The workforce treating substance use disorder (SUD) is complex, ranging from primary care providers, to master’s level clinical counselors, to certified social supports. Understanding SUD treatment capacity requires a deeper understanding of how each segment of this workforce is trained to treat SUD. This project, part of Michigan’s Section 1003 Demonstration, seeks to better understand the state’s SUD workforce training and education at the national, state, and program levels.
AIM #1: State-based Comparisons of Substance Use Disorder Scopes of Practice
Previous research by the BHWRC determined mental health counselors (MHCs) typically hold 3 different types of credentials and credentialing of SUD counselors varied across the country. Some states offering licenses to practice as an SUD counselor while others have specialty certifications for use in tandem with licensure for practicing as a different behavioral health provider.
Among the eleven behavioral health provider types examined, the credentialing process outlined required education hours, training hours, supervised training hours, and CE hours for each of Michigan’s eleven providers. These typically fell into the national average with two exceptions that exceeded the averages:
Required training hours for social workers – we require 4,000 hours, average is just over 3,000. Michigan social workers also have one of the highest CE requirements, too.
CE for psychiatrists – we require 50 hours/year, average is 20-30
Many Michiganders in need of behavioral health do not receive the support they need due to a range of barriers that hinder their access to care, including individual-level challenges (e.g., cost, transportation, stigma), provider challenges (e.g., provider shortages, expertise, attitudes), and regulatory challenges (e.g., prescriber mandates, insurance reimbursement). A multifaceted approach of prevention, early intervention, treatment, and long-term recovery support is critical for addressing the needs of persons with SUDs, including opioid use disorders (OUDs).
AIM #2: National Education Accreditors and Michigan Training Programs for Behavioral Health Providers
This aim examined the United States Department of Education’s Database of Accredited Postsecondary Institutions and Programs to identify accredited training programs for eleven behavioral health providers in Michigan. To address the lack of state licensure or national accrediting bodies for some of these behavioral health provider types, internet searches were used to supplement this information to aid in identification of all behavioral health training programs in Michigan. Information on training program curricula, specifically any information related to SUD training, as well as geographic locations were also collected.
Internet search data collection efforts revealed that the availability and types of behavioral health training programs in Michigan varied by provider type and region of the state. Training programs for all behavioral health provider types were overwhelmingly concentrated in highly populated southeastern Michigan, with southwestern Michigan as the region with the second greatest number of training programs. Few behavioral health provider training programs were in the Upper Peninsula.
To encourage greater practice in these health professional shortage areas, incentive programs can be implemented by training programs based in southeastern Michigan to provide financial support for students in exchange for their agreements to practice in a health professional shortage area once they become licensed providers.
AIM #3: Assessing Content and Curriculum for Behavioral Health Providers: A Survey and Qualitative Analysis of Michigan Education and Training Programs
This aim examined general and SUD-specific elements of behavioral health education and training programs throughout Michigan. Programs offered to 11 behavioral health provider types were included in this study and program contacts were invited to participate in an online survey. The second phase of this study included 10 key informant interviews with local champions for behavioral health training and education programs.
Survey data collection efforts revealed that behavioral health education and training programs are offered to a variety of behavioral health professionals, but largely serve social workers, psychologists, SUD counselors, and mental health counselors. Barriers which prevent behavioral health providers from participating in behavioral health training programs are a lack of funding or financial support and insufficient time to participate in a program. Survey responses specific to SUD content (no hyphen) that the majority of programs offer some form of SUD education, most frequently as required content. Additionally, various topics covered in SUD-required content and curricula are available to behavioral health professionals. Survey results indicate that the major barriers to including SUD content in a behavioral health training program are lack of financial support, insufficient faculty/staff support, and too-restrictive time and content requirements.
Results from interviews with local stakeholders in the field of SUD-related behavioral health education and training programs are consistent with findings from the survey. The key informant interviews further provided insight into innovative approaches utilized when incorporating SUD content and curricula. The key informant interviews also provided actionable recommendations from individuals who have experience in SUD programming and training for behavioral health providers.