Implement Behavioral Health Training Programs to Address a Crucial National Shortage in Community Health Care Settings
•
0 likes•103 views
Health centers are uniquely positioned to address the unprecedented need for behavioral health services but are challenged by the workforce shortage. Participants will gain the knowledge needed to begin conceptualization of a training pathway. Join us to discuss the considerations of sponsoring an in-house training program across all educational levels, including the benefits, program structure, design, curriculum, supervisors' role, and required resources. Experts will provide participants with examples from practicum and postdoctoral level training programs to help them gain confidence in developing a behavioral health training pathway.
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Similar to Implement Behavioral Health Training Programs to Address a Crucial National Shortage in Community Health Care Settings
Similar to Implement Behavioral Health Training Programs to Address a Crucial National Shortage in Community Health Care Settings (20)
More from CHC Connecticut
More from CHC Connecticut (18)
Recently uploaded
Recently uploaded (20)
Implement Behavioral Health Training Programs to Address a Crucial National Shortage in Community Health Care Settings
- 1. Implement Behavioral Health Training Programs to Address a Crucial National Shortage in Community Health Care Settings Thursday, March 9th 2023 12:30-1:30pm Eastern / 9:30-10:30am Pacific 1
- 2. Continuing Education Credits In support of improving patient care, Community Health Center, Inc. / Weitzman Institute is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. A comprehensive certificate will be available after the end of the series, Summer 2023. 2
- 3. Disclosure • With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (or spouse/partner) and any for-profit company in the past 12 months which would be considered a conflict of interest. • The views expressed in this presentation are those of the presenters and may not reflect official policy of Community Health Center, Inc. and its Weitzman Institute. • We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or under investigation (not FDA approved) and any limitations on the information hat we present, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. • This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $137,500 with 0% financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. 3
- 4. At the Weitzman Institute, we value a culture of equity, inclusiveness, diversity, and mutually respectful dialogue. We want to ensure that all feel welcome. If there is anything said in our program that makes you feel uncomfortable, please let us know via email at nca@chc1.com 4
- 5. National Training and Technical Assistance Partnership Clinical Workforce Development Provides free training and technical assistance to health centers across the nation through national webinars, learning collaboratives, activity sessions, trainings, research, publications, etc. 5
- 6. Speakers • Tim Kearney, PhD • Chief Behavioral Health Officer, Community Health Center, Inc. • Chelsea McIntosh, PsyD • Training Director for the Postdoctoral Residency Program, Program Director for the Graduate Professional Education (GPE) Grant, Community Health Center, Inc. 6
- 7. Objectives 1. Address the current landscape of the behavioral health workforce projections. 2. Describe the benefits to sponsoring an in-house behavioral health training program (masters and doctoral level therapy trainees). 3. Understand how a health center can establish a behavioral heath student and/or postgraduate clinical psychology residency program. 4. Review program structure, design, and curriculum; the role of supervisors; the recommended resources. 7
- 8. Behavioral Health Training Levels at CHC 8 Practicum • Still in training program prior to receiving degree • In placement as part of their training • Each discipline has a different variation Internship • Completed all training with the exception of dissertation • Nationally competitive program • APA Accredited internship Residency • Completed training and received terminal degree, but in order to get licensed, you need additional supervision to qualify for licensure • APA Accredited Postdoc Residency program
- 9. Behavioral Health Workforce Projections • There are shortages in 6 out of the 12 behavioral health professions reported currently including adult psychiatrists, child and adolescent psychiatrists, psychologists, addiction counselors, mental health counselors, and marriage and family therapists.1 • Training programs help with recruitment by creating a pathway of highly qualified future applicants ready to work in integrated clinics. • https://data.hrsa.gov/topics/health-workforce/workforce-projections Explore Workforce Projections 9 https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/Behavioral-Health-Workforce-Projections-Factsheet.pdf
- 10. For the common good For the good of the trainee For the good of your agency What are the benefits of having a behavioral health training program? 10
- 11. For the Common Good To develop staff to address behavioral health needs of our clients, particularly those trained to an integrated model of primary care and behavioral health 11
