Make it Quick! NIATx Principle #5: Use Rapid-Cycle Testing

Maureen Fitzgerald
Editor, NIATx and Great Lakes ATTC 






The fifth principle of the NIATx model is rapid-cycle testing, structured around what’s known as the PDSA (Plan-Do-Study-Act) Cycle.

In rapid-cycle testing, the executive sponsor, change leader, or team comes up with ideas for changes to test and then tests each of those changes in quick succession for a short time on a limited test pool. During each test (a.k.a. PDSA Cycle), the team collects and analyzes data relevant to its chosen aim to determine whether the change has produced a desirable effect on performance levels. Depending on the outcome of that analysis, the team may decide to:

· abandon the change completely and begin testing an entirely new change;

· adapt the change for further improvement and retest the modified version; or

· adopt the change, testing it again on a slightly larger scale, or in conjunction with other changes that have already proven successful in testing.

In any case, the team uses the knowledge it has gained from one testing cycle to improve subsequent cycles. A new procedure is only implemented on a full scale once it has been proven in testing to yield significant improvement in the project’s aim.

Why “rapid” is key


The key to rapid-cycle testing is in the name itself: rapid. Each testing cycle, including planning, execution, and analysis, should take no longer than a few weeks. Another key to this method is repetition; in the majority of cases, the team will have to test several changes in quick succession (with each test lasting no longer than a couple of days) to figure out which changes will yield the most improvement, and to refine those changes to maximize benefits. Because each cycle is so short, you’ll be able to do more of them, getting better and better with each one, progressing closer to your goal.*

Learn how to conduct a Plan-Do-Study-Act (PDSA) Cycle

Dave Gustafson, Director
Center for Health Enhancement Systems Studies
“Rapid-cycle testing helps people shift out of the mind set that there’s nothing they can do to solve a long-standing problem,” says Dave Gustafson, director of the Center for Health Enhancement Systems Studies at the UW-Madison. “It gets people moving. They try out an idea on a small scale—maybe with just a couple of patients for just a couple of weeks. But the lessons that emerge from that brief test help inform the next rapid cycle, strengthening a team’s ability to identify effective improvements.”

Gustafson launched the NIATx model in 2003 in response to a request from the Robert Wood Johnson Foundation: Could process improvement techniques used widely in business and manufacturing help the addiction treatment field increase access to and retention in treatment?

One rapid-cycle test that Gustafson often uses to demonstrate the value of the exercise took place at a New England treatment center.

“The center director at the time, Lynn Madden, was thinking about eliminating scheduled appointments all together. She told her staff that on the following Monday morning, they would tell the first four people that called for an appointment to just come in, and those four would get into treatment by noon that day. She assigned one counselor to be available for walk-ins. For the first and third patients who called, the walk-in system really worked well. But the second person who called couldn’t come in for a walk-in because they had to work that day.

So Lynn got the team back together to discuss how to modify the process for people who couldn’t make the walk-in appointments. Then they tried it again with ten patients and two counselors. Today, walk-in access is standard procedure at the APT Foundation.”

See related blog post: No appointment necessary

Gustafson says that rapid-cycle testing helps change teams scale their change efforts appropriately. “A lot of times improvement projects start out too big,” explains Gustafson. “If you can’t do a rapid-cycle test on the change, the project is too big.”

Another advantage is that rapid-cycle testing allows teams to learn from changes that don’t work.

“Seek failure. Look for the ways the change doesn’t work,” says Gustafson. “Anything worth doing is worth doing wrong the first time.”


*From The NIATX Model: Process Improvement in Behavioral Health

NIATx Essential Tools: The Walk-through That Almost Never Happened




Mat Roosa, LCSW-R
NIATx Coach


During the early days of NIATx, I was working for an agency, and decided to do a walk-through of the intake process at a community residential program for people with co-occurring mental illness and substance use disorders. The entire walk-through process was very helpful, and resulted in some significant changes to the way that we engaged people at that first visit. This program was located in an attractive old house on a quiet side street. The large bedrooms were a pleasant surprise to clients who had grown used to living in far less pleasant surroundings. As a result of the walk-through we decided to flip the intake process by conducting a tour of the house at the beginning, instead of our traditional approach of touring at the end. This resulted in more enthusiasm on the part of new clients, and made it much easier for them to manage the challenging paperwork of the admissions process.

But perhaps the most important part of the walk-through, was how it almost never happened…

When I arrived at the house, a house I had visited dozens of times as an administrator, I worked to stay in my role as a new client for the walk-through. And so, I walked to the front door of the house. This door was locked, with no sign. I knocked and there was no response. After a brief wait, and some concern, I proceeded to the side door that I had noticed when I had pulled into the driveway. This door was also locked, with two buzzers, a speaker, and no signs. After trying the door, I began pushing the buzzers. I felt anxious that I might now be late for the appointment, or that no one would answer, or that I was doing the wrong thing by pressing the buttons. Finally, a crackly voice came out of the intercom speaker advising me that the door had been opened and that I could try it again. I was relieved, but annoyed. Why couldn’t somebody just come to the door, greet me, and let me in? I felt like they were trying to keep me out.

