The Office of Workforce Development & Training

1. The Office of Workforce Development & Training • What is Workforce Development? • An economic development approach that attempts to enhance a region’s economic stability by focusing on people • A human capital system focused on identifying future needs, developing a productive workforce, identifying and examining the competencies and skill levels of employees at all levels, and determining both proficiency and skill gaps • A wide range of activities, policies and programs employed by geographies to create, sustain and retain a viable workforce that can support current and future business and industry • May include a problem-focused approach (i.e., low-skilled workers or the need for more employees in an industry) or a holistic approach considering participants’ many barriers and the overall needs of the region.

2. Workforce Development • Public health organizations are in transition: • state budget cuts • changes in laws • accreditation of public health agencies • Affordable Care Act • Workforce development is a high priority for the addiction, prevention, treatment, and recovery fields • Nationally, the existing behavioral health workforce is recognized as older than the general workforce, under credentialed, and fewer in numbers than required to meet current and future needs

3. Population-based health • Workforce & Training • continuing education • professional development and training • leadership development • competency-based curriculum development, delivery and evaluation • organizational technical assistance to public health agencies • disseminate promising practices in public health  • A population-based approach to health care with emphasis on prevention, education, health maintenance, strengthening of connections with other health agencies, capacity building and community outreach.

4. Workforce Development Concerns: • SUD workforce: • Older • Under credentialed • Supply does not meet anticipated demand • SBIRT and the ACA will demand increase in workforce • Retirees outpacing new entrants ?Does this describe other workforces in Maryland? • Skill Levels: • Annapolis Coalition/SAMHSA/ATTCs – coming up with uniformed definitions • Reciprocity between states • The Maryland Board of Professional Counselors & Therapists – Licensing and Certifications requirements under review including Trainee status

5. Workforce Development Concerns: • Roles?: • Counseling • Mental health • Administrative/ Support • Peers • Diversity: • Race • Ethnicity • Culture • Gender

6. Creating a workforce: • State Roles: • Projections of Need • Roles definitions • What do we know about today’s and tomorrow’s SUD Treatment Workforce? • What do we know about today’s and tomorrow’s Behavioral Health Treatment Workforce? • Planning the pipeline - Are they totally new to the field? In high school or college now? Currently in another field? In current workforce but in need of new skills?

7. Non-profit organization dedicated to improving the recruitment, retention, training and performance of the prevention and treatment workforce in the mental health and addictions sectors of the behavioral health field. • Seek to strengthen the workforce role of persons in recovery and family members in caring for themselves and each other, as well as improving the capacity of all health and human services personnel to respond to the behavioral health needs of the individuals they serve. • Workforce Needs of Selected Populations • Persons with Mental Health Conditions • Persons with Addictions/Substance Use Conditions • Persons with Co-Occurring Mental and Substance Use Conditions • Children and Adolescents • Young Adults and Adults • Older Adults • Rural and Frontier Americans • Culturally and Racially Diverse Populations • U.S. Military • International Populations • http://annapoliscoalition.org/

8. Concluding a two-year strategic planning process that involved more than 5,000 individuals across the nation, the Annapolis Coalition completed the Action Plan on Behavioral Health Workforce Development in 2007. Funded by the three Centers within Substance Abuse and Mental Health Services Administration (SAMHSA), the Coalition was charged with developing a comprehensive plan to address the nation’s growing crisis surrounding efforts to recruit, retain, and effectively train a prevention and treatment workforce in the mental health and addiction sectors of this field. • http://annapoliscoalition.org/wp-content/uploads/2013/11/action-plan-full-report.pdf

9. AC’s Strategic Goals:Broaden the Concept of Workforce Goal 1: • Significantly expand the role of individuals in recovery, and their families, when appropriate, to participate in, direct or accept responsibility for their own care, provide care and support 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.

10. AC’s Strategic Goals: Strengthen the Workforce Goal 3: • Implement systemic recruitment and retention strategies at the federal, state and local levels, including wages and benefits, expansion of stipends, tuition assistance and loan forgiveness. Goal 4: • Increase the relevance, effectiveness and accessibility of training and education. This includes the adoption of evidence-based education methods, and a national initiative to ensure that every member of the workforce acquires basic competencies related to both mental health and addiction disorders. Goal 5: • Actively foster leadership development among all segments of the workforce. Focusing on the development of supervisory skills was recommended as the first step in leadership development.

