Dallas Addiction Leadership Training (DALT) - VA North Texas Health Care System
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Dallas Addiction Leadership Training (DALT)

Overview

Dallas Addiction Leadership Training (DALT) is an advanced fellowship focused on developing the next generation of leaders to improve quality of care, encourage health care innovation and program implementation in the VA health care system. The fellowship is uniquely designed to promote interdisciplinary collaboration across clinical and professional/leadership contexts. This collaborative focus aims to improve health care outcomes through innovative health care delivery models, discovery through clinical research and inter-agency collaboration.

This is a two-year fellowship that is open to physicians, psychologists, clinical pharmacists, master level social workers, nurses and chaplains. The fellowship is designed to develop future clinical, academic and administrative leaders in the addiction field. Within the field of addiction, our fellows have explored a number of co-occurring mental health areas such as homelessness, and special populations, i.e., LGBTQ health and justice involved Veterans. Fellows will spend at least 75% of their time on a mentored project of particular interest and relevance to the fellows' future goals. No more than 25% of fellow effort will be spent providing clinical care. Specialized training in leadership skills is emphasized during the fellowship. Physicians can be board eligible or board certified in any specialty. Nurses with a master’s degree may apply. Associated health applicants (psychologists, clinical pharmacists, social workers, and chaplains) can be licensed or license eligible. Recent graduates as well as mid-career applicants are encouraged to apply.

Description

The three core components of the DALT fellowship are leadership, mentored project(s), and scholarship. In addition, fellows may spend up to 25% of their time engaged in clinical care.

Leadership

The leadership aspect of the training is designed to cultivate the following:

  1. Essential components of leadership and management skills needed to promote addiction clinical care and/or research and its resourcing.
  2. Appreciation of interdisciplinary collaboration, organization and communication.
  3. In-depth understanding of addiction programs and its alignment with local and national organizational goals.

Knowledge and skills in these areas will be acquired through structured educational activities and key publications. Individual supervision and mentorship are provided by current clinical, academic and/or administrative leaders at VANTHCS, affiliated sites such as UT Southwestern Medical Center, UT Arlington or other professionals within the community whose areas of expertise align with those of the DALT fellow.

Mentored Project(s)

The mentorship component of the DALT fellowship facilitates the individualized career goals and interests for the fellows. Fellows work with co-Directors of the program to determine mentor(s) with expertise consistent with fellows’ professional goals. Mentors are local administrators and researchers at Dallas VAMC. Additional mentors may be selected from affiliated sites such as UT Southwestern Medical Center, UT Arlington, or other professionals within the community.

Within the realm of addiction, DALT fellows pursue varied areas of focus. Mentored projects can involve program evaluation, investigation of resource utilization in the treatment of substance use disorders, design of novel treatments, research projects or other approaches that guide fellows toward competence in leadership, scholarship and/or management.

Examples of current and past DALT fellow projects:

Opioid Education Series: This psycho-education series focuses on aiding medical providers in identifying at-risk factors of Veterans developing Opioid Use Disorder as well as giving medical provider's additional resources for treating pain for Veterans diagnosed with Opioid Use Disorder. To aid in the development of this project the fellow has benefitted from interdisciplinary collaboration with a Clinical Pharmacist, Medical Doctors, and other medical staff.  

ARREST Research Project: Previous research has shown the prevalence of addiction and other mental health disorders in Veterans involved in justice system. This multi-phase research project seeks to explore key arrest and non-arrest factors among Veterans with histories of incarcerations. The first phase of the study will involve qualitative interviews to explore and identify comprehensive arrest and non-arrest factors.

Augmentation of Evidence-Based Treatments for PTSD with comorbid Substance use disorders: This pilot project explores exercise as augmentation for cognitive processing therapy in a group format for PTSD with and without comorbid substance use disorders.

