NIATx consultant Matt Russo recently sat down with Horizon Treatment Services to unpack how a relationship-first framework, rapid testing, and staff voice turned a chronic pain point into a durable win: medication errors in residential and withdrawal management dropped from 55 to just four in a month, with daily audits and a higher census.
Tune in to Horizon Treatment Services’ Podcast to learn about NIATx, celebrate the execution of its framework at Horizon, and discuss why the NIATx process is important.
Author: niatxfou
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Horizon Podcast: Building a Culture of Continuous Improvement with NIATx
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Increasing Access to Medication for Addiction Treatment (MAT)
Challenge
In 2022, the California Advancing and Innovating Medi-Cal (CalAIM) initiative was launched to improve the health and well-being of Medi-Cal enrollees with complex needs, including improving the quality of outcomes, advancing equity, and reducing health disparities related to mental health and Substance Use Disorder (SUD) treatment. Pharmacotherapy has become widely accepted over the past decade as a leading treatment for Opioid Use Disorder (OUD); unfortunately, access to Medication for Addiction Treatment (MAT) remains limited, and the need for MAT exceeds its availability.
As part of California’s broader initiative, the California Commission for Behavioral Health, California Institute for Behavioral Health Solutions (CIBHS), and the Los Angeles County Public Health Substance Abuse Prevention Control (SAPC) have entered into a multi-year partnership to design and facilitate training and assistance to increase prescriber capacity and increase access to MAT beyond OUD to include other SUDs (e.g., alcohol, nicotine).
Solution
The SAPC MAT Prescribing Clinician startup project addresses substance use in California by removing barriers and improving access to MAT through a financially sustainable model. The objectives of the pilot project are to:
- Increase the availability of MAT in the SUD Specialty System of Care by increasing the number of prescribers.
- Explore whether Medi-Cal reimbursement rates will support and sustain the salary and associated costs of prescribers in the county’s provider network.
- Identify best practices for integrating prescribers and medical services into traditionally non-medical programs in small, medium, and large counties.
- Identify any barriers to this process concerning Incidental Medical Services (IMS) certification, recruitment of prescribers, and billing for MAT and related medical services.
CIBHS has contracted with the NIATx Foundation to provide six of the twelve coaches, who support the project and apply their expertise in MAT and NIATx evidence-based practice implementation. These coaches are focused on advising addiction treatment providers on best management practices for implementing MAT treatment. This includes clinical skills (e.g., which medications to prescribe, how to use them); workflows to effectively provide MAT; billing mechanisms to accurately capture services (e.g., Medi-Cal); and leadership support.
Specifically, coaches provide the following training and technical assistance (TTA):
- Coaching calls: Schedule regular calls with assigned sites to assist providers in designing an integrated care model and navigating the implementation process.
- Monthly collaborative calls: Attend and facilitate training and small group discussions.
- Technical assistance and resource development: Collaborate with the CIBHS project team to develop training modules and resources.
- Quality improvement (QI) training: Provide consistent training on best practices, NIATx process improvement, and business models to support expansion.
Outcomes
This project is pushing forward the progressive trend to increase the use of This project is pushing forward the progressive trend to increase the use of pharmacotherapies and expand their use to other SUDs beyond OUD (e.g., alcohol and nicotine). With year one establishing the baseline, the project will measure outcomes in the following areas in the next fiscal year:
- Increased prescriber capacity.
- Increased access to MAT Education, within the provider agency, and broader care community.
- Broadened the uses of MAT to alcohol and nicotine use disorders.
- Increased the frequency of MAT use for all SUDs.
Offering MAT further offers a business opportunity and a competitive advantage in an increasingly competitive healthcare landscape, where providers and clinics seek to attract patients by offering valued services that improve patients’ continued recovery.
