Author: niatxfou

  • Cultural Responsiveness: Exploring the CLAS Standards

    Cultural Responsiveness: Exploring the CLAS Standards

    Background

    In recent years NIATx has focused on a “What-How” strategy:

    • A range of evidence-based practices and improvement agendas have provided the “What” (i.e., what we want to implement or improve).
    • The NIATx improvement model has provided the “How” (i.e., how we can effectively implement or improve it).

    Using this model, NIATx has found success in supporting states, provider systems, and organizations in effectively implementing and improving a range of practices. These have included motivational interviewing, substance use screening, peer services, contingency management, regulatory compliance, family engagement, clinic services, and other practices across a spectrum of health and human services.

    Focus on Cultural Responsiveness

    A powerful “What-How” that has recently emerged involves organizational and systemic efforts to improve Cultural Responsiveness (CR). CR includes efforts to understand and engage the wide array of cultural attributes that individuals and groups bring to the service environment. This includes both service staff and customers, such as service recipients, and other community partners.  These cultural features can include language, behaviors, beliefs, values, and customs. A focus on culture tends to create a broader dialogue beyond race and ethnicity, including cultural differences found in different regions, generations, urban and rural locations, gender and sexual orientation, faith communities, etc. 

    Much energy is being focused on CR right now as SAMHSA promotes the Culturally and Linguistically Appropriate Services (CLAS) Standards framework in health and healthcare.  The 15 action steps of CLAS focus on advancing health equity, eliminating disparities, and improving service quality.

    In support of the CLAS Standards, the NIATx Foundation has developed the NIATx CLAS Assessment Tool (NCAT). The assessment features multiple subscales and can be delivered to a team or a broader system to determine the organization’s perspectives and needs related to CLAS. Participant responses to the web-based survey result in scores that represent the four quadrants below, including low or high scores related to the organization’s “world view” and low or high scores related to the organization’s “actions” as they pertain to CLAS.

    Case Study: Alcohol and Drug Dependency Services (ADDS) of Southeast Iowa

    Challenge

    Alcohol and Drug Dependency Services (ADDS) of Southeast Iowa in Burlington, Iowa has a clear understanding of the cultural diversity present in the community and the need to address this diversity to effectively provide services. “ADDS’s challenge is everyone’s challenge,” explained NIATx Foundation’s Mat Roosa, “but because they are progressive and have self-awareness, they see it and the opportunities it can bring.”

    Solution

    ADDS partnered with the NIATx Foundation to complete a CLAS assessment and facilitate a day-long CR training. The objective of this project was to leverage ADDS’s progressive ideals to identify ways to more thoughtfully engage with the community’s culturally diverse groups.

    The ADDS team actively participated in an initial meeting to explore their experience on a range of cultural variables that impact—and sometimes challenge—their care delivery. The staff team then completed the CLAS assessment using NCAT to develop an operational baseline for the organization.

    Upon completion of the assessment, ADDS staff came together with two NIATx Foundation subject matter experts in CLAS/Culture and Process Improvement. This day-long work session supported the ADDS team in:

    1. Understanding the multiple ways that cultural differences impact how they deliver care, and
    2. Developing implementation and change strategies to enhance their ability to engage service recipients.

    Outcomes

    While the population of Burlington, Iowa is 86% white (U.S. Census), the ADDS team was readily able to identify a number of cultural diversity issues that could be the focus of future service enhancement projects. Potential targets include:

    • Improving access for Spanish speaking populations.
    • Engaging youth/college students and senior residents.
    • Conducting outreach to rural and agricultural communities.


    The ADDS team left the CR work session with a clear understanding of their current world view related to culture and associated action plans to improve service access. The team also refined their awareness of the tremendous amount of cultural diversity that exists in the Burlington community, much like any other community.

  • CLAS Standards as a Catalyst for Prevention: A Learning Collaborative

    CLAS Standards as a Catalyst for Prevention: A Learning Collaborative

    Overview

    The Culturally and Linguistically Appropriate Services (CLAS) Standards as a Catalyst for Prevention: A Learning Collaborative (CLAS Learning Collaborative) gave participants the skills to improve service delivery and integrate culturally responsive strategies into their organizational structures. The CLAS Learning Collaborative presented cultural competence not as a distinct knowledge base, but as a framework to incorporate CLAS Standards, leadership development, and process improvement into the inner workings of an organization.