While the locks needed to stay in place for safety, this walk-through experience resulted in some simple signs to help people to navigate the entrance to the program. This experience also helped me to understand the power of the walk-through, and the importance of seeing programs through the eyes of those we serve. I had entered that building dozens of times, but have never noticed how difficult it would be for an anxious first-time client trying to find the way inside.


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

Learn more about process improvement and the NIATx model Mat Roosa's podcast:
Great Lakes ATTC Implementation Science Podcast Series 

American Academy of Addiction Psychiatry’s 30th Annual Meeting and Scientific Symposium



Exciting things are happening at American Academy of Addiction Psychiatry’s (AAAP) 30th Annual Meeting and Scientific Symposium this year in San Diego, CA. AAAP is offering two Pre-Conference courses: Advanced Addiction Psychopharmacology, and Addictions and Their Treatment. These two courses will immerse you into a world of clinical knowledge that will help you improve your patients’ care.

The Advanced Addiction Psychopharmacology course will take place on Wednesday, December 4 from 8:00 am – 5:30 pm and Thursday, December 5 from 8:00 am – 12:15 pm. This intensive two-day, 12-hour course is designed for physicians, NPs, and PAs who have a foundation in prescribing medication for patients with substance use disorders but would like a deeper understanding of these pharmacologies. The course will be approached as a didactic lecture with equal time for peer discussion and questions and answers.

The Addictions and Their Treatment course will take place on Tuesday, December 3, from 8:00 am – 5:50 pm; Wednesday, December 4, from 8:15 am – 5:40 pm; and Thursday, December 5th from 7:00 am – 12:25 pm. This course provides a comprehensive overview of the current research and clinical practices in preventing, identifying, and treating substance use disorders and co-occurring mental disorders. It is recommended for PGY-V residents, general psychiatry residents, and periodically for all academic and treatment personnel to stay updated on the most recent trends in the addiction field. Participants will find that course material is equally relevant to junior faculty and all clinicians as well as experienced practitioners and other health professionals. This activity was planned by and for the healthcare team.

If those pre-conference courses aren’t enough, AAAP will hold its 30th Annual Meeting and Scientific Symposium from December 5 – December 8. We will showcase five Symposia with topics ranging from treating youth with OUD to cannabis policies. View a description of our symposia at: https://www.aaap.org/annual-meeting/annual-meeting-overview/conference-schedule/

AAAP will also have five workshop sessions with topics ranging from revolutionizing your addiction practice to CRAFT and the invitation to change approach. Select your preferred workshops here: https://www.aaap.org/annual-meeting/annual-meeting-overview/workshop-schedule/

If you haven’t registered for the AAAP Pre-Conference courses or AAAP’s 30th Annual Meeting and Scientific Symposium yet, sign up here: http://www.cvent.com/d/h6qmlm.

We can’t want to see you in sunny San Diego, CA! The opportunity to network with leading experts in the field in a collegial atmosphere is waiting for you.

Recovery Month: Reflections on 30 Years

Since beginning in 1989, SAMHSA’s National Recovery Month has celebrated the millions of Americans who have achieved recovery from a substance use or mental health disorder. It’s also a month to shine a light on the hard work of those who work in treatment and recovery services. Here, treatment professionals and researchers reflect on how recovery has changed over the past 30 years.


Pat Stilen, MSW
As what is commonly referred to as a “two-hatter” –a woman in long term recovery and a clinical social worker, my journey began almost 40 years ago at a time when there were few – if any – specialized addiction treatment programs for single, pregnant and/or parenting women. Women’s specific services emerged in the 1970s, yet most treatment programs were designed for male clients. Gender-specific treatment programs initiated in the mid-1970s were reduced significantly following a federal shift in combining alcohol/drug treatment and mental health services into one block grant (Finkelstein, 1994). Within the treatment mileu, the traditional adage insisted women needing treatment put their recovery first (i.e., “go to treatment”) and put their children second (i.e., leave your child in foster care or with family members).

Fortunately, I didn’t need to make that untenable decision to choose. I, along with my three pre-schoolers, was able to access residential and community-based services through efforts of a determined and progressive counselor. By the mid-1980s, I had completed an MSW and entered the workforce at a time when treatment approaches were becoming more sensitive to the needs of women and family members. The concept of “family recovery” led to the introduction of family programs (primarily educational in nature) as an optional resource for those with family members in addiction treatment.

While we have made considerable progress in developing services for women and their families, recent data shows that we still have a way to go. In 2015–2017, there were 4,500 opioid treatment programs in the United States—but only 12 programs for pregnant women. And while 22% of substance use disorder treatment programs offer at least one special program or group for pregnant/postpartum women, only 3% offer residential beds for clients' children (SAMHSA N-SSATS, 2017).

At the Mid-America ATTC, we're trying to close that gap: training and technical assistance to support treatment and recovery services for pregnant and parenting women is one of our special areas of focus, and we continually strive to help organizations make recovery possible for the whole family.


