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7 Increasing Workforce Capacity for Quality Improvement
Pages 286-324

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From page 286...
... , but also because of the great variation in the types of clinicians licensed to diagnose and treat M/SU conditions and substantial variations in their training. In contrast to general health care, in which the diagnosis and treatment of medical conditions are typically provided by physicians, individuals licensed to diagnose and treat M/SU problems and illnesses include a wide range of practitioners- psychologists, psychiatrists, primary care and specialist physicians, social workers, psychiatric nurses, marriage and family therapists, addiction therapists, and a wide variety of counselors (e.g., psychosocial rehabilitation, school, addiction, and pastoral counselors)
From page 287...
... As a result, there continues to be a large gap between what is known, what is taught, and therefore what is done in practice. Sustained, multiyear attention and resources have been applied successfully to the education and training of physicians and nurses through the Council on Graduate Medical Education and the National Advisory Council on Nurse Education and Practice.
From page 288...
... While recognizing the importance of such problems as workforce shortages, geographic maldistribution, and insufficient diversity that afflict the M/SU and general health care workforces alike, this chapter focuses on the special problems resulting from the greater diversity of the M/SU health care workforce, their varying education and training, and the difficulties of delivering high-quality patient care in the solo practices that are more typical among those who treat M/SU conditions. GREATER VARIATION IN THE WORKFORCE TREATING M/SU CONDITIONS Caregivers who provide care to individuals with M/SU problems and illnesses, like those who care for those with general health care problems
From page 289...
... Particularly keen shortages are found in the numbers of mental health professionals serving children and adolescents with serious mental disor ders, and older people" (DHHS, 1999:455)
From page 290...
... Although the diagnosis and treatment of general health conditions are typically limited to physicians, advanced practice nurses, and physician assistants,2 M/SU health care clinicians include psychologists, psychiatrists, other specialty or primary care physicians, social workers, psychiatric nurses, marriage and family therapists, addiction therapists, psychosocial rehabilitation therapists, sociologists, and a variety of counselors with different education and certifications 2 Dentists, chiropractors, and podiatrists also are licensed to diagnose and treat, but typically within prescribed domains.
From page 291...
... They also include social workers, counselors, nurses, and therapists who either have received additional, specialized training in treating mental problems and illnesses prior to their professional practice, or have chosen to practice in a mental health care setting and gained advanced knowledge in treating mental problems and illnesses through experience (West et al.,
From page 292...
... , and in studies of the health care workforce overall, "the addiction treatment workforce is generally overlooked" (McCarty, 2002:1)
From page 293...
... The remainder were about equally composed of unlicensed counselors and "other" professionals who were predominantly master's-level social workers, mental health counselors, marriage and family therapists, and psychologists with no certification or licensure as substance-use treatment providers; these "other" professionals also included psychiatrists and specialty-certified primary care physicians and nurses (Harwood, 2002)
From page 294...
... Variation in Amounts and Types of Education Psychiatry Eligibility for board certification in psychiatry requires 4 years of college, 4 additional years of medical education leading to a medical degree, followed by a minimum of 4 years of residency training. Psychology Although the doctoral degree in psychology is the standard educational path for independent clinical practice, individuals with a master's degree in psychology also can practice under the direction of a doctorally prepared 4This section incorporates content from a paper commissioned by the committee on "Workforce Issues in Behavioral Health," by John A
From page 295...
... . Social Work Although social workers can practice with a bachelor's, master's, or doctoral degree, the Master of Social Work (MSW)
From page 296...
... ; or a postgraduate clinical training program following training in psychology, psychiatry, social work, nursing, pastoral counseling, or education (Morris et al., 2004)
From page 297...
... Deficiencies in Professional Education The education of all health professionals is deficient in a number of areas and has not kept pace with advances in knowledge and changes in the delivery of health care (IOM, 2001, 2003) , despite an IOM call that: All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics (IOM, 2003:3)
From page 298...
... . Moreover, quality improvement strategies have received little attention in M/SU education (Morris et al., 2004)
From page 299...
... a strategic plan for interdisciplinary faculty development to prepare the general health professions workforce to provide care for substance-use problems and illnesses, (2) an interdisciplinary faculty development program to improve the educational curriculums for general health care professionals, and (3)
From page 300...
... Annapolis Coalition on Behavioral Health Workforce Education The Annapolis Coalition on Behavioral Health Workforce Education (Annapolis Coalition) grew out of a 2001 conference convened by the American College of Mental Health Administration and the Academic Behavioral Health Consortium, with funding from SAMHSA and the Agency for Healthcare Research and Quality (AHRQ)
From page 301...
... . Social work education The Interdisciplinary Project to Improve Health Professional Education in Substance Abuse found that most schools of social work failed to provide students with a basic knowledge of alcohol
From page 302...
