AMERSA People & Passion, Episode 9: History of AMERSA with Sid Schnoll

Sid Schnoll, one of the founders of AMERSA, discusses with Paula Lum the origin of the organization out of the Career Teacher Program of the early 1970s. The desire by the federal government to cultivate experts in substance use disorders into health professional schools has resulted in a vibrant, growing organization that helps health educators provide cutting-edge information to their students.





Sidney H. Schnoll, M.D., Ph.D.
, is an internationally recognized expert in addiction and pain management who has recently applied his experience of over 30 years in academic medicine to the issues of risk management of controlled substances. Sid was a member of the team that developed the Tramadol Independent Steering Committee (ISC), and he was the principal investigator on the health care professional surveillance project to determine rates of use of tramadol among health professionals. Sid also developed the RADARS® System to study the use and diversion of prescription opioids, which was cited by the FDA as a model risk management program. With over thirty years in academic medicine, Sid has published over 150 research papers, book chapters and educational materials. His areas of research include both addiction and pain management with special emphasis on perinatal addiction and prescription drug use.
 


Sid Schnoll on 1971 Philadelphia Magazine Cover


Paula J. Lum, MD, MPH
 is an HIV primary care physician, addiction medicine specialist, and Professor of Medicine at the University of California, San Francisco.  Board certified in internal medicine and addiction medicine, her research, clinical, and teaching activities for the last 25 years have focused on evidence-based and patient-centered care to improve the health and wellness of the urban poor.  After attending her first AMERSA conference in 2008, Dr. Lum “felt the love” and knew she had found her professional home.   She enjoyed reviewing abstracts for the conference so much, that she went on to co-chair the Abstract Committee in 2012 and 2013, and to co-chair the Conference Program Committee in 2014 and 2015.  Encouraged by AMERSA colleagues and other giants in the field, she established the first accredited Addiction Medicine Fellowship Program in the University of California.  In 2019, Dr. Lum received AMERSA’s W. Anderson Spickard, Jr. Excellence in Mentorship Award and began her current tenure as President of the AMERSA Board of Directors.  At the Annual National Conference, pestering Sid Schnoll for stories about the Summer of Love has become one of her favorite traditions. 




AMERSA People & Passion, Episode 8: Key Conversations: Dismantling racism against Black, Indigenous, and people of color across the substance use continuum

The Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA) released a solidarity statement and a position paper articulating racism’s deadly effects on persons who use alcohol, tobacco, and other drugs. This cascade of negative effects, compounded with the social determinants of health results in higher rates of incarceration, increased risk of overdose, fewer employment options, multi-generational poverty and economic disadvantages for Black, Indigenous, and People of Color (BIPoC).

The AMERSA Board of Directors (BOD) proposes an initial set of strategies to promote diversity, equity, and inclusion using a framework that speaks to four key AMERSA experiences: engagement, education, mentorship, and leadership. Please join Dr. Holly Hagle, Marlene Martin, and Miriam Komaromy in this podcast for a discussion on how AMERSA commits to promoting equity and inclusion to dismantle the individual, institutional, and structural racism that has pervaded the United States for centuries. Through these actions we stand in solidarity with BIPoC and all persons who use substances across the spectrum of harm reduction, prevention, intervention, treatment, and recovery; committing to promoting equity and inclusion. The AMERSA BOD cannot achieve this alone. We invite our members to join us in building an inclusive, multidisciplinary professional society equitable for all. Please visit us at AMERSA.org





Holly Hagle, Ph.D
. is an Assistant Research Professor at the Collaborative to Advance Health Services, at the University of Missouri-Kansas City’s School of Nursing and Health Studies. Dr. Hagle is a proven leader and educator with over 18 years’ experience developing educational programming, curricula for traditional face-to-face and online education, supervision of staff and consultants, and the management of multi-million dollar federal grant budgets. She is the Co-Director of the National Addiction Technology Transfer Center (ATTC) Network Coordinating Office (NCO) and Principal Investigator (PI) for the Prevention Technology Transfer Center (PTTC) NCO. In addition, she is the UMKC PI, and Co-Director on behalf of the ATTC Network for the Opioid State Targeted Response Technical Assistance (STR-TA) grant. Dr. Hagle has been actively working with medical and behavioral health providers for more than 20 years on the integration of behavioral health interventions, including educational programming on intercultural sensitivity. Her area of expertise is in adolescent co-occurring disorders, screening, brief intervention, and referral to treatment, and the application of evidence-based practices in community settings with a special focus on qualitative research methods.



Marlene Martin, MD
, is an Assistant Clinical Professor at UCSF and a hospitalist at San Francisco General Hospital. She is driven to improve care for populations in the safety net.

