understanding the roles of addiction professionals in ......angela j. beck, phd, mph, director...

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

[email protected]

Produced ByNAADAC, the Association for Addiction Professionals

www.naadac.org/webinars

https://www.naadac.org/addiction-professionals-in-BHC-webinar

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Using GoToWebinar – (Live Participants Only)

Control Panel

Asking Questions

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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)


GRADUATE DEGREE=

~4000 hours of work experience (n=29)


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.

Cost to Watch:Free

CE Hours Available:1 CEs

CE Certificate for NAADAC Members:Free

CE Certificate for Non-members:$15

To obtain a CE Certificate for the time you spent watching this webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at


3. If applicable, submit payment for CE certificate or join NAADAC.

4. A CE certificate will be emailed to you within 21 days of submitting the quiz.

CE Certificate

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understanding the roles of addiction professionals in ......angela j. beck, phd, mph, director...

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