MINUTES – NFATTC CAAP (Coalition for the Advancement of Addictions Professionals)
Advisory Board Meeting: October 15-16, 2009: Portland, OR
Participants: Chris Brown (HI), Shawn Clark (OR), Darcy Edwards (OR), Fred Garcia (WA), Donna Hirt (OR), Donnalyn Kalei (HI), Cheryl Mann (AK), Traci Riekman (OR), Tim Smith (WA), Mike Towey (WA), Karen Wheeler (OR), Theresa Willet (OR).
NFATTC Staff: Mary Anne Bryan, Lynn McIntosh, John Porter, Denna Vandersloot, Jennifer Verbeck.
Topic / Discussion/Analysis/Action / Group Discussion & Follow-upReview of Year 02 Activities / NIDA Blending Product Trainings: Reviewed state and national maps showing where specific NIDA events have been held. NFATTC completed about 24 NIDA events in Year 02 (not including pre-events delivered in preparation for NIDA events, e.g., offering MI training to prepare providers for MIA:STEP). A new training is being developed about using buprenorphine with adolescents.
Clinical Supervision Service Improvement Project (extends to Year 03). NFATTC is offering CS-I and CS-II in both OR and WA as part of a national ATTC evaluation; the added evaluation component is examining what people are learning and implementing as a result of the four days of CS-I and CS-II training.
NIATx DDCAT Project: NFATTC collaborated with WA agencies, using the DDCAT to evaluate agencies’ capability across several domains to deliver effective co-occurring services, then using NIATx process improvement to target improvements in specific domains.
Regional Educator’sConference: held in OR last fall.
Training Point: A seven week TOT for the development of participant adult-education training skills. A Training Point was held last year for participants from AK, OR, and WA; while it’s time-intensive for trainers, it’s a worthwhile curriculum, including on-line and intensive face-to-face components. / Suggestion on maps of events – show what regions in states that the trainings occurred, so states can see where NFATTC efforts are focusing and avoid duplication of efforts.
Buprenorphine: Suggestion to do something to lay groundwork prior to buprenorphine trainings; also, consider using real-world stories and examples to help break through resistance at abstinence-based agencies. Medicaid is key.
Year 03 Workplan
And Spotlight on NFATTC Activities / NFATTC Events: NFATTC has committed to 24 NIDA events plus 48 non-NIDA events for Oct. 2009 to Sept. 2010; about 30 events are already planned.
Addiction Messenger: Is now being distributed to about 34 countries (though some have only a few subscribers). Distribution will soon include national dissemination within the ATTC network. The AM is only being distributed via email now; also, subscribers get a list of scheduled NFATTC events with their AM issue.
ChangeLeaderAcademy: Scheduled for January 28, 2009, in Olympia, WA; will use NIATx Process Improvement.
Clinical Supervision: Continues as huge NFATTC Initiative. John Porter was heavily involved in drafting the new SAMHSA TIP 52 – now available!
FTCC: The Federal Training Center Collaborative is an ongoing national initiative whereby federal training centers meet locally and regionally to plan collaborations that will share resources and avoid duplication of efforts. There are 8 regional FTCC groups; our region has a Pacific Northwest regional FTCC, and also a Seattle group. Each regional group was recently funded (at about $100K each) through the Office of Population Affairs to conduct specific collaborations. PN FTCC will plan and stage two rural conferences, one each in WA and CA, to focus on prevention and care of HIV/AIDS, STDs, TB, and substance abuse. Other topics will include issues for pregnant and parenting women and challenges in serving rural communities. Also, focus groups of pre-identified participants will discuss ideas for, and barriers to, integrating prevention services into healthcare systems, with an overall goal to identify cross-training needs and next steps for the regional PNW FTTC group. A report will also be drafted and disseminated, documenting content, process, and outcomes of the two rural conferences; potential for replication; focus group results; plans for future collaborative efforts; and lessons learned.
Latino Institute: NFATTC is co-sponsoring this again; Fred noted the importance of this conference, particularly in that it offers a forum for providers who work with “shadow people”, for example clients who may speak only Spanish and/or may not be U.S. citizens.
Leadership Institute: NFATTC is considering how to provide more ongoing support of previous participants, e.g., by offering more booster sessions. This year’s LI is for Native American addiction professionals in OR. Mary Anne has been attending tribal meetings for several months, which has strengthened interest and buy-for the LI. Changes for this year include participants choosing their own mentors, and mentors attending the entire intensive training.
Learning Collaboratives: NFATTC is using a Learning Collaborative model to bring individuals together for training and TA focused on a shared topic or topics. For example, agencies that have already been working on clinical supervision could combine continued development of that with MI. King County (WA) is participating in learning collaborative that will combine clinical supervision, MI, and ROSC.
A National Evaluation of the ATTC Network is being conducted by the following contractors: Manila, ABT, and RMC. Some of you may be contacted in the future to provide a telephone interview or fill-out a survey for this evaluation.
