Addiction Treatment Starts Here (ATSH) Learning Network - Application Submission Form

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Background

ATSH is a program of the Center for Care Innovations (CCI). CCI created an 18-month Learning Network for previous Addiction Treatment Starts Here and Treating Addiction in the Primary Care Safety Net (TAPC) teams. The Learning Network will serve as a continuation of the journey that teams began in TAPC or ATSH. It will focus on learning, sharing best practices, and taking action and is an opportunity to expand and elevate the MAT work undertaken thus far. Multiple sites within the same organization may apply but we ask that each site complete its own application. Applications for the Learning Network must be submitted by 5 pm PT on January 19, 2021. Please refer to the ATSH Learning Network Request for Applications (RFA) for details about the program and participation requirements. 


If you are interested in applying for CCI's other offering, the Addiction Treatment Starts Here Learning Collaborative, you can access the application form here


Organization Overview













Racial/Ethnic Data






Site Specific Characteristics



For Each of the Options Below, Enter the Number of Patients at Your Site With Stimulant Use

Disorder Who Receive the Following Services: If unsure, state "unsure/don't know"







Learning Network Team

Please list the contact information for each member of your anticipated team. At least two individuals are required to participate in the Learning Network to promote continuity. Ideally, participants are a combination of individuals who can take ideas and put them in practice and individuals who can support the spread of ideas gained in the Learning Network to others in their organization. We typically see a combination of 2 - 4 individuals who represent clinician champions, front-line staff champions, and MAT program managers. We recognize that some roles may overlap, so you may list the same person for more than one role. 

Program Lead Contact Info

The program lead contact will serve as the point person for communication with CCI and for day-to-day management of ATSH-related program activities. This may include reminding team members about upcoming events, participating in evaluation-related interviews and discussions, and other activities.







Other Team Member Contact Info

Please add your other team member's contact information below. To add another team member, click the blue "add another learning network team member" link below. 









Application Components

Please keep your responses to the following questions as brief as required to describe your organization. Please note that some of the questions below are to help us better understand the potential capabilities of the Learning Network and interest areas -- they may not necessarily influence decisions about your application. 


1. Describe the current state of MAT implementation within your site. In your response, please address: 

















2. What are the three biggest challenges your site currently faces with your MAT program? 




3. Define your goals for Learning Network participation: 





Additional Opportunity (Learning Network + Peer Mentorship)

CCI seeks up to 10 “peer mentor teams” for the next wave of the Addiction Treatment Starts Here Learning Collaborative. Peer mentor teams participate in the Learning Network and also receive a stipend to provide support and guidance to Learning Collaborative teams. We define peer mentor teams as approximately 2-4 people within a clinic site that would serve as faculty for Collaborative learning sessions and webinars (based on areas of expertise), provide informal coaching to teams new to providing MAT, and offer feedback and guidance in other ways. 


Your peer mentor team is the same as your Learning Network team. While applying as a team, support to Learning Collaborative teams can occur in group or individual settings (e.g., prescriber to prescriber discussions). CCI is able to provide a stipend of up to $10,000 for peer mentors (in addition to travel expenses as applicable). We anticipate that peer mentor teams would devote about 20-25 hours to mentoring activities over the course of the program.


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