Growing Their Own: One Solution from Alaska Mimi McFaul, Psy.D.

2. Growing Their Own: One Solution from Alaska Mimi McFaul, Psy.D.

3. Behavioral health trends, issues, and influences are magnified in RURAL communities! • Changing Demographics • Aging Population • High Turnover • Low wages and benefits • Stigma around mental health • Increase in Medicaid as funding source

4. Unique Workforce Issues in Rural Communities • Geography • Rural culture “Fish Bowl” • Transportation • Challenges to Recruit and Retain Rural Placements • Limited access to supervision & mentorship opportunities, & peer support

5. Potential Strategies • Create New Rural Educational Delivery Methods and Models • Grow Your Own • Partnering, Natural Community Supports, Technology

6. Rural Workforce Innovations: An Example from Alaska

7. Background • About 20 percent of Alaska’s 650,000 residents are Native or are of Native descent • 3 groups of Alaska Natives – Indian, Eskimo and Aleut. • Within the three categories, Native culture is further divided into five cultures based on similarities in tradition, language and proximity.

8. Alaska Native Cultural and Language Maps

9. Grow Your Own Example The Alaska Native Tribal Health Consortium (ANTHC) is a non-profit health organization owned and managed by Alaska Native tribal governments and their regional health organizations.

10. The Concept • Village-based behavioral health generalist was born out of a recognition that traditionally (university/college) educated and trained behavioral health clinical service providers have not been able to adequately promote, facilitate, and/or provide appropriate village-based behavioral health prevention, early intervention, and case management with Alaska Native people.

11. The Concept • Need for a broader behavioral health and public health approach.  • Need behavioral health providers who • can be trusted, • know the living conditions of the community, • is culturally connected, and • able to facilitate bridging between western and traditional Alaska Native approaches to living, health, healing, and wellness.

12. What has been done in the past… • Various project and programmatic efforts have been initiated over the past 20 years such as: village suicide prevention counselor, village alcohol counselor, village wellness counselor, mental health technician, "Indian Child Welfare Worker", and rural human services certificate training, etc.  • Each effort has made a contribution to trying to resolve or at least reduce raising behavioral health related morbidity and mortality rates.  

13. Not a complete answer • Hampered by a combination of:  • limited funding availability, • inconsistent provider skills, • inconsistent or lacking training/educational opportunities, • trainers/educators not prepared to train/teach to employer "market" needs, • too academic, discipline insulated, and non-pragmatic. 

14. Village-based Behavioral Health Aide Generalist • From the community of service (or neighboring); • Trained using specific provider competency expectations based on Alaska Tribal Health System need; • Able to work across major disciplines (psychology, social work, or substance abuse/addiction); • Able to promote, facilitate, and/or provide village-based prevention, early intervention, and case management; and • Able to be a team member of the village-based service provider team.

15. Grow Your Own Example • Based on success of the Community Health Aide Practitioner/Program (CHAP). • Use these programs as models and links to train and deploy behavioral health care providers.  Source: http://www.anthc.org/

16. Training and Education • Specific to BHA competency needs • Responsive to the employing Alaska Tribal Health System organizations • Available through several different potential sources • distance delivery • employer developed in-service, • specialized contact training hours, • university-based coursework and non-university-based training

17. Perspective of “Consumer” • Whole Alaska Native community through the Alaska Tribal Health System.  • Very different from the typical trainer/educator view that the consumer is the student/trainee or an individual.

18. Behavioral Health Aide Project Mission • Develop village-based behavioral health service capacity to help ensure the viability and survival of rural and remote Alaska Native villages. Source: http://www.anthc.org/

19. Behavioral Health Aide Project • “A counselor in every village” • Village-based services goals • Focus on prevention, early intervention and case management (Treatment, Aftercare and Follow-up) • Increase "Team Capacity" of providers already in village • Reduce outpatient, emergency, and inpatient medical workload and cost • Reduce long-term chronic health problems and family and community disruption

20. Responsibilities of BHAs • BHA’s help Alaska Natives to address their behavioral health needs such as substance abuse, grief, depression, and suicide. • BHA's may also: • Help individuals face serious health problems related to lifestyle choices such as cancer, heart disease, influenza, and pneumonia • Assist families dealing with disruptions related to abuse, neglect and violence • Help communities cope with injury or death related to accidental and intentional injury Source: http://www.anthc.org/

21. BHATraining Opportunities • Learn how to develop a helping relationship with people who are seeking treatment • How to understand, evaluate and provide treatment for someone facing and addiction, substance abuse or mental health issues. • Provide group, family and individual counseling • Become knowledgeable about local and statewide resources that are available, and connect those facing behavioral health issues with the assistance they need to achieve success. Source: http://www.anthc.org/

22. BHA Levels of Practice • Trainee • BHA-I • BHA-II • BHA-III (Behavioral Health Associate) • BHA-IV (Behavioral Health Practitioner) • Clinical Supervisor

23. BHA Competencies • Foundations (behavioral health, tx knowledge, application to practice and professional readiness) • Practice Dimensions (clinical evaluations, treatment planning, service coordination, counseling, client communication, documentation, professional and ethical responsibilities.

24. BHA Competencies • Practice competencies for each level • Knowledge and skill attainment

25. Benefits to the BHA • Begin a career path to addiction treatment, mental health, psychology, social work or other related health services. • Work in the village where they live. • Support a community they have intimate knowledge of.

26. Status of BHA Development • Certification for 4 levels of practice under federal (IHS) authority. • Grandfathering for individuals already providing village-based behavioral health services. • About 150 village-based individuals employed and providing some level of behavioral health service.  (minimum goal is 470). • Standards for providing clinical support and supervision through direct contact, and tele-health technology.

27. Financing • The traditional system of care was developed to respond only when there is a diagnosable disorder.  • Currently negotiating rates that will pay for at least part if not all services (prevention - treatment).  • Need a system of behavioral health care that can sustain itself.

29. Why is this example important? • Developing BHAs would likely fit anywhere rural or with special populations.  • Bridge public health, behavioral health, and community development to revamp the process to develop meaningful service capacity for a given rural community.

30. www.wiche.edu/mentalhealth • Dennis Mohatt • Scott Adams • Mimi McFaul • Deb Kupfer • Jenny Shaw • Chuck McGee • Candice Tate • Plus a cast of other wonderful folks we drag into the work with us….