Overview

1. Workforce Development Overview

2. This training is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), US Department of Health and Human Services (HHS) The contents of this presentation do not necessarily reflect the views or policies of SAMHSA, or HHS.

3. STAR- SIfunded under Contract No. HHSS2832007000031/HHSS28300002T • Currently working on 2 projects • Identify and Improve Provider Network Development • Promoting Use of Technology to Improve Treatment and Recovery

4. Addiction Workforce Traits… Older than general workforce Under-credentialed Supply does not meet anticipated demand

5. Size Retirees are outpacing new entrants State of Washington predicts the need for 700 new workers

6. Skill Level Definitions: Annapolis Coalition/SAMHSA/ATTCs New/Existing Workforce Reciprocity

7. Roles? Counseling Administrative/Support Peer Support

8. Diversity? Race Ethnicity Culture Gender

9. State Roles Projections of…. Need Roles definitions Planning the pipeline

10. What do we know about today’s and Tomorrow’s SU Tx Workforce Mental Health and Addiction Workforce Development: Federal Leadership Is Needed to Address The Growing Crisis (Hoge, M; Stuart, G.; Morris, J.; Flaherty, M.; Paris, M. and Goplerud, E. ,Health Affairs, 32, NO11 (2013); available for viewing and download at http://annapoliscoaltion.org/healthaffairs/ Substance Abuse and Mental Health Services Administration Report to Congress on the Nations Substance Abuse and Mental Health Issues January 24, 2013 Pamela S. Hyde, J.D. Administrator

11. Major Forces Effecting Workforce Work in Health Care Today • Mental Health Parity (MHPAEA) • Affordable Care Act (ACA) • Integration of Care – BH/Med • SAMHSA Priorities 2014; NBHQF • Need for Treatment – Capacity exists for only 10.8% of those with SU need* • Worker shortage/turnover/diversity and need to prove effectiveness • Purpose – Why do you do what you do? *ONDCP 2013 National Drug Strategy - 2.5 million of 26 million; SAMHSA 2009 - 6,800 per 10%

12. DUE TO ACA & MHPAEA . . . Over 65 million people will have access to MH/SA benefits due to ACA and MHPAEA • 30 million currently without adequate BH benefits • 35 million currently uninsured • 11 million have M/SUDs

13. SAMHSA’S STRATEGIC INITIATIVES

14. NBHQF - Measures Defined and to be tracked for: Payer/System, Provider/Practitioner and patient/populations across sixNQS priorities: evidenced-based practice being used; person-centered care; healthy (measured) living for communities, reduction of adverse events, and cost reductions. Example of measures: System: Provider: Initiation of AOD Treatment Prevention, Screening and admission of EBPs; patients reporting abstinence after treatment Patient/ Population: Family communication around drug use; reduction in AOD related suspensions/expulsions; % of population in jail/homeless, in CJ system.

15. What today’s Health Care demands: • Greater attention to preventing illness and promoting wellness • Increased access to care • Increased focus on the coordination/integration of services between primary care and behavioral health • Increased focus on quality, outcomes and accountability • Enhanced infrastructure to support the delivery of effective services (e.g. HIT) • Medicaid/Exchanges will play a much larger role in MH/SUD • Focus on evidence-based medicine • Shrinking or capitated budgets • Need to develop organizational cultures that are adept at effectively responding to change!

16. Competent Providers and Service Will be Key* Providers will lead if they have ability to: - be accessible - utilize electronic health records to coordinate care - collaborate effectively or integrate care - are efficient -Service that tracks outcomes that matter to the patient (i.e. “recovery”) • Engaged clients and natural support network • Help clients self manage their wellness and recovery • Greatly reduce need for disruptive/high cost services • Promote community wellness • Effectively promotes sustained recovery (* Porter and Lee, The Strategy That Will Fix Health Care, Harvard Business Review, Oct. 2013)

17. Data – Populations In Search of a Workforce • Today substance use conditions affect about 26 million (up 16% since 2000) of Americans age 13 and older (CDC, 2012). • OD deaths now are the leading cause of accidental death in America exceeding even traffic deaths.(CDC, 2012) • Teens today often experience an opiate before MJ or cocaine use. (Archive of Ped/Adol. Med, 2009)

18. DATA- Populations in Search of a Workforce • Americans are 4.7% of the world’s population; we consume 80% of the worlds opioids, 99% of the world’s supply of Oxycodone and two-thirds of all of the world’s illegal drugs. (Manchikanti et al, 2010) • Only 10.8% of those needing SU treatment receive treatment (ONDCP, 2013); capacity exists in specialty care for about 2.6 million Americans leaving 20+ million outside of treatment (societal cost? $585 billion year). • SU treatment itself is evolving with enhance generalist identification and care; new medications and a new model of SUD being best addressed as a chronic illness needing continuing care. • Today here are a scientifically estimated 35-55 million Americans in recovery – not including tobacco! (White, 2012) Can they help?

19. Annapolis Coalition and other workforce studies – “déjà vu all over again” Patient gaps: stigma, related discrimination, lack of healthcare coverage, insufficient services and linkages among services; age, diversity and cultural specificity needs – overall an insufficient behavioral health care workforce to meet demand. (Hoge et al, 2013; SAMHSA, 2010, Schomerus, G. et al, 2011;SAMHSA, 2013; et al.)

20. Annapolis Coalition and other workforce studies – “déjà vu all over again” • Workforce gaps: insufficient size, frequent turnover, relatively low compensation, minimal diversity and limited competence in evidenced based treatments. (Hoge et al, 2007) • Need to address above with an aging within workforce itself while addressing the increasing aging, rural, racial and cultural diversity of America … and demands of health care reform. • And address the integration of care by building prevention, intervention, treatment and recovery for both specialist and generalist populations – with accountability.

