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

Maxine Henry, MSW, MBA

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.


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.

ATTC Region 2: Preparing and Managing Natural Disasters

Robert Peralta De Jesus, MA, MHS
Northeast & Caribbean ATTC

The Institute of Research, Education and Services in Addiction at the Universidad Central del Caribe, School of Medicine has provided various trainings for first responders, community leaders and healthcare providers. In early January of this year, with the atmospheric events that occurred in Puerto Rico, being impacted by earthquakes, we developed a series of trainings in order to train first responders, community leaders, and healthcare providers to be able to cover the needs of citizens who were directly and indirectly affected. The first training was Psychological First Aid, based on scientific evidence to help children, adolescents, adults and families to face the immediate consequences of disasters or acts of terrorism. It was designed to reduce the initial distress produced by traumatic events, promote adaptive functioning and coping skills. We then provided a training in Psychological Strategies for disaster recovery so that the trainees could acquire skills in managing distress and coping with the stress caused by the events that occurred. Given the situation that the first responders and healthcare providers were going through, we decided to provide them with the tools and training they would need to avoid Compassion Fatigue. This series of trainings were offered in both languages ​​(English and Spanish) for both Puerto Rico and the USVI, and they were also modified to the COVID-19 pandemic.

As part of our commitment to educate and train during the pandemic, we offered a training titled; Skills for managing the isolation period among people recovering from substance use disorders. This was aimed for first responders, to offer tools to people who are in the recovery process with a substance use disorder, in the face of stressors that can cause social isolation due to the pandemic. Understanding the impact that this can have on the family, we also offered a training titled; How to prepare the family to offer support to a family member who is recovering during isolation.
This training was aimed at mental health workers to provide tools for the families of those still in treatment for substance use disorder during COVID-19, in which everyone must remain at home.

Given the uncertainty of what might happen in the future, we set out to offer training based on TAP 34; Emergency Response Planning: Behavioral Health Services for People Using Psychoactive Substances. Emergency response planning is an institutional standard, as it enables the continuity of essential services for communities in critical circumstances. The effectiveness of a plan depends on its consistency with the needs of the population it serves. This webinar is intended to integrate behavioral health services for people who use psychoactive substances as an essential part of a comprehensive emergency response plan.

It is our expectation to continue to provide trainings to all first responders, community leaders and healthcare professionals so they can provide quality service to all that are in need of there assistance.

David Jefferson, MSW
Director of Training and Technical Assistance
Northwest ATTC

Over the past three years, in collaboration with the Northwest ATTC, I have led a large technical assistance project to support implementation of Motivational Interviewing (MI) for 200+ members of the behavioral health workforce employed at social service agencies in Whatcom County, Washington. During the course of this targeted technical assistance project, workforce members participated in basic and intermediate MI training workshops and received individualized, skills-focused coaching. In March 2020, when I became the Director of Training and Technical Assistance at the Northwest ATTC and we found ourselves in the midst of the pandemic, with providers being asked to quickly pivot to telehealth, it seemed like the perfect opportunity to build on their MI skills.

In mid-March, local programs discontinued face-to-face sessions and their workforce started providing all services virtually (i.e. phone, video-conferencing). Knowing we had a robust number of MI-trained workforce members, we thought this would be an opportune time to offer them individualized coaching in applying MI in their telehealth services. We speculated workforce members needed to increase their confidence in providing care, needed skills in this new medium, and could use guidance on how to be more effective with MI. We also knew many programs would be overwhelmed with administrative and programs complications related to Covid-19.

In response to this need, the Northwest ATTC developed a MI telehealth coaching protocol and by early April started delivering individualized coaching sessions to 41 workforce members. The coaching sessions were 30 minutes in length and delivered via Zoom. Prior to each coaching session, workforce members filled out a skill development form, which included identifying skills they were interested in developing, and writing out a case scenario. During the sessions, the coach role-played the client and the workforce member practiced his or her skills. The sessions ended with a debrief about what worked well, what were the challenges, and what skills to improve. Workforce members were offered up to four individual coaching sessions, and most completed at least three. In all, we completed 99 coaching sessions through the end of May.

The coaching revealed a depth of dedication and commitment by workforce members, who signed up to advance their skills during a time when their stress was peaking, workloads were more complicated and certainty in their day-to-day lives, hard to find. Workforce isolation prompted us to invite all participants to a one-hour Zoom session with the goal of sharing lessons learned and strengthening community. We asked the 25 attendees to answer three questions in small groups and report their top impressions. Here are the questions and responses.

What have you learned to improve your Telehealth services?
  • Workforce members benefit from setting up a workspace, being prepared to provide guidance and structure for the call and taking responsibility for setting the tone.
  • It is important to start calls by checking in about the basics. Asking the client initial questions like: “is this still a good time?”, “are you in an appropriate location?”, and “do you have privacy?” was critical, prior to exploring their comfort and skill level around using the phone and/or computer for services.
  • Acknowledge the common awkwardness, empathize with your shared dilemma of this new medium, and use humor to defuse the situation.
  • Adjust to shifting goals and respect the silence, not all clients like to talk on the phone.

