The National Focus Area ATTCs work with ATTC Regional Centers to serve as subject matter experts, provide information on the latest research-based best practices, and coordinate efforts on four topics of national focus. Learn more about these four Centers and their areas of expertise.

4. National Focus Area ATTCs
Meeting with SAMHSA’s RAs
Suzan Swanton, LCSW
Public Health Advisor
Center for Substance Abuse Treatment
SAMHSA

5. Purpose of ATTCs
“The purpose of this program (ATTCs) is to
develop and strengthen the workforce that
provides addictions treatment and recovery
support services to those in need.”
(ATTC RFA, 2012)

6. SAMHSA’s Perspective
 Creation of the National Focus Area ATTCs
increases the level of focus to specific areas
related to the Strategic Initiatives
 As stated in the RFA…
“The National Focus Area ATTCs will focus their
activities primarily on nation-wide initiatives
involving the entire ATTC Network.”

7. SAMHSA’s Commitment
National Focus Areas ATTCs reflect
SAMHSA’s commitment to
reduce
health disparities
(ATTC RFA, 2012)

9. Challenges
 Ensuring the timely and meaningful
communication of information between
ATTCs and Regional Administrators
 Ensuring National Focus Area ATTCs are
responsive to Regional Administrators
requests

11. Solutions
 ATTC Regional Center Directors will
be the primary contacts for the
Regional Administrators for any
item or request relating to the
work of any ATTC.

12. Solutions
 A web-based conference call held
in Spring 2013 to present the work
plan and level of expertise of each
of the National Focus Area ATTCs
to Regional Administrators

13. Solutions
 A special section of the ATTC Network’s
monthly electronic publication, the
Addiction Messenger, will be dedicated
to highlighting the current activities of
the National Focus Area ATTCs.
(February 2013)

14. National Focus Area ATTCs
National American Indian and Alaska Native ATTC
• University of Iowa
National Frontier and Rural ATTC
• University of Nevada, Reno
National Hispanic-Latino ATTC
• Universidad Central del Caribe Puerto Rico
National Screening and Brief Intervention ATTC
• Institute for Research Education and Training in
Addictions (IRETA) Pittsburg, PA

16. Population We Serve
• Population: 5,220,579 million people
• Recognized tribes by the federal government, by
state government, and unrecognized tribes trying to
receive recognition status
– 566 federally recognized tribes
– 206 SUD treatment programs operated by tribal
communities and Indian Health Service
– 38 Urban Indian programs across the country
– 70% of people with SUD are treated in Urban Indian
facilities
• Many American Indian and Alaska Native are moving
between urban areas and their tribal communities

17. Specific Issues
• Health disparity:
– Physical
• Disproportionally high prevalence of chronic conditions, such as
cardio-vascular disease, diabetes, STIs, hepatitis:
– Mental health disparity:
• Depression, PTSD
• Historical trauma
• Economic disadvantage
– 27% of the population live in poverty (11.5% in the general
US population)
– Over 1/3 have no medical coverage

18. The 12 IHS Regions

19. IHS Regions & the HHS Regions
Region 1 Region 7
– Nashville – Aberdeen
– Nashville
Region 2 – Oklahoma City
– Nashville
Region 8
Region 3 – Aberdeen
– Nashville – Albuquerque
Region 4 –
–
Billings
Navajo
– Nashville
– Phoenix
Region 5 Region 9
– Bemidji
– California
– Nashville
– Navajo
Region 6 – Phoenix
– Albuquerque – Tucson
–
–
Nashville Region 10
Navajo – Alaska
– Oklahoma City – Portland

20. Mission
Serve as the national subject expert
and key resource on adoption of
culturally legitimate addiction
treatment/ recovery services to
support professionals working with
AI/AN clients with substance use
and other behavioral health
disorders and the AI/AN behavioral
health workforce.

21. Our Goals
• Advance the AI/AN SUD treatment field by enhancing
communications and collaborations with stakeholders
and organizations.
• Conduct ongoing assessment of needs and workforce
development issues.
• Facilitate and promote the use of culturally
legitimate EBPs.
• Use state of the art technology transfer
principles in our educational events.