Marlene was born and raised in Los Angeles and is a first-generation college graduate. She attended college and medical school at Stanford prior to completing Internal Medicine residency at UCSF. Her bilingual and bicultural Mexican immigrant background influenced her to serve socially oppressed populations.

Marlene is board certified in addiction medicine and founded and directs the Addiction Care Team, a novel interprofessional consult service that delivers compassionate, evidence-based care for hospitalized people with unhealthy substance use. She is interested in alcohol use disorders among LatinX populations as well as eliminating the inequities faced by persons with substance use disorders.

 

Dr. Miriam Komaromy
is an addiction medicine physician who is medical director of the Grayken Center for Addiction at Boston Medical Center, where her work focuses on all aspects of substance use disorders and the intersection between addiction and health equity. In the past she led the development of the ECHO model for education of clinical teams about how to treat substance use disorders in primary care. She currently leads a federally-funded program studying the best way to treat co-occurring addiction and mental health disorders in primary care settings.

Change Project 911: Customers don’t notice improvements



Mat Roosa, LCSW-R
NIATx Coach

How do we know if a change is an improvement?

Change teams and change leaders ask this question frequently. It often refers to the measures and data they’re using to monitor change results.

But there is another and perhaps more meaningful way to ask this question: How do our customers know that a change is an improvement? 

The number one NIATx Principle asks us to understand and involve the customer. The most important way to involve customers is to make sure that they are experiencing the improvements resulting from a change.

Collecting quantitative data on the change is essential, but collecting qualitative data about the customer/client/ patient experience is also essential. For example, do the results of the change create a real impact that the customer feels? Does the change make the service process more satisfying, comfortable, or useful to the people we are trying to serve?  

Quality customer experience by design

Most of us try to gather customer feedback to help us to improve our services. Surveys and focus groups of service recipients can be excellent strategies for determining the impact of a change that we have implemented. Typically this feedback is gathered after the implementation to support efforts to improve a flawed process further. 

Wouldn’t it be better to design the process to ensure quality in the customer experience from the beginning? 

Wouldn’t it be better to gather customer experience data before developing change projects? 

The best way to ensure that the customer feels the change is to engage the customer on the front end of the change development process. So what can we do to ensure that we include the customer’s values from the beginning of the change process?

Include customers on the change team

“Nothing about us without us” has been a powerful refrain in the behavioral health peer recovery movement. These words underscore the importance of including people who are receiving services or support in all decisions related to that service. Perhaps the best way to do this in a change project is to include customers on the change team.  Many organizations that have adopted the NIATx model have found that a change team that consists of both service recipients and service providers generates change ideas with greater impact. 

Use the “So What?” test

The history of product design is filled with clever products that excited designers but left customers saying, "So what?” Again, if we return to the NIATx principle number one, we need to know and understand the customer to develop services or make service improvements that create a strong positive customer response. 

Use customer impact criteria to select a strategy

In the NIATx model, we often use Nominal Group Technique (NGT) to brainstorm change strategies to address our chosen aim. Typical NGT uses a simple return on investment criteria to select a strategy from the list generated: 

What is the level of resource required to implement the strategy, and what are the expected results? 

We can add to this criteria a question about customer impact to ensure that the selection process includes these critical elements: Which of these strategies will have the greatest desired impact on the customer's experience? As described above, including customers on the change team is a great way to ensure that the change project addresses customer values and priorities. In addition, customers participating in the NGT process will generate ideas that focus on customer experience. 

To believe that the customer is “always right” is to believe that the customer is the first and best source for improvement ideas. Regardless of the industry or service type, customers/ clients/ patients vote with their feet. If you engage customers in building and improving your service, they will keep coming back, and you will be able to deliver the services, care, and supports that will make a difference in their lives.  

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

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. 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 (Change Project SOS) at matroosa@gmail.com.

AMERSA People & Passion, Episode 7: Palliative Care: Bridging the Gap for Addiction Treatment in People with Serious Illness

Substance Use Disorders are common in people with serious illness and contribute immensely to suffering and poor quality of life. People with addiction and serious illness are an underserved population with unmet and complex medical and psychosocial needs. In this episode, Palliative care clinicians will discuss the overlap between both fields, educational initiatives, patient cases, and innovative models of collaboration to bridge the gap.

 



A photo of  Dr. Julie Childers
Julie W. Childers, MD
, graduated from the University of Pittsburgh School of Medicine in 2005 and completed residency training in internal medicine at the University of Rochester in 2008. She completed fellowship training in palliative care in 2009 and obtained a master’s degree in medical education in 2010. She began treating opioid use disorder in 2010, and in 2018 became board certified in Addiction Medicine. In addition to her work as a palliative care specialist, she attends on the inpatient Addiction Medicine Consult Service, has an active outpatient practice treating substance use disorders, and developed a new ACGME-accredited addiction medicine fellowship. She has written and taught nationally in the areas of teaching communication, motivational interviewing, medical ethics, and managing addiction in patients with serious illness.


