Great strides have been made in Arizona in screening. The Interagency Case Management Project and the Model Court program have promoted better collaboration among different children’s services, including streamlined screening and referral systems. There is ongoing collaboration between the Arizona Health Care Cost Containment System (AHCCCS), the state’s Division of Behavioral Health Services (DBHS), and the five Regional Behavioral Healthcare Authorities (RBHAs) in furthering integration of general health and behavioral health care at the local and regional levels. Further, the Arizona Levels-of-Care system is recognized as one of the best in public behavioral health care,¹⁰ and DBHS has continuously sought to improve the content of behavioral health service delivery.

In recent months the issue of behavioral health credentialing has received considerable public attention in Arizona. DBHS has stipulated that by 2003, a Master’s level and certification as a Primary Behavioral Health Professional (PBHP), or licensure as a PBHP, is required for those carrying out initial behavioral health assessments.¹¹ The added cost to the system in recruiting and retaining qualified personnel to meet this requirement, especially in rural regions of the state, has raised concerns in some quarters.

Currently Arizona has several boards overseeing certification of behavioral health professionals. The Board of Medical Examiners licenses allopathic physicians, and the Board of Osteopathy licenses osteopathic physicians. Allopathic and osteopathic physicians can then become certified by the National Board of Psychiatry and Neurology as psychiatrists, or are considered "Board Eligible" if they have completed an accredited psychiatric residency. Registered nurses and nurse practitioners are licensed by the Board of Nursing (and physician assistants by another board). They can be considered behavioral health professionals if they have two years of experience with psychiatric patients. The Association of Psychologists licenses psychologists. The Board of Behavioral Health Examiners provides certification for social workers, substance abuse counselors, marriage and family therapists, and other counselors. While certification of behavioral health professionals other than psychiatrists and psychologists is voluntary at present, there is some pressure – as well as incentive – for all such certification to become mandatory, as DBHS moves to implement its credentialing requirements by 2003.

The rules and procedures of the Board of Behavioral Health Examiners stipulate a period of 90 days for its initial administrative review of applications for certification, followed by a second review of up to six months by a credentialing committee, and a final decision by the Board. Since both the committee and the Board meet once a month, even assuming that all documentation is in order, an application may take six months or longer. The certification takes far longer than is typical of similar certification process used in other states (see next section). At a time when more credentialed behavioral health professionals are being required by payers, regulators and RBHAs, obviously more resources will be necessary to shore up the Board’s capacity to process new applications and reduce certification time. It may well be necessary for the Board of Behavioral Health Examiners to further simplify and streamline its rules and procedures.

Financing and recruitment/retention will remain important considerations. While RBHAs are projecting costs incurred by requiring Master’s level credentialed professionals to perform initial assessment, there is also the related concern that, even if cost is of no concern, it remains questionable, given overall recruitment and retention problems, that enough personnel are available in Arizona to meet such a requirement. Again, this raises the fundamental question: Is it really necessary, to use credentialed professionals in all screening and initial assessment activities?

Adequate training and supervision by credentialed professionals ought to be able to provide sufficient assurance of quality. Obviously there will be attendant cost associated with this training. Arizona officials might want to consider conducting comparative studies to determine if the added training is cost effective when compared to meeting state credentialing requirements.