22. Our Goals
• Enhance the AI/AN workforce through a
workforce development initiative.
• Offer TA and training to AI/AN organizations on
integrating behavioral health into primary care,
based on SAMHSA and Health Resources and
Services Administration (HRSA) Center for
Integrated Health Solutions (2012).
• Facilitate the development of ROSC in AI/AN
communities.

23. Target population
• Behavioral Health workforce providing training
for American Indian and Alaska Native clients
– Recovery support specialists
• Trainers
• Educators
• Clinical supervisors
• Future leaders in behavioral health
organizations

24. Methods
• Training and technical assistance
• Capacity building
• Training of trainers
– Develop trainers in Indian Health Service regions
• Learning collaboratives
• Mentoring networks

25. Advisory Council
Lorrie Miner, JD
Dan Dickerson, DO, MPH, Acting Chief Judge, Lower Brule
Inupiaq Sioux Tribal Court
Associate Research Psychiatrist, UCLA
Integrated Substance Abuse Programs
Wayne H. White Wolf-Evans, E.Ed.
Teton Sicangu Lakota
Professor Emeritus, USD School of
Education
Dennis Norman, S. EdD, ABPP
Cheyenne & Cherokee
Associate Professor & Faculty
Chair, Harvard University
Dolores Subia BigFoot, PhD
Caddo Nation
Director, Indian Country Child Trauma
Center, University of Oklahoma

26. Advisory Council
Representative from the
Sac & Fox Tribe of Mississippi in Iowa
Clyde McCoy, PhD MADAC, Meskwaki Health Clinic
Professor of Epidemiology
University of Miami School of
Medicine
Ralph Forquera, MPH
Executive Director, Seattle Indian Health Board
Director, Urban Indian Health Institute
Associate Clinical Professor University of Washington
Richard Bird, MMS, CCDCIII
Sisseton-Wahpeton Oyate Ray Daw, MA
Director, Dakota Pride Treatment Behavioral Health Administrator, Yukon-Kuskokwim-
Center, South Dakota Health Cooperation

27. Ex-Officio Members
Juanita M. Mendoza
– Bureau of Indian Education
– Washington D.C.
Invited Ex-Officio Organizations
– National Indian Health Board
– National Council on Urban Indian Health
– Indian Health Service
– Bureau of Indian Affairs

28. Staff and Major Consultants
Anne Helene Skinstad, Ph.D
Program Director
Karen Summers, MPH, CHES
Evaluations & Curriculum
Development
Jacki Bock Faculty Consultants
Fiscal & Contract Vanessa Simonds, Sc.D
Peter E. Nathan, PhD
Graduate Research Assistants
Rachel Cahoon, MPH student
Kari Folkedahl, MSW student

29. Staff and Major Consultants
Erin Thin Elk, MSW
Sicangu Lakota Oyate
Senior Behavioral
Health Consultant
Dale Walker, MD
Member of the Cherokee Nation
Consultant, One Sky Center
Donovan Sprague, MA
Member of the Cheyenne
River Sioux Tribe
Cultural Consultant
Kate Winters, MA
Project Consultant

30. Consultants
• Harlan Pruden, BA • Janet Zwick, BA
• Richard Moreno, MEd • Andrew Finch, Ph.D.
• Spero Manson, Ph.D.
• • Pam Waters, MA
Jacque Gray, Ph.D.
• Gary Neumann • Paula Horvatich, Ph.D
• Debra Painte, MPA • Rosemary Whiteshield, PhD
• Ed Parsells, BS, CCDCIII
• Ken Winters, Ph.D.
• Representatives from the
National Native American
AIDS Prevention Center

31. Collaborators
• Federal partners
• ATTC regional offices and HHS Regional
Directors
• ATTC Focus area ATTC

32. First Year Milestones
• Strategic planning
– Strategic Planning Meeting held in January
– Strategic plan anticipated in May
• Initiate two webinar series
– Essential Substance Abuse Skills
– Behavioral Health Webinar
• Develop trainers
– Offer TOTs for specific training programs
• Develop workgroups on
– Leadership development
– Recovery oriented care
– Evidence based treatment

