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APNA 29th Annual Conference Session 3046: October 30, 2015 Conflict of Interest Statement I have no financial disclosures of conflicts PMH Nurses and the Evolving to report Behavioral Health Care Workforce: The Road to Directing our Future Kathleen R Delaney, PhD, PMH ‐ NP Professor, Rush College of Nursing Mental Health Service Delivery is Objectives Experiencing a Tsunami of Change • Explain how new practice models generate demand for a PMH RN/APN workforce with particular skills • Understand the current workforce and practice data for PMH Nursing and strategies for communicating to larger healthcare arena • Discuss how educational models must change to prepare PMH RNs and APNs for future behavioral healthcare models This Tsunami of Health Care Change Generates Facing such change, tendency may be to Dialogue and PMH nurses’ presence is critical seek high ground and stay till it all settles . Healthcare workforce development strategies must begin with a clear understanding of how new models of care will affect future demand for certain types of health care workers and new skill requirements.” Health Care Task Force Report to Illinois Workforce Investment Board Delaney 1

APNA 29th Annual Conference Session 3046: October 30, 2015 PMH nursing skills are essential to the We need to craft an effective message fundamental changes of health care and find our collective voice transformation ‐ but our voice is sporadic What would an effective message convey • Our commitment to the mental health and well being of individuals and populations • Our disciplinary foundation in relationship ‐ based care • Positions our work and capabilities in new health care delivery models Heisler & Bagalman, 2013 Let’s Build a Statement that Marries Connect the dots from workforce Essential Elements of that Message Demand to PMH RN/APN Capacity to PMH Nursing Capabilities: Demand …… Capacity …… Capabilities What PMH Nursing will bring Judging Demand from New Care Models: Dig into Assumptions, Support, Incentives, Policy Milieu How to anticipate and depict demand? Delaney 2

APNA 29th Annual Conference Session 3046: October 30, 2015 Team Based, Capitated Models of Care Policy Environment: ACA Reform: Provisions by Year Will Increase Demand For New Skills 2010 2011 2012 Minimum Medical Loss Ratio for Insurers • RN: Screening for mental health/substance use Review of Health Plan Premium Increases Accountable Care Organizations in Medicare Changes in Medicare Provider Rates Closing the Medicare Drug Coverage Gap Uniform Coverage Summaries for Consumers Qualifying Therapeutic Discovery Project Credit Medicare Payments for Primary Care conditions; Telephone triage; proficiency in Medicare Advantage Plan Payments Medicaid and CHIP Payment Advisory Commission Medicare Prevention Benefits Medicare Independence at Home Demonstration Comparative Effectiveness Research Center for Medicare and Medicaid Innovation stepped care decisions; deliver basic behavioral Prevention and Public Health Fund Medicare Provider Payment Changes Medicare Premiums for Higher ‐ Income Medicare Beneficiary Drug Rebate Fraud and Abuse Prevention Beneficiaries Small Business Tax Credits Annual Fees on the Pharmaceutical Industry health interventions; wellness; engagement Medicare Advantage Payment Changes Medicaid Drug Rebate Medicaid Payment Demonstration Projects Medicaid Health Homes Coordinating Care for Dual Eligible Data Collection to Reduce Health Care Disparities Chronic Disease Prevention in Medicaid Generic Biologic Drugs Medicare Value ‐ Based Purchasing National Quality Strategy New Requirements on Non ‐ profit Hospitals Changes to Tax ‐ Free Savings Accounts Medicaid Coverage for Childless Adults Grants to Establish Wellness Programs • APN: Leveling care; tracking patient progress; Reinsurance Program for Retiree Coverage Pre ‐ existing Condition Insurance Plan Teaching Health Centers New Prevention Council Medical Malpractice Grants population health; quality improvement around Consumer Website Funding for Health Insurance Exchanges Tax on Indoor Tanning Services Nutritional Labeling attrition and premature treatment dropout. Expansion of Drug Discount Program Medicaid Payments for Hospital ‐ Acquired Infections Adult Dependent Coverage to Age 26 Graduate Medical Education Consumer Protections in Insurance Medicare Independent Payment Advisory Board Insurance Plan Appeals Process Medicaid Long ‐ Term Care Services Coverage of Preventive Benefits Health Centers and the National Health Service Corps The Educational Implications are Rather Obvious Health Care Workforce Commission Medicaid Community ‐ Based Services Depicting Workforce Capacity Requires Data: On the size, distribution, and practice sites Demand …… Capacity …… Capabilities What is the Capacity of PMH Nursing Workforce ? Graph compiled by Kathleen Delaney I stock photo 22843139 purchased 3/2015 What do we know about our current PMH RN Workforce Estimated ‐ 4% of respondents practice in a Mental Health Setting PMH/substance abuse RN workforce 4% ‐ Hospital 5% ‐ Community From: Budden, J. S., Zhong, E. H., Moulton, P., & Cimiotti, J. P. (2013). Highlights of the national workforce survey of registered nurses. Journal of Nursing Regulation, 4(2), 5-14. Delaney 3

APNA 29th Annual Conference Session 3046: October 30, 2015 Where we Practice and What we Do ? APNs in psychiatry very small numbers in NP surveys, (5.6%) Geographic/state distribution: Not sure about density in APN in rural counties. State by state. can tell general APN/RN distribution From: Budden, J. S., Zhong, E. H., Moulton, P., & Cimiotti, J. P. (2013). Highlights of the HRSA (2014) Highlights from the 2012 National national workforce survey of registered nurses. Journal of Nursing Regulation, 4(2), 5-14. Sample Survey of Nurse Practitioners. Limited Data available for PMH RN Role in Integrated Care: Care Coordination Roles Demand …… Capacity …… Capabilities Depicting the Capabilities of PMH Nursing Workforce ? I ‐ Stock Photo – 17871965 purchased 9 ‐ 2014 PMH ‐ APNs: Educated in Multiple Sciences PMH RNs: Education creates a unique skill Create a Provider with Wide Breadth of Skills base particularly for integrated services • Licensed to provide the full spectrum of mental health services; assessment and diagnosis, implementing In addition to providing a full range of therapeutic interventions, psychotherapeutic interventions, and prescribing PMH RNs are: medications • Capable of monitoring medical conditions and thus • Trained to provide mental health care across the life manage an integrated treatment plan span, including older adults and children • Skilled in screening for a wide variety of MH/SU issues • Able to assess how medical and behavioral issues create • Skilled provider of Integrated (medical/behavioral) an intensity of need and match with intensity of services care since they are educated to address both mental • Focused on assisting individuals to successfully navigate health/substance abuse and physical health concerns. the continuum of care from hospital to home • Provide services in a wide variety of settings (primary • Address health issues with understanding of how serious care, hospital, long term care, forensic, schools) mental illness can bring with it behaviors that impact how • Practice within the full spectrum of behavioral health health issues are addressed, i.e. poor sleep, poor eating. care services, from prevention, through intervention to long term care Delaney 4