Workforce
The changing healthcare landscape necessitates the integration of behavioral health and primary care service delivery. However, several workforce factors need attention to support integration, including:
- Recruitment and retention
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Accessibility, relevance, and effectiveness of training
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Staff competency in integrated care, evidence-based practices, and recovery-oriented approaches
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Attitudes and skills in prevention and treatment of persons with mental and substance use conditions
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Leadership development
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Workforce roles for persons in recovery and their family members.
CIHS addresses these barriers by supporting both organizational and system reform. In Primary and Behavioral Health Integration: Guiding Principles for Workforce Development, CIHS shares guiding principles and recommended strategies to strengthen the workforce, understand that both the primary care and behavioral health workforces need help accommodating behavioral health services in primary care.
CIHS also provides the necessary expertise in both the clinical “what” and operational “how” and its activities address bidirectional integration training, an aging workforce, and evidence-based practice adoption, as well as offer support for licensure, credentialing, curriculum development, and accreditation. CIHS also identifies, catalogues, and disseminates the latest competency sets and curricula, which are all central to strengthening the behavioral health and primary care workforce.
CIHS Resources
To begin to look at issues around integrating substance use services into primary care, the Office of National Drug Control Policy (ONDCP), SAMHSA, and HRSA hosted Workforce Issues: Integrating Substance Abuse Services into Primary Care Summit on August 10-11, 2011. The Summit provided experts from across the country the opportunity to discuss and review workforce issues and begin to identify innovative solutions regarding substance use disorders in primary care. CIHS summarized the Workforce Issues: Integrating Substance Abuse Services into Primary Care Summit’s key themes and discussions and developed a series of related issue briefs:
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- Issue Brief 2: Critical Importance of Integration
- Issue Brief 3: SA Tx Integration into Primary Care
- Issue Brief 4: Current SA Tx Workforce
- Issue Brief 5: Continuing Education and Training
- Issue Brief 6: Summary
Resources
Workforce Issues Related to Physical and Behavioral Healthcare Integration Specifically Substance Use Disorders and Primary Care: A Framework was developed by Joan Dilonardo, PhD, RN, to provide a context and expanded discussion of the workforce issues related to the integration of substance abuse into primary care and other health care settings. This document was developed to inform the Workforce Issues: Integrating Substance Abuse Services into Primary Care Summit.
Workforce Capacity for Reducing Rural Disparities in Public Mental Health Services for Adults with Severe Mental Illness, a study published in the Journal of Rural Mental Health (Jan. 13, 2012) examined workforce capacity in publicly-funded mental health agencies in rural mental health service areas (MHSAs). Overall, workforce capacity in rural MHSAs varied greatly, with some areas’ workforce capacity similar to of metropolitan areas,’ while others have little to no capacity. The study asserts that better leverage of rural MHSA’s core workforce would lead to more comprehensive, higher quality services, noting that the current core workforce lacks high levels of training in specialty care or adequate access to support from urban areas. It also calls for future efforts to establish sustainable mechanisms for ongoing training, education, and support for the core workforce in rural areas and for de facto rural systems of care in general.
Health Navigator trainings expands the traditional case manager role from helping consumers with serious mental illness establish a life in recovery to a broader role of assisting them to learn to manage chronic physical illness.
The Community College Consortia to Educate Health IT Professionals Program funds community colleges to train mid-career healthcare or IT professionals on HIT. The program aims to create a skilled workforce that can implement electronic healthcare systems and connects provider organizations with graduates to hire.
The Collaborative Mental Health Care Pedialink course helps primary care clinicians identify referral sources to help expand their role in behavioral healthcare. After the course, primary care clinicians are able to identify needs that require emergency specialist care, determinate other clinical circumstances that require specialty mental health or substance abuse services, and describe methods for making effective referrals to mental health or substance abuse specialists.
Health Care Workforce: Future Supply vs. Demand, an Alliance for Health Reform policy brief, estimates that the nation will need 10 to 12 million new and replacement direct care workers in 10 years, and explores options for growing the workforce, including options within the Affordable Care Act.
Peer-Delivered Wellness Recovery Services: From Evidence to Widespread Implementation, written by Judith Cooke (Psychiatric Rehabilitation Journal, Fall 2011), discusses the growing body of evidence suggesting that peer-provided, recovery-oriented mental health services produce outcomes as good as and, in some cases superior to, services from non-peer professionals. The editorial asserts that as evidence continues to mount, the stage has been set for a coordinated, national peer workforce development and maintenance initiative.
Health Worker Shortages and Global Justice, a Millbank Memorial Fund report, points to a shortage of about 4 million health workers needed to deliver essential health services. The report also references the World Health Organization’s assertion that health workforce shortages have replaced system financing as "the most serious obstacle" to realizing the right to health within countries.
SAMHSA’s Scopes of Practice and Career Ladder for Substance Use Disorder Counselors guides states in developing scopes of practice (e.g., rules, regulations, and boundaries) and career ladders for counselors working with people with substance use disorders. It includes a full range of responsibility and practices, from entry level to supervisory.
The Psychiatric Services article, Racial-Ethnic Composition of Provider Practices and Disparities In Treatment of Depression and Anxiety, published in September 2011, features research on disparities in depression and anxiety care in primary care. The study determined that physician bias, resource issues, and patient factors are contributing factors in the diagnosis and treatment of depression and anxiety.
The Patient Centered Primary Care Collaborative is a coalition of over 900 members from major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, clinicians, and others that works to develop and advance the patient-centered medical home.
The Robert Wood Johnson Foundation’s Prescription for Health: Promoting Healthy Behaviors in Primary Care Research Networks is a national program that tested the use of evidence-based models and innovative tools in primary care to counsel patients to change unhealthy behaviors. Prescription for Health funded 22 practice-based research networks.
The Kaiser Permanente Northern California Family Violence Prevention Program is a model of care program that provides a comprehensive, integrated approach to build awareness, provide care, and prevent future cases of domestic violence. This model has been instituted at all of Kaiser Permanente’s Northern California facilities, as well as in other regions.
HealthTeamWorks focuses on continuous quality improvement using a systems approach to optimize (1) the care team and their role in the care delivery; (2) health information technology; (3) patient engagement via effective self-management; and (4) the creation of learning communities.