Behavioral health workforce development

 

Workforce development includes enriching the work environment through education, staff recognition, and skills training in best practices and supervision, and is recognized as a critical component of the Office of Behavioral Health (OBH). OBH workforce development principles are:

  • Identify core competencies and skills
  • Maintain a skilled workforce
  • Increase occupational preparedness
  • Reinforce best practices
  • Support employee retention
  • Support a culture of learning through ongoing training
  • Promote effective communication

  • Promote effective use of current technology
  • Create new employee and intern orientation process
  • Increase awareness of OBH staff supports and resources connections
  • Align strategic goals with management systems
  • Emphasize customer service

Behavioral Health Integration Modules

The objective of the Behavioral Health Integration (BHI) Modules is to provide comprehensive and practical information about behavioral health integration that can be applied to healthcare practices. The modules are designed to be interesting, engaging, and to enhance the learners' ability to understand and maximize BHI into healthcare practice. The content of each module was provided by highly regarded national, regional and local experts. All content is free and available to use for practice instruction and provider support.

Caring for People with Intellectual and Developmental Disabilities in the Primary Care Setting

What are the unique elements of caring for people who have Intellectual and Developmental Disabilities (IDD)in primary care settings? How can we best adapt our team approach and deliver care that best meets their needs?

The goal in this training module is to ensure our integrating physical and behavioral health care provider-teams have current and relevant information necessary to best serve patients with intellectual and developmental disabilities (IDD).

Of particular importance is the providers' ability and commitment to assess potential dual diagnoses involving a behavioral health related disorder. The National Association for the Dually Diagnosed (NADD) estimates that as many as 30-35% of people with IDD also have a psychiatric disorder (NADD, 2019). Caring for people with IDD requires curiosity on the behalf of the provider, individualized and thorough engagement with each patient, and creative ways of getting information from the patient. For example modifying screening for depression to accommodate unique communication methods will both, assist in ensuring the highest quality of whole-patient care and also ensure your ability to most accurately report clinical quality measures.

Caregivers may need to be included to ensure the accurate and timely assessment of health needs. Prior to including individuals, other than the patient, in conversation it is imperative that providers confirm HIPAA compliance is intact. It is critical that providers listen to ensure each person's communication abilities are maximized.

Learning Objectives

  • Identify the importance of understanding the unique needs of each person with IDD.
  • Describe the roles of team members involved in supporting people with IDD.
  • Recognize the aspects of communicating with and accurately assessing people with IDD.

Who should complete this module?

The information in this module is valuable for all integrated team members including clinicians, nurses, behavioral health, medical assistants, front and back office staff, and care managers.

Introduction

One of the top priorities for integrated teams in the primary care setting is to include all integrated team members in assessing, determining treatment, and delivering care specifically tailored to meet the needs of people with IDD. People with IDD are living a life that demands careful and tailored care. Each person, as we will all experience, has unique wants and needs that must be balanced through consideration of their communication methods and desired lifestyle (e.g., physical and mental wellness, ability to communicate pain, ability to provide information, etc.). All people deserve respect, thorough and thoughtful care planning, and rely on the care team to ensure integrated health teaming.

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Resources

Articles

  • Lamptey, D. L. (2019). Health beliefs and behaviours of families towards the health needs of children with intellectual and developmental disabilities (IDD) in Accra, Ghana.Journal of Intellectual Disability Research, 63(1), 12-20. doi:10.1111/jir.12545
  • Salomon, C., Britt, H., Pollack, A., & Trollor, J. (2018). Primary care for people with an intellectual disability ‚Äì what is prescribed? An analysis of medication recommendations from the BEACH dataset.BJGP Open Journal, 2(2), bjgpopen18X101541. doi:10.3399/bjgpopen18X101541
  • Selick, A., Durbin, J., Casson, I., Lee, J., & Lunsky, Y. (2018). Barriers and facilitators to improving health care for adults with intellectual and developmental disabilities: what do staff tell us? Health Promotion and Chronic Disease Prevention in Canada, 38(10), 349-357. doi:10.24095/hpcdp.38.10.01
  • Smith, G., Ouellette-Kuntz, H., & Green, M. (2018). Comprehensive preventive care assessments for adults with intellectual and developmental disabilities: Part 1: How do we know if it is happening? Canadian Family Physician, 64(Suppl 2), S57-S62.
  • Sullivan, W. F., & Heng, J. (2018). Supporting adults with intellectual and developmental disabilities to participate in health care decision making.Canadian Family Physician, 64 (Suppl 2), S32-S36.
  • van Duijvenbode, N., VanDerNagel, J. E., Didden, R., Engels, R. C., Buitelaar, J. K., Kiewik, M., & de Jong, C. A. (2015). Substance use disorders in individuals with mild to borderline intellectual disability: current status and future directions. Research in Developmental Disabilities, 38, 319-328.
Delivering Whole Person Care for Our Veterans

What are the unique elements of caring for people who are veterans in integrated primary care? How can we best understand, asses and plan care in ways that best meet their needs?

