Professor and Chair, Department of PsychiatryCollege of Medicine – Tucson

University of ArizonaClinical Service Chief, Behavioral Medicine

Banner University Medical Center and Group - Tucson

Jordan F. Karp, MD

Academic Health Center Collaborations Across Psychiatry

and Psychology, Psychiatric Nurse Practitioners, and Community-Based Service-Learning Models

Teaching Health Center:Is it the right fit for your organization?

Flagstaff, AZ. October 9,2021

Disclosures

Salary University of Arizona

Research Support

Patient Centered Outcomes Research Institute; National Institute of Health

Advisor Aifred Health, NightWare

Other Preparation and presentation of (disease-state) educational activity for Otsuka.

Compensation for editorial board service: American Journal of Geriatric Psychiatry and Journal of Clinical Psychiatry

Agenda

• Behavioral Health Workforce in Arizona• Seizing opportunities• Preparing for the future of behavioral

healthcare in underserved regions

Behavioral Health Workforce in Arizona

Behavioral Health Workforce

5

• According to HRSA, 40% (~3 million) of Arizonans lives in a Mental Health - Health Professional Shortage Area (HPSA)

• Only 11% of need met compared to 26.9% nationally

• Arizona HPSA based on the psychiatrist workforce

• 182 practitioners needed to remove the designation 6th highest # of MH HPSAs in the US

Behavioral Health Workforce Report

6

• Analyzed a portion of the behavioral health workforce in Arizona

• This report includes psychiatrists, psychologists, behavior analysts, counselors, marriage and family therapists, social workers, substance abuse counselors

Behavior AnalystsMarriage & Family TherapistsPsychiatristsSubstance Abuse CounselorsPsychologistsCounselorsSocial Workers 4628

46151553

811779

558389

67.9367.74

22.8011.9011.43

8.195.71

Total Providers Ratio of Providers per 100,000 population

Total Providers

Psychiatrists PsychologistsBehavioral Analysts

Social Workers Counselors

Marriage & Family Therapists

Substance Abuse Counselors

Arizona 779 1553 389 4628 4615 558 811Apache 3 2 0 16 4 5 10Cochise 4 13 1 43 39 6 7Coconino 24 79 8 106 117 10 18Gila 0 5 0 8 14 2 0Graham 0 7 0 5 11 1 2Greenlee 0 0 0 1 0 0 0La Paz 0 0 0 1 4 0 4Maricopa 516 1050 331 3096 3087 403 443Mohave 10 5 0 37 53 4 38Navajo 5 4 0 37 54 9 12Pima 174 300 44 928 824 76 152Pinal 13 27 1 146 179 14 63Santa Cruz 0 3 0 6 6 0 4Yavapai 26 51 1 155 177 20 44Yuma 4 7 3 43 46 8 14

Psychiatrists PsychologistsBehavioral Analysts

Social Workers Counselors

Marriage & Family Therapists

Substance Abuse Counselors

Arizona 11.43 22.80 5.71 67.93 67.74 8.19 11.90Apache 4.07 2.72 0.00 21.73 5.43 6.79 13.58Cochise 3.11 10.12 0.78 33.47 30.36 4.67 5.45Coconino 17.70 58.25 5.90 78.16 86.27 7.37 13.27Gila 0.00 10.36 0.00 16.58 29.02 4.15 0.00Graham 0.00 17.80 0.00 12.71 27.97 2.54 5.08Greenlee 0.00 0.00 0.00 10.67 0.00 0.00 0.00La Paz 0.00 0.00 0.00 4.88 19.53 0.00 19.53Maricopa 12.37 25.18 7.94 74.24 74.03 9.66 10.62Mohave 4.91 2.45 0.00 18.15 26.00 1.96 18.64Navajo 4.51 3.61 0.00 33.41 48.76 8.13 10.84Pima 10.69 18.42 2.70 56.99 50.60 4.67 9.33Pinal 3.26 6.78 0.25 36.65 44.94 3.51 15.82Santa Cruz 0.00 6.42 0.00 12.83 12.83 0.00 8.55Yavapai 11.60 22.76 0.45 69.16 78.97 8.92 19.63Yuma 1.96 3.42 1.47 21.04 22.51 3.91 6.85

Providers per 100,000University of Michigan Behavioral Health Workforce Research Center

2018 Report

9

Seizing Opportunities

But first, it’s useful to understand how clinical departments in academic medical centers are organized.

This provides some context for opportunities for training.

Each department is unique, but the tripartite mission is generally the same.

I started work October 1, 2020.

