Building the Behavioral Health Workforce
Congress has called it the “workforce crisis.” The need for an educated and seasoned workforce stems not only from demand, but high turnover rates, a shortage of professionals, aging workers, and low compensation. And with the advent of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act, policies that provide inclusion and insurance coverage for mental and/or substance use disorders, behavioral health services and supports must be covered just as other medical care is.
SAMHSA is responding to this need with a Workforce Development Strategic Initiative to build the behavioral healthcare workforce so that those who need services and support can obtain them.
In its 2013 Report to Congress on the Nation's Substance Abuse and Mental Health Workforce Issues, SAMHSA outlines how these laws are reshaping the workforce and delivery of services by moving the field toward improved coordination and integration of behavioral health care with other health care in primary, specialty emergency, and rehabilitative care settings, and, with that, the need to apply team approaches to address an individual’s health concerns.
Anne Herron, SAMHSA's lead for the new Workforce Development Strategic Initiative, says, “The inclusion of behavioral health services which are covered by health insurance means people will have greater access to the help that they need. But right now, 55 percent of U.S. counties do not have any practicing behavioral health worker and 77 percent reported unmet behavioral health needs. It’s clear our robust effort in promoting relevant professions, building skills, and making sure that communities in need have support will have a positive effect on many.”
Because people see their primary care physician more often than specialists, the integration of behavioral health screens and supports into primary care will help to address concerns more quickly. It may also make recovery more accessible by providing the alternative of a general doctor for those who may feel uncomfortable seeking out a behavioral health specialist. This effort also encourages primary care providers to look at whole health of their patients – not just a symptom that may have prompted a visit to the doctor.
In addition, changes in healthcare legislation and delivery have increased the use of health information technology for billing, elevated the importance of prevention and recovery-oriented systems and principles that include individual choice and self-directed care, and focused attention on the value of using peers and paraprofessionals in behavioral health care delivery.
SAMHSA and the Health Resources and Services Administration (HRSA) are working to address the integration of behavioral health in primary care settings. A number of these joint workforce efforts develop models that support integration, technical assistance, and training. Some of these programs include:
- Center for Integrated Health Solutions: A jointly funded resource center that provides training and technical assistance to community behavioral health programs, community health centers, and other primary care organizations.
- Behavioral Health Minimum Data Set Project: This effort works to develop a Minimum Data Set for the health care workforce – essentially creating a national database on addiction services and the mental health workforce.
- Military Culture Training: Cooperative efforts between SAMHSA and HRSA provide technical assistance, curriculum development, continuing education, and other tools to inform the primary care and education fields about behavioral health issues of veterans and their families.
- Screening, Brief Intervention, and Referral to Treatment (SBIRT): SAMHSA and HRSA developing training for community health workers on the use of Screening, Brief Intervention, and Referral to Treatment (SBIRT), a public health approach that uses community settings as opportunities for early intervention with at-risk substance users before more severe consequences occur.
SAMHSA has a number of its own new and emerging programs that will improve behavioral health knowledge and capacity.
Launched in 2006, the two-year fellowship program provides 10 participants with the education and training to build the needed skills for success in the substance abuse prevention and behavioral health fields. Fellows spend a required 32 hours each week during their fellowship building their skills in substance abuse prevention. They are supported by mentors from participating states and territories to establish or assess the performance of substance abuse prevention efforts. During the course of the fellowship, participants may develop educational programs, organize and participate in trainings, and prepare reports related to funding, data collection or evaluation. In addition to building competencies, there are opportunities to develop critical research, writing, evaluation, and presentations. All of the activities aim to prepare fellows for the International Certification and Reciprocity Consortium (IC & RC) Certification as substance abuse prevention specialists. Lieutenant Commander Daniel Bailey, PFP project manager, said “the program focuses on creating the next generation of prevention advocates with the critical work experience and training that will positively impact state and community systems of care.”
Center for Substance Abuse Treatment (CSAT) Cooperative Agreement for the Historically Black Colleges and Universities Center for Excellence in Behavioral Health
The cooperative agreements with the Historically Black Colleges and Universities initiative build interest in behavioral health, expand campus-based services, and facilitate workforce development. This funding also helps address disparities among racial and ethnic minorities by employing strategies that ease access, making services uniformly accessible, and improving outcomes. By addressing behavioral health on campuses, student retention is improved and early interventions can be accessed before problems worsen.
Designed as a leadership development academy, Project LIFT began in 2013 to enable emerging leaders to work with individuals with behavioral health needs in marginalized or underserved communities. Those participating in this program participate in monthly web or phone meetings, to learn more about behavioral health and how the Affordable Care Act covers such services. At the end of six months, teams give presentations to demonstrate their knowledge and understanding and ability to bring new learnings back to their communities. Emerging leaders apply for and are selected to Project LIFT.
The Minority Fellowship Program provides specialized training and mentoring relationships to address health disparities. Fellowships are given to individuals who have a history of working with underserved communities and are committed to continuing the work to lessen disparities and make behavioral health supports accessible. Fellows are given the opportunity to provide leadership on the development and implementation of culturally specific and patient-centered programs for underserved communities with behavioral health needs. Additional federal funding was provided in 2012 to increase the number of culturally competent mental health professionals.
Although the fellowship program is managed by CMHS, it is jointly funded by CMHS, CSAT, and CSAP. The fellowship is offered in one of the three domains: substance abuse prevention, substance abuse treatment, or mental health treatment.
SAMHSA is also committed to developing supports within a “nontraditional” workforce by including peers, or people in recovery from mental and substance use disorders. According to CMHS Director Paolo del Vecchio, “One area that provides a lot of promise is the use of peers as providers.” SAMHSA supports clarifying competencies for peers and family members to accomplish this work and the development of a peer professional career ladder that will include training and supervision of peers by peers.
- Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice
- An Action Plan for Behavioral Health Workforce Development: a Framework for Discussion
- Knowledge Application Program (KAP) - online learning
- Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues
- SAMHSA and HRSA Collaborative Workforce Grants
- Strengthening Professional Identity: Challenges of the Addictions Treatment Workforce
- Workforce Development á la Webinar