Issue Brief

May 2018
Milbank Memorial Fund

 

Behavioral Health Integration and Workforce
Development

By Rachel Block

Introduction

States are paying increased attention to the behavioral health needs of their resi-
dents as part of larger strategies to improve health outcomes and make the health
care system operate more effectively and efficiently. Behavioral health integration,

or BHI, requires that the health and mental health systems are organized through
integrated care models that address the full spectrum of health needs. Integrated
care delivery and financing requires a workforce specifically prepared to practice in
these new models. However, states have found that there is not sufficient supply,
distribution, and training for this workforce, and there are legal and policy barriers to
facilitate practice in these settings.

The Milbank Memorial Fund and the Reforming States Group (RSG) have a track re-
cord of work in this area, including convenings and presentations for state leaders on
behavioral health integration. The Fund has published several reports documenting
the evidence base for BHI and its effectiveness, including within specific populations
such as pediatrics and individuals with serious mental illness. In 2017, the Fund
conducted a technical assistance meeting for state health policymakers in which
representatives from eight states met with national experts to discuss BHI program
design as well as federal policy issues, quality measurement, and value-based pay-
ment models.

Supported by the Milbank Memorial Fund since 1992, the RSG is a bipartisan group
of state executive and legislative leaders who meet annually to share information,

Milbank Memorial Fund ¢ www.milbank.org
develop professional networks, and commission joint projects. In 2017, the RSG
identified BHI workforce as a topic on which it wanted more information, and the
Fund convened a workgroup comprised of RSG members to guide the project.

The group heard presentations from two leading state-focused organizations

about work supported by federal and state grants related to behavioral health and
workforce. These presentations focused on three areas that will be described in this
report: state data collection, policy barriers to integrated practice models, and
coordination of resources for training and recruitment. This issue brief grew out of
these presentations as well as interviews with many experts from federal and state
agencies and from various national organizations devoted to improving behavioral
health services and outcomes.

Key themes emerged from the Fund's research and the RSG workgroup's discus-
sion-namely, that to address BHI workforce needs systematically, states need to
have dedicated and coordinated resources focused on:

e Assessing BHI workforce needs (i.e., how many practitioners and what types of
practitioners are needed to support BHI programs);

e Identifying legal and policy barriers to practice that state policymakers can
address to make BHI programs work more effectively; and

e Aligning workforce development resources based on state priorities and
effectiveness of programs to train and retain these practitioners, particularly
in underserved areas.

In this issue brief, case studies are used to illustrate these themes. The brief is
intended to assist state policymakers such as legislators and executive branch staff
who are responsible for BHI policy in their states. It may also be helpful to academic
research organizations that could apply these findings and resources in the context
of their research, operations, or evaluation activities for states.

Background on State BHI Strategies: What Populations Need BHI
Services and What Are the Models?

States are implementing BHI models to meet growing population needs:

Milbank Memorial Fund ¢ www.milbank.org

More health care costs and utilization are driven by high-cost, high-need patients.

Many of these patients have health and mental health comorbidities that cannot be well
addressed through "siloed" treatment models.

People with these comorbidities not only cost more to care for, they are more likely to
die from common, treatable chronic diseases,! so there can be significant benefits if
their health and mental health needs are managed simultaneously.
e The increase in substance use disorders, often co-occurring with other health and men-
tal health issues, presents new challenges.

Research and program initiatives have shown that to address these challenges, the health
and mental health systems need to be organized, staffed, and reimbursed differently
through integrated care models that address the full spectrum of health needs, including
behavioral health. BHI encompasses integrated care delivery and financing, staffed by a
workforce equipped to practice in these new models.

While there are a variety of BHI models, they can be grouped into two broad categories,
each with their own workforce impacts:

Primary Care and BHI.These models focus on changes in primary care practice roles and
support in which primary care and behavioral health services are co-located or coordinated
to address populations with mild to moderate behavioral health conditions. The predomi-
nant models for BHI in primary care are the patient-centered medical home (PCMH),? that
include recently developed PCMH enhanced standards for BHI care management,? and the
collaborative care model, that coordinates primary and specialty care for behavioral health
conditions.* These models require significant workforce-related changes including, but not
limited to, use of team-based care and/or dedicated care managers, telehealth consults
with specialists, and expanded prescribing authority for nurse practitioners and physician
assistants.