- 12. For the Good of Your Health Centers • Influx of new energy and enthusiasm with the most recent evidence based knowledge • Increased staff satisfaction • Professional development: • Learning to supervise • Increasing skill of clinical teaching • Recognition of skill • Passing on knowledge • Improved retention • Increased access for clients • Opportunity to build a strong talent pool from which to hire 12
- 13. For the Good of the Trainee • Prepares residents to work with vulnerable populations in an FQHC setting • Builds confidence within a clinical setting to become an independent clinician with enhanced treatment abilities and leadership skills • Learn by doing and introject a picture of the role of a behavioral health provider in an integrated care setting that informs professional self image at the start of a career • Prepares the trainee for the next steps in professional development • Increases competitiveness in the job market for those who do not remain at their training site by a broad clinical exposure 13
- 14. Community Health Center, Inc. Breakdown 14
- 15. CHC Student & Resident Overview: 2022 • 390 Students and Residents completed their placements at CHC in 2022 • Student disciplines include non- clinical research, resident, and medical • Placements primarily hybrid Behavioral Health Dental Medical Nursing Nurse Practitioner Medical Assistant Resident Non-clinical Chiropractic Dietitian 15
- 16. Behavioral Health Student and Trainee Overview COVID-19 Updates Welcome & Intro Discipline Students MS Mental Health Counseling 1 PsyD 6 PMHNP Student 7 MSW Student 6 Art Therapy & Counseling 1 Psychiatry Fellow 1 PMHNP Resident 4 Post Doctoral Resident 5 BH Doctoral Interns 4 TOTAL: 35 16
- 17. The Road to Developing a Training Program • Answer the question: What are your drivers for a behavioral health training program? • Identify requirements of training: discipline/level • Assess your own resources (physical, human, financial) • Secure board, leadership, and clinical buy-in • Develop financial and strategic plan including potential partners • Costs and benefits: • Direct and indirect costs • Return on investment: immediate and longer term • Benefits beyond the financial return 17
- 18. Considerations in Selecting Training Students vs. Post Graduates 18 Students Student program builds a relationship with local programs and community partnerships. Promotes relationships for engagement in residency programs or being hired on as staff. Typically no salary. Follows academic year. Post Graduate Trainees Less intensive supervision. Resident can carry larger case load, take on a wider range of responsibilities. Hired as employees. 12 month program.
- 19. 19 Students Fewer hours. Prioritization of face-to-face time. Selective didactic programming. School requirments Post Graduate Trainees Tailoring training to specific training goals. Promoting leadership opportunities. Increased breadth of training experiences. External accreditation and licensing standards Considerations in Program Design Students vs. Post Graduates
- 20. Stories from the Field • Jodi Anderson: Licensed Professional Counselor Clinician in New London, CT, Virtual Group Therapy Coordinator, Former Student • Rosarimar Rodriguez: Current Postdoctoral Resident 20 Questions: 1. Why did you choose CHC? 2. How did your training experience at CHCI shape your career? 3. What were the top benefits of completing your training at an health center?
- 21. Key Elements to any Training Program 21
- 22. Recruitment Building community partnerships and relationships with local schools Outreach email Website presence Attending academic placement fairs Postdoc: Association Psychology Postdoctoral and Internship Centers (APPIC) Alumni network 22
- 23. Selection 23 • Who is your selection group? • What qualities are you looking for in a candidate? • How will you assess that? • Minimizing bias Interviewing Candidates • Group vs. individual interviews • Case discussion • Mock client simulation • Clinical writing sample Interview Components
- 24. Building Professional Competencies • Example: American Psychological Association (APA) Postdoctoral Competencies • CHCI developed a set of competencies specific our setting (e.g. professional competency, telehealth, primary care integration work, OUD/SUD care) • Be training setting specific 24
- 25. Elements of Training Program 25 Didactic types: •OUD/SUD Treatment, Multicultural Considerations, Trauma Informed Care, Integrated Care, Treating Chronic Health Conditions, Providing Telebehavioral Health, Conducting Group Treatment Group and individual supervision Leadership training opportunities Additional training opportunities Clinical exposure and scaffolding
- 26. Example: CHCI Postdoctoral Training Content • Direct clinical care • In integrated care settings, school based health centers, and homeless/domestic violence shelters • Minimum of 900 visits/year • Goal of three groups/week • Full age range • WHOs • Real time consults: reactive and proactive, face-to- face or remote • Brief screening with care planning • Supervision • Meets CT licensing requirements • 2 hours individual, 1 hour group • Multidisciplinary teams (peer supervision) 26
