Several opportunities present themselves to Arizona decision-makers in addressing the issue of allowing only credentialed professionals to perform initial behavioral health assessment. Making use of these opportunities will require active and conscientious dialogue among key stakeholders.
Separate screening from initial assessment components, in order to target required credentials for specific activities.
DBHS can assume a leadership role in fostering such a dialogue. It can offer key stakeholders across the state the opportunity to participate in a meaningful discussion about the intended purpose of screening, initial assessment and ongoing assessment, with a view toward developing a more results-oriented delivery system. Determining to what end screening and assessment should guide practice will be another step toward an outcome-focused orientation.
Some implementation problems may disappear upon separating screening from initial assessment. The fact is, screening is already done by non-credentialed but appropriately trained personnel in many parts of Arizona without ill effect. And in referring consumers for behavioral health services, some initial screening has also been performed by other service systems. Indeed, DBHS may find it desirable to stipulate the content of screening and assessment, as well as the expected outcomes, rather than requiring that only Master’s-level and credentialed Behavioral Health Professionals be involved in performing the task.
Develop uniform initial assessment instrument, and make it available at multiple doors to foster service integration.
To realize Arizona’s "No Wrong Door" policy, DBHS will be better served in its role in developing state policy-by focusing on standardizing the content of initial assessment rather than on the credentials of those who perform it. In fact, DBHS has come a long way in standardizing scoring tools for levels-of-care (although not necessarily assessment content). Development of uniform assessment instruments for consumers of behavioral health care will help ensure accountability. It will reduce the administrative burden on consumers and professionals, and also assist cross-system comparisons of service outcomes. Integrating screening and initial assessment has long been promoted by advocates for children’s services, and services to individuals with co-occurring disorders.
Create a collaborative training institute or academy in conjunction with Arizona educational institutions or other interested parties to expedite competency-based training of existing and potential behavioral health personnel.
Such a training institute can include multiple modules and curricula in its training program, and be accessible to the existing and potential work force in health and human services. Training in the use of standardized screening and initial assessment can be part of overall training for Primary Behavioral Health Professionals, a new title supported by DBHS.
In this endeavor, there can be no monopoly on excellence. Ongoing training is critical and necessary for future human resources in public behavioral health; the short supply of qualified personnel and the high cost of formal training programs make this training initiative an urgent task. Further, if Arizona is to enhance cultural diversity in service delivery – to enable individuals of diverse racial and ethnic minorities to enter the health care work force – use of non-traditional personnel and individuals capable of providing culturally competent practice should be moved to the forefront over formally trained and credentialed personnel alone.
Revisit all relevant rules and regulations for potential revision.
To help promote a quality-improvement and quality-management system, some state mandates may benefit from a fresh look at their intended purposes, with a focus on high-quality outcomes rather than only on process indicators. Where revision is necessary, further action needs to be taken by the appropriate parties, including participation by consumer advocates to address ongoing litigation concerns. Carefully reasoned strategies for improving service outcomes should be the common goal of all stakeholders, including consumer advocates.
Clearly, undertaking a revision of state rules should be done in the context of what is within the purview of state discretion. Medicaid is a joint federal-state program and state discretion is available, especially in a Medicaid waiver environment.
Arizona can be principled in its concern for high quality of behavioral health services without being rigid and unbending. Initial assessment can be performed by adequately trained staff without losing quality results – especially when consumers are involved in the process and the format is standardized – so long as credentialed providers are ultimately accountable. In this sense, everyone turns up a winner, most of all consumers of public behavioral health care who are embarked on a process of rehabilitation and recovery.