Specialty Care and BHI. These models focus on stronger coordination between specialty
behavioral health care, the medical care system, and community services that support
people with more complex health and social needs. Examples of specialty BH! models may
include health homes and new accountable care models, such as Oregon's coordinated
care organizations that focus on the full continuum of population needs.® In addition to the
issues raised in patient-centered BHI models, the specialty BHI models may utilize new
workforce categories such as peer support® and recovery counselors,' and require policies,
mechanisms, and special training to appropriately share patient information across a broad-
er array of personnel and care/service settings.

In addition to changes at the delivery system level, BHI initiatives may involve new admin-
istrative, policy, and operational approaches for states. Arizona has focused on integrating
state-level functions to improve their approach to BHI.® Washington State Governor Jay
Inslee has created a new health sub-cabinet to coordinate policies, and consolidated health
agency management responsibilities, with the goal of accelerating BHI.°

More states are contracting for new managed care and accountable care models that
include BHI; there is an opportunity to embed workforce considerations in these require-
ments. This may include, but not be limited to, numbers of behavioral health personne!
relative to enrolled populations; policies and procedures to reduce barriers to practice; and
performance measures that reflect workforce issues (e.g., patient experience and staffing).

Milbank Memorial Fund ¢ www.milbank.org 3
State Policy Levers for BHI Workforce Development:
Three Case Studies

Once priority populations and models have been identified, BHI workforce development
becomes an important component of state program design and implementation for those
populations and models. The supply, distribution, and training of behavioral health profes-
sionals and personnel are important to BHI success.

Addressing these needs requires coordinated state strategies. Through the Fund's research,
we identified three organizations and models that exemplify this coordination:

e The University of Washington Center for Health Workforce Studies is conducting a compre-
hensive assessment of BHI workforce policy issues informed by state data and stake-
holder input.

e The Behavioral Health Education Center of Nebraska at the University of Nebraska Medi-
cal Center has a legislative mandate to collect and analyze data on behavioral health
workforce needs and to administer and measure outcomes for training and recruiting
programs.

e The Behavioral Health Workforce Research Center at the University of Michigan is con-
ducting BHI workforce policy research activities in a joint initiative with the Health
Resources & Services Administration (HRSA) and the Substance Abuse and Mental
Health Services Administration. Its research focuses on improved data collection and
identifying policy barriers.

The following case studies describe these models and provide links to specific resources on
these activities:

Case Study: Washington State Behavioral Health Workforce Assessment

Washington's governor and legislature commissioned the Behavioral Health Workforce As-
sessment to evaluate the state's behavioral health workforce needs and develop a recom-
mended action plan to address those needs. The state's Workforce Training and Education
Coordinating Board and the University of Washington Center for Health Workforce Studies
collaborated on this work.

The comprehensive workforce assessment is one of several initiatives designed to improve
Washington's behavioral health system. According to Governor Inslee's press release, "Be-
havioral health encompasses mental health as well as behaviors such as drug and alcohol
use. Integrating primary care and behavioral health services will ensure that treatment is
better coordinated, and conditions are caught earlier and treated, or even prevented.... It
is not clear from current data how many Washington health care professionals offer behav-
ioral health services and if they are adequate in number to meet demand. This evaluation
will establish a baseline for behavioral health workforce shortages and provide a plan for
improving how we coordinate the right services for patients." !2

Milbank Memorial Fund ¢ www.milbank.org 4
The state's workforce assessment has been conducted in two phases: phase | provides a
preliminary analysis of priority issues, while phase I| updates the earlier report and in-
cludes more in-depth workforce data as well as additional recommendations on the initial
set of priorities.

Data Collection

The phase | report published in 2016 summarized feedback obtained through an extensive
consultation process with state officials and stakeholders to identify barriers and potential
short-term solutions related to the behavioral health workforce.13

The Washington Health Workforce Sentinel Network conducted a parallel study that fo-
cused on changes in behavioral health workforce demand." It featured an employer survey
to determine specific categories of the behavioral health workforce for which employers
reported shortages or increased demand for personnel, as well as the need for particular
skills and training.