    Process

    A request for applications was announced, and participation was open to OhioMHAS-certified prevention agencies. Eleven unique prevention agencies serving urban, rural, and suburban communities in NE, NW, Central, and SW Ohio, as well as Appalachia Ohio, were selected to participate in the learning collaborative.

    Twenty-nine participants representing the 11 agencies attended a two-day summit to initiate prevention and agency-specific CLAS Standards change projects. All agencies were given the opportunity to assess their agency’s understanding and utilization of the National CLAS Standards using a customized NIATx Foundation CLAS Assessment (NFCA™) tool provided by Prevention Action Alliance in collaboration with NIATx. This assessment was used as the baseline measurement to track progress and outcomes for the project.

    A combination of collaborative and individual organization coaching sessions were provided during the three months after the summit. All teams participated in these learning collaborative webinars during the implementation phase of the collaborative to share ideas, successes, and challenges with others in the collaborative. Throughout the process, the learning collaborative coaches provided technical assistance through Zoom meetings, phone, and email feedback on plans and implementation. This included a review of each organization’s strategic plan prior to implementation.

    At the conclusion of the CLAS Learning Collaborative, all the participating organizations came together to celebrate and present their respective change project in a “5×5” PowerPoint presentation (i.e., five slides in five minutes).

    Next Steps

    The trainers will be meeting with each agency again to review their NIATx Foundation CLAS Assessment (NFCA™) and progress made over the course of the project. A more formal report will be created and published. The collaborative team will continue to meet and consider ways to support this group of CLAS Standards Collaborative alumni, as well as ways that we can expand upon this work.

    Read more…

  • Virtual Training: ASAM Criteria

    Virtual Training: ASAM Criteria

    Starts March 14, 2024

    The NIATx Foundation is partnering with Train for Change to provide an ASAM Implementation Guide training that aids organizations in using 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 ASAM Criteria and make organizational changes that support its fidelity.

    This training teaches the NIATx model for process improvement in conjunction with the ASAM Criteria Implementation Guide as a foundational, straightforward way to implement, improve and sustain fidelity to the ASAM Criteria. 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 ASAM Criteria but for any improvement or implementation project, Trauma Informed Care, Motivational Interviewing, CBT, Decreasing “no shows,” EHR, Treatment Plan Quality, Documentation, etc.

    This training is an evolution of a Training for Trainers model. It goes beyond the single strategy and frequently ineffective belief that more trainers and training creates change. Although training and local expertise is an important component of implementation, it is commonly the only piece and is typically ineffective for implementation and sustainability.

    Dates

    This training consists of FIVE 2-hour sessions (one session/week for 5 weeks):

    Session 1: March 14
    Session 2: March 21
    Session 3: March 28
    Session 4: April 4
    Session 5: April 11

    Registration

    This event is open to the public. The registration fee is $649.00/person and includes a printable electronic handout and/or an electronic training journal to use as a resource during the training. For more information, please contact: candacel@trainforchange.net or call 1-775-434-1562.

    Register to Attend

    Details

    Training includes:

    • 2.0 NAADAC Continuing Education Credits (CEs) per session for a total of 10 CEs.
    • A copy of “The ASAM Criteria Implementation Guide”

    Note: Participants must attend all 5 sessions to receive CEs. Full attendance and participation is required in all 5 sessions to receive full credit. Partial credit cannot be issued. Sessions cannot be made up at a later date. ABSOLUTELY NO REFUNDS WILL BE ISSUED IF A SESSION IS MISSED.

    Pre-requisites:

    • Completion of a 2-day ASAM Criteria Skill Building Training (3rd or 4th Edition)
    • Possession of the Third or Fourth Edition of the ASAM Criteria (separate purchase)
    • Competency with ASAM Criteria
    • Agreement to complete up to 1 hour of out-of-session work between sessions

    About the Trainers

    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.

    Mathew Roosa, LCSW-R is a consultant who provides training, coaching, technical assistance and planning support to universities, research studies, governments and health and human service provider organizations. He was a founding member of NIATx, and currently works part time at the UW Madison Center for Health Enhancement Systems Studies (CHESS). Focusing on quality/ process improvement and implementation of evidence based practices, Mr. Roosa’s experience also includes psychotherapy for mental health and substance use in agencies and private practice, teaching at the undergraduate and graduate levels in Human Services and Social Work, agency administration, and governmental planning.