References
Finkelstein, N. (1994). Treatment Issues for Alcohol- and Drug-Depending Pregnant and Parenting Women. Health & Socal Work, 19(1),8. Retrieved from http://search.ebscohost.com.proxy.library.umkc.edu/login.aspx?direct=true&db=edb&AN=9406010858&site=eds-live&scope=site 09/28/2019

Substance Abuse and Mental Health Services Administration, National Survey of Substance Abuse Treatment Services (N-SSATS): 2017. Data on Substance Abuse Treatment Facilities. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2018.

Patricia (Pat) Stilen, MSW is a clinical social worker and Project Director in the Collaborative to Advance Health Services at the University of Missouri-Kansas City’s School of Nursing and Health Studies. Stilen has led the Mid-America Addiction Technology Transfer Center since 2000. She also served as the s PI/Director of the ATTC Center of Excellence on Behavioral Health for Pregnant & Postpartum Women and Their Families (2015-2017).



Fred Dyer, Ph.D

So much has taken place in 30 years since the first national Recovery Month observation: parity legislation; treatment solutions as alternatives to incarceration; drug courts with emphasis on treatment and recovery versus incarceration; successful advocacy movements; the promotion of non-stigmatizing language; increased acceptance of medication for substance use disorders, the use of recovery coaches/specialists, recovery care organizations, a greater emphasis on recovery and recovery-oriented systems of care and not just acute care treatment; a humane response to the current opiate epidemic (as compared to the harsh response to previous crack cocaine epidemic); and a recognition of multiple pathways and styles of recovery that should be celebrated.

The past three decades have also seen an increase in research-based treatment solutions for adolescents. Adolescents seeking recovery have also become more involved in recovery activities. The enthusiasm generated by Recovery Month celebrations sends a message to teens and young adults that it is possible to live a healthy and rewarding life without drugs.

Fred Dyer, Ph.D., CADC, is a nationally known behavioral health trainer and consultant. He is a specialist in adolescent and emerging adult treatment and recovery and a regular contributor to the Online Museum of African American Addictions Recovery.

Dennis McCarty, Ph.D.

The total spend on treatment for alcohol and drug use disorders was $9.1 billion in 1986, and the projected spend for 2020 was $42.1 billion (Mark, Levit, Yee, & Chow, 2014). Figure 6.4 in The Surgeon General’s Report on Alcohol, Drugs and Health, Facing Addiction in American, illustrates how spending on addiction treatment changed between 1986 and 2014 (the most current data when the report was prepared). Multiple changes in the system of care for alcohol and drug use disorders are apparent. There was a dramatic reduction in the proportion of spending for inpatient care from about 45% in 1989 to 19% in 2014 (Office of the Surgeon General, 2016). The growth of managed care in the early 1990s promoted reductions in lengths of stay in inpatient and residential settings. Spending in outpatient increased from about 30% to nearly 50% and leveled off at about 40%. The lowest line highlights another important change in the treatment landscape. The spend on prescription medications to treat alcohol and drug use disorders climbed from 0% (1986 through 2005) to 5% beginning in 2006. The 2019 estimate may be higher because of increased use of buprenorphine and naltrexone for opioid use disorders and naloxone for opioid overdose reversal. In summary, total spending has increased despite the reduction in inpatient treatment and, more recently, the use of pharmacotherapy has become more available to support recovery. Despite the increase in access to medications, however, many programs fail to use these critically needed recovery supports.


Figure 6.4 Percentage Distribution of Spending on Substance Misuse Treatment by Setting, 1986-2014. Source: SAMHSA, 2016



Mark, T. L., Levit, K. R., Yee, T., & Chow, C. M. (2014). Spending on mental and substance use disorders projected to grow more slowly than all health spending through 2020. Health Affairs, 33(8), 1407 - 1415.

Office of the Surgeon General. (2016). Facing Addiction in America: The Surgeon General's Report on Alcohol Drugs and Health. Retrieved from Washington, DC: https://addiction.surgeongeneral.gov/surgeon-generals-report.pdf

Dennis McCarty, Ph.D., is a Professor Emeritus in the OHSU-PSU School of Public Health at Oregon Health & Science University, works at the intersection of policy, research and practice assessing the organization, financing, and quality of prevention and treatment services for alcohol and drug use disorders.



Michael Miller, MD, DFASAM, DLFAPA

I have practiced addiction medicine in Wisconsin since 1983. Over the past 30-plus years, I’ve seen a steady exodus of health systems from addiction services, and this has had an impact on the workforce. Hospitals in cities large and small that had designated inpatient detox units have closed them, and nurses who worked in alcohol detoxification in hospital settings have shifted to other units or retired, taking their knowledge and clinical skills with them. While alcohol withdrawal in hospitals has improved with the use of the CIWA (Clinical Institute Withdrawal Assessment for Alcohol), the clinical skills of experienced detox nurses for assessment and management have gone away.