A ROSC conference will be planned for 2010, probably as an OR/WA collaboration; it’s tentatively scheduled for September 2010.
The Rubrics are being revised and will hopefully be out by the end of this year, following a review process. The competencies and the rubrics will be combined in the new version.
Karen Wheeler reports AMH is working on developing a set of competencies for working with individuals with
co-occurring disorders.
SBIRT: NFATTC has developed a curriculum for medical residents at OHSU aimed at developing skills in pre-screening and screening (using AUDIT and DAST) to identify people using substances at risky levels. The curriculum includes a handy physician “prompt” card; a sample of which was provided to CAAP attendees. SBIRT will also be available on-line shortly. / Events: Show on map the regions where trainings occur, and bring a list of scheduled events organized by state.
Training Costs: In collaborating with agencies and other organizations NFATTC charges $600 (1day) and $1100 (2 days) for training in Oregon and Washington, with fees negotiable depending on how organizations want to share costs.
Latino Institute: The conference needs more resources in Spanish (for WA and OR providers); those brought to past conferences were snapped up by attendees.
Caribbean Basin ATTC will be assisting with the editing of the addiction messenger to make it is culturally appropriate before it is sent to people and put on the website.
ROSC: Suggestion to create a short video (4-7 minutes) about what ROSC means.
Rubrics: Fred Garcia offered to help with a section on cultural competency.
State Reports / Alaska
Three top priorities in state:
- A tri-lateral collaborative (state, university, Mental Health Trust) continues to focus on workforce development; areas include: 1) developing direct service workers (e.g., assisted living, DD); 2) Bring the Kids Home Initiative (about 800 children with MH issues are hospitalized outside of AK); and, 3) developing behavioral health workers (e.g., cross-training SA and MH). Note: The MH Trust funds only pilot and temporary projects.
- A new mayor is making it a high priority to help homeless people with SA issues; this year 13 SA-related deaths of homeless people occurred in Anchorage (most in the summer months). The city may establish something similar to Seattle’s model for “wet housing”, and is focusing on strengthened partnerships along the continuum of care.
- Alaska desperately lacks detox services.
- Medicaid changes include enabling providers to bill for SA services.
- A resurgence of heroin abuse is related to decreased methadone services; even pregnant women are wait-listed.
How budget issues may impact training/workforce efforts:
- State budget cuts continue with ensuing adverse impacts; however, funding for next year is in place.
Three top priorities in state:
- Workforce – adequate clinical supervision for those both in and entering the field.
- Efforts to get more EBPs implemented.
- COD integration is ongoing, though momentarily off the table; providers still need increased awareness and skills in the area of cross-disciplinary collaboration (i.e., how to consult and refer).
- ROSC – ATR continues to be most visible focus of this; it’s going well.
- The 70K/year training budget is gone; HI somehow needs to maintain its quality and quantity of training without it.
- Budget cuts continue and include furloughs being raised to two days per month.
Three top priorities in state:
- Shifting workforce – need for recruitment due to the “graying issue” of workers retiring, need for people that reflect the populations they serve, for more bi-lingual providers, peer mentors, and people that can navigate other systems and have new skills (e.g. the ability to conduct brief interventions in non-treatment settings such as ERs).
- OR – 75% of people who need services currently aren’t getting them. If healthcare reform ensures everyone has insurance even more will request SA services – how will that capacity be met? Addictions professionals need to learn to talk with doctors (e.g., be able to facilely communicate statistics on addictions).
- Scaled back services make it important to increase collaboration and collaborate more creatively (e.g., healthcare sectors have behavioral health funding, too).
Three top priorities in state:
1. Integrating behavioral health with primary health (managed care to Medicaid).
2. Surviving/managing change.
3. Shift from recruitment of AOD counselors to training and retention of those in the workforce.
- Treatment of veterans; especially in helping them navigate systems of care in ways that optimize their use of available benefits.
- The impact of rule changes within the regulatory system coupled with severe budget cuts has slowed down the processing of credentials.
- ROSC.
- Need specialty training for addictions professionals in providing effective SA treatment to individuals with developmental disabilities.
- Need for more individualized (less cookie cutter) patient care; shifting focus to brief treatment; need to make better use of counselors, agencies, and distance education technology (e.g., videos, webinars, teleconferences).
Potential collaborations to strengthen NFATTC work:
- NativeAmericanCenter for Excellence (SA prevention); Gary Newmann ().
- MH Trust Authority has established a training collaborative in AK with a broad focus of workforce development; perhaps NFATTC could have a regional training collaborative. MH Trust Authority – Bill Herman (907) 279-7966.
- Consider videotaping trainings and making them available at low cost to rural areas.
- In some cases AK is using WICHE training.
- Partnering with peers: A brand new distance education curriculum (two semesters long) is training people in recovery to be peer specialists; of 24 attending orientation,18 registered. It’s designed for those recovering from MH issues but about 70% of enrollees have COD.
Potential collaborations to strengthen NFATTC work:
- Request for increased electronic marketing of ATTC resources.