What MI skills have been most useful?
  • The Four Processes of MI; Engagement, Focusing, Eliciting and Planning are helpful for structuring the call and guiding the conversation.
  • Slowing down helps clients make faster connections
  • Moving away from my “to-do list” and developing an agenda with the client.
  • Open-ended questions and reflection keep the conversation going but the reflections need to be deeper and lean toward what is possible, what is helpful, and what is hopeful.
  • Meaningful and well-crafted affirmations shine a light on clients’ skills and abilities especially during these times when they feel desperate and stagnant. Affirming that they have the resources to go forward helps them identify their self-efficacy.
  • Summaries help start and end the conversations and add structure. They create a story or narrative about the client’s life that is difficult to capture in these two-dimensional settings.
  • Explore the discord, as it helps increase engagement.

What are your pending challenges to strengthen services?
  • Building rapport and making genuine connections over the phone is the hardest part. Not all clients are comfortable with using phones for counseling sessions and do not see the value.
  • Maintaining connections via virtual sessions is hard and must be attended to each time.
  • Ambivalence is on the increase. Everything seems to be put on hold. Encouraging change talk is a bit harder as clients are hesitant to move on, due to fear, etc. (e.g., some have chronic diseases are afraid to go to healthcare providers).
  • They want Covid-19 information, which is limited, so it triggers the desire to fix clients and leaves workforce members feeling like they did not help.
  • Hard to move people to the eliciting phase. Need to make use of looking forward strategies to build hope and rekindle dreams.

Offering this cohort an opportunity to practice their MI skills with mock client role-plays, seemed well timed, and many expressed their appreciation and gratitude. The success of the project led the Northwest ATTC to offer the same opportunity starting in late May to the Idaho behavioral health workforce and we are exploring the possibility of expanding in other areas in region Ten.

Addressing the Syndemic of Addiction, COVID-19, and Structural Racism by Strengthening the Workforce

By Sara Becker 
New England ATTC

According to the latest data from the Centers for Disease Control and Prevention, over 105,000 Americans have died and at least 1.7 million Americans have been infected with the novel coronavirus disease (COVID-19). Social distancing measures put in place to contain the spread have decimated entire sectors of the United States economy, with the stock market dropping so precipitously that it erased three years of gains. Unemployment rates are also at historically high levels with the national rate rapidly approaching 15%. In a few short months, COVID-19 has upended our country and harmed millions of Americans.

Data on the toll of COVID-19 are troubling in aggregate, but even more concerning when we consider those Americans hit the hardest. Recent commentary by NIDA director Nora Volkow (2020) underscored how individuals who use opioids are at increased risk for the most adverse consequences of COVID-19 due to both direct (e.g., slowed breathing due to opioid use) and indirect (e.g., housing instability, incarceration) pathways. In addition, Black Americans and Hispanics have been disproportionately affected by COVID-19: emerging regional data suggests that the COVID-19 death rate for Black and Hispanic Americans is about 2.5 times higher than for whites. The disproportionate toll of disease reflects the effects of structural racism, which manifests in increased risk of underlying health conditions (e.g., chronic respiratory disease); decreased access to testing and care; and decreased ability to socially isolate due to factors such as crowded living conditions and employment in sectors deemed essential. Taken together, these data indicate that the United States is in the midst of a syndemic - defined as the interaction of a set of linked health problems involving two or more conditions, interacting synergistically and contributing to excess burden of disease. Addressing the syndemic of addiction, COVID-19, and structural racism requires responses on multiple levels and across multiple fronts. One of those fronts is ensuring that the addiction treatment workforce is equipped with the tools needed to help patients facing these interacting epidemics.

The Addiction Technology Transfer Center (ATTC) Network has been working to meet this challenge by developing new products and resources focused on these intertwined public health issues. The National Coordinating Office hosted a Listening Session and a 5-part Strategic Discussion Series focused on emerging issues around COVID-19 and social determinants of health. The Listening Session solicited feedback on ways COVID-19 has highlighted racial and ethnic disparities, and each Strategic Discussion focused on concrete actions that could be taken to support specific communities of color.

Regional ATTCs have also risen to the challenge to create new tools for the addiction workforce during these unprecedented times. The New England ATTC has developed multiple products including a 2-part webinar series (in partnership with the New England Mental Health Technology Transfer Center) focused on the intersection of addiction, mental health, and COVID-19; a training focused on Trauma-Informed Approaches to Substance Use Assessment and Intervention (which includes new content on how to sensitively assess and address the trauma of racism and the traumas inflicted by COVID-19); and a workshop on Cultural Intelligence and Cultural Humility (which has been adapted to address the disparities and racism highlighted by COVID-19). The New England ATTC has also partnered with the South Africa HIV ATTC to develop a series of products focused on provider self-care in recognition of the toll that caretaking places on front-line health professionals. Finally, in October 2020 the New England ATTC will proudly host this year’s national Addiction Health Services Research Conference (delivered fully virtually)! One of the plenary talks by Dr. Ayana Jordan will specifically address the intersection of structural racism and addiction, and spotlight awards will be given to addiction researchers from underrepresented minority groups.

The New England ATTC is proud to join other Regional ATTCs in not only building the skills of the SUD workforce but also providing supportive strategies for sustaining hope and encouraging self-compassion during this trying times. Please visit the New England ATTC’s COVID-19 resource page to see the latest products and training events devoted to addressing this syndemic.

How to Reduce No-shows to Virtual Appointments

Todd Molfenter, Ph.D.
Director, Great Lakes ATTC, MHTTC, and PTTC

Is this a familiar scenario for your organization?

Day 1: Stay-at-home order: Your agency enacts social distancing guidelines.