    Register to Attend
  • ASAM Criteria Implementation Webinar

    ASAM Criteria Implementation Webinar

    Thursday, January 25, 2024 | 11:00 am – 12:00 pm PST

    We invite you to join us for a live recording of our conversation with special guests Matthew Roosa, Maureen Boyle, Todd Molfenter, and Scott Boyles on Thursday, January 25 at 11:00 am PST.

    This webinar will provide a brief introduction to the ASAM Criteria Implementation Guide and the new training, “Implementation, Improvement, Sustainability, and Coaching of the ASAM Criteria: A How-to, Science-Based Approach,” offered in partnership with the NIATx Foundation and Train For Change.

    Register to Attend
    About Train for Change

    Train for Change, a division of The Change Companies, bridges the gap between knowledge of “what works” in addiction treatment and helping providers develop requisite skills in these practices for use in real-world settings.

  • Creating Change for Program and Service Improvement

    Creating Change for Program and Service Improvement

    Challenge

    As one of the largest providers of community-based health services and housing in New York State, Services for the Underserved (S:US) provides services to make sure every New Yorker has a home and can create a life of purpose. S:US values continuous quality improvement and engages in ongoing efforts to improve its services and internal practice.

    S:US recently experienced a transition in leadership, including the creation of an Innovation and Quality (I&Q) Team with new staff tasked with working on S:US programs in partnership with senior leadership, program evaluation, and Quality Assurance (QA) Teams. This presented an opportunity to explore alternatives for enhancing the quality of S:US’s services and programs, focusing on the fundamental question: What model would be most effective for orienting the I&Q Team efforts and aligning I&Q with agency priorities?

    Solution

    S:US reached out to several consultants and organizations to help its quality improvement efforts and contracted with the NIATx Foundation as a consultant who could:

    • Directly apply continuous quality improvement (CQI) methods;
    • Offer familiarity with S:US’s program types and licensing bodies; and
    • Provide onsite, hands-on training and coaching.

    NIATx worked with S:US to implement the learning collaborative model, focusing on 11 programs covering a wide range of service types (e.g., supportive housing, homeless services, clinic service, Assertive Community Treatment (ACT), care coordination). The learning collaborative approach provided S:US with a variety of methods for sharing innovative ideas to implement positive change.

    Using this approach, NIATx consultants provided the following services:

    • Developed a plan to support the 11 identified programs, as well as the I&Q Team, with the ultimate objective to transfer the tools and implementation of the model from NIATx to the I&Q Team for ongoing sustainment.
    • Conducted a live meeting with executive leadership to engage and energize executive sponsorship for the I&Q Team’s improvement efforts.
    • Facilitated a Change Leader Academy (CLA) training with supervisors for the 11 programs to implement a structured, team-based approach to change management.
    • Engaged in ongoing monthly coaching for the I&Q Team on the NIATx approach and tools (e.g., walkthroughs, flow charts, nominal group technique) and how to effectively coach their 11 sites through the implementation process.
    • Developed and implemented change projects for the 11 programs.
    • Conducted a mid-project meeting to assess progress and will follow-up with a final meeting to evaluate lessons learned and celebrate results.

    Outcomes

    This project has a six-month timeframe. Over the first half of the project, members of the I&Q Team successfully learned the NIATx approach and have supported program use of the NIATx tools to begin implementing change. The program sites were encouraged to define their own improvement projects and to gather feedback from service recipients, according to the NIATx principal of understanding the customer. The nominal group technique has further helped the I&Q Team members and sites identify strategies for implementing these improvements.

    As this project progresses, the program sites are beginning to incorporate NIATx’s plan-do-study-act (PDSA) change model, developing baseline data, implementing changes, and measuring the results of their efforts. The sites are clearly motivated to seek measurable improvements that enhance the collective experience of the people they serve.

  • Advancing Racial Equity in Family SUD Recovery Programs

    Advancing Racial Equity in Family SUD Recovery Programs

    Challenge

    Women and their children are increasingly impacted by SUD, and accessible and equitable treatment programs that integrate comprehensive services for both women and children are sorely needed. With a 60% Black population and 30% of children living in poverty, New Orleans is particularly vulnerable in its lack of access to quality SUD treatment—especially facilities that allow the family unit to remain intact and provide equity in access to treatment across racial lines.

