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Perspectives from the Annapolis Coalition on the behavioral health workforce

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Behavioral Health Workforce Development in the Age of Healthcare Reform: Change is in the Air PERSPECTIVES FROM THE ANNAPOLIS COALITION ON THE BEHAVIORAL HEALTH ... – PowerPoint PPT presentation

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Title: Perspectives from the Annapolis Coalition on the behavioral health workforce


1
Behavioral Health Workforce Development
in the Age of Healthcare Reform Change is in
the Air 
  • Perspectives from the Annapolis Coalition on the
    behavioral health workforce
  • John A. Morris, Executive Director
  • Navigating the new landscape
  • Maryland addictions directors council
  • Ocean city, md May 11, 2011

2
It will be quite a ride
3
Context for this presentation
  • BEHAVIORAL HEALTH 1969 2011
  • Trans- and de-institutionalization
  • Major transition from state mental health
    authorities to Medicaid as the driver of services
    for people with mental illnesses (and
    increasingly for substance use conditions as
    well)
  • Move from 12-step models of recovery to more
    professionalized models
  • The rise of the consumer movement in MH
  • Better But Not WellFrank Glied

4
Better but not well
  • Mental Health exceptionalism vs. mainstream
    integration
  • Substance use treatment and prevention are a
    greater priority while these fields are changing
    paradigms to better address the often chronic
    nature of the illnesses and the need for more
    recovery focused care.
  • Behavioral health moving closer to being a
    reality
  • Now behavioral health/primary care integration
    (including bi-directional integration) is an
    accelerating reality

5
Better but not well
  • Historical Barriers to BH and SU integration to
    consider in developing unified workforce
  • Etiology of nature of MH and SU and their
    treatment philosophies and techniques
  • Practitioners from MH and SU have trained
    differently and often are unwilling or unprepared
    to treat MH, SU or COD
  • Competition for scarce resources

  • - White/Davidson, 2006

6
Better but not well
  • BUT Individual, family recovery and community
    health and resilience are the common denominators
    the unifying principles of our work we cannot
    lose them!
  • Each person must be the agent of his or her own
    recovery, each community must bolster its
    strengths.

7
Behavioral health/primary care integration
  • Do we really know what this will mean?
  • Are providers in either sector really prepared?
  • What are the dynamics likely to be?

8
Agreed.
  • There is a lot at stake.
  • The history of behavioral health integration has
    some scary precedents
  • Reduced access and benefits
  • Inappropriate limits on visits and medications
  • Dramatically under-priced reimbursement rates
  • Narrow definitions of medical necessity that
    negatively impacted using natural supports and
    peers resistance to inclusion of substance use
    treatment in basic coverage
  • Loss of recovery focus in care to medical
    management

9
On the other hand.
  • Data on mortality and morbidity for people
    diagnosed with major mental illnesses, including
    comorbid substance use disorders a scandal for
    our field
  • Life expectancy reductions of 20 years cannot be
    allowed to continue

10
The way forward Reasons for optimism
  • Health care reformimproved potential for access
    for millions (ACA 2010)
  • Behavioral health actually has something to bring
    to the table (more on this later)
  • Co-occurring disorders are increasingly
    recognized as the norm not an anomaly
  • The new buzz word in federal integration circles
    is bidirectional not a foregone conclusion
    that the mergers or integration will all be from
    behavioral health into primary care.

11
Lessons from the rest of healthcare
  • The history of how we arrived at the current
    general healthcare system is every bit as
    haphazard as ours.
  • Atul Gawande, MD Health care development was
    path-dependent, following the paths of least
    resistance
  • M.C. Escher might have envisioned this history
    thus

12
Can we all say non-linear?
13
Wisdom from rural behavioral health
  • Behavioral health Exceptionalism never an issue
    in rural America
  • Practical realities have always encouraged if
    not required collaboration, co-location,
    integrated approaches
  • But what about the PEOPLE needed to make it all
    work?

14
Workforce development
  • For decades we have been using methods that dont
    work
  • In the Annapolis Coalition Work, we refer to
    these as the
  • PARADOXES OF WORKFORCE
  • DEVELOPMENT IN BEHAVIORAL HEALTH

15
THE PARADOXES OF WORKFORCE DEVELOPMENT
  • Paradox 1 We train graduates of our
    professional programs for a world that no longer
    exists
  • Paradox 2 Those who spend the most time with
    consumers receive the least training
  • Paradox 3 Training programs persist in utilizing
    ineffective teaching strategiesin continuing
    education

16
THE PARADOXES OF WORKFORCE DEVELOPMENT
  • Paradox 4 We train only where willing crowds
    gather
  • Paradox 5 Consumers and families receive little
    educational support and their lived experience
    doesnt inform the rest of the workforce
  • Paradox 6 The diversity of the current
    workforce doesnt match the diversity of those
    served

17
THE PARADOXES OF WORKFORCE DEVELOPMENT
  • Paradox 8 We do not systematically retain or
    recruit staff
  • Paradox 9 Once hired, little supervision or
    mentoring is provided
  • Paradox 10 Career ladders and leadership
    development are haphazard
  • Paradox 11 Service systems thwart the competent
    performance of individuals

18
So whats to be done?What direction do we head
in?
19
National Action Plan
20
The planning process
  • Two years 5,000 participants
  • Federally funded
  • Mental health addictions
  • Treatment prevention
  • Seeking to identify
  • A core set of strategic goals objectives
  • High priority ACTION items by stakeholder
  • A planning resource
  • Call to action

21
The players
  • SAMHSA
  • The Annapolis Coalition
  • Senior consultants
  • Expert panels Advisory Groups (12)
  • Reviews of existing recommendations
  • Planning sessions in existing meetings
  • Specially convened planning sessions
  • Targeted requests and open calls for
    recommendations

22
The seven major goals
  • GOAL 1 Significantly expand the role of
    individuals in recovery, and their families when
    appropriate, to participate in, ultimately
    direct, or accept responsibility for their own
    care provide care and supports to others and
    educate the workforce.
  • GOAL 2 Expand the role and capacity of
    communities to effectively identify their needs
    and promote behavioral health and wellness.