Day 3: Your agency has switched in-person counseling to telephonic or video-based counseling.

Day 12: Virtual services, particularly telephone, have increased engagement rates!

Day 30: The honeymoon is over: show rates to virtual appointments are decreasing, especially among new consumers.

In the COVID-19 era, an old nemesis has returned: appointment no-shows. While telehealth has removed some barriers to behavioral health services, other engagement challenges are emerging. Agencies can take the “how exactly are we going to do this?” approach that COVID-19 has thrust us into since the beginning.

Another way is to turn to existing tools and proven practices to address the new no-show dilemma.

Three Tips to Reducing No-Shows During COVID-19 and Beyond
Apply these three tips, in this order, and watch your no-show rates decrease and show-rates increase.

1. Track No-Show Performance 

You can’t improve what you do not measure. No-shows should be measured. Measure no-shows to virtual appointments the same way you measured no-shows to in-person appointments before COVID-19. Compare no-show rates pre- and post- COVID. Segment the data as needed: new vs. existing client; by client age; by appointment type, etc. This measurement creates a foundation for improvement.

2. Use PDSA Cycles!

The Plan-Do-Study-Act (PDSA) method creates a simple process to test new approaches and observe their impact on no-shows. (See related post from NIATx coach Mat Roosa: Learning from Crisis: PDSA in Times of Challenge.) Plan a change; Do a change; Study the impact of the no-shows; then, Act on the change. (Adopt, adapt, or abandon.) You can conduct PDSA Cycles as part of an organized agency-based improvement initiative. Or, individual clinicians can perform PDSA cycles to improve their show rates.

What are good practices for addressing no-shows in a PDSA cycle? See Tip 3:

3. Use Proven Practices to Reduce No-shows
While COVID-19 provides us with some very new situations, we can learn a lot from what’s worked in the past to reduce no-shows.

Open scheduling: Book appointments to accommodate consumers’ schedules. Evening hours? Weekend hours? Ask the consumer, “When would you like us to talk next?”

Reminder calls, e-mails, and text messaging work for virtual appointments as well as they do for in-person appointments. Note the scheduling of the reminder message or text: Two days prior seems to work best for in-person appointments; one day before or on the day of for virtual appointments.

Evidence-Based Practices to Reduce No-Shows

Use Motivational Interviewing (MI) to reduce no-shows by increasing the consumer’s interest in coming back. The growing evidence base for MI shows its effectiveness in a variety of settings.

Use incentives or Contingency Management. Contingency Management is proving to be an effective EBP to enhance retention, particularly for stimulant use disorders. Offer consumers an incentive to reward attendance: a recognition certificate, gift card, or other small prizes.

Learn more about Motivational Interviewing and Contingency Management through the free online courses available through HealtheKnowledge, the ATTC Network’s online learning portal.

Patient no-show trend analysis can identify high-risk no-show patient categories (new vs. existing patients, payer source, patient age) as well as situations (day of the week, time of day, location). Develop patient scheduling practices to increase show rates from identified areas. This practice is particularly relevant as we need to understand better when, where, and how virtual appointments have greater participation.

Interested in learning more about how you can use these tips to reduce no-shows in your organization? Watch for information on the new Virtual NIATx Change Leader Academy—details available soon on the Great Lakes ATTC, MHTTC, and PTTC websites.

What have you found most useful in increasing participation in virtual care? What conditions and practices hurt appointment attendance? What have helped? Let us know in the comment section below.

Dr. Todd Molfenter is the deputy director of the Center for Health Enhancement Systems Studies at the UW-Madison. He is also the director of three SAMHSA-funded Technology Transfer Centers: the Great Lakes Addiction Technology Transfer Center, Mental Health Technology Transfer Center, and Prevention Technology Transfer Center. Todd specializes in implementation science, with a particular focus on technology and evidence-based practices in behavioral health.

South Southwest ATTC: Implementing Remote Technology In a Time of Crisis

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

The recent COVID-19 health pandemic has accelerated the implementation of behavioral health services via remote technology, including telephone and video conferencing. In March 2020, as behavioral health treatment and recovery organizations prepared to continue critical services while implementing social distancing guidelines needed to keep patients and staff safe and healthy, many turned to the use of technology as a solution, including video conferencing and telephone services. For organizational leadership, decisions around critical issues such as compliance with laws and best practices related to patient confidentiality and protection, choice of platforms, licensing and certification regulations for practitioners, and costs and reimbursement procedures, had to be made at an accelerated rate. Federal and state agencies began issuing guidance related to relaxation of enforcement of privacy protections in a limited way due to the short-term health crisis, and funders addressed modifications to reimbursement policies to include telehealth services. However, much of the guidance was necessarily high level, leaving leadership of individual behavioral health programs to assess the fiscal and practical ramifications of responding to the new service landscape via the use of telehealth in the both the short and long term.

Over the past several years, the South Southwest Addiction Technology Transfer Center, in partnership with National Frontier and Rural Telehealth Education Center (NFARtec), has been offering training and technical assistance to states, tribal communities and behavioral health organizations and practitioners as part of its telehealth initiative. This includes documenting best practices and real world examples of implementation, such as the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) successful initiative to increase the uptake of telehealth technologies to deliver assessment, treatment and recovery services in their public health system. It also includes offering behavioral health clinicians and peer support specialists learning collaborative opportunities to build and practice their videoconferencing skills and receive coaching and feedback from experienced behavioral health telehealth practitioners.