The phase II report provides more information on current workforce characteristics, includ-
ing detailed occupational profiles.!5 Some key findings:

e The landscape of behavioral health practice is very complex, making it difficult to
monitor supply and distribution. There are 24 occupational categories that can provide
some form of services, and there are significant differences in education and training
requirements among these categories.

e There is increased urgency to address behavioral health workforce needs because the
current workforce is getting older (mean age is above 50 years old).

e Less than 5% of behavioral health practitioners work in rural areas, creating access
problems.

Policy Barriers

The stakeholder input gathered during phase | identified policy challenges in four key
areas:

e Recruitment and retention.

e = Skills and training.

e Credentialing and licensing.

e Paperwork and documentation.

The phase II report builds on this framework and provides recommendations for state
action:

e Address behavioral health provider reimbursement rates to improve workforce recruit-
ment and retention. The legislature approved increased managed care rates in 2017,
but these increases were offset by additional cuts to community mental health ser-
vices. The report suggests adding more community-based services to the Medicaid
state plan and continuing support for value-based payment models.

Milbank Memorial Fund ¢ www.milbank.org
e Promote team-based and integrated care models through health plans and managed
care organizations, as well as with continued technical assistance. The report suggests
streamlining and standardizing credentialing processes for health plans and managed
care organizations and modifying current policies and processes to credential behavior-
al health practitioners in the context of new care and payment models.

e Increase access to clinical training and supervised practice for new behavioral health
practitioners. The report suggests building capacity within practice settings and pro-
viding financial incentives for providers to offer clinical training and for staff to take on
training supervision roles.

e Build more capacity for treatment. The report suggests expanding behavioral health
prescribing capacity through training and practice support, including increased use of
telehealth.

e Improve supply, distribution, and diversity of the behavioral health workforce. The re-
port suggests a need for better matches of training and employment, increased finan-
cial support, increased use of a community-based workforce, and development of new
career pathways.

Coordination of State Agencies and Resources

Coordination and targeting resources to support BHI models including workforce models
are an important component of Washington's Behavioral Health Workforce Assessment
process. This includes defining organizational relationships and pooling resources focused
on behavioral health workforce support.

Coordination of State Agencies: Washington's Behavioral Health Workforce Assessment
project was conducted in collaboration with the state's Workforce Training and Education
Coordinating Board. The Health Workforce Council is part of the board and focuses on data
collection and programs to address emerging health workforce needs. These activities are
described in more detail in the council's 2016 annual report.!® The council includes a be-
havioral health stakeholder group giving input into the Behavioral Health Workforce Assess-
ment project. As a result, the board and the council provide a focal point for the state to
determine health workforce needs and identify solutions. The governor also created a health
sub-cabinet specifically focused on strengthening BHI. The sub-cabinet is charged with
developing a strategic plan to accelerate BHI. State oversight of the county-based mental
health agencies and services will be consolidated and focus on advancing BHI efforts. The
state will also facilitate coordination between these county agencies and managed care
organizations-including alignment of contracts, administration, and financing-to develop
fully integrated care models including behavioral health."

Coordination of Resources: The phase | report provides detailed information about the
state's approach to coordinating training and technical assistance resources. Healthier

Milbank Memorial Fund ¢ www.milbank.org 6
Washington is the organizing framework for the state's health care transformation and pop-
ulation health improvement strategies (including behavioral health integration).!® Healthier
Washington is promoting the development of new organizations, payment models, and data
analytics capacity to drive health improvement. These activities are also aligned with the
state's Medicaid Transformation Demonstration that includes a major emphasis on expan-
sion of BHI.

More specifically, the Healthier Washington Practice Transformation Support Hub provides
technical assistance to clinical practices to promote and expand patient-centered BHI
models; to support adoption of value-based payment; and to improve population health by
strengthening connections between clinical and community settings.19 Practice coaching,
facilitation, and training services that support clinical and administrative staff are among
the hub's core functions.

