CASAT Podcast Network. Welcome to season six of CASAT Conversations, where we sit down with professionals who have spent decades in their fields like mental health, addiction treatment, business, sociology, and more. In this special season, our guests share valuable wisdom from their careers, reflect on what has kept them grounded and inspired, and, and offer advice for future generations. Whether you're new to the field, uncertain about your next steps, or feeling burned out, these conversations provide guidance and reassurance from those who've walked this path. Let's dive into today's episode.


 

Today, I am happy to welcome Mark Disselkoen He is a senior project manager at CASAT at unr, and we are delighted to have you here today. Mark, welcome.

Thank you very much. Glad to be here.

So I would love for you to just share with our listeners, what your career trajectory has looked like to date.

Okay. well, it's been a long road, like most of people that have been around doing this as long as I have. So, you know, really, I didn't think I was going to even go to college because I struggled with, you know, undiagnosed learning disabilities, but some form of dyslexia. So I always had a lot of challenges trying to figure out, you know, could I have some kind of career that involved college and so forth and so on. So I, I kind of, wandered around in the wilderness from probably age 18 to about 22. I was in college, but I was going to, community college in California. And I was working and stuff like that. I thought I wanted to be a teacher, at some point because I thought, well, hey, I have learned disabilities. And I didn't feel like I always had my needs met in school, so maybe I could get back and do that. And so I kind of went through that process of getting a goal, which was good. And I wanted to be a high school history teacher. And I, ended up after, two colleges, I ended up. Or no, three colleges, I ended up at, UNLV down in Las Vegas, moved from Southern California and was going to work on being a teacher. And I heard about this thing called social work, and I didn't really know what that was, actually, because I had a friend in it. And so I ended up going, I think that's what I want to do. So I said, maybe I can just get my bachelor's and, you know, be a case manager, and that would be wonderful. Right. as I went through there, I kind of got my legs. I met my, wonderful wife, Heather, and, she was really instrumental in helping me kind of focus, proofread my stuff, encourage me because she was very academically sound. And ultimately I got through my bachelor's and said, well, maybe I'll go get my master's. So then I ended up at University of Tennessee for my social work masters. And that was a great experience. I got to work with folks in Appalachia, related to, you know, individuals that would have a severe mental illness diagnosis. Did a lot of psychosocial rehab and went to school part time and worked full time. and then after that we headed back to Las Vegas and I got my first job, out of graduate school and was there for about a, ah, year, year and a half. And then I went to another agency in Vegas, a for profit, and was there for about a year. Came back to Bridge as their executive director, Bridge Counseling, in the, you know, mid-90s. and from there I started to think about do I really want to be doing direct practice or do I want to be doing something different. And I started thinking I was executive director but I was also providing counseling because you know, when you're in a non profit, you do everything right and grant writing, all that kind of stuff. And I thought to myself, maybe I'd rather give money away than ask for money. So I went to the work for the state. At the time it was a Bureau of Alcohol and Drug Abuse. It's now, you know, well then it moved over to sapta and now it's a new name beyond that. but I was with Beta sapta, for five years. And then I had an opportunity to come to CASAT in 2003, because there was a contract opportunity in Wyoming to certify all of their substance use prevention and treatment programs. And so I worked with Gary Fisher, Dr. Fisher, the originator of CASAT. And we wrote for that contract, got it. And we worked in Wyoming doing certification and a lot of training and technical assistance for approximately 10 years. while we were doing Wyoming, Idaho, said hey, do you want to do Idaho too? So we started doing Idaho. And then my old bureau chief back at sapta, said hey, would you like to do Nevada? So now we're sort of, we started certifying, substance use prevention and treatment programs in Nevada in 2006. So that's kind of a whirlwind. Started off in direct practice. Had an interest in going into the kind of the administrative side of things. And I always just felt like Kind of being in the administrative side of things, providing oversight. I feel like I can advocate for providers but also for clients to be able to help them provide more evidence based practice, provide services with you know, with you know, efficacy, so forth and so on. And that's kind of my. So I ultimately ended up being a teacher more or less in the end even though I'm not a high school history teacher like I originally had planned. So that's a quick overview. Hopefully that provided a good sense of my life.

Yeah.


 

You know, as you reflect back on all of these different sort of mile markers along the way, I'm curious what advice you might give to people who are just starting out their career.