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Developing Change Leader Capacity
Challenge: Systems-level Adoption and Sustainment of New Practices
Implementation science has demonstrated over the past decade that training is necessary but not sufficient to successfully implement a new practice. This holds especially true for the NIATx model as an evidence-based practice. Technical assistance in the form of coaching, mentoring, and train-the-trainer models can help increase system-wide adoption and sustainment.
Services for the Underserved (S:US) has been working with the NIATx Foundation for several years to train Program Directors on how to use the NIATx model for continual improvement and the associated core NIATx tools (i.e., walkthrough, flow chart, nominal group technique, and plan-do-study-act (PDSA) rapid cycle testing) using Change Leader Academy (CLA) training. S:US’s vision is to develop and leverage the change management skills of the agency’s three Performance Improvement (PI) Managers to ensure sustainable NIATx implementation throughout the agency.
Solution
S:US’s vision is well aligned with NIATx Foundation’s prioritization on sustained change, and so NIATx Foundation and S:US worked together to develop a plan to incorporate a robust train-the-trainer component into the CLA to help ensure sustainable implementation.
Under the supervision of the Assistant Vice President of Practice Advancement, the PI Managers work closely with quality assurance staff and other administrative services departments across S:US to support practice improvements. The NIATx Foundation implemented a train-the-trainer model focused on developing the PI Managers through strong mentoring and regular individual and group coaching sessions. The objective was to equip them to then train, coach, and support Program Directors in their practice improvements efforts across the wide array of S:US’s programs.
At the beginning of the train-the-trainer process, the PI Managers had modest familiarity with NIATx or other Continuous Quality Improvement (CQI)/PDSA change models. As such, the NIATx coach implemented an intentional coaching model to develop the PI Managers’ skills, increase their independence over time, and ensure a strong and lasting skill set:
- Initially, the NIATx expert coach heavily supported much of the PI Managers’ early coaching work with the Program Directors to introduce the NIATx model. This approach provided the PI Managers with the opportunity to build their skills with real-time support and guidance from an expert.
- The plan evolved to gradually increase the PI Managers’ independence, as they moved from providing program support with the assistance of a NIATx expert to providing independent coaching to the programs, which were subsequently reviewed with the NIATx expert to identify opportunities for continual learning.
- Team meetings continued as the PI Managers coached more independently to encourage ongoing improvement. Concurrently, the Assistant Vice President of Practice Advancement met individually with the NIATx expert to ensure that the PI Managers continued receiving the individualized support needed to advance their NIATx coaching skills.
Outcomes
The PI Managers began their NIATx journey with motivation and enthusiasm but very limited understanding of the PDSA change model. As a result of three six-month rounds of project implementation over two years across a wide array of S:US programs and services, the PI Managers have emerged with strong skill and confidence levels. The PI Managers are now able to effectively coach Program Directors in the NIATx model to sustain continual improvement. Further, they have advanced the use of the NIATx model within S:US by implementing some creative applications of the NIATx tools, including an enhancement to the nominal group technique related to choosing strategies that are easy to do and have a high impact (i.e., Ease and Impact).
This approach to developing change leader capacity is a clear demonstration of the following training principles:
- It takes time. A train-the-trainer mentoring model requires an investment over time. In this case, S:US committed to multiple rounds with a NIATx expert coach who employed an intentional model of increased independence with the PI Managers to ensure a strong and lasting skill set.
- It requires a culture committed to learning. The S:US administration demonstrated a strong commitment to the NIATx improvement model, as well as a keen awareness of the importance of sustaining practice improvement to achieve the full return on investment. The S:US team did their initial homework by exploring several PDSA models and then committed to the NIATx model. Ongoing support from senior management enabled the project to achieve strong and lasting results.
The NIATx Foundation continues to evolve toward using more e-learning and implementation coaching as critical supplements to the traditional didactic training focus. These new approaches will enable other organizations to join S:US as they build NIATx into the foundation of their quality improvement journeys.
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Upcoming ASAM Criteria Trainings
Ready to enhance your clinical skills and stay ahead with the latest ASAM Criteria updates?
