SA Counselors of the Future: Recovery Coaches, Care Coordinators, or PH.Ds?

Health care reform will mean more roles for substance
abuse professionals, but they will be new
roles, not the traditional counselor roles, field experts
told ADAW this week.

“It’s clear to me that medical homes and integrated
care will mean roles for peers and peer supports but
in direct care and as care managers with managed
care organizations or whoever manages the care,”
said Michael Flaherty, Ph.D., board member of the
Annapolis Coalition on Workforce Development, and
a clinical psychologist certified in addictions. “It can’t
be more M.D.s and Ph.D.s, because they are simply
too costly.”

The overriding workforce innovation is moving the
high-cost skills of specialty care to “competently
skilled care in lower cost environments,” said Flaherty.

SAMHSA and HRSA

SAMHSA has undertaken a series of initiatives such
as Bringing Recovery Supports to Scale Technical
Assistance Center Strategy (BRSS-TACS) to build new
skills in peers, the Center for Integrated Health Solutions
(CIHS) which, though the National Council on
Community Behavioral Healthcare (National Council)
and others is helping specialty workers integrate
into the healthcare system, and the Addiction Technology
Transfer Center (ATTC) network, which is
conducting a national survey of the demographics of
the specialty substance abuse treatment workforce.
The Health Resources and Services Administration
(HRSA), on the other hand, is focused on nurses,
Ph.D.s, and M.D.s., said Flaherty. “HRSA doesn’t know
how many substance abuse counselors there are,
and I don’t think they care,” said Flaherty. “Substance
abuse counselors are at risk now.” Turf battles are
inevitable, as is worry about jobs. “There’s a great
deal of anxiety for the substance abuse professional
career ladder, and that needs to be addressed,” said
Flaherty.

HRSA directed us to SAMHSA as best suited to answer
questions about substance abuse counselor
workforce.

Integrated care

The Annapolis Coalition helped the National Council’s
CIHS “engage the substance abuse community
on workforce issues,” said Laura M. Galbreath,
deputy director of the National Council’s CIHS. A key
question for the Annapolis Coalition — and the CIHS
and SAMHSA — is to identify the core competencies
for the workforce. “Our goal is to identify these
within this calendar year,” Galbreath told ADAW. The
core competencies will be released by SAMHSA, she
said. The core competency activities under CIHS will
include a project on the development of a curriculum
for substance abuse counselors, she said, as well
as guidance on how to provide services in primary
care settings.

Substance abuse counselors who want to prepare
for 2014 should think about care coordination, said
Galbreath. “How do I show I can help coordinate care
for someone, to address prevention, wellness, and
recovery?” This new position is going to be part of
medical health homes in any setting — addiction,
mental health, primary care — she said. “I think substance
abuse counselors should be looking for ways
to expand their capacity.”

Advanced degrees

Meanwhile, IC&RC is very concerned about any suggestions
that reimbursement for addiction counseling
may be limited to professionals who hold
a Master’s degree or above. “As a sociologist, I am
always interested in the unintended consequences
of people’s bright ideas and best intentions,” said
Phyllis A. Gardner, Ph.D., IC&RC president, in an
email to ADAW. “Unfortunately, I am seeing a trend
in thinking that could have serious consequences for
the addiction counseling profession, as we move forward,”
said Gardner, who is professor of Sociology/
Psychology/Addiction Studies at Texarkana College.
“First, if only Master’s level counselors can receive
reimbursement, our current workforce will be decimated,”
she said. “What happens to the thousands
of dedicated, competent professionals who are and
have been providing quality services for decades?”
Furthermore, there is a limited number of Master’s
degree programs that address substance abuse, she
sad.

Because a Master’s requirement will mean fewer
professionals, there will be higher caseloads and
longer waiting lists, said Gardner. “In an already
underfunded service area, fewer professionals mean
less access to services,” said Gardner, adding that a
Master’s degree does not guarantee competence in
substance abuse.

