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What’s the Question?
Studies conducted in rural communities have underscored the severity of the opioid crisis among rural youth and young adults. According to research, rural adolescents with OUD are more likely to have past-year prescription opioid use, start using opioids at a younger age, start injecting opioids at a younger age, and become infected with HCV. They also have major challenges in access to and availability of MOUD and mental health services. Plus, patients in rural settings also frequently confront time, travel, and cost-related barriers – factors typically even harder for youth to overcome than adults.
Given all this, researchers for this study wanted to know: what’s the actual prevalence of OUD for youth vs. adults in rural communities? And what kind of care are they receiving?
This study looks at these two questions, comparing the prevalence of OUD and rates of prescription MOUD between transition age youths (TAY) aged 18-25 and adults aged 26 years or older in rural settings, as well as differences in MOUD treatment adherence, retention, and care.
How Was This Study Conducted?
Researchers used electronic health records from a large multisite study conducted in the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN-0102). Data from 36,762 patients across 6 primary care clinics in rural communities were analyzed.
What Did Researchers Find Out?
In this sample, OUD prevalence was lower among TAY compared to adults aged 26+. Notably, OUD prevalence was higher for both age groups in this study compared to the national average, though this may be due to the fact this sample was taken from CTN-0102 participants, rather than general patient data.
Among those diagnosed with OUD, 72.73% of TAY and 64.52% of adults aged 26+ were prescribed MOUD in the study – this was actually the opposite of what researchers were expecting to see (they hypothesized that older adults would be more likely to be prescribed medications). This was again higher than the national average, which again may be because of the samples’ research involvement (this time because clinic staff may have had access to more resources and training). Still, almost one-third of patients still did not receive MOUD, a significant number.
Despite similar rates of MOUD receipt between the two age groups, TAY had significantly were prescribed MOUD for significantly fewer days compared to the adults aged 26+ sample, suggesting inconsistences in care, like lower MOUD adherence or retention in treatment for younger adults.
What Are the Implications for the Workforce?
This study highlights findings that underscore the need for age-specific interventions to improve diagnosis and MOUD initiation, retention, and consistency of care for youth and young adults in rural communities. Opioid use disorder and deaths from overdose continue to be a major problem across the U.S., with rural areas facing additional barriers to care – strategies to address those barriers need to be adaptable to serve the needs of young people from rural communities.
Clinical supervisors play an important role throughout the workforce acting simultaneously as a teacher, mentor, coach, and consultant, working to enhance the skills, knowledge, and expertise for those they supervise.
In addition to these skill development roles, clinical supervisors often find that they are responsible for the administrative oversight and responsibilities of a traditional manager. While challenging, this role can be quite rewarding and is key to the improvement and successful implementation of evidence-based practices.
In general, quality supervision practices:
Just like the skills learned and subsequently imparted to a supervisee, clinical supervision is a skill that requires development to support the capacity of new and experienced supervisors. This skillset requires flexibility and a range of ability to adapt to the specific needs of supervisees who are at varying stages of their career development. Ultimately quality supervision can support retention, morale, culturally appropriate service delivery, EBP adherence, and overall quality care improvements (SAMHSA, TIP 52).
Recommended Resource:
The NWATTC offers several different trainings on Clinical Supervision:
This workshop will provide a broad overview of clinical supervision for those who have not had formal training in this area. It's also a helpful refresher for those who have been practicing as supervisors and want reinforcement of clinical supervision models. The goal of the first level of clinical supervision (CS1) is to help providers understand the research supporting effective supervision methods, identify the roles in the supervisory relationship, increase awareness of cultural considerations in applying a framework of cultural humility to supervision, practice skills that structure clinical supervision (e.g., Feedback Model, Professional Development Plan, Supervisory Interview), and gain familiarity with available resources for clinical supervision.
The second phase of the training in clinical supervision for behavioral health providers focuses on dilemmas clinical supervisors face and how to put into practice the CS skills learned in phase one. CS2 is designed to further increase supervisors’ understanding and skill in assessing counselors in mental health and substance use disorder treatment settings. This training emphasizes how to handle problems that may arise in the supervision process. It also emphasizes the importance of creating structure, collaborative teaching and mentoring, and builds on skills in risk management and setting boundaries as a supervisor.
