between grants and the advancement of our field, and the symposium that we're going to be talking about this year is going to address how SAMHSA can help move the field forward. The symposium is named What is Your Kryptonite? How to Boost Your Superpowers, and it's chaired by our fearless leader, Catherine Gates- Russell. So for those of you who don't know Catherine, Catherine is the CEO and the Executive Director of AAAP. She leads multiple federally funded grants including the PCSS grant, and she was the Associate Director of Brown University Center for Alcohol and Addiction Studies, and the Executive Director of the Physicians and Lawyers for National Drug Policy. So thank you Catherine. Okay folks, we're going to take a different turn here. It's good to see you all, very excited about the various opportunities. But also I would just want to take a moment to remind you, you are superheroes already, and I don't think you acknowledge that, and you do really amazing things for a lot of people, so you need to give yourself a round of applause first. This is an opportunity to give you ways that you can better enhance what you do and have resources to support you, and not only what you're doing, but others as well. So we want to give this as an opportunity, one, to let you know what we've been doing on behalf of the Academy, but also to get you involved. Quite a few of you are already helping us, which is awesome, but there's a lot more that you can do. And particularly around the opioid response network, that's a local driven type of opportunity, and more times than not we hear primary care say they don't want to get involved because they don't have anybody to help with behavioral health issues. Psychiatrists won't talk with them. So as he said, here are the presenters. I'm fortunate to have three of our superstars that are working with us feverishly with each of the grants, and we're going to give you a quick overview. So I have no disclosures, so that makes it easy. We are, all these grants are funded by the Substance Abuse and Mental Health Services. We've been very fortunate, and we hope to continue in that vein. The first project we're going to talk about, most of you I think have heard about it. Has everybody, how many know about the PCSS project? Hopefully more, you should. Everybody here, we've had it for 18 years. It really is at the hallmark of getting information and training for health professionals. One of the learning objectives to describe the resources, examine ways TA can be implemented, and demonstrate how TA can lead to an implementation of evidence-based practices in a variety of settings. The thing to differentiate PCSS-MAUD from the other grants is PCSS is built to be a support system, as it says, only for health professionals. Now more recently we've brought in the recovery community and other groups, which is great, but it really is to make up for what hasn't happened in health professional training. So our mission is to increase health care providers' knowledge, skills, comfort level. Comfort level, very important, because you can teach them, but if they're not comfortable working in this field with this population, they won't. With patients and evidence-based practices and prevention, identification, treatment, recovery, harm reduction, and substance use disorder with a focus on opioid use disorders and stimulant use disorders. But we do all the other substances and co-occurring psychiatric disorders. Our target audience, all health professionals. If you look at our website at PCSSMAUD.org, you'll see it's physicians, it's nurse practitioners, it's PAs, it's social workers, it's dentists. Now we've brought in counselors. So we really want to do the whole approach, because it's not just about one particular area. Even though you folks are like the dream team, you have to work with others. And if they're not on board, things are not going to all happen. And so we need to be very mindful. And AAAP invests a lot in being an interprofessional accredited provider, so we can train everybody together to address things. So our steering committee, and I'll just briefly go, is we have about, I think, close to 40 partner organizations. If you don't know me, the one thing I want you to leave here is I'm a coalition builder. I'm all about bringing people together, building networks, because it's not just one group, it's not just one person, it's not one discipline. It's all of us coming together. I'm from the South. I'm from North Carolina. I was brought up Sunday, you go to your grandparents, everybody brings their dish, you bring what you're best at. My mother was best at tomato sandwiches and fried chicken. That's what she brought. But somebody else was best at dessert. Everybody comes in together as a village, and everybody supports each other in any way they can. That's what makes me up, is to have coalitions and networks. So here's just a sampling of our steering committee members. I will not go through all of them. It's pretty much all of medicine, and we have the American Dental Association for a while. They've been very involved. We have the AMA, we have the orthopedics, we have a much broader group than we've ever dealt with, but we've also brought in like the National Association of Social Workers. We have to work with these people. We have to learn how to build relationships, and as long as we can come together, we share the resources of the money that we have for the PCSS as the coordinating site and the recipient, but they're out there doing this in the name of their organizations. Their members are going to come to them. They're not going to come to addiction psychiatry. They don't even know we exist, but we're all coming together and learning from each other how we can support them. So we give them money to do what they feel their members need, and that works out really well. More groups that we've brought in. We've brought in some other recovery groups, Black Faces and Black Voices, Faces and Voices of Recovery, Mobilize Recovery, Public Health Foundation, so much broader. The more groups we can bring in, the better. So just take a chance when you take a moment, when you get a chance, and go to the website. If you haven't, really get involved. There's lots of opportunities there. So I'm going to turn it over to Frances Levin. She's our medical director. She's my partner in crime. She's the medical director for all the projects that I work on. I'm the PI of each of these grants. That just means I'm responsible for getting things done. Everybody else does the work. So this is Frances. Thanks, Catherine. So this has been such a pleasure for me. You know, I came more from being a clinician than an academic, and I would