Join the NIATx Foundation and Train for Change Inc. this fall for virtual training sessions that empower you to deliver person-centered, evidence-based care. Whether you’re a clinician, facilitator, or program leader, these sessions offer practical tools you can apply immediately.
Register today for our upcoming sessions:
- 8/12-13: Virtual Two-day ASAM Criteria 4th Edition Skill Building Training
- 9/23-24: Virtual Two-day ASAM Criteria 4th Edition Skill Building Training
- 10/6-7: Virtual Two-day ASAM Criteria 3rd Edition Skill Building Training
- 10/30-31: Virtual Two-day ASAM Criteria 4th Edition Skill Building Training
- 12/2-3: Virtual Two-day ASAM Criteria 4th Edition Skill Building Training
- 12/16-17: Virtual Two-day ASAM Criteria 3rd Edition Skill Building Training
About the Events
Virtual Two-day ASAM Criteria 4th Edition Skill Building Training
This two-day, application focused training will provide participants with an in-depth look at some the significant changes and improvements in the ASAM Critieria Fourth Edition. Participants will have opportunities to apply and practice key components of the Criteria, including but not limited to, the following:
- Six dimensions
- Level of care assessment
- Application of risk ratings to each of the dimensions
- Dimensional admission criteria decision rules
- Shared decision making
- Overview of service characteristic standards, discharge, and transition criteria.
Virtual Two-day ASAM Criteria 3rd Edition Skill Building Training
This two-day, application-focused training provides participants with an in-depth look at the theoretical foundations of the Criteria, including clinically driven services, biopsychosocial assessment, the six dimensions, continued stay and transfer/discharge criteria. Incorporating the use of the 3rd Edition of the ASAM Criteria, participants have opportunities for skill practice at every stage of the treatment process: assessment, engagement, treatment planning, continuing care and transfer or discharge.
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Now Hiring: Customer Engagement and Operations Professional
Job Title: Vice President, Customer Engagement and Operations
Location: Remote
Job Type: Half- to Full-Time
Supervisor: Reports to the PresidentJob Summary
The NIATx (Network for the Improvement of Addiction Treatment) Foundation is seeking a dynamic and results-driven professional to lead new client engagement, nurture and expand existing client relationships, and oversee the implementation of NIATx tools into the operations of treatment/recovery programs, as well as health systems. This multifaceted position requires a strong focus on customer service, effective organizational skills, creative problem-solving, and the ability to handle multiple tasks simultaneously.
The ideal candidate will have a proven track record in developing growth opportunities; establishing and sustaining client relationships; managing projects; assessing new markets, partnerships, and grant funding; and working with health systems/services, health insurance plans, Federal, State, and Local Healthcare entities, health-related philanthropies, and Federal, State, and Local Healthcare authorities.
Key Responsibilities
The Vice President of Customer Engagement and Operations is responsible for:
- Developing and initiating relationships with new clients, stakeholders, and partners to increase the adoption of NIATx solutions and effectively address clients’ critical delivery system needs.
- Negotiating client engagement contracts on behalf of the President.
- Developing outcome and milestone measures to assess progress toward project deliverables.
- Setting up and monitoring a system for client onboarding by consultants.
- Frequently assessing client satisfaction with NIATx products.
- Obtaining referrals from existing, satisfied clients to expand the reach of NIATx to additional organizations (e.g., community-based providers, health systems, providers, city, county, and state government, etc.).
- Reporting to the President on progress being made relative to client engagement, execution of project strategies, and achievement of project deliverables.
- Serving as a single point of contact for clients to resolve interfaces between client and NIATx staff.
- Representing NIATx at networking events and conferences to increase awareness of NIATx.
Required Skills and Qualifications
- Bachelor’s degree; Master’s degree preferred.
- Proven experience in business development and a passion for helping client organizations to grow, succeed, and provide better services.
