eSolutions is a monthly e-newsletter bringing you practical solutions and resources on primary and behavioral healthcare integration from across the United States.
Linda Rosenberg, President and CEO, National Council for Community Behavioral Healthcare
Four million — that’s the number of health workers needed to deliver essential health services worldwide, according to a new Milbank Memorial Fund report. Shortages have even replaced system financing as "the most serious obstacle" to realizing the right to health within countries, according to the World Health Report 2006.
In the context of integrated primary and behavioral healthcare, the issue is somewhat compounded when you consider that the workforce is actually comprised of three distinct workforces: primary care, mental health, and addictions (and myriad provider types). As CIHS promulgates integration in communities nationwide, it must help health and behavioral health centers address the ‘usual’ workforce challenges, as well as issues unique to integrated settings. However, most individual workforce development efforts are modest compared to the size and scope of need. So, while CIHS develops and draws upon a variety of resources to offer guidance and practical assistance to augment your local efforts, it is also developing a comprehensive action plan for the integrated workforce. To begin, CIHS ‘named the problem’ in Guiding Principles and Recommendations for Workforce Development, which articulates the issues facing the integrated health workforce and informs the planning process currently underway.
Given the importance and sheer size of our workforce challenges, I’m reminded of the saying, “There is only one way to eat an elephant: one bite at a time.” The following may help you tackle your agency’s workforce challenges, one bite at a time:
- The National Health Service Corps (NHSC) is an invaluable resource for attracting and retaining employees and increasing your agency’s capacity to serve. CIHS’ new Understanding the National Health Service Corps can help you understand the program and navigate its application processes. The manual’s timing couldn’t be better: fueled by greater allocation in the Affordable Care Act, the U.S. Department of Health and Human Services recently announced that the program tripled in size in 2011. HRSA, which oversees NHSC, also has a host of other workforce development initiatives.
- Mental Health First Aid puts skills directly into the hands of the public, enabling them to identify and help someone experiencing emotional stress. This program helps provider organizations engage and educate their communities to act as workforce extenders. Notably, Mental Health First Aid is also used as an orientation program for new, non-clinical staff in behavioral health settings, and through CIHS’ help, is now expanding into a tool for training primary and integrated healthcare professionals.
- Addressing Health Disparities Leadership Program addresses the lack of a multi-ethnic representation in behavioral health organizations’ leadership. This program engages talented, up-and-coming leaders by investing in middle managers who represent communities of color and/or work directly with culturally diverse populations.
- Trauma-Informed Care is a CIHS priority and we are committed to helping primary and behavioral health organizations create and sustain trauma-informed systems of care and best practices. The most recent issue of National Council Magazine, focused exclusively on trauma-informed care, providing a comprehensive round up of trauma information and perspectives. You can except to see much more on trauma-informed care from the Center in the coming months.
- Whole Health Peer Support Program is a new CIHS initiative to build the capacity of peers to help others work toward whole health, resilience, and prevention goals through self-management to address both behavioral and general health issues. Pilot trainings have recently concluded; we are excited to share the program broadly in early 2012.
CIHS also has a host of new initiatives and products on the horizon, including:
- A Learning Community for federally qualified health centers (FQHCs) that self-identify as having limited and/or no behavioral health capacity to help them expand behavioral healthcare;
- The development of core competencies for primary care and behavioral health professionals working in integrated health settings;
- The creation of “integration standards” for adoption by social work and medical schools, as well as the design and implementation of health curriculum and modules and field placements;
- Two postgraduate continuing medical education (CME) training programs — for psychiatrists and primary care physicians, respectively — to ensure their success in integrated care settings; and
- The development of a web-based Health Navigator Curriculum for case managers.
Now more than ever, workforce development is paramount. There is no more important factor in achieving successful integration of care than adequate workforce preparation, which means assuring that primary care, mental health, and substance abuse professionals are prepared to meet individuals’ needs, across behavioral health and primary care.
I encourage you to visit the CIHS website often to access the latest reports, guides, state and local activities, webinars, and more, and contact us for technical assistance at Integration@thenationalcouncil.org or 202.684.7457.
The National Health Service Corp (NHSC) presents a unique opportunity for both community health centers and community behavioral health centers. Administered by HRSA, the NHSC builds healthy communities by supporting qualified medical, dental, and behavioral healthcare providers working in areas of the U.S. with limited access to healthcare services. Behavioral health providers comprise about a third of the NHSC. The below quick tips can help you begin the process of becoming an NHSC-approved site.
- Read CIHS’ new manual Understanding the National Health Service Corps to learn about the program and its application process.
- Determine if you are located in a Health Professional Shortage Area (HPSA) by entering your address in HRSA’s HPSA Locator.
- Contact your State Primary Care Office (PCO). Your PCO will walk you through the application process and answer any of your questions.
- Review the NHSC Service Site Reference Guide for details about what it means to be an NHSC site before you begin the application process.
- Apply online at the NHSC website (you must first created an online account).
Annapolis Coalition on the Behavioral Health Workforce
The Annapolis Coalition on the Behavioral Health Workforce works to improve the quality of life of individuals and communities by strengthening the effectiveness of all who work to prevent, treat, and support recovery from mental health and substance use conditions. Comprised of stakeholders from the addiction and mental health sectors, with active participation and leadership from individuals in recovery, the Coalition works with the knowledge that a key component of strengthening the workforce’s effectiveness is to ensure individuals with mental health and substance use conditions can access the same great care whether they are seen in a specialty behavioral health setting or a primary care provider setting.