    Solution

    Volunteers of America (VOA) is designing an enhanced and equitable substance use treatment model for women and their children for 2023 implementation in New Orleans. The VOA Family-Focused Recovery (FFR) model will be customized for New Orleans, applying a racial sense. Using the evidence-based NIATx Co-Production technique, a culturally responsive program will be co-created with the community. The purpose of this Co-Production approach is to develop a program that aligns with local culture and needs.

    The NIATx technique is based on five key principles:

    1. Partner with community-based lived-experienced individuals and stakeholders to uncover needs and establish preferences for program planning.
    2. Gain commitment and engagement from community and organizational leaders.
    3. Use individuals from outside the system to provide breakthrough thinking.
    4. Engage a respected progressive team leader to integrate innovative ideas into practice.
    5. Conduct pilot and rapid-cycle testing until equity aims are achieved.

    The Co-Production Planning will be centered around a Community Policy Planning Board that includes community stakeholders who are opinion leaders in the Black community. The Board’s purpose is to establish the most pressing needs for pregnant and postpartum Black women with SUDs and to collect their insights into how VOA can most effectively meet those needs. The optimal program operational features generated by the Board will be integrated into a Patient Mapping Exercise to determine structural, workflow, and clinical features the New Orleans program will apply to attract and retain Black pregnant and parent women.

    Outcomes

    VOA will learn from the New Orleans experience; refine the design process for future programs; and use the process to co-create treatment programs in future locations that are inclusive, equitable, culturally relevant, and responsive to their communities. Success will be measured not only by increasing family access to comprehensive SUD treatment and reducing disparities in treatment by aligning programs to the local culture, but also through continuous engagement with recognized community leaders, church leaders, community advocates, and peer-led groups.

    Download the Report

  • Providing the COVID-19 Vaccine

    Providing the COVID-19 Vaccine

    Situation

    Patients were coming to Main Street Addiction Recovery Center unvaccinated and uncertain about getting the COVID vaccine. However, news about filling emergency rooms and spread of the Delta variant has caused growing concern. In addition, the Recovery Center is working to keep their patient population safe and build trust that the facility is a protective environment to receive care. To create this safer environment and offer patients an important public health service, Main Street Addiction Recovery Center decided to commence the braided strategy of administering COVID vaccines.

    There were two key steps required to implement this braided strategy:

    1. The Center had to apply to become a COVID vaccine provider from the local public health department and secure promotional COVID vaccine materials and doses of the vaccine (once approved).
    2. Workflow needed to be adjusted so patients (and even members of the public) could receive the vaccine without interrupting existing clinical workflows.

    Based on NIATx guidance, the Center established a NIATx team to quickly implement the new service. The team completed a NIATx Charter Form, which outlined how the change would be tested and implemented. They developed a flowchart of the new workflow and conducted a patient simulation walkthrough to work out the initial kinks of the service. Once the service was tested on a half-dozen patients, the team reconvened to finalize how the service would be delivered. A private exam room was created off the lobby where patients could get their vaccines, as well as extended release naltrexone injections. The flowchart also included the required steps to receive revenue for the service. Finally, a sustain leader was assigned to the project so the Center can ensure the service continues to work effectively.

    Mutually Beneficial Outcomes of Braided Strategies

    • Patients can conveniently receive a service that could prevent sickness, long-term disability, or even death without having to schedule another appointment, fill out paperwork, etc.
    • The Recovery Center realizes multiple benefits, including:
      • Keeping staff safe.
      • Earning additional (limited) revenue from administering the vaccine.
      • Preventing lost revenue from patients who have avoided the Recovery Center out of concerns for their safety (a reality during the initial COVID pandemic).
      • Establishing the Center’s reputation with patients and the public as more than a behavioral health provider.
    • Of the 140 patients served thus far, there have been zero lost charges and a significant increase in reported patient satisfaction at the ease of getting protection from COVID.

  • Testing for HIV/HCV

    Testing for HIV/HCV

    Situation

    Patients were walking into the Northeast Recovery Center with symptoms of fevers and joint or stomach pain. Over time, the Center often learned that the patients were having symptoms of HIV or HCV (Hepatitis C). Use of alcohol, crack cocaine, meth, poppers (amyl nitrite), opioids, and heroin are all closely associated with incidence of HCV and HIV. Both HCV and HIV significantly compromise the auto-immune system, and HIV left untreated progresses to AIDS, which can be deadly and severely hamper quality of life.