- Experience with nonprofit organizations, for-profit organizations, and the public sector.
- Engagement scoping and budgeting.
- Familiarity with behavioral health systems and services.
- Strong verbal and written communication skills.
- Excellent organizational and time management skills, with the ability to multi-task and prioritize work in a fast-paced environment.
- Ability to work independently and as part of a team
- Strong analytical and negotiation skills.
Why Join Us?
- Work in a supportive, collaborative environment where your ideas are valued.
- Develop meaningful projects that make a positive impact on organizations, patients, and communities.
- Work with a wide range of clients, including stand-alone community agencies, healthcare providers, networks of service providers, and State and Federal governmental agencies.
Benefits
- Flexible work environment, including remote work options.
- Opportunity to work with a spectrum of service providers working in diverse settings and across multiple areas of business.
- Competitive compensation package with performance-based bonuses..
Apply Now
Email your resume to niatxfoundation@gmail.com.
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Minimizing Regulatory Paperwork for Counselors and Improving SUD Systems
Challenge
Excessive paperwork burden is one of the leading causes of burnout among behavioral health providers, reducing the time they can spend on patient care and creating inefficiencies in the timely delivery of services. Nearly every step in the process of caring for an individual with substance use disorder (SUD) comes with multiple documentation requirements for counselors.
Solution
To address regulatory paperwork challenges, the team of NIATx and Advocates for Human Potential (AHP) has developed a process that evaluates the following types of paperwork-related issues: lengthy intake assessments, duplicate intake questions, duplicate assessments triggered by co-occurring conditions, group therapy requiring multiple entries in different places, and comprehensive assessments repeated upon readmission.
The AHP-NIATx team implemented the following steps to develop recommendations focused on helping the State of Minnesota minimize regulatory paperwork for counselors, while improving SUD systems:
- Assessed the current state of paperwork requirements.
- Conducted an environmental scan of alternative licensing approaches.
- Performed site visits and key informative interviews with stakeholders.
- Reviewed existing statutes and regulations.
- Assessed and mapped processes and requirements.
- Consulted with stakeholder groups.
Outcomes
Once recommendations from the process are implemented, counselors will be less burdened with inefficiencies related to regulatory paperwork, while consumers will have quicker access to treatment and receive more patient-centered treatment.
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Guidance for Implementing the ASAM Criteria
Virtual 2-Day Event | April 29-30, 2025 | 9:30 am – 4:30 pm ET
About the Event
Through partnership with the NIATx Foundation, Train for Change will provide an ASAM Implementation Guide training that helps organizations utilize NIATx’s evidence-based process improvement model to help treatment programs and systems improve care and find a balance between fidelity to standards and the flexibility to meet the needs of patients. This training is essential for leadership to implement the Criteria and make organizational changes that support its fidelity.
Focusing on the NIATx Five Principles, the training provides a science-based foundation for evolving a culture of continuous improvement within the organization, not only for The Criteria but for any improvement or implementation project, Trauma Informed Care, Motivational Interviewing, CBT, Decreasing “no shows,” EHR, Treatment Plan Quality, Documentation, etc.
Key Takeaways
Participants will:
- Learn a system of change through the NIATx methods
- Understand how to use the ASAM Criteria Guiding Principles to identify and initiate improvements
- Understand the role of a Change Leader in facilitating implementation and improvement
- Conceptualize how to support the “neutral zone” and how to rethink “resistance”
- Develop strategies for addressing staff needs during implementation and change
- Develop additional expertise and understanding of the ASAM Criteria so they can supervise, educate, and coach others.