A photo of Katie Fitzgerald Jones
Katie Fitzgerald Jones, BSN, MSN, APN
, is a Palliative Nurse Practitioner at VA Boston Healthcare System and PhD student at Boston College Connell School of Nursing. Her clinical and research interests improve pain management, quality of life and enhance opioid safety in individuals with cancer and substance use disorder. Past clinical experience includes developing a sustainable Palliative Care Nurse Practitioner Fellowship at Dana Farber Cancer Institute and Brigham and Women’s Hospital, serving as the Palliative Nurse Director, and creating an innovative Palliative Care Program for older adults at Hebrew Senior Life. Ms. Jones has been an active member of the Palliative Care Academic Community. Over the past years has been an invited speaker at the Harvard Center for Palliative Care, the Harvard Inter-Professional Palliative Care, and the Harvard Geriatric Fellowship. Ms. Jones is a co-leader of the national hospice and palliative care buprenorphine clinical mentorship support group and research group. In her early research work- she has examined biopsychosocial factors associated with long-term opioid use in cancer survivors, parallels between Palliative Care and Substance Use Disorder Treatment, and Buprenorphine prescribing practices in Palliative Care clinicians. Her research is currently funded by the Foundation of Addiction Nursing and the National Institute of Nursing Research Predoctoral Fellowship Award (F31). She has authored several manuscripts and book chapters on the intersection between palliative care and substance use disorders and has spoken nationally on various related topics.

A photo of Janet Ho
Dr. Janet Ho
is a board-certified palliative medicine and addiction medicine physician at the University of California, San Francisco. She completed internal medicine training and chief residency at Yale, a masters in public health at Harvard, and fellowships in health services research, palliative care, and addiction medicine at Harvard, Dana Farber Cancer Institute, and Massachusetts General Hospital in Boston, MA. Her clinical and research interests lie at the intersection of serious illness, addiction, pain, and chronic cancer pain. Dr. Ho is dedicated to improving provider knowledge and confidence in primary palliative care and addiction medicine; improving disparate quality of life and care for patients with life-limiting serious illness and addiction; understanding the role of buprenorphine in palliative care; and challenging stigma against patients who use drugs. She has been invited to teach with the Harvard Center for Palliative Care, the Harvard Inter-professional Palliative care fellowship, the UCSF Division of hospital medicine, the UCSF palliative care fellowship, and has presented at several national conferences. She is a co-leader of the national buprenorphine peer mentorship support group for palliative and hospice providers and has contributed to several book chapters and manuscripts on addiction and serious illness.

AMERSA People & Passion, Episode 6: Leveraging Media and Medicine to Reduce Stigma and Improve Access to Addiction Treatment

The COVID-19 pandemic is distinct from other catastrophic events because of massive population exposure to ongoing trauma. Illness, death, loss, grief, job- and food-insecurity have led to increased substance use, return to use/relapse, overdose and death. In the face of widespread misinformation, accurate and engaging health messaging matters NOW more than ever. Health messaging should target stigma of SUD, myths about MAT/MOUD and stress reduction (without using alcohol/drugs) and other pandemic-related health issues. We also know that physician and other healthcare professionals' voices matter: amid the coronavirus pandemic, Americans have a high level of trust in their doctors. Media - traditional and social - are effective ways to educate and empower the public about key issues about SUD/addiction.

 

Dr Stefan G. Kertesz
is a physician in internal medicine and addiction medicine with a long-term commitment to fostering better care for populations whose clinical care is affected by social challenges such as homelessness, and clinical concerns like chronic pain. He is currently a researcher and clinician at the Birmingham Veterans Affairs Medical Center and Professor at the University of Alabama at Birmingham. He has engaged in national advocacy on how changes in national policies on opioid prescribing affected the care of patients with long-term pain, recently winning the David Calkins award in Health Policy Advocacy from the Society of General Internal Medicine. He also is cohost of the podcast "On Becoming a Healer" with Dr. Saul Weiner.


Dr. Lipi Roy is an internal medicine and addiction medicine physician, keynote speaker and sought-after media medical commentator who has appeared on MSNBC, NBC News and CNN. A Forbes Contributor, she has been featured in The New York Times, Wall Street Journal and Boston Globe, and her articles have been published in STAT, Psychology Today and The Huffington Post. Dr. Roy currently serves as the Medical Director of COVID Isolation and Quarantine Sites at Housing Works in New York City. She also serves as clinical assistant professor at NYU Langone Health. Dr. Roy’s work spans academia, clinical medicine, media, homeless health, social and criminal justice and public speaking. As the former Chief of Addiction Medicine at Rikers Island, Dr. Roy oversaw substance use treatment and recovery services at the nation’s 2nd-largest jail complex. Dr. Roy completed her medical and master’s in public health degrees at Tulane University, followed by residency training in internal medicine at Duke University Medical Center. Follow Dr. Roy on Twitter, Instagram and YouTube.