With the opioid epidemic, health systems are paying more attention to addiction. But we still have a long way to go for health systems to recognize that this is a problem they should be addressing instead of something for someone else, like a county social services department to address.

A huge change in the past 30 years has been the introduction of FDA-approved medications to treat addiction. For nicotine dependence, the deadliest addiction of all (contributing to almost 500,000 premature and avoidable deaths per year), we now have nicotine replacement therapy in the form of the “gum,” lozenges, and the patch–but insurance companies have decided to take these off their formularies and require patients to self-pay for them as over-the-counter medications. These medications can make a huge difference in population health and lead to great savings in health care utilization; I think insurance companies should be eager to cover nicotine replacement therapies.

We also now have naltrexone and acamprosate for alcoholism and a number of off-label medications being used for addiction involving alcohol use, which is encouraging. The biggest change is buprenorphine and its introduction in 2003 for opioid use disorder. Buprenorphine is now used in general medical care, unlike methadone treatment for addiction which was administered in free-standing clinics far away from health care campuses. Generalists as well as specialists can prescribe buprenorphine, and it has become a vehicle for helping generalists understand that addiction treatment needs to be part of their wheelhouse.

From a workforce standpoint, a huge and more recent change is the new certification for physicians in the specialty of addiction treatment. Not only is there now a credential physicians can receive that is recognized by the American Board of Medical Specialties (ABMS), there are also fellowship training programs accredited by the Accreditation Council on Graduate Medical Education (ACGME). This has gotten the attention of medical schools like never before. The American Society of Addiction Medicine has doubled its membership in the last 30 years and is now accepting non-physician members, such as advanced practice nurse practitioners and physician assistants. Physicians and others in primary care providers working in the addiction arena are taking on more of the characteristics of the healthcare workforce that addresses other chronic illnesses. This bodes very well for the future.

Dr. Miller is a Director of the American Board of Addiction Medicine and the American College of Academic Addiction Medicine, and a past president of the American Society of Addiction Medicine. He is certified in addiction medicine by the American Board of Preventive Medicine (ABMS).

National Recovery Month 2019: ATTC Resources Address Treatment and Recovery in Diverse Populations


By Maureen Fitzgerald 
Great Lakes ATTC 

The Substance Abuse and Mental Health Services Administration (SAMHSA) first launched National Recovery Month in September 1989 to celebrate the millions of Americans living in recovery from substance use and mental health disorders. Over the past 30 years, National Recovery Month has promoted the message that treatment works, people do recover, and behavioral health is essential to overall health.

National Recovery Month also highlights the fact that substance use and mental health disorders affect everyone, regardless of age, race, gender, or socioeconomic status. With our increasingly complex and diverse population, providing culturally and linguistically appropriate treatment and recovery services is of vital importance.

Recognizing this, the ATTC Network Coordinating Office, regional centers, and population-specific centers have created a variety of relevant training resources. Topics covered include the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care and cultural humility. You’ll also find resources for working with African Americans, Latinx/Hispanic populations, American Indian & Alaska Native Populations, women, the LGBTQIA population, and youth.


Building Health Equity and Inclusion


All of these materials are now available for viewing and download on Building Health Equity and Inclusion, a new section of the ATTC website. This new page unites the Network’s collective expertise on culturally appropriate treatment and recovery services. Resources listed include practical tools that organizations can customize to meet the needs of a particular population or area.

New White Paper: Roadmap for Training and Technical Assistance Efforts in Substance Use Service Administration The Building Health Equity and Inclusion site features the recently published white paper, Roadmap for Training and Technical Assistance Efforts in Substance Use Service Administration: A Journey to Culturally and Linguistically Appropriate Services, which is also available in Spanish: Hoja de Ruta Para El Trabajo de Formación y Asistencia Técnica en la Administración de Servicios Para El Abuso De Sustancias. Developed by members of the ATTC Network CLAS Standards Workgroup and translated by the National Hispanic and Latino ATTC, the paper offers 7 recommendations to behavioral health and healthcare providers working to improve health and health care equity:

  1. Increase awareness and recognition of non-conscious stereotyping and prejudice toward racial and ethnic disparities in health care.
  2. Encourage full consideration of access to care.
  3. Recommend developing culturally sensitive assessment tools.
  4. Policy change.
  5. Diverse workforce.
  6. Improve efforts to conduct research with diverse populations.
  7. Increase efforts toward interprofessional collaboration in the prevention, treatment, and recovery of substance use disorders.


Updated Regularly with New Resources
Building Health Equity and Inclusion will be updated regularly with new resources developed across the Network. New this month is the Recovery Month 2019 Podcast: Recovery in African-American Communities, produced by the Great Lakes ATTC.


Related Resources from SAMHSA
In addition to the Recovery Month Toolkit, SAMHSA offers Recovery Month Promotional Materials ,which include public service announcements in English and Spanish. Other resources and information are available the SAMHSA page, Behavioral Health Equity Resources.


Does your organization serve clients from diverse populations? What resources do you find most useful in providing culturally and linguistically appropriate services? Let us know in the comment section below!

