National AHEC ConferenceJune 22, 2010

John T. Bigger, MS, LPCAdministrator of Mental Health CE

Southern Regional AHECFayetteville, 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 toolkitso Begin training in the TFC toolkito Workforce Development in the areas of

substance abuse serviceso Cultural Diversity in the areas of TFC

and Workforce Developmento 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

Confused Lack of confidence Isolated and unsupportedBurned 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 practices2) Enhance collaboration

3) Promote cross referrals3) Improve morale4) Disseminate useful information5) CE credit

Method:Case presentation

Relevant Need based Flexible

Partial day Full day Site based

Wide range of topics Administrative

Program Design and delivery National accreditation preparation Nonprofit management

Skills based Group therapy Family therapy Dialectical Behavioral Training Motivational Interviewing Cognitive Behavioral Therapy

Evidence Based Models Integrated Dual Disorders

Treatment Medication management Wellness and recovery Intensive Outpatient

Treatment Therapeutic Communities

Special Populations Children Adolescents Criminal Justice Co-occurring Geriatric Women Minorities

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.

ObjectivesDesign a prevention, intervention and treatment

system consistent with science based perspectives

Focus on serving treatment-needy vs. only the treatment-ready

Involve the entire communityEnsure efficient and coordinated use of resourcesReduce reliance on limited professional servicesPromote 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 practices2) Enhance collaboration

3) Promote cross referrals4) Improve morale5) Disseminate useful information6) 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

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

New Model

Serve the treatment needy as well treatment readyTrained first respondersUniversal screeningEarly 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 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• 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 Participation12 – 15 members initiallyAttend 15 hour training sessionDevelop personal/organizational ‘’make a difference” plan

Participate in monthly 1.5 hour team meetings for one year following graduation Support Share experiences Ongoing training Technical Assistance Consultation Resource orientation

Implementation Plan:

Community roll out and distribution of applications Review applications and make selection12-15 applicants invited to participatePre-session contact with team membersTraining 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 discussionDay III (3 hours) Treatment best practices and review of local resourcesDay IV (3 hours) Introduction to Motivational InterviewingDay 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 Judge

Sickle Cell 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, LPCAdministrator of Mental Health CESouthern Regional AHECFayetteville, NC(910) 678-7207John.Bigger@sr-ahec.org