33. First Year Milestones
• Media
– Newsletter: First edition in mid April
• Develop relationships with American Indian
and Alaska Native providers
– Visit Indian Health Service regions
– Assess needs for training and TA
• Continue already initiated training and
technical assistance initiatives

34. Training Programs Offered This Year
• Alcohol and Drug Exam Review
– Developed in 1999 as the Certification Prep Training Programs
for Native American Counselors
– Preparation for Certification or Licensure Exams
• Native American Curriculum for State Accredited,
Non-Tribal Substance Abuse Programs
– Adapted to tribal communities in Minnesota.
– Hoped to extend the adaptations to other tribal communities
outside of the Aberdeen Area
• Two Spirit Initiative

35. Other Projects Initiated
• Recovery Oriented Systems of Care
– Focus groups
• Motivational Interviewing
– The Spirit of Communication: MI and Native American
Teaching Curriculum
• Clinical Supervision
– Adapted clinical supervision models to tribal communities -
Addendum to TAP 21-A: Competencies for Substance
Abuse Treatment Clinical Supervisors
• Recruitment, Retention, and Leadership Development
– Finding Purpose: Recruiting Native Americans into
Behavioral Health recruitment video

36. Other Continued Prairielands ATTC Native American
Programs
• Training in Fetal Alcohol Spectrum Disorder (FASD)
– Adapted a FASD training program developed by Mountain West ATTC
– Offered training in FASD prevention and treatment at conferences
across the Upper Midwest region.
• Healthy Women: Healthy Lives
– Culturally adapted to Sioux Tribal Communities
– In collaboration with the great Plains’ Tribal Chairmen’s Health Board
• Online Courses
– Substance Use Disorders in Minority MSM
– Medication-Assisted Treatment with Special Populations
– Essential Substance Abuse Skills: Foundations

37. Thank you
Contact us:
•Anne Helene Skinstad: Anne-skinstad@uiowa.edu
•Karen Summers; karen-summers@uiowa.edu
•Jacki Bock: jacki-bock@uiowa.edu
National American Indian and Alaska Native ATTC
200 Newton Road, 1207 Westlawn
Department of Community and Behavioral Health, University of Iowa
Iowa City, IA 52242
319-335-5564

39. Over half of country’s land mass is
designated as frontier or rural
(USDA, 2000)

40. Approximately one quarter of U.S.
population (62 million) lives in
frontier/rural areas
with 16-20% of those individuals experiencing
substance dependence, mental illness, or
co-morbid conditions

41. Individuals residing rural and remote areas have
higher mortality rates, suicide rates, and their
alcohol/drug problems are more severe

42. A 2009 workforce study reported that the
lowest concentration of mental health
professionals was found in frontier/rural
areas (counties with less than 10,000 people)

43. Definitions
Telehealth
‘the use of telecommunications and information
technologies to provide access to health information
and services across a geographical distance’
Telemedicine
‘use of medical information exchanged from one site
to another via electronic communications to improve
patient health status’
(Institute of Medicine , 2012)

44. Telemedicine
Annually, 10 million patients
receive telemedicine services

45. VA Services
 146 hospitals provided 55,000 patients in
community-based outpatient clinics with
140,000 telemental health visits
 Home-based telemental health services were
provided to 6,700 patients
 2006-2010 hospitalization decreased by 25%
for those that participated in telemental health
services
(IOM, 2012)

46. Addiction Treatment Lags Behind

47. 23.2 Million People Meet the Criteria for SUDs
(NSDUH; SAMHSA, 2007)

48. Telehealth Technologies Help Address
Barriers to Treatment

49. Barriers Include
 Privacy and Confidentiality
(Moyer & Finney,
2004/2005)
 Travel Costs and Burden
(Rheuban,
2012)
 Time Away From Work (Berwick, 2008)
 Child Care (Berwick, 2008)

50. Telehealth is not about the technology but serves as
a bridge reaching out to clients so services that
support behavior change are available. (Shore, 2012)

51. Whether its Group Counseling
or Like This
Like This

52. or Client Homework
Like This
Or Like This

53. Can a meaningful clinical relationship be
developed if a client and counselor do not
share the same physical space?
(Chester & Glass, 2006)