The Role of Spirituality and Faith in the Treatment and Healing of SUDs



Dawn Tyus, LPC, MAC, NCC
Director, Southeast ATTC

Celene Craig, MPH, MS


Over the past decade, there has been an emphasis on addressing the acute alcohol and drug addiction crisis in the United States. In 2016, more than 63,000 drug overdose deaths occurred in the U.S., a 21.5% increase from 2015. As of 2018, 20.1 million Americans age 12 or older have a substance use disorder (SUD) involving alcohol or illicit drugs. Within this estimation, 2.1 million people had an opioid use disorder (OUD), according to Substance Abuse and Mental Health Services Administration. Though it may seem that life-saving medicines and psychological interventions are important biological aspects in helping a person with a SUD, treating the inner, spiritual side of healing through recovery is also a central part of the continuum of addiction healthcare.

From 2002 to 2018, recognition has increased for evidence-based studies that focus on the importance of patient spirituality in treatment and healing of SUDs due to a mandate by the Joint Commission on Accreditation and Healthcare for the administration of a spiritual assessment by healthcare providers for patients and their families. Evidence-based studies have demonstrated the positive impact of faith on health and wellbeing — such as leading to lower levels of substance abuse and reducing the likelihood of using various drugs — in the course of a lifetime. These findings make including a body-mind-spirit integrated model of intervention essential, and indispensable in substance abuse prevention and recovery. Addiction specialists have found that 73% of addiction treatment programs in the United States include a spirituality-based element and faith-based volunteer support groups contribute up to $316.6 billion in savings to the economy every year. According to an overview of the available evidence-based studies on the effectiveness of faith-based substance use support programs, conducted by Brian and Melissa Grim in 2019, 84% of the studies show that faith is a positive factor in addiction prevention or recovery and a risk in less than 2% of the studies reviewed.

Faith-based organizations fill the gap where federal and state agencies are logistically unable to effectively and comprehensively confront the substance use epidemic. It shows that these organizations are able to reach beyond the person with a SUD and wrap support around their family and community.

“The value of faith-oriented approaches to substance abuse prevention and recovery is indisputable and the current decline in religious affiliation in the USA is not only a concern for religious organizations but constitutes a national health concern,” Grim said.

For the past 17 years, the Southeast Addiction Technology Center’s (SATTC) vision has been to transfer technology to faith leaders; increase the SUD workforce capacity within faith settings; and increase assessment, referral and engagement to care. SATTC has collaborated with communities of faith through the facilitation of conferences, learning academies, listening sessions, webinars and SUD workshops. It has been our mission to:

  • Dialogue and strengthen the substance use disorder knowledge for people working in communities of faith.
  • Teach communities of faith how to be catalyst for change in their communities.
  • Teach faith communities how to spark the conversation that “recovery is real, and treatment does work”
  • Bridge the gap between faith systems and community providers.
  • Empower faith communities to reduce the stigma associated with substance use disorders.
  • Provide measurable results for our target population.
  • Build capacity associated with substance use disorders that will aid in creating powerful and sustainable recovery ministries.
  • Promote access to services and resources that will empower communities and their partners, to create a welcoming and supportive environment.

We are committed and eager to bridge the gap between community providers and communities of faith to dispel the stigma around addiction and increase the knowledge capacity of faith leaders in the Southeast region. Through our intensive technical assistance program-development process, learning communities and trainings, we are able to equip faith leaders with the knowledge and skills to be change agents in their communities and help all people suffering with a substance use disorder.


NIATx Principle #2: Fix Key Problems (And Help the CEO Sleep at Night)

Mat Roosa, LCSW-R
NIATx Coach



The NIATx model is driven by five principles that research has shown to be the hallmarks of successful improvement projects. These five principles emerged from an analysis of decades’ worth of research that gathered data from 640 organizations in 13 industries, examining 80 factors on why certain projects fail while others succeed.

Principle 1, Understand and Involve the Customer, is the single most important action a change team can take to set up a project for success. In fact, the NIATx research analysis showed that this one principle has a greater impact on success than the other four combined. (See related blog post: Why Understanding and Involving the Customer Matters in Behavioral Health.)

Lose sight of your customer (your client), and you lose sight of success. 

Principle 2: Fix Key Problems (And Help the CEO Sleep at Night) switches the focus to leadership. If a change project is to be successful, it needs the full support of the agency’s leadership. The way to ensure that support is by addressing the problems that truly matter to the CEO.

Kim Linwood of Milwaukee learned the NIATx principles at
NIATx Change Leader Academy in Madison, WI, June 2019.

Change Project Pitfall: Lack of executive sponsorship
Often when change leaders are completing the NIATx project charter, they come to the “executive sponsor” box, and simply fill in the name of their supervisor.

Many are fond of saying that “team” is more of a verb than a noun. It is the act of “teaming” that creates results. The executive sponsor role in relation to the change team reflects this same truth. That is why we need to ask a critical follow-up question: Who is the Executive Sponsor, and what are they doing to ensure the success of the change project?

If everything is a priority…
We all know the second half of this statement: then nothing is a priority.