Our goal in this training module is to ensure our integrating primary care physical and behavioral health care providers have the most current and relevant information to care for our veterans. Providers will be best positioned to care for veterans when they know who has served our country. In many cases people are not asked, when scheduling with a primary care practice, to indicate if they are a veteran. As a result, providers do not know to assess and care for people in ways that account for the unique health concerns often associated with having served for our country.

Frequently people who are veterans experience disturbances in sleep, mood, and attention. Their health care needs are often highly complex - which can be complicated by a sense of discomfort due to their experiences during their time of service. Factors that add to the complexity can include layered trauma, from repetitive combat deployments, compounded by compromised cognition from traumatic brain injuries, sleep disturbances and pain from injury. It is critical that providers listen with the head and heart - to understand their veteran patients as whole people.

Learning Objectives

After completing this module, the learner should be able to:

  • Recognize the impact your interactions as a provider may have when you are working with your Veteran patients.
  • Recognize ways to adapt your relationships and care delivery to every Veteran who seeks your care.
  • Describe the specific ways you and your team can create a practice environment that puts your veteran patients at ease when seeking care.
  • Know where you can seek information regarding the needs and challenges of Veterans seeking care in the non-VA primary care practice setting.

Who should complete this module?

The information in this module is valuable for all integrated team members including physicians, clinicians, nurses, behavioral health providers, medical assistants, front and back office staff, and care managers.

Introduction

Working to deliver whole-person care for people who have served our country must be tailored to meet each individual's needs. Though there are many similarities in action, each person returns from service with their own experiences, needs, challenges, and concerns. One of the top priorities for integrated teams delivering patient care for veterans outside the VA is to ensure each person is cared for individually. The demands on providers time and energy may be greater, but the needs of veterans are real and warrant the provider's investment.

The risk of misunderstanding symptoms and behaviors is high if the provider does not know and consider the patient as a veteran. As an example, a symptom such as difficulty sleeping or staying asleep requires different consideration when the patient is a veteran. The cause and impact of sleep deprivation for a veteran is often heightened and may result in more severe residual difficulties.

First and foremost, practice leadership must actively ensure providers are notified that a person is a veteran when added to a provider's patient roster. This information is critical to ensuring a practice setting that communicates safety, confidence, and calm. Veterans report that they are most able to relate to providers in such settings and, then they will be most able to accept and comply with care.

Our veterans have served our country and deserve the highest level of care to heal and return to our communities as healthy members. Our duty is to provide the highest level of care - to do this each provider must understand how they can contribute.

After viewing this video, please review the resources section. All links and resources are available for your use as you work to ensure the people in your care who are veterans can receive the highest level of integrated whole person care.

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Resources
  • Rallypoint: A social network for veterans similar to LinkedIn
  • StayQuit App: A support service for veterans who want assistance to stop alcohol and drug use including smoking.
  • Colorado Crisis Services:1-844-493-8255Speak to a trained counselor 24/7 and 365 days a year.
  • Employment opportunities:www.HireHeroesUSA.organdwww.hireveterans.com
  • Connecting Veterans with information, resources, and solutions to issues affecting their health, well-being, and everyday lives: https://maketheconnection.net/
  • Education benefits (GI Bill): www.va.gov/education/about-gi-bill-benefits
  • Resource guide to over 45 vetted organizations who help veterans thru mental health crisis or concerns: www.qualifiedlisteners.org
  • Veterans living in rural areas www.togetherwithveterans.org
  • PTSD Coach App by the U.S. Department of Veterans Affairs
  • Mindfulness Coach App by the U.S. Department of Veterans Affairs
  • VetChange App: Offers tools for cutting down or quitting drinking, managing stress symptoms, and provides education about alcohol use and how it relates to PTSD symptoms, as well as guidance to find professional treatment.
Clinics and practices that provide care specifically tailored to meet the needs of veterans
  • Healing Warriors Program-Provide Acupuncture, CranioSacral and Healing Touch Therapy to Service Members and their family for pain, PTSD and sleep.
  • Community Care- Find eligibility criteria and general information on this program providing veterans with greater choice over their health care.