21. Projecting Workforce Need Every 10% increase in demand for SU treatment would result in a need for 6,800 counselors (SAMHSA, 2009). Conservative estimate is need for 18,000 new SU counselors; 26,800 social workers; 16,800 psychologists by 2018 (SAMHSA/DOL, 2013).

22. How to Meet the Need-Macro • Broaden “concept” of workforce – no silos. • Train all healthcare providers in SU and chronic nature of SUD; its treatment and continuing care needs. • Build consumers and peers as providers. • Strengthen collaborations of all professionals involved at both generalist and specialty settings - include peers and peer supports as advocates, extenders of care and early interventionists. Build a common CE and credential for public trust.

23. How to Meet Need-Micro • Build career ladders and higher education for addressing the illness as a “specialist.” • Train and certify in best practice • Address compensation and wage inequality issues. • Recruit and Retain • Build the political will to address the problem – we can’t afford not to!

24. How to Meet Need-Micro (Cont.) • Offer tuition reimbursement to work x amount after getting degree • Working with schools for existing employees to do a paid intern program • Reaching out to Master’s level programs to accept interns.

25. 4 Specific Steps • Government and private payer collaboration and leadership is critical – at all levels – if we are to succeed. Competence and trust. - Includes professional organization collaboration - Must include States, Payers and Peers 2. Each State, community and agency must allocate a greater portion of its time and resources to develop and assure a competent worker. - Consumer/payer trust is critical - Resources from within states and payers are critical -

26. 4 Specific Steps 3. Create a robust national technical infrastructure to coordinate and sustain efforts and implementation. - Invite new partners – HRSA, CMAP, PCORI, DOL, VA, IOM, CIHC, Comm.Colleges/Universities and Trade Schools, Nat. Council, – all guilds. 4. Collaborate with all agencies and entities at all levels to assess and address the problem and shape Macro/Intra (e.g. silos) and Micro/Inter (e.g. 2R’s, inter-guild, salary, career ladder) solutions for steady improvement.

27. Solutions in Action • HHS Secretary Strategic Initiatives (13); Vision – Promote High-Value, Safe and Effective Health Care • Goal 5 Strengthen the Nation’s Health and Human Service Infrastructure and Workforce • “We at the Department of Health and Human Services consider it our mission to address the looming health professional workforce shortage and to recruit, train, and retain competent health and human service professionals across America.” HHS Secretary Kathleen Sebelius • Objective A: Invest in the HHS workforce to help meet America’s health and human service needs today and tomorrow • Objective B: Ensure that the Nation’s workforce can meet increased demands • Objective D: Strengthen The Nation’s human service workforce

28. Solutions in Action • 12.10.13 HHS announced that $50 million from health care law will be used to expand mental health and substance use disorder services in approximately 200 Community Health Centers. Funds are to be uses to expand these health centers service capacity. Additionally the President’s 2014 Budget includes $130 million for teachers (recognize MH) and train 5000 new MH professionals. • 12.05.13 HHS Awards $55.5 million to strengthen and increase size of health care workforce. While mostly for nursing development $1.4 is four research centers to improve understanding of both local and national health workforce needs. • Special SAMHSA grants and supplements

29. Solutions in Action • 6.17.14 HHS awards $110 million for health care innovation, additional $730 million available. To promote health care delivery reform and improve patient outcomes, the U.S. Department of Health and Human Services (HHS) awarded 12 organizations a combined $110 million under round two of the Health Care Innovation Awards program. Authorized under the ACA, awardees will focus on the following priority areas: (1) reducing costs for Medicare and Medicaid enrollees, (2) improving care for populations with special needs, (3) testing improved financial and clinical models, and (4) linking clinical care delivery to preventive and population health. In addition, to further support the design and testing of health care delivery and payment systems, HHS announced $730 million in funding for State Innovation Model (SIM) grants. Also authorized under the ACA, this funding includes $700 million available to fund 12 SIM Testing grants and $30 million to fund 15 SIM Design grants (HHS, 5/22). • 6.17.14HHS offers $300 million to community health centers and $40 million for insurance rate review. On June 3, HHS announced plans to award community health centers up to $300 million in Affordable Care Act Health Center Expanded Services grants. Under the grants, awardees will expand service hours and hire additional medical providers.

30. Solutions in Action • SAMHSA Recovery to Practice Initiative www.samhsa.gov/recoverytopractice/ APA, ApA, APNA, CSWE, NAPS, NAADAC (situational analysis and training/curricula) SAMHSA/BRSS-TACs brsstacs@center4si.com • People in recovery, state, county, and city behavioral health authorities, policy makers, researchers, behavioral health providers, including peer providers, other health and human service providers, family members.

31. Solutions in Action • SAMHSA Addiction Technology Transfer Centers - 2012 Vital Signs at www.attcnetwork.org/documents/vital signs • SAMHSA NIATx • SAMHSA CAPS • SAMHSA ATTC SBIRT Initiative • NAADAC – www.naadac.org - Situational Analysis - Web based core training (9 modules)

32. In BH we are only as good as our worker. In human services our worker is our greatest asset and our society’s best hope for preventing, treating and addressing any illness and its costs while affording health and wellness. If we do this together, all professions and each community, we will succeed not only for each individual, family and community - but for ourselves. That’s the way it works. Michael Flaherty, Ph.D. Annapolis Coalition flahertymt@gmail.com