AMERSA People & Passion, Episode 5: Are Peer Counselors the Missing Link in Addiction Care?

This episode of the AMERSA People & Passion podcast highlights peers in an acute care setting engaging with vulnerable patients suffering from active substance use disorder, with a focus on the intersection of lived experience, evidence-based treatment, and harm reduction strategies. Discussion centers around the safe space a peer creates in an environment that is traditionally unwelcoming toward populations encountering substance use disorders. Peers are the conduit to potentially change the trajectory of engagement during an emergency room visit.




Paul Bowman
is an At Large member of the NIDA MA-HEALing Communities CAB. He serves as the HCS-MA national Steering Committee CAB representative. Paul has 30 years of experience working for the Commonwealth; he has lived experience, and he has been an advocate for people with substance use disorder (SUD) and stigma reduction. Paul has been the regional supervisor at the MA Department of Housing, served as the Chapter Director of MA National Alliance for Medication Assisted (NAMA) Recovery and NAMA Board of Directors member. Paul was Vice Chair of MA Department of Public Health’s Bureau of Substance Abuse Services (BSAS) Consumer Advisory Board. He is a Certified Methadone Advocate.


Colleen LaBelle, MSN, RN-BC, CARN is the Director of the OBAT TTA program and the founder and director of Boston Medical Center's OBAT Clinic. She also serves as the Program Director of many related projects, including two Opioid Addiction Treatment Extension for Community Healthcare Outcomes (ECHOs) at BMC. Ms. LaBelle has over 30 years of experience treating HIV and addiction and over a decade of experience advising health care organizations on incorporating addiction treatment into their programs. She is a member of the Massachusetts Board of Nursing and Governor Charlie Baker's Opioid Working Task Force. In recognition of her work to improve and expand treatments for patients with addiction, Colleen received the 2017 Betty Ford Award from the Association for Medical Education and Research in Substance Abuse (AMERSA) and the 2016 Lillian Carter Exemplary Acts in Nursing Award from Modern Healthcare and the Lillian Carter Center for Global Health & Social Responsibility at the Emory University School of Nursing, among many others. She also received an honorable mention for the Gage Award from America's Essential Hospitals in 2016. Ms. LaBelle is board certified in addiction nursing and pain management, and she earned both her BSN and MSN from Grand Canyon University, in addition to a Diploma in Nursing from St. Elizabeth's School of Nursing.



Nicole O’Donnell
is a Certified Recovery Specialist, recognized by the Philadelphia Inquirer for excellence in patient care for her work at Penn Medicine’s Center for Addiction Medicine and Policy, which includes expansion of opiate use disorder treatment and engagement initiatives at Penn Presbyterian, Pennsylvania Hospital, and the Hospital of the University of Penn.

AMERSA People & Passion, Episode 4: A Path for Substance Use Disorder Content in the Education Setting

Join AMERSA and ATTC in celebrating a journey through AMERSA time with Marianne Marcus, in conversation with Sid Schnoll.




This podcast summarizes Dr. Marianne Marcus’ career as a nurse educator and researcher, and the role AMERSA played in developing her understanding of substance use disorders. Her career included sequential faculty positions in Herman H. Lehman College and Columbia University in New York and the University of Texas Health Science Center in Houston, Texas. A serendipitous opportunity to open a primary care clinic in a residential substance use treatment facility led her to increase substance use content in nursing curricula and research. She sought out the support of like-minded health care faculty through her involvement with AMERSA.


AMERSA People & Passion, Episode 3: Barriers to treatment for opioid use disorder: Why aren’t pharmacists stocking buprenorphine?

Patients with opioid use disorder must be able to obtain prescribed buprenorphine from a pharmacy promptly to reduce risk for a recurrence of use and subsequent morbidity and mortality. However, phone-based secret shopper surveys indicate many pharmacies do not consistently maintain an adequate stock of buprenorphine and qualitative surveys show some pharmacists refuse to dispense it altogether. The underlying reasons for this problem are complex and will require innovative collaborations between pharmacists, buprenorphine prescribers, policymakers, and other healthcare team members.




