understanding the roles of addiction professionals in ......angela j. beck, phd, mph, director...
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Angela J. Beck, PhD, MPH, DirectorClinical Assistant Professor of Health Behavior and Health Education
September 14, 2017
Understanding the Roles of Addiction Professionals in Behavioral Health Care
Greg Potestio, MPAManager of Programs and Technology
NAADAC, the Association for Addiction Professionals
www.naadac.org
Produced ByNAADAC, the Association for Addiction Professionals
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Polling Questions
Webinar Presenters
Behavioral Health Workforce Research Center at the University of Michigan School of Public Health
Angela J. Beck, PhD, MPHA
• About the BHWRC• Addiction Professionals in the Behavioral Health Workforce• Scopes of Practice for Addiction Professionals• Addiction Professionals on Integrated Care Teams
Presentation Outline
Polling Question #1What is your current profession?A) Counselor B) Social Worker C) Peer Support D) Physician E) Other
About the BHWRC• Established September 2015 at the
University of Michigan School of Public Health
• Part of HRSA’s Health Workforce Research Center Network
• Jointly supported by SAMHSA and HRSA
• Interdisciplinary core research team with expertise in: public health systems, health services, social work, qualitative methods, law, medicine
• Work through a Consortium model with key advisors: Peter Buerhaus, PhD; Ron Manderscheid, PhD 11
BHWRC Focus Areas
12
Minimum Data Set
Characteristics and Practice
Settings
Scopes of Practice
• Workforce Diversity• Service Provision to Special
Populations• Team-based and Integrated Care• Core Competencies• Telemedicine• ACA Changes
• Individual Data• Discipline-specific
Data Collection• Organizational Data
• Legal SOPs• Professional SOPs• Studies on Specific
Disciplines and Services• Billing Restrictions
Addiction Professionals in the Behavioral Health Workforce
Overview of SUD Workforce Crisis• Increased demand for addiction
services
• Inadequate supply of addiction professionals
• High turnover• Aging workforce
• Unmet need: • Approximately 22M needed treatment
for SUD in 2010….only 2.6M (~11%) received care
SAMHSA. Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce, 2013.
Who is Considered an Addiction Professional?
From a workforce research perspective, it’s complicated…
Multiple professions
Varied education and training backgrounds
Different levels of licensure and certification
Differing functions and scopes of practice
Multiple Professions • Addiction Counselors• Drug and Alcohol
Counselor• Criminal Justice
Addiction Professional• Social Workers
• Administrators• Educators• Prevention Specialist• Peer Recovery Specialist• Behavioral Health Aide
Broad group of professionals contributing to addiction treatment
Enumerating the WorkforceBureau of Labor Statistics provides data for some professions
Title Substance abuse/behavioral disorder counselors
Mental health/substance abuse social worker
What They Do Advise people who suffer from alcoholism, drug addiction and other behavioral problems.
Assess and treat individuals with mental, emotional, or substance abuse problems
Functions Evaluate addiction; assess readiness to treat, develop treatment goals and plans, help clients develop skills, teach families coping strategies, refer clients
Individual/group therapy, crisis intervention, case management, client advocacy, prevention, and education
Typical Entry-LevelEducation
Bachelor’s degree (but educational requirements can vary from high school to master’s degree)
Clinical: Master’s degree +2 years experience
Number 94,900 114,040
Workforce Growth
Behavioral health is considered among the fastest growing fields, meaning there is a projected growth in jobs…
But can we fill them?