- 27. Example: CHCI Postdoctoral Training Content (cont.) • Quality Improvement Training • Program development and methods of change • Integrated quality improvement project • Participation in quality improvement initiatives, Performance Improvement committee, BHQI committee • Weekly didactic seminar • Individualized training opportunities • IRB, school-based, Project ECHO • Supervision of practicum students with supervision of supervision 27
- 28. Considerations throughout the Year 28
- 29. A Year in the Life of a Training Program Getting Ready • Minus 3 months: Leadership retreat to plan for coming year and recruitment one year out • Minus 2 months: Review training materials, ensure placements and supervisors are finalized, plan orientation • Minus 1 month: Make individualized templates for client scheduling, plan individualized schedules (time and place at each site), match outgoing trainee’s clients with incoming trainees (when applicable) 29
- 30. A Year in the Life of a Training Program Trainees Arrive! September • Joint orientation with shared training and tracks for each specialty • Individual and group training goals set • Shadow medical staff and supervisors • Start seeing clients (ramp up starting with intake, transfers and warm- handoffs) 30
- 31. A Year in the Life of a Training Program Trainee Ramp Up October – February • Building a caseload • Assignment to specialized training and other duties • Recruiting for the next cohort begins in the fall • Monthly supervisor meetings • First written evaluation in December • Halfway through! - structured feedback session or survey with trainees in February • Trainees participate in interviews for next year’s class • Tentative discussions begin about interest in staying on post residency as the budget process for the next fiscal year gets underway in February 31
- 32. A year in the Life of a Training Program The Trainees Settle In March – June • Residents each lead one didactic seminar December to February (This is now the second half of the year) • Established relationships with medical providers lead to increased confidence • Deepening relationships with cohort. Program should provide ways to encourage this • Focus on skill development and self awareness as soon to be independent psychologists • Second formal written evaluation occurs in April for Postdocs, final evaluation for students, students end placement • New classes are finalized • Interviews for CHCI positions which will be open or created in the fall occur and job offers for those staying on are made 32
- 33. A Year in the Life of a Training Program Preparing to Move On July and August • Future plans at CHCI or elsewhere are finalized • Those accepting academic appointments may need to plan to leave earlier than end of August • For some states EPPP may be taken when supervised hour requirements are met even prior to completion of postdoc • Transfer and termination of clinical cases completed • Third and final written feedback completed by supervisors and reviewed with Residents • Program ends last week in August • Graduation celebration for residents and families, supervisors, and clinical staff 33
- 34. What we have Learned 1. The importance of collecting data 2. Trainees improve processes and systems by providing feedback to staff about workflow issues 3. Supervision training is needed 4. One day per week for didactics, supervision, and cohort activity is invaluable 5. Be very clear about expectations and what you can and cannot offer 34
- 35. Questions? 35
- 36. Contact Information 36 For information on future webinars, activity sessions, and learning collaboratives: please reach out to nca@chc1.com or visit https://www.chc1.com/nca
Editor's Notes
- Bianca (12:30-12:32)
- Bianca (12:30-12:32)
- Bianca (12:30-12:32)
- Bianca (12:30-12:32)
- Bianca (12:30-12:32)
- Bianca (12:30-12:32)
- Tim Begin to understand potential future threats and opportunities, possible case based scenarios, and potential strategies for program development, either through formal agreement with an external organization or by offering their own residency training program Include nuts and bolts – looking at guidelines as first step for broader reach How to pick what kind of students to train, what’s different between training someone in grad school vs not in grad school Unlicensed staff and developing training for them – what would that look like? Include similarities vs differences Possible Tim contact Recruitment – building relationships with local schools etc, Model design – make more specific Building professional competencies What would be necessary to train discipline to discipline, shaping a profession Balance between specific steps vs broader context – acknowledge Questions to ask your team Mention previous Victoria content – full breakdown of CHC students? Include Panel/guest speaker (Jodi, Rosarimar – 100% remote residents, backups: Christa Sansone, Meaghan) E-blast, session 4 LC, most on postdoc, wait for title, hps session 1 final victoria breakdown A slide or two workforce shortage – a slide or two why do student health programs – training the next gen Workforce shortage Chc breakdown External postdoc
- Tim Not included on slide – speak to each one how it works at CHC Considerations of which discipline you are training 7 in CT, will vary state-to-state At what level are you training?
