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. Author manuscript; available in PMC: 2017 Jul 1.
Published in final edited form as: J Behav Health Serv Res. 2016 Jul;43(3):513–514. doi: 10.1007/s11414-015-9486-3

Letter to the Editor on “Implementation of Network for the Improvement of Addiction Treatment (NIATx) Processes in Substance Use Disorder Treatment Centers”

James H Ford II 1
PMCID: PMC4865443  NIHMSID: NIHMS738044  PMID: 26563104

The article, Implementation of Network for the Improvement of Addiction Treatment (NIATx) Processes in Substance Use Disorder Treatment Centers,1 provides an excellent overview of the organizational characteristics associated with use of the NIATx model. However, my experience both as a process improvement coach and researcher suggest that the findings do not fully explain the entire picture. For example, Appendix A associated with McCarty et al2 indicates that the size of the providers in the original NIATx cohort appears to be larger (avg. = 4.48, SD=0.99) than this articles’ sample. However, those numbers reflect total staff not FTE’s where NIATx was implemented (e.g., residential or IOP).

I also had the privilege of coaching the Jackie Nitschke Center in Green Bay, Wisconsin. When selected as one of the ten initial Robert Wood Johnson Foundation Paths to Recovery winners, they had 12 staff members with one perhaps two individuals who could be considered in an administrative role. Over the years, the JNC has embraced the NIATx principles as a critical part of its overall mission. A 2013 interview with Bill Labine shows how a small agency with low administrative intensity and minimal slack resources utilized the NIATx model to transform their agency.3

In the NIATx200 study, we collected information about the number of FTEs. An analysis indicates that the average provider was smaller (avg. = 2.69, SD=1.02) than the selected sample in this study. While not every provider actively participated in NIATx200, results indicate that smaller treatment providers are capable of successfully implementing the NIATx approach to process improvement.4 Findings from Grazier and colleagues5 indicated that higher rates of participation is association with clinic’s not having a hospital affiliation, being privately owned, and having staff who perceived management support for quality improvement. Other organizational characteristics such as type of provider and primary setting,6 management score,7 as well as accreditation or geographic location were not associated with participation or identified as predictors of overall improvement in the NIATx200 study.4

The article by Fields and colleagues1 provides valuable and important insight into what type of substance abuse providers adopt and utilize the NIATx model to improve processes of care. However, results also suggest that other organizational characteristics outside of those identified in this article may be associated with provider utilization of the NIATx process improvement model. Further research is need to more thoroughly understand this important issue.

References

  • 1.Fields D, Knudsen HK, Roman PM. Implementation of Network for the Improvement of Addiction Treatment (NIATx) processes in substance use disorder treatment centers. Journal of Behavioral Health Services & Research. doi: 10.1007/s11414-015-9466-7. Published 2015 online. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.McCarty D, Gustafson DH, Wisdom JP, et al. The Network for the Improvement of Addiction Treatment (NIATx): Enhancing access and retention. Drug and Alcohol Dependence. 2007;88(2–3):138–145. doi: 10.1016/j.drugalcdep.2006.10.009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Fitzgerald M. Growing and evolving with NIATx: The Jackie Nitschke Center. [Accessed on June 5, 2015];NIATx. Available online at http://www.niatx.net/News/NewsDetails.aspx?id=1078. [Google Scholar]
  • 4.Gustafson DH, Quanbeck AR, Robinson JM, et al. Which elements of improvement collaboratives are most effective? A cluster-randomized trial. Addiction. 2013;108(6):1145–1157. doi: 10.1111/add.12117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Grazier KL, Quanbeck AR, Oruongo J, et al. What influences participation in quality improvement? A randomized trial of addiction treatment organizations. Journal for Healthcare Quality. doi: 10.1111/jhq.12064. Published 2014 online. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Quanbeck A, Wheelock A, Ford JH, II, et al. Examining access to addiction treatment: Scheduling processes and barriers. Journal of Substance Abuse Treatment. 2013;44(3):343–348. doi: 10.1016/j.jsat.2012.08.017. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.McConnell KJ, Hoffman KA, Quanbeck A, et al. Management practices in substance abuse treatment programs. Journal of Substance Abuse Treatment. 2009;37(1):79–89. doi: 10.1016/j.jsat.2008.11.002. [DOI] [PMC free article] [PubMed] [Google Scholar]

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