Yeah, well one of the things that I think about related to advice is and I've had to learn it and I'm not by any way, I have not in any way mastered this is really just trying to come from a place of humility. And I think that's sometimes against our nature to be humble. because I think if you come from a place of humility, you'll be much easier to work with. you'll listen to other people's ideas and what they bring to the table which I think just encourages not only the people around you, but it also ultimately impacts you personally. Right. Because you learn a lot. You know, if you're always trying to push your idea or your agenda, you're not going to grow as an individual. So really always try to be team oriented, focus on working with others, and you know, realizing you're just one ingredient, to a recipe to make it really good. And so that's the really the thing I think about more than anything is am I talking too much, am I a good listener, so forth and so on. And I think this really being open to feedback. I think when you start off your career you may lack confidence. And when people ask you questions or even critique you, I think sometimes our first response is negative. We push back. But I can tell you the best thing I ever learned is to allow myself to be critiqued. even if it's not always in a gentle spirit. Because sometimes people critique you and it's not in a gentle spirit. But maybe what they're saying is true or there's a grain of truth to it. And what can you glean from that? and that really helped me get over a lot of my fears because I said I had a lot of learning disabilities. So I already had kind of a lack of confidence, but once I learned to say, I'm only going to be better if I listen to other people, allow, myself to be mentored, those types of things.


 

And you know, as you made some of these different career choices, right, like thinking that you wanted to be a history teacher and then moving into social work and then moving from clinical practice to more administrative roles, how did you make some of those decisions along the way?

Really good question. One of the things I always, share with people who are thinking about making good decisions like that is, a couple of things is you should never, go into a new position or make a transition because where you're at, there's a significant, struggle. Right. and, and maybe, you're at a place where you don't feel like all of your needs are being met and so you're looking, to see if the grass is greener on the other side. And often when people make decisions kind of out of duress like that, they find that the grass is not greener on the other side and then they go, oh, why did I do that? So I always tell people that if you're going to make a career decision, is it really something that is, is in the best interest of yourself? Right. And it's, it's, it's, it's a sense of progression, maturity and growth. And those are the reasons why you're doing that. You're not trying to escape something terrible. Now, I always put a caveat in there. Obviously, if you're in a very hostile work environment and it's very difficult, sometimes you have to make a job change. Right. But often when I talk to people, that's not the case. And for myself, everything that I did always had kind of a thoughtful, meaningful reason for it. And it was always, helpful not only for myself, you know, career wise, professionally, but often, you know, you have to also take it with, take any kind of decision like that within the context of your family. You know, depending on what your family, you know, situation is. You know, some people make a decision, maybe they're married, some people will make a decision, they're married and have kids. So, so you always have to take those things into considerations and how that will impact them as well.

Thank you.

So that's a big thing.

Yeah.


 

So, you know, this teacher part of you, you provide lots of training and education in the field of substance use and mental health treatment. What are the key skills or knowledge that you think are most essential for professionals entering the field today.

I kind of referenced this earlier, but I'll reference this, reference it in the sense of training. Read your post evaluations and take them seriously. Even though sometimes people might be a little, you know, terse in those evaluations. So that's first and foremost is always, listen to feedback. And I think that's, that's extremely helpful. I did have somebody on a post interview once, right. That they didn't like my sense, of humor, even though the overall, evaluation was fine. So I thought that was kind of cute. But it was one of those things. Ah, preparation is so significant. And you know, my younger mind, you know, I probably had to do less preparation as I get a little older because I'm 61 now. Preparation, is really important. And so I can't like rely on my younger mind as much. So that's important. ask colleagues to proofread stuff. I think that's really important. And again, it goes back to that whole feed lap, feedback loop. I told you earlier, you know, take feedback. But in reality that's why, you know, if you have the time to let somebody kind of read through your presentations, it's only going to be better because we all have blind spots and for whatever reason. And so when, when a colleague, read your stuff, they often give, a kind of a fresh look at it and help you to further develop what you're doing. stay stay focused on topic. You know, I talk a lot. I like to work in humor, but that's why I have to have good talking points to make sure that I know I don't get kind of off on a trail and stuff like that. A little bit of trail is okay, but the talking ports, talking points bring you back. I think that's helpful as well, related to that. And you know, one of the things that I think is really important and people that do a lot of public speaking probably are aware of this is be thinking about your cadence, your pace, your tempo, so forth and so on. And a lot of times you'll get that from colleagues because they're more willing to say, hey, you know, maybe you need to slow down a little bit, you know, and sometimes I'm at my best when I can actually kind of see what I'm saying and really, articulate well, you know, and that, that's very helpful. not to the point where it becomes distracting because it can become distracting too. but always be thinking about that pace and there's going to be some days I get ready for a training and just your whole mood and how you're feeling physically can negatively impact that. Right. Other times I feel really calm and just kind of steady. and that's good. So I try to remember those times that I'm calm and steady, think about those, see those and try to practice those. So those are some really key things for me. The last thing I want to say is I had a social work professor once say, never turn down an opportunity to public speak. And I was kind of mortified of public speaking. I'm a very spontaneous person. So that doesn't mean I don't like to talk in front of groups. But it's got to be spontaneous. When I was younger, so when somebody would say, oh you're gonna, can you do a training on this day or can you do a presentation on this day? You know, maybe a month down the road I would start to get really anxious about it. But it is true, I started to not say no to training. And as time went on I became more comfortable. and actually now getting up in front of people is kind of fun, exhilarating, and it's positive. So and in our field it's really important to be able to get out there and share with people what's, what you're doing and you know, what providers are doing, what kind of evidence based practices there are. All that kind of stuff is enhanced if you can feel comfortable getting up in front of people. Thank you.