say in the last 10-12 years I've been involved both in the PCSS and ORN, and it's probably one of the most gratifying things that I've done, and it's also gratifying to see how many people in the country have begun to realize that this is a great resource for them. So it's interesting. We started off, it's just sort of the way things work, we started off calling ourselves the PCSS Buprenorphine, where the focus was primarily on providing buprenorphine training, and then it expanded by 2014 when we submitted the grant. It became the PCSS Opiates, PCSS Medications for Addiction Treatment. That's a little of a misnomer because we actually were MASH, which was Medication Assisted Treatment, and as you well know, that terminology has been replaced because the idea is that medications for treatment of opiate use disorder really is central, and to call it assisted suggested that maybe you should consider it but not do it, and I think the field has really changed in that way, such as now the terminology is Medications for Opiate Use Disorder, and that encompasses not just buprenorphine but also methadone and naltrexone. Also what's happened in terms of a shift is the target audience. So initially the grant was called Physicians Clinical Support System, which then morphed to Prescriber Clinical Support System, which morphed again to Provider Clinical Support System, with the idea that this is not just about training physicians or PAs or nurse practitioners, but also social workers, recovery coaches, and a wide range of health professionals that may be working with individuals, particularly with opiate use disorders. So the other big issue that came up is we really got branded as, you know, PCSS does buprenorphine waivers and that's all you do, and there was some question about the persistence of the grant and whether we should continue to get it, and of course what happened or what changed was that even though the waiver went away, there still was this mandatory training that's required through the DA, and I guess we were also smart enough in that people recognized that what we were offering would apply to that, so actually the PCSS waiver program became the buprenorphine training program. So it's no longer a waiver, but it provides the requirements, what you need if you want to get your DA renewed or if you're applying for the first time. So this became a real boon because people can come to the site, it's totally free of charge, and really my medical colleagues have been ecstatic about this because many of them have needed to get this training and to be able to come to the PCS website and get that training for free in a variety of ways, either taking the buprenorphine training or they can do part of the PCSS curriculums, which you're going to hear about, curricula from Kevin Severino, so there's a variety of ways that you can meet the requirements, and it's a one-stop shopping. You can get onto the website and do it, and so a lot of residency programs, it's really taken off, and so you see in 2003, we actually had more people taking the buprenorphine training than we had in any other previous year, and it still has persisted into 2024, and we're not yet even done with the end of this year. So what do we have to offer? Well again, all I can do is say please go to the website, because what you'll find is there are live webinars, there's on-demand webinars, there's modules, there are partners, live partner and demand webinars that are provided by our partner organizations as well as PCSS Exchange. There's a tremendous amount of opportunity there, and we've just redone a repository in which the way you can access a range of interests that you might have. Today we've trained over 124,000 participants with the online training, which is a huge number of individuals, and we also have this new program, which is not so new anymore, which is the PCSS MOUD Exchange, and what this provides is ongoing training. It's a four-week course. It helps health care providers feel more confident, because one of the things Catherine just mentioned is while we can provide this training, people often don't feel comfortable, particularly if they haven't been trained in addictions. So what we do is we provide four lectures, four course module trainings, in which we teach about the treatment of MOUD, how to integrate MOUD into clinical practices, how to develop resources in terms of clinic and clinical workflows, and also to address stigma, because if there's stigma in the clinic or there are doctors who don't want to prescribe or even the front desk, if the front desk is negatively inclined towards individuals with substance use disorders, it's not going to go very far. So all of these topics are covered, and it's very interactive, and it really works at targeting an interprofessional audience, including both prescribers as well as allied health professionals. And again, this is a pretty intense, comprehensive providing of service and training, and we've trained almost 8,000 individuals using this approach. So now I'm going to turn it over to Kevin, who's our medical director of AAAP, because he's also been very actively involved in PCSS, and let him step forward and provide the next few information about PCSS. Thanks, Fran. Thanks, Catherine. I have been involved in AAAP in its coursework and helping direct those and develop courses for many years, and what I was struck by in my, especially CL work at the VA and in a rehab hospital, and now with Hartford HealthCare, is that a lot of the basic concepts that were taught in those courses never seemed to filter down to the frontline clinicians. So we weren't getting the message out. So we were teaching people who were already interested, such as addiction psychiatrists and addiction medicine physicians and advanced practice nurses, but then with general hospitalists and whatnot, the message wasn't getting out. I would ask them, have you ever heard of when they wanted to know some basics about substance use disorder treatment? And what I asked them, have you heard about PCSS? And often they didn't. This is the go-to thing I use when people want to know about CME for both SUD training and for some chronic pain issues, is I refer them to PCSS. And I hope that you can also disseminate the knowledge that PCSS exists and some of the programs that you're going to hear about today that PCSS has. I mean, ultimately the goal would be to make this the Amazon Prime of getting out knowledge about substance use disorders. So one of the programs, PCSS implementation, is very important. Many of the surveys that have looked at what keeps people from prescribing buprenorphine or other MUDs, even if they've had the buprenorphine waiver training in