HB 1023 Draft Report: Policy Recommendations Outline
Greg Hansch (email me for copy of full report) – email@example.com
Comments on these policy recommendations are due back to DSHS by April 1st. Please advise on the comments NAMI Texas should make.
1. General Shortage of Mental Health Providers (the state shortage of mental health providers should be addressed through improved employee recruitment and retention and the reorganization of service delivery).
a. incentives for workers:
-early exposure to career opportunities in the field and the special populations served
-mentoring by behavioral health specialists
-loan repayment programs
-intern sites across professions
b. expansion of medical education
-robust expansion of graduate medical education
-increase availability of funded residency slots (psychiatry in particular)
-targeting graduate medical and undergraduate pre-medical students with specialty clerkships
and curriculum tracks.
c. reconsideration of scope of practice and integrated care
-existing practitioners should be deployed to use the best of their abilities and each profession
should be granted a maximum amount of reasonable responsibility.
-team-based care, collaborative care organizations, and medical/health homes
-physicians cede some simpler tasks and practice ‘at the top’ of their training, allowing other
professions to fill in the gaps through role extension.
-expanding the capacity and roles of other health care providers.
2. Maldistribution of the Mental Health Workforce
a. targeted recruitment
-recruit and retain needed health care professionals to underserved areas quires rewarding
personal and professional environments. “home-grown products” more sustainable.
-clinical rotations in underserved areas and appropriate education preparation for rural practice.
location of university departments and/or teaching clinics in rural areas, the provision of rural
-clinical experiences for medical students, and rural and scarce skills allowances for
-for geriatric specialties, multiple providers in an underserved area should consider forming
networks that would allow them to act as a single underserved site.
-increase use of telepsychiatry and tele – mental health services
-look at Medicare and Medicaid reimbursement for tele-health services of psychiatrists, nurse
practitioners, clinical nurse specialists, physician assistants, clinical psychologists, and clinical
-Texas Medical Board has rules for out-of-state practitioners to practice telemedicine in Texas,
but other relevant licensing boards do not.
3. Lack of Diversity – health care consumers have better therapeutic relationships and stronger retention rates when using a practitioner of their own race/ethnicity
a. Target Recruitment
-efforts to recruit minorities into health professions should be expanded.
-should be accompanied by efforts to improve the education attainment of minorities at large.
-Psychiatric care in the U.S. and Texas is and will continue to be dependent upon the services of
international medical graduates.
4. Outdated Educational Content and Teaching Methods – need for innovative practices, inter-professional collaboration, and improved quality of care. Roles and activities of health care workers must likely be reorganized to maximize the productivity of the workforce.
a. Curriculum Changes
-higher education programs and accrediting bodies must update curriculums.
-academic medical centers must embrace the innovation imperative and address the projected
workforce shortages. These efforts should identify and employ ‘disruptive innovations’ that will
spark true workforce innovative growth and increased efficiency
-Programs will require additional faculty and greater leadership development among existing
faculty, but must also seek to align changing elements of the education system and health
system with each other and with patient care needs.
b. Expanded Training in Clinical Settings
-Psychiatry clerkships and electives should be expanded and made available to students
entering medical school who have not yet chosen a specialty.
-Psychiatry residents and fellows should receive specific training in telepsychiatry delivery,including such diverse topics as program sustainability, model of health service delivery, program
infrastructure development, legal and regulatory issues, administrative strategies,
technical applications, quality of service, and clinical outcomes assessment.
-inclusion of child psychiatry and developmental-behavioral pediatric training in primary
care residency (though it has been shown that few primary care practitioners feel capable of
diagnosing or treating psychopathology in children or adolescents)
-For psychologists, a greater concentration of academic training and workplace experience
should occur in the clinical psychological setting, including the expansion of rotations for
psychologists in the primary care setting.
-Doctoral psychology training programs should: find ways to maximize the expertise of their
faculty; provide greater teaching and supervisory renumeration; maximize the knowledge and
skills of their students; and create and expand clinic relationships and affiliations.
-Community health centers have been presented as offering an ideal place for psychological
training in primary care behavioral health as these efforts would be available to patients with
fewest resources and greatest needs.
-Nursing faculty should share and build new curricula for RNS entering psychiatric nursing.
5. Insufficient Data to Inform Workforce Planning – Effective planning must involve the sustained investment on iterative collection of data on population need, models of health care delivery, and workforce productivity.
a. Assessment of Mental Health Service Nees
-Need sufficient demand models for Texas’ mental health workforce – should consider the local
morbidity of mental illness, mental health service utilization rates for both patient with serious
mental illness and the population at-large, and the proportion of mental health needs currently
being met by primary care providers.
-Greater need to distinguish between spatial (geographic barriers to care and aspatial (social
organizational) variables in the description of patient need. Measurements of shortage should
conceptualize access using more nuanced means, including the prevalence of mental health
disorders, the extent of need among those in need, the extent primary care providers can meet
mental health needs, and the mismatch between the level of need and the services provided.
b. Workforce Development Data
-Greater consideration of factors affecting workforce development and distribution are
-More and better data should be collected on the level of service provided for different levels
of health and illness and the productivity of providers should be measured.
-Greater investments on the activity and productivity of health workers are needed to ascertain
the effectiveness of staffing levels.
-More extensive and complete minimum data requirements, including race, ethnicity, and
languages spoken would allow a better understanding of provider ability to meet population