 

What are some of the training topics, the timely training topics right now that you're most excited about in the field?

very good. The first one's going to sound pretty dry, but one of the things I love training on is privacy and confidentiality. we, you know, you have, you know, you have two federal regulations related to privacy and you have state regulations. And what's interesting is, is when I train on it, this, the participants are very engaged. You would think they kind of be falling asleep, but there's so many nuances, there's privacy and so much liability as well. But I like to teach privacy, kind of in the tune or in light of building a therapeutic relationship with your client. And if you take the time to really explain privacy to your client, they are going to have more confidence in you as a clinician. And so I constantly am updating and adding nuances to it. And then obviously one of the big topics right now is AI, artificial intelligence. And how that is impacts privacy. And so I'm getting, I did a blog with you on that. but I'm also going to be doing a training with our ATTC as well and further kind of develop it because there's implications like using AI on your, as in your electronic health record for example. And so how does that impact privacy and the delivery of services? So that's one thing obviously ASAM. I'm an ASAM member. I was trained in ASAM going back to 1996 with Dr. V. Lee when CASAT used to do the summer institutes a long, long time ago. And so I've been doing, you know, developing you know, my understanding of ASAM through now the fourth edition for the adults. And really the idea and the importance of ASAM is, is that it really is a client centered way to help determine what level of care somebody needs in the moment. And it's instead of, it's a living kind of documentation process to make sure that your client's getting what they need in that moment. So ASAM is always very, very important to me. you know, I do a lot of training, and technical assistance as a part of the team that oversees and certifies certified community behavioral health centers in Nevada. And so that is really focused on integrated care. So that's my other big area I like to talk about is integrated care which is co occurring diagnosis but not just you know, substance use and a mental health condition. It's also what kind of biomedical needs does the client have to. So those are probably three areas that I really enjoy training on and are very important to me. Obviously there's a lot more, but those are the three, three that I'll just focus on.


 

Well, and so with the privacy and confidentiality for any clinicians who might be listening, I'd love if you'd just give us like your elevator speech on what you would say about privacy and confidentiality to a client so that they might hear from your perspective.

Yeah, exactly. And really from my personal experience in direct practice when I first started doing counseling out of graduate school, I really took all of that intake paperwork that client needs to do before you even start doing a biopsychosocial. And I really began to articulate and be able to provide a summary of what all this means because just like putting a piece of paper in front of a client and say this is about your consent to treatment, this is about your patient rights, this is about your privacy Please sign here. that's really not ethical in many ways, really giving them an overview of that. And I often share the example of when you go into a medical doctor, they tend to hand you all the HIPAA stuff and once you sign it, but they don't give you a summary and I don't think anybody's reading it to see that it's complete. So it's really important that if you don't have a signed, dated copy and a complete, in a completed form, it's invalid. So it's really important to go through that with a client. You don't have to go through every line and you know, explain everything, but you really want to give them the essence. And one of a couple of examples I'll give because I always tell, participants and clinicians is that you need to really share and set this up before you start getting into the biopsychosocial. areas such as, you know, you know, by federal regulation and state regulations are required to report child abuse and neglect. And I just want you to know that. Okay. That if I have any suspicion of that, I'm going to need to share that. and that's really important for a client to know. Right. So that's like one of the things that I like to share with, them. I also say that, you know, I'm here, this is a helping profession. So if you're struggling with, you know, some kind of thoughts of self harm or stuff like that that I may have to, you know, address that as well. And, and we may need to, you know, do an intervention on something like that. So that's another thing that is really, really important to share with them. so those are a couple of things that are, that are obviously like under 42 CFR Part 2, which is the federal confidentiality regulations for substance use treatment programs, is that if you don't have to have a consent, signed by the client to report that stuff. Right. That those are exceptions to the general rule and that you can make a report without a consent. And they need to understand what their rights are and what they're also what the limitations of those rights are. So it's really important to kind of go through all of that stuff with a client before you ask any personal questions through the biopsychosocial.

Yeah, it, I mean it strikes me as, you know, there's like this, it seems like kind of routine now, right. To just receive forms and sign them and move on.