Behavioral Health Workforce Projections: 2025
https://bhw.hrsa.gov/sites/default/files/bhw/health-workforce-analysis/research/projections/behavioral-health2013-2025.pdf
Scopes of Practice (SOPs) for Addiction Professionals
Purpose: review every state’s statutes, administrative codes, certification programs, and job classification materials to find scope-of-practice language for 10 behavioral health professions:
BHWRC Analysis of State SOPs for Behavioral Health
21
• Psychiatrist• Psychologist• Advanced Practice Registered Nurse
Licensed Professional Counselor Marriage and Family Therapist
• Social Worker• Addiction Counselor• Prevention Specialist• Peer Recovery Specialist• Psychiatric Aide
Analysis was limited to the statute/regulatory language, which may differ from actual practice
Addiction Counselor Peer Recovery Specialist Certified Prevention Specialist
• Screening• Intake• Orientation• Assessment• Referral• Treatment Planning• Counseling• Crisis Intervention • Case Management• Report and Record Keeping• Consultation
• Advocacy• Ethical Responsibility• Mentoring and Education• Recovery and Wellness
Support
• Planning & Evaluation• Prevention Education and
Service Delivery• Communication • Community Organization• Public Policy and
Environmental Change• Professional Growth and
Responsibility
Professional Functions
Source: IC&RC
Addiction Counselors
STUDY YEAR 1
Limited to 1 record per state
• Credential must be for full practice
• Licensed positions when possible
• Positions with least amount of required education
STUDY YEAR 3
Multiple records per state (121 records currently)
• Credential must be for full practice
• Certified and licensed positions
• All levels of education/experience
• State specific and reciprocal licenses
• Addiction counselors/therapists• Substance use disorder counselors/therapists• Chemical dependency counselors/therapists• Alcohol and drug counselors
Inclusion Criteria: Addiction Counselor Job Titles
Addiction Counselors
Licensed(30 states)
Certified(44 states)
Both(22 states)
Educational Requirements (n=121 records)
5
43
11
20
22
20
0 10 20 30 40 50 60 70 80 90
Licensed
Certified
No Requirement Assoc/Bach Degree Grad Degree
Credential Requirements by Required Degree: Licensure and Certification
CredentialRequirements(Average)
No Degree Requirement
(n=48)
Assoc/Bach Degree(n=31)
Graduate Degree(n=42)
Education 213 contact hours
242 contact hours or55 credit hours
188 contact hours or41 graduate credit hours
Work Experience 4460 hours 3384 hours 3100 hoursSupervision 254 hours 166 hours 326 hours
Thirty-eight of the 121 licensure/certification records identified permitted degrees to substitute for some experience requirements
Degree Completion vs. Work Experience
ASSOCIATE’S DEGREE=
~1000 hours of work experience (n-25)
~50 supervision hours (n=8)
BACHELOR’S DEGREE=
~2000 hours of work experience (n=30)
~100 supervision hours (n=9)
GRADUATE DEGREE=
~4000 hours of work experience (n=29)
~200 supervision hours (n=9)
Work Experience Hours: Post-graduate supervised experienceSupervision Hours: hours under direct supervision
Definition and function:
• Have lived experience in mental health treatment, or substance use disorder recovery, and guide clients that are just beginning their own treatment
• Do not serve in a clinical capacity; they are peers that offer advice and recommendations Assist with crisis managementSteer clients toward resourcesHelp build strategies to stay healthy and safe
Peer Recovery Specialists (PRS)
29
• PRS credentials were available in 42 states 5 states have a regulatory board specific to PRS20 states credential PRS through a certification board (like the IC&RC)17 states credential PRS through state licensing boards – typically the state board of addiction counselors
• Credential requirements:Average education required: 49 contact hours (mode: 46); 2 states required a degree greater than a high school diplomaAverage work experience required: 1034 hours (mode: 500)Average supervision required: 48 hours (mode: 25)
Peer Recovery Specialists (PRS)
30
Definition and function:
• Focus on community-building in order to prevent substance use disorder before it begins
• Not clinical practitioners; perform awareness-building and educational functions
• Typically certified professionals, as opposed to licensed professionals
Certified Prevention Specialists (CPS)
31
• CPS credentials were available in 44 states 10 states have a regulatory board specific to CPS27 states oversee CPS through a regulatory board that also oversees at least one other behavioral health profession7 states have other types of regulatory structures