In addition to practice transformation support, Healthier Washington focuses on workforce
needs through two other programs:

e The Health Workforce Sentinel Network reports on real-time training and workforce
needs by collecting information from providers, as well as education and training
programs. The availability of a trained behavioral health workforce is often cited as a
critical need.

¢ The Community Health Worker Task Force provided recommendations to key state
agencies regarding definitions of roles, skills, and training for community health work-
ers to work in integrated health systems.

The hub is one of two centralized resources for BHI practice support. The University of
Washington AIMS Center also focuses on advancing BHI, specifically through adoption of
the evidence-based collaborative care patient-centered BHI model."° The center contributes
resources to the hub in support of practice- and site-level implementation, training, and
workforce development; clinical consultations; and research partnerships. It also serves as
a national resource center to further develop evidence and experience with the collaborative
care model.

Case Study: Behavioral Health Education Center of Nebraska

The Behavioral Health Education Center of Nebraska (BHECN) was established by legisla-
tion in 2009 to provide data on and develop programs to meet the state's behavioral health
workforce needs. One of the BHECN's core functions is to facilitate the collection, analysis,
and dissemination of behavioral health workforce data. This includes monitoring workforce
trends and establishing priorities for workforce development by gathering valid data to
inform workforce practices.

The BHECN has published several reports tracking the state's behavioral health workforce
supply, as well as statistics on its training and recruitment activities. A summary of these
data can be found in two reports-one provided to the legislature?! and another summa-
rizing workforce statistics.22 The BHECN also developed the Nebraska Behavioral Health

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Workforce Dashboard that maps behavioral health personnel availability by county,2°
allowing visualization of high-priority shortage categories and geographic areas. These data
resources help the BHECN to systematically develop programs and target resources to train,
recruit, and retain behavioral health personnel based on the state's needs.

Training, recruiting, and retention coordination is a major focus for the BHECN. In addition
to its role collecting and presenting BHI workforce data for policymakers and behavioral
health professionals, the BHECN coordinates statewide actions and investments in pro-
grams to train, recruit, and retain the behavioral health workforce based on its statewide
needs assessment. Key strategies include:

© Behavioral health regional education and training sites to support local participation in
interprofessional workforce development.

e Behavioral telehealth and integrated care training?* and other innovative means of care
delivery to the entire behavioral health workforce. For example, the BHECN partners
with the Munroe-Meyer Institute, a state developmental disabilities clinical and educa-
tional center, to sponsor and support 42 integrated behavioral health clinics in primary
care statewide, 24 of which are rural. The model has been replicated in several states.

© -Interprofessional behavioral health training, curriculum development, and outcomes re-
search through collaborative partnerships to create, link, and disseminate education
and training materials for the development of the behavioral health workforce, with
emphasis on the recovery-focused needs of consumers.

e Funding for psychiatry residents and other behavioral health trainees prepared for interpro-
fessional and telehealth service delivery to rural and underserved areas.

A detailed description of these activities is included in the BHECN's recent report to the
legislature.2° The BHECN also provides learning collaborative resources focused on building
interdisciplinary training and practice.76

Case Study: University of Michigan Behavioral Health Workforce Research Center

The University of Michigan Behavioral Health Workforce Research Center (BHWRC) is one
of six state-based academic organizations funded by HRSA to address a variety of health
care workforce policy issues through collaboration with national and state organizations.

It is working under a federal contract to focus on several key areas related to building
behavioral health workforce capacity: how are behavioral health personnel defined and
counted; where and how do behavioral health personnel practice; and how do state scope-
of-practice laws affect behavioral health workforce capacity. The products from this work
will help states design their BHI workforce strategies.

Behavioral Health Workforce Data

One of the BHWRC's key tasks is to develop a behavioral health workforce minimum data
set. To assess the availability, type, and distribution of the behavioral health workforce at
the state level, it is important to define what data elements are needed and how the data

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will be collected. There is significant variation in what national or state data sources can
measure and report on.?° Many federal and state agencies are involved, including those
with jurisdiction over labor and employment, education and training, professional licensing,
regulation, and payment (e.g., Medicaid).

