Transcript Slide 1

Addressing Workforce Issues
Paula K. Horvatich, Ph.D.
May 26, 2010
Advanced Organizer
1. Workforce reports of the past decade – what do they say?
2. Changing the paradigm – it’s a public health issue!
3. Miscellaneous observations, trends, direction, initiatives.
4. What are the implications for curricula?
5. Curriculum infusion packages as resources.
6. Conclusions.
3
Remember
this?
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2000-2010
The DECADE for Workforce Reports
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•
(2000) Center for Substance Abuse
Treatment, The National Plan to
Improve Substance Abuse
Treatment, Panel V: Addressing
Workforce Issues
•
(2006) Strengthening Professional
Identity: Challenges of the
Addictions Treatment Workforce
•
(IOM, 2006) Improving the Quality of
Health Care for Mental and
Substance-Use Conditions
•
(HHS 2007) Report to Congress:
Addictions Treatment Workforce
Development
•
(SAMHSA, 2007) An Action Plan for
Behavioral Health Workforce
Development
(2003) New Freedom Commission
on Mental Health
•
(IOM, 2003) Health Professions
Education: A Bridge to Quality
•
(2005) the Annapolis Coalition on
Behavioral Health Workforce
Education
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Key Trends With An Impact On The Substance Abuse Treatment
Workforce (2007 HHS Report to Congress)
•
Insufficient workforce/treatment
capacity to meet demand
•
A movement toward a recovery
oriented system of care
•
The changing profile of those
needing services
•
Provision of services in
generalist and medical settings
•
A shift to increased public
financing of treatment
•
Use of performance and patient
outcome measures
•
Challenges related to the
adoption of best practices
•
Discrimination and stigma
associated with substance use
disorders
•
Increased utilization of
medications in treatment
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Workforce Problems
(Annapolis Coalition Testimony to Senate Finance
Committee 2009)
1. Absence of career ladders
2. Marginal wages and benefits
3. Limited access to relevant and effective training
4. The erosion of clinical supervision
5. Financing systems that place enormous burdens on the
workforce to meet high levels of demand with inadequate
resources
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What is Known –
Basic Demographics Of The Workforce
–
–
–
–
–
aging or graying
does not reflect the treatment population
diverse in discipline and setting
better educated, though exact data is unclear
high turnover rates, but professionals seem to
stay in the substance use disorders field
– salaries are low and effect retention rates
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Occupational Outlook Handbook 2010-2011
• SUD and behavioral disorders counselors = 13% of the
counselor workforce
• Translates to approx. 86,100 jobs (all counselors = 665,500
jobs)
• Employment expected to grow by 21% for SUD and behavior
disorders counselors
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What is Known - Common Strategies And Methodologies To
Prepare, Retain, And Maintain The Workforce
•
•
general consensus around
workforce development
recommendations
professional development
strategies are key to retaining and
maintaining a strong Workforce
•
leadership and management
practices can reduce turnover
•
a renewed focus on recruitment
and retention processes is needed
•
salary, tenure, education, and
workload affect retention
•
early substance use disorders
treatment staff show lower levels
of job satisfaction
•
not enough research and
evaluation data about the
workforce or to inform
workforce development efforts
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New Drug Control Strategy Signals U.S.
Policy Shift
SAM HANANEL Associated Press Writer Published: May 11, 2010
WASHINGTON — President Barack Obama on Tuesday announced a revised
approach to “confronting the complex challenge of drug use and its
consequences,“ putting more resources into drug prevention and treatment.
The new drug control strategy boosts community-based anti-drug programs,
encourages health care providers to screen for drug problems before addiction
sets in and expands treatment beyond specialty centers to mainstream health
care facilities.
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We Face Multiple Challenges
• Reaching those in need of services
• Finite resources
• Developing culturally-appropriate
evidence-based interventions
• Building and sustaining a qualified
workforce
• Supporting systems-level changes
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The Treatment Gap
21.1 Million People Needing But Not Receiving Services
Felt They Needed
Treatment and Did
Not Make an Effort
Did Not Feel
They Needed
Treatment!