At the start of the response to the pandemic, South Southwest ATTC began receiving multiple requests from organizations across the region for immediate guidance on how to translate many of the strategies for remote technology on the ground in a rapid and timely manner. SSW ATTC facilitated regional dialogues between state and local behavioral health organizations with telehealth experience and organizations new to the use of remote technology, including an event in Oklahoma with tribal communities, experienced behavioral health providers and ODMHSAS. Through those discussions, it became apparent that concrete guidance on practical steps for organizations to take in order to implement remote technology was needed. As a result, SSW ATTC developed the Framework for Implementation of Telehealth Services in a Behavioral Health Setting in a Short Time Frame, which covers topics that include:

  • Determining participant interest and capacity for use of technology
  • Selection of technology platforms
  • Patient safety and privacy considerations
  • Staff support and training
  • Review of internal policy and procedures
  • Adapting work flows
  • Fiscal considerations and reimbursements

The goal is to provide a framework for behavioral health care providers that guides organizational leadership through short term practical steps for implementation of remote services via technology while including successful long-term strategies for sustaining telehealth services.

This guide is one piece of a regional and national TTC network partnership designed to provide resources and support to the behavioral health field to ensure services to individuals in our community are accessible, evidence based and culturally responsive during the current challenging health crisis and beyond. Additional resources from the TTC network are available at attcnetwork.org, mhttcnetwork.org and pttcnetwork.org. To access regional assistance from the South Southwest Addiction Technology Transfer Center, please contact us via website or email.

Share Your Perspectives about Opioid Use Disorder among People with Disabilities from Minority Backgrounds

Share Your Perspectives about Opioid Use Disorder among People with Disabilities from Minority Backgrounds.Please click or cut and paste survey link below to participate:


We are pleased to invite substance, mental health service and vocational rehabilitation professionals (e.g., counselors, clinicians, directors) from across the country that provide to participate in a national study on Opioid Use Disorder Impacts on Employment Prospects for People with Disabilities from minority backgrounds (i.e., African American, Hispanic or Latino, American Indian, Alaskan Native, or Native Hawaiian or other Pacific Islanders). Opioid use disorder (OUD) can involve maladaptive/misuse of prescribed opioid medications, use of diverted opioid medications, or use of illicitly obtained heroin.

This study is being conducted by The Langston University Rehabilitation Research and Training Center (LU-RRTC) on Research and Capacity Building for Minority Entities. Langston University is the only historically black college or university (HBCU). The LU-RRTC is funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

The new information generated through this study would provide insights on how policy makers, educators and federal research sponsoring agencies such as the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and the National Institutes of Health (NIH) can better respond to the needs of people with opioid use disorder, especially people with disabilities from minority backgrounds. In addition, the study findings may be used as a foundation for developing interventions that seek to improve the experiences and outcomes of individuals with disabilities from minority backgrounds with opioid use disorder.

The information in this study will be used only for research purposes and in ways that will not reveal who you are. Study participants will not be identified in any publication from this study. The survey will take around 20 minutes to complete. If you have any questions or concerns, please contact Dr. Corey Moore (Principal Investigator) via email: corey.moore@langston.edu or Dr. Edward Manyibe (Co-PI) via email: manyibe@langston.edu. If you experience technical difficulty with the survey, contact Dr. Andre Washington: andre.washington@langston.edu and he will be happy to assist you.

Please click or cut and paste survey link below to participate:


Thank you in advance for your contribution.

How social isolation, loneliness, and insecurity affect people in recovery from addiction and mental illness during COVID-19; and what to do about it

By Pierluigi Mancini, Ph.D.
Project Director, National Hispanic and Latino ATTC

We are going through a difficult period, together, and we are all going through it in our own way. What COVID-19 has done to us as a society is traumatic and the impact of untreated trauma can be subtle, insidious, or outright destructive.

The American Psychiatric Association (APA www.psychiatry.org) reported in a recent survey that almost half of Americans (48%) are anxious about the possibility of contracting coronavirus, COVID-19, that 40% are anxious to get seriously ill or die, and 62% are anxious about the possibility of family and loved ones becoming infected.

It is natural to feel stress, anxiety, anguish and worry during and after a crisis like COVID-19. Each person reacts differently, and their own feelings will change over time. You have to become aware of how you feel and accept it.

Separation from loved ones, loss of freedom, and uncertainty about the state of the disease are cause for concern. Studies have begun to show that most people in social isolation have negative psychological effects, including symptoms of post-traumatic stress, confusion, and anger. The biggest stressors include fears of infection, frustration, boredom, inadequate supplies, inadequate information, financial losses, and stigma.

Lack of connection can cause a feeling of loneliness and is especially aggravated in those recovering from addictions or mental health problems. Each one reacts differently to stressful situations. The typical reactions that occur when sheltering in place due to an immediate problem are different. Some of the emotions that we may be feeling in this situation include anxiety, fear, worry, uncertainty, frustration, sadness, boredom, fear of asking for income or work and negative effects on the ability to sleep well and eat healthy.

The fact of not being able to continue with the routine itself is a factor that disorganizes our structure since we lose the feeling of control. It is important to remember the ability we have to reorganize a new structure.

We can also go through different changes including changes in behavior such as the increase or decrease in energy and activity levels or excessive worry and even the inability to feel pleasure or have fun.