Resources for Practice Leadership and Providers

  • Patient Care Resources- U.S. Department of Veterans Affairs' articles and information specifically available for practices working to better serve veterans. This site also includes useful non-VA websites.
Delivering Whole Person Care for People Who are Deaf or Hard of Hearing

What are the unique elements of caring for people who are deaf or hard of hearing in integrated primary care? How can we best understand, assess and plan care in ways that best meet their needs?

Our goal in this training module is to ensure primary care providers have the most current and relevant information to integrate and deliver care for people who are deaf or hard of hearing. Providers are best positioned to care for people when they know who is deaf or hard of hearing - this often includes seniors and people who are deaf/blind. In many practices, people are not asked to indicate if they are deaf or hard of hearing.

It is the practice's responsibility to provider an ASL interpreter and so it is in their best interest to know who needs this service prior to scheduling. When providers do not know a patient is deaf or hard of hearing they can inaccurately assess and care for people. Frequently people who are deaf or hard of hearing find themselves having to meet the providers' needs, instead of their own, which may lead to inaccurate needs assessment and care planning. People who are deaf or hard of hearing report that their care as patients is often complicated by miscommunication or lack of provider attention. This disconnect can be complicated by a sense of discomfort due to past experiences when attempting to receive quality whole person care. It is critical that providers communicate with both head and heart - to ensure they accurately and completely assess and work to meet the needs of people who are deaf or hard of hearing.

Learning Objectives

After completing this module, the learner should be able to:

  • Recognize limitations in your practice setting that may complicate your interactions when you are caring for people who are deaf or hard of hearing.
  • Recognize ways to adapt your relationship skills and care delivery for every person who seeks your care including those who are deaf or hard of hearing.
  • Describe the specific ways your team and you can create a practice environment that meets the needs of people who are deaf or hard of hearing.
  • Know where you can access information regarding of the delivery of integrated care for people who are deaf or hard of hearing.

Who should complete this module?

The information in this module is valuable for all integrated team members including physicians, clinicians, nurses, behavioral health providers, medical assistants, front & back office, and care managers.

Introduction

Working to deliver whole-person care for people who are deaf or hard of hearing must be tailored to meet each individual's needs. Though there are many similarities, each person experiences being deaf or hard of hearing differently. One of the top priorities for integrated teams delivering primary care for people who are deaf or hard of hearing, is to ensure accurate, timely and complete communication.

It is the practice's responsibility to engage an ASL interpreter who is best prepared to translate in a health care setting. This typically precludes family members, children, or a patient's friend who know are signers. HIPAA compliance alone is best ensured by engaging a professional interpreter. The demands on providers' time and energy may be greater, but the needs of people who are deaf or hard of hearing, the need for strong communication to deliver quality patient care, are real and warrant the provider's investment of time and attention.

The risk of misunderstanding symptoms is high if the provider does not know and consider the cruciality of communication. First and foremost, providers must be informed that their patient is deaf or hard of hearing when they begin providing care.

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Resources

Articles and Resources

Early Childhood Development in Primary Care

What role does the primary care team play in identifying and treating behavioral health issues for children and families?

The focus of this module is on the primary care team as it addresses behavioral health issues with young children and their families. Through the 4 domains of Screening Processes, Prevention and Health Promotion, Consultation or Intervention, and Care Coordination and Systems Navigation, primary care providers have an amazing opportunity to support parents by validating their concerns, and caring for children when development is happening more rapidly. The team benefit of having an integrated practice is discussed where team members can support each other in a full and comprehensive way.

Learning Objectives

  • Understand the role of primary care providers as a port of entry for both medical and behavioral health issues for young children and their families.
  • Identify four different domains of activities for early childhood behavioral health integration.
  • Recognize the effectiveness of an integrated practice team to support parents as new skills and capacities are developed for the child.
  • Recognize the importance of the integrated practice team as a means to support each other in a full and comprehensive way.

Who should complete this module?

The information in this module is valuable for all integrated team members, including clinicians, nurses, behavioral health staff, medical assistants, front & back office staff, and care managers.

Introduction

Primary Care physicians play a critical role as a port of entry for the health and well-being of young children and their families. They often serve in the positions of front line behavioral health specialists, because families trust their primary care providers and primary care providers are often the very first ones to hear when things aren't going well.

The primary care team can identify when there are concerns or delays or challenges for a young child, and then support parents by taking their concerns seriously and help them find the best solutions. This pro-active approach to behavioral health can happen at a time in a child's life where it is more cost-effective to intervene early. Development is happening more rapidly for the young child, serious concerns can be redirected, and new skills and capacities can be supported to be developed for the child.

