Changing the Actions, Strategies & Behaviors of Clinicians, Consumers, Families & Organizations: The critical role of education and training
March 15 – 18, 2000
Eldorado Hotel & Spa Santa Fe, NM
Leighton Y. Huey, M.D. , Program Chair
Pamela S. Hyde, JD, Co-Chair
There was clear, if not overwhelming consensus, that across all disciplines and for adults, children, and families, training and education, for both pre-professional programs and the established behavioral health workforce, are failing the field, and therefore the people we serve. While acknowledging the problem and its scope are important steps, the Summit employed a number of techniques to try to get at the core of the problem, its issues, and possible solutions.
The first day’s panel, moderated by Mary Jane England (Lenore Behar, Jeanette Harrison, Steve Hayes, John Rush, Christina Corp) was a general articulation of the problems posed by an inadequately trained and educated workforce. They provided specific examples of approaches being taken at certain sites around the country, e.g., North Carolina. Varied approaches to training would have to be employed to reach the 75% of the behavioral health workforce representing line staff and the 25% component of the workforce comprised of post-baccalaureate clinicians. Further acknowledged was the problem that pre-professional training programs of all disciplines do not address health care reform and the need to develop new training models to more realistically address contemporary health care issues.
Five dialogue groups served as vehicles to address specific and fundamental core issues associated with the central theme of Training and Education:
Content and Values: Co-Chaired by Chris Ringwalt and Leighton Huey
This group identified the problems of institutional and professional resistance to including training in the existing structure and an inability to provide incentives to staff for meaningful retraining. The group focused on the problems inherent in the present state of managed care, the relative lack of attention to outcomes, and what should be taught. The group refined and augmented a list of proficiencies and competencies for both the existing workforce and for trainees in pre-professional training programs and they also discussed strategies for their implementation.
Delivery and Integration: Co-Chaired by Ting Mintz and Beverly Abbott
High quality education and training was the focus of this group as it clearly articulated the problem “Universities are ineffective and largely unchangeable for the delivery of high quality education and training needed in today’s behavioral healthcare world.” They proposed an alternative model to create a non-profit “Corporate Virtual University” that would market and deliver custom-designed, consumer-focused, evidence-based, outcomes-oriented, feedback-driven products desired and needed by a variety of customers, including behavioral healthcare delivery systems, managed care companies, consumers and families, public systems, and possibly universities themselves.
Process and Change: Co-Chaired by Jeanette Harrison and Sonya Schoenwald
This group considered what processes are necessary for creating effective training and education approaches. It reviewed areas such as relevance, proficiency, multiple vs. single processes, and what these processes should facilitate and represent. There was considerable focus on what would be necessary to establish more relevant practice and how to establish training that would support such practice using economic influences as leverage.
Socio-Political Issues: Co-Chaired by Wilma Townsend and Areta Crowell
The Socio-Political Dialogue Group identified common goals with a focus on improving the lives of recipients and families, consistent with the value domains outlined in the 1997-1999 ACHMA Summits. Active consumer and family participation in service provision and identification of providers who accept the ACMHA values and evidence-based standards of best practices were also considered to be critical aspects of the reform process. The mismatch between current training/accreditation and what needs to be done was discussed. Strategic steps to eliminate this mismatch include: 1) identifying and convening influential stakeholders, accreditation bodies, training/education systems; 2) determining structure and processes to ascertain points of leverage and potential reform; 3) identifying the framework for pre-service education and training; 4) identifying the various discipline-based academic training bodies; and 5) identifying licensing, certification, credentialing, and continuing education organizations.
Quality and Costs: Co-Chaired by Christy Beaudin and Sandy Forquer
Within the context of Training and Education, this group centered its discussion around three fundamental questions: 1) What should be the new benchmarks for what constitutes quality in the new healthcare models? 2) What is the research agenda to measure how effective the new models are at achieving the values articulated in the new systems? 3) What does a beginning evaluation of financing these changes and the costs of the new models look like? Quality dimensions were discussed from the perspective of organizational, provider, and consumer domains. Value-driven dimensions included a model of recovery, the restoration of hope, consumer and provider partnerships and application of evidence-based interventions. Models for promoting quality and cost efficiencies were considered as well.
The highlight of Summit 2000 was the debate forum orchestrated by Pam Hyde. The formal debate topic was:
Whether participants in pre-professional and post-graduate academic training programs should be reviewed by a national accrediting commission and determined to be proficient in managed care, the application of health care reform principles to actual practice, and qualified to both work in the public sector and to be added to managed care panels at the time of graduation from a similarly accredited, reform-oriented training program.
The two debate teams (Pro with David Shern, Marylou Sudders, Julian Ford; Con with Wilma Townsend, Michael Hoge, Christy Beaudin), in a spirit of good fun and jest, actually managed to offer in depth and penetrating analyses of the debate question.
Three Caucus Groups, representing Prevention (Chair-Chris Ringwalt), Consumers (Chair-Ting Mintz), and Children and Families (Chair-Marsali Hansen) met as well during the course of the Summit to consider and express to the conference participants their important perspectives as related to training and education.
At the Summit 2000 wrap-up, there was agreement that this initiative of training and education reform should go forward as a national agenda across all disciplines. Molly Finnerty, Jeanette Harrison, and Leighton Huey agreed on behalf of ACMHA to author a Call to Action article, Building a National Behavioral Health Training and Education Strategic Agenda: A Workforce Crisis for 2000 and Beyond, which will appear in the June, 2000 edition of Behavioral Healthcare Tomorrow. In addition, based upon the Summit, a number of individuals will be working on a Training and Education White Paper, which will be submitted to professional journals. Finally, there was interest in generating momentum for a Surgeon General’s Report on how the crisis in Training and Education of the behavioral healthcare workforce, its pre-professional training and its post-graduate education, have a direct bearing on care and outcomes in the area of behavioral health.
Summit 2000 serves as a lead-in to Summit 2001, with Pam Hyde as Program Chair and Leighton Huey as Co-Chair, which will consider the financing of workforce improvement through training and education initiatives.