Substance Use Disorders in the U.S. Armed Forces (2013) / Chapter Skim
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8 Substance Use Disorder Workforce
8 Substance Use Disorder Workforce
Pages 227-246
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From page 227... ...
The committee also examined the Psychological Health Risk-Adjusted Model for Staffing (PHRAMS) to understand the current ratios of physicians and nonphysician health care professionals assigned to treat alcohol and other drug use disorders.
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From page 228... ...
licensed clinical social workers with master's or doctoral training; (2) licensed clinical psychologists with doctoral training; and (3)
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From page 229... ...
, and adheres to its certification standards. The Air Force Substance Abuse Counselor Certification Board encourages mental health technicians, mental health providers, and nurses providing substance abuse treatment in a military treatment facility to seek certification as a substance abuse counselor (U.S.
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From page 230... ...
Mental health technicians who are not certified alcohol and drug counselors must have written training plans to develop competence in working with patients with alcohol and other drug use disorders. The training plan must include completion of Qualification Training Package 1, which includes the Twelve Core Functions of Substance Abuse Counselors identified by IC&RC (U.S.
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From page 231... ...
, who are responsible for staff management and supervision, management of the drug and alcohol testing program, coordination of all risk reduction and prevention services, coordination of and assistance with Command referrals, development of an ASAP staff training plan, evaluation of prevention activities, and preparation and approval of all reports. A prevention coordinator, an employee assistance program coordinator, a drug testing coordinator, a risk reduction program coordinator, a suicide program manager, a clinical director, counselors, clinical consultants, and substance abuse professionals support the ADCO and the delivery of ASAP services.
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From page 232... ...
Prevention Workforce Position Civilian Alcohol and drug control officers (ADCOs) 63 Risk reduction program coordinators 55 Drug testing coordinators 132 Suicide program managers 34 Prevention coordinators 81 Employee assistance program coordinators 47 Total 412 SOURCE: Personal communication, Les McFarling, Ph.D., Army Center for Substance Abuse Program, February 22, 2012.
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17 Licensed clinical social workers 219 Licensed professional counselors 165 Licensed marriage and family therapists 70 Counselors (not licensed independent practitioners) Master's-level substance abuse certification 406 Other Social workers (not licensed clinical social workers)
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From page 234... ...
TABLE 8-4 Substance Abuse Rehabilitation Program (SARP) Workforce Active Position Duty Civilian Contractor Licensed Independent Practitioners Licensed clinical social workers 16 1 Licensed clinical psychologists 18 2 Psychiatrists 5 Counselors Substance abuse counselors (alcohol and drug counselors I)
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From page 235... ...
Counselors, directors, and medical officers implement and coordinate screening, assessment, and treatment services. Alcohol abuse prevention specialists and drug demand reduction coordinators have lead responsibility for prevention activities.
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Table 8-5 shows the numbers of providers by job title that the Marine Corps reported to the committee. The Marine Corps is assessing the feasibility of amending credentialing requirements to include licensed professional counselors and licensed clinical social workers as licensed independent practitioners.
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The resulting PHRAMS model defines psychological health services and needs broadly to include prevention services, diagnosis and treatment of mental health conditions, and behavioral and psychological health issues not defined as mental health conditions (Harris and Marr, 2011)
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The encounter-based staffing requirement is based on the estimated number of encounters divided by the productivity expectation. The encounter estimate reflects the population covered in the Defense Health Plan, multiplied by the prevalence rate of the specific psychological health needs, multiplied by the encounter rate.
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Enrollment (enrolled in a military treatment facility, enrolled in the purchased care network, not enrolled) Deployment exposure history (never deployed, moderate–not recent deployment, moderate-recent deployment, high–not recent deployment, high-recent deployment, currently deployed)
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From page 240... ...
diagnoses are common. Treatment for comorbid mental health diagnoses is outside the scope of practice for most certified alcohol and drug counselors.
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From page 241... ...
Finding 8-2: The SUD counselor training manuals of the Air Force and Navy are dated, do not address the use of evidence-based pharmacolog ical and behavioral therapies, and do not reference the VA/DoD Clini cal Practice Guideline for Management of Substance Use Disorders. Chapter 10 of the Air Force Alcohol and Drug Counselor Certification Handbook (U.S.
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From page 242... ...
General medical officers and flight surgeons receive minimal instruction in SUDs, yet often are on the front lines of diagnosis, suggesting that these providers should receive additional training to diagnosis and treat alcohol and other drug-related disorders. Beyond specialty training, one opportunity to increase background SUD training among the larger workforce of primary care physicians who provide care to military personnel is for these physicians to have a continuing medical education requirement in screening, brief intervention, and referral to treatment (SBIRT)
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From page 243... ...
During fiscal year (FY) 2010, 10.4 percent of the psychological health encounters in the MDR database were related to "psychotic and nonpsychotic substance use," with a mean of 3.5���������������������������������������������������������� ��������������������������������������������������������� encounters among individuals with a substance use encounter ( arris and Marr, 2011)
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From page 244... ...
De partment of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Alcohol Abuse and Alcoholism.
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From page 245... ...
2007. Direct care workers in the National Drug Abuse Treatment Clinical Trials Network: Characteristics, opinions, and beliefs.
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