Exactly.

and what you're talking about is intentionally setting aside time to develop rapport, create the boundaries of the relationship, which really is being trauma informed in a lot of ways. As far as outlining, here's what you can expect from me.

Yeah. And the other thing, that I thought of that he didn't say was, you know, the first question, from you to the client should be kind of like, why are you here? What are your problems? Right. because they're uptight, they're just getting to know you. So asking, these questions, going through this intake paperwork sometimes is a little bit of a buffer, because you're not getting into the, into the depth of kind of why they're there and what's going on. You use that kind of first 10, 15 minutes to kind of talk about other stuff. But that's important. but it also isn't like jumping in again and you know, getting into stuff. Now obviously, if your client comes in and they're in imminent danger, you're not going to, spend as much time on them signing forms. So you have to have wisdom and understand kind of what's going on and then go from there.

That makes sense.


 

so if you're good, we'll transition to the 4th edition of ASAM. And if you want to just hit some of the highlights about the changes that are in this new edition.

Yeah. So in many ways it's going to look similar, because, you know, it's asam. and the biggest thing with the fourth edition, it is an adult version, it is not an adolescent version. And one of the, issues with past ASAM editions is that the adolescent version was kind of always a little bit of a add on and it really didn't have its own, you know, language and stuff like that. In fact, they were getting ready to have the fourth, edition for the adolescents come. Well, it would be the first edition technically of the adolescent version, come out, at the end of last year, and they realized, and I learned this at the ASAM conference last year, they realized that they really needed to take a step back and build it from the ground up and not use, you know, evidence based practice for adults to build the ASAM adolescent version. And thus the reason why it slowed down and really taking that serious. So that's one of the biggest reasons also they are wanting to create a Justice Informed edition, because sometimes, ASAM traditionally doesn't always fit well within the criminal justice system because the justice system, tends to be less flexible than asam. And so I really believe that this fourth or the first edition of the Justice Informed will address some of that, some of those challenges that you may have applying ASAM in a, you know, a program that's outside of the justice system. So those are some nuances there related to that. They did change the six dimensions a little bit. you know they're essentially all there but they, they rename them and shorten them, which is nice. And then they kind of reordered, ordered them based on severity. Right. so I think that that's helpful too. so you know, like, you know, relapse risk has been moved up to the fourth dimension and then the environment has moved up to the fifth, dimension. And now you know, you have withdrawal intoxication, you have biomedical, you have psychiatric, then you have, you know, they haven't, they don't call it relapse anymore. It's basically kind of you're measuring risk, with continued use and then you have your environment and then, and then the, the sixth dimension is really focused on readiness to change. Right. and basically you're supposed to make your treatment recommendation on dimensions 1 through 5. And then dimension 6 is what's the client willing to do, thus readiness to change. So to me I think that's a really good change that they kind of pre ordered them based on severity and also made them I think more practical in practice. So that's part of it. some other big changes is they really have made it more robust related to biomedical and cognitive kind of conditions. And now they have a 1.7, a 2.7 and a 3.7. All of those, biomedical levels of service also address any cognitive issues that the individual has as well as any withdrawal management issues. Right. In fact they would, they withdrew withdrawal management as a level of care out of the fourth edition. It's not there anymore. Now the idea is regardless of the level of care you provide, ah, you should be able to do withdrawal management. So it's kind of more integrated into the level of care. So for example, level 3.5, which is residential, now is required to provide social model detox. Whereas before you could have like I can do 3.2 withdrawal management in and of itself without residential, or I can do residential without social model detox. and you know, ASAM really thought to myself, you know, we need a more robust continuum of care. And if you're going to be doing 3.5, usually clients that come in need some level of withdrawal management. So having not being able to provide that in a 3.5 is not really the best interest of the client or the provider. So, so that's some basic changes related to that. there used to be level 3.3, in the third edition, going back to the second and the first edition. And that level of care was really ah, a specialized residential level of care for an individual that has some kind of cognitive impairment or issue traumatic brain injury, for example. now 1.7, 2.7, 3.7 address that across the spectrum. So it's not like this little like 3.3 out here that nobody really was doing. Right. So, so, so those are some kind of significant changes. traditionally they had a thing called the ACM six dimensional assessment that you would provide and you would do risk ratings related to that. Now they have, that's moving over to what they call level of care assessment through the six dimensions. And the way you rate risk is going to be different than in the third edition. so that's kind of the biggest change and that's going to create the greatest challenge for folks to kind of like shift gears. Like a new rating system, a new risk rating system, you know, a new way to do kind of that dimensional assessment on the front end. That's going to be a big challenge and a big change. So that's kind of a nutshell.

Perfect. And what do you think some of the benefits might be for this new assessment that will require some reorganization in the mind?