Executive Sponsors create and maintain priorities. One of the most powerful functions of the Executive Sponsor can be expressed in the following contrasting statements from two Executive Sponsors:

  • ES #1: “This change project is important, but make sure you keep doing everything else that we are already working on.”
  • ES #2: “This change project is important, so I am going to reassign a couple of tasks to make sure that you have the time you need for the change project to succeed.”

Strong Executive Sponsors like #2 approve the new project for takeoff, and they clear the runway to make sure that the project can pick up the speed it needs to lift off. It is critical to have the ES at the table during the formative stages of the project development to ensure adequate engagement and support. When an ES is reluctant to come to the table beyond a simple approval of the project, the Change Leader can help by reminding the ES of their critical role:

  • We need you to role model support for the change project.
  • We need you to dedicate resources to this effort.
  • We need you to remove the obstacles to our success.
  • We need you to encourage our team.

Change projects with weak executive sponsorship often fail to get off the ground. Change projects with strong executive sponsorship can soar.

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

Hepatitis C (HCV) Current Initiative Prepares New Trainers


Meet the Trainer: Jess Draws


Maureen Fitzgerald
Great Lakes ATTC




Back/Middle Row from left: Cindy Christy, Erin Winstanley, Joe McAdams, Kurt Begaye, Brian Hartzler, Hannah Eckes, Jace Dyckman, Lucas Piper, Diana Padilla (master trainer), Ed Johnson, Chris Harsell, Grant Hovik, Al Hasson, Maxine Henry, Robert Peralta, Holly Hagle, Robert Jope

Front row from left: Tammy Wenz, Ahani Valenzuela, Jess Draws, Taylor D’addario, Jude Dean, Kelly Reinhardt, Jayce Dykeman 

More than 20 team members from across the ATTC Network gathered in San Diego in April for the HCV Current Initiative Training of Trainers (ToT). The three-day training was led by master trainer Diana Padilla of the Northeast and Caribbean ATTC, who prepared the group to present the new and updated HCV Current curriculum—soon to be available on the ATTC Network website.

Jess Draws of the Great Lakes ATTC was among the group of trainers-in-training. Jess joined the Great Lakes ATTC team in November 2018 as a technology transfer specialist for the Opioid Response Network, covering Ohio. Jess earned an MSW in 2017 from the UW-Madison School of Social Work. Previous work experience includes youth restorative justice, phone counseling for sexual assault survivors at the Dane County Rape Crisis Center, and student services and advocacy work for LGBT students. With an interest in learning more about the opioid epidemic and related health issues, Jess jumped at the chance to attend the HCV Current ToT.

Before attending, Jess took the online course, HCV Snapshot: Introduction to Hepatitis C for Health Care Professionals, available on HealtheKnowledge. “The HCV Snapshot course helped me prepare for the ToT and gave a good overview of hepatitis C prevention, treatment, and recovery,” says Jess.


Interactive Training Tapped In To Participants’ Expertise

Arriving at the training, Jess was impressed by the expertise of the fellow participants. “The group included doctors and nurses with 10 to 15 years of experience working with people with hepatitis c,” Jess explains. “I felt a little bit like a fish out of water, but knew that this would be a great learning opportunity.”

The first day of the session, Diana Padilla took the group through the HCV Current online and face-to-face training content.

“Diana’s training style is very interactive, and she really tapped in to the expertise in the room to bring in insider knowledge from the perspective of a nurse, addictions counselor, or physician,” says Jess.

Jess also noted how Diana deftly folded the participants’ knowledge into the training modules, as well as into the revision of the HCV Current curriculum.

“Every time someone had a question we stopped and talked about it, so we could learn how to teach to various audiences,” says Jess. “Diana talked about nuances of the information for those of us who would be teaching families or other social workers rather than nurses or physicians,” adds Jess. “Stopping to take in everybody’s perspective as a presenter is something that I hope to incorporate into my training style.”


Jess’s Top Three Take-aways

  1. Personal Take-away: Attend a Training of Trainers, even if you don’t consider yourself a subject matter expert (SME). “I felt out of place at first, but left with a higher level of confidence after watching others and getting tips and great feedback during the teach-back. Even though I came to the ToT without the technical expertise on hepatitis C, I was able to make meaningful contributions to the content based on my knowledge and experiences. So even if you are not an SME and think you never will be, remember that we always need to hear from different voices who can translate the content in terms that are relevant to a specific audience."
  2. Take-away about hepatitis C: “Many may not be aware of the advances in HCV treatment. It used to require taking medication with truly debilitating side effects for a year or longer, with a cure rate of only 30 to 50%. But today, HCV treatment is considered one of the miracles of modern science—it is the only viral infection that is curable.”
  3. Take-away for health care professionals: “We, as trainers, are hoping to get physicians and addiction treatment counselors to make testing for HCV more accessible. Because there are so many factors that elevate the risk of infection, include information about HCV prevention, treatment, and recovery along with information on HIV and sexually-transmitted diseases. “Patients could check a box on a form, asking “Would you like to be tested for hepatitis C today?” Substance use disorder professionals could add this question to the intake process. Health care professionals also need to share the message getting tested and treated for hepatitis C can radically improve a person’s quality of life and life expectancy.”


