Strengthening the workforce

The Annapolis Coalition on the Behavioral Health Workforce has been engaged in an ongoing effort to improve training, education, recruitment, and retention in the mental health and substance use disorders fields. What follows is a review of the first five phases of this work, culminating in a draft national workforce action plan that was completed this past summer.

Phase I—Building National Consensus

Sixty-five individuals came together in Annapolis, Maryland, on September 10 and 11, 2001, to focus on growing concerns that the behavioral health workforce was in a crisis. Those gathered included providers, educators, persons in recovery, and family advocates with expertise in both mental healthcare and substance use disorders treatment. These participants adopted a broad definition of workforce that encompasses persons in recovery, family members, professionals, direct-care staff without professional training, and other health and human services providers, such as teachers, emergency room personnel, and primary care providers.

Although the meeting was cut short because of the terrorist attacks, consensus had been reached about a number of key problems related to workforce training and education, as well as potential strategies to address these issues. This initial meeting was the impetus for what has become a continuing and ever-widening effort to develop a national consensus on the nature of the workforce crisis and to stimulate key strategies for reform, not only in education and training, but in recruitment and retention practices as well.

The initial meeting was funded by the federal Agency for Healthcare Research and Quality, along with SAMHSA's Center for Mental Health Services (CMHS). The meeting was organized by representatives from two organizations: the Academic Behavioral Health Consortium and the American College of Mental Health Administration. With these organizations' support and encouragement, the Coalition was formed as a separate, not-for-profit entity. The Coalition is focused on strengthening the behavioral health workforce through policy development with federal and state agencies, and through the provision of technical assistance to all types of behavioral health organizations.

Phase II—Dissemination of Recommendations

The second phase focused on dissemination of the recommendations from the first Annapolis Conference and continued efforts to raise awareness nationally about the workforce crisis. The findings and recommendations from the conference and subsequent strategic planning were summarized in two special issues of the journal Administration and Policy in Mental Health. This work was distributed in hard copy to key leaders in the field, presentations at professional and advocacy meetings, and a Web site (https://www.annapoliscoalition.org). The Coalition offered consultation to the President's New Freedom Commission on Mental Health and drafted recommendations on workforce issues for the commission's final report.

Phase III—Focus on Competencies

The greatest area of consensus among workforce experts was the need to place increased emphasis on competency development and assessment. To move this agenda forward, the Coalition convened a national summit on competencies in Annapolis in May 2004. Experts from business and 13 sectors of behavioral health reported on the status of competency development in their workforce sectors. A summary of these reports and recommendations to guide future work on competencies was published as a third special issue of Administration and Policy in Mental Health in May 2005. (Note: Issues of Administration and Policy in Mental Health can be accessed via https://www.annapoliscoalition.org.)

Phase IV—Consultation to the Institute of Medicine

To promote attention to workforce issues, the Coalition organized a panel of mental health and substance use disorder workforce experts, persons in recovery, and family advocates that developed recommendations for consideration by the Institute of Medicine (IOM) committee developing the landmark report released in November 2005. Two senior members of the Coalition in collaboration with Eric Goplerud, PhD, an expert in substance use disorders workforce issues, were commissioned by CMHS and the IOM to draft a detailed background paper for the IOM committee. The final IOM report did indeed place a major emphasis on workforce issues.

Phase V—National Strategic Plan

The Coalition's work entered its most ambitious phase during 2005 and 2006. With support from SAMHSA, the Coalition managed the development of a national action plan on behavioral health workforce development. The New Freedom Commission's report called for the development of such a plan, and SAMHSA's Center for Substance Abuse Treatment (CSAT) and Center for Substance Abuse Prevention (CSAP) had organized various efforts to examine and address workforce issues. SAMHSA decided to commission a national workforce plan that encompassed prevention and treatment across the mental health and addiction fields, and identified a core set of practical strategies for strengthening the workforce.

The Coalition used a variety of planning vehicles to gather input, analyze existing workforce plans and recommendations, and craft comprehensive recommendations that would be broadly applicable to all sectors of the field. Senior workforce experts convened panels or advisory groups to manage workforce planning in a dozen topics, such as substance use disorders treatment; substance abuse prevention; children, youth, and families; adults in recovery from mental illness; cultural competency; rural healthcare; and workforce financing. Experts also examined technology's impact on the workforce and the role of accreditation organizations in workforce development.

The Coalition and its experts conducted diverse stakeholder focus groups, convened special planning sessions, and hosted open calls for recommendations via the Web site and through direct requests to various organizations. It is conservatively estimated that the Coalition engaged more than 5,000 individuals in the planning process.

Final recommendations and the plan's content were shaped by the Coalition's National Steering Committee, comprised of some of the foremost experts on workforce issues. A draft of the plan, tentatively titled A Thousand Voices: The National Action Plan on Behavioral Health Workforce Development, was delivered to SAMHSA in the spring and reviewed by approximately 200 stakeholders at a SAMHSA-sponsored meeting in July.

The draft plan is centered around a set of strategic goals that emphasize three primary themes: (1) broadening the concept of "workforce" to include persons in recovery, youth, families, and community coalitions; (2) strengthening the workforce through systematic recruitment and retention efforts, more relevant and effective training, and sustained leadership development; and (3) improving the structures that support the workforce, such as information technology and financing.

An Action-Oriented Future

While the plan's release date has not been finalized, the Coalition is shifting its focus to assisting state and federal agencies and private organizations with strengthening and implementing their own workforce plans, informed by the findings and recommendations of the national planning process. Coalition representatives are conducting briefings for various organizations on emerging themes and recommendations from the planning process, consulting on specific interventions, and exploring partnerships with a variety of organizations to tackle specific workforce problems. For more information about the Coalition or to discuss possible collaborations, please contact us.

Ann McManis, MA, is the Director of Operations for the Annapolis Coalition, and she can be reached at director@annapoliscoalition.org.
Michael A. Hoge, PhD, is a Professor of Psychology at the Yale School of Medicine, as well as Senior Science and Policy Advisor for the Coalition. He can be reached at michael.hoge@yale.edu.
John A. Morris, MSW, is a Professor and Director of Health Policy Studies in the Department of Neuropsychiatry and Behavioral Sciences at the University of South Carolina School of Medicine, as well as the Coalition's Executive Director. He can be reached at jmorris@tacinc.org.