Yeah, I think what it does is it helps the clinician and the provider, I think more thoughtfully think through various questions and where a client is for each dimension. And I think it will lead to better treatment recommendations is what I think it will ultimately do. and to me it has more of a, kind of a, more of a robust living kind of document. Even though ASAM third edition was better than, you know, the second and the first edition and you know, prior to asam, everything was very cookie cutter and not client centered. So I think it's just a new iteration that just brings it to another level. and it makes a lot of sense if you stay true to the principles and you go through the questions and you don't get impatient and try to rush or just not complete them, you're going to do a better job and your client's going to be you know, served better because you did. That.

Sounds like it creates a deeper level of understanding of where the Client is.

Yes, but like, with anything, it's gonna create, anxiety, because change is never easy. And it's going to feel different, even though a lot of it is going to seem similar because it's asam. But it will take, like with all of the ASAM additions, a maturation integration process. Nice.


 

and for your third training topic that you're most interested in, what's on the horizon for integrated care?

Well, you know, really CCBHCs, the certified community behavioral health Centers, very much supported by samhsa. you know, Nevada was one of the original seven demonstration states, which was pretty cool. there's now, you know, a provider type for CCBHCs. Provider types, 17, 1, 188. we currently have 10 CCBHCs in the state and there's open enrollment. So if a provider can get certified, then they can then, enroll in Medicaid, then enroll with the MCOs, and, then be able to get a higher rate, than they would with other provider types. And really the idea with integration is, is that, you know, CCBHCs are outpatient. That's the requirement. but they work closely with residential providers. But, you know, this really brings me back to my early days when I was at bridge Counseling in 1995. One of my biggest frustrations when I was doing an assessment is, or just treatment. A client would need medication. They didn't have insurance, they weren't on a Medicaid. And so really the only option was for me to send them to Southern Nevada Mental Health. And at the time, that might be three to four weeks before they could get in, you know, unless it was imminent. Right. And so that was a frustration. Well, the CCBHCS really, in many ways have addressed that issue because one of the requirements of a CCBHC is they have to provide medication management for a mental health or sud dying diagnosis. So that's something that's not optional for our CCBHCs. They have to provide that. The other thing that the CCBHCs have to provide is 247 mobile crisis and crisis services. And so that's really helpful too. And that really speaks to integration as well. you know, standard outpatient services, intensive outpatient services, those things are a part of a ccbhc. But some of the other cool things that CCBHC provide and really speak to integration is they, they do psychosocial rehab, they do targeted case management, they do basic skills training, and stuff like that. And that's super helpful. And then they're also required to provide peer support services. So again these, these services are not optional to be a ccbhc. and so because other providers can kind of pick and choose like they go well we're going to do this but we don't have to do that. The ccbhc, they have to be able to provide the nine core services or they'll not be a CCBHC and not be able to get that higher rate through pt 17188. So that's really SAMHSA is really pushing more CCBHCs. So that's why we have an open enrollment. When I say we, I should say Medicaid has an open enrollment. I work closely with Medicaid on that and I think that that's really cool going forward. And just to the credit to a lot of substance, use treatment providers prior to CCBHCs who are not CCBHCs, they have found ways over the years to provide more integrated care just out of necessity because at least half of the clients they serve have a co occurring diagnosis. And I'm being conservative on that number but I'll say generally half. And so if you're not treating the whole person your outcomes are not going to be as good or if you're treating the whole person but at different like treatment providers that bifurcation is not as effective as if you could do it under one roof.

So well that's an exciting movement in creating more integrative systems.


 

so with all of the experience that you had around really delivering as well as training in person centered care. What are some of the most valuable lessons that you've learned along the way?