11. AC’s Strategic Goals: Structures to Support the Workforce Goal 6: • Enhance the infrastructure available to support and coordinate workforce development efforts. This includes increased use of data, strengthening of training and human resource departments, and increased use of information technology to train and support the workforce. Goal 7: • Implement a national research and development evaluation agenda based on behavioral health workforce development. A second objective is to provide TA to service organizations and systems of care on evaluation strategies to increase their capacity to evaluate the impact of their workforce interventions.

12. Major forces effecting workforce in health care today: • MH Parity (MHPAEA) • Affordable Care Act (ACA) • Integration of Care – BH/Med • SAMHSA Priorities 2014 • Need for treatment • Need to build capacity • Worker shortage/turnover/diversity • Why do you do what you do? And how to do it better? • Why is our workforce not a priority?

13. Health Reform Brings Change and Opportunity • “The mental health workforce identified core competencies that will allow them to fit into a primary care environment, and primary care has recognized the importance of adopting the use of Electronic Health Records and other uses of technology. It is now crucial for the SUD workforce to adjust and address the emerging requirements in health reform which creates a tremendous opportunity to make long-needed changes to the workforce scopes of practice, credentialing system and career ladder allowing the SUD workforce to remain competitive in the changing healthcare environment.” Workforce Development Needs in the Field of Substance Use Disorders A Report from Department of Alcohol and Drug Programs June 26, 2013 http://cchealth.org/aod/pdf/Workforce-Development-Needs-in-the-Field-of-Substance-Use-Disorders.pdf

14. Substance Abuse and Mental Health Services Administration (SAMHSA) • Developed the National Behavioral Health Quality Framework (NBHQF) Measures: • http://www.samhsa.gov/data/NBHQF/index.html • promote EBPs, person-centered care, coordinated care, promote wellness, offer prevention, increased access to care, integration of services, increased focus on quality, organizational development • competent providers and service will be key, addressing a chronic illness needing continuing care

15. What is happening at the Federal level? • Federal Leadership is needed to address the growing crisis • Pam Hyde Jan 2014: Report to Congress • SAMHSA’s Strategic Initiatives: • Prevention • Trauma & Justice • Military Families • Recovery Supports • Health reform • Information Technology • Data, Outcomes & Quality • Public Awareness

16. The need is now… • Every 10% increase in Substance Use Treatment results in a need of 6,800 counselors (SAMHSA, 2009) • Strengthen collaborations of all professionals involved – include peers and peer supports as advocates, extenders of care and early interventionists • Build career ladders and higher education opportunities, continuing education, paid internship, tuition reimbursement, Master’s level programs to accept interns • Develop a Training of Trainer Expert – in SBIRT, COD, etc. • Train and certify in best practice • Address compensation and wage inequality issues • Recruit and retain • Payer collaboration – reimbursable services

17. SAMHSAs Strategic Initiative 6: Workforce Development • SAMHSA has identified the need for a Strategic Initiative, which provides a focus for our programs and activities to provide for the behavioral health needs of the nation. • This Strategic Initiative will support active strategies to strengthen and expand the behavioral health workforce, including those health care workers not considered behavioral health specialists. • Through technical assistance, training, partnerships and outreach through traditional and social media, SAMHSA will promote an integrated, aligned, competent workforce that enhances the availability of prevention and treatment for substance abuse and mental illness, strengthen the capabilities of behavioral health professionals, and promotes the infrastructure of health systems to deliver competent, organized behavioral health services. • This initiative will monitor and assess the needs of youth, young adult and adult peers, communities and health professionals in meeting behavioral health needs within America’s transforming health promotion and health care delivery systems. SAMHSA Leading Change 2.0: Advancing the Behavioral Health of the Nation 2015 – 2018

18. Goal 6.1: • Develop and disseminate workforce training and education tools and core competencies to address behavioral health issues. • Objective 6.1.1: Collaborate to establish and disseminate evidence-based behavioral health core competencies for behavioral health, primary care and peer providers.

19. Goal 6.2: • Develop and support deployment of peer practitioners in all public health and health care delivery settings. • Objective 6.2.2: Working with stakeholders, increase the proportion of individuals with mental and/or substance use disorders who are employed as peer practitioners. • Objective 6.2.3: Support and disseminate evidence-based practices related to employment, supervision and education for peer practitioners.