In addition to documenting the wide variety of existing definitions, metrics, and data
sources, the BHWRC is working with a cross-section of stakeholder groups to build con-
sensus for a minimum data set that will standardize data collection processes and improve
data quality for the behavioral health workforce. Data collection domains would include:
demographics; licensure and certification; education and training; occupations and areas
of practice; and practice characteristics and settings. Once completed, these data speci-
fications can be incorporated more consistently into federal and state data collection and
reporting requirements and yield more reliable and comparable results. State policy action
(e.g., legislation and regulations) will be needed to adopt the recommended standards and
ensure that data is submitted in a complete and timely manner.

Policy Barriers to Practice in Integrated Care Models

Integrated care models require practitioners to work in new ways, triggering several policy
issues. How will practitioners and services be reimbursed in new models such as tele-
health? Do scope-of-practice laws limit new roles and responsibilities within an integrated
care team? Because behavioral health information is subject to specific federal (and, in
some cases, state) protections, how will the exchange of information be facilitated across a
system of care involving multiple practitioners and organizations? State policymakers need
to address these potential policy barriers to advance new BHI models.

A conceptual model illustrates the interrelationship of policy issues affecting practice in
integrated care models. (See Figure 1.)

Figure 1.

Addressing Integrated Care Barriers through Policy

 
 

What Providers Are What Providers Reean '
Authorized to Do Can Bill For Su

    
 

ST Reimbursement State Workforce
Practice Policies ON lm

   

Services

~~
we,
oa
a
wn
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see
oa
wee
on,
see
oa

Reciprocity Pte ered

RA

Requirements Telehealth eC

Source: Behavioral Health Workforce Research Center, University of Michigan School of Public Health

Milbank Memorial Fund ¢ www.milbank.org
The BHWRC is focused on two broad areas related to policy barriers for BHI:

Practice Characteristics and Settings. Any assessment of a behavioral health workforce
needs to match workforce characteristics with the types and settings for behavioral health
practice. The BHWRC has conducted studies on the diversity of population needs, work-
force diversity, behavioral health practice competencies, and new models or settings of
care, such as team-based care or corrections facilities.!!

For example, a report on team-based care features results from a survey of eight organi-
zations that are implementing patient-centered BHI models. Some of the barriers (and
policies) identified through the survey include:

e Restrictions on sharing personal health information across treating providers and set-
tings (privacy) and across different electronic health record systems (interoperability);

e Restrictions on reimbursement for team-based care encounters (billing policies and
codes); and

e Sustained funding for operational practice changes (payment reform).

The study also identified several barriers to organizational culture, such as agreement on
new roles for care team members. Integrated care models require new ways to communi-
cate and organize workflow within and across practice disciplines and settings. Policy and
operations need to be aligned to achieve more robust integration.

Additional BHWRC studies are exploring the use of telehealth to strengthen behavioral
health workforce capacity, how state telehealth policies differ, and the evolving role of
social workers practicing in health care settings.

Scope of Practice. A scope of practice (SOP) defines what services or activities a licensed
professional can perform, including the authority to diagnose, treat, and prescribe. The
SOP definition also outlines who is precluded from engaging in that practice.

The BHWRC conducted a survey of state SOPs for nine common behavioral health pro-
fessions and found significant variation as to whether and how SOPs were defined. There
were gaps among states in three areas that are important components of integrated care:
SOP definitions for paraprofessionals (such as peer support); authority to participate in
telehealth; and authority to administer medication-assisted treatment for substance use
disorders.

Milbank Memorial Fund ¢ www.milbank.org 10
Conclusion

These case studies suggest a series of steps that state policymakers can take to address
BHI workforce needs:

1.

Develop a BHI strategy including priority target populations and a model to meet those
population-based needs for behavioral health services, with a focus on integrated care.

Within that strategy, specify how workforce needs will be identified and reported to the
state.

Designate an executive branch focal point to set goals and priorities for the state's BHI
needs, including workforce development.

Create mechanisms to collaborate with external partners including state health re-
search entities and organizations dedicated to improving behavioral health services and
outcomes.