23
The 7 major goals
  • GOAL 3 Implement systematic recruitment and
    retention strategies at the federal, state, and
    local levels.
  • GOAL 4 Increase the relevance, effectiveness,
    and accessibility of training and education.
  • GOAL 5 Actively foster leadership development
    among all segments of the workforce.

24
The 7 major goals
  • GOAL 6 Enhance the infrastructure available to
    support and coordinate workforce development
  • GOAL 7 Implement a national research and
    evaluation agenda on behavioral health workforce
    development

25
GOAL 1 Its all about individuals and families
  • Objectives
  • Increased educational supports for them
  • Shared-decision making with them
  • Expand peer family support by them
  • Greater employment as paid staff
  • Formal engagement as educators of the workforce
  • Healthcare reform cannot happen on the backs of
    M.D.s and Ph.D.s alone. Mike Flaherty,
    Executive Director IRETA

26
Goal 2 Its all about communities
  • Objectives
  • Competency development with communities
  • Competency development of the behavioral health
    workforce in community collaboration
  • Strengthening connections between behavioral
    health organizations and their communities

27
Goal 3 RETAIN and recruit
  • Objectives
  • Implement evaluate interventions
  • Salary, benefits, financial incentives
  • Non-financial incentives rewards
  • Job characteristics
  • Work environment
  • Develop career ladders
  • Grow your own workforce
  • Cultural linguistic competence
  • Public relations campaigns
  • Too often our approach might be seen as

28
TRAINING Relevance, effectiveness, accessibility.
  • Objectives
  • Competency development
  • Curriculum development
  • Evidence-based training methods
  • Substantive training of direct care workers
  • Technology-assisted instruction
  • Addiction and co-occurring competencies in every
    staff member
  • Systematic support to sustain newly acquired
    skills

29
And are we perpetrating what we call
  • RHETORIC INFORMED CARE?

30
Nothing to it.
  • We seek to provide person-centered, consumer-
    and family-driven, recovery and resilience
    oriented, strength-based, trauma-informed,
    gender-specific, age appropriate, developmentally
    relevant, community-based, co-occurring,
    time-limited, culturally and linguistically
    competent, transformational, health- and
    wellness-oriented, wrap-around, evidence-based
    care.

31
  • And now we are going to do that ALONG WITH
    providing primary healthcare.
  • Did I mention we need to fasten our seatbelts.?

32
Goal 5 Leadership development
  • Objectives
  • Identify leadership competencies tailored to
    behavioral health
  • Competency-based curricula
  • Succession planning
  • Formal, continuous leadership development in all
    sectors beginning with supervision (or is it
    surveillance?)

33
Goal 6 Infrastructure change
  • Selected Objectives
  • A workforce plan for every agency
  • Data-driven CQI on workforce issues
  • Strengthen HR training functions
  • Improve the economic market for services
  • Improve IT support for training, workforce
    support, tracking
  • Decreased paperwork burden variable, redundant
    or purposeless reporting

34
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35
Goal 7 Research and technical assistance
  • Objectives
  • Federal and state inter-agency research
    collaboratives
  • Technical assistance to field on evaluation of
    workforce practices

36
Help is coming..!!!
  • SAMHSA/HRSA Center for Integrated Health
    Solutions
  • An important federal leadership partnership
  • Led by the National Council for Community
    Behavioral Health
  • Partners with broad workforce experience in
    behavioral health and primary care..across the
    life span
  • Designed to provide practical, implementable
    solutions to the challenges of addressing the
    whole person

37
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38
Change in the real world.
  • What role can we play in shaping the change?
  • We have learned a lot about engaging healthcare
    consumers in self-care, peer-supports, and
    non-medical supports and recovery services. We
    need to build on this and bring more competent
    workers into our ranks at ALL levels.

39
Change in the real world -2
  • The Institute of Medicine has been pushing
    person-centered care for yearssubstantive
    convergence around the whole person.
  • E-health and the Internet are arming healthcare
    consumers with vastly more knowledgebut its
    changing the behavior that improves health
    outcomes. New practitioners (e.g.
    interventionists) and practices (e.g. phone
    follow-up and outreach) are emerging.

40
The change process
  • Change always occurs in some real-world context
  • Managing change is not an illusion, but it is
    also non-linear
  • One mans theory of change

41
Policy pinball.
42
The message for us
  • Be prepared for the
  • Political dimensions
  • Economic dimensions
  • Practice dimensions
  • Need to keep building measurable resiliency,
    wellness and recovery in the impending change.
  • And there is even some helpful science an
    emerging body of literature on integration, and
    successful models, too.

43
Some models to look at
44
In closing
  • The True North of healthcare reform has got to
    be improved health outcomes for real people in
    the real worldwhich means people who have
    multiple health conditions.
  • There can be no health without behavioral health.
  • Therefore we are positioned to provide leadership
    and context as we navigate the various paths
    that Gawande alerts us lie ahead.

45
The Annapolis Coalition Motto
  • I get up every morning determined to change the
    world AND to have one hell of a good time.
    Sometimes this makes planning the day difficult
  • Adapted from E.B. WHite

46
Thanks for listening, and
47
Be in touch
  • www.annapoliscoalition.org
  • jmorris_at_tacinc.org
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