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Resources

Article

Sattler, A. F., Leffler, J. M., Harrison, N. L., Bieber, E. D., Kosmach, J. J., Sim, L. A., & Whiteside, S. P. H. (2018, May 17). The Quality of Assessments for Childhood Psychopathology Within a Regional Medical Center. Psychological Services.

Integrated Behavioral Health Best Practices Training Symposium (Nov. 2, 2018)

What is the role of integrated care team members as they work together to assess, identify and provide care to patients who are experiencing the ongoing or immediate impact of psychologic trauma?

Frank deGruy and Parinda Khatri are nationally recognized speakers and innovators in the field of Behavioral Health Integration into primary care practices. They presented at the OBH-sponsored Integrated Behavioral Health Best Practices Training Symposium at the University of Denver on Nov. 2, 2018. In their presentations, they share their vision and experience of what it takes to move a medical practice into an integrated practice, and note some key milestones along the way.

Dr. Frank deGruy: "Integrated Behavioral Health: Why We Do It, What it is, How to Begin"

Dr. Parinda Khatri: "Moving the Needle by Integrating Primary Care: Successes and Lessons Learned in Colorado"

Provider Burnout and Resilience

What are the unique elements of caring for patients in primary care settings that may contribute to provider burnout? How can we best adapt our team approach and care delivery to meet their unique needs?

The goal in this training module is to ensure that integrating primary care physical and behavioral health care provider teams have the most current and relevant information to develop resilience to burnout. Providers will be best positioned to care for patients when they are fully engaged and satisfied in their work. Patients\' needs and wants can be time intensive, because health needs are becoming increasingly complex. It is critical that providers listen with the head and heart - to their own personal and professional needs. Every team member has a role in the development of resilience to burnout – both for themselves and for each other.

Learning Objectives

  • Identify the unique need of our providers, to build resiliency, as they care for patients.
  • Describe the specific roles of team members as they deliver care to patients.
  • Recognize the indicators that are key to recognizing burnout and the importance of self-care.

Who should complete this module?

The information in this module is valuable for all integrated team members including clinicians, nurses, behavioral health, medical assistants, front and back office staff, and care managers.

Introduction

Working to deliver whole-person care in an integrated team can be challenging. One of the top priorities for integrated teams - delivering patient care in the primary care setting - must be to ensure each team member is individually and cumulatively effective as providers. The demands on providers’ time and energy continue to expand. The risk of burnout and dissatisfaction is high. Research demonstrates that providers working in primary care more frequently report burnout due to the growing demands of conflicting priorities - beyond actual patient care. As a member of a team, each provider must monitor their own level of burnout as well as consider the well-being of their teammates. Resilience to burnout can be strengthened through consideration of individual needs and lifestyle (e.g., physical and mental wellness, safe and healthy nutrition, physical strength and fitness, and access to work/life balance). Additionally, practice leadership must actively engage in supporting providers as they work to become resilient and avoid unnecessary stressors.

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Resources

Psychological Trauma & the Integrated Care Team

What is the role of integrated care team members as they work together to assess, identify and provide care to patients who are experiencing the ongoing or immediate impact of psychologic trauma?

Our goal in this training module is to examine the value and importance, for both the medical and behavioral health primary care team members, to consider the potential role psychologic trauma may have on a patient's health and corresponding care plan.

Learning Objectives

  • Understand the potential role and long-term impact of traumatic responses to the overall health and wellness of your patients.
  • Describe the benefits of integrating physical and behavioral health care for the delivery of whole person care to your patients related to psychologic trauma and trauma-informed care.
  • Describe key practices that may be implemented by your team to proactively identify, treat or refer patients who are experiencing effects from exposure and response to trauma.

Who should complete this module?

The information in this module is valuable for all integrated team members including clinicians, nurses, behavioral health, medical assistants, front & back office, and care managers.

Introduction

One of the emerging priorities for integrated teams in the primary care setting is the consideration and identification of the role psychological trauma may play in a patient's health. This is becoming increasingly important in the treatment of patients as whole people. It is critical to delivering timely and effective care that each integrated care team member is prepared to assess, identify, and treat or refer patients who are currently or have in the past, experienced trauma which is impacting their overall health. Any patient can experience complications in their physical health related to psychologic trauma. The patient treated with integrated care is more likely to have stronger outcomes.

Research articles and tools are provided below to conveniently connect you and your team to current, well-respected information specific to trauma. We will discuss key points related to understanding trauma and how it may be impacting your patients. We provide information about the key role traumatic responses can play as they hamper treatment of what may appear to be unrelated issues.