Identify specific priorities for workforce development based on assessment of need and
resources available, and target resources to those needs, either through existing chan-
nels or new competitive awards.

Identify lessons learned within this field and related fields. Examples include defining
scope of practice and core curriculum for community health workers and recruiting and
retaining various health workers in underserved areas.

Decide on some goals and measures and regularly report on progress-what gets mea-
sured is improved.

Workforce planning and capacity development is a long-term effort. As we learn more about
the significant effects of behavioral health on physical needs and health care and how to
address them in an integrated matter, government will have to provide leadership and sup-
port to encourage the development of a workforce able to respond to these discoveries. The
likelihood of success will be far greater if state policymakers focus on these three broad
areas of work and specific topics within:

1.
2.

Identifying priority populations and models for BHI work;

Organizing core state policy levers for BHI workforce development, including assessing
BHI workforce assessment needs, identifying policy barriers to practice in integrated
care models, and aligning resources for BHI workforce development; and

More strategically utilizing available federal resources.

Milbank Memorial Fund ¢ www.milbank.org 11
Resources

Federal Resources

In addition to the state-based models described in this issue brief, there are significant
federal resources available to support state BHI and workforce development initiatives. This
section provides a brief overview of the key federal agencies and programs:

Health Resources & Services Administration (HRSA)

Bureau of Primary Health Care
e Supports health centers adopting PCMH and integrated care models, including expand-
ed access to treatment for substance use disorders.

Bureau of Health Workforce

e Analyzes health workforce availability and needs through the National Center for Health
Workforce Analysis, which conducts analyses and projections on a wide range of health
care occupations; develops and distributes results through reports, briefs, and fact
sheets; collects and distributes data through mechanisms such as surveys and the Area
Health Resources Files; provides technical advice to states on health workforce data
collection, analysis, and interpretation; and supports Health Workforce Research Cen-
ters at various universities through cooperative agreements.

e Makes grants for behavioral health workforce training.

Federal Office of Rural Health Policy
e Publicizes opportunities for rural health stakeholders to review and comment on federal
policy and regulations (e.g., opioid prescribing guidelines).

e Makes grants for rural health system development (e.g., telehealth).
e Funds rural health research centers that have published reports on BHI-related topics.

e Designates state offices of rural health that serve as focal points for rural health issues
within each state, linking communities with state, federal, and nonprofit resources,
and helping to find long-term solutions. Depending on the needs in each state, the
state offices may focus on increasing provider awareness of new health care initiatives,
collecting and disseminating and/or data and resources, offering technical assistance
for funding and quality improvement, and/or supporting workforce recruitment and
retention efforts.

Substance Abuse and Mental Health Services Administration
Develops and oversees the nation's strategy for mental health and substance abuse preven-
tion and treatment, including support for integrated systems and workforce development.

Funds the Primary and Behavioral Health Care Integration grants program. Among the
resources developed through this program is sample job descriptions for key staff partici-
pating in BHI.

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Provides policy and funding support for the behavioral health workforce.

Co-manages the Center for Integrated Health Solutions with HRSA. It serves as a focal
point for resources on BHI, including clinical policy and workforce issues.

National Organizations
The Annapolis Coalition on the Behavioral Health Workforce
National Association of State Mental Health Program Directors

National Council for Behavioral Health

State Examples

Alaska

Alaska Mental Health Trust Authority: Alaska Health Care Workforce Profile
Alaska Health Workforce Coalition: Webinar on behavioral health workforce
Colorado

Eugene S. Farley, Jr. Health Policy Center: Core Competencies for Behavioral Health Pro-
viders Working in Primary Care

Hawaii
Behavioral Health, Workforce, and a Better Health Care System for Hawaii

Minnesota
Behavioral Health Collaborative

New Mexico
New Mexico Behavioral Health Collaborative: Strengthening New Mexico's Behavioral
Health Service Delivery System

New York
DSRIP/SIM Workforce Workgroup: Guidelines for Core Curriculum to Train Care Coordina-
tion Workers

Oregon
Behavioral Health Collaborative: Workforce Workgroup

Vermont
Blueprint for Health Hub and Spoke Vermont's Opioid Use Disorder Treatment System

Milbank Memorial Fund ¢ www.milbank.org 13
Acknowledgments

The author would like to thank the RSG Behavioral Health Integration workgroup. Their

affiliation while in the workgroup is listed.

