National Training Center on UMKC Campus

The number of people seeking treatment for alcohol and drug problems might double in the near future, when millions will suddenly become eligible for insurance coverage under the Affordable Care Act. The University of Missouri-Kansas City is taking the lead in making sure that health systems across the country are ready to handle this huge influx.

The Collaborative for Excellence in Behavioral Health Research and Practice at UMKC’s School of Nursing and Health Studies is a group of about a dozen professionals committed to improving the care provided to people with substance use and other co-occurring health disorders. Through a number of grant and contract-funded projects, including national and regional offices of the Addiction Technology Transfer Center Network (ATTC), the Collaborative advances health and wellness by bringing behavioral health research to practice and by supporting people, organizations and systems through change processes.

The Collaborative’s mission is critical. A lack of health insurance has been a big barrier to treating those with alcohol and drug problems. In less than a year, the surge in patients is expected to push a marginal part of the healthcare system (only 1 cent of every healthcare dollar in the U.S. goes towards addiction) into the mainstream of medical care.

There could be up to twice as many people seeking treatment over current levels, depending on how many states expand their Medicaid programs and how many people with substance use disorders choose to take advantage of the new opportunity, according to an Associated Press analysis of government data. Roughly 3 million to 5 million people with drug and alcohol problems — from people who are homeless and have long-term, severe substance use disorders to working parents who drink too much — suddenly will become eligible for insurance coverage under the new health care overhaul. The Collaborative is working to make sure the workforce is ready for the opening of the floodgates.

Pat Stilen, director of the Mid-America ATTC Regional Center, has led intense meetings with behavioral health and primary care providers, as well as state policy authorities, about the impact of the Affordable Care Act on substance use treatment.

“I don’t think they had realized the magnitude of what is coming,” Stilen said. “Now it is definitely on their radar.”

The Mid-America ATTC transfers research-based information and technologies to behavioral health organizations in Iowa, Kansas, Missouri and Nebraska. One of the areas the Mid-America ATTC is focusing on is training Federally Qualified Health Centers (FQHC) about the importance of hepatitis C screening for people with a history of substance abuse. There is no vaccine for the infectious disease, and people who have used drugs intravenously are at risk.

“There is a huge need,” said Stilen. About 75 percent of FQHCs provide mental health services but only 55 percent provide substance-use services. And more than 35 percent of FQHCs don’t routinely screen for substance use.

The National ATTC Network Office manages and organizes high-profile, nationally-focused projects and promotes collaborations to improve the efficiency and effectiveness of the overall ATTC Network of 14 centers (all funded by the Substance Abuse and Mental Health Services Administration). It also offers online training courses for health care professionals.

The National ATTC Network Office recently completed a five-year study of the addiction treatment workforce that identifies the big challenges that lie ahead. These include a lack of proper training in the addictions treatment workforce and stigma against people with substance use disorders, including from healthcare professionals. For solutions, the ATTC recommends recruiting more diverse people in their 20s and 30s into the field, more education, more training and more collaborating.

Through the work of associate research professor, Heather Gotham, the Collaborative also focuses on how to move research-based addiction, mental health and health-related practices into healthcare settings (this type of work is called implementation science). There is often a gap — 7 to 17 years — between the development of a research-based treatment and its use in real-world settings. The Collaborative works with healthcare providers and state systems to accelerate the use of more effective treatments and help these organizations through the sometimes difficult system changes that need to take place. For example, Gotham recently published a tool that assesses how capable mental health providers are of serving patients who also have substance use disorders, and studies factors that help or hinder agencies trying to implement these new treatments.

The Collaborative relocated in October to the School of Nursing and Health Studies.

“The location in the center of the country is beneficial and part of the reason we’re here,” said Laurie Krom, co-director of the National ATTC Network Office. “But being located at UMKC also has to do with the knowledge and expertise of the staff. We are clinicians, educators and technology transfer experts.”

The Collaborative is working to educate future health-care providers, too, which is why they chose to partner with the UMKC School of Nursing and Health Studies. They are training future nurses how to screen for substance use disorders, and writing grants to help integrate addiction science into the School’s curriculum. They provide opportunities for students and faculty to learn from national experts, such as Michael Dennis, a renowned adolescent addiction treatment researcher. In the future, they hope to work with the other Hospital Hill schools of Dentistry, Medicine and Pharmacy given UMKC’s emphasis on interprofessional health education.

Stilen, Krom and Gotham recently delivered a data-packed presentation about the Collaborative to nursing students. Some highlights:

• Substance use disorders are as prevalent as other chronic health conditions. (8.7 percent vs. 8.3 percent who have diabetes)
• Relapse rates are similar for drug addiction and other chronic illnesses. (40 to 60 percent vs. 30 to 50 percent among diabetes patients)
• There is a huge treatment gap. In 2010, 23.1 million people needed treatment for substance use disorders. Only 2.6 million received treatment at a specialty addition treatment facility.
• About 68 million people use alcohol at harmful or risky levels and could benefit from brief intervention in primary care and other health settings.
• Treatment for substance use disorders is effective, especially a combination of psychosocial and medication-assisted practices.

The Collaborative’s recent relocation to the school was one of the reasons the former School of Nursing changed its name to the School of Nursing and Health Studies this year. UMKC faculty members knew it was appropriate to rename the School since the scope of programing, research and teaching extended beyond traditional nursing education.

“We are fortunate that the Collaborative is based at the school,” said UMKC School of Nursing and Health Studies Dean Lora Lacey-Haun. “Integrating their expertise into our curriculum puts our students at a great advantage. They are in the forefront of learning how to fill an enormous need in our healthcare system.”