54. Telehealth is in the Best Interest
of the Clients
Expanding Access
Enhancing
Treatment Services

55. Literature Review
Addiction Treatment Using Telehealth Technologies
Computer-based Interventions
Web-Screeners
Web-based Support Groups
Telephone
 Continuing Care
 Interactive Voice Response
Smart Phones
 Web-Portals
 Video
 Messaging (text and email)

56. Serve as the national subject area
expert and key resource to PROMOTE
the awareness and implementation of
telehealth technologies

57. Create addiction treatment
telehealth competencies and develop
policy recommendations for national
license portability to encourage the
addiction treatment and recovery
workforce to ADOPT the use of
telehealth services

58. Use state-of-the-art
culturally-relevant training and
technical assistance activities to help
the frontier/rural addiction treatment
and recovery workforce IMPLEMENT
telehealth services

59. PREPARE pre-service addiction
treatment and allied health students
on using telehealth technologies by
DEVELOPING and DISSEMINATING
academic curricula for infusion into
existing courses

60. Advisory Board
Work Group Members
 NASADAD- Executive Director
 SAAS- Executive Director
 NAADAC- Executive Director
 IC&RC-Executive Director
 HRSA’s Telehealth Resource Centers
 ATTCs
 Telehealth Experts
 Frontier/Rural Addiction Treatment Providers
 Researchers
 National Focus Area ATTC

61. Year 1 Key Events
 Build compendium through Literature Searches
 Develop Graphics/Marketing Themes
 Conduct Telehealth Needs Assessments
 Develop Curricula
 Present at National Conferences
 Present at Regional Summer Institutes
 Sponsor two TOTs
 Conduct State Presentations - 2 x each ATTC Region
 Sponsor Early Adopters Summit

62. TARGET POPULATION
Addiction Treatment Providers & Counselors

63. Upcoming Trainings
Brief Introductory Training - Counselors
Administrators Training

64. Curricula
 Brief Introductory Workshop for Counselors
 Types of telehealth used and treatment outcomes
 Ethics
 Scope of Practice Issues
 Competency
 Privacy/Security and Confidentiality Issues
 Administrators’ Workshop
 Types of telehealth used and treatment outcomes
 Reimbursement and Billing Issues
 Telehealth Policies
 Privacy/Security and Confidentiality Issues
 Decision Matrix

65. Where in the World is NFAR?
Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

67. Years 2-5
 Film and Disseminate Two Telehealth Workshops
 Develop Clinical Supervisor Curriculum
 Annotate Bibliographies
 Create Marketing Videos
 Host Webinars of Curricula
 Build Addiction Educators Curriculum and Sponsor Training
 Sponsor Telehealth Competencies Workgroup and Develop
a Product
 Create and Implement Peer Recovery Curriculum
 Develop Addiction Treatment Curricula

68. Terra Annie
Hamblin Vicente
Michelle
Nancy Joyce Wendy Padden
Trisha
Roget Hartje Woods Dudkowski

69. Mike Wilhelm
John Dell

70. Thank you
http://www.attcnetwork.org/frontierrural

71. Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

72. Definition of Hispanic and Latino
According to the US Census Bureau,
“Hispanic or Latino” refers to a person of Cuban,
Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin
regardless of race.
Reference: Ennis, S. R., Ríos-Vargas, M., & Albert, N. G. (2011, May). The Hispanic population: 2010. Retrieved from
http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf

73. Justification
• Largest minority
• Growing population
• New destinations
• Health insurance coverage
• Substance abuse and treatment episodes
• Culturally competent workforce

74. Largest Minority
• 52 million Hispanic and Latinos
• 16.7% of the total US population
Reference: US Census Bureau (2012, August). Hispanic Heritage Month 2012. Retrieved from
http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb12-ff19.html

75. Growing Population
Source: Starks, B. (2012, March 14). Data for the day: Growth in Hispanic populations 2000-2010. Retrieved from University of Notre
Dame: http://blogs.nd.edu/thecc/2012/03/14/data-for-the-day/