Michelle Alletto
Deputy Secretary
Louisiana Department of Health

Michael Barbieri

Director, Division of Substance Abuse
and Mental Health

Delaware Department of Health and
Social Services

Linda Berglin

Vice Chair, RSG Steering Committee
Public Policy Program Manager
Hennepin County Government

Allen Brenzel

Medical Director

Kentucky Department for Behavioral Health,
Developmental, and Intellectual

Disabilities

Mary Beth Carozza

Member, Appropriations Committee
Maryland House of Delegates

Eileen L. Cody
Chair, Health Care and Wellness Committee
Washington House of Representatives

Sheri Dawson

Director, Behavioral Health
Nebraska Department of Health and
Human Services

Shannon Fagan

Director, Bureau of Children's Behavioral
Health

Pennsylvania Office of Mental Health and
Substance Abuse Services

David E. Heaton (Project Co-Chair)
Co-Chair, Health and Human

Services Appropriations Subcommittee
lowa House of Representatives

Jane Kitchel (Project Co-Chair)
Chair, Appropriations Committee
Vermont Senate

Tony Lourey

Ranking Minority Member, Health and
Human Services Finance and Policy
Committee

Minnesota Senate

Alan Solano
Majority Whip
South Dakota Senate

The author would also like to thank those at the university-based research programs in
Michigan, Nebraska, and Washington State who contributed so generously to this issue brief.

Angela Beck

Director, Behavioral Health Workforce
Research Center

University of Michigan School of
Public Health

Bianca Frogner

Director

Susan Skillman

Deputy Director, Center for Health
Workforce Studies

University of Washington

Milbank Memorial Fund ¢ www.milbank.org

Howard Liu

Director, Behavioral Health Education
Center of Nebraska

University of Nebraska Medical Center

14
Notes

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gov/pubmed/24890068. June 13, 2014. Accessed March 12, 2018.

2. Patient-Centered Medical Home (PCMH) recognition. NCQA website. http://www.ncqa.org/
programs/recognition/practices/patient-centered-medical-home-pcmh. Accessed March
12, 2018.

3. Distinction in Behavioral Health Integration. NCQA website. http:/Avww.ncqa.org/pro-
grams/recognition/practices/patient-centered-medical-home-pcmh/distinctions/behavior-
al-health-integration?utm_source=pressrelease&utm_medium=pressrelease&utm_cam-
paign=behavioralannouncement. Accessed March 12, 2018.

4. Collaborative Care. AIMS Center website. University of Washington, Psychiatry & Be-
havioral Sciences Division of Population Health. https://aims.uw.edu/collaborative-care.
Accessed March 12, 2018.

5. Coordinated Care: the Oregon Difference. Oregon Health Authority. Oregon.gov website.
http:/Avww.oregon.gov/oha/HPA/Pages/CCOs-Oregon.aspx. Accessed March 12, 2018.

5 Peer Delivered Services. Oregon Health Authority. Oregon.gov website. http://Awww.oregon.
gov/oha/HSD/AMH-PD/Pages/index.aspx. Accessed March 12, 2018.

7. Recovery and Recovery Support. Substance Abuse and Mental Health Services Adminis-
tration website. https://www.samhsa.gov/recovery. Accessed March 12, 2018.

8. Bachrach D, Boozang PM, Davis HE. How Arizona Medicaid accelerated the integration
of physical and behavioral health services. The Commonwealth Fund Issue Brief. http://
www.commonwealthfund.org/~/media/files/publications/issue-brief/20 1 7/may/bachrach_
arizona_medicaid_integrated_behavioral_hlt_ib.pdf. May 2017. Accessed March 12,
2018.

° Inslee J. Directive of the governor 17-11. http:/Avww.governor.wa.gov/sites/default/files/
directive/17-11HealthSubCabinet.pdf. November 2017. Accessed March 29, 2018.