Changes in your body such as stomach pain or headaches or other discomforts or loss or increase in appetite; changes in thoughts like difficulty remembering things or feeling confused. All these symptoms can be interpreted as excuses or reasons to drink or use drugs or to give up and not want to go on.

If the madness of addiction is lived in solitude during its last stages, recovery always occurs with the help and participation of others. And for that we need to build resilience.

The American Psychological Association (https://www.apa.org/topics/resilience) defines resilience as "adaptation to adversity, trauma, tragedy, threats, or major sources of stress."

The concept of resilience helps to understand and promote positive development in situations originally perceived as negative and in potentially destructive challenges. It is the ability to respond to pressures and tragedies quickly, adaptively and effectively, remembering and acknowledging that experience to face future adversities. Applied to humans, resilience is the ability of an individual to develop positively despite adversity. Their goal is to come out strengthened and transformed by the experience, however painful it may be.

We can build resilience using various tools such as focusing on one's strengths, rather than weaknesses; acting on the solutions, and not on the causes of the problem; substituting rigidity for flexibility and recognizing that the past cannot be changed, but that we can learn how it is influencing our present to make the appropriate adjustments today.

For those in social isolation, the general recommendation is to establish a routine with space for leisure and exercise; stay informed through official trustworthy channels like the CDC (www.cdc.gov) and SAMHSA (www.samhsa.gov) and do not overexpose yourself to the news about the coronavirus. It is also recommended to keep in touch with family and friends. It is important to stay connected through social media, but again, with limits. Connections, even if they are virtual, are the great shock absorbers of stress.

We must trust our recovery. What we have achieved so far is worth a lot and you should not forget everything you have done to achieve it. Use your tools, just because you can't go out you don't have to forget them. And in order to relax, start with things you know that help you relax, such as deep breathing, stretching, meditating or praying, or entertaining yourself with a hobby you like.

Do things you enjoy, like reading, listening to music, exercising, or taking a bath; talk about your experience and feelings with loved ones and friends; keep hope and think positively.

And finally, if you need help, please find her. Today we have help available and you can go to www.samhsa.gov where you will find support phones and websites.

[A webinar of this same title is available on our page in English, Spanish and Portuguese. Please visit https://attcnetwork.org/centers/national-hispanic-and-latino-attc/home]


Cómo el aislamiento social, la soledad, y la inseguridad afecta a las personas en recuperación de adicción y salud mental durante COVID-19; y que hacer al respecto

Por Pierluigi Mancini PhD
Director del Centro Hispano Latino de Capacitación y Asistencia Técnica en Adicción

Estamos pasando por un momento realmente difícil, juntos, y todos lo estamos pasando en nuestra propia manera. Lo que el COVID-19 nos ha hecho como sociedad es traumático y el impacto del trauma que no es tratado puede ser sutil, insidioso o totalmente destructivo.

La Asociación Americana de Psiquiatría (APA www.psychiatry.org) informó en una encuesta reciente que casi la mitad de los estadounidenses (48%) están ansiosos por la posibilidad de contraer coronavirus, COVID-19, que el 40% está ansioso por enfermarse gravemente o morir, y que el 62% está ansioso por la posibilidad de que la familia y los seres queridos se infecten.

Es natural sentir estrés, ansiedad, angustia y preocupación durante y después de una crisis como el COVID-19. Cada persona reacciona de manera diferente y sus propios sentimientos cambiarán a lo largo del tiempo. Hay que tomar conciencia de cómo uno se siente y aceptarlo.

La separación de los seres queridos, la pérdida de libertad, y la incertidumbre sobre el estado de la enfermedad son causantes de preocupación. Estudios han comenzado a demonstrar que la mayoría de las personas que se encuentran en aislamiento social registran efectos psicológicos negativos, incluidos síntomas de estrés postraumático, confusión y enojo. Los mayores factores estresantes incluyen temores de infección, frustración, aburrimiento, suministros inadecuados, información inadecuada, pérdidas financieras y estigma.

La falta de vinculación puede provocar una sensación de soledad y agravarse especialmente en aquellas personas en recuperación de adicciones o de problemas de salud mental. Cada uno reacciona de forma diferente ante situaciones estresantes. Son diferentes las reacciones típicas que ocurren cuando hay que refugiarse en sitio debido a un problema inmediato. Algunas de las emociones que podemos estar sintiendo ante esta situación incluyen la ansiedad, el miedo, la preocupación, le incertidumbre, la frustración, la tristeza, el aburrimiento, temor por pedida de ingresos o trabajo y efectos negativos en la habilidad de dormir bien y comer saludablemente.

El hecho de no poder continuar con la propia rutina es un factor que desorganiza nuestra estructura ya que perdemos la sensación de control. Es importante recordar la capacidad que tenemos para reorganizar una nueva estructura.

También podemos pasar por diferentes cambios incluyendo cambios en conducta como el aumento o disminución en sus niveles de energía y de actividad o la preocupación excesiva y hasta la incapacidad de sentir placer o divertirse. Cambios en su cuerpo como el dolor de estómago o dolores de cabeza u otras molestias o la pérdida o aumento de apetito; cambios en sus pensamientos como la dificultad para acordarse de cosas o el sentirse confundido. Todos estos síntomas pueden ser interpretados como excusas o razones para beber o usar drogas o para rendirse y no querer seguir adelante.

