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Workforce
Development
Overview
This training is supported by the Substance
Abuse and Mental Health Services
Administration (SAMHSA), US Department of
Health and Human Services (HHS)
The contents of this presentation do not
necessarily reflect the views or policies of
SAMHSA, or HHS.
2
STAR- SI
funded under Contract No. HHSS2832007000031/HHSS28300002T
Currently working on 2 projects
• Identify and Improve Provider
Network Development
• Promoting Use of Technology to
Improve Treatment and Recovery
Addiction Workforce
Traits…
•Older than general
workforce
•Under-credentialed
•Supply does not meet anticipated
demand
Size
• Retirees are outpacing new
entrants
• State of Washington predicts the
need for 700 new workers
Skill Level
• Definitions: Annapolis
Coalition/SAMHSA/ATTCs
• New/Existing Workforce
• Reciprocity
Roles?
• Counseling
• Administrative/Support
• Peer Support
Diversity?
• Race
• Ethnicity
• Culture
• Gender
State Roles
Projections of….
•Need
•Roles definitions
•Planning the pipeline
What do we know about today’s
and Tomorrow’s SU Tx Workforce
Mental Health and Addiction Workforce Development:
Federal Leadership Is Needed to Address The Growing Crisis
(Hoge, M; Stuart, G.; Morris, J.; Flaherty, M.; Paris, M. and Goplerud, E. ,Health Affairs, 32, NO11
(2013); available for viewing and download at http://annapoliscoaltion.org/healthaffairs/
Substance Abuse and Mental Health Services Administration
Report to Congress on the Nations Substance Abuse and Mental
Health Issues
January 24, 2013
Pamela S. Hyde, J.D.
Administrator
Major Forces Effecting Workforce
Work in Health Care Today
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Mental Health Parity (MHPAEA)
Affordable Care Act (ACA)
Integration of Care – BH/Med
SAMHSA Priorities 2014; NBHQF
Need for Treatment – Capacity exists for only
10.8% of those with SU need*
• Worker shortage/turnover/diversity and need to
prove effectiveness
• Purpose – Why do you do what you do?
*ONDCP 2013 National Drug Strategy - 2.5 million of 26 million; SAMHSA 2009 - 6,800 per 10%
DUE TO ACA & MHPAEA . . .
Over 65 million people will have access to
MH/SA benefits due to ACA and MHPAEA
– 30 million currently without adequate BH
benefits
– 35 million currently uninsured
11 million have M/SUDs
SAMHSA’S STRATEGIC
INITIATIVES
1.Prevention
2. Trauma
and Justice
3. Military
Families
4. Recovery
Supports
5. Health
Reform
6. Health
Information
Technology
7. Data,
Outcomes
& Quality
8. Public
Awareness
& Support
NBHQF - Measures
Defined and to be tracked for: Payer/System,
Provider/Practitioner and patient/populations across
six NQS priorities: evidenced-based practice being
used; person-centered care; healthy (measured)
living for communities, reduction of adverse events,
and cost reductions.
Example of measures:
System:
Provider:
Initiation of AOD Treatment Prevention, Screening and admission
of EBPs; patients reporting abstinence
after treatment
Patient/ Population: Family communication around drug use; reduction
in AOD related suspensions/expulsions; % of population in
jail/homeless, in CJ system.
What today’s Health Care
demands:
» Greater attention to preventing illness and promoting wellness
» Increased access to care
» Increased focus on the coordination/integration of services between
primary care and behavioral health
» Increased focus on quality, outcomes and accountability
» Enhanced infrastructure to support the delivery of effective services (e.g.
HIT)
» Medicaid/Exchanges will play a much larger role in MH/SUD
» Focus on evidence-based medicine
» Shrinking or capitated budgets
» Need to develop organizational cultures that are adept at effectively
responding to change!
Competent Providers and
Service Will be Key*
Providers will lead if they have ability to:
- be accessible
- utilize electronic health records to coordinate care
- collaborate effectively or integrate care
- are efficient
-Service that tracks outcomes that matter to the patient (i.e.