Photo of Jeffrey Bratberg
Jeffrey P. Bratberg, PharmD, Clinical Professor at the University of Rhode Island, studies community pharmacists' roles play regarding opioid safety, opioid overdose, harm reduction and opioid use disorders. He is a consultant or co-investigator on two federal grants, a randomized controlled trial of pharmacists’ use of a CPA to manage medications for opioid use disorder and a multi-state, randomized control trial testing the effectiveness of a pharmacist and pharmacy focused intervention to improve naloxone provision, nonprescription syringe access and buprenorphine dispensing in community pharmacies.


Lucas G. Hill, PharmD, BCPS, BCACP
 serves as PhARM Director, The University of Texas at Austin. Dr. Hill graduated from the UMKC School of Pharmacy and completed a combined residency/fellowship in the UPMC Department of Family Medicine. He is now a clinical assistant professor at The University of Texas at Austin College of Pharmacy where he founded the PhARM Program and led implementation of Operation Naloxone. Dr. Hill is the principal investigator for a five-year, $25 million TTOR grant which seeks to address the opioid crisis in Texas by educating health professionals and the public while conducting pragmatic research.


Photo of Lindsey LoeraLindsey J. Loera, PharmD is a PhARM Fellow at The University of Texas at Austin. Dr. Loera graduated from The University of Texas at Austin College of Pharmacy and is currently completing a two-year fellowship with the PhARM Program. In this role, she will develop an innovative clinical pharmacy practice at an outpatient medical home for SUD and conducts statewide research exploring the pharmacist’s role in addiction treatment. She previously served as President of the Student Pharmacist Recovery Network and co-founded the Addiction Medicine Advanced Pharmacy Practice Experience.


Change Project 911: Help! How do we deal with change project interruptions?



Mat Roosa, LCSW-R
NIATx Coach

Maintaining forward momentum on top priorities

Once your team has developed a change project and you have strong executive support, it might seem like things should be smooth sailing. But there are a number of ways that a strong project can be blown off course.

Competing priorities

Before the 1900s, the word “priority” was only used in the singular. The logic seems clear: there can only be one most important element. During the last 100 years, we have grown to accept the notion of multiple priorities and have then focused on strategies to juggle them. Most of us keep adding new elements until we experience failure. We keep adding balls to our juggling effort until we start dropping them. 

You’ve probably heard the adage, “If everything is a priority, then nothing is a priority.” It speaks to one of the most important roles of  executive sponsors, as they help the team to maintain a focus on the critical priority activity(ies). With leadership help, your change team can work proactively to limit elements that are not true priorities and to focus the team energy where it counts: on mission-critical work.  

Maintaining momentum

Even with effective prioritization, new challenges can emerge that threaten the team’s focus. COVID 19, and all of the related stressors that systems have experienced because of it, are powerful examples of challenges to even the best priority planning. 

So how can a team maintain forward momentum when new priorities or crises emerge that challenge the change effort? When we coach teams that encounter these challenges, we sometimes think about the simple act of riding a bicycle. Strong forward motion creates a high level of stability to the change project. While slowing the project down reduces some project stability, maintaining some motion will ensure project health. The change project, like a bike, falls over when it stops moving forward.

Coaches, executive sponsors, and change leaders can work to ensure that, regardless of emerging priorities and challenges to momentum, the change project continues to move forward. Circumstances may require that the project slow down to accommodate challenges, but steady motion will maintain change project stability and progress.  

Staying Focused

Try these four practical strategies to help a team stay focused on top priorities and maintain forward motion:

  1. Provide regular “focusing” messages from leadership. Executive sponsors can set the tone by regularly reminding staff about the critical functions and goals. Accountability to leadership regarding progress on these priorities will also ensure proper priority focus and forward momentum. 

  2. Meet regularly. This is a simple and often-neglected fix. One of the ways that teams can maintain focus and momentum is to maintain a disciplined meeting schedule to address next steps and sustain a change project. 

  3. Use a checklist and check in. Using a checklist can add structure to ensure that the team addresses the key priorities when they meet. A short list and a timed agenda will aid the team in moving each priority forward in each meeting and will avoid the stalling of momentum that occurs when items are neglected.

  4. Create a data dashboard. Each priority project should be managed with a simple graph or table that reflects the project’s key measures. Gathering these graphs together in a central and accessible location provides a highly useful dashboard for monitoring activities —and a motivating visual display of change team progress.  

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

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. 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 (Change Project SOS) at matroosa@gmail.com.