the past, and the two most common things were feeling there was lack of administrative support or feeling that the providers themselves didn't feel competent in prescribing. And so what PCSS implementation is meant to do is to go out at the level of different programs and to provide the resources, hook them up with the resources, and provide the training so that they then can provide MUDs such as buprenorphine prescribing. So the implementation goals with PCSS are to identify the barriers in the particular areas and to deliver the education on SUD and MUD appropriate for all staff, both administrative staff and the prescribers. Support the integration of SUD services into clinic workflow, which is something that's always been a barrier. They say, well, how do we bill for it? How do we get the staff for it? What staff can we use for it? And the ultimate goal is then increase the number of patients that get MUD, evidence-based MUD. And then, with the knowledge we gather with PCSS implementation, develop nationalized, centralized portal, which will have resources that people then can go to. The nuts and bolts of it, basically, there are clinical sites that request and are selected to make a six-month commitment to the PCSS implementation. And then the clinical experts will meet with the full team monthly and find out not only the barriers and then develop ways to overcome those barriers. Most importantly, each, just like with anything that you'll find in your health care systems, each site really needs a champion that wants to get this moving. And that local champion then develops a team around them with which we work. So far, it's worked with 22. PCSS has worked with 22 clinical sites, and it goes all the way from New Hampshire down to Florida, out to Oregon. The next two sites are, I think, in Kansas and, yeah, Kansas and Oregon. The next thing you should be aware of is the mentoring program that PCSS has. That gives you a group of nationally trained clinical experts that anybody can access at any time. You can do it through the discussion forum, which usually occurs about once a month. You can do it through, you get onto the site and you can ask a clinical question. And then within about, usually within a week, but hopefully a few days, you'll get an answer from one of the rotating mentors. And there is one-on-one mentoring. There are 202 mentors that work with PCSS of different medical specialties. And so far, they've worked with 752 mentees. So these are all ways not only to just go on to an online module, but to get actual help in prescribing. This actually kind of jumps the gun a little. It shows you the total participants we have. So far, 337, 820 participants. And given the recent national election, we can do a recount on that if you want. But there are not only the many webinars and online modules that we have, but then more personable would be the clinical roundtables, which occur about once a month. And then finally, the mentor program. Two things I'm particularly proud of and have been involved with in PCSS has done a great job on are their two bundled courses. One is called SUD 101, and you can see here the different online modules and speakers that are available. It's an incredible list of experts. And it ranges all the way from general neurobiology, all the way through things like treatment of TUD, all the important opiate use disorder, cannabis use disorder, stimulant use disorder, etc. Then it goes on to mutual help groups and lab assessment, opioids for pain, and all the way through 28 modules. It's a great resource. And actually, we've actually had some healthcare systems use this as their primary training tool. An area of particular interest for me is the overlap between addictions and chronic pain. So we also have a PCSS pain curriculum. Roger Chow, Melissa Weimer, and I have been involved in keeping this up to date. It's being currently updated now. And you can see here the list of those modules as well. And then finally, we have clinical roundtables. We've had over 40,000 participants so far. These actually have been sometimes moved all the way up during COVID to three or four times a week, but now it's more like two a month. But these are very good discussions that you can sign up for. And then now we have PCSS office hours, which have been on Friday afternoons, but there are now going to be some on Wednesday afternoons as well, where a lead mentor such as myself opens up a one-hour session that you can call into, or I should say zoom into, zoom in and out of. And these really are times besides the ask a question format to get your questions answered. And we try, it's very important to address health disparities with PCSS MOUD goals, to have case-based learnings, to share evidence-based and practice-based approaches, focusing on underrepresented minority communities such as the black communities. So far, 561 have attended the first iteration. And this upcoming year is going to focus a bit on Hispanic and Latinx communities. And now I'm going to turn it back over to Catherine. She's going to discuss the Opioid Response Network. Hopefully, you're taking lots of notes and figuring out ways you can make use of this, but also get involved. There are lots of opportunities for you. The Opioid Response Network, it's actually called the State Opioid Response Technical Assistance. Originally, it was set up to be the support system for state opioid grantees. That was the basis of it. And two days before we got the funding, I got a call from SAMHSA, and they said, oh, we changed the model. We not only want you to do all the grantees, we want you to do anybody in the country. And I went, what do you mean anybody in the country? And they said, all states and all territories. And I'm like, but that's not what we set up. And they said, well, we're going to change it. So one of the first requests we got was for a grandmother in Rhode Island. And I was like, a grandmother? I like grandmothers, but I don't know what to do with grandmothers. But you're going to learn a little bit how this is supposed to be really focusing on the community. The thing about ORN is I wanted to take, my idea was taking what we've been doing very well in PCSS, but bigger and broader. We needed to, we collaborate very closely with Francis' team at Columbia and the University of Missouri Kansas City with the ATTCs. If you're familiar with the ATTCs, they have the Addiction Technology Transfer Center. They are already in the states. They're on the ground working with the single state agencies. They already are familiar with them. I don't want to recreate the wheel. I don't want to waste resources. I don't want to compete. I want us to capitalize on what we have and