95.5%
4.1% 3.0%
1.5%
Felt They Needed
Treatment and Did
Make an Effort
Source: NSDUH/SAMHSA (2006)
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Greater Burden on the Public Sector
1986
2003
Private
Private
23%
50%
Public
50%
Public
All SA = $9.3 B
Public = $4.6 B
Private = $4.6 B
77%
All SA = $20.7 B
Public = $16.0 B
Private = $4.7B
(Health Affairs, July-August
SAMHSA/CSAT’s response is a public health
approach that:
• is population-based
• is comprehensive and holistic
• incorporates early intervention, recovery
support, and health promotion
• works across systems and professions
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Recovery-Oriented Systems of
Care (ROSC):
Operationalizing a Public Health
Approach
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ROSCs Embrace a Public Health Approach
The science and art of preventing disease,
prolonging life and promoting health through
the organized efforts and informed choices of
society, organizations - public and private communities and individuals.
- C.E.A. Winslow,
Professor of Public
Health, Yale School of
Medicine, 1920
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Goals of ROSCs
• To support preventive strategies related to
substance use problems & disorders;
• To intervene early with individuals with
substance use problems;
• To support sustained recovery for those with
substance use disorders; and
• To improve individual and family outcomes.
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A Paradigm Shift in Systems of Care
Current Systems
ROSCs
Reactive
Proactive
System-driven care
Individual/Community-driven
care
The most severe cases
The entire population
Process
Outcomes
Treatment-based approach
Recovery-based & Public
Health approach
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Demand for Behavioral Health Services
Will Increase
• The advent of Health Care Reform and Parity for
mental health and substance use disorders
services will increase demand for qualified and
well-trained behavioral health care staff.
• The trend toward more integration of primary
care and behavioral health care underscores the
increased access people will have to behavioral
health services.
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FY 2011 HHS Priorities
1. Public Health
– Teen Pregnancy
– Food Safety
– Substance Abuse
– Tobacco
– Global Health
– HIV
– Pandemic Influenza
– Autism
2. Access to Health Care
– Insurance Reform – Community Health Centers
– Health Workforce
– AI/AN
– Medicare/Medicaid – HIT
3. Human Services
– Services for Children age 0-5
– Aging Caregivers
4. Research and Development
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Preparing to Meet the Needs of
Tomorrow
• It is important not only to focus on meeting the
needs of today’s population, but to be prepared
to meet the needs of tomorrow’s.
• Among the issues that need to be addressed
are:
– The effects of the aging population
– The effects of new parity laws
– The potential effects of health care reform
– The speed with which the states recover from
the economic crisis.
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SAMHSA: Four Fundamental Beliefs
Pamela S. Hyde, J.D.
Administrator, SAMHSA
These beliefs are the foundation
upon which all SAMHSA
programs and initiatives are
built:
• Mental illness and substance
abuse are parts of overall
health.
• Mental illness and substance
abuse can be prevented.
• Mental illness and substance
abuse can be treated.
• People can – and do –
recover.
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We Face Multiple Challenges
• Reaching those in need of services
• Providing adequate resources
• Developing culturally-appropriate, evidencebased interventions
• Building and sustaining a qualified workforce
• Integrating substance use disorder services
into the public health paradigm
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Past Year Perceived Need for and Effort Made to Receive
Specialty Treatment among Persons Aged 12 or Older
Needing But Not Receiving Treatment for Illicit Drug or
Alcohol Use: 2008
Did Not Feel
They Needed
Treatment
(19.8 Million)
95.2%
Felt They Needed
Treatment and Did
Not Make an Effort
(766,000)
3.7%
1.1%
Felt They Needed
Treatment and Did
Make an Effort
(233,000)
20.8 Million Needing But Not Receiving
Treatment for Illicit Drug or Alcohol Use
Source: NSDUH 2008
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SAMHSA’s 10 Strategic Initiatives
The ATTC Network supports SAMHSA’s strategic
initiatives:
• Prevention of Substance Abuse & Mental Illness
• Violence and Trauma
• Military Families – Active, Guard, Reserve, and Veteran
• Housing and Homelessness
• Jobs and Economy
• Health Insurance Reform Implementation
• Health Information Technology for Behavioral Health
Providers
• Behavioral Health Workforce – In Primary and
Specialty Care Settings
• Data and Outcomes – Demonstrating Results
• Public Awareness and Support
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SAMHSA Workforce Initiative
• In support of SAMHSA Initiative: Behavioral
Health Workforce – In Primary and Specialty
Care Settings
• Objective: to provide a coordinated approach to
address workforce development issues affecting
the behavioral health service delivery
community and
– promote training and use of behavioral health
screening, brief interventions and referral for
treatment in primary care settings.
