John A. Morris

Mental Health And Addiction Workforce Development: Federal Leadership Is Needed To Address The Growing Crisis

The mental health and addiction workforce has long been plagued by shortages, high turnover, a lack of diversity, and concerns about its effectiveness. This article presents a framework to guide workforce policy and practice, emphasizing the need to train other health care providers as well as individuals in recovery to address behavioral health needs; strengthen recruitment, retention, and training of specialist behavioral health providers; and improve the financial and technical assistance infrastructure to better support and sustain the workforce. The pressing challenge is to scale up existing plans and strategies and to implement them in ways that have a meaningful impact on the size and effectiveness of the workforce. The aging and increasing diversity of the US population, combined with the expanded access to services that will be created by health reform, make it imperative to take immediate action.

REPORT OF RECOMMENDATIONS: THE ANNAPOLIS COALITION CONFERENCE ON BEHAVIORAL HEALTH WORK FORCE COMPETENCIES

In May 2004, the Annapolis Coalition on Behavioral Health Workforce Education convened a national meeting on the identification and assessment of competencies. The Conference on Behavioral Health Workforce Competencies brought leading consumer and family advocates together with other experts on competencies from diverse disciplines and specialties in the fields of both mental health care and substance use disorders treatment. Aided by experts on competency development in business and medicine, conference participants have generated 10 consensus recommendations to guide the future development of workforce competencies in behavioral health. This article outlines those recommendations. A collaborative effort to identify a set of core or common competencies is envisioned as a key strategy for advancing behavioral health education, training, and other workforce development initiatives.

TRAINING AND EDUCATION NEEDS OF CONSUMERS, FAMILIES, AND FRONT-LINE STAFF IN BEHAVIORAL HEALTH PRACTICE

Much of the behavioral health care delivered to people with serious mental illnesses and chronic addictive disorders is provided by front-line or direct service mental health workers. Issues related to the qualifications, training, and ongoing evaluation of the competencies of this important provider group have received scant attention in the behavioral health field. This paper explores the educational needs and best practices of the consumers and families who carry much of the burden of caring for disabled populations, as well as the front-line staff, many of whom are employed in state psychiatric hospitals and community mental health or addiction treatment systems. Within the overall context of culturally competent behavioral health care, specific recommendations are proposed in an attempt to move the field forward.

Innovation in behavioral health workforce education.

This article describes an effort to promote improvement in the quality and relevance of behavioral health workforce education by identifying and disseminating information on innovative training efforts. A national call for nominations was issued, seeking innovations in the education of behavioral health providers, consumers, and family members. A review committee evaluated each nomination on four dimensions: novelty, significance, transferability, and effectiveness. Nineteen innovations were selected for recognition, all of which are briefly described.

Human Resource Development: A Critical Gap in Child Mental Health Reform

The past decade has seen major reform Knitzer (1982), Rafferty (1992), Sullivan (1993), and others have highlighted critiin the way that mental health services for children and adolescents have been concal shortcomings in the quality, quantity, and coordination of services to children ceptualized, organized, delivered, and funded. Beginning in the mid-1980s and with emotional disorders, particularly those suffering from serious and disabling continuing to the present, the mental health needs of children and their families mental disorders. The emergence of managed care aphave become a major focus of governmental, private, and philanthropic attention. proaches and contracting for children’s services has put additional pressure on The works of England and Cole (1992), agencies to perform. Hernandez and colleagues (1998) refer to this impact as a “growing sense of urgency regarding the John Morris, MSW, CHE, is Professor of Clinineed to reform patterns of delivering hucal Neuropsychiatry and Behavioral Science, University of South Carolina School of Mediman services to children and families.” cine, and Director, South Carolina Center for Grobb (1995), Mechanic (1969, 1985, Innovation in Public Mental Health, South Car1986), Mechanic and Surles (1992), among olina Department of Mental Health; he is also others identify the pivotal role of state President, American College of Mental Health Administration. Jerome Hanley, Ph.D., is Direcmental health authorities in serving peotor of the Office of Children’s Policy and Culple with persistent or very serious mental tural Competence, S.C. Center for Innovation disorders, a role that dates to the creation in Public Mental Health, and Professor of Cliniof the first asylums in the 1820s. Even cal Neuropsychiatry and Behavioral Science, when one considers the comparatively reUniversity of South Carolina School of Medicine. cent attention of the federal government Address for correspondence: John A. Morris, and prominent national foundations, M.S.W., S.C. Center for Innovation in Public much of the visible activity in addressing Mental Health, Wilson Bldg., Suite C, 1800 Cothe needs of children with serious emolonial Dr., P.O. Box 202, Columbia, SC 29203. E-mail: JAM66@WSHPI.DMH.STATE.SC.US. tional disorders has rested with state gov-

