Overview

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Workforce Development
Overview
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• 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.

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STAR- SIfunded 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

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Addiction Workforce

• Traits
• Older than general
• workforce
• Under-credentialed
• Supply does not meet anticipated demand

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Size

• Retirees are outpacing new entrants
• State of Washington predicts the need for 700 new
  workers

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Skill Level

• Definitions Annapolis Coalition/SAMHSA/ATTCs
• New/Existing Workforce
• Reciprocity

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Roles?

• Counseling
• Administrative/Support
• Peer Support

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Diversity?

• Race
• Ethnicity
• Culture
• Gender

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State Roles

• Projections of.
• Need
• Roles definitions
• Planning the pipeline

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What do we know about todays and Tomorrows 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

 
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Major Forces Effecting Workforce Work in Health
Care Today

• 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

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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

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SAMHSAS STRATEGIC INITIATIVES
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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.

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What todays 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!

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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)

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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)

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DATA- Populations in Search of a Workforce

• Americans are 4.7 of the worlds population we
  consume 80 of the worlds opioids, 99 of the
  worlds supply of Oxycodone and two-thirds of all
  of the worlds 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?

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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, 2011SAMHSA, 2013 et al.)

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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.

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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).

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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.

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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 cant afford not to!

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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 Masters level programs to accept
  interns.

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4 Specific Steps

• 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. 2Rs, inter-guild, salary, career
  ladder)
• solutions for steady improvement.

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Solutions in Action

• HHS Secretary Strategic Initiatives (13) Vision
  Promote High-Value, Safe and Effective Health
  Care
•  
• Goal 5 Strengthen the Nations 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 Americas health and human service needs
  today and tomorrow
• Objective B Ensure that the Nations workforce
  can meet increased demands
• Objective D Strengthen The Nations human
  service workforce

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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 Presidents
  2014 Budget includes 130 million for teachers
  (recognize MH) and train 5000 new MH
  professionals.
•  
• 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

• 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.

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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
• brsstacs_at_center4si.com
• 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.

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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)

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• In BH we are only as good as our worker.
• In human services our worker is our
• greatest asset and our societys 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.
  Thats
• the way it works.
• 
  Michael Flaherty, Ph.D.
• 
  
  
  Annapolis Coalition
• 
  
  
  flahertymt_at_gmail.com