find gaps that we can fill. So the three groups, AAAP and Columbia and UMKC work together on being the leadership team. That's who writes the grants and puts it together. And then from there, we took the PCSS partners, but we broadened it out because it's not just health professionals now. It's prevention, treatment, recovery and harm reduction and beyond. I feel very strongly in working with the legal community because I've done a lot of work with judges. And if you don't get them talking the same language, it's not going to go because most often people think about the legal consequences of addiction and substance use more than they do the medical. So we brought in the National Judicial College that teaches all the state judges. We brought in family court judges, prosecutors, defense attorneys. So it's really important for us to broaden out who we talk to because often we just talk to ourselves a lot. So here are our partners. We have over 50. And we'll continue to add more to fill other gaps. And I think it's really important if there are other groups. And again, yes, people ask, oh, how much was the grant? The grant was $54 million, yes, over three years. A lot of money, no question. AAAP is not flush with cash now. Everybody goes, oh, you have all this money. No, we don't. We have a lot of work and coordination because we share it with these groups. And we go to them and say, okay, the American Heart Association, I would never have thought us working with the American Heart Association. They have been one of the best partners because they're really putting it into mainstream. Their project is to work with black and Hispanic churches and teaching the churches how to talk about smoking cessation and the use of naloxone. So boom, okay, here's money for you to do that. Other groups are doing black faces and black voices. They're bringing together communities to, they call them, it's like a dinner but we don't provide food. But it's people getting together in a community talking and sharing information the way they want to learn it, through their elders and others in the community. We've brought in the indigenous community. So we have a whole group of people, very broad and across the board, to get us all saying the same thing and sharing with each other. So how does it work? This is a two-minute video. It's going to give you a very succinct overview of what ORN is. And I hope it works. Teens across the nation are mobilizing to address opioid and stimulant use and the overdose crisis. You can't overcome this alone, but we can, together. And we are. We are the Opioid Response Network, a coalition of 40 national organizations representing more than 2 million people. We serve all 50 states and 9 territories locally through our network of nearly 1,000 professionals working across prevention, treatment, and recovery. For state agencies, organizations big and small, and individuals working to address local needs, we bring training and education to bear on your efforts. We're here to help you help others through evidence-based support, all at no cost to you. For instance, the Opioid Response Network helped the tribal college in New Mexico join forces with local organizations to develop a culturally appropriate prevention, treatment, and recovery training series for its students. In Rhode Island, we convened correction staff from 34 states to share how our program had reduced post-incarceration overdose deaths by more than 60% and supported them in their efforts to build similar programs in their home states. In West Virginia, we mobilized to help a clinic incorporate substance use disorder services into their practice, serving a faith-based community. We helped health care providers in South Dakota address barriers they face providing treatment services for their patients. We're here to help those on the front lines. So, what are your needs and how can we help? Visit theopioidresponsenetwork.org to learn more and to submit a request for support. The Opioid Response Network, funded by the Substance Abuse and Mental Health Services Administration. So, hopefully that'll give you an idea of the kinds of things. We trained over 600 clinical staff in all the states in California jails on motivational interviewing. We Skyped with people in Anchorage, Alaska on building systems. So, it's a very broad, sometimes very brief, but people like you are ideal. I know you're overwhelmed, but you have fellows, you have colleagues. We pay everybody the same. You have 20 years of recovery, you get $100 an hour as a consultant. You're an addictions specialist, you get $100 an hour, because everybody comes at different perspectives and different needs. And we are really trying to build sustainability in looking at the local needs. So, if you have people that might be interested in getting involved, you can let us know. But Frances is going to go and tell you a little bit more about what we've done with ORN and what we've learned. But there are opportunities and ways that you can take advantage yourself. If you don't want to be a consultant, you can put in a request and you can get support to have things happen for you. Thanks, Katherine. Glad we're going back and forth here. Okay. So, the request system. The goal is to provide education, training, and consultation, which we describe or is known as technical assistance. And we have these designated local technology transfer specialists, which I'm going to call TTSs from now on, that facilitate this work. The goal is to really streamline efforts and fill gaps where needed to address the local needs and to build sustainability. That's a very important thing that we've been charged with is not and why we're working with local communities. I mean, it's easy if somebody in New York could help somebody in South Dakota. But the idea is to find local networks so that those can be accessed and be something that can continue even if the grant at some point ended. How do you do a request and what is done with a request? Well, it's basically there to offer evidence-based practices in harm reduction, prevention, treatment, and recovery of substance use disorders. So, there's now a focus on harm reduction, which was not the case with the earlier grants. And also, not simply a focus on opioids, but also on stimulants. And all of this is provided at no cost, which is really something that I think is fairly remarkable. ORN is available for everyone. Like Katherine said, it was really focused initially we thought for single state agencies, that governmental agencies. And we were quickly told when we got the grant that we really had to work much beyond that. So, working with tribal organizations, work with cities, counties, and government, community