20. Goal 6.3: • Develop consistent data collection methods to identify and track behavioral health workforce needs. • Objective 6.3.3: In collaboration with stakeholders, develop behavioral health workforce skills in areas where gaps are identified, such as business competencies, telehealthand mobile strategies, recovery supports, disparities/culturally-specific approaches, screenings and brief interventions, collaborative care models, integrated care models, evidence-based and emerging practices, etc.

21. Goal 6.4: • Influence and support funding for the behavioral health workforce. • Objective 6.4.1: Support the identification and analysis of pay incentives and barriers for behavioral health practitioners across settings. • Objective 6.4.2: Identify and disseminate best practice funding strategies for the behavioral health workforce. • Objective 6.4.3: Work with stakeholders and federal partners to influence and support appropriate compensation for behavioral health services within health care and health systems.

22. Workforce Initiatives in Maryland • DHMHs BHA Workforce Development Committee • Stakeholders from multiple agencies participate in quarterly meetings • Tasked by Secretary to be the Central Repository of statewide workforce information and Co-Occurring Disorder training (COD Workgroup) • Oversight of training provided to Peer workforce in order to become credentialed • BHA's FY 2016 Strategic Plan – to align our efforts/goals with SAMHSA's Initiatives

23. BHAs WDC partners: • BHA staff with experience in both mental health and substance related disorders • University of MD Evidenced-Based Practice Center • Alliance Health • Mid-Shore Mental Health Systems, Inc. • On Our Own of Maryland • University of MD (School Social Work) • Behavioral Health System Baltimore • CSAs - Harford Mental Health • Maryland Board of Professional Counselors & Therapists • Maryland Addiction Professional Certification Board (MAPCB) • DDAs Training division, etc

24. BHA WDC Next Steps… • How do we build greater capacity? • Telehealth initiatives, training opportunities • AVATAR – are providers implementing? • Increasing buprenorphine providers • LHDs need to recruit doctors • What can BHA do to get Health Officers to recruit doctors? • SAMHSA hosting free CE training (October 2014 in central Maryland), for OTP Clinical Staff: “Appropriate Use of Methadone in the OTP”

25. DHMHs Office of Primary Care Access (OPCA): Workforce Development Office 2012: OPCA established to improve access to healthcare for all Maryland residents. OPCA is comprised of the Office of Primary Care, Workforce Development Office, and the Office of Rural Health. OPCAs Workforce Development Office: • Ensures adequate health workforce especially in the most high need areas • Markets and Administers Workforce Programs (J-1 Visa, State Loan Repayment Program, National Health Service Corp) to expand access in underserved communities • Utilizes data and local community engagement to understand workforce needs • Integrates workforce programs and workforce development into the Community-Integrated Medical Home (CIMH) model • Working on increasing the number of psychiatric nurse practitioners in the State

26. OPCAs Workforce Development Office National Health Services Corps: • The NHSC is a competitive federal program that deploys various types of health professionals, including physicians, dentists, and dental hygienists, to communities and sites that have been designated by the federal government as a Health Professional Shortage Area (HPSA)

27. OPCAs Workforce Development Office State Loan Repayment Program (SLRP): • SLRP in Maryland is a collaborative effort among state and federal entities • Offers physicians an opportunity to practice in a designated Health Professional Shortage Area (HPSA) while also getting funds to help pay their higher education loans

28. OPCAs Workforce Development Office Maryland J-1 Visa Waiver Program: • The Maryland Primary Care Office (PCO) reviews applications and makes recommendations to the U.S. Department of State for foreign-born physicians requesting waivers from their J-1 Visa, which requires them to return to their home country for two years at the end of their medical training. The waiver is granted in exchange for the physician's agreement to work in an underserved area for three years. National Interest Waiver Overview

29. OPCAs Workforce Development Office Access to Care- County Profiles: The Maryland Access to Care Survey designed to help develop a better understanding of Maryland’s currently uninsured population, their health needs, and where they currently receive care Provides knowledge of the capacity of safety net providers across the state and estimates the readiness for health reform implementation Fosters collaboration between the state, health insurers, and safety net providers and helps policy makers to prepare for when more Marylanders will become eligible for health insurance through the Maryland Health Connection

31. Integrates workforce programs and workforce development into the CIMH model:

32. Working with others: • Workforce Development efforts are aimed at strengthening the professionalism of substance use disorder treatment professionals • “The need for treatment continues to grow at a time when the profession is challenged to engage highly qualified, educated and trained practioners.”

