Step 1 Envision
Inspire your staff to make COD pharmacotherapy and supportive care a reality.
Step 1: Envision
Introduction
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Your staff is the pulse of your clinic. That makes them the most crucial element in the process of helping clients receive quality and comprehensive COD-alcohol or COD-opioid care, which includes the option of pharmacotherapy.
So, before you do anything else, you’ll need to identify your Treatment Team—the people who deliver COD care.
Next, you will need to create a COD Change Team to help you implement your care program. The team should be composed of representatives from your Treatment Team and might also include information technology (IT), billing, and administrative staff as you build your program.
This step is designed to help you do just that: create a team. Once you’re done, you’ll have established the groundwork to create the personnel infrastructure for implementing your new COD care process.
Perhaps most importantly, this step will help motivate everyone at your clinic to do their part, whether big or small, to help deliver COD care.
Goals
- Motivate clinical staff to buy into a shared vision and objectives
- Identify key personnel to oversee implementation
- Empower staff to understand their roles and deliver COD care
Who
- Clinic Leaders
What you'll need
- COD Care Kickoff Meeting Agenda (PDF)
- Staff Engagement Guide (PDF)
- COD Change Team Personnel Spreadsheet (PDF)
Action Steps
Develop a shared vision
Envision a future in which your clinic staff works together to screen and treat clients with COD.
As a Clinic Leader, you’ll need to motivate your staff to rally around a shared vision for the future of COD care at your clinic to make it happen.
What is a shared vision?
A shared vision is a goal for the future COD care environment at your clinic, shared collectively among everyone on your staff. This vision should be revisited and referenced throughout the course of your program implementation process and beyond.
Quick Tip
Define a vision statement so that goals and motivations are clear to the entire team. Here’s an example:
“Every person served with a co-occurring substance use disorder will be assessed and, if appropriate, offered and provided with state-of-the-art treatment with medication, along with recovery support services in a client-centered manner.”
Adding key objectives to your vision statement can help clarify specific goals that are informed by evidence-based practices and are appropriate for your unique clinic. For instance,
“Each nurse on staff will receive training to deliver naltrexone injections.”
Why is a shared vision important?
A shared vision clarifies the general direction for change within your clinic.
A powerful vision focuses on what needs to be achieved and helps clinical staff understand the driving motivation of the process changes that will eventually be implemented. The vision also helps illuminate differences in beliefs and opinions among the clinical staff about the changes being proposed, providing an opportunity to resolve potential conflicts before they materialize.
Obtaining buy-in from your staff is crucial to implementing a successful COD care program. Without a shared vision, teams run the risk of internal conflict, differing opinions on strategies, and lack of role clarity.
Engage your staff
COD care should become everyone’s responsibility
Implementing and sustaining a successful vision requires actively involving staff in the vision’s implementation, including any potential concerns they may have.
Begin by creating a strategy to engage your team, and tailor it to account for issues that may be unique to them.
Host a kickoff meeting
An easy way to engage staff with your shared vision is through team meetings.
Investing this time early in the process will help ensure that your clinical staff support the project goals, understand Clinic Leaders’ expectations, and have a sense of ownership and pride as the vision slowly comes to fruition in the clinic.
Securing staff buy-in will not only lead to the long-term sustainability of the vision but also aid in a smoother transition to integrating COD care in your clinic.
Resources
These guides could help inform your strategy to engage your staff.
- COD Care Kickoff Meeting Agenda (PDF)
Introduce your staff to the new COD-alcohol and/or COD-opioid care process and its goals, vision, and importance and identify potential staff concerns and areas for staff contribution.
- Staff Engagement Guide (PDF)
Facilitate a discussion between Clinic Leaders and staff about potential barriers, concerns, and areas for involvement in the vision’s implementation.
Be transparent and collaborative
It is important to revisit the shared vision regularly to keep an open and transparent dialogue among your staff. It is especially important any time the staff’s working conditions change, including through existing initiatives, the addition of new initiatives, changes in scope or goals, or the entry and exit of staff members.
Quick Tip
It helps to be clear with staff about exactly why COD pharmacotherapy and supportive care is so important. For tips and talking points on the value of COD care, visit this toolkit’s About page.
Build a COD Change Team
Now that your staff understands the plan and purpose of integrating a COD pharmacotherapy and supportive care program, it’s time to identify the people who will bring your vision to life.