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Trauma Resources

Adverse Childhood Experiences (ACES)

Adverse childhood experiences (ACEs) are stressful or traumatic events, including abuse and neglect. They may also include household dysfunction such as witnessing domestic violence or growing up with family members who have substance use disorders. ACEs are strongly related to the development and prevalence of a wide range of health problems throughout a person's lifespan, including those associated with substance misuse.

Children
Adults
Support
Implementation

Supervision of Providers and Clinics implementing trauma-informed treatments

Vicarious Trauma

Vicarious Trauma for Providers treating patients with trauma-related disorders

Articles

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013.

Blackman, J. S. (2016). Diagnostic and Statistical Manual of Mental Disorders , by American Psychiatric Association. Washington, DC: Author, 20. Psychoanalytic Psychology, 33(4), 651-663.

Foa, E. B., McLean, C. P., Zang, Y., Zhong, J., Rauch, S., Porter, K., … & Kauffman, B. Y. (2016). Psychometric properties of the Posttraumatic Stress Disorder Symptom Scale Interview for DSM–5 (PSSI–5). Psychological Assessment, 28(10), 1159.

Psychotropic Medications - Children & Adolescents

What is my role as a clinician in issues related to the role of psychotropic medications in the treatment and care of youth?

It is your responsibility as the clinician to ensure children and youth in out-of-home care receive appropriate treatment and medication by following the most current Psychotropic Medication Guidelines for Children and Adolescents in Colorado's Child Welfare System publication. Youth treated with psychotropic medications must be followed to ensure that treatment is not prescribed for inappropriate reasons, is implemented correctly, and is adjusted as necessary throughout placement.

Learning Objectives

  • Recognize and consider the current issues surrounding the use, maintenance, and monitoring of psychotropic medication as treatment for youth within Colorado's foster care system.
  • Recognize and adhere to the safeguards in place to protect youth from over prescribing, relative contraindication, and dosing.
  • Identify resources that provide information to ensure relevant and current prescribing and treatment.

Who should complete this module?

The information in this module is valuable for clinicians, practice staff, behavioral health workers, foster care providers, patient advocates, front & back office staff, nurses, care managers, and school representatives.

Introduction

Colorado State Guidelines for Psychotropic Medications

Nationally, there is a growing awareness of how many youths in foster care are being prescribed multiple psychiatric medications. Research data suggests that about half of youth who enter the foster system have emotional and mental health needs and may benefit from specialized mental health treatment. While higher needs would explain a disproportionally higher rate of psychotropic medications among foster youth than the general population, concerns remain about whether there may sometimes be an overreliance on psychotropic medications to solve the complex problems these youth face.

Why is this important?

The overall purpose of treatment with psychotropic medication is to reduce unwanted mental health symptoms and to restore meaningful quality of life for youth. Medication should never be used as a punishment, as a condition of placement, as a means to restrain a youth, except in emergency situations, or for the convenience of caregivers. Whenever possible, the youth and their caregivers should have a voice in their treatment, and they should clearly understand why a medication is being given. Above all else, medication prescribing should keep youth safety in mind, with constant vigilance for short-term and long-term adverse effects.

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Guidelines

The State released guidelines in the2017 Colorado Guidelines for Psychotropic Medication Use for Children and Adolescents. This work was led by the Colorado Department of Human Services and the Colorado Department of Health Care Policy and Financing. This document is an essential tool to help providers and caregivers connect foster kids to the right care at the right time to improve their quality of life and promote a healthy future.

Substance Use Disorders Part I: Introduction

What are the roles of integrated care team members as they participate in Substance Use Disorder (SUD) screening, identification, treatment, and referral within the primary care setting?

The goal in this training module is to examine the value and importance for medically trained primary care team members to address substance use disorders during a patient encounter, and to provide tools to help you move efficiently through this process. We will discuss key points related to assessing and screening, options for treatment and referral, and accommodations for differences between children, adolescents, adults and seniors, as well as any similarities.

Learning Objectives

  • Recognize and assign the roles of integrated team members in the screening, identification, and treatment of patients experiencing substance use and substance induced disorders.
  • Describe the benefits of integrating physical and behavioral health care for the delivery of whole-person care to your patients.
  • Describe the key practice components necessary for your team to proactively screen, identify, and treat or refer comorbid health and substance related issues.

Who should complete this module?

The information in this module is valuable for all integrated team members, including clinicians, nurses, behavioral health staff, medical assistants, front & back office staff, and care managers.