77. Traditional vs. Non Traditional
Destinations
• South Carolina • New York
• Alabama • California
• Tennessee • Texas
• Kentucky • Illinois
• Arkansas • Arizona
• North Carolina • Florida
Reference: Ennis, S. R., Ríos-Vargas, M., & Albert, N. G. (2011, May). The Hispanic population: 2010. Retrieved from
http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf

78. Health Insurance
Almost 1 in 3 (30.7%) individuals uninsured in
the U.S. is Hispanic or Latino.
Reference: US Census Bureau (2010). Income, poverty and health insurance coverage in the United States: 2010.
Retrieved from: http://www.census.gov/newsroom/releases/archives/income_wealth/cb11-157.html

79. Hispanic and Latinos: Health Care Reform
• Expected to provide
increased coverage of
health insurance to almost 6
million Hispanics and
Latinos.
• Hispanics and Latinos are
expected to experience the
largest increase in insurance
coverage.
Reference: Henderson, A, Robinson, W, & Finegold, K. (2012). The Affordable Care Act and Latinos. Retrieved from:
http://aspe.hhs.gov/health/reports/2012/ACA&Latinos/rb.pdf

80. Hispanic and Latinos:
Drug Use and Treatment Admission
• 8.4% of Hispanics (12yrs or older) reported current
illicit drug use.
• Treatment admissions for Hispanic and Latinos
have increased from 10.7% to 14.0% since 1992 to
2010.
References
Substance Abuse and Mental Health Services Administration [SAMHSA]. (2012). Results from the 2011 National Survey on
Drug Use and Health: Summary of national findings. Rockville, MD: Author.
Substance Abuse and Mental Health Data Archive [SAMHDA]. (2013). Treatment Episode Data Set - Admissions (TEDS-A),
Concatenated, 1992 to 2010. Retrieved from http://www.icpsr.umich.edu/icpsrweb/SAMHDA/sdatools/resources

81. Workforce and Disparities
• Hispanic and Latinos are underrepresented in
professions related to behavioral health.
• Lack of a bilingual/bicultural behavioral health
workforce.
• Few service models developed for the Hispanic
and Latino population.

82. Mission
Develop and strengthen the workforce providing
substance abuse treatment and recovery support
services for Hispanic and Latino populations
across United States.

83. Vision
Serve as the national subject matter expert and
key resource for the workforce that provides
instruction to and substance abuse treatment and
recovery support services for reducing health
disparities among Hispanic and Latino populations.

84. Primary Focus Population
• Trainers offering instruction to the workforce servicing
the Hispanic and Latino population
• Workforce providing addictions treatment and recovery
support services to Hispanic and Latino populations.

85. Project Goals
1. Identify resources available and needs regarding
training and capacity of culturally appropriate services.
2. Ensure Hispanic and Latino populations are seen as
key and given priority among stakeholders.
3. Broaden the ATTCs scope on implementation practices
and system transformation.
4. To develop and strengthen the skills and capabilities of
the workforce.
5. To build a collaborative and communication relationship
with other training, TA centers, and technology transfer
providers.

86. Critical Element to Reach Center’s
Purpose
• Training need assessments
• Capacity assessments
• Strategic plan
• Learning community
• Suite of services
• Exhibitors
• Marketing

87. Partnerships and Collaborations
• Three key groups
– ATTC Regional Centers
– Advisory Board
– Panel of Experts

88. Partnerships Strategies
Competencies
ATTC Regional Centers
Project Task Force
Non duplication Strengthen
Delivery

89. Advisory Board
Henry Acosta, MA, MSW, LSW Dona M. Dmitrovic, MHS Marco E. Jacome, Alex Kopelowicz, MD
Faces and Voices of MA, LPC, CSADC, CEAP Latino Behavioral Health
Acosta Consulting Recovery Healthcare Alternative Institute
Systems
Cynthia Moreno-Tuohy, Mary Jo Mather José Szapocznik, PhD
NCAII, CCDCII Executive Director
NAADAC University of Miami
IC&RC Miller School Medicine

90. Panel of Experts
Experts on the field
Up-to-date resources
Relevant resources
and information
SAMHSA
Strategic
Initiatives

91. Staff
Ibis Carrión, PsyD
Director
Miguel Cruz, MS
Associate Director
Digmarie A. Alicea-Santana, PhD
Product Planning and Development
Coordinator