Each member of your team should be educated on the contents of this toolkit and their discipline’s clinical role in the new process. It’s also important for them to be familiar with evidence-based practices that are relevant to their roles.
COD Change Team
Identify the people who will bring the COD care program vision to life.
Program Advocates
For smaller clinics, one individual may serve as both the COD Champion and COD Change Team Leader, and for larger clinics, you may want one or two of each.
Treatment Team
The COD Change Team includes representatives from your Treatment Team who are involved in executing COD care at your clinic. The team is made up of a Clinic Leader, Primary Clinician, Prescriber, Nurse, Substance Abuse Disorder Counselor, and Peer Support Specialist. Each member of the COD Change Team will be responsible for representing the considerations, concerns, and perspectives of all staff members on the Treatment Team.
Appoint a COD Champion
The COD Champion is an advocate for the successful implementation of COD pharmacotherapy and supportive care at your clinic. They provide support for the overall transition to COD care integration, including both team-building and technical support.
Clinic Leaders should select someone on the staff in a supervisory role to become the COD Champion. The COD Champion may work across clinics or be a supervisor within one clinic.
Quick Tip
You may want to identify a COD Champion from both the administrative and clinical staff to encourage active engagement across teams.
Appoint a COD Change Team Leader
To make your vision of COD care a reality at your clinic, you’ll need to appoint a small, core COD Change Team that will help plan, launch, and monitor COD care.
First, you’ll need to select someone to lead this team. The COD Change Team Leader can be the same person as your COD Champion.
The COD Change Team Leader is responsible for coordinating pre-launch planning activities, coordinating trainings, and facilitating and monitoring the project’s implementation post-launch. A COD Champion may also support these activities if they are not also serving as the COD Change Team Leader.
For smaller clinics, one individual may serve as both the COD Champion and COD Change Team Leader, and for larger clinics, you may want one or two of each.
Designate representatives from your Treatment Team to serve on the COD Change Team
The COD Change Team consists of representatives from your Treatment Team. Each member of the COD Change Team will be responsible for representing the considerations, concerns, and perspectives of their Treatment Team colleagues.
Each Treatment Team representative on the COD Change Team is vital to ensuring that the whole clinic is effectively meeting project goals and the expected outcomes outlined in the vision. It is important that COD care is integrated into the overall workflow of the clinic and not put in a separate silo.
The composition of the COD Change Team will vary depending on what works best for your clinic. Although we list specific roles and responsibilities associated with these team members, smaller clinics may adapt or consolidate responsibilities among staff you already have at your clinic. It is also important to think of ways to ensure that Clinic Leaders are involved by having them as members of the COD Change Team or by designing a system to inform them about your efforts.
Resource
Use this spreadsheet to document potential members of the COD Change Team to represent staff from the Treatment Team:
The spreadsheet will help the COD Champion or Clinic Leaders document potential candidates for each role, schedule one-on-one discussions about expectations, gauge interest, and determine best fit.
Meeting candidates individually allows potential COD Change Team members to ask questions and voice their concerns about the role and helps the COD Champion or Clinic Leaders evaluate personality and communication compatibility.
Treatment Team
The successful delivery of COD pharmacotherapy and supportive care relies to a great extent on each member of the COD Change Team and the Treatment Team groups they represent understanding their roles and having the knowledge and skills necessary to fulfill those roles.
The team is in charge of overseeing the diagnosis and treatment plan for clients with COD. The composition of this team will vary depending on the resources and staffing available at your clinic. The key feature of this team is that it is collaborative, efficient, and client-focused.
Quick Tip
When reviewing Treatment Team descriptions, please keep in mind any staff or resource limitations your clinic may have. This will help you identify potential gaps in the implementation process later on.
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Clinic Leaders
Clinic Leaders refers to the Clinic Director and Lead Department or Program Staff. Clinic Leaders play an important role in supporting change and motivating staff, making decisions about staff and resources as they relate to COD care, and setting up the COD care program for success.
COD Change Team Representative
A Clinic Leader may also serve as the COD Champion. An administrative representative could bring a valuable perspective to the COD Change Team. The Clinic Leader
- participates in team-building processes and the development of specific implementation plans.
- encourages their colleagues to participate in planning, training, and other activities, as appropriate.
- participates in the review of post-launch metrics to evaluate program success and help brainstorm solutions to areas of the program that need adjustment.