organizations and coalitions and organizations that are both big and strong, as well as individuals who are health professionals and peer specialists and advocates. So, it's really a very broad, much broader than actually PCSS is. And we really have to be available for anyone. So, anybody who contacts us, our job is to find out what their needs are and provide technical assistance, if it makes sense. How do you do a request? Well, it's really quite simple. You go to the website. Anyone can make a request. And a request is triaged to a designated TTS individual who then finds the request and works with them. The TTSS is located or assigned for a specific state and territory. The requester is contacted, which is fairly remarkable, within one business day. And then they schedule a day or a time to discuss their needs. So, it's very responsive. You don't wait for weeks. It happens right away at the convenience of both the requester and the work of the person who's going to provide the technical assistance. Here are some examples, just to give you an idea. You already heard the examples on the video. But, for example, in terms of prevention, there was requests that come in that like to train family members or colleagues about the use of naloxone or Narcan. Guidance on how to create a prevention curriculum in schools. Steps to create effective community awareness and anti-stigma campaigns. This is all prevention TAs. In terms of treatment TAs, this might be something that you might be more acquainted with. How to expand telehealth services to expand access to treatment. How to provide MOUD in rural and tribal communities. How to screen for suicide and self-harm, which is often very much associated, as we all know, with substance use disorders. And also the basics, which a lot of people still need, and how to provide the three FDA-approved medications for opiate use disorders, being methadone, naltrexone, and buprenorphine. Recovery examples, educating staff on MOUD and their role in recovery. How to expand recovery support in rural areas. How to create peer recovery services. And how to even train recovery coach models. What kind of coach models are out there, and what can we do to help provide the technical assistance in that area as well? Harm reduction, building community-centered support. The use of fentanyl test strips and other drug-checking equipment. People need the basics and need to get into the weeds of understanding how to use those test strips. Trauma-informed practices with people who are unhoused and frequently also suffer from substance use disorders. And developing syringe exchange programs. These are all the kinds of TA requests that we've gotten. So what's been going on? Well, the TA requests continue to increase. We've had almost 8,000 TA requests in total today. And as you can see with each grant year, the requests have come in and have gone greater. And I think that's because of this outreach and people becoming more and more aware of what ORN can offer. We've had almost 60,000 participants in ORN activities just in the last two years. Most of them are individual TA requests. But we also have partners who have also done a lot of activities, both summits and other kinds of activities and trainings in their communities as well as regional summits. So we've had a lot of individuals involved in getting the TA that they need through various approaches or various ways that we offer the TA in our system. In terms of satisfaction with the program, we rate, we ask people to rate their satisfaction from 1 to 10. And happily, most people are rating things in the high 9s. Some of the questions we ask is, would you recommend a training like this to others doing similar work? 9.5. How satisfied were you with how the presenter presented the material? 9.4. And how satisfied with the materials themselves? 9.3. One of the initiatives we're going to be doing in the next iteration of the ORN is develop an out-facing repository for family members and other people who might want to access that to have more materials directly available for them. So if you want to submit a text, here's a QR code. You can take a picture of it if you want or just simply go to the website and you can easily get there. And I've been very gratified and honored that I've been able to be part of this and work with Catherine for the last six, seven years on this project. So thank you and please use the site and please go to it. Thank you all so much. I am bringing up the rear and I'll make sure that we have time for questions. It's a pleasure to really be on the panel here with Dr. Levin, of course Catherine, and also Dr. Severino. This is my professional home. I first came to AAAP as a travel awardee. So to be able to come and actually present a mini-symposium is quite fulfilling. So I'm grateful. So the program that I am going to talk about is really one that centers equity but also really focuses on increasing diversity in terms of racial and ethnic diversity in the types of addiction leaders that we have. So the program is called REACH, Recognizing and Eliminating Disparities in Addiction through Culturally Informed Health Care. And this is a picture of both mentors that are a part of AAAP but also part of the scholars that were a part of our inaugural cohort. And this idea for the grant really came from the statistics and we published a paper in 2018 looking at all of the addiction psychiatrists, addiction medicine, but then also breaking down by racial and ethnic minoritized communities and the numbers were surprisingly for me quite dismal in terms of less than 1% of addiction leaders were from historically excluded backgrounds. So really partnering with Catherine, she was very excited about writing this grant with SAMHSA, I was at Yale at the time, to really figure out how can we increase the amount of racial and ethnic minoritized addiction leaders but also realizing that we had to form partnerships with majority addiction specialists as well to be able to really understand topics specific for people from racial and ethnic minoritized backgrounds. So skip to we've been doing REACH for six years, this is the sixth year, this is from the picture you can see, I love this picture because it just shows the difference of how we've come from really here, here to here in terms of really just seeing so many black and brown faces and these are all trainees both from addiction medicine, addiction psychiatry, many different subspecialties within medicine as well as physician associates and advanced nurse practitioners who all came to Puerto Rico for an intensive of how to learn specifically about culturally informed care. So some of those topics include things like how