HCV Current Updated Content

Jess is looking forward to putting her new skills to use with the newly revised HCV Current curriculum. The updated content includes the latest information on HCV treatment options, along with information on the intersection between the opioid epidemic and increase in HCV infection rates.


World Hepatitis Day: July 28, 2019


The World Health Organization has designated July 28 as World Hepatitis Day, dedicated to increasing awareness of viral hepatitis prevention, treatment, and recovery. It’s a perfect time to explore HCV Current. Interested in setting up an HCV Current face-to-face training? You can find Jess Draws and other HCV Current trainers on the ATTC Network Trainer Registry!


AMERSA Conference: Reflecting back on 2018 highlights and looking ahead to this year's conference


Claire Anne Simeone, DNP, FNP
Matthew Tierney, RN, MSN, NP
Shannon Mountain-Ray, LICSW
Scott E. Hadland, MD, MPH, MS



AMERSA (The Association of Multidisciplinary Education and Research in Substance use and Addiction) held its 42nd annual conference at the InterContinental Mark Hopkins Hotel in San Francisco on November 8-11, 2018, with sponsorship support from the ATTC Network as well as NIH, NIDA CTN, and SAMHSA. With 375 attendees from the fields of nursing, social work, behavioral health, psychiatry, medicine, pharmacy, research and policy, the conference provided a platform for the presentation of current challenges and innovations in research, education and clinical practice in substance use disorder prevention and treatment, as well as opportunities for collegial discussion and networking.


AMERSA, founded in 1976, is a non-profit professional organization whose mission is to improve health and wellbeing through interdisciplinary leadership in substance use education, research, clinical care and policy. A key goal is to improve education and clinical practice in the identification and management of substance-related problems by promoting leadership, mentorship and collaboration among multiple healthcare professions. AMERSA members represent numerous disciplines including physicians, nurses, social workers, psychologists, dentists, pharmacists and public health professionals. The annual conference attracted national and international attendees and provided opportunities for networking, mentorship, collaboration, and receiving feedback on work in progress.

During the pre-conference day on Wednesday, many early arriving attendees participated in pre-planned local site visits to agencies doing innovative work in the field. These included avant-garde opioid treatment programs at the San Francisco Veteran’s Administration and Zuckerberg San Francisco General Hospital, San Francisco’s Behavioral Health Access Center, and the Tenderloin Health Service’s planned safe injection facility. On Wednesday evening, a couple dozen AMERSA members attended a screening of the documentary movie “The Providers” by film-makers Laura Green and Anna Moot-Levin. The movie screening, sponsored by the ATTC who also provided popcorn and snacks, features three healthcare providers, an NP, a PA, and an MD, who care for people living on the margins in a rural American community struggling with a shortage of providers and the health and social problems associated with alcohol and drug use.

The formal conference began with a plenary on neural pathways that play a role in stigma presented by Deborah Finnell, DNS, CARN-AP, FAAN from Johns Hopkins School of Nursing. Dr. Finnell engaged the audience in a discussion of the neural basis of the complex interplay between stigma, disgust, prejudice, bias and discrimination, including implications for policy and clinical practice.

Jalie Tucker, PhD, MPH of the University of Florida, the 2018 recipient of AMERSA’s Betty Ford Award, presented a plenary entitled The Many Pathways to Recovery from Substance Use Disorders: Contributions from Psychology, Public Health and Behavioral Economics. The audience was captivated by Dr. Tucker’s discussion of natural recovery, the principles of behavioral economics and the importance of considering choice biases when developing interventions for problematic alcohol use.

A multi-disciplinary panel of experts affiliated with San Francisco’s justice system presented information on local collaborative justice and substance use treatment services. The panel included Lisa Lightman, MA, Judge Eric Fleming from the Collaborative Courts of San Francisco’s Superior Court, Angelica Almeida, PhD, Linda Wu, MSW, LCSW and Charles Houston from the SF Department of Public Health.

A second panel of experts presented Cannabis: Updates, Neurobiology and Public Health. Garth Terry, MD, PhD from the University of Washington and VA Puget Sound’s Mental Illness Research, Education and Clinical Center set the stage with an overview of cannabis neurobiology. Tista Gosh, MD, MPH from the Colorado Department of Public Health and Environment and Rick Garza from the Washington State Liquor and Cannabis Board shared key aspects of policy challenges, successes and surveillance during marijuana legalization in their respective states.

Current research in stimulant use epidemiology and interventions was the focus of the third interdisciplinary panel. Glenn Milos-Santos, PhD, MPH from the University of California San Francisco (UCSF) School of Nursing, Elise Riley, PhD, from UCSF School of Medicine, David Olem, MS from UCSF Division of Preventive Services and Walter Gomez, MA, MSW, PhD from University of California Berkeley School of Social Welfare each presented their ongoing research addressing treatment approaches to methamphetamine and cocaine use disorders in marginalized populations, including homeless women, and men who have sex with men.