“recovery”)
•Engaged clients and natural support network
•Help clients self manage their wellness and recovery
•Greatly reduce need for disruptive/high cost services
•Promote community wellness
•Effectively promotes sustained recovery
(* Porter and Lee, The Strategy That Will Fix Health Care, Harvard
Business Review, Oct. 2013)
Data – Populations In Search of a
Workforce
• Today substance use conditions affect about
26 million (up 16% since 2000) of Americans
age 13 and older (CDC, 2012).
• OD deaths now are the leading cause of
accidental death in America exceeding even
traffic deaths.(CDC, 2012)
• Teens today often experience an opiate
before MJ or cocaine use. (Archive of Ped/Adol. Med,
2009)
DATA- Populations in Search of a
Workforce
• Americans are 4.7% of the world’s population; we consume 80%
of the worlds opioids, 99% of the world’s supply of Oxycodone
and two-thirds of all of the world’s illegal drugs. (Manchikanti et al,
2010)
• Only 10.8% of those needing SU treatment receive treatment
(ONDCP, 2013); capacity exists in specialty care for about 2.6 million
Americans leaving 20+ million outside of treatment (societal cost?
$585 billion year).
• SU treatment itself is evolving with enhance generalist
identification and care; new medications and a new model of SUD
being best addressed as a chronic illness needing continuing
care.
• Today here are a scientifically estimated 35-55 million Americans
in recovery – not including tobacco! (White, 2012) Can they help?
Annapolis Coalition and other workforce
studies – “déjà vu all over again”
Patient gaps: stigma, related discrimination, lack
of healthcare coverage, insufficient services and
linkages among services; age, diversity and cultural
specificity needs – overall an insufficient behavioral
health care workforce to meet demand. (Hoge et al, 2013;
SAMHSA, 2010, Schomerus, G. et al, 2011;SAMHSA, 2013; et al.)
Annapolis Coalition and other workforce
studies – “déjà vu all over again”
• Workforce gaps: insufficient size, frequent
turnover, relatively low compensation, minimal
diversity and limited competence in evidenced
based treatments. (Hoge et al, 2007)
• Need to address above with an aging within workforce
itself while addressing the increasing aging, rural, racial
and cultural diversity of America … and demands of
health care reform.
• And address the integration of care by building
prevention, intervention, treatment and recovery for both
specialist and generalist populations – with
accountability.
Projecting Workforce Need
Every 10% increase in demand for SU
treatment would result in a need for
6,800 counselors (SAMHSA, 2009).
Conservative estimate is need for 18,000 new
SU counselors; 26,800 social workers; 16,800
psychologists by 2018 (SAMHSA/DOL, 2013).
How to Meet the Need-Macro
• Broaden “concept” of workforce – no silos.
• Train all healthcare providers in SU and
chronic nature of SUD; its treatment and
continuing care needs.
• Build consumers and peers as providers.
• Strengthen collaborations of all professionals
involved at both generalist and specialty
settings - include peers and peer supports as
advocates, extenders of care and early
interventionists. Build a common CE and
credential for public trust.
How to Meet Need-Micro
• Build career ladders and higher education
for addressing the illness as a “specialist.”
• Train and certify in best practice
• Address compensation and wage
inequality issues.
• Recruit and Retain
• Build the political will to address the
problem – we can’t afford not to!
How to Meet Need-Micro (Cont.)
• Offer tuition reimbursement to work x
amount after getting degree
• Working with schools for existing
employees to do a paid intern program
• Reaching out to Master’s level programs
to accept interns.
4 Specific Steps
1. Government and private payer collaboration
and leadership is critical – at all levels – if we
are to succeed. Competence and trust.
- Includes professional organization collaboration
- Must include States, Payers and Peers
2. Each State, community and agency must
allocate a greater portion of its time and
resources to develop and assure a competent
worker.
- Consumer/payer trust is critical
- Resources from within states and payers are critical
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4 Specific Steps
3. Create a robust national technical
infrastructure to coordinate and sustain
efforts and implementation.
