Growing Their Own: One Solution from Alaska

Mimi McFaul, Psy.D.

Behavioral health trends, issues, and influences are magnified in RURAL communities!Changing DemographicsAging PopulationHigh TurnoverLow wages and benefitsStigma around mental healthIncrease in Medicaid as funding source

Unique Workforce Issues in Rural Communities

Geography Rural culture Fish BowlTransportationChallenges to Recruit and Retain Rural Placements Limited access to supervision & mentorship opportunities, & peer support

Potential StrategiesCreate New Rural Educational Delivery Methods and ModelsGrow Your OwnPartnering, Natural Community Supports, Technology

Rural Workforce Innovations: An Example from Alaska

BackgroundAbout 20 percent of Alaskas 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.

Alaska Native Cultural and Language Maps

Grow Your Own ExampleThe 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.

The Concept

Village-based behavioral health generalist was born out of a recognition that traditionally (university/college)educated and trained behavioral health clinical service providershave 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.

The Concept

Need for a broader behavioral health and public healthapproach. 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 andtraditional Alaska Native approaches to living, health, healing, and wellness.

What has been done in the pastVarious 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", andrural 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.

Not a complete answerHampered 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.

Village-based Behavioral Health Aide Generalist From the community of service (or neighboring); Trainedusing 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/orprovidevillage-based prevention, early intervention, and case management; and Able to be a team member of the village-based service provider team.

Grow Your Own ExampleBased on success of the Community Health Aide Practitioner/Program (CHAP). Use these programsas models and links to train and deploy behavioral health care providers.

Source: http://www.anthc.org/

Training and EducationSpecific to BHA competency needs Responsive tothe employing Alaska Tribal Health System organizations Available through several different potential sources distance deliveryemployer developed in-service, specialized contact training hours, university-based coursework and non-university-based training

Perspective of ConsumerWhole 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.

Behavioral Health Aide ProjectMissionDevelop 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/

Behavioral Health Aide ProjectA counselor in every villageVillage-based services goalsFocus 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

Responsibilities of BHAsBHAs 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 pneumoniaAssist families dealing with disruptions related to abuse, neglect and violenceHelp communities cope with injury or death related to accidental and intentional injurySource: http://www.anthc.org/

BHA Training Opportunities

Learn how to develop a helping relationship with people who are seeking treatmentHow to understand, evaluate and provide treatment for someone facing and addiction, substance abuse or mental health issues.Provide group, family and individual counselingBecome knowledgeable aboutlocal 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/

BHA Levels of PracticeTraineeBHA-IBHA-IIBHA-III (Behavioral Health Associate)BHA-IV (Behavioral Health Practitioner)Clinical Supervisor

BHA CompetenciesFoundations (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.

BHA CompetenciesPractice competencies for each levelKnowledge and skill attainment

Benefits to the BHABegin 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.

Status of BHA DevelopmentCertification 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.

FinancingThe traditional system of care was developed to respond only when there is a diagnosable disorder. Currently negotiating rates that will pay for at least partif notall services (prevention - treatment). Need a system of behavioral health care that can sustain itself.

Why is this example important?Developing BHAs would likely fit anywhere rural or withspecial populations.

Bridge public health, behavioral health, andcommunity development to revamp the process to develop meaningful service capacity for a given rural community.

www.wiche.edu/mentalhealthDennis MohattScott AdamsMimi McFaulDeb KupferJenny ShawChuck McGeeCandice TatePlus a cast of other wonderful folks we drag into the work with us.

The terms Inuit and Native American are sometimes used in place of Eskimo and Indian in an effort to be politically correct, but in Alaska, Eskimo and Indian are not considered derogatory terms.The Consortium was created in 1997 to provide statewide Native health services. Still in development and/or being refined.