Valuable lessons. I think I probably spoke to this a little bit earlier but one of the things I think about is always remember there's nothing new under the sun. and being able to adapt and grow through your, through the, through the life process, the professional process is really good. If we get too Saturn in our ways, we don't learn from others. And that's a theme. I talk about learning from others a lot. one of the things that I've learned as I've gotten a little bit older is that younger people have really good ideas and even though I say there's nothing new under the sun, some of the stuff that they say is new and to me or maybe it's a, it's a hybrid of maybe something I knew at one time but it's been further developed so I Think that. I think that that's, that's really important. the other thing I think about is, mentoring. You know, mentoring is really important. Allow yourself to be mentored, but also look to mentor others and find ways to do that. I think that that's really, really helpful. other things. Going back to what I just said a few minutes ago, sometimes I'll get, I get a lot of questions from providers about everything, you know, and part of the luxury of being around as long as I've been, everybody knows me, everybody has my cell number, everybody has my email address. So I get a lot of questions about a number of things. But one of the things that I've learned is that I see some questions and I think, you know, I could answer that or I can send it to the team I work with and see what they think. So I've kind of started this practice of sending some of the questions that I get and asking for staff to chime in. and they really give me some really thoughtful ideas. and it also helps prevent me from being on an island or start or me for making unilateral decisions on myself by myself. Because I've been around so long I know what to do. unfortunately that's not true. just because you've been around a, long time doesn't mean you know what to do in every situation. So really, you know, reaching out to those around you. So ah, peer, you know, kind of supervision and dynamics, but also being mentored and also internal mentoring others. I think those are some things that I've really thought learned over the period of time that I think is, is helpful. and you know, again, always looking about how to be a team player. You know, I, I wrote this down. It's not about me, it's about us. Right. So that, that's kind of a good thing to remember, when you're in your career. And, and you know, I know that sometimes people in the helping professions, you know, people outside probably don't think we struggle with ego and control and stuff like that. But sometimes I think we struggle with it more than other people professionally. And, and sometimes I don't see people in the profession always treating each other very well. And that really, you know, disheartens me, because I think that, you know, even if you disagree with somebody, you should still respect them as a colleague or, you know, maybe a supervisor or even somebody you supervise is just really trying to look for ways to build consensus, being willing to, being willing to give up and compromise. Maybe part of what you want, understanding that to move forward you need to compromise and so forth and so on. I think those are really helpful things for me, career wise that I would like other people to hear about and think about.

Thank you. all seem critically important, especially to creating a psychologically safe team environment.

Always thinking about, what's the solution in this situation? Rather than drawing a line and saying, you know, I'm not going to cross that line unless I get a, B and C. Well, maybe you do need to cross the line. As long as you know what is being proposed is ethical and well thought out, you know, and you do need to consider that because there are times in your career where you have to draw the line and say, hey, that's unethical, you know, I can't, you know, support that. I, think also looking for teachable moments. You know, sometimes I'm working with folks that are maybe not clinicians, but they are in the helping profession. Maybe they're a funder, you know, maybe they're somebody that works within the state. You may hear them say something that is stigmatizing about clients, instead of like hitting them over the head with a hammer, step back and teach. Look for teaching moments and to share that with them. And it's amazing when people hear it with a gentle spirit, they, they tend to respond like, I never thought about that. Thank you so much for sharing that with me. And I think that's helpful too because, you know, sometimes, we get into a got you moment. Like I can't believe you said that. Well, just because you may have awareness of that because you've been doing something for many years, that's everybody is. So the way to teach, somebody that moment is to be nice and gentle and teach without being condescending, without.

Being judgmental and making that other person wrong or bad. We get a lot farther when we Yeah, the gentle spirit, right?

Yep, absolutely.


 

so the field is seeing some significant changes in policy funding, as well as practice, practice recommendations. What advice would you give to professionals about adapting to a, constantly changing environment?

really stay up to date. you need to read policies regularly. You need to know what the latest evidence based practices are. you need to reach, out to folks that maybe have developed the policies and ask for clarifications and so forth and so on. I think that that's really important and it's one thing that we suffer from because we're so busy that sometimes we don't stop to understand. and so I just really encourage people to take time one way and I tell people like when I'm doing a site visit, doing certification, one good measure of continuous quality improvement is to take one or two days a month and put it on your calendar to review policies and research evidence based practice. So you kind of keep up on what's going on. I think that's really helpful. Especially if you're in a role of an executive director or a clinical director. it's really important for you to be able to do that and then turn around and disseminate, disseminated to those that you supervise. I think that's very helpful too. you know a lot of people, not a lot. Some people will call me or email me and they want the quick answer because they know I may know. and sometimes I give them the short answer and then give them the reference on what they need to further read and understand. Because again, if we're relying on only somebody else to do it for us, that doesn't help either. So trying to not, not be standoffish, give them like a summation, this is kind of what it looks like, but you really need to look at that.


 

Going back to privacy, A lot of times, I'm teaching privacy. There's a lot of legalities to it. I'll share a lot, but I'll, and I rely heavily on Legal Action center in New York, you know, to help with interpretation because there are groups, the lawyers that interpret federal law related to privacy. But I often remind folks that you know, this is kind of the overview of this regulation. But Legal Action center recommends you get a lawyer to help you further interpret that. So always make sure that you stay within your scope and then recommend the people that you're working with that this, this you may need to go to this person sometimes I may give a quick overview of a regulation related to professional licensing. But then I always say you should read it out, reach out to your board and get in writing an answer to that to further development. So I think that that's important, but I have to start from understanding what the regulation actually says. So yeah, I do know what the regulations say for the various licensing boards. I do know the Nevada administrative code for, you know, for alcohol and drug programs and also for healthcare quality compliance. I do know all those things and the statutes behind them. and that's really helps me to have more clarity when people ask questions. I have better context. I, don't just stay in my lane. I do stay in my lane, but I also try to understand what's going on in somebody else's lane. So when we're conversing, it's, more, more, you know, helpful to everybody involved. So really keeping up on policies, regulations that pertain to what you do in your job is really, really critical.