This training includes:
- 1 copy of the ASAM Criteria Implementation Guide for each participant
- 1 hour of coaching post-training (must be completed within three months after training completion
Prerequisites
- Completion of a 2-day ASAM Criteria Skill Building Training (3rd or 4th Edition)
- Competency with ASAM Criteria
- Possession of the Third or Fourth Edition of the ASAM Criteria
About the Trainer
Scott Boyles is a licensed addiction counselor, MINT trainer and the Senior National Training Director for Train for Change Inc.® Mr. Boyles has spent more than three decades in the behavioral health field and has many years of experience working with the ASAM Criteria. Mr. Boyles is one of the original early adopters of the ASAM criteria, starting in 1991.Before becoming a full-time trainer, Mr. Boyles used the criteria professionally as a counselor and director. From 2007-2011, Mr. Boyles also served as a member of the ASAM Steering Committee for the ASAM Patient Placement Criteria. He also spent many years as a site reviewer, monitoring programs’ application of the criteria. Mr. Boyles’ experience at all levels of service and observation has enabled him to understand trainees’ needs in both education and application at different levels of the service system. Since 1993, he has trained more than 8,000 people in proper use of the criteria. Mr. Boyles has passion and expertise in system-change approaches to support effective implementation and use of the ASAM criteria. He is well-known for his information, engaging, and entertaining trainings, which include practical, real-world applications.
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Study on Expanding Pharmacy Roles in Treating OUD
Access to treatment for opioid use disorder (OUD) is a challenge in rural settings and communities of color due, in part, to the limited availability of healthcare providers equipped and willing to provide medications for opioid use disorder (MOUD). Recent discussion has explored the role of pharmacies in enhancing access to MOUD within underserved areas. However, pharmacies face multiple obstacles related to expanded responsibilities in dispensing MOUD, especially in rural and other communities.
To address this issue, the National Drug Abuse Treatment Clinical Trials Network (CTN) funded a study (CTN-0124) to examine the practicality of expanding pharmacy roles in treating OUD in underserved communities.
The NIATx Foundation helped to lead the nine-month engineering systems analysis, assessing the existing system, envisioning an ideal future state, identifying gaps, and highlighting improvement opportunities. The study, Delivering MOUD to the Underserved: How Can Pharmacies Really Helped?, was published in the October 15, 2024 edition of the Journal of Studies on Alcohol and Drugs.
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Using a Racial Equity Initative to Double Admissions
Challenge
Recent research indicates that in New Orleans, a predominantly African American city, approximately 15% of women receiving residential substance use disorder (SUD) treatment are Black/African American (B/AA). This disparity contributes to increased involvement in the child welfare and criminal justice systems and incurs costs for the African American community, the city of New Orleans, and associated parishes.
Solution
Volunteers of America Southeast Louisiana (VOASELA) is developing a Family-Focused Recovery (FFR) inpatient program to address this disparity by successfully recruiting, retaining, and helping to facilitate recovery for B/AA pregnant women and those with children.
Using the evidence-based NIATx Co-Production technique, NIATx consultants worked with VOASELA to co-create a culturally responsive program with the community to align with local culture and needs.
As a significant and important part of this effort, NIATx conducted 14 structured interviews with B/AA women in New Orleans with lived experience. Based on these interviews, NIATx identified the following recommendations for VOASELA to consider as it prepares to open its inpatient FFR program:
Before Residential Admission
- Continue outreach strategies to recruit B/AA women and children as clients to participate in the residential program.
- Continuously evaluate the recovery coach-recoveree ratio to identify the ideal number of recoverees that should be assigned to a coach to avoid burnout and compassion fatigue.
- Initiate the planning process to ensure the program creates comfort for all women in treatment, particularly concerning racial balance.
- Help increase recovery capital (i.e., internal and external resources) and hope for B/AA women seeking treatment by helping identify goals and purpose in recovery.
During Residential Treatment
- Foster treatment retention and help women complete the treatment to achieve better outcomes.
- Become a trauma-informed system of care and create safety for women and girls who have experienced abuse and/or may fear losing custody of children.
- Provide specialized services for children, including afterschool programming; homework help; sports, drama, and arts; medical, dental and eye exams; mentoring, and parenting classes.