does colonization impact how we teach substance use, right? How does race and racism impact who gets care? Why does the mainstream media continue to talk about the dip in opioid overdose death when that's really focused on white people only and totally regards the increased death among black, Latinx, and indigenous people? Why do we have access to medication for opioid use disorder but our profession are least likely to prescribe MOUD to black and other racial minority communities even if they have access to insurance? So these are the topics that we really interrogate and get into with REACH that just still are not found in mainstream curriculum. So again, the goals of REACH are really twofold. Increase the overall number of racial and ethnic minoritized addiction specialists both in addiction psychiatry and addiction medicine but then once we recruit those into the program, how do we train them to specifically work with this population? Just a little bit about the inaugural program. We really tried to target around 20. We got 19 scholars our first year. Now you'll see in the next slide we have trained over 121 addiction specialists but at first we did a one-week intensive course. It was held at Yale. It was 37.5 hours of in-person training. We had the leading experts from historically excluded backgrounds teach the class. We had heavy hitters. And then all of the scholars get funding to implement a project that specifically helps to improve outcomes for racial and ethnic minoritized communities. So these projects are submitted. They're approved by our advisory board and then they get money to actually carry out these projects in their local community. One of the things that I will say and it's really nice to hear about the Opioid Response Network that was described in such detail because many of our REACH scholars now are attending or in private practice and have actually worked with the ORN to provide expert consulting for many communities. So that's a nice collaboration and partnership from there. Just showing that this is the leadership of REACH. Myself, Dr. Petro. She's addiction medicine doctor at Yale. And then of course Catherine. So what does REACH look like now? One of the things we learned from the inaugural cohort of having one-week intensive training is that our program and fellowship directors were not happy with us taking their trainees for an entire week, especially in July. So we said, we hear you. We have to condense that. So we condensed the welcome works up to three days. We knew that was still important for us to gather together. There is a national network now of addiction specialists from historically excluded backgrounds that serve in the model of mentors. And then we have also had many of our early REACH scholars now serve as advisory board members that provide expert consultation in terms of making sure our curriculum is evidence-based and making sure that it meets the needs of our scholars. Every scholar goes through a one-year training experience. So they're doing the REACH program in parallel to their training at their home institution. We have monthly webinars. Those are mandatory. Those are live. And if there's any reason that someone cannot attend, they actually have to email me, tell me why they cannot attend. And then the expectation is that they have to watch the video by Friday of that same week. The lectures happen on Monday. So it's really intentional, but also understanding that this is another curriculum on top of the curriculum that you're already involved in. And we've also added the structure of not just having the REACH mentor, because every single REACH scholar is paired with a mentor. But we also realize in order to really effectively get those scholarly projects done, we had to have a local mentor. So every REACH scholar has both a professional mentor within the REACH network, but also at their home institution. And what was really nice in doing this work is really not having a deep appreciation for the trauma that many of our scholars have to endure with working in predominantly white environments or environments that are not affirming of their humanity, having to deal with not only sexism, but racism and misogyny. So what we did in the third year of the program, like I said, we're in year six. We started in 2018, was we implemented what is called the health and liberation spaces. And these, again, are mandatory. These are executed by Dr. Anru Health. No, I'm not going to. He is a social worker. Mr. Anru Health, but he is a trained licensed clinical social worker and a healer in the West African Yoruba tradition, and really does allow our scholars to have a liberated space to share about their experiences and really process the trauma from being a minoritized person doing this work. Just a few more slides, but this is from our REACH. We had a reunion where we brought cohorts from 2019 to 2024 together in Atlanta. And I'm just showing you that the number of addiction psychiatry fellows, addiction medicine fellows, and then the total number of REACH scholars, which, again, are medical students, APRN students, and PA students over the years. And in total, like I said, to date, we've trained 121 trainees. This is the breakdown of every single cohort. And you can see, as the years have gone by, that we have become more and more diverse and really have been able to recruit from different parts of the nation. And I'll show you that. It's interesting because many of the REACH scholars are here now as presenters, now as mentors themselves. So it's really nice to see the progression of trainees to leaders in the field. I wanted to just pause here for a second because I think this is important, especially in this political climate that we're facing where we are just showing where the predominant amount of REACH scholars are coming from. You can see the coast, a lot from California, the East Coast. And we have really worked hard to expand into the middle of the United States, but we still have more work to do. In terms of looking to the future, one of the things with REACH 2.0 is to really be strategic about recruiting scholars from middle America. And so I almost am pleading with you, if you have a scholar from a racial, ethnic, minoritized background that wants to go on and have a career in addiction and is really committed to equity, please, please, please have them apply for the REACH 2.0 program. I think this is important because in terms of who actually engages in care, it is shown in the literature that representation really does matter. So really thinking about creating the network of scholars that can provide care to people who are non-white, and there is an inherent safety in that. So a green book