 

I'm curious, what has been most meaningful about your career?

I'm sorry, say that one more time.

What has been most mean meaningful about the work that you do?

I think the most meaningful part, of my job is I know that at the core of it, it's about helping people and not, to say that other professions don't help people and they do. but I just love that that's what the core of my job is, is that I don't have to wake up in the morning, go to another job, and I might help somebody along the way if there's a need. Right. My job is just to help people, indeed, every breath that I take in my work. Right. And so that's really helpful. One of the most fun things and rewarding things is I get a lot of, you know, professionals in the field that contact me and say, I have a family or, or I have a friend and they need, they need substance use treatment. Are you aware of, you know, a provider that can do this or help them? And, you know, to me, that's nice because even though that's not, quote, unquote, my job, it's, it's a, it's a by, it's a byproduct of my job to be aware of what the system has, the good, the bad, and maybe sometimes the not so good, in that. But I can help people at least get family and loved ones, maybe in the treatment. And, you know, I can advocate for that for them. And I think that's really rewarding. But that's the most rewarding, thing for me is just the ability that my job is to actually help people. Right.

Sounds like that. You see, you see the impact of it as well, and that that's meaningful.

I hope so. Right. Yeah. Treatment does work. You've heard that before. But I've seen it work. I said, I just, I, I, you know, I've seen so many, you know, people's lives, you know, repaired, healed, you know, productive after having a lot of issues with a mental health and, or substance use, you know, issue.

So, yeah, you've seen people, people come out the other side and are living a life that they want.

And you know, when I think about that, one of the key there's NIDA has these 13 principles, National Institute of Drug Abuse. and one of the principles is, is that it takes repeated treatment to have long term recovery. So one of the things I always share with people is, is that if somebody lapses or has a relapse, that's okay. You learn something through that. And every episode of treatment, you learn something. And if you go through five, six, seven episodes of treatment, the likelihood of having long term recovery goes significantly up. So we need to have an open door for people for treatment, not a closed door. So we shouldn't have the attitude, which I did have in 1995. If somebody was struggling and they came back to treatment, I had this kind of attitude as are they really ready this time? Rather than celebrating that they came back? Right. I had it backwards. So I really think, having an open door policy for people that are struggling, will only benefit them long run. In other words, it's a journey. It's not like, hey, I go to treatment and everything's great. no, you might need to go to treatment more than once, maybe you'll have to go five or six times. But the door is always open and we're here to help you. And I think that's really important for people to hear, especially if they have family members that are struggling with substance use or mental illness, is that, you know, it's a journey and if you walk with people, things, do get better, things do improve.

Yeah, I wholeheartedly agree. Really, I. One of the things I do, as a health coach when supporting people to, you know, make long term behavior changes is the, bulk of the work is after someone has set goals and they didn't go as planned. And that is life. And so, you know, it's reframing the, this idea that these are failures because I didn't attend, attain whatever my goal is to. Okay, so what did you learn from this and how can you adapt to integrate the change that's most important to you?

I could have used you when I was 20. It's interesting that thought about that. You know, wanting to be a high school teacher and having a focus got me unstuck and got me over some hurdles which led me to social work. So sometimes moving towards something, even if it's not ultimately what happens is healthy. So I always thought, you know, because before that I was just basically like wandering and I was struggling. I, you know, I went to, you know, two community colleges and another college and things weren't working out until I finally figured out, well, I think I'm going to walk towards this and be okay if you ultimately don't accomplish what you set out to accomplish, but it maybe it led you to something else. So when you said that, that's what came to mind. In my old life, in my own life, getting on the trail and moving.

You know, the way that I sometimes, if I'm teaching about well being, I'll describe it as a spiral staircase. And I think that really well being is life.

Right.

And throughout our life we're climbing this spiral staircase, staircase. And sometimes we might fall down a, ah, couple stairs or maybe a flight or two. and it doesn't actually negate all that we've learned as we've climbed the staircase. And then we just continue to learn and grow from there.

Yeah, we, we learn equally, as much from our, setbacks as we do from our accomplishments. So sometimes setbacks are actually healthy. You know, if everything came to us easy, I think that would ultimately cause us to not be as empathetic and caring of other people.

Well, and I think the other part that I heard that's really important for all of us to remember, especially on the hard days when it just seems like we're not making a difference, is having unconditional positive regard for that.