Si la locura de la adicción se vive en soledad durante sus últimas etapas, la recuperación siempre ocurre con la ayuda y la participación de otros. Y para eso necesitamos construir la resiliencia.

La Asociación Psicológica Americana (https://www.apa.org/topics/resilience) define resiliencia como ‘la adaptación ante la adversidad, el trauma, la tragedia, las amenazas o las fuentes importantes de estrés.’

El concepto de resiliencia ayuda a entender y promover el desarrollo positivo en situaciones percibidas originalmente como negativas y en retos potencialmente destructivos. Es la capacidad de responder a presiones y tragedias rápida, adaptativa y efectivamente, recordando y reconociendo dicha experiencia para enfrentar futuras adversidades. Aplicado a los seres humanos, la resiliencia es la capacidad que tiene un individuo de desarrollarse positivamente a pesar de las adversidades. Su objetivo es salir fortalecidos y transformados por la experiencia, por más dolorosa que pudiera resultar.

Podemos construir la resiliencia utilizando varias herramientas como enfocándonos en las propias fortalezas, en vez de las debilidades; actuando sobre las soluciones, y no sobre las causas del problema; sustituyendo la rigidez por la flexibilidad y reconociendo que el pasado no puede ser cambiado, pero que sí podemos aprender cómo está influenciando en nuestro presente para hacer hoy los ajustes convenientes.

Para quienes están en aislamiento social, la recomendación general es establecer una rutina con espacio para el ocio y el ejercicio; informarse por canales oficiales como el CDC (www.cdc.gov) y SAMHSA (www.samhsa.gov) y no sobreexponerse a las noticias sobre el coronavirus. También se recomienda mantener el contacto con familia y amigos. Es importante permanecer conectados a través de redes sociales, pero de nuevo, con límites. Los vínculos, aunque sean virtuales son el gran amortiguador del estrés.

Tenemos que confiar en nuestra recuperación. Lo que hemos logrado hasta hoy vale mucho y no debes olvidar todo lo que has hecho para realizarlo. Utiliza tus herramientas, solo porque no puedes salir no tienes que olvidarlas. Y para relajarnos, comience con cosas que sabes que te ayudan a relajarte, como el respirar profundo, meditar o rezar, o entretenerse con un pasatiempo que le agrade.

Haga cosas que disfruta, como leer, escuchar música, hacer ejercicio o darse un baño; hable sobre su experiencia y sus sentimientos con sus seres queridos y sus amigos; mantenga la esperanza y piense positivamente.

Y finalmente, si necesita ayuda, por favor búsquela. Hoy tenemos ayuda disponible y puedes visitar www.samhsa.gov donde encontraras teléfonos y sitios web de apoyo.

[Un seminario web de este mismo título está disponible en nuestra página en inglés, español y portugués. Por favor visite https://attcnetwork.org/centers/national-hispanic-and-latino-attc/home]


Como o isolamento social, a solidão e a insegurança afetam as pessoas em recuperação de transtornos por uso de substâncias e distúrbios mentais durante o COVID-19; e o que fazer sobre isso

Por Pierluigi Mancini, Ph.D.
Diretor de Projeto, Centro Hispânico -Latino de Treinamento e Assistência Técnica em Abuso de Substâncias (NHL-ATTC)

Estamos passando por um período difícil, juntos, e todos estamos lidando com isso à nossa maneira. O que o COVID-19 nos causou como sociedade é traumático e o impacto de traumas não-tratados pode ser sútil, insidioso ou totalmente destrutivo.

A Associação Americana de Psiquiatria (APA) www.psychiatry.org relatou em uma pesquisa recente que quase metade dos americanos (48%) estão preocupados com a possibilidade de contrair o coronavírus, 40% estão preocupados em ficar gravemente doente ou morrer e 62% estão preocupados com a possibilidade de ter a família e os entes queridos infectados.

É natural sentir estresse, ansiedade, angústia e preocupação durante e após uma crise como o COVID-19. Cada pessoa reage de maneira diferente e os sentimentos mudam com o tempo. Você precisa se tornar consciente de como você se sente e aceitar.

A separação dos entes queridos, a perda da liberdade e a incerteza sobre o estado da doença são motivo de preocupação. Estudos começaram a mostrar que a maioria das pessoas que estão em isolamento social relata efeitos psicológicos negativos, incluindo sintomas de estresse pós-traumático, confusão e raiva. Os maiores estressores incluem o medo de infecção, receio de perder o emprego, frustração, tédio, suprimentos inadequados, informações inadequadas, perdas financeiras e estigma.

A falta de conexão pode causar uma sensação de solidão e é especialmente agravada naqueles que se recuperam de transtornos por uso de substâncias e distúrbios mentais. Cada um reage de maneira diferente a situações estressantes. As reações típicas que ocorrem quando existe a orientação de ficar em casa durante um determinado período, por conta de um problema imediato são diferentes. Algumas das emoções que podemos sentir nessa situação incluem ansiedade, medo, preocupação, incerteza, frustração, tristeza, tédio, medo de não ter renda ou trabalho e efeitos negativos na capacidade de dormir bem e comer de forma saudável.

O fato de não podermos continuar com a rotina em si é um fator que desorganiza nossa estrutura, pois perdemos a sensação de controle. É importante lembrar a habilidade que temos de reorganizar uma nova estrutura.

