New Mexico s Behavioral Health Workforce

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1 New Mexico s Behavioral Health Workforce Caroline Bonham, MD Vice Chair for Community Behavioral Health UNM Department of Psychiatry and Behavioral Sciences Psychiatric consultant with BHSD

2 In 2012 HB19 the Health Care Work Force Data Collection, Analysis and Policy Act became law: Licensure boards developed surveys on practice characteristics. Licensure data was directed to UNM Health Sciences Center The New Mexico Health Care Workforce Committee was established including statewide constituents. The Committee evaluates workforce needs and make recommendations. In December 2014, the Behavioral Health

3 Nationally, there is unmet need for behavioral health treatment 28% of U.S. adults have diagnosable mental health or substance use condition Approximately 2/3 do NOT receive any treatment Of those who do receive treatment, about 60% receive treatment in primary care or other generalist settings

4 Composition of Behavioral Health Workforce Prescribers Psychiatrists Advanced practice nurses Physician Assistants Prescribing Psychologists Primary care providers Delivery of therapy and psychosocial interventions: Counselors Social Workers Addictions counselors Psychiatrists Psychologists Peer specialists

5 Behavioral Health Workforce Committee includes representation from: Psychiatric nursing Social work and counselling Psychology Psychiatry Primary care Additionally, efforts were made to reach out to experts from the fields of peer support workers, community health workers, and physician assistants to understand their perspectives and experiences

6 Behavioral Health Workforce Committee Participants include: Deborah Altschul, PhD Bill Belzner, MA Doreen Bird, MPH Caroline Bonham, MD Carol Capitano, PhD, CNS Molly Faulkner, PhD, CNP, LISW Gloria Dixon, PhD, CNP Steve Hansen Jerry Harrison, PhD Jenny Hettema, PhD Wayne Lindstrom, PhD Mark Moffett, PhD Brad Samuel, PhD Joseph Sanchez, MBA Helene Silverblatt, MD Ann Waldorf, PhD Mauricio Tohen, MD, DrPH, MBA William Wagner, LISW, PhD

7 Our Approach: Reviewed state and national documents on workforce including: Annapolis Coalition Action Plan on the Behavioral Health Workforce NM healthcare workforce 2013 and 2014 annual reports NM Behavioral Health Provider Alliance 2014 list of priorities LFC Reports on workforce and behavioral health outcomes 2002 NM Behavioral Health Gaps Analysis Currently in process of analyzing workforce data from licensing boards

8 Review of needs assessments and state reports: Limited access to prescribers with specialty training in child health Fragmented crisis system of care Limited integration efforts with primary care Limited access to independently licensed providers who can conduct intakes and assessments and provide supervision Limited implementation of recovery oriented programs Current infrastructure problems major agencies transitioning Insufficient implementation of evidence based practices with team approach

9 Convened group of experts to focus on following topics: Training Recruitment and Retention Sustainability Infrastructure Behavioral health workforce models that meet NM needs

10 Where are we training our workforce? Counselors 12 campuses across NM Social workers 13 campuses across NM Nurse practitioners NMSU; plans to develop program at UNM in 2016 Psychiatry UNM with rural elective placements Psychology PhD programs at UNM and NMSU; clinical internships at UNM and SW Consortium Physician Assistants can obtain specialty certification once in practice Peer specialists state run course and certification process

11 Encourage training programs to prepare clinicians to address NM healthcare needs Interdisciplinary outpatient training environments Training in team based approaches e.g. CALM, IMPACT Exposure to behavioral health in primary care settings Understanding of NM s cultural diversity Training in use of telehealth to provide

12 Since providers are more likely to remain where they train: Importance of developing clinical placements in rural communities Enhanced co-ordination of student placements across disciplines Explore options for student housing Explore reimbursement for services provided by trainees Use of telehealth to augment clinical supervision

13 Recruitment and Retention Consider organized recruitment efforts for out of state professionals Consider expansion of loan forgiveness programs especially for non-prescribers Implementation of evidence based practices with team approach can improve morale Consider focus on behavioral health workforce at annual CEU retention conference sponsored by DOH

14 Sustainability: Explore payment structures that Maximize access and health outcomes Reimburse for prevention activities such as harm reduction, suicide prevention, early intervention Can include capitated rates and performance related contracts that emphasize population health Compensate case consultation between providers

15 Sustainability: Service delivery structures Consider investment in leadership and governance structures for behavioral health agencies Development of collaborations in rural areas to maximize economies of scale and diseconomies of scope Development of centralized telehealth hub and spoke structure to provide emergency psychiatric assessments in collaboration with Nurse Advice Line and Crisis and Access line

16 Current priorities Preliminary analysis of survey data suggest significant shortages in NM s entire behavioral health workforce Key strategies to address this crisis include: - Pipeline programs supporting trainees likely to practice in rural areas - Strategic implementation of team based approaches with care co-ordination at point of service - Focus on bringing current workforce towards full independent licensure - Long term investment in leadership and governance structures for behavioral health

17 Next steps: In process of analyzing licensure data for NM behavioral health professionals to better understand: Distribution of behavioral health care workforce Distribution of independently licensed professionals Comparisons with national benchmarks Final report to be delivered to LHHS and LFC on 10/1/2015 which will include licensure data analyses and recommendations on models of

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