    The diminishing health of these patients was very concerning to the Recovery Center, especially as they witnessed how these health conditions impact the individual’s treatment recovery. As a health services provider, Northeast Recovery felt they had an obligation to address these diseases linked to substance misuse.

    Mutually Beneficial Outcomes of Braided Strategies

    • Patients can be tested for HIV and HCV sickness and, if positive, receive health care services that will considerably diminish the impact of these serious diseases. At Northeast Recovery, all patients at intake are now given the chance to opt out of HIV and HCV blood testing.
    • The Recovery Center realizes multiple benefits, including:
      • Being able to bill for these two tests and for any HCV/HIV services they provide (or refer patients to their local HCV/HIV specialty provider).
      • Providing a considerable public health benefit by helping infected individuals learn how to prevent the spread and harmful effects of these diseases.
      • Developing a mutually beneficial relationship with the local HCV/HIV provider, which has begun providing Northeast with SUD referrals.

  • Providing Buprenorphine in the Emergency Department

    Providing Buprenorphine in the Emergency Department

    Situation

    The local Emergency Department (ED) is continually calling the Main Street Recovery Center for assistance with overdose patients and currently provides referrals to the Center without any coordination of services. Main Street Recovery wanted to directly address this issue, as did the local ED. The ED first discussed the option of having a peer recovery specialist or even a therapist located at certain times in the ED; however, Main Street and the ED agreed this was too labor intensive. Instead, ED and Main Street decided to have the ED induct eligible patients wanting to begin Suboxone therapy and then provide three-day Suboxone starter kits.

    To make this possible, Main Street trained ED staff on how to:

    • Reduce stigma,
    • Assess for OUDs,
    • Assess for Suboxone eligibility, and
    • Have conversations with patients about Suboxone care and use.

    Once a patient is given the first dose and a three-day Suboxone “booster pack,” the patient is given a referral to Main Street and all paperwork is sent to Main Street.

    Mutually Beneficial Outcomes of Braided Strategy

    • ED has a strategy of how to triage patients who present in opioid withdrawal—a strategy they feel reduces return ED visits and even saves lives.
    • The Recovery Center appreciates the public health benefit and the new patients that are referred from the ED. These patients often have insurance, are adherent to their regimen, and increase treatment group census. Main Street feels this is a great example of how a braided strategy can benefit the patient, the service provider, and the community!
    • The program has experienced a 92% follow-up rate for referred patients.

  • Improving Access & Retention in Treatment

    Improving Access & Retention in Treatment

    Background

    Opioid Use Disorder (OUD) is a chronic condition that affects an estimated 2.4 to 5 million Americans. It is also estimated that of the individuals with OUD, only 21% have received any past-year substance abuse treatment, and only 15-20% of those have received Medication for Opioid Use Disorder (MOUD).  

    The APT Foundation, Inc. (APT) is a Connecticut-based not-for-profit community-based organization that specializes in the treatment of substance use disorders. To address the growing opioid epidemic, APT began using the Network for the Improvement of Addiction Treatment (NIATx) rapid-cycle model to improve treatment access and program outcomes especially wait time to treatment. Since May of 2007, APT has continued to use the NIATx model to sustain results and navigate current treatment challenges associated with COVID-19.

    NIATx Approach

    The NIATx-informed open-access treatment model uses process improvement strategies to improve treatment access and capacity. Patient waiting time to treatment is a key metric to improve overall patient care and outcomes. Opioid Treatment Programs (OTPs) have traditionally operated under the assumption that a fixed number of individuals can be treated at any given time; when demand for treatment exceeds allocated treatment slots, prospective patients are turned away or assigned to a waiting list. Waiting times of at least one month for methadone maintenance are common in the U.S. These excessive wait times remain a significant barrier to treatment, as they minimize the problem and cause prospective patients to not enter treatment at all.

    APT recognized a real need to shift the treatment model and create process efficiencies that provide enough capacity to allow for immediate access to prospective patients. Using the NIATx approach, APT began development and implementation of the open-access model to support this objective in two phases:

    • Phase 1: APT began using the NIATx rapid-cycle model in May 2007. A walk-through of existing intake procedures identified multiple possible barriers involving wait time and access. The change team initiated a series of related change projects to improve these areas.
    • Phase 2: In fall 2007, change teams identified barriers to access, retention, and expanding treatment capacity. The development and implementation of key elements of the open-access model occurred during this phase, including walk-in evaluations, same-day treatment initiation, and provision of drop-in groups.