Também podemos passar por diferentes mudanças, incluindo mudanças no comportamento, como aumento ou diminuição dos níveis de energia e atividade, ou preocupação excessiva e até a incapacidade de sentir prazer ou se divertir.

Alterações no seu corpo, como dores de estômago, dores de cabeça, outros desconfortos ou perda ou aumento do apetite; mudanças nos pensamentos, como dificuldade em lembrar as coisas ou se sentir confuso. Todos esses sintomas podem ser interpretados como desculpas ou razões para beber ou usar drogas ou para desistir e não querer continuar.

Se a loucura por conta do uso de substâncias é vivida em solidão durante seus últimos estágios, a recuperação sempre ocorre com a ajuda e participação de outras pessoas. E para isso, precisamos construir resiliência.

A Associação Americana de Psiquiatria (https://www.apa.org/topics/resilience) define resiliência como "adaptação a adversidades, traumas, tragédias, ameaças ou principais fontes de estresse".

O conceito de resiliência ajuda a entender e promover o desenvolvimento positivo em situações originalmente identificadas como negativas e em desafios potencialmente destrutivos. É a capacidade de responder a pressões e tragédias de forma rápida, adaptativa e eficaz, lembrando e reconhecendo essa experiência para enfrentar adversidades futuras. Aplicada aos seres humanos, a resiliência é a capacidade de um indivíduo se desenvolver positivamente, apesar das adversidades. Seu objetivo é sair fortalecido e transformado pela experiência, por mais dolorosa que seja.

Podemos construir resiliência usando várias ferramentas como focar nos nossos pontos fortes, e não nas nossas fraquezas; atuar nas soluções, e não nas causas do problema; substituir rigidez por flexibilidade e reconhecer que o passado não pode ser mudado, mas que podemos aprender como ele está influenciando nosso presente para fazer os ajustes apropriados hoje.

Para quem está em isolamento social, a recomendação geral é estabelecer uma rotina com espaço para lazer e exercício; mantenha-se informado através de canais oficiais confiáveis como o CDC (www.cdc.gov) e SAMHSA (www.samhsa.gov) e não se exponha demais às notícias sobre o coronavírus. Também é recomendável manter contato com familiares e amigos. É importante manter-se conectado através da mídia social, mas novamente, com limites. As conexões, mesmo que sejam virtuais, são os grandes amortecedores do estresse.

Devemos confiar em nossa recuperação. O que alcançamos até agora é muito valioso e você não deve esquecer tudo o que fez para chegar até aqui. Use suas ferramentas, só porque você não pode sair, não precisa esquecê-las. E, para relaxar, comece com coisas que você sabe que te ajudam a relaxar, como respiração profunda, alongamento, meditação ou oração, ou mantendo-se ocupado com um hobby que você gosta.

Faça coisas que você goste, como ler, ouvir música, se exercitar ou tomar um banho; fale sobre sua experiência e sentimentos com entes queridos e amigos; mantenha a esperança e pense positivamente.

E, finalmente, se precisar de ajuda, encontre-a. Hoje temos ajuda disponível e você pode acessar www.samhsa.gov para encontrar telefones e sites de apoio.

[Um seminário com esse mesmo título está disponível em nossa página em inglês, espanhol e português. Por favor visite https://attcnetwork.org/centers/national-hispanic-and-latino-attc/home]

Great Lakes ATTC: Helping Build Recovery-Oriented Systems of Care

Implementation, the final phase of the ATTC Technology Transfer Model, moves an innovation into routine practice in real-world settings.

For the Great Lakes ATTC, implementing Recovery-Oriented Systems of Care in real-world settings has been a particular focus since the concept first began to take shape. (See related blog post: Building a Science of Recovery: The Pinnacle ATTC Achievement.)

SAMHSA defines a Recovery Oriented System of Care as:

“A coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness and quality of life for those with or at risk.” (SAMHSA, 2011)

The Recovery-Oriented Systems of Care Illinois State Network (ROSC-ISN)
The Great Lakes ATTC provides training and technical assistance for ROSC implementation projects throughout the six-state region at the state, county, and local levels. 

One example of a statewide initiative currently underway is the Recovery-Oriented Systems of Care Illinois Statewide Network (ROSC-ISN), launched by the Illinois DHS in the fall of 2018 under the leadership of Dani Kirby, director of Substance Use Prevention and Recovery (SUPR) at IDHS. Rex Alexander, also of IDHS SUPR, serves as the project director for ROSC-ISN.

“Our technical assistance has included all of the coordination, planning, and delivery for the ROSC-ISN,” says Scott Gatzke, Great Lakes TA coordinator for the project. “This includes face-to-face meetings, one-on-one coaching calls, monthly peer learning calls, and report-out sessions where participants share lessons learned.”

The goal of ROSC-ISN to help eight local ROSC Councils throughout the state build community-based recovery supports tailored to the unique needs of the community. Each ROSC Council has a lead agency that provides leadership for the local council, with support from IDHS/SUPR.

One of those lead agencies is the Chicago Recovery Communities Coalition, a peer-driven, peer-run Recovery Community Organization founded by Dora Dantzler-Wright.

“We are collaborating with organizations that provide substance use disorder services to identify service gaps,” explains Dantzler-Wright. “Being part of the ROSC-ISN has enabled us to reach over 13 communities on the west side of Chicago, provide information to those agencies, and collect data. This state initiative is helping our RCO to work on a system transformation.”