for the REACH network, per se. OK, I want to make sure that we have time for Q&A, but here I'm just showing you the racial and ethnic minoritized background breakdown of many of our REACH scholars. The predominant group are black. That's the orange. We have a critical mass of Latinx people. That's the reddish orange. And then we have Caucasian, American Indian, and Alaskan Native. And so we're really happy to have over-representation of women in the group, also non-binary. And you can see the breakdown in terms of the medical specialties that we recruit. So where is the REACH program headed? This is our last year with REACH as it exists. And we are going to what's called REACH 2.0 and really thinking about how do we go earlier in the pipeline. REACH, the first one, was really focused on fellows, which was great, but we realized that we needed to pivot much, much earlier and provide a lot of attention to our medical students, grabbing them when they're still a pluripotent stem cell and really pushing them to why a career in addiction is important. Also, we realized that we have to focus more on near peers. So we've added a component of thinking about, yes, it's nice to have people who are established in their career, but how do we partner our medical students and residents with trainees that are coming right out of training in maybe a year or two to provide some closer mentorship. And I'm happy to announce that Dr. Darryl Shorter, who is a AAAP leader, is going to be the director of the near peers. So we're going to continue to provide a space for mentorship and wellness. Unfortunately, in a new iteration, SAMHSA was really clear that we had to focus just on medicine so we no longer have that interdisciplinary network that has to be within medicine or medicine subspecialty. But through partnerships like ORN, I do think that we'll be able to continue with that interdisciplinary care. So with that, I'll end. I love this slide. Together, we can make a difference. And I look forward to answering questions about the symposium. Thank you. So there are quite a few of you that have been involved with each of these initiatives. And I think, hopefully, we can get even more of you. So there's so many opportunities. So even though REACH is not going to be led by AAAP, I am a huge champion for the addiction psychiatry field. And we still continue to have a hard time getting enough people to take advantage of these funding and resources. So if you have people that might be interested in being a part of this, please do. If you have people that might be interested in being involved, get with IANA for the REACH grant. And we'll help and continue to be involved in some capacity. PCSS MOUD and the Opioid Response Network, huge opportunities across the area. And again, if you get requests, we all know you get requests to do things. You don't have the time. You don't have the resources. Send them to ORN. And then we'll pay somebody to come and do the things. Or if you need somebody to come as a speaker to come present a journal club or something, put a request in yourself. So take advantage of it. Your tax dollars are paying for this. And this is all helping you. So again, we don't want to compete with anybody. We don't want to ignore. We don't want to waste resources. We really want to come together, identify gaps, and then try to fill those gaps. So does anybody have any questions? Let us know. I have staff that are going to be outside the door and handing out materials if you don't see and you want to take something home with you. Sit the back, and he'll be happy to share things. So if you have any questions, let us know. There's a question here. I can't see. Oh, hi. Can you hear me? Yeah. OK. My name is Muna Telsom, and I am a chief psychiatry resident at the University of Missouri, so a PGY-3. And I was also cohort five for the REACH program and this year's AAAP awardee. So I was born and raised in Alexandria, Virginia, to parents who are asylum seekers. And through my journey, I've come to understand that the resources available for black residents, especially in Missouri, are largely untapped. And despite having these opportunities for interviews in coastal areas, I chose to remain in Missouri because of these unique challenges and opportunities here. And I have met so many black, especially forensic patients in maximum security hospitals who have been there for over a decade and have never seen a black resident, let alone a black psychiatrist. And this lack of representation motivated me to stay in Missouri, despite having no close ties in Missouri and to serve black patients in rural areas. However, with my work here, I often felt isolated, especially when there are limited resources and few black staff members to help represent and serve this community. So how do programs like the REACH or the Opioid Response Network to help address these gaps? I believe it's crucial not only to recruit and train black psychiatry residents or brown people, but how can we engage and educate psychiatrists from other racial backgrounds, such as white psychiatrists who represent a significant portion in the field of psychiatry? And also, medical director of AAAP, how do you think you could help in this regard to create an equitable mental health care system? I mean, I, listen, Muno, you know, I love you, I adore you. You're a REACH scholar. And I think that all that you said, there's not much more I can add except ashe, ashe, ashe. I mean, there's a lot of work to do. I think that one of the things that we have really tried to do with REACH, and I'm really, really proud of it, of the work is creating spaces where people can be their authentic selves, be their full selves, and still learn about how to take care of themselves in the work, be minoritized, oftentimes disrespected in the field, but also still be an advocate for patients. So I'm really, really proud of that. And we'll continue to do that and develop addiction leaders. I also know that because there is a lot of work to do, I also know that because there is not yet a critical mass, well, there's a critical mass, but we're not where we are, that we're going to have to rely on many of our colleagues here to figure out how can they learn and have access to the resources that they need. I think some of that can happen through PCSS, but more focused on equity, how to take care of asylums, people, asylum seekers, people from minoritized backgrounds. I think that type of education can be infused into the training. I think that's going to happen, quite frankly, from our REACH scholars, so I'm really proud about that. I also think in having folks participate, like we've already done in those collaborations with ORN, and