“I think it is incumbent upon us not to overreact —
and we should not allow others who do not understand
our profession to do so either,” said Gardner.
“I think the field is in transition,” agreed Cynthia
Moreno Tuohy, executive director of NAADAC, the
Association for Addiction Professionals (NAADAC).
But Tuohy disagrees with IC&RC’s Gardner about
the Master’s degree requirement. “The reality is that
HRSA at this point has not come forward with any
solutions for people who don’t have a Master’s,” said
Tuohy. In the future, healthcare integration will “lean
towards the Master’s degree for clinical work and
clinical supervision,” said Tuohy. “We know that’s going
to happen. If we don’t look at the writing on the
wall, we’re not telling our counselors what’s true.”
This doesn’t answer the question for people who
don’t have a Master’s degree about what the future
holds. “We don’t want to lose anybody, particularly
those with years of experience,” said Tuohy, noting
that not everyone wants to go on to get a Master’s.
“But we do want to help professionals who want to
move forward with getting higher education so that
they can compete in this new workforce.”

ATTC survey

SAMHSA’s Linda Kaplan was scheduled for an interview
with ADAW but had to cancel at the last minute
for medical reasons. The ATTC Network’s Laurie
Krom also was unavailable for a telephone interview
but emailed this statement: “SAMHSA’s Addiction
Technology Transfer Center (ATTC) Network has a
long history of workforce development. The ATTC
Network improves addiction treatment by strengthening
the knowledge, skills and attitudes of current
and future substance abuse treatment practitioners
as well as professionals from other disciplines. The
Network creates and expands continuing education
and university coursework, develops academic programs,
increases clinical placements and sets educational
standards. For example, in FY 2011, the ATTC
Network held 1,037 educational events with 22,642
participants nationwide. Additionally, the Network
advocates for and carries out initiatives enhancing
the addiction treatment profession and making it attractive
to today’s best and brightest professionals.”

In the end, said Flaherty, it comes down to meeting
the larger demand for health care with skilled but
lower cost workers. “SAMHSA, HRSA, the National
Council and others have to lead, as do our educational
and professional associations, in bringing
whole-person thinking to those served, without the
cost of acute care for all. Wouldn’t this be a great
place to have a national jobs program?”

Report to Congress

The Senate Appropriations Committee is demanding
an accounting from the Substance Abuse and Mental
Health Administration (SAMHSA) on how it plans
to handle addiction workforce issues, and made its
demands clear in report language last September
(see ADAW, Oct. 3, 2011). The Committee said that
there is a “workforce crisis in the addictions field due
to high turnover rates, worker shortages, an aging
workforce, stigma and inadequate compensation.”
The increase in people seeking treatment due to parity
and health care reform will exacerbate this crisis,
the report said, adding that “the provision of quality
substance use disorder services is dependent on an
adequate qualified workforce.”

The report is due March 31 and must cover “current
workforce issues in the addiction field, as well as
the status and funding of its substance use disorder
services workforce initiatives.” The report should also
identify the “roles, responsibilities, funding streams
and action steps” of SAMHSA and HRSA to strengthen
addiction workforce. The report directed SAMHSA
to make sure the ATTCs “maintain a primary focus on
addiction treatment and recovery services in order
to strengthen the addiction workforce.”

“As more individuals become eligible for substance
abuse services through Medicaid and private insurance,
the ATTC network is critical to ensure there is a
skilled workforce able to meet the demand in substance
use disorder services.”

The report requirement was not repeated in the
megabus spending bill but it still stands. At the beginning
of the conference report, this is made clear:

“In implementing this conference agreement, the
Departments and agencies should be guided by the
language and instructions set forth in Senate Report
112-84 accompanying the bill, S. 1599, unless specifically
addressed in this statement. In cases where
the language and instructions in the Senate report
specifically address the allocation of funds, each
has been reviewed by the conferees and those that
are jointly concurred in have been endorsed in this
statement of managers.”

By Alison Knopf

Article was first published in Alcoholism & Drug Abuse Weekly
Volume 24, No. 3, January 16, 2012.