This training was created for supervisors, clinicians, administrators, and others who are at any stage of integrating peer support into their organization's recovery support services. Due to the unique nature of peer professionals compared to others working around them, there's a need to ensure clear communication, expectations, and procedures to avoid role drift outside of best practices that allow peer professionals to provide care that is both in scope and aligned with professional guidelines.
This six-month long full immersion program in clinical supervision is intended to introduce participants to a model of supervision, familiarize them with competency-based counselor skill development, prepare them to be highly qualified clinical supervisors, and meet state guidelines for being an approved supervisor in the four states in region 10. The curriculum includes live experiential training sessions and on-going learning session opportunities, culminating in direct observation combined with individual coaching in specific supervision skills. This program, when fully completed, will provide participants with 30 NAADAC CE hours, which meets Alaska, Idaho, Oregon and Washington training requirements to be recognized as a Clinical Supervisor. All the training material have been customized to meet the cultural and clinical needs of Tribal Clinical Supervisors.
This workshop aims to examine the role supervisors may have from an ethical perspective to become a preventionist for their supervisees and ultimately the community members they serve by exploring practical strategies for identifying supervisee blind spots or growth areas, as well as key factors that may support a supervisor’s ability to foresee and prevent their own ethical missteps. Additionally, those who participate in this learning opportunity explore how these strategies and skills can aid them in their efforts to engage supervisees in their own professional development and self-care.
Having formally emerged in the United States in the 1990s, harm reduction is a public health approach to managing substance use and other behaviors that pose risk of harms to the individual and society. Initial efforts in the U.S. were pioneered by the late Alan Marlatt—an internationally-renowned professor at the University of Washington who in 1998 published the seminal textbook on harm reduction1.
Dr. Marlatt drew inspiration from the compassionate pragmatism inherent in successful public health examples occurring at that time in the Netherlands, Switzerland, the United Kingdom, Canada, and Australia. He distilled this set of principles, that harm reduction:
Another renowned proponent of harm reduction, Andrew Tatarsky, later proposed additional values underlying the harm reduction approach for persons who provider therapeutic services2. These are to:
With passage of time, public opinion has become more accepting of harm reduction principles and values, Though what the public embraces as harm reduction services or resources continues to evolve, two persistent pillars that define harm reduction—compassion and pragmatism—should continue to guide efforts to reduce personal harms to individuals and macro-harms to society3. Such efforts are now promoted amongst prominent American institutions like the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of National Drug Control Policy, and Centers for Disease Control and Prevention, among others.
If you are interested in harm reduction training or technical assistance please contact us at [email protected].
Harm Reduction, within the context of clinical care, aims to decrease the unwanted impacts of substance use and other behaviors on the lives of our clients. While Harm Reduction is gaining traction and interest throughout behavioral health, the integration of Harm Reduction principles may be challenging for some as many evidence-based practices utilized by the field may be perceived to be at odds with a perspective that isn’t strictly aiming for abstinence as the end result of care.
This 6-hour training is designed to pull together familiar practices and concepts like Motivational Interviewing and the Stages of Change to provide a framework for how to integrate the principles of Harm Reduction into an existing clinical practice.
Learning Objectives:
This 3-hour virtual training examines how Recovery Mentors, Recovery Coaches, and Peer support specialists may talk to the people they serve using the language of harm reduction. This interactive training aims to support those in the recovery field who utilize their own lived experience but may be seeking additional support to aid the peers/ community members they support through a lens of harm reduction by providing opportunities for learning, discussion, and practice of related skills.
Learning Objectives:
Talking to Change: A Motivational Interviewing Podcast.
Located at the University of Washington’s Addictions, Drug & Alcohol Institute (ADAI) as of October 2017, the NWATTC seeks to accelerate community-based implementation of evidence-based practices (EBPs) for treatment and recovery by:
Learn more about what we do in Region 10 in our informational flyer.
Learn more about us in our informational flyer!
the Northwest ATTC reaches large segments of the addiction workforce in a multi-state region via diverse professional education activities. These activities are encompassed under a rubric of what is now commonly termed "technical assistance" (TA), which includes:
Learn more about technical assistance and how the ATTC supports the addiction workforce in these engaging short videos from the Network (available in English and Spanish).
