Workforce Development in the North Carolina Mental Health System

1. Workforce Development in the North Carolina Mental Health System National AHEC Conference June 22, 2010 John T. Bigger, MS, LPC Administrator of Mental Health CE Southern Regional AHEC Fayetteville, NC

2. Objectives: • Identify 3 models used in North Carolina to enhance workforce development and retention. • Describe how training needs can be identified through working closely with provider groups and contracting agencies. • Identify 3 benefits of workforce retention that be achieved through implementation of the training and technical assistance models.

3. Background of North Carolina Evidence Based Practices CEnter

4. Funded through the Duke Endowment in 2004 • Initial plans were to address Mental Health Reform in NC by offering training in certain Evidence Based Practices • Identified toolkits to implement to assist with training the workforce • There was a call in the State Plan in the NC Division of MH/DD/SAS for the use of “evidence based practices” • Applied for a 3 year extension in 2006

5. Background of NC EBP CEnter • This called for several areas of focus: • Continued dissemination of the toolkits • Begin training in the TFC toolkit • Workforce Development in the areas of substance abuse services • Cultural Diversity in the areas of TFC and Workforce Development • Outcomes studies on the impact of trainings on consumer outcomes

6. What do we do now? • Continued training in EBP toolkits through regularly scheduled offerings as well as contracted trainings at sites throughout NC • Workforce Development through a cadre of trainers coordinated through Paul Nagy at Duke University with a focus on substance abuse trainings • TFC training throughout the state • Cultural Issues related to TFC training throughout the state

7. What do we do now? • Received a 3 year grant from the Health and Wellness Trust Fund to provide Tobacco Cessation training to mental health “clubhouses” throughout North Carolina • This has already been established and we are on target to meet all of the goals of this program. • Facing Addiction through Community Empowerment and Intervention Teams (FACE-IT Academy) as component of workforce development

8. Workforce Development • Focused on three major areas: --Responses to training needs of Mental Health Workforce --Training and focusing on retention in relation to the substance abuse workforce --Training through the FACE-IT and SAY-IT Academies to assist in strengthening the need for the substance abuse workforce

9. Mental Health Workforce • Identification of training needs --Knowing the state plan and what requirements are for given areas of service --Surveying provider groups on topics related to needs --Needs Assessments with a wide variety of constituents --Advisory Boards and input from a variety of clinical and behaviorally related settings

10. “Across the nation there is a high degree of concern about the state of the behavioral health workforce and pessimism about the future. There is overwhelming evidence that the behavioral health workforce is not equipped in skills or numbers to respond adequately to the changing needs of the American population….Most critically there are significant concerns about the capability of the workforce to provide quality care.”The Annapolis Coalition – An Action Plan for Behavioral Health Development, SAMHSA, 2007

11. Background • Administrative demands • Recruitment challenges • Retention and turnover • Competency and quality • High stress • Confused • Lack of confidence • Isolated and unsupported • Burned out

12. Our Purpose Enhance workforce competence, retention and morale by providing services using effective dissemination strategies for the adoption of best practices.

13. Our Goals • Disseminate knowledge about best practices • Improve clinical competencies • Facilitate provider collaboration and cohesion • Enhance workforce retention and morale

14. Our Approach: Strategies for Improving Provider Performance (Miller, et. al, 2006) • Preparatory knowledge • Practice with feedback • Ongoing coaching and supervision

15. Our Services • Teaching case conferences • Training • Supervision • Consultation • Technical assistance • Special programs

16. Example: Teaching Case Conference Purpose: Organize a learning community approach to improving application of best practices in the realworld Goals: 1) Learn best practices 2) Enhance collaboration 3) Promote cross referrals 3) Improve morale 4) Disseminate useful information 5) CE credit Method: Case presentation

17. Relevant Need based Flexible Partial day Full day Site based Wide range of topics Administrative Program Design and delivery National accreditation preparation Nonprofit management Skills based Group therapy Family therapy Dialectical Behavioral Training Motivational Interviewing Cognitive Behavioral Therapy Evidence Based Models Integrated Dual Disorders Treatment Medication management Wellness and recovery Intensive Outpatient Treatment Therapeutic Communities Special Populations Children Adolescents Criminal Justice Co-occurring Geriatric Women Minorities Training and Consultation Packages

18. Service Deliveries • Face to face • Internet based • Web conferences • Fidelity reviews

19. Special Programs • Community presentations • Presentations and/or consultations with agency boards • Supervision groups • Advise local action committees • Advocate training (e.g. FACE-IT and SAY-IT Academies)

20. Expected Outcomes • Enhance collaboration • Easier recruitment • Improve retention • Improve morale • Better patient care

21. Training and focusing on retention in relation to the substance abuse workforce • The Need for a New Approach

22. The Need for a New Approach • Treatment professionals can’t be “all things to all people” as expected • Addiction effects the entire community and it “takes a village” to restore an addicted person to wholeness • Few people who need treatment are accessing services • The treatment people receive is not consistent with best practices

23. How We Got Here: A Perfect Storm of Opportunity • Mental health “reform” • Community awareness and concern • Commitment by local policymakers • Academic and community partnerships in place

24. Developing a Substance AbuseSystem of Excellence Our Mission: Plan, develop and implement an integrated, system-wide healing response to addressing substance use disorders based on science based perspectives and best practices.