- Chelsea Why health centers would want to do these student training programs – training the next generation
- Tim
- Tim For the common good Increase the pool of qualified, effective well trained psychologists Provide quality training settings for upcoming psychologists who need supervised hours for licensure Shape the future of the field by teaching postdocs how to conceptualize the role of the psychologist by what they see and what they do in their last year of supervised experience prior to licensure
- Tim Have students increases staff satisfaction – by giving staff the opportunity to expand their own professional skills in learning how to supervise and the opportunity for clinical teaching (often across discipline). Staff consistently tell us they enjoy the experience and learn from their students by increasing variety of daily activities for staff – varied work day is consistently linked in the literature to job satisfaction by being recognized as a role model and someone who is able to teach how to be an excellent clinician. by passing on knowledge and feeling the reward of watching a resident’s skill level increase Of course not all of these apply to every supervisor, and some staff have no interest or no skill in clinical teaching and would not want to (and probably should not be asked) to supervise, but for most of our staff participating in the program in a big plus In addition to the rewards for staff, residents in and off themselves, may bring many benefits to the agency, including increased intellectual rigor to clinical team meetings and supervision. While those of us in the clinical setting for decades keep up with continuing education and some professional reading, our postdocs are fresh out of school with great ideas and current knowledge – some tremendously applicable to our settings, some maybe a little ivory towerish, all of it blowing a breath of fresh air into our agency postdocs bring additional minds and hands to put to work for program development – fresh, trained eyes may spot something we do not see or bring us ideas we can borrow from another setting where they saw something in action we can adapt to our situation, and their lowered clinical load allows them time to work to plan and implement ideas postdocs require supervision ( 3 per week for us) and didactic training (another 2 for us) as well as the real time consultations that occur during the clinical day, but on balance, they see clients for many more hours per week than we spend in teaching, supervision, and consulting and that represents a net gain in access for our clients depending on how your state allows for billing for work done under supervision (most private insurances not allow it but the CT Medicaid program does under specific conditions which our postdoc program meets) you may find that your postdoc program is a break even or even a moneymaking operation. Many agencies who cannot bill find the other benefits compelling and start a program anywayl As we will show you on the next slide, postdoctoral residencies also give the opportunity to train a group of bright young psychologists to our model and then hire the best of them who want to stay in the area. And as a segue into the next slide, even if they don’t stay we have helped to produce a good employee who can continue to contribute to the field elsewhere.
- Tim Student means all levels of training For the Good of the Resident: High quality setting that prepares the postdoc for the job market Further clinical experience, training, and the consolidation of professional identity Build confidence within a clinical setting to become an independent clinician with enhanced treatment abilities and leadership skills,. Experience in the job setting will increase postdocs success at first independent job setting and thus improve retention and morale
- Tim
- Chelsea
- Chelsea
- Tim
- Chelsea
- Tim
- Tim (12:55/1:00) Bianca let them know and meet with them before Thursday Question #1: Jodi goes first, Rosarimar second Question #2: Jodi goes first, Rosarimar second Question #3: Jodi goes first, Rosarimar second
- Chelsea
- Chelsea
- Tim
- Chelsea Slide 14 in example link can discuss how we developed our set of competencies specific to what we observed (eg professional competency, telehealth, primary care integration work, OUD/SUD care) Include AAPIC link competencies for postdoc training
- Chelsea - Reference
- Tim Lets start with an overview of our program – based on our answers to the issues raised about in our setting, we designed the following program to meet the needs of the residents and CHCI. We wanted to utilize postdocs to increase access throughout our system while supporting our program needs, to maximize their variety of clinical experience, and to train them to working in an integrated interdisiplinary setting in a PCMH (hence the emphasis on WHOs) So they are placed in all of our settings, given a goal of 75% of a FTE staff member, and have one day a week set aside for didactic seminars and group supervision Supervision is for clinical training and designed to meet CT licensing requirements for posdtdocs. You will need to be familiar with the requirements in your states – and postdocs who plan to practice in another state should check sooner rather than later re what they will need in the other state their needs can be me if at all possible. Two years ago we had a postdoc who wanted to qualify for a MA license and so we made sure he got the extra supervision time needed so that he could do that. Our postdocs each have two supervisors each one for one hour per week. One is in person face to face and the second may be via zoom videoconferencing. Group supervision is for all postdocs and the Chief BH Officer and/or the Training Director and covers topics of concern to the residents, case consultations, and agency wide issues. Post docs often are the group that tries out a new procedure and gives feedback during the seminar time and this forum allows leadership tp to hear about concerns that arise at one or more of the sites the postdocs are stationed in.
- Tim Psychologists will play a role in program planning and PI/QI efforts, so we have intentionally included both didactic and experiential training in this area through training in the model we use for our PI efforts and in the 2016-2017 year we will be adding postdoc PI projects to the program offering the opportunity to work with our BHQI committee and PI staff to develop and carry out at least one PI project in their year with us. Our didactic seminar is 2 hours weekly - we focus on issues related to integrated care, bring in expert CHC staff (both psychologists and those from other disciplines) and invite outside speakers in topics of interest. Also, each postdoc is required to lead at least one seminar per year and given feedback and coaching as this too – serving as a clinical teacher to peers – is an important part of what we do as psychologists.
