Degree programs that are preparing both young and advancing addiction professionals are increasingly paying attention to the emergence of novel work settings for these specialists. Some institutions of higher learning are establishing programs that specifically seek to prepare substance use clinicians to work in more integrated healthcare environments, as addiction services become less isolated from the rest of the healthcare market.
One of the crucial adjustments in thinking, of course, must occur with regard to the pace under which behavioral health professionals will be required to work in these primary care settings.
“You’re not going to be able to close the door for 45 minutes to spend time with each patient,” says Ronald R. O’Donnell, PhD, director of behavioral health for the doctorate-level Nicholas A. Cummings Behavioral Health Program at Arizona State University. “You can’t go into a detailed psychosocial history.”
For the past several years, Arizona State has offered a doctor of behavioral health program in which master’s-level clinicians are prepared to excel as integrated behavioral health experts in medical settings. The program’s establishment was made possible by a $3 million legacy gift from Nicholas and Dorothy Cummings; Nicholas Cummings’ long career in the behavioral health field included running Kaiser Permanente’s mental health operations in the 1950s.
“We focus on improved identification and of course treatment of alcohol and substance use disorders in primary care and related settings, where they are often missed,” O’Donnell says.
Speaking the language
Another key area of focus in Arizona State’s program involves assisting the counselors and social workers who are attracted to the curriculum in how to communicate most effectively with physicians and nurses in general medical environments.
Behavioral health professionals can immediately earn medical professionals’ respect if they can demonstrate at least a basic knowledge of chronic medical conditions, O’Donnell says. “They should at least know the difference between Type 1 and Type 2 diabetes,” he says by way of example.
Also, addiction-focused professionals should be able to engage in substantive conversations with those who occupy the executive suites in these organizations, O’Donnell says. “We train people to do financial outcome analyses,” he says. “If they can talk the talk, that’s very impressive in these settings.”
Other topics covered in the management-related area in Arizona State’s program include healthcare policy, research design, and performance improvement initiatives, O’Donnell points out.
The Arizona State program trains students in the techniques of Screening, Brief Intervention and Referral to Treatment (SBIRT), the prevalent approach for seeking to uncover substance-related problems that might be compromising primary care patients’ overall health and well-being. In addition, O’Donnell says, “We recognize addictions as a key reason that individuals with chronic medical conditions do not respond well to treatment, and we prepare our graduates to offer therapeutic lifestyle change to address obesity, lack of physical activity, poor diet and nutrition, and cigarette smoking.”
Nicholas Cummings, who also formerly served as president of the American Psychological Association (APA), embraced a therapeutic model that combines psychodynamic theory, a solution-focused orientation, and family systems work, O’Donnell says.
He adds that university officials originally had hoped that the degree program that bears Cummings’ name would attract about 30 enrollees by its third year, but instead it quickly moved toward enrollment of 50 students per year.
Many of these students are showing an inclination to shift gears in their profession and work in more comprehensive care environments, O’Donnell says. Because they are not novices in the healthcare world, these clinicians can readily experience much of their clinical training in an online format, including through weekly webinars in which 6 to 8 students receive guidance that seeks to mirror the experience of in-person clinical supervision.
Preparing for critical role
At the Adler School of Professional Psychology in Chicago, the coordinator of the school’s substance abuse program sees behavioral health professionals situated in an enviable position to assist federally qualified health centers (FQHCs) in meeting statutory requirements for incorporating behavioral health services.
The school’s coursework and practicum placements for clinicians, including advanced work that can lead to a specialization in substance abuse, highlight the new realities that professionals will encounter in primary care.
“In an FQHC, an encounter is about 20 minutes,” says Joseph Troiani, PhD, an assistant professor at the school and also the head of behavioral health services for Will County, Ill.’s health department. “You’re not going to be sitting there working on relationship development. It may be more of a scenario of a warm handoff.”
An understanding of healthcare systems also becomes a critical part of clinicians’ training, as the curriculum continues to shift somewhat based on developments such as the ongoing implementation of the Affordable Care Act (ACA). “We educate students on system transformation, and how systems have evolved historically,” says Troiani.
He says that in the county in which he oversees behavioral health services, individuals with substance use-related training are becoming more coveted for certain “mental health” positions. For example, a director of emergency screenings for mental healthcare needs to have certified addiction counselor qualifications, he says.