Predictors of Incarceration in SUD treatment Setting: Using the brief addiction monitor (BAM), this study examined predictors of incarceration in Veterans before and after their residential substance use treatments.

Healthcare utilization outcomes in PTSD and Alcohol use disorder: This research evaluates the effects of Selective Serotonin Reuptake Inhibitors on dual diagnosis - PTSD and Alcohol Use Disorder. Data were extracted from the VA Corporate Data Warehouse. Using the advanced research technique-high dimensional propensity score analysis generated estimations of likelihood of SSRIs use in this sample population.

Language, Stigma, SUD Outcomes - Evaluation of the use of non-patient centered stigmatizing language within a specialty healthcare setting: This program evaluation was a chart review evaluating the prevalence of stigmatizing language among treatment providers for patients who have completed the Substance Use Intensive Outpatient Program (SUD-IOP).

Scholarship

The scholarship experience will develop professional skills and knowledge in academic research, ethics and education. Although the focus of this effort is on addictive disorders, skills and knowledge translate into all areas of medicine and psychology. Scholarship is promoted with didactics, clinical experience, journal clubs, and supervisory discussions focused on ethics in research, research design, manuscript writing as well as individualized mentorship. Extensive leadership training is available via the Leadership Development Institute and Lean Six Sigma at the VA North Texas Health Care System. Fellows will share training experiences with advanced trainees from other programs at VA North Texas Health Care System, including the Interdisciplinary Substance Abuse Fellowship Program, Addiction Psychiatry Fellowship Program and VA North Texas’ Clinical Psychology Postdoctoral Program.

Multiple mentors and sites are available for scholarship experience. Listed below are potential scholarship experiences and mentors for an incoming DALT fellow.

Apprentice in VA Clinical Leadership: Dr. Shubham Gupta is the Chief of Hospitalist Services at the Dallas VA Medical Center. Through his practical hands-on approach style of training, he provides mentorship for DALT fellows to develop critical leadership skills for program initiatives and implementation. Fellows mentored by Dr. Gupta will have opportunities to develop educational programs tailed to hospitalists and ambulatory care providers, with overall goal to improve clinical outcomes in addiction in hospital settings.

Apprentice in Education Leadership: Dr. Jamylah Jackson is the Director of Mental Health Education/Training and Director of Psychology Training for the VA North Texas Health Care system. Fellows interested in proposing, developing, and evaluating interprofessional continuing education activities within our Mental Health Service (currently the largest MH Service in VA) would work with Dr. Jackson. Educational activities managed by Dr. Jackson are varied and include both clinical and professional development resources for staff. Fellows working with Dr. Jackson would develop expertise in identifying educational areas worthy of increased focus as well as experience managing logistical and administrative considerations associated with staff resource development.

PTSD and SUD Treatments and Women’s Health: Dr. Geetha Shivakumar is the site PI for CSP studies in PTSD and Opioid Use Disorder, and PTSD Insomnia Study. These studies are evaluating treatment interventions to improve outcomes in PTSD and comorbid conditions. She is also site PI for COMFORT study that is evaluating maternity care outcomes in the VA health care system. Fellows who have an interest in PTSD and Women’s health, will receive mentorship to develop research projects and programs in these areas.

Vocational Rehabilitation in Justice involved Veterans: Dr. James LePage is evaluating the use of distance learning principles in vocational rehabilitation with Veterans with histories of legal convictions and mental illness and/or substance use disorders (RR&D funded MERIT award). He is also conducting a project to develop a prison transition program with accompanying assessment tools for veterans leaving prison with mental illness and/or substance use disorders (RR&D funded MERIT award).

