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) [email protected]