Other human being one of my favorite phrases. Yes. Also when I think about that, it's kind of a social worker thing, the right to self determination. So the idea is, is that sometimes the clients that we work with are not going to make, the best decisions in our own estimation. But we, we are really here to help people learn to be more, you know, independent and improve their functioning. and sometimes we have to help them, make, you know, better decisions, grow in skills to be able to do things. But that doesn't mean that they're going to do everything that we give them ideas on or maybe what we do personally. But that doesn't mean that they aren't going to progress as a person. And I always say, and the key to self determination is really people need to learn to own their own decisions. And if we're overly intrusive as, as counselors and helpers, we can actually take that privilege away from them and that's not doing them any, service for their, you know, development as a human.

Yeah, it also, it reminds me of this example. So, I used to lead a lot of chronic Disease self management workshops. And we had a participant who, was eating 10 candy bars a day, and her action plan for that week was to eat eight. and, you know, there was a lot of judgment in the room about this person, A, eating 10 candy bars and then B, not just cutting them all out. and yet it's a really wise way to look at changing habits and behaviors in these small incremental steps that still are having an impact. Right. And it's like we want to just see someone make sometimes this leap from all or nothing to, to minimizing that risk. And so I think that, yeah.

One of the, one of my, the most important kinds of practices is look in the mirror at yourself when you're judging somebody. Because often we're judging them for things that we struggle with ourselves. Maybe a different arena. Maybe it's not 10 candy bars. Maybe it's something else we're doing in excess. And so we all struggle with ambivalence to change.


Sometimes when you're talking to a client, proper use of stealth disclosure is important

I love the stages of change thing. So sometimes when you're talking to a client and you're thinking about stages of change, proper use of stealth disclosure without overstating it, is maybe share some of the things that you personally have ambivalence to change. Like, you know, I want to, you know, exercise, more. Right. And I probably should exercise five days a week, but I'm gonna, I exercise three days a week. and, and, and that's better than no days a week. Right. And so those kinds of stories and self disclosure in a healthy way, because you can sometimes use self disclosure, unhealthy way. I think sometimes helps the client go, oh, you know, they understand what it is to struggle. Maybe not with a thing I'm struggling with, but with something. And clinicians need to remember that when they're getting a little bit like, why can't they just do A, B and C? You need to look in the mirror and say, well, where do I, what do I need to change? And I'm not willing to do anything. So I think that's helpful to keeps us human and real in those moments.

Yeah, absolutely. and that's where I've generally seen the magic happen.

That's right. It is. So I mean, when the magic happens, that's a great way. That, that's, that's beautiful. And again, you, have to be willing to be, you know, vulnerable. but appropriately vulnerable.

Yeah.

Right. You don't want to become the client and the client become the counselor, because people do that too. so, yes, and that's why, you know, talking to colleagues about this kind of stuff is very helpful. and if you're, if you're. If you're experiencing some counter transference or something with a client, the best thing that you can do is talk to somebody that you trust and know to, to get through that, because they, you know, acting like it's not happening is really unhealthy. Right. and so getting it out in the room, talking with somebody that's professional and, and getting support for that and wisdom, I think, is very helpful, too.

Yeah. Ah, thank you for naming that.


 

all right, well, as we wrap up our time together today, do you have any final thoughts for our listeners?

I just appreciate you thinking about me related to this. you know, it's one of those things where I've been around a little while, and I could look at that as like, oh, I've been around too long. But, you know, and there's always a little bit of hesitation. Do I want to spend time talking about my career myself? and I, go back to the professor that said, never turn down an offer to publicly speak. And I know this isn't public speaking, but it's like public speaking, because, you know, you have a life experience. And sharing some of the lessons along the way, I think is helpful and goes back to, I think, the importance of. Of mentoring. And this is a. An indirect form of maybe mentoring some of the younger folks out there, the young beautiful minds, as I like to call them. And, I'm excited about the field and work, what people are doing. And, that is. That is an exciting thing because when I entered the field, there was still a little bit of, you know, maybe not as professional as we should, should be, you know, and I think we grown professionally through the years, and we're. We're really doing a really good job, you know, as compared to 30 years ago, which should be the case. I feel like we progress, not digressed. So, yes.

Well, thank you for mentoring us, today. It was lovely to have you here.

Thank you so much, Heather. This is a lot of fun.

Thank you for listening to CASAT Conversations, your resource for exploring behavioral health topics. We hope you found today's conversation timely and meaningful. Please share this podcast with your friends and colleagues. If you want to learn more, visit us at our blog at casatondemand.org CASAT Podcast Network this podcast has been brought to you by the CASAT Podcast Network, located within the center for the Application of Substance Abuse Technologies, a part of the School of Public Health at the University of Nevada, Reno. For more podcast information and resources, visit casat.org.