... The report of the Interdisciplinary Project to Improve Health Professional Education in Substance Abuse (Naegle, 2002) includes only information from two surveys conducted in 1987.
From page 303...
... , sponsored by the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse, was one of the first multidisciplinary faculty development programs in substance use health care for health professionals (Galanter, 1980)
From page 304...
... VARIATION IN LICENSURE AND CREDENTIALING REQUIREMENTS Licensing standards for the health professions are set by the states and typically specify minimum standards for competency. In addition, the different health professional associations, such as NAADAC -- the Association for Addiction Professionals, and the American Nurses Association, frequently establish independent certification or credentialing processes that formally recognize an individual's knowledge or competency in a specialized area.
From page 305...
... . Like professional practice education, however, continuing education for health professionals has been found lacking in content, methods, financing, and organizational support.
From page 306...
... , continuing education has been found to have little effect in changing clinical practice (Davis et al., 1999)
From page 307...
... The IOM's report on health professions education (IOM, 2003) identifies utilizing information technology to communicate, manage knowledge, mitigate error, and support decision making as a core competency that should be possessed by all health professionals.
From page 308...
... . Solo practice does not facilitate building the infrastructure needed to take up new knowledge and store, collect, and share the clinical information required to deliver high-quality collaborative patient care.
From page 309...
... . Observations from experts in the use of information systems by managed behavioral health care organizations support this conclusion.
From page 310...
... . In a study of the adoption of clinical practice guidelines for treatment of attention deficit hyperactivity disorder (ADHD)
From page 311...
... As some assert, "while face-to-face contact with patients is certainly desirable, the primary medium of treatment, psychotherapy, requires no direct physical contact; many assessment and treatment services could potentially be delivered, at least in part, over the Internet" (Flanagan and Needham, 2003:312)
From page 312...
... 1956. The American Psychiatric Association Committee on Medical Education proposes a curriculum for teaching psychiatry in medical schools and recommends that physician training develop "well-rounded physicians, who, in their relationships with all patients, recognize the importance of unconscious motivation, the role of emotional maladjustment in the ideology and chronicity of illness, the emotional and personality problems engendered by various illnesses; and who habitually see the patient in his family and general environmental setting" (APA Committee on Medical Education, 1956:128)
From page 313...
... The program aims to develop a new profession combining three main areas of knowledge -- biological science, psychological science, and social science -- in a clinical curriculum, with the goal of unifying the way behavioral health professionals are trained (Wallerstein, 1991)
From page 314...
... and the Academic Behavioral Health Consortium (ABHC) initiate the Annapolis Coalition on Behavioral Health Workforce Education to build national consensus on the nature of the problems facing the M/SU treatment workforce and improve the quality and relevance of their education and training.
From page 315...
... 2004. The Annapolis Coalition on Behavioral Health Workforce Education convenes a national meeting that generates 10 consensus recommendations to guide the development of M/SU health care workforce competencies (Hoge et al., 2005a)
From page 316...
... · Efforts to be carried out by hospitals, educational institutions, and accrediting bodies with respect to these matters, including changes in undergraduate and graduate medical education programs. · Improvements needed in databases concerning the supply and distribution of, and postgraduate training programs for, physicians in the United States and steps that should be taken to eliminate those deficiencies.
From page 317...
... With respect to furthering interdisciplinary education and practice, for example, the two worked together to produce the report Collaborative Education to Ensure Patient Safety (COGME and NACNEP, 2000) , which makes recommendations pertaining to faculty development, quality improvement, interdisciplinary collaboration, and competency development.
From page 318...
... Recommendation 7-3. The federal government should support the de velopment of M/SU faculty leaders in health professions schools, such as schools of nursing and medicine, and in schools and programs that educate M/SU professionals, such as psychologists and social workers.
From page 319...
... and, more recently, the Annapolis Coalition on Behavioral Health Workforce Education can offer the expertise, collaboration, and flexibility necessary to collect and analyze additional evidence that needs to be brought to bear on these issues. Therefore, the committee strongly recommends that the council seek out AMERSA and the Annapolis Coalition as partners in this process.
From page 320...
... 1999. Impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care out comes?
From page 321...
... Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: National Academy Press.
From page 322...
... 2002. The alcohol and drug abuse treatment workforce.
From page 323...
... In: Haack MR, Adger H, eds. Strategic Plan for Interdisciplinary Faculty Development: Arming the Nation's Health Professional Workforce for a New Approach to Substance Use Disor ders.
From page 324...
... In: Haack MR, Adger H Jr, eds. Strategic Plan for Interdisci plinary Faculty Development: Arming the Nation's Health Professional Workforce for a New Approach to Substance Use Disorders 23:319­340.


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