10. Singer PM, Beck AJ, Buche J. Health workforce policy brief: an assessment of behavioral
health workforce data sources. Behavioral Health Workforce Research Center, Univer-
sity of Michigan, website. http://www. behavioralhealthworkforce.org/wp-content/up-
loads/2016/09/UM_FA1P2_MDS-Data-Sources-Policy-Brief.pdf. August 2016. Accessed
March 12, 2018.

11. University of Michigan School of Public Health. Behavioral Health Workforce Research
Center website. http:/Avww. behavioralhealthworkforce.org/projects/. Accessed March 12,
2018.

Milbank Memorial Fund ¢ www.milbank.org 15
12. Inslee takes action to address challenges in behavioral health care workforce. Wash-
ington Governor Jay Inslee website. https:/Avww.governor.wa.gov/news-media/ins-
lee-takes-action-address-challenges-behavioral-health-care-workforce. June 6, 2016,
Accessed March 12, 2018.

13. Gattman E, Reule R, Balassa A, Skillman SM, McCarty RL, Schwartz M. Washington's
behavioral health workforce assessment: Project phase |. http://depts.washington.edu/
fammed/chws/wp-content/uploads/sites/5/20 1 6/1 1/FINAL-BH-Workforce-Assessment-
Phase-|-Report-2016.pdf. November 2016. Accessed March 28, 2018.

14. Washington State Health Workforce Sentinel Network. Workforce Board website. http://
www.wtb.wa.gov/healthsentinel/. Accessed March 12, 2018.

15. Gattman NE, McCarty RL, Balassa A, Skillman SM. Washington state behavioral work-
force assessment. http:/Avww.wtb.wa.gov/Documents/WABehavioralHealthWorkforceAs-
sessment-2016-17.pdf. December 2017. Accessed March 29, 2018.

16. Health workforce council 2016 annual report. Workforce Training and Education Coor-
dinating Board. http://Awtb.wa.gov/Documents/HWCReport-FINAL.pdf. December 2016.
Accessed March 12, 2018.

17. See footnote 9.

18 What Are the Three Core Strategies of Healthier Washington? Washington State Health
Care Authority website. https:/Avww.hca.wa.gov/about-hca/healthier-washington/what-
were-working. Accessed March 12, 2018.

19. Practice Transformation Support Hub. Washington State Health Care Authority website.
https:/Awww.hca.wa.gov/about-hca/healthier-washington/practice-transformation-sup-
port-hub. Accessed March 12, 2018.

20. AIMS Center website. University of Washington, Psychiatry & Behavioral Sciences Divi-
sion of Population Health. https://aims.uw.edu/. Accessed March 12, 2018.

21. Gonzalez H, Jones-Hazledine C, O'Dell M, Dawson S. Behavioral Health Education Cen-
ter of Nebraska: Legislative report FY 2016 & 2017. https:/Awww.unmc.edu/bhecn/_doc-
uments/FY 16-17-legislative-report.pdf. Accessed April 11, 2018.

22. Nebraska Behavioral Health Workforce reports - 2017. Behavioral Health Education
Center of Nebraska website. https://unmc.edu/bhecn/workforce/workforce-reports.html.
Accessed March 12, 2018.

3. Nebraska Behavioral Health Workforce Dashboard. College of Public Health & Behav-
ioral Health Education Center of Nebraska. http://app1.unmc.edu/publichealth/bhecn/.
Accessed March 12, 2018.

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24. MMI Integrated Behavioral Health Clinics. Behavioral Health Education Center of
Nebraska. https://unmc.edu/bhecn/about/stories/mmi-integrated-bh-clinics. Accessed
March 12, 2018.

25. See footnote 21.

26. Learning Collaborative Resources. Behavioral Health Education Center of Nebraska.
https:/Awww.unmc.edu/bhecn/collaboratives/learning-collaborative-resources.html.
Accessed March 12, 2018.

Milbank Memorial Fund ¢ www.milbank.org

17
Suggested Citation:

Block, R. Behavioral health integration and workforce development. Milbank Memorial
Fund. May 2018. hitps://Awww.milbank.org/publications/behavioral-health-integration-work-
force-development

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