• Credential requirements:Average education required: 136 contact hours (mode: 120); 13 states required a degree beyond a high school diplomaAverage work experience required: 2388 hours (mode: 2000)Average supervision required: 138 hours (mode: 120)
Certified Prevention Specialists (CPS)
32
Addiction Professionals on Integrated Care Teams
Levels of Integrated CareLevel Location or Health Services
Coordinated Care 1. Minimal collaboration: Patients are referred to providers at another site
Separate facilities
2. Basic collaboration: Providers periodically communicate about patients
Separate facilities
Co-located Care 3. Basic collaboration: facilities are shared but primary care and behavioral health care develop separate treatment plans for patients
Separate spaces in shared facility
4. Close collaboration: providers share patient records and have some systems integration
Some shared space in same facility
Integrated Care 5. Close collaboration approaching integrated practice: BH and PC providers develop and implement collaborative treatment for most patients
Most shared space in same facility
6. Full collaboration: BH and PC providers develop and implement collaborative treatment for all patients
Sharing all space in same facility
SAMHSA. A Standard Framework for Levels of Integrated Healthcare; Heath et al, 2013
Qualitative study of SUD administrators outlined 3 main models:
• SUD services delivered by BH staff in primary care settings
• PC services delivered in SUD settings
• SUD services delivered by SUD specialists in PC settings
• Broader effort to integrate mental health and SUD services into primary care
• PC physicians maintain responsibility care provision; BH services delivered in conjunction with BH specialists
• BH providers (counselors, social workers) screen patients and provide brief interventions
• Screening is relatively informal, not done universally, not focused on special target populations
• Interventions tended to be more focused on MH than SUD in some of these settings
SUD Services Delivered by BH Staff in Primary Care Settings
Padwa et al, 2012
• Sometimes referred to as “reverse co-location” or “reverse integration”
• Methadone clinics are a common setting for this delivery of care
• PC services tend to focus on physicals, screenings, and treatment for chronic disease, as it can be difficult to employ staff in a formal medical position; non-medical staff help link patients to medical services
Primary Care Services Delivered in SUD Settings
Padwa et al, 2012
• SUD services delivered by certified and licensed specialists in primary care settings
• SUD staff conduct screenings for substance use disorder and provide brief intervention and SUD treatment on site
• In many cases, SUD staff are partially integrated into the medical clinic, but still use separate billing and documentation systems
• Integrated structure has been successful in identifying new SUD service needs and facilitating warm hand-offs
SUD Services Delivered by SUD Specialists in Primary Care Settings
Padwa et al, 2012
How Do SUD Providers Contribute to Care Teams?
• Addiction Counselors: provide direct counseling to patients and families; assist patients with addiction management; and provide community support resources for recovery
• Peer specialists: serve as case managers or health and wellness coaches
Skillman et al, 2016
A review of studies of peer recovery support showed:
“Studies demonstrated reduced relapse rates, increased treatment retention, improved relationships with treatment providers and social supports, and increased satisfaction with the overall treatment experience.”
But, a stronger evidence base is needed.
Is it Effective?
Reif et al, 2014
Center for Integrated Health Solutions
Provides resources on care models, workforce development, and many other areas! www.integration.samhsa.gov
Thank YouBehavioral Health Workforce Research CenterUniversity of Michigan School of Public Health1420 Washington HeightsAnn Arbor, MI 48109www.behavioralhealthworkforce.org
Angela Beck, Director: [email protected]
42
@BHWRC Behavioral Health Workforce Research Center
This Center is jointly supported by SAMHSA and HRSA; funded through HRSA Cooperative Agreement U81HP29300: Health Workforce Research Centers Program.
https://www.naadac.org/addiction-professionals-in-BHC-webinar
Cost to Watch:Free
CE Hours Available:1 CEs
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1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
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4. A CE certificate will be emailed to you within 21 days of submitting the quiz.
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