teaching the things that they've learned for REACH, when they consult is going to be impactful. And then I think that understanding that there is a sense of responsibility amongst all of us, right, not just the folks from historically excluded backgrounds, that we have to center this teaching. We have to understand how to provide equitable care and educate ourselves is going to be vastly important, because, you know, we just don't know what the future holds for many people who have already been marginalized, and I think it may get worse, likely, and so how can we find those pockets of opportunities as a field to always promote equity? We might not be able to say equity, but we're going to have to figure out a language, and so I think that's what lies ahead. If people have ideas, let me know. I think this is a perfect way ORN is trying to help, is that you locally, and I need people in Missouri, so I'm going to come tap you to come help us to be a consultant. One of the things this year, we just got funded for three more years, is we have to have an addiction physician in every state, and that person to be a champion, not to be doing everything, but help us identify others in your community. But have you come in and put a request that, here's some challenges that you have, you want to put together, say, a learning collaborative, or you want to have a series of people come in, whatever it is, because SAMHSA is all over this. They're on me all the time. They want to know what's happening. They want to take these examples to Congress. That's not unheard of with this project, because there's a lot of money invested in it, and we're really being pushed to focus on rural. We're pushed to look at health equity disparities. I mean, these are important things that have to happen, and the money's going into that. So these are the kinds of things you need to bring to me, and we can talk about, are there projects that you're interested in doing that we could potentially help you with, or to help support you? I can't fix all of them, but we certainly have resources that we can help potentially work with you on steps, and I think that's what's going to have to be important, to move things and make change. Hopefully that helps. Next question. Oh, yeah. Thank you for this talk. I just wanted to follow up on the Amazon Prime comment. I don't know if people noticed, but Netflix, Amazon Prime, they now have really innovative things, like video games and whatnot. And I was looking through the PCSS website. I didn't see any interactive trainings or simulations, those types of things. I'm just curious if those have been explored, or if there's funding opportunities, particularly for early and middle career. Yes, we actually looked at avatar training probably about four years ago, and it wasn't quite where it needed to be. We don't have the money, just to be perfectly honest. We were cut a third of our budget a year ago, even though we are one of the go-tos. So to do innovative things, we're not able to, but we are encouraged for PCSS and ORN to collaborate. So we are looking at doing more simulated and gaming-type things to help move us to the next level of ways of learning and so forth. So yes, PCSS acknowledges it, sees it, but we really run on a very thin line about how much money that we have. Thank you. Oh, sorry. Just a couple quick questions. Do you know if the ORN's participating in any of the overdose fatality reviews that are happening across the country? I can't answer that, but I can find somebody who can answer that question. Okay, and then for Dr. Jordan, one of the things that's been coming up is the pushback against, like how to push back against pushback around DEI. So I was wondering if you have any thoughts on that. Yeah, I mean, I think about this all of the time. So I run a lab, it's called the Jordan Wellness Collaborative, and we focus on running NIH-funded research trials that focuses on how to increase access to evidence-based treatment, specifically for black and Latinx people who use drugs and those with substance use disorders. So I literally employ people, right? And all of my work is focused on diversity, equity, inclusion, anti-racism. So I think about this constantly. I actually am enraged, but have tried to be hopeful around what are next steps, and how do you rest, resist, repeat? I think part of my strategy, and really thinking through this, is the importance of being strategic in the ways in which we continue to do the work. The work is not going to stop, we will continue. It perhaps may have to be underground, and I referenced this last night when the REACH scholars gathered, because I do think we're going to have to develop a underground railroad of sorts, really channeling the spirit of Harriet Tubman, and thinking about how do we create a faith network where we have addiction leaders, both white and non-white, that are champions for equity, that wanna take best care of our patients, and how do we create language together that still signals those concepts, but that doesn't explicitly state that. I point to the Green Book because it was a real thing in the 1960s, where there was a pianist that was traveling from New York to the Deep South, and because of all of the racial tension, and violent attacks, police brutality, et cetera, she was not safe, and they literally made a book of where can they stop where there was safety, where there were white allies, where they could go eat, sleep, and still do the work. Similarly, Katherine and I were talking, and I'm grateful that she is going to be able to fund this through the REACH original program. We're going to have a summit in March where it was supposed to be about healing. There will still be some healing there, but we're now gonna shift gears into what is the strategy to make it through the next four years in terms of taking best care of folks who need access to equitable care. So we're working, right? I think right now, for me, it's a point of rest. Gearing up in January for a fight. But yeah, it's top of mind, and I'm hopeful because I think if we are at a place where there's blatant disrespect of humanity, we have to come out of it. And the history has shown us that we will. And we'll be strategic, and we'll do so. So thanks for that. We have one more question, and then Ellie's gonna line this up. Thanks. I apologize if I missed this, but if we're interested in getting involved with the PCSS or ORN as a mentor, what's the best way to make that happen? Grab me or let one of the staff. Nick is ORN. Anybody, any of the crew here, just let us know. Okay, cool, thank you. Awesome. Thank you. Thank you for a great panel discussion.

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