Adds Gatzke, “The ultimate goal of this project is to create multiple stand-alone Recovery Community Organizations in Illinois that will spin off from the ROSC Councils. The system change that emerges from this important initiative will provide valuable lessons that our Center can apply in other ROSC initiatives in our region and beyond.”

Mid-America ATTC: Creation of Intensive technical assistance manual for trauma informed care (TIC)

The Mid-America Addiction Technology Transfer Center (a collaboration between Truman Medical Center Behavioral Health and the University of Missouri-Kansas City School of Nursing and Health Studies) developed an intensive technical assistance manual to be used by Technology Transfer Centers to facilitate trauma informed care (TIC) implementation in substance use and recovery service settings.

The manual will provide guidance for TIC consulting teams on issues such as:

  • Evidence for effectiveness of TIC implementation, including improved client experience and employee well-being and retention
  • Key considerations for TTCs as they determine capacity and strategies to provide TIC consultation
  • Examples of different levels of TA activities to promote implementation
  • Core components of trauma-informed care and corresponding consultant and organization activities during each stage of implementation
  • Defining and navigating the role of a consultant in organizational change
  • Organizational assessment tools, meeting facilitation techniques, and approaches for developing strategies for change with leadership
  • Building and supporting organizational capacity to lead, sustain, and evaluate TIC implementation
  • Future considerations for TIC implementation may be developed for peer recovery coaches, CLAS standards, child welfare, and other community partners

To pilot the manual’s multi-faceted TIC implementation process, Mid-America conducted site visits to regional provider agencies expressing interest in becoming a TIC environment. Osawatomie State Hospital (OSH) in Kansas was selected as the initial pilot site; OSH leadership signed a memorandum of understanding committing the organization to weekly on-site and virtual engagements with TIC TA specialists. The OSH leadership and the TIC TA specialists will navigate through multiple steps including relationship building and program design, and movement through four stages: trauma aware, trauma sensitive, trauma responsive, and trauma informed.

Movement to a trauma informed culture requires dedication from all levels of staff, from the ground up and top down. With thorough self-evaluation through surveys and group discussions regarding individuals and the provider organization as a whole, the end goal is operating with a Trauma Informed Care lens. Once provider organizations have reached this stage, the aim is that the organization will:

  1. Have a mission statement, goals and/or objectives explicitly reference sustaining a Trauma Informed Care culture and environment;
  2. Demonstrate a sustainable commitment to trauma-informed values and all employees and volunteers implement trauma-informed practices;
  3. Other agencies and community partners turn to organization for expertise and leadership;
  4. All staff respond to internal and external changes, barriers, and growth through a Trauma Informed lens.
A secondary goal of the project is to field-test evaluation tools, resources, tips, case studies, and step-by-step guidance for TIC consultant teams. In 2021, Mid-America plans to initiate a virtual TTC TIC Team Learning Collaborative to provide initial guidance in how to use the intensive technical assistance manual and support those regional ATTCs providing TIC consultation.

For more information about Trauma Informed Care, please see the Mid-America ATTC’s website: https://attcnetwork.org/centers/mid-america-attc/implementing-trauma-informed-care-sud-treatment-and-recovery-settings

Learning from Crisis: PDSA in Times of Challenge

Mat Roosa, LCSW-R
NIATx Coach

Crisis requires that we triage the most urgent matters, and take rapid action to address them.
Crisis demands that we limit our analysis to the critical data points.
Crisis demands that we try new and untested strategies, and rapidly respond to the results of our efforts.

Crisis is dangerous, chaotic, messy, heart-wrenchingly painful,…and also an opportunity for invention.

During the past several weeks you probably have:
  1. Recognized immediate problems.
  2. Prioritized resources.
  3. Taken rapid action to test new strategies.
  4. Made decisions based on key data.
  5. Learned a lot from testing these new strategies and refined your efforts.
Put another way, you have been working your way through a challenging crisis using Plan-Do-Study-Act change cycles.

Rapid-cycle Testing: One of the Five NIATx Principles
“The fifth principle of the NIATx model is what we call rapid-cycle testing. Structured around what’s known as the PDSA (Plan-Do-Study-Act) Cycle, rapid-cycle testing is used to quickly evaluate the impact of potential changes on a given aim. 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 regard to the project’s aim.”

From The NIATx Model: Process Improvement for Behavioral Health

See related blog post: Make it Quick: NIATx Principle #5

A Perfect Time for Rapid Change

A crisis like the one we are all facing right now is tailor-made for rapid-cycle PDSA change. Many of us have been using the NIATx model—perhaps without even knowing it. Right now is an excellent time to document the PDSA cycles that you have been conducting.

A few questions may help you to refine your understanding of the crisis work that you have been doing, and to document your PDSA efforts.
  • What did you observe through data or experience?
  • What did you do in response?
  • What was the result?
  • What did you learn?
You might also want to use the NIATx Change Project Form to document your recent efforts retrospectively. You can find the form and step-by-step instructions on how to conduct a PDSA Cycle on the NIATx website.

As this crisis persists, we struggle to figure it out as we go. Finding the opportunity in this unprecedented challenge is both difficult and painful. Yet, one way to find purpose and meaning moving forward is to learn everything we can from it.

Consider how rapid-cycle PDSA can teach you more about what you have done and will do, as we work our way through this together.

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, evidence-based practice implementation. He 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