- Help provide a seamless transition from residential treatment back into the community by creating a Recovery Plan and establishing connections with recovery communities.
After Discharge from Treatment
- Provide recovery coaching for at least 90 days post-discharge from residential treatment, integrating support in the client’s natural environment and monitoring the effectiveness of both the relapse prevention and recovery plans.
- Provide family recovery coaching to work with whole families in recovery.
- Provide continued support to mothers to increase occupational, education, and vocational recovery post-discharge.
- Continue to be a resources broker, connecting women with needed resources in the community to help support recovery.
NIATx then completed a mapping exercise to integrate these recommendations into clinical and administrative work processes and further help VOASELA address and reduce inequities faced by B/AA women.
Outcomes
During this period, admissions have nearly doubled in VOASELA’s outpatient and peer recovery support programming. In addition, 60% of the program’s admissions are now B/AA, representing a proportional representation within the community.
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Implementing Evidence-based Practices to Address SUD
Challenge
The opioid and other substance use crises remain one of the nation’s most pressing public health challenges. Despite the recognized efficacy of pharmacotherapy, the challenge of implementing evidence-based practice (EBP) persists, with several barriers hindering the successful implementation of medications for opioid use disorder (OUD) and alcohol use disorder (AUD). Combatting the substance use disorder (SUD) crisis requires effective approaches that employ a comprehensive strategy for implementing EBPs that work in conjunction with behavioral therapies.
Solution
States play a pivotal role as public policy champions in shaping and advancing transformative healthcare practices, such as the broad use of pharmacotherapies for SUDs. Hospital emergency departments (EDs) can further serve as a critical access point for individuals to start treatment for SUD.
The State of Vermont has become a trendsetter in treating OUDs by developing the Hub-and-Spoke (H&S) model of SUD treatment. Building on this foundation, Vermont introduced the Rapid Access to Medication (RAM) for OUD initiative and the subsequent Rapid Treatment Access (RTA) for AUD initiative to improve the responsiveness of the treatment system for individuals seeking SUD treatment.
Both initiatives leveraged team-based and individual learning collaborative sessions using change strategy tools, such as NIATx coaching, the walk-through, and the Plan-Do-Study-Act (PDSA) cycles. Vermont’s implementation approach’s core components involved selecting a relevant aim, assembling dedicated teams, pilot testing, providing individual and group coaching to practitioners, and emphasizing continuous improvement.
The Time-to-Treatment Tracking Tool (T5) and Incentive Payment Opportunity (IPO) provided financial incentives for providers who accomplished items on a checklist within three days of treatment initiation, ranging from conducting community provider sessions to providing rapid treatment access. The T5 helped identify both real and perceived barriers to treatment access and pinpoint gaps in service provision.
Outcomes
In the RAM project, 13 out of 14 Vermont-based hospital EDs established protocols for starting individuals with OUD on MOUD, along with a warm handoff to a designated outpatient treatment provider for continuation after discharge. These individuals are also offered support from a recovery coach in the ED. In the RTA program, 92% of respondents engaged in improving access to AUD treatment, and 100% of respondents supported using medication to manage alcohol withdrawal.
The innovative approach used to refine and improve Vermont’s substance use treatment landscape has brought about transformative change in addressing OUD and AUD. The RAM and RTA initiatives are creating a paradigm shift in the provision of treatment, with the State taking the lead in promoting a timeliness standard for MOUD and AUD service initiation. These initiatives recognize and reward an integrated community-based treatment system responsive to individuals seeking treatment. They further support hospital EDs in starting individuals on medications to treat OUD and AUD during an ED stay and facilitating access to continued medication after discharge.
Vermont is well-positioned to proceed with the RAM and RTA initiatives. Of equal importance, these initiatives present a replicable framework for spreading and scaling up EBPs in other states to address three clear aims:
- Initiate treatment for OUD or AUD, including medications, within three days of initial contact.
- Eliminate barriers to access.
- Ensure continuation of care.