Integrated Stepped Care of Patients with HIV and Alcohol Use Disorders: Dr. Roger Bedimo is site principle investigator of a 5-site NIAAA-funded study assessing the effectiveness of an Integrated Stepped Care (ISC) intervention versus treatment as usual (TAU) on alcohol consumption in HIV+ Veterans. Dr. Bedimo also leads a project on Medications, Alcohol, and Substance use in HIV (MASH): A Sub-study of the Veterans Aging Cohort Study (VACS). The purpose of MASH is to collect additional observational data concerning the use of VA and non-VA medications to inform our understanding of the relationship between HIV disease, aging, mental and physical comorbidities, multi-substance use (MSU including alcohol, tobacco), and polypharmacy (prescription and nonprescription drugs) and adverse drug effects so that modifiable mediators of important patient outcomes (costs, utilization morbidity and mortality) might be targeted for intervention.

National Center on Homelessness among Veterans (the Center) track: Dr. Dina Hooshyar is the Center’s Director. The Center was established in 2009 and authorized through federal legislation in 2016 to (1) carry out and promote research into the causes and contributing factors of homelessness among Veterans; (2) assess the effectiveness of programs in the Department of Veterans Affairs (VA) at meeting the needs of Veterans experiencing homelessness; (3) identify and disseminate best practices in the use of housing stabilization, income support, employment assistance, community partnerships, and other strategies to address homelessness among Veterans; (4) integrate evidence-based best practices into VA policies, programs, and services for Veterans experiencing or at risk for homelessness and provide implementation guidance to VA staff and community partners; (5) serve as a resource center for all research and training activities related to Veteran homelessness. The Center track (NCHAV Fellowship) will be tailored to support applicant’s professional aspirations. Opportunities exist in research, education, and model development as it relates to all aspects of Veteran homelessness and its prevention.

Clinical Training

A broad array of clinical service programs focused on treating Veterans with substance use disorders are available at VANTHCS. This provides opportunities for DALT fellows to train in a variety of settings, including: 1) Substance Abuse Residential Rehabilitation Program, 2) Inpatient Detoxification Unit, 3) Intensive Outpatient Treatment Program for Addictions, and 4) Methadone Maintenance Clinic. These programs utilize empirically supported pharmacological interventions as well as evidence-based psychotherapy for addiction and comorbid psychiatric conditions. The integrated approach to treatment is a clear strength of our facility and a focus of the fellows' clinical training experience.  As noted above, fellows will spend no more than 25% of their time providing clinical services. 

Eligibility:

Physician Applicants:

  1. Completion of an ACGME accredited residency program
  2. Full and unrestricted license to practice in the U.S. or any of its territories
  3. Board certified or eligible
  4. If a graduate of a foreign medical school, ECFMG certification that is valid indefinitely
  5. U.S. citizen or hold a current visa suitable for participation in this paid educational activity

 

Psychology Applicants:

  1. Completion of an APA-accredited doctorate in clinical or counseling psychology (or meeting APA criteria for re-specialization training)
  2. Completion of an APA-accredited psychology internship
  3. U.S. citizen

 

Pharmacy applicants:

  1. Completion of an ACPE-accredited Pharm.D. program
  2. PGY1 residency training, PGY2 preferred
  3. Full and unrestricted license to practice in the U.S. or any of its territories
  4. U.S. citizen

 

Social Work applicants:

  1. Master's in Social Work from an accredited U.S. university program
  2. Completion of a clinical internship in a psychiatric or substance abuse treatment setting
  3. U.S. citizen

For other disciplines (e.g., nursing, chaplaincy), please contact facility co-directors for specific eligibility requirements.

Application Process

Interested applicants should submit a personal statement (maximum 2 pages), CV, VA Form 1028D, and three letters of reference. One of the references should be the training program director or medical director/chief of staff. The letter of interest should include: a brief summary of educational, clinical and research experiences relevant to addictions and a statement of career goals, including areas of focus you are interested in pursuing. Materials should be submitted by email to the program co-Directors, Geetha Shivakumar, MD at Geetha.Shivakumar@va.gov and Jamylah K. Jackson, Ph.D. at JamylahK.Jackson@va.gov.

Applications will be accepted until positions are filled.