92. Staff
Darice Orobitg, PhD
Training and TA Planning and
Development Coordinator
Víctor Flores, MC
Training and TA Planning
and Development Consultant
Carmen Andújar, BA
Logistic Specialist

93. Staff
Jesús D. Díaz-Peña, MEd
Instructional Designer &
Technology Specialist
Maribel González, BA
Research Assistant
Joaquina Escudero-Texidor
Fiscal Administrator

94. National Hispanic and Latino ATTC
Universidad Central del Caribe
P.O. Box 60327 Bayamón, PR 00960-6032
787-785-5220
hispanic@attcnetwork.org

96. Substance Use Is
A Public Health Problem

97. Learning from Public Health
The public health system of care routinely screens
for potential medical problems (cancer, diabetes,
hypertension, tuberculosis, vitamin deficiencies,
renal function), provides preventative services
prior to the onset of acute symptoms, and delays
or precludes the development of chronic
conditions.

98. “SBIRT has been defined by SAMHSA as a
comprehensive, integrated, public health
approach to the delivery of early
intervention for individuals with risky
alcohol and drug use, and the timely
referral to more intensive substance
abuse treatment for those who have
substance abuse disorders.”
SAMHSA White paper on SBIRT in Behavioral Healthcare (4/1/11)
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf

99. National SBIRT ATTC Goals
– Goal 1. Serve as the national subject matter expert
and key resource for SBIRT;
– Goal 2. Broaden ATTC scope of implementation
practices and system transformation for SBIRT
through the development of an SBIRT suite of
services;
– Goal 3. Develop strategies to expand the workforce(s)
that utilize SBIRT and work to insure the consistent
application of the SBIRT model to insure fidelity and
sustainability.

100. Team and Collaborators
• ATTC regional centers, network office, and other NFAs
• Brief Intervention Group (BIG) initiatives - NORC at the
University of Chicago – learning communities for EAP
and hospital initiatives
• SAMHSA – other SBIRT funded projects
– State and medical residencies grantees via POs
– SAMHSA-HRSA Center for Integrated Health
Systems (CIHS)
• HRSA – AHECs
• NIDA & NIAAA
• Others – coming soon many more

101. Advisory Board
Deborah S. Finnell, DNS, PHMHP-BC, CARN-AP, FAAN
- Johns Hopkins University School of Nursing
Thomas E. Freese, PhD
- UCLA Integrated Substance Abuse Programs
David C. Lewis, MD
- Center for Alcohol and Addiction Studies at Brown University
Karen D. Lloyd, PhD, LP
- Behavioral Health Partners
A. Thomas McLellan, PhD
- Treatment Research Institute
Faye S. Taxman, PhD
- Center for Advancing Criminal Excellence at George Mason
University
Sharon Reif, PhD
- Schneider Institutes for Health Policy at Brandeis University
Paul Sacco, PhD
- University of Maryland School of Social Work
Richard Spence, PhD
- Center for Social Work Research at the University of Texas
Laurie Krom, MS
- National ATTC Network Coordinating Center
Daniel R. Kivlahan, PhD (ex officio)
- Addictive Behaviors Research Center at the University of
Washington
Suzan Swanton, LCSW-C (ex officio)
- Substance Abuse and Mental Health Services Administration
Rita Vandivort-Warren, MSW (ex officio)
-Health Resources and Services Administration

102. Staff
Peter F. Luongo, PhD - Holly Hagle, PhD – Dawn Lindsay, PhD –
Principal Investigator Project Director Program Evaluator
Jim Aiello, Melva Hogan, Jess Williams, Kris Pond,
Project Associate Administrative Assistant Project Manager Logistics Coordinator

103. Year 1 Key events and Upcoming Key events

104. We can’t do something for everyone…
but we can have something for everyone.
• Work plan
• Suite of services - online resources
• Trainings and T/A – based on our work plans
• Needs assessment
• Strategic plan
• Tools – clinical and implementation tools
Contact us at
Main phone: 412-258-8565
Fax: 412-391-2528
Office email: sbirt@attcnetwork.org