- Tim
- Tim – photo from Ann Marie Hess A word about recruitment. We did not know our first year if we would have any applicants. We notified training directors of CT schools, and utilized APPIC listserv of internship and program training directors to send out announcements. We have continued to do this over the years, and word of mouth has increased as we continue to offer training. We also have an annual training lunch for all local BH schools where we invite training directors from psychology, social work, psychiatric nursing, counseling, and marriage and family programs to come and share lunch, learn about our program, and give us feedback. Graduating postdocs have also referred others to our program. As you can see from the slide, in addition to recruiting we begin the focused work on each years program in June of the preceding clinical year. About a month before the new class comes, our training director nails down the logistics of sheduling. We’d like to focus a on that for a moment. Our residents are each placed in at least two settings for clinical work – a large fixed site, and some combination of a smaller one, a school based health center, and/or a homeless or domestic violence center site. Each site has a template that is set up to show client visits types – intakes, 30 and 45 minute slots, times dedicated to warm handoff and clinical team meetings, and other resident commitments. Wednesday is a nonclinical didactic day for the weekly group supervision, the two hour didactic seminar, and some individual supervision sessions (others take place during the week at the sites) Here is a shot of what a schedule might look like: Adriana do you have one of the schedules you send out to the Officer Manager’s we can stick in here as slide 10A
- Chelsea Residents are seen as one year employees with a decreased clinical expectation and added training components. As we go through the year they function more and more independently as fitting the fact that this is their last year of training prior to sitting for state and national exams and being set free to operate as independent providers. Initial orientation is a shared Postgraduate Residency Interdisciplinary Orientation with specific tracks for each discipline in break out sessions. We off Postdoc, Medical Nurse Practitioner, and Psychiatric NP Residencies. Orientation process reflects this dual nature with Review CHCI Postdoctoral Residency Manual, Behavioral Health Policies and Procedures Week long standard CHCI orientations For several years we have had an informal brunch for supervisors, residents, and spouses/sig others. Residents like having their partners know who they are working with and meeting families at the beginning of the training year gets us off to a nice start. Setting goals. – competency evals (self) with same form used at 6 month and 12 month point and by supervisors at 4, 8, and 12 months specialty training opportunities assigned (IRB, agency wide work groups and committees/ Reflective Journal – borrowing a tool from our NP colleagues, we ask our residents to reflect on some aspect of their experience in the program every week. The journals are read by the CHBO and the Training Director and one or both give regular written feedback. This is one important qualitative tool we use to assess the program. In a upcoming seminar on Accreditation, we will talk further about quantitative assessment (such as goal settings and competency evaluations) and q
- Tim Residents build their caseloads - continuing to do intakes 2 to 3 times a week, meet with transfers, and form groups. Expectation is to have at least one group up and running by December 1. Assignments to trainings, PI projects, specialized opportunities in place by November1 Applications for the next year’s class start in early fall, with interviews in February in which residents’ participate. Supervisors need support and training too – you will need to think through how you want to do this, we have a monthly meeting of all supervisors which includes discussion of any difficulties that arise and a resident by resident review of how the program is going.
- Chelsea pod photo (from previous webinars) This second half of the training year sees a shift in emphasis from training to the interdisciplinary model and skill development to skill consolidation and increasing self awareness of the end of a long training period and the beginning of life as independently licensed psychologists. Relationships are established with other professional groups leading to more referrals to BH and increased communication within the pod. This models how professional relationships are formed and maintained, and you will need to be ready to problem solve and trouble shoot any rocky relationships, including giving what may be difficult feedback to residents about how they come across to others and ways they may need to change their presentation and approach. Parallel to the development of one year’s cohort, the selection of the next year’s class is finalized. Our post docs have participated in both Round 1 and Round 2 interviews. As the staffing needs for the coming fiscal year as clearer, conversations about staying at CHCI and/or interviews for the next step professionally occur.
- Tim Plans for next year come into focus Those with academic appointments may need to leave earlier – you will need to take this into account in planning EPPP national exam may be taken at different times in different states depending on where postdoc is seeking licensure Clinical wrap up – transfer and termination
- Chelsea (End around 1:18pm) 2. Thinking of what software platform you use, your agency may already have one which can save money. It’s not only for accreditation, it also reports that we have to generate external resources. Feedback from trainees to improve your program.
- Bianca Pre questions: -We don’t have a student trainee program right now, which should we start with? -What are two or three key things I need to have in place to start a training program?
- Bianca