33. MADC • Behavioral Health Higher Education Collaborative • Partnered with institutions of higher education throughout Maryland to address the behavioral health workforce crisis through efforts aimed at increasing enrollment, promoting degree completion, fostering career pathways and expanding the availability of financial incentives for students and graduates.

34. MADC • Maryland Integration Learning Community • The goal of the year-long project was to expand the integration of substance use disorder, mental health and primary care services in local communities throughout the state

35. MADC • MADC Workforce Development Platform • Cultivate high-quality behavioral health professionals • Foster workforce growth and sustainability • Promote recognition for behavioral health professionals • Advocate for respect and support of professionals who provide prevention, intervention, treatment and recovery services for persons with substance use disorders

36. MADC • HB0112/SB0448 allows the Board of Professional Counselors and Therapists to issue cease and desist orders and increase penalties for misrepresentation and practicing without a license. MADC supported this legislation which ensures that only qualified professionals are providing therapy based upon their scope of practice.

37. MADC • HB1222 creates the Ruth M. Kirk Public Social Work Scholarship. This provides opportunities for Maryland students to obtain scholarships to get a degree in social work provided that they agree to work in workforce shortage areas. MADC supported this legislation as one way to address the behavioral health workforce shortage.

38. MADC • SB0198 (HB0802) created a telemedicine program for the Maryland Medical Assistance program. MADC presented written and oral testimony in support of this legislation addresses the workforce shortage by allowing health professionals to provide treatment and consultation via telemedicine. This is very helpful in rural areas where there is a shortage of specialists including behavioral health professionals. This bill passed the House and the Senate and was signed by the Governor.

39. MADC • SB0784 The Loan Assistance Repayment Program (LARP) bill proposed by MADC and introduced by Senator Montgomery expands the LARP to allow licensed professional counselors and therapists, licensed addiction counselors and licensed marriage and family therapists to apply for the program which provides loan repayment funds for chosen applicants working in workforce shortage areas. MADC worked on obtaining sponsors, coordinating and presenting oral and written testimony and negotiating amendments to ensure passage of the bill. This bill passed the House and the Senate and was signed by the Governor.

40. US Department of Health & Human Services (HHS) • Strategic Plan 2010-2015 • Goal 5 to strengthen the nation’s health and human service infrastructure and workforce • http://www.hhs.gov/strategic-plan/stratplan_fy2010-15.pdf • Strategic Goal 5: Objective A • Invest in the HHS workforce to meet America's health and human service needs • Strategic Goal 5: Objective B • Ensure that the Nation's health care workforce can meet increased demands • Strategic Goal 5: Objective C • Enhance the ability of the public health workforce to improve public health at home and abroad • Strategic Goal 5: Objective D • Strengthen the Nation's human service workforce

41. HHS • The general themes that run through the strategies are requirements to: • take a preventive, population-based approach to improving health outcomes • shift the emphasis of service delivery and resourcing from secondary and tertiary services to primary care, and link with services across the sector • increase the accessibility and acceptability of service provision in the community

42. Next Steps… If the goal is to develop the organizational culture and systems which will attract and grow the Behavioral Health Workforce and meet service needs, then our actions need to • Improve leadership capacity and practice (by under-represented workforce groups) • Increase the range of health workforce groups involved in governance • Develop innovative models of care and support (i.e., continuum of care approach, primary health teams) • Adopt Evidence Based Practices (SBIRT, Medication-assisted tx)

43. Next steps…. • Offer Continuing Education/Effective Training (working in teams, cultural competence training) • OWDT, COD Workgroup, The Evidence-Based Practice Center, Danya Institute/ ATTCs, MADC • Train physicians, nurses, social workers in Addiction • Improve access to and the quality of Substance Related Disorders treatment in primary care settings • Improve healthy workplace environments and practices • Align workforce with service needs (i.e., identify and plan to address service gaps)

44. Staying involved: • “Meeting the Behavioral Health Needs of Service Members, Veterans, and their Families through Workforce Development” • Conference hosted by SAMHSA and its Service Members, Veterans, and their Families Technical Assistance Center, September 8-9, 2014, Baltimore, Maryland

45. Two tracks explored: Strengthening the SMVF BH Workforce • Staff development in military culture, trauma, peer support, and suicide prevention • Best practices in training and supervision approaches • Reimbursement and credentialing options Broadening the SMVF BH Workforce • Behavioral healthcare workforce opportunities • Peer support expansion • Recruitment and retention strategies