Potential collaborations to strengthen NFATTC work:
- Maybe NFATTC could take lead on buprenorphine awareness (with state support); and OR could take the lead on healthcare reform, meaning shifting needs, e.g. a need to partner with Medicaid (public) and insurance companies (private). It’s important for NFATTC to partner around these issues on state and national levels.
Potential collaborations to strengthen NFATTC work:
- Collaborate on surviving during severe budget cuts as costs go up and revenue goes down – i.e., how to do treatment better, faster, and cheaper.
Discussion:
NFATTC Shift to Tech Transfer / How might NFATTC shift to more tech transfer intensive activities; for example, by using learning collaboratives and/or coaching and mentoring?
- Look at organizations as clients, e.g., measure readiness.
- Consider using incentives.
- Emphasize data collection as key to adoption.
- Make strong business cases, e.g., for using new interventions; for supervision increasing satisfaction and staff retention; for workforce development (including of executive directors/administrators); for better workflow, including caseloads, logistics, and daily workflow.
- Shift the view from developing the “craft” of individuals to a systems-wide focus.
ATTC Role:
- Bring executive directors/administrators together, for example to discuss what is and isn’t working.
- Use of chatroom/internet, etc.
- Link with professional organizations.
Discussion:
Distance Education / Ideas to greater utilize distance learning technologies to disseminate training and facilitate meetings.
- NFATTC being a clearinghouse, e.g., being the distance education link and offering the stamp of approval for course offerings.
- Learn more about how to provide distance education.
- Collect resources on distance education mechanics, e.g., state video-conferencing resources (Greta has info for OR; also, WA has K-20 videoconferencing resources – e.g., how does this work in WA?).
- Evaluate effectiveness of distance education.
- Ideas of courses to put on-line: CBT (maybe); business practices (via web conference?); videotapes of short trainings; maybe use videoconferencing for CAAP (perhaps one of the two yearly meetings).
- Those focused on workforce development.
- Having on-site techs would be helpful.
- Partner with universities to evaluate distance education offerings (e.g. the University of the Pacific CAPP (Curriculum, Advising, and Program Planning) Degree Evaluation).
Discussion:
ROSC Conference / Key take-home points people would want to get from attending a ROSC conference:
- Shift in thinking from "this is what we already do” to "OMG we have to change everything” – empowerment.
- How is this applicable to behavioral health/COD.
- Practical application – How to do it? Where is it working?
- Lessons learned.
- Targeted information and strategies for each person and their role in the system.
- How to make the change; how is it done.
- How are providers thinking about this?
- Panel from communities where it has been done.
- Clear blueprint of how it's done and what it looks like.
- Participants identify what they can do realistically at the conference, then conduct a six-month follow up.
- What is the practice of holistic recovery? Definition and clarification of the wellness paradigm.
- Understanding of Maslow's hierarchy and how to incorporate these ideas.
- What does it mean for youth?
September 2010
Discussion:
NIATx Dissemination and Implementation / What role should ATTC play? How might we help agencies sustain improved practice? What type of training/TA is needed?
- Be more strategic by targeting efforts to helping agencies who are not meeting state-contract targets; NFATTC could include these agencies in learning collaboratives.
- Offer workshops on NIATx at the onset of performance-based contracting.
- Educate CountyCoordinators.
- Work closely with SSA’s on this topic area (e.g., CountyCoordinators).
- Suggestion for Dennis McCarty and Traci Riekman to present NIATx results and provide data assistance.
- Have agency peer groups.
Discussion:
Veterans Issues,
Treatment / What do behavioral/SA health providers need to best serve military personnel? Have you and/or your agency been impacted? Any other issues (e.g., cultural, benefits)?
- WA passed a law that requires colleges to be more military friendly.
- PacificIslands have increasing numbers of returning vets.
- Need for PTSD and TBI training.
- Collaborate with Veterans Administration.
- Providers need to know what services are available and the eligibility requirements; information on military “culture”; resources/fact sheets.
- Suggestion to pick one state to focus on and have a group work on this (e.g., creating a fact sheet of available resources?).
- Another Addiction Messenger series.
- Information on navigating systems for providers and consumers.
- Convene people, e.g., spouses, VA, VA in prison, DVR.
- Coordinate with other groups around this issue.
- Link up with military prevention/resiliency training.
- Note: Dr. Jim Sardo (active military and a substance abuse treatment provider at the PortlandVA) would be a great resource; Traci Rieckman has other names for reference ().
NFATTC/NIATx/AMH Pilot Project / Conducted January – September 2009 with OR agencies not participating in the NIATx 200 Project. / A PowerPoint presentation of results was reviewed at CAAP and distributed to the group.
NIATx/DDCAT Project / See Year 02 Activities (above). / A PowerPoint presentation of results was reviewed at CAAP and distributed to the group.
Parking Lot / Medication-assisted treatment.
Next Meeting / April 15-16, 2010 (Thursday and Friday); Seattle, WA / Date is confirmed.
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