July of 2020, the departmental administrator sent me an email

entitled, “Bad news…”

Challenge of Paying for Psychology Internships

• Cost:• Annual salary for each psychology intern: ~$28,000 + benefits• Ideal to have protected administrative time for program director (~$23,000)• Ideal to have administrative support (~$10,000)

• Insurance-funded• Self-funded

• Departmental funds• Hospital funds

• Grant-funded

• Part of Department of Health and Human Services.

• Primary federal agency responsible for improving access to health care and enhancing health systems for the tens of millions of people who are geographically isolated a/o economically or medically vulnerable.

• Mission: To improve health outcomes and achieve health equity through access to quality services, a skilled health workforce, and innovative, high-value programs.

BHWETBehavioral Health Workforce Education and Training

• Aims to increase the supply of behavioral health professionals while also improving distribution of a quality behavioral health workforce and thereby increasing access to behavioral health services.

• A special focus is placed on the knowledge and understanding of children, adolescents, and transitional—aged youth at risk for behavioral health disorders.

• In November 2020, there was a call for proposals due January 31, 2021.

•I’ll write one!

Not so Fast

• HRSA only funds 1 BHWET per organization.

• College of Nursing Psychiatric Nurse Practitioner program had a BHWET that would be sundowning, but they were prepared to submit a competing continuation.

• BHWET program looks favorably at cross-disciplinary training and creative approaches to solving the behavioral health care workforce shortage.

• Opportunity to partner with the College of Nursing if we were to pursue HRSA funding to re-launch the psychology internship.

Preparing for the future of behavioral healthcare in

underserved regions

Goals of our BHWET

1. Improve access to care in rural, border, and medically underserved communities in Arizona through new and enhanced community partnerships that integrate primary and behavioral healthcare services to educate psych NP students and psychology interns during their clinical training.

2. Improve behavioral health treatment through online didactic and clinical training activities for psych NP students and psychology interns related to telehealth and interprofessional, team-based, and trauma-informed care.

3. Increase the number and diversity of practicing psych NPs and psychologists who will practice in rural, border, child, adolescent, and transitional age youth, and medically underserved communities.

Program Organization

Training Mental Health Care Teams of the Future

”Our own experiences working as psychologists, psychiatric nurse practitioners, and

psychiatrists, and as part of integrated clinical (and educational) teams have taught us that

the best mental health care is that which is informed by unique but shared and respected

perspectives. Given the complexity of human nature, mental illness, and social systems,

blending care teams and assuring that the next generation of behavioral health providers

know how to effectively function within such a team is necessary to respond to the mental

health crisis accentuated by the COVID-19 pandemic.”

Training Mental Health Care Teams of the Future• Focusing on training in integrated care delivery models

• Shift from reactive acute care to comprehensive/coordinated care.• Recommended for treating patients with comorbid medical and physical conditions.

• Train psych-NPs and psychology interns as dyads participating in shared didactics.• 5 psych-NPs and 5 psychology interns every year for 4 years.

• The trainee dyads will meet in small group discussions with faculty mentors to discuss their clinical experiences and skills acquired during the clinical rotation at each site.

• Whenever possible, trainee dyads will see patients together and develop interdisciplinary treatment plans.

12-Month Tracks and Areas of Concentration (AoC)

12-month longitudinal tracks• Align with the purpose of the BHWET and

the trainee’s professional interests. • Each trainee will be integrated into the

partner site’s care team to learn best practices in multidisciplinary care.

• Child and adolescent mental health• Rural/underserved areas• Substance use• Late-life mental health

• Training in telehealth is prioritized

AOC• 4 month training opportunities to assure

diverse training.

Community Partners

• Marana Healthcare• BUMC-S Behavioral Health Clinic

• Adult• Child and Adolescent

• EPICenter (Early Psychosis Center)• Juvenile Detention Center

• Tuba City Regional Healthcare• BUMC-S Inpatient Psychiatry• Banner Alzheimer’s Institute• BUMC-T Pediatric Medicine• Pascua Yaqui Centered Spirit

Program

• Adding new agencies as we launchBUMC-T: Banner University Medical Center – Tucson

BUMC-S: Banner University Medical Center – South

Next Multi-Disciplinary Professional Training Project

• Adding psychiatric pharmacist for our two ambulatory psychiatry clinics.

• Once this position is filled, partnering with the School of Pharmacy, will launch a PGY2 Psychiatric Pharmacy Residency Program.

PGY2 = Post Graduate Year 2

Summary

• The public health need and opportunities to build behavioral health training programs across Arizona is vast.

• Finding education partners leverages expertise and resources and reflects the need for multidisciplinary solutions to complex behavioral health problems.

• Clinical departments in academic health systems have the education infrastructure needed for successful coordination and implementation and are eager to partner with community agencies and allied health specialties to grow the workforce.