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SAMHSA Workforce Initiative
Issues and concerns of the Behavioral
Workforce:
• Recruitment and retention of personnel
• Adequate pre-service and in-service training &
education
• Adoption of evidence-based practices
• Ongoing clinical supervision of front-line staff
• Preparation of the next generation of managers
& leaders
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SAMHSA Workforce Initiative
Issues and concerns of the Behavioral Workforce
(cont’d):
• Recruitment of qualified staff in rural and
frontier areas
• Increasing the diversity of the workforce so it
reflects the individuals, families, and
communities receiving services
• Integration of peers/consumers/family
members into the workforce.
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SAMHSA Workforce Initiative: Proposed
Goals
Proposed Workforce Initiative goals include:
• Improve the ability of behavioral health workers to adopt
evidence-based practices by developing and delivering
training across behavioral health disciplines.
• Address the behavioral health workforce shortage by
increasing the number of adequately prepared
peers/consumers & family members who provide
services based on a set of core competencies.
• Promote competency in recovery-oriented services
through training of current professionals across
behavioral health care.
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ATTC Addiction Workforce Survey
• The ATTC national Office convened and facilitated the
ATTC Workforce Survey Planning Meeting in February,
2010.
• The survey will provide important information regarding:
– The demographics of the addiction treatment
workforce
– The anticipated workforce development needs for
2010-2015
– Common strategies and methodologies to prepare,
retain, and maintain the workforce.
• Survey data will be useful to studies regarding
Healthcare reform.
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Preparing the
Workforce
What are the
implications for
curricula for
pre-service and
professional
development?
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TOPICS
• Culturally appropriate
EBPs
• SBIRT
• MAT
• Integration w/ Primary
Care (team skills)
• Health Care Reform
•
•
•
•
ROSC/recovery
Public Health
Prevention
Health Information
Technology
• Performance Evaluation
• Change (individual)
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Well, you know, Dad, when you pay $2.98 for
something, you expect it to last.
“MI is harder to do than
clinicians expect.”
Martino, S. et. al. (2006)
MI for
Supervisors
Advanced
___
MI Spirit
OARS
___
Resistance
Change talk
Check up;
Increased
intensity
Strategy
Integration
(2 days)
(2 days)
EVENT 3
(1 day or
Online)
EVENT 1
EVENT 2
___
3 - 6 months
Skills
Acquisition
3 – 6 months
Overview
of MI
1 - 3 months
___
Required
tapes before
& after
(Online &
2 days)
EVENT 4
Continuing TA
Mid-Atlantic ATTC: MI Training for Fidelity
PRE-SERVICE ADVANTAGE
OVER TRAINING
• ATTC Experience teaching skills,
particularly MI (deceptively simple)
• Not enough resources, time, funds,
sequence, feedback, supervision etc. are
devoted to learning new clinical skills after
academic education
• Implementation Science vs. Change
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Basics – Still
Relevant
(Revised, 2006)
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Additional Resources
Mountain West ATTC
The intent of the CIP is to translate researchfindings and established curricula into a
format that addiction educators can easily
infuse into their existing courses
Materials in the CIP include:
PowerPoint presentation slides
Lecture or Instruction Notes
Sample test questions
Classroom Exercises
Briefing sheets
Treatment or training manuals
References
The workforce is the field’s
most important asset because
the quality of substance abuse
treatment is dependent upon
the workforce that delivers it.
Horvatich, P. K. Frontlines: Linking Alcohol
Services Research & Practice,2003
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www.attcnetwork.org
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Resources
Recognizing PowerPoint contributions from:
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H. Westley Clark
Jack Stein
Nancy Roget
Pam Waters
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