AMERSA People & Passion, Episode 2: Stigma – The Not So Silent Killer

The use of alcohol and other drugs is rising in the United States in the setting of Covid-19. In the 12-month period ending in May 2020, more than 80,000 people in the U.S. lost their lives to a drug overdose, the highest number ever recorded in a single year. Substance use and addiction affect millions of people across the nation as healthcare systems work to create innovative solutions related to prevention, early identification, treatment and recovery. One major barrier to accomplishing this monumental goal is the stigma experienced by people with substance use disorders. Stigma creates feelings of shame, limits access to care, and ultimately contributes to challenging and life-threatening cycles of addiction. While we know how to define stigma and how it impacts individuals and families, how we eliminate stigma specifically in healthcare settings to improve care and outcomes is poorly understood. In this podcast, we will describe the many barriers stigma forces on people with substance use disorders and how healthcare can support people with substance use disorders.


Cheyenne Johnson
is Saulteaux (Ojibwe) and of mixed Settler ancestry and is a member of the Tootinaowaziibeeng Treaty 4 Reserve (Valley River) in western Manitoba. She is a Registered Nurse who works in addiction and substance use care in Vancouver. She is currently a member at large with AMERSA and the Co-Interim Executive Director at British Columbia Centre on Substance Use and an Adjunct Professor at the School of Nursing at University of British Columbia and actively collaborates with interdisciplinary clinicians, educators and researchers across Canada.



Dr. Deborah S. Finnell is a doctorally-prepared registered nurse, certified in addictions nursing and a Fellow in the American Academy of Nursing. She is currently AMERSA’s President Elect, an Associate Editor for AMERSA’s journal Substance Abuse, and led the publication of AMERSA’s substance use competencies for nursing.

Dr. Finnell has been a staunch advocate for vulnerable populations, seeking to address the bias, prejudice and discrimination that leads to stigma. She is a coauthor of the seminal publication , “Confronting inadvertent stigma and pejorative language in addiction scholarship,” has published her plenary address at the 2018 AMERSA conference on the neural basis of stigma, and has evaluated the impact of a substance use-related curriculum on students’ attitudes and perceptions.

Richard Bottner, DHA, PA-C is an Assistant Professor in the Department of Internal Medicine at Dell Medical School at The University of Texas at Austin and a physician assistant in the Division of Hospital medicine at Dell Seton Medical Center.

Bottner is also the Director of Support Hospital Opioid Use Treatment (SHOUT) Texas, a program seeking to increase access to opioid use disorder treatment in hospitals across the state and is the Co-PI on a grant from the Association of American Medical Colleges to develop and disseminate the Reducing Stigma Education Tools (ReSET) modules.

Introducing the "AMERSA People & Passion" Podcast, Sponsored by the ATTC Network

AMERSA is proud to announce a new podcast exploring the world of substance use education, research, care and policy! AMERSA People & Passion is a 10-episode series sponsored by the ATTC Network and hosted by executive director Doreen Baeder, featuring subject matter experts across a variety of topics, as well as special guests detailing their experiences as AMERSA members.

You can listen to new episodes of the podcast every week, beginning with today's episode, "Screening and Brief Intervention, AMERSA, and What You Should Do." Rich Saitz, former AMERSA president, is interviewed by his colleague, friend, and former mentee Nic Bertholet. We find out about whether screening and brief intervention are effective, and what the controversy is. We also learn about the evidence, what research should still be done, what we should teach, what we should do in practice, and how it has loomed large at AMERSA. Rich also shares how great it is to be very involved with AMERSA based on his experience with the organization, the value of colleagues met and friends made there, and by thinking about what other areas of research, education and care AMERSA plays big roles in.


Photo of Richard Saitz


Richard Saitz, MD, MPH
is professor and chair, Department of Community Health Sciences at Boston University School of Public Health, professor of medicine in the section of general internal medicine at Boston University School of Medicine, and a primary care physician and addiction medicine specialist at Boston Medical Center and the Grayken Center for Addiction. He is editor in chief of the journal of Addiction Medicine, associate editor of JAMA, and a past president of AMERSA.



Photo of Nicolas Bertholet



Nicolas Bertholet, MD, MSc
is an addiction psychiatry and prevention and public health specialist, he is senior lecturer at the University of Lausanne, Switzerland.

Change Project 911: When Your Rapid-cycle PDSA is not Working

Change Project 911 logo

Mat Roosa, LCSW-R
NIATx Coach

Rapid-Cycle Plan-Do-Study-ACT (PDSA) is a powerful tool for improvement that can enable a team or organization to achieve its short-term goals and move toward long-term success. But sometimes, PDSA change cycles do not yield the desired results.



Here are a few questions to consider when your change project does not achieve the goal.


What are the lessons learned from “failure”?

Rapid-Cycle PDSA has been called a “no-fail” method. The lessons learned from change that does not achieve the desired result can yield as much information as a highly successful change project. Finding out what does not work enables a team to avoid future investments in ineffective strategies and focus on efforts with a high return on investment.


Was the goal realistic?