25. A Substance Abuse System of Excellence

26. A Substance AbuseSystem of Excellence Objectives • Design a prevention, intervention and treatment system consistent with science based perspectives • Focus on serving treatment-needy vs. only the treatment-ready • Involve the entire community • Ensure efficient and coordinated use of resources • Reduce reliance on limited professional services • Promote strategies to enhance effectiveness of existing service providers

27. Strategies for Workforce Development • Teaching case conferences • Training • Supervision • Consultation • Technical assistance • Special programs

28. Workforce Development Initiative: Teaching Case Conference Purpose: Establish a learning community approach to improving application of best practices in the realworld Goals: 1) Learn best practices 2) Enhance collaboration 3) Promote cross referrals 4) Improve morale 5) Disseminate useful information 6) CE credit Method: Monthly get together and Case presentation

29. Substance Abuse System of Excellence Based on Best Practices Guiding Principles • Recognize addiction as a malignant disease vs. moral weakness • Adhere to a “no wrong door” and “treatment on demand” standard (SAMHSA Change Plan, 1998) • Apply a research based readiness to change model • Ensure coordinated, integrated service delivery • Use available evidence based practices • Evaluate what works • Change what doesn’t

30. Best Practices for the Treatment of Addiction • Comprehensive assessment • strengths, needs, abilities and preferences • Person centered and holistic • Disease management • Staged and adaptive service delivery using evidence based models • Family and community involvement

31. Old Model Serve only treatment ready Episode of care/symptom reduction Limited involvement of families Fragmented system of care Limited use of available science informed practices Lack of accountability New Model Serve the treatment needy as well treatment ready Trained first responders Universal screening Early identification Chronic disease management: long term, ongoing care Services adaptive to need, readiness and choice Integrated system of care Evidence based treatments Outcome driven and performance based contracting Proposed System Change

36. Our Academies:

37. Our Academies:

38. Our Academies: • Entire community involvement was mentioned earlier as a key component to addressing addiction. • So was: • Ensure efficient and coordinated use of resources • Reduce reliance on limited professional services • Promote strategies to enhance effectiveness of existing service providers

39. Purpose: To promote a community wide response to address substance use disorders based on science based perspectives and best practices

40. Background: Substance Abuse is a High Impact Problem with Low Resourced Solutions $500 Billion a year in direct medical expenses, crime, and lost earnings (National Institute of Drug Abuse, 2006) States spend 15% of their total budget on substance abuse - 95% of government spending on substance abuse problems is on the consequences and only 1.9% on treatment and prevention and 0.4% on research. (National Center on Addiction and Substance Abuse, Columbia University, 2009)

41. Background:Few Individuals Who Need Treatment Seek or Receive It 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 (Source: National Survey on Drug Use and Health, 2007)

42. Background:Missed Opportunities as well as Misdirected Efforts to Help Happen Everyday and in Lots of Places

43. Background:We’re All Affected by the Problem and Working Together We Can All Effect the Solution – IT TAKES A VILLAGE! “Any problems faced by the individual substance abuser cannot be seen in isolation of their family, local community and society.”Scottish Advisory Committee on Drug Abuse, 2008

44. Background:Knowledge Can Be Power and is the First Step to Making a Difference

45. Guiding Principles • Recognizes addiction as a chronic, malignant but treatable disease • Promotes the idea that a science based understanding and approach to the problem enables a more informed and effective response • Believes that an addicted individual receiving help from an informed individual will be more likely to accept that help • Acknowledges that early identification and intervention has the greatest impact on the problem • Recognizes the value of evidence based approaches to treatment and embodies the notion that community based support is an essential element of recovery (Recovery Oriented Systems of Care, SAMHSA, 2005)

46. Goals • Promote a community wide understanding of science based perspectives on addiction and recovery • Adopt a social marketing approach to increasing a local commitment to addressing the problem and to eliminating stigma and misperception • Increase a greater awareness and use of local resources • Develop “in house” resources within agencies that deal with addicted individuals • Increase advocacy for the needs of addicted individuals • Assist with intervention and referrals if and when appropriate • Assist with the evaluation and development of the local system of care in support of those with addictive disorders

47. Expected Outcomes • Raise community awareness and reduce stigma • Earlier identification, intervention and engagement of those in need of services • Increase service penetration rates • Promote the use of best practices and the implementation of evidence based services • Enhance outcomes for those served within the system • Demonstrate effectiveness of Academy members efforts

48. Team Member Scope of Participation • 12 – 15 members initially • Attend 15 hour training session • Develop personal/organizational ‘’make a difference” plan • Participate in monthly 1.5 hour team meetings for one year following graduation • Support • Share experiences • Ongoing training • Technical Assistance • Consultation • Resource orientation

49. Implementation Plan: • Community roll out and distribution of applications • Review applications and make selection • 12-15 applicants invited to participate • Pre-session contact with team members • Training of team members • Monthly meetings and ongoing training

50. Training Curriculum (based on a 5 half day format) Day I (3 hours) • Introductions and review of goals and experiences • Scope and impact of the problem • Science based perspectives of addiction Day II (3 hours) • Theory and process of behavioral change • Principles of recovery • Testimonials and discussion Day III (3 hours) • Treatment best practices and review of local resources Day IV (3 hours) • Introduction to Motivational Interviewing Day V (3 hours) • Team development and project planning session • Wrap up and evaluations • Graduation