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Primary Clinician
Each client will have a Primary Clinician who is tasked with the following: identifying new or existing clients with COD-alcohol and/or COD-opioid, regularly screening for and assessing COD, arranging for or providing urgent withdrawal management, conducting a brief intervention, initiating shared decisionmaking in the treatment plan with clients, providing information on specialty COD care, and arranging or providing individual or group treatment.
Possible staff that can fulfill this role include
- psychiatrists
- nurses
- psychologists
- licensed clinical social workers (LCSWs, LICSWs)
- marriage and family therapists (MFTs).
The specific staff members assigned this role can vary depending on the resources available at your clinic and your clinic's daily workflow processes.
COD Change Team Representative
The ideal candidate is a Clinician who is supportive of implementing COD care, has some familiarity with COD treatments, and can influence other medical providers in the organization. The Clinician
- participates in team-building processes and the development of specific implementation plans
- encourages their colleagues to participate in planning, training, and other activities, as appropriate
- participates in the review of post-launch metrics to evaluate program success and help brainstorm solutions to areas of the program that need adjustment.
A social worker representative should define the treatment plan elements that include COD care implementation procedures, provide solutions to overcome barriers to COD care, and support COD care program evaluation processes.
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Prescribers
A Prescriber could be a physician, psychiatrist, nurse practitioner, or physician assistant who is licensed to order and/or prescribe a wide variety of treatments, including psychotherapy, medications, and psychosocial interventions.
COD Change Team Representative
The ideal candidate is a Prescriber or other Clinician who is supportive of implementing COD pharmacotherapy, has some familiarity with COD pharmacotherapy, and can influence medical providers in the organization. The Prescriber
- participates in team-building processes and the development of specific implementation plans
- encourages their colleagues to participate in planning, training, and other activities, as appropriate
- participates in the review of post-launch metrics to evaluate program success and help brainstorm solutions to areas of the program that need adjustment.
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Nursing Staff
For clients with COD, Nursing Staff tasks could include sample collection for and ordering of laboratory tests along with medication administration (i.e., injections, oral medications). With each client interaction, nurses are expected to provide a brief client assessment, apply nursing judgment, and update the treatment plan as needed. Nurses also educate clients on the prevention and management of chronic health conditions.
COD Change Team Representative
The ideal candidate for this role is a Nurse who is already an established member of the care team at the clinic and who has familiarity with COD. Nursing Staff
- participate in the development of the nursing-specific COD care process
- inform each care process relevant to the client care experience
- increase the involvement of nurses in implementing COD care
- support program evaluation.
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Substance Use Disorder (SUD) Counselor
SUD Counselors function as support for the Primary Clinician. In many mental health systems, SUD Counselors do not carry a case load. SUD Counselors may co-facilitate didactic, psycho-education groups and participate with the treatment team in developing, implementing, and evaluating the treatment plan. They are generally able to provide outreach and make connections to SUD services in the community, support clients attending Alcoholics Anonymous, Narcotics Anonymous, or 12-step meetings, and connect clients to sponsors. SUD Counselors may work one-on-one with clients to increase readiness for COD care and to prevent relapse by assisting the client in developing appropriate coping behaviors. Licensing and credentialing requirements may vary. In some clinics, the role of the SUD Counselor and the Peer Support Specialist may be performed by the same person.
COD Change Team Representative
The ideal candidate for this role is an experienced SUD Counselor who collaborates effectively across internal clinical disciplines and external community organizations. SUD Counselors
- act as key mentors on the implementation of COD care at the client, clinic, and community levels.
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Peer Support Specialists
Peer Support Specialists are designated staff members who have identified themselves as living with COD. They provide experience, strength, and support to clients during all phases of treatment and recovery support. Peer Support Specialists may include family members, community members, or friends affected by COD. Peer Support Specialists engage in a wide variety of activities, including the provision of resources, community- and relationship-building, group facilitation, skill-building, mentoring, and goal setting. They may also plan and develop groups, services, or activities; provide training; gather information on resources; administer programs or agencies; educate the public and policymakers; and work to raise awareness. In some clinics, the role of the SUD Counselor and the Peer Support Specialist may be performed by the same person.
COD Change Team Representative
The ideal candidate is a peer or family member who already works as a Peer Support Specialist on your staff. If your staff does not have any Peer Support Specialists, look for clients and family members who have had recent care experiences at your clinic and who are interested in helping make improvements. Peer Support Specialists
- provide a critical connection to client and family perspectives, needs, and concerns
- communicate with other team members on specific issues related to engagement and ongoing recovery and life goal support.