Introduction

Among the top priorities for integrated teams in the primary care setting are the identification, early intervention, and treatment of risky substance use and substance use disorders. Critical to delivering timely, whole-patient care is the ability of each integrated care team member to screen, assess, identify, and treat or refer patients of all ages, cultures, faiths, genders, and socio-economic levels. Any patient can experience complications in their physical health related to their mental health and or substance use, and visa versa. The patient treated by an integrated care team prepared to assess and treat using whole-patient thinking will be better served and will receive a higher level of quality care.

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Resources

General

Implementation

Child and Adolescent

Veterans

Potential Assessment Tools

SBIRT (Screening, Brief Intervention, and Referral to Treatment) Colorado

  • Improving Health. Changing Lives. Using evaluation, experience and lessons learned to establish screening, brief intervention, and referral to treatment (SBIRT)for substance use as a standard of care in health care settings.
Substance Use Disorders Part II: Opioids

What are the roles of integrated care team members in the primary care setting in identifying, treating, and referring patients misusing opioids?

Primary care teams play a vital role as the first, and often most frequent opportunity, to identify and treat patients who are misusing opioids. This module examines the value and importance of the medically trained primary care team member in prescribing and monitoring opioid use during a patient encounter and how the primary care team can treat as well as refer these patients. Provided herein are tools to help team members work alongside each other efficiently and effectively in an effort to reduce the risk of patient opioid use disorders. We will discuss key points related to prescribing opioids, assessing patient use and potential abuse of opioids, and programs for monitoring opioid use. Additionally, alternative options for pain management and chronic care accommodations are provided.

Learning Objectives

  • Recognize and assign the roles of integrated team members in pain reduction and pain management, which includes prescribing medication and alternative treatment as well as screening, identifying and treating patients experiencing opioid use and opioid-induced disorders.
  • Describe alternatives to the use of opioids for pain management and pain reduction for all patients.
  • Describe the key practice components of safe storage and safe disposal of opioids.

Who should complete this module?

The information in this module is valuable for all integrated team members, including clinicians, nurses, behavioral health staff, medical assistants, front & back office staff, and care managers.

Introduction

Two of the top priorities for integrated teams in the primary care setting are the reduction of opioid prescribing and increased patient utilization monitoring. Preventing patients from starting opioids at all and early identification of use are key to assisting patients in avoiding opioid use disorders. It is critical that integrated care team members are vigilant in working with the whole patient to screen, assess, identify, and treat or refer patients of all ages, cultures, faiths, genders, and socio-economic levels. Any patient can experience complications in their physical health related to their mental health and or substance use, and visa versa. The patient treated by an integrated care team that is prepared to assess and treat using whole patient thinking will be better served and will receive a higher level of quality care.

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Resources

General

Articles

  • William C. Becker, MD, Sara N. Edmond, PhD, Dana J. Cervone, APRN, Ajay Manhapra, MD, John J. Sellinger, PhD, Brent A. Moore, PhD, Ellen L. Edens, MD, MPE, Evaluation of an Integrated, Multidisciplinary Program to Address Unsafe Use of Opioids Prescribed for Pain, Pain Medicine, 23 March 2017.
  • Lasser, K. E. (2017). Prescription Opioid Use Among US Adults: Our Brave New World. Annals of Internal Medicine,167(5), 351-352.
  • Runyan, C. N., Hewitt, A. L., Martin, S. A., & Mullin, D. (2017).Confronting the new epidemic: Integrated care for opioid use disorders. Families, Systems, & Health, 35(2), 248-250.
Substance Use Disorders Part III: SBIRT

processes in the primary care setting sounds good - but how do you actually implement SBIRT strategies into your team‚Äôs practice procedures?

In this third module on substance use disorders, we dive deeper into the realities of incorporating screening, intervening, and referring patients experiencing them. SBIRT is about helping patients understand where they are with substance use, planting thoughts of change, and providing small interventions that may lead to change over time. We want to ensure our integrating primary care physical and behavioral health care providers have the most current and relevant information to assist them in their work to assess, intervene, and refer patients who are exhibiting risky behavior or substance use disorders. The key points related to incorporating SBIRT in your practice, by the entire patient care team, are discussed. Every member has a role in this powerful and effective approach to early identification and treatment of substance use disorders.

Learning Objectives

Integrating the four components of SBIRT (i.e., screening, brief intervention, and referral to treatment) into integrated team patient care

  • Identify the process of developing SBIRT-based protocols in your practice.
  • Describe specific roles for team members within the SBIRT protocols and with the "warm hand-off."
  • Recognize the indicators of risky behavior and potential substance use disorders that would lead to you providing a brief intervention for the purpose of educating your patient.