As a CIHS subcontractor, the Annapolis Coalition contributes its expertise to the Center’s efforts to strengthen the integrated health workforce. It led the development of Guiding Principles and Recommendations for Workforce Development as the first step in creating a strategic integration plan to address workforce challenges. As this plan is developed, the Annapolis Coalition is also leading the compilation and development of Core Competencies for Primary Care and Behavioral Health professionals providing integrated health interventions.
For more information on the Annapolis Coalition, visit www.annapoliscoalition.org.
Guiding Principles for Workforce Development
Primary and Behavioral Health Integration: Guiding Principles for Workforce Development shares strategic recommendations to strengthen the behavioral healthcare workforce, as well as articulates the guiding principles for action planning.
Understanding the National Health Service Corps
Understanding the National Health Service Corps: A Guide for Community Behavioral Health Providers and Primary Care Partners provides guidance to behavioral health sites interested in applying to become NHSC-approved sites, as well as information for providers interested in participating.
Interim Billing and Financial Worksheets for States
CIHS provides tools and resources to primary and behavioral healthcare organizations to help them successfully implement bidirectional integrated healthcare; a key success factor is the financial viability and sustainability of programs’ integration efforts, including appropriate and accurate billing for services. CIHS has developed customized Interim Billing and Financial Worksheets for each state that identify existing billing opportunities for services provided in integrated settings. In states where the identified codes are not currently reimbursable, these worksheets identify areas of potential state policy work.
New Grant Opportunity for Healthcare Innovators
HHS announced that it will award up to $1 billion in grants for healthcare innovation targeted at high-needs populations. The Health Care Innovation Challenge presents a unique opportunity for the mental health and addiction field.
SAMHSA’s New State Guide on Substance Abuse Counseling
SAMHSA’s Scopes of Practice and Career Ladder for Substance Use Disorder Counselors guides states in developing scopes of practice (e.g., rules, regulations, 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.
NPR Features Massachusetts PBHCI Grantee
A Boston NPR affiliate featured PBHCI grantee Community Healthlink in a segment on embedding primary care in behavioral health settings as the Massachusetts legislature prepares to tackle global payment reform.
Russian Medication Professionals Visit Integrated Health Site
Thirteen Russian medical professionals visited Cherokee Health Systems as part of Open World, a congressional program for young professionals interested in learn about the U.S. democratic process and business practices. The visiting professionals — physicians and hospital administrators who work in rural areas and are interested in learning how to provide better patient care — met with agency administrators to learn about Cherokee’s unique service delivery model that integrates primary and behavioral healthcare.
NIH Releases New Spanish-Language Publication on Palliative Care
A new Spanish-language publication from the National Institute of Nursing Research (NINR), a component of the National Institutes of Health, provides those in the Hispanic community with information about palliative care, a comprehensive treatment that reduces or eliminates pain and other symptoms of illness and medical treatments. Available in Spanish and English, Cuidados Paliativos: El alivio que necesita cuando tiene sintimos de una enfermadad grave (Palliative Care: The relief you need when you’re experiencing the symptoms of serious illness) explains palliative care, who it benefits, and how it works. NINR developed the brochure to increase awareness among Hispanic patients and caregivers and care providers who serve Hispanic communities. Order a copy of Cuidados Paliativos.
Buprenorphine/Naloxone Successfully Treats Painkiller Abuse
People addicted to prescription painkillers reduce their opioid abuse when given sustained treatment with the medication buprenorphine plus naloxone (Suboxone), according to National Institute on Drug Abuse research published in the Archives of General Psychiatry. The study, which was the first randomized large-scale clinical trial that used a medication to treat prescription opioid abuse, also showed that the addition of intensive opioid dependence counseling provided no added benefit.
Adults with Complex Health Conditions Fare Better in Medical Homes
Adults with complex medical conditions, including those with serious or chronic illness, benefit from receiving care from a medical home, according to the Commonwealth Fund's latest international health policy survey. According to the 2011 survey, which focused on the healthcare experiences of "sicker" adults in the U.S. and 10 other high-income countries, patients connected with primary care practices that have medical home characteristics were less likely to report medical errors, test duplication, and other care coordination failures. Moreover, they reported better relationships with their doctors and rated their care more highly.
New Brief on Communicating Integrated Care’s Value to Stakeholders
Stakeholder participation is critical to a successful integration strategy, beginning early in program design through to monitoring and evaluation. A Center for Health Care Strategies brief discusses why stakeholder engagement is important, how to identify distinct audience groups within the stakeholder community, how to target messages to specific audiences, and what communication methods are available. Examples of ways in which states are engaging with stakeholders are also presented.
InSHAPE: Health Coaches Take It to the Community
Date: December 5, 1:00-2:00 pm EST
Speaker: Ken Jue, InSHAPE Founder
Organizer: National Council for Community Behavioral Health
Studies show that persons with serious mental illness die decades before the general population, often due to under or untreated physical illnesses. After attending yet another funeral for a consumer who died far too young, Ken Jue decided that it was time to act. His agency, Monadnock Family Services, worked with community partners to establish InSHAPE, a program that offers comprehensive health supports to people with serious mental illness — pool access, gym memberships, nutrition education, exercise, personal coaches, and primary care. Hear Ken discuss InSHAPE’s amazing results and what it takes to replicate InSHAPE in your community.
Check out CIHS’ webinar archived webinar recordings and presentations:
Building Behavioral Health Capacity through the National Health Service Corps
Recorded: October 25, 2011
Coordinated Care for Homeless Populations
Recorded: September 22, 12:00-1:30
Brief Behavioral Health Interventions in Primary Care
Recorded: September 14, 2011
Establishing Smoking Cessation Initiatives in Health Centers
Recorded: August 15, 2011
Introduction to Effective Behavioral Health Service Delivery in Primary Care Settings
Recorded: June 1, 2011
Person-Centered Health Homes
Recorded: May 16, 2011