We often recommend a “stretch goal” for a project that pushes the team toward a result that might seem unattainable. Stretch goals can energize a team toward greater achievement. However, sometimes a lack of information or an overabundance of enthusiasm can result in an unattainable goal. Recalibrating the goal toward a more realistic expectation can clarify the level of success the change achieved. 


What does the early data tell us?

Some change teams make the mistake of waiting until the “Study” phase of PDSA to look at the data collected. However, an initial review of the data during the “Do” phase may uncover the need to restructure the change or reconsider the data plan. These adjustments can rescue some change projects from heading too far in the wrong direction.


Are we experiencing unexpected variables?

Confounding variables can have a big impact on change project results. Teams should conduct some form of environmental scan to consider factors such as seasonal events, economic trends, political or social events, changes in staffing, or other variables affecting the people being served or the people providing the service.


Was our aim statement hypothesis correct?

Increase A from B to C by date D through strategy E.

Teams can consider a number of assumptions related to this equation when a change project is not yielding the desired results:

  • Is E actually a primary driver of A? Perhaps other strategies will have a better impact on the thing that we are trying to change.
  • Is C too high? See our discussion of realistic goals above.
  • Do we need more time? An adjustment to D may allow the change to unfold in a manner that creates better understanding of the impact of the change, or achieves greater results.
  • Is A the key indicator of success? Are we measuring the right thing? Maybe there are better ways to understand the impact of strategy E. Maybe we are having an effect on a different goal.
  • Is our data source valid and reliable? Is our chosen measure giving us accurate information about the thing that we are seeking to change? Are all participants following the measuring and reporting process consistently? Sometimes participants in the data collection process have a different interpretation of the data collection rules. (Oh, I thought we were only counting attendance for people who showed up on time…etc.)   

Rapid-cycle change projects should always yield valuable results, even when they do not achieve the desired goal. Taking some time to consider the questions above will result in more reliable results that can serve as a compass to guide your ongoing change project journey.  

 

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

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. 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 (Change Project SOS) at matroosa@gmail.com.

Change Project 911: Counting what Counts: Addressing the challenge of incomplete data collection


Mat Roosa, LCSW-R
NIATx Coach

“Help! We don’t know if our change is an improvement!”

 

At the foundation of all quality improvement work lies data.

 

Imagine driving down a twisty road at night and having your headlights turned off for a portion of the journey. That’s what happens when we try to manage a change project without consistent data access.

 

It can be helpful to think about the data needed to steer a change in three stages:

 

Data at the beginning of the change journey: Baseline

The only way that we know if a change is an improvement is by measuring before the change, and comparing that measure to ongoing data collection during and after the change. We all know this. And yet, too often teams rush to implement changes and fail to collect baseline data. They are then left confused about the impact of the change and may be at risk of sustaining new activities that soon demonstrate little or no benefit.

 

Data during the change journey: Data-driven change management

As we drive along, we keep gathering data by looking down the road as far as we can see. Each turn in the road reveals new data to interpret and incorporate into our effort to steer safely. A failure to regularly collect data blinds a change team’s effort to interpret the change as it evolves.  

 

Data toward the end of the journey: Sustainment

At the conclusion of the change project, the team must ask whether they want to abandon, adopt, or adapt the change project based upon the data collected. The best way to sustain a successful change is through regular data checks that ensure that the new practice is firmly established and continues to have the desired effect.

 

This focus on data can all seem like a lot of work. However, focusing on a few key factors can help ensure that data collection continues for the duration of the project and beyond. The following tips can help you make sure that you count what counts:



Keep the data simple
: If you have the choice between a perfect measure that is complex and a “good enough” measure that is simple, pick the good enough measure. To keep the entire team engaged in the project, keep the data clear and understandable to all team members. A simple line graph helps the team to track the trend.


Use existing data sources: Most teams have access to a range of existing data sources that they can use to steer the project without adding any additional burdens to the system. 




Assign a data coordinator.
Placing one team member in charge of managing the data can ensure accountability. Each time the team meets, the data coordinator can make sure that the data is available and current. It can also help to have a second party assigned to the data coordination task, so that the data production process does not stop if the coordinator is not available.


Frontload the data effort
. Too often, the data measurement components of a change project are developed and implemented in a mad scramble as a change project commences. Careful consideration of data well before the project begins will ensure consistent data.



Train people in data collection. There’s often an assumption that all participants in the change project have a clear understanding of data collection definitions and procedures. “Oh, I thought we were counting it this way!” is a frequent comment as teams realize that they failed to train the team on the specific data collection details. This confusion can result in a need to restart the change or throw away a portion of the data collected.



There are many different ways to count things
. Engage the team in generating ideas about what data metrics to use and how to collect them. Even simple measures can be collected in different ways and require team dialogue. The team can help to consider how best to measure your change to make sure that you count what counts.






