges. They began comparing strategies that they’d found useful when faced with an unprecedented challenge and began accepting help from each other. Connecting these virtual neighbors allowed them to improve their practices by comparing the relative effectiveness of different treatment and prevention approaches in native communities.

Telecommunication events are still imperfect and may never match up to the connection found in face-to-face interactions. I’m sure that most professionals are too familiar with the audio/video problems and awkward delay problems that come with teleconferencing. Still, keeping that connection alive during these stressful times is more important than ever.

Unfortunately, 8 months since it was declared, the pandemic is still not over. Even worse, providers are already beginning to see the wave of mental health and substance use disorders that follow a period of stress, uncertainty, and isolation. To date, our centers have hosted over 100 of these listening sessions and we plan to continue them for as long as they are useful, perhaps even once we’re able to meet face-to-face again. Even through this virtual meeting space, we’ve seen once again the kind of resilience that Native communities display when relying on cooperation, empathy, and trust.

For an overview our listening sessions, please visit our webpage here:
https://attcnetwork.org/centers/national-american-indian-and-alaska-native-attc/covid-19-related-programs






Strategies for Addressing Stimulant Use Among Women: An ATTC Collaborative Project ECHO Series

Maureen Nichols
Director, South Southwest Addiction Technology Transfer Center
HHS Region 6


Co-authors:

Pat Stilen
Director Mid-America Addiction Technology Transfer Center
HHS Region 7

Thomasine Heitkamp
PI and Co-Director
Mountain Plains Mental Health Technology Transfer Center Mountain Plains Addiction Technology Transfer Center
HHS Region 8



An overriding concern in the behavioral health field in HHS Region 6 in the past several years is the continued impact of stimulant use on individuals in our states and tribal communities, and the need to promote effective, evidence-based and holistic strategies for recovery and wellness for this population. Taking a focused approach on the specific needs of women who use stimulants, three regional ATTCs brought together their collective expertise to develop a Project ECHO series that the utilized case-based learning model to build community capacity to address this growing epidemic: Mid-America ATTC, a leader in evidence-based treatment for pregnant and post-partum women, Mountain Plains ATTC, with expertise in serving rural populations, and the South Southwest ATTC with experience in implementation of substance use peer recovery services. Each Project ECHO session included a didactic presentation followed by one or two de-identified case presentations related to stimulant use among women. All the case scenarios (required in an ECHO Model) had a stated goal of reunification of children with mothers who were struggling with a stimulant use disorder. This underscored for the cross-regional ATTC team the needs to work “hand in glove” with professionals with expertise in child welfare practice and encouraging cross-disciplinary efforts. The case reviews also underscored the limitation of resources to support mothers, especially in rural communities.



Results of this collaborative project advanced behavioral health service improvement in several ways:

Advancement of participant knowledge, skills and resources: The presentation of evidence-based approaches targeted to the specific target population of women who use stimulants and the productive discussion of specific, complex and challenging case presentations provided participants from across the primary and behavioral health care systems effective strategies and resources to meet the needs of their communities and patients. Didactic presentations remain available through the Mountain Plains ATTC website.

Implementation Strategies for the Project ECHO Model: The Project ECHO model, developed by the University of New Mexico, has effectively dispersed health care knowledge and services to underserved communities using a remote tele-mentoring model across the health care specialties. Implementation of the Project ECHO model in this setting revealed challenges in recruiting and supporting individual practitioners in the case presentation component. Time constraints on the part of practitioners and expert advice from our hub team caused the ATTCs to significantly streamline and modify the case presentation form and questions, focusing on patient strengths and immediate needs. Case presentations in front of hub team experts and a wide multi-regional audience could be somewhat intimidating, and mentoring from the ATTC staff members and local colleagues provided critical support to practitioners who volunteered to participate. Presentations by teams of service providers who were working together to meet the needs of the individual, rather than an individual presentation, also encouraged participation and lowered the barriers for practitioners.

Effective Collaboration between Technology Transfer Centers: The three regional ATTCs discovered effective strategies for collaboration between the regional teams that proved particularly meaningful in the subsequent transition online delivery of training and technical assistance as a result of the COVD-19 pandemic. The Mountain Plains MHTTC summarized these lessons learned in the publication 30 Steps for Cross-TTC Collaborations. Highlights include commitments on sharing expertise, evidence-based practice, agreement on evaluation/engagement on knowledge about outcomes, and practical considerations such as format and method of delivery, external communication and shared staff responsibilities.



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