    Change projects to address barriers to methadone maintenance access or retention include the following:

    BarrierChange Project
    Long waiting timeWalk-in screening, intake, medical screening, and methadone or buprenorphine initiation are available same day, Monday through Friday, if indicated. Physical exams are performed on a walk-in basis and tuberculosis tests are read after admission to eliminate long waiting time.
    Financial costs to patientsEligible patients are admitted irrespective of insurance coverage or ability to self-pay; following admission, patients without insurance are assisted with procurement (e.g., Medicaid).
    CounselingThe primary mode of counseling has changed to drop-in groups that allow for more patient flexibility, with individual counseling available, as needed or as requested by the patient.
    Dosing & medicationStandardized protocol and procedures have been implemented for methadone dosing and take-home medication eligibility.
    Discharge criteriaAdministrative discharge criteria have been updated, and patients are discharged only after review by clinical team and approval of CEO confirming safety risk or absence of treatment efficacy.

    Outcomes

    Through the open-access model, prospective patients are rapidly enrolled in APT’s methadone maintenance treatment—irrespective of ability to pay—and provided real-time access to multiple voluntary treatment options. Based on data collected through routine quality assessment, this open-access model appears to improve treatment access, capacity, and financial sustainability without evidence of deleterious effects on treatment outcomes. Specifically, the following outcomes were realized between the period of July 2006 (pre-model) through June 2015:

    • Patient census increased by 183%, from 1,431 to 4,051.
    • Average waiting-time days decreased from 21 to 0.3 (same day) without apparent deleterious effects on rates of retention, non-medical opioid use, or mortality.
    • Net operating margin rose from 2% to 10%, while state-block grant revenues declined 14%, and the proportion of total revenue from state-block grant revenue decreased from 49% to 24%.

    During the first five years of the open-access model, most patients were screened, assessed, and medicated on the same day. Reduced waiting time was achieved partly by shortening delays between initial screening, intake, and admission. Relative to national statistics from 2003 to 2012, when patient census (or treatment capacity) increased only 37%, APT’s census increased 183% over ten years following implementation of the open-access model. The model provides services immediately and offers a potentially important approach for eliminating extant treatment access disparities through drop-in counseling that offers more patients access and choice about counseling.

    COVID-19 Response

    The COVID-19 pandemic has presented complex challenges related to maintaining treatment to respond to increased demand brought on by psycho-social isolation, while reducing transmission of COVID-19. Correspondingly, APT has set important goals of reducing in-person contact between patients and staff and identifying opportunities for social distancing to reduce transmission of COVID-19, while maintaining access to treatment through no wait times and walk-in evaluations.

    One of the top NIATx principles to create change is to understand and involve customers. APT’s COVID-19 response has focused largely on understanding patient needs and resources to make individual and aggregate process changes following the NIATx approach. As soon as federal guidance was released on March 16, 2020, APT implemented the following process changes:

    • Increased the number of doses of take-home medication for stable patients. Of the facility’s 4,500 patients, 2,000 were transitioned to receiving a supply of medication that would last at least 14 days. This huge staff effort has resulted in a highly successful process that has significantly decreased the number of in-person interactions required.
    • Created a standard medical and COVID-19 safety sheet/checklist. Standard questions are used to measure stress, COVID-19 symptoms, and treatment concerns/status. This allows for data and trend analysis to inform future changes.
    • Implemented telehealth protocol. Clinicians are conducting regular telephone check-ins with patients, sometimes almost daily depending on the patient’s risk factors and pre-existing conditions. These phone calls also use a standard checklist to help assess trends.

    APT has found the changes implemented above to respond to COVID-19 have allowed the facility to continue providing treatment to patients and, in several cases, have improved treatment approaches, particularly for those with access disparities. For example, telehealth visits remove barriers to transportation and provide more flexibility for patients in scheduling. APT is still conducting 20-30 walk-in evaluations per week but has the appropriate processes and protocol in place to minimize in-person contact, transition patients to telehealth options once admitted, and reduce COVID-19 transmission.