Make data collection an essential part of your change project from the beginning, and you and your team will have a built-in tool for seeing if your change is an improvement!  

 

About Change Project 911

Change Project 911 is a monthly blog post series covering common change project barriers and how to address them. Has your change project hit a snag that you’re not sure to tackle? Share your issue in the comments section below, or email Change Project 911 at matroosa@gmail.comWe’ll offer solutions from our team of change project experts!

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. 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 (Change Project SOS) at matroosa@gmail.com.

The Treatment Challenge in Jail Settings: Detox and Withdrawal or Continuing Medication?

Jessica Vechinski, MSW
Project Manager, Justice Community Opioid Innovation Network (JCOIN)
Center for Health Enhancement Systems Studies, UW-Madison

Opioid use disorder (OUD) is prevalent among people in the criminal justice system—estimates show that as many as 50–65 percent of people entering the system have an OUD or other substance use disorder (SUD). Yet, access to high-quality treatment that includes medications for opioid use disorder (MOUD) is limited, with fewer than one percent of jails and prisons providing access to medications. This lack of access leads to high recidivism rates and preventable overdose deaths. The risk of death within the first two weeks after release is 12 times higher for individuals with OUD due to fatal overdose, often related to loss of tolerance during incarceration.

A new National Institutes of Health and National Institute on Drug Abuse study conducted by the University of Wisconsin’s Center for Health Enhancement and Systems Studies (CHESS) and George Mason University’s Center for Advancing Correctional Excellence! are testing ways to expand use of medications such as buprenorphine, naltrexone, and methadone for OUD in criminal justice settings. The study, titled Justice Community Opioid Innovation Network (JCOIN), is exploring two evidence-based coaching interventions for disseminating MOUD in justice-involved populations: the NIATx model for process improvement and Extension for Community Healthcare Outcomes (ECHO).

As part of the NIATx intervention, sites are asked to identify a project “aim.” A recurring primary aim that jails have identified is establishing policies and procedures for continuing a prescribed buprenorphine regimen when a person enters the jail setting. Jails and prisons around the country face multiple barriers to use of MOUD for persons with SUD, forcing those individuals into detox rather than continuing care.

This is a topic of considerable debate within jails, justice systems, and state governments. Our study team feels that providing justice-involved individuals with continuing MOUD care is ethical medical practice. Like diabetes, heart disease, or cancer, SUD is a chronic condition caused by behavioral, psychological, biological, and environmental factors. When a person with diabetes enters jail, they receive insulin and continuity of care. But a person on a prescribed buprenorphine regime for their SUD often has no choice upon entering jail other than to suffer through detox and withdrawal.  

Two chronic conditions. One receives continuity of care, but the other does not. Why is that?

Barriers to MOUD in jail settings

Stigma

The view that addiction is a moral failing and not a medical condition is a top reason, combined with the view that public resources should not go to treating a moral failing. A second factor is the pervasive misconception of MOUD as “just replacing one drug with another.” A third significant barrier that keeps jails from providing buprenorphine is the risk of diversion: the person receiving buprenorphine will sell or give the medication to other incarcerated individuals. Yet jails that have administered buprenorphine either by strips or crushed pills have found ways to decrease diversion. Strategies include having the individual eat crackers and drink water or conduct post-dose “mouth checks.”

Lawsuits against jails: Addiction is a disability

The evidence for continuing buprenorphine in jail settings far outweighs the reasons for discontinuing care. The most substantial support comes from cases of justice-involved individuals suing jails on the grounds that addiction is a disability, and that being denied treatment is a violation of the Americans with Disabilities Act. The Act requires that public places or services be accessible to all, including those recovering from alcoholism and drug addiction. Justice-involved individuals have claimed that denying medication while incarcerated is discrimination based on their disability. Even though justice-involved individuals are winning their cases and states are starting to take note, many jails disagree with this position.

One last point to consider

Isn’t rehabilitation one of the main reasons for incarceration? By not allowing an individual who has taken the responsible steps to be on a prescribed buprenorphine regimen to continue care, the jail is not providing adequate healthcare or an environment conducive to rehabilitation.

What do you think?

Should jails be required to continue providing medication to those already on a prescribed buprenorphine regimen when entering the jail?



About our Guest Blogger

Jessica Vechinski is a member of Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin. She serves as the Project Coordinator for a five-year study with the Justice Community Opioid Innovation Network (JCOIN), an initiative funded by NIDA/NIH. The study is testing the combination and dosages of two evidence-based strategies to implement or improve Medications for Opioid Use Disorder (MOUD) programming within justice settings around the country. You can reach Jessica at jvechinski@wisc.edu.