Who should complete this module?

The information in this module is valuable for all integrated team members, including clinicians, nurses, behavioral health staff, medical assistants, front & back office staff, and care managers.

Introduction

One of the top priorities for integrated teams in the primary care setting is to include all integrated team members in the assessment for, intervention of, and referral for treatment related to risky substance use and substance use disorders.

Prevention and early identification are central to assisting patients in avoiding long-term and life-affecting addiction. SBIRT protocols can be an effective tool when implemented correctly by your entire team. It is critical that integrated team members are vigilant in working with the whole patient to screen, assess, identify, and treat or refer patients of all ages, cultures, faiths, genders, and socio-economic levels.

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Resources

General

Toolkits for Implementation

Articles

  • Kaiser, D. J., &, Karuntzos, G. (2016).An examination of the workflow processes of the screening, brief intervention, and referral to treatment (SBIRT) program in health care settings. Journal of substance abuse treatment,60, 21-26.
  • Manuel, J. K., Satre, D. D., Tsoh, J., Moreno-John, G., Ramos, J. S., McCance-Katz, E. F., &, Satterfield, J. M. (2015).Adapting Screening, Brief Intervention and Referral to Treatment (SBIRT) for Alcohol and Drugs to Culturally Diverse Clinical Populations. Journal of Addiction Medicine,9(5), 343‚Äì351.
  • Nunes, A. P., Richmond, M. K., Marzano, K., Swenson, C. J., &, Lockhart, J. (2017).Ten years of implementing screening, brief intervention, and referral to treatment (SBIRT): Lessons learned. Substance Abuse, 1-5.
  • Ozechowski, T. J., Becker, S. J., &, Hogue, A. (2016).SBIRT-A: adapting SBIRT to maximize developmental fit for adolescents in primary care. Journal of substance abuse treatment, 62, 28-37.
Whole-Person Care for the Aging and Senior Patient

What are the unique needs of our aging patients? How can we best adapt our team approach and care delivery to meet their unique needs?

The goal of this training module is to ensure integrated primary care teams have the most current and relevant information to develop the foundational relationships needed to deliver care to their senior patients. It is from these relationships that care teams will be best positioned to assess, determine appropriate care plans, and deliver care to their senior patients. Seniors need and want to be heard. It is critical that providers listen with the head and heart - to hear both what is said and what isn't. Every team member has a role in this powerful opportunity to meet the unique needs of our senior patients.

Learning Objectives

  • Identify the unique needs of our senior patients and their care networks.
  • Describe the specific roles of team members as you care for seniors.
  • Recognize the indicators that are key to assessing senior patients risk tolerance, level of safe independence, and a plan to move through end of life changes.

Who should complete this module?

The information in this module is valuable for all integrated team members, including clinicians, nurses, behavioral health staff, medical assistants, front & back office staff, and care managers.

Introduction

One of the top priorities for integrated teams in the primary care setting is to include all integrated team members in assessing, determining treatment, and delivering care specifically tailored to meet the needs of our seniors. Working with people in the later years of life is unlike treating a patient's illness or disorder. Seniors are living a stage of life that demands careful and tailored care. Each person, as we will all experience, has unique wants and needs that must be balanced through consideration of their individual lifestyle (e.g., physical and mental wellness, safe and healthy nutrition, physical strength and mobility, and access to a social network). Seniors ask for respect, thorough and thoughtful care planning, and rely on the care team to ensure integrated health teaming.

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Resources

Care team resources
General

Toolkits

Communication

Patient resources

“Healthy Aging” — Colorado Gerontological Society"

Caregiver resources

Tools for Those Caring for Aging Parents

AARP Caregiving Resource Center Colorado Senior Resource Guidebook by the Colorado Gerontological Society

What our aging patients are looking for:

How to Choose a Doctor You Can Talk To
Article

Hartgerink, J. M., Cramm, J. M., Bakker, T. J., Eijsden, R. A., Mackenbach, J. P., & Nieboer, A. P. (2014). The importance of relational coordination for integrated care delivery to older patients in the hospital. Journal of Nursing Management, 22(2), 248-256.

Certified Addiction Counselor Clinical Training Program

OBH has the authority for setting competency training standards for the addiction counselor workforce. Certification and licensure in Colorado requires a combination of specialized training and clinically supervised work experience in the addiction field. Additionally, OBH periodically reviews the addiction counselor certification and licensure rules and revises them when needed to reflect current research, treatment methods and competencies needed for the workforce. OBH and the Colorado Department of Regulatory Agencies (DORA) work together to provide the path to certification and licensure for aspiring addiction counselors in Colorado.

