Transcript 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
 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.
 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

This called for several areas of focus:
o Continued dissemination of the toolkits
o Begin training in the TFC toolkit
o Workforce Development in the areas of
substance abuse services
o Cultural Diversity in the areas of TFC
and Workforce Development
o Outcomes studies on the impact of
trainings on consumer outcomes
 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
 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
 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
 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
 Administrative
demands
 Recruitment challenges
 Retention and turnover
 Competency and quality
 High stress
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Confused
Lack of confidence
Isolated and unsupported
Burned out
Enhance workforce competence, retention and
morale by providing services using effective
dissemination strategies for the adoption of
best practices.
 Disseminate
knowledge about best practices
 Improve clinical competencies
 Facilitate provider collaboration and cohesion
 Enhance workforce retention and morale
 Preparatory
knowledge
 Practice with feedback
 Ongoing coaching and supervision
 Teaching
case conferences
 Training
 Supervision
 Consultation
 Technical
assistance
 Special programs
Purpose:
Organize a learning community
approach to improving application
of best practices in the real world
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
 Relevant
 Evidence Based
 Need based
Models
 Integrated Dual Disorders
 Flexible
Treatment
 Partial day
 Medication management
 Full day
 Wellness and recovery
 Site based
 Intensive Outpatient
Treatment
 Wide range of topics
 Therapeutic Communities
 Administrative
 Program Design and delivery
 Special Populations
 National accreditation preparation
 Children
 Nonprofit management
 Adolescents
 Skills based
 Criminal Justice
 Group therapy
 Co-occurring
 Family therapy
 Geriatric
 Dialectical Behavioral Training
 Women
 Motivational Interviewing
 Minorities
 Cognitive Behavioral Therapy
 Face
to face
 Internet based
 Web conferences
 Fidelity reviews
 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)
 Enhance
collaboration
 Easier recruitment
 Improve retention
 Improve morale
 Better patient care
 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
 Mental
health “reform”
 Community awareness and concern
 Commitment by local policymakers
 Academic and community partnerships in
place
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.
Community Partners
Duke
University
The MH
Center
N.C. Evidence Based
Practices Center
Objectives
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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
 Teaching
case conferences
 Training
 Supervision
 Consultation
 Technical
assistance
 Special programs
Purpose:
Establish a learning community approach to
improving application of best practices in
the real world
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
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
 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
Old Model
New 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


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
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

Purpose:
To promote a community wide response to
address substance use disorders based on
science based perspectives and best
practices
$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)
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)
“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
Guiding Principles
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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)
Goals
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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
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
•
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
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Support
 Share experiences
 Ongoing training
 Technical Assistance
 Consultation
 Resource orientation

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
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
Continuation Plan
 Monitor
impact of the training through ongoing
assessment of change related outcomes
 Recruit new team members and repeat training
at targeted intervals
 Continue monthly meetings with new and
ongoing members
 Offer periodic update trainings for Academy
graduates
 Disseminate findings
 District Court
 Sickle Cell
Judge
Association
 Street outreach
workers
 Congregational
Nursing
 Public Health
 Maternal Group
Home Director
 Police Department Narcotics Unit
Supervisor
 Hospital
Case
Manager
 Salvation Army
Counselor
 Pretrial Service
Coordinator
 Public Library
 Department of
Social Services
Social Worker
 AIDS Alliance
 Merchants
Association
Community education events and in-service sessions
organized by graduates (e.g. the faith community
groups, parents and teens attending a private high
school, public housing residents, health clinic
professionals)
 Professional conference presentations by Academy
graduates
 Website and blog regarding Academy activities
 Production of a testimonial video
 Translation of curriculum slides into Spanish & French
 Resource brochures and materials for library patrons
 Changed guidelines for dealing with relapse at a local
homeless shelter
 Motivational group for HIV infected individuals served
at a public health clinic

 We
are creating a national model that can be
used by AHECs, community coalitions,
advocacy groups, community mental health
centers, local governments.
 Inaugural class to be trained August 19-20,
2010.
 Additional trainings for potential trainers
will be scheduled. Please visit website for
details: www.ncebpcenter.org
Contact me for information:
John T. Bigger, MS, LPC
Administrator of Mental Health CE
Southern Regional AHEC
Fayetteville, NC
(910) 678-7207
[email protected]