Practice guidelines in mental health and addiction services: contributions from the American College of Mental Health Administration.

Practice guidelines have proliferated in mental health and addiction services; more than 40 organizations have developed guidelines in the field. However, much confusion, controversy, and contextual issues remain, particularly regarding effective dissemination and the clinical, financial, political, and ethical issues that emerge when evidence-based behavioral health practice guidelines are implemented in systems of care. The American College of Mental Health Administration (ACMHA) focused on these problems in their 1999 and 2000 Santa Fe Summits and produced a number of specific outcomes that contribute to thinking in the field. These include the following: (a) a taxonomy of building blocks for informed decision-making in behavioral health assessment and treatment; (b) a paradigm for the development of practice guidelines; (c) characteristics of a good practice guideline; (d) strategies for disseminating and implementing practice guidelines; and (e) areas in need of future research.

The Annapolis Coalition Report on the Behavioral Health Workforce Needs of the United States: International Implications

In the United States, the vast majority of resources dedicated to helping individuals with mental health and substance-use problems are human resources, and while there are many committed and hardworking individuals in the behavioral health delivery system in the United States, there also are many forces that work against them in their daily work environments. In 2007, under the leadership of the Annapolis Coalition on the Behavioral Health Workforce, over 5,000 voices came together to address this growing crisis and produced the national Action Plan for Behavioral Health Workforce Development. The reports and recommendations of the multiple expert panels and workgroups yielded a set of seven final action goals, objectives for accomplishing each of the goals, and detailed preliminary implementation tables that identify specific action steps for each objective, linked to potential stakeholders who could take those actions. Building on this report are potential opportunities for an international collaboration agenda for the development of behavioral health workforce education, research and clinical care.

Playing policy pinball: making policy analysis palatable.

The author presents a teaching tool to make policy analysis accessible to a wide range of audiences, especially those who might normally be reluctant to engage in policy discussions or debate. The tool has been used with good results in a variety of venues, and is presented with brief examples of how it can be used.

Guest Editors' Introduction: Implementing Best Practices In Behavioral Health Workforce Education--Building A Change Agenda.

There is a national crisis in the training of the behavioral health workforce. This crisis is marked by a number of paradoxes that characterize the education of providers of mental health and addiction services. First, graduate programs have not kept pace with the dramatic changes wrought by managed care and subsequent health care reforms, leaving students unprepared for contemporary practice environments. Second, continuing education programs persist in using passive, didactic models of instruction that have been proven ineffective in changing practice patterns or improving healthcare outcomes. Third, non-degreed and bachelor-degreed direct care providers, who may have the most contact with consumers, receive very little training. Fourth, consumers and their families, who play an enormous care-giving role, typically receive no educational support, nor is their considerable expertise about the lived experience of illness and recovery tapped by engaging them as educators of the workforce. This special issue of Administration and Policy in Mental Health is the second in a series on this critical topic. The first was published as a special double issue (Hoge & Morris, 2002). We are grateful to the journal’s Editor, Saul Feldman, for his exceptional support of the efforts reported

State services research capacity: Building a state infrastructure for mental health services research

State mental health agencies in the United States manage increasingly larger and complex systems of care. This requires an increasingly sophisticated workforce and decision support infrastructure. However, with the exception of larger states with their own research and evaluation offices, few states have the necessary resources to develop these important elements. Bringing in talent from academic organizations who have research as a priority may be the preferred direction for many states. The unique approach developed in South Carolina is the first systematic collaboration between a state mental health system and a multi-institutional, inter-disciplinary academic group oriented towards developing a comprehensive, statewide infrastructure for policy-relevant mental health services research.