Learn more about certification and licensure

OBH also approves trainers for the Certified Addiction Counselor (CAC) required training classes and the curriculum for these classes. 
 
DORA regulates addiction counselors in Colorado and is responsible for the following activities related to counselor certification and licensure:

  • Establishing fees for certification and licensing of addiction counselors
  • Processing applications for certification or licensure using the Addiction Counselor Certification and Licensure Rules as a guide
  • Issuing and renewing certificates or licenses that meet statutory requirements
  • Initiating investigations with regard to complaints against any individual who is providing a service that requires regulation by DORA
  • Issuing various forms of discipline regarding violations of the Colorado Mental Health Practice Act.
  • Implementing the Continuing Professional Development legislation passed in 2009 that mandates continuing professional development learning plans for mental health professionals.

For information and/or application regarding addiction counselor certification or licensure, please contact:

DORA (Department of Regulatory Agencies)
State Board of Addiction Counselor Examiners
1560 Broadway, Suite 1350
Denver, CO 80202
P 303.894.7800

Become a Licensed Addiction Counselor

A Licensed Addiction Counselor (LAC) is a true behavioral health clinician who can provide co-occurring services
Substance use treatment is in the scope of practice for licensed behavioral health clinicians but there’s little focus on addiction training
Becoming a LAC means potential for job promotion and higher compensation

Correcting Common Myths:
  • It IS acceptable for students and new professionals post-graduation to work towards an addictions credential (CAS, LAC) while also working concurrently towards an additional behavioral health credential (LPC, LMFT, LCSW, PSY).
  • A student in a clinical behavioral health Masters program CAN earn clinically supervised work experience hours towards an addiction credential, if they are supervised by a CAS or LAC while accumulating their internship or practicum hours.
  • It takes 18 months to get your Licensed Addiction Counselor clinically supervised work experience hours.
Eligible Master’s/Doctoral Degrees for Dual Credential:
  • Community Counseling
  • Human Services Counseling
  • Marriage and Family Therapy
  • Clinical Psychology
  • Counseling Psychology
  • Human Psychology    Clinical Social Work
  • Psychiatric Nursing/Advanced Practice Nursing
  • Addictionologist – Addiction Medicine
  • Behavioral Health Sciences or qualified equivalent
Contact

For more information about becoming a licensed addiction counselor, please contact:

Mary McMahon, CAC Clinical Training Program Manager
Office of Behavioral Health
mary.mcmahon@state.co.us | 303.656.7968

Training of trainers

Periodically, trainings will be offered for new and existing OBH approved trainers in order to roll out new programs, provide updates to core competencies for required classes, provide training for newly developed classes, and to provide additional training on classroom management and trainer skills.
 
Three required classes for the CAT level certification are referred to as the core curriculum. They are Addiction Counseling Skills, Case Conceptualization and Documentation (a.k.a. Client Record Management) and Principles of Addiction Treatment. A training of trainers for the core curriculum will be offered periodically by OBH for new trainers interested in becoming approved for these three classes. The curriculum, agenda and examination for all three classes is provided by OBH.

Intern and Trainee Documents for Programs & Agencies

OBH has developed sample documents to be utilized by programs and agencies who want to work with interns and trainees desiring to gain clinically supervised work experience hours to be applied toward a certified addiction counselor application. The three documents are an intern/trainee application, a site agreement, and a supervision contract. Contact mary.mcmahon@state.co.us for these documents.

Counselor Training Requirements for CAT, CAS, and LAC
CAC Training Program Handbook for Addiction Counselors

Download the CAC Handbook

Addiction Counselor Certification and Licensure Rules
Addiction Counselor Certification and Licensure Rules
Addiction Counselor Continuing Professional Development
OBH Approved Trainer Handbook

Download the OBH Approved Trainer for CAC Training Classes

Download the OBH Approved Trainer Application

Training Facilities

Download a list of CAC Clinical Program Training Facilities

Core Competencies for CAC Required Training Classes

Strategies for Self-Improvement & Change (SSC) Training

The State of Colorado is sponsoring a series of training courses in the Strategies for Self-Improvement and Change curriculum. This curriculum is an evidence-based, cognitive-behavioral treatment model for the substance abusing adult offender.

The Criminal Conduct and Substance Abuse Treatment Strategies for Self-Improvement and Change (SSC) series is a 3-day training. To attend the course, download the 2021-2022 SSC training locations and an application.