- Invite new partners – HRSA, CMAP, PCORI, DOL,
VA, IOM, CIHC, Comm.Colleges/Universities and
Trade Schools, Nat. Council, – all guilds.
4. Collaborate with all agencies and entities at all
levels to assess and address the problem and
shape Macro/Intra (e.g. silos) and Micro/Inter
(e.g. 2R’s, inter-guild, salary, career ladder)
solutions for steady improvement.
Solutions in Action
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HHS Secretary Strategic Initiatives (13); Vision – Promote High-Value, Safe and
Effective Health Care
Goal 5 Strengthen the Nation’s Health and Human Service Infrastructure
and Workforce
“We at the Department of Health and Human Services consider it our mission to
address the looming health professional workforce shortage and to recruit, train,
and retain competent health and human service professionals across America.”
HHS Secretary Kathleen Sebelius
Objective A: Invest in the HHS workforce to help meet America’s health and
human service needs today and tomorrow
Objective B: Ensure that the Nation’s workforce can meet increased demands
Objective D: Strengthen The Nation’s human service workforce
Solutions in Action
•12.10.13 HHS announced that $50 million from health care law will
be used to expand mental health and substance use disorder
services in approximately 200 Community Health Centers. Funds
are to be uses to expand these health centers service capacity.
Additionally the President’s 2014 Budget includes $130 million for
teachers (recognize MH) and train 5000 new MH professionals.
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•12.05.13 HHS Awards $55.5 million to strengthen and increase
size of health care workforce. While mostly for nursing development
$1.4 is four research centers to improve understanding of both local
and national health workforce needs.
•Special SAMHSA grants and supplements
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Solutions in Action
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6.17.14 HHS awards $110 million for health care innovation, additional
$730 million available. To promote health care delivery reform and improve
patient outcomes, the U.S. Department of Health and Human Services (HHS)
awarded 12 organizations a combined $110 million under round two of the
Health Care Innovation Awards program. Authorized under the ACA,
awardees will focus on the following priority areas: (1) reducing costs for
Medicare and Medicaid enrollees, (2) improving care for populations with special
needs, (3) testing improved financial and clinical models, and (4) linking clinical
care delivery to preventive and population health. In addition, to further support
the design and testing of health care delivery and payment systems, HHS
announced $730 million in funding for State Innovation Model (SIM) grants.
Also authorized under the ACA, this funding includes $700 million available to
fund 12 SIM Testing grants and $30 million to fund 15 SIM Design grants
(HHS, 5/22).
6.17.14 HHS offers $300 million to community health centers and $40
million for insurance rate review. On June 3, HHS announced plans to award
community health centers up to $300 million in Affordable Care Act Health
Center Expanded Services grants. Under the grants, awardees will expand
service hours and hire additional medical providers.
Solutions in Action
• SAMHSA Recovery to Practice Initiative
www.samhsa.gov/recoverytopractice/
APA, ApA, APNA, CSWE, NAPS, NAADAC
(situational analysis and training/curricula)
SAMHSA/BRSS-TACs
[email protected]
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People in recovery, state, county, and city behavioral health authorities,
policy makers, researchers, behavioral health providers, including peer
providers, other health and human service providers, family members.
Solutions in Action
• SAMHSA Addiction Technology Transfer
Centers
- 2012 Vital Signs at www.attcnetwork.org/documents/vital
signs
• SAMHSA NIATx
• SAMHSA CAPS
• SAMHSA ATTC SBIRT Initiative
• NAADAC – www.naadac.org
- Situational Analysis
- Web based core training (9 modules)
In BH we are only as good as our worker.
In human services our worker is our
greatest asset and our society’s best hope
for preventing, treating and addressing
any illness and its costs while affording health
and wellness. If we do this together, all
professions and each community, we will
succeed not only for each individual,
family and community - but for ourselves. That’s
the way it works.
Michael Flaherty, Ph.D.
Annapolis Coalition
[email protected]