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National Association of County Behavioral Health and Developmental Disabilities Directors
2013 Legislative and Policy Conference
“Taking Stock and Sprinting Ahead”March 5, 2012
Marcia K. Brand, PhDDeputy Administrator
U.S. Department of Health and Human Services
Health Resources and Services Administration
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America’s Health Safety Net
Agency Mission
• Improve Access to Quality Health Care and Services
• Strengthen the Health Workforce
• Build Healthy Communities
• Improve Health Equity
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HRSA’s Commitment to Integrating Behavioral Health
and Primary Care
• Mental and substance abuse disorders and physical health problems are interwoven; delivering behavioral health services in primary care settings may reduce stigma and discrimination
• HRSA’s aim is to provide access to high-quality behavioral health services to the millions of people we serve through safety net service providers and assuring a well trained workforce
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The Affordable Care Act
• Once in a Lifetime Opportunity
• Potential to make a enormous difference in the lives and the health of vulnerable populations in the United States.
• Change Agent for Behavioral Health
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The Case for Integrated Care
National Comorbidity Survey Replication, 2001-2003 as Reported in Druss and Walker, 2011
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SAMHSA/HRSA Center for Integrated Health Solutions
• Technical Assistance and Training Center on Primary and Behavioral Health Integration;
• Integrated Care• Improving Access to Primary Care for Behavioral Health
Patients• Improving Access to Behavioral Health for Primary Care
Patients
• Provided under Cooperative Agreement with the National Council on Community Behavioral Health Care.
www.integration.SAMHSA.govwww.thenationalcouncil.org/cs/center_for_integrated_health_solutions
Partnership to Promote Integration
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Current and Planned CIHS Projects
Completed or Underway• Medication Assisted Treatment of Addictive Disorders
(MAT) - Learning networks of 12 team members comprised of State and County Officials, Health Centers, Specialty Addiction Providers and Mental Health Providers from six states
• Peer Counseling focusing on training Promotoras and Community Health Workers working in Health Centers in the concepts and practices of peer counseling
Year III (current Year) Projects• Tele-behavioral Health Learning Collaborative • Describing what is needed for an effective behavioral
health/primary care team• Web Based Training for HRSA Safety Net Providers –
Treating veterans and their families in primary care settings
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Community Health Center Program
• Located in or serve high need communities
• Governed by a community board
• Provide comprehensive primary health care
• Deliver services to all based on ability to pay
• Meet performance and accountability requirements
• Increased funding under the Affordable Care Act
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Access• Two-thirds provide on-site mental health services• One-third provide on-site substance abuse services• 53% have a formal tobacco cessation program• Screening, Brief Intervention, and Referral to Treatment (SBIRT)
is a service that primary care providers provide• Homeless health centers must provide substance abuse services
Workforce5,360 Behavioral Health Workforce
• 401 Psychiatrists• 403 Psychologists• 1,394 Social Workers• 874 Substance Abuse Providers• 1,006 Other Licensed Mental Health Staff• 1,282 Other Mental Health Staff
Behavioral Health in Health Centers
Source: Uniform Data System, 2011
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Behavioral Health Patient Visits
In 2011, 951,000 persons with behavioral health conditions made more than 5 million visits to health centers
Depression was the third most common reason for a visit (after diabetes and hypertension)
Health Center Behavioral Health Clinic Visits
Mental Health Visits 4,674,450
Substance Abuse Visits 1,056,754
Total Behavioral Health Visits 5,731,204Source: Uniform Data System, 2011
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Office of Rural Health Policy
• Supports the Telehealth Network Grant Program
• Administers Rural Healthcare Services Outreach Program
• Flex Rural Veterans Access Program
• Mental Health First Aid in Rural Settings
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Behavioral Health Conditions may be a co-morbidity
in 50% of HIV/AIDS patients. (IOM, 2005)
• Injection drug use has directly and indirectly accounted for more than one-third (36%) of AIDS cases in the US (CDC)
• “Integrating Buprenorphine Therapy Into HIV Primary Care Settings” Monograph to assist grantees and others
• Minority AIDS Initiative Retention and Re-engagement Project
HRSA - HIV/AIDS
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HRSA - Maternal and Child Health
• MCHB programs serve more than 44 million women, infants and children yearly
• HRSA Healthy Start
• Autism Intervention Research Network on Behavioral Health (AIR-B Network)
• Fetal Alcohol Spectrum Disorder Training to Health Centers
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Maternal, Infant, and Early Childhood
Home Visiting Program
• Funds enable states to provide evidence-based programs
• Home visits to pregnant women, expectant fathers, and parents and primary caregivers of children aged birth to kindergarten
• Though ACA, $1.5 billion provided over 5 years
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HRSA – Maternal and Child Health
Workforce Development
• Funds undergraduate, graduate and post-graduate health professions training and workforce development
• Psychologists and social workers are trained in an inter-professional manner, joining teams with disciplines such as medicine, nursing, public health and nutrition.
In 2010, the MCH Training Program trained:• 2,267 long-term trainees (>300 contact hours)
• 426 Psychologists (18.8%)• 133 Social Workers (5.9%)
• 1,620 medium-term trainees (150-299 contact hours)
• 128 Psychologists (7.9%)• 109 Social Workers (6.7%)
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National Health Service Corps (NHSC)
• Loan repayment and scholarship programs provide funding to primary care and behavioral health care clinicians and students in exchange for service in underserved communities experiencing critical shortages of health care providers
• Program expanded through the Affordable Care Act
• 82 percent of NHSC mental and behavioral health professionals supported through the ACA
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NHSC Behavioral Health Field Strength
Psychiatric Nurse Specialist0%
Marriage and Family Therapists
5%
Licensed Pro-fessional
Counselors34%
Health Service Psychologists
28%
Licensed Clinical Social Workers
33%
Psychiatric Nurse Specialists 0.2%
• Of the nearly 10,000 National Health Service Corps members*,
2,809 are mental and behavioral health professionals
*as of September 30, 2012
•
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Bureau of Health Professions (BHPr) Clinical Training includes Behavioral
Health• Area Health Education Centers (AHECs)
• 1,100+ sites with 3,000+ Offerings• Geriatric Education Centers (GECs)
• 300+ sites with 2,100+ Offerings• Comprehensive Geriatric Education
Programs • 200+ offerings
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Mental and Behavioral Health Education
and Training Program• Created by the Affordable Care Act• Provides support to plan, develop, operate, or
maintain schools of social work and graduate psychology education programs to train behavioral health care providers to work with underserved populations
• Twenty-four programs were awarded FY 2012 funding to assist eligible institutions of higher education. The awards are used to augment internship programs and field placements