It is an AMERSA conference tradition to have a “spicy debate” on a controversial topic in the field of substance use and addiction. Our 2018 topic, Are Safe Consumption Spaces a Necessity for Public and Personal Health? was debated by Lindsay LaSalle, JD from the Drug Policy Alliance and John Lovell, JD from the Law Offices of John Lovell. The debate was very spicy indeed, and covered the pro and con arguments currently being hotly debated in public forums in communities across the country. Ongoing energetic discussions were overheard throughout the conference on this topic where scientific evidence, drug laws, and public opinion often clash.

Kevin Kunz, MD, MPH, DFSAM, Executive Vice President of the American College of Academic Addiction Medicine and the American Board of Addiction Medicine received AMERSA’s prestigious John P. McGovern award. He presented his vision for the field of addiction treatment through an inspiring talk on the cycle of drug epidemics and transformative change.

Saturday morning was rich with brief plenaries from AMERSA award winners who presented their innovative work in the categories of best research abstract, best curriculum and quality improvement abstract and best workshop. Winners included Julie Netherland, PhD and Sheila Vakharia, PhD, MSW for “Becoming an Effective Drug Policy Reform Advocate”, Rachel H. Alinsky, MD for “Receipt of Addiction Treatment Following Opioid-Related Overdose among Medicaid-Enrolled Youth”, Christopher S. Stauffer, MD for “Oxytocin- Enhanced Motivational Interviewing Group Therapy for Methamphetamine Use Disorder in Men who have Sex with Men: Preliminary Results from a Randomized Controlled Trial”, Jessica A. Kattan, MD, MPH for “New York City Health Department’s Multi-Pronged Approach to Expanding Buprenorphine Treatment Capacity” and Rachel Winograd, PhD for “Missouri’s Implementation of a ‘Medication First' Treatment Model for Opioid Use Disorder."

Beyond the provocative plenaries, the conference was rich with opportunities to review and discuss current trends in educational, clinical, research and policy work by both established and early-career professionals working in the field. The Thursday evening scientific poster session was held in the hotel’s beautiful “Room of the Dons.” The cozy space provided ample opportunity to review excellent posters, and to network with fellow AMERSA members. Numerous workshops and brief oral presentations throughout the conference offered a broad spectrum of topics in substance use and addiction from a variety of disciplinary perspectives.

Special interest group meetings (nursing, social work and behavioral health, physicians, adolescent and youth initiative, hospital-based addiction consult services, and medication for substance use disorders initiative) and mentor-mentee opportunities provided additional learning platforms, and rounded out the successful conference.

The 2018 AMERSA Annual conference was the largest annual conference to date and included many first-time attendees.

Preparations are underway for the 2019 annual conference which will be held in Boston at the Hyatt Regency on November 7th to 9th, with continued sponsorship support from the ATTC Network. The theme of the conference will be: Challenges and New Horizons in Addressing Substance use and Addiction.

Plenary presentations will address important challenges including a discussion by Ayana Jordan, MD, PhD. of Yale University on health disparities in accessing substance use treatment. Elizabeth Miller, MD, PhD, FSAHM of University of Pittsburgh School of Medicine and Children’s Hospital of Pittsburgh and Lynn Sanford, LICSW will present novel, evidence-based healing and resiliency-centered approaches to trauma treatment. Panelists Christopher Stauffer, MD, of University of California San Francisco, Matthew W. Johnson, PhD and Mary P. Cosimano, MSW both of Johns Hopkins University School of Medicine will present on the use of psychedelics in addiction treatment. In addition, presentations will be made by winners of the Betty Ford award - Gail D'Onofrio, MD, MS, the John P. McGovern award, Daniel P. Alford, MD, MPH, and Best Abstract Awards as well as a variety of skills-based workshops and oral presentations covering a breadth/diversity of topics in the field of substance use and addiction.

The highly anticipated “Spicy Debate” will be on “Tapering Opioids: Compassionate Care or Punitive Policy?” Anna Lembke, MD of Stanford University and Stefan Kertesz, MD of University of Alabama at Birmingham School of Medicine will review current research including gaps in knowledge and areas for future research, identify needs in health professional education, and discuss the clinical and public health impact of policy on both sides of the debate.

Conference attendees will have the opportunity to attend site visits highlighting various diverse and innovative resources and programs available to youth and adults in the Boston area on Wednesday, prior to conference opening.

As is AMERSA’s tradition, there will be several opportunities for attendees to network and connect as a community such as the daily Fun Run-Walk and Saturday yoga session. New members and first-time attendees will be invited to attend an orientation to AMERSA. Mentor/mentee meetings will be held throughout the conference. In addition, luncheons for the seven special interest groups and the annual conference award/auction luncheon, a breakfast for attendees interested in planning for AMERSA 2020 and a Thursday evening welcome and scientific poster session will be held.

AMERSA 2019 is shaping up to be one of our best conferences yet!