Study Examines Behavioral Health Care Workforce Training
It’s a trend that’s not a secret — America’s population is aging.
There have been numerous studies on the challenges that come with an aging population. Where will they live? Who is providing adequate health care? What resources will they need to maintain their quality of life?
One such study, led by the University of North Carolina at Chapel Hill Behavioral Health Workforce Research Center, sought to better understand how improving workforce training might improve care of this population. The study focused on the geriatric behavioral health care workforce, trends in geriatric fellowship training, and how enhanced training can improve the lives of seniors.
In their policy brief “Advanced Behavioral Health Training in Geriatric Fellowships,” UNC Department of Family Medicine and School of Social Work Research Assistant Professor Brianna Lombardi and Associate Professor Lisa de Saxe Zerden examine current behavioral health care training within family medicine (FM) and internal medicine (IM) geriatric fellowship programs. The pair were joined by UNC School of Medicine Associate Professor Mallory M. Brown.
Specifically, the research team looked at behavioral health training content present within FM/IM geriatric fellowship training programs; how training settings affect training received by fellows; and the barriers and facilitators to integrating behavioral health care training within geriatric training programs.
“Despite the dramatic demographic shifts the U.S. is experiencing with our aging population increasing, living longer and becoming more diverse, there are worrying trends in how this population is accessing behavioral health services,” Zerden said. “Older adults are less likely to receive behavioral health treatment compared to their younger counterparts and there are several reasons, sometimes simultaneously, why this occurs.”
Some of those barriers include stigma around receiving mental health care treatment, cost, unfamiliarity with telehealth care, and transportation.
“Another important consideration is the workforce and the lack of geriatric trained physicians including behavioral health providers who specialize in the health and wellness of older adults,” Zerden said.
Workforce shortage
The American Geriatrics Society reports a need for 20,000 geriatricians to address the current needs for seniors in the United States. However, there are just 7,300 certified geriatricians practicing nationwide and that number is trending downward.
“This means that older adults do not have enough people prepared to meet their needs,” Lombardi said. “Despite increased demand, supply is going down. For example, despite more than 700 accredited geriatric fellowship training positions across the U.S., 50% of these training slots remain vacant. This has a cascading effect on who is available to train, inspire and support future geriatricians. It also creates potential burdens for existing mentors and preceptors who have older adult expertise but lack other colleagues who can share this teaching responsibility.”
To better understand the current geriatric workforce, its barriers and incentives that could bolster the workforce in the future, the research team administered an electronic survey that was distributed to FM/IM geriatric fellowship program directors and coordinators.
Survey findings
Fifty-six fellowship programs across 28 states responded to the survey, providing a snapshot of current behavioral health trends in geriatrics.
The survey found that the reporting fellowship programs documented a high rate (80%) of classroom and clinical training for screening and assessment of common behavioral health issues, including depression, anxiety and other mental health conditions. There was a lower rate (52%) of reported training for suicide risk, bipolar disorder and psychotics disorders, and an even lower rate for training on substance use and addiction content.
Fellows were also more likely to report psychosocial and behavioral health management training in clinical opportunities (75%) compared to classroom opportunities, with the most common settings in academic hospitals, academic outpatient settings, and nursing homes.
“Overall, a positive finding reinforced the essential nature of interprofessional teams when providing care to older adults,” Zerden said. “Programs described working with social workers and other behavioral health providers to help train fellows. We also found that the most common facilitator to help enhance behavioral health content for geriatric fellows was when fellowships were connected to other programs such as psychology training programs, social work trainees, psychiatry training — again further highlighting collaboration and interprofessional training.”
The survey also identified barriers to behavioral health care training for geriatric fellowship programs, including not enough training preceptors (55% reporting), limited training sites (50%) and too many competing curriculum interests (46%).
Having existing community partnerships and training sites with an emphasis on behavioral health care was a facilitator for training, while establishing interprofessional partnerships between fellowship educators also helped facilitate training opportunities.
“A central theme to the barriers and facilitators identified in integrating behavioral health content into geriatric fellowships centered around partnerships — partnerships with other behavioral health trained preceptors and partnerships with community organizations that provide this type of care to older adults,” Zerden said.
“Expanding behavioral health care for older adults cannot solely fall on fellows alone. Rather, preceptors and faculty who interact with geriatric fellows also require the skills and competence to work with older adults in meeting their behavioral health needs. This is an opportunity for social workers to share their expertise and knowledge and help prepare the geriatric workforce.”
Policy implications
Overall, the survey findings highlighted that many of the programs do provide advanced behavioral health care training both in the classroom and during clinical rotations. However, expanding training and clearly identifying behavioral health competencies for older adults is needed.
The authors call for two things: Increasing the number of trained and passionate preceptors for training and establishing partnerships with settings that provide behavioral health care and training.
The study also recommends increasing funding for geriatric fellowship programs “to enhance training content, partnerships, and behavioral health expertise can help facilitate a more well-rounded, prepared geriatrician workforce who can meet the full spectrum of older adults’ needs.”
“Given the population growth and the behavioral health needs of older adults, identifying mechanisms to increase behavioral health service access for older adults is critical for medicine; but it is also incumbent on behavioral health and social work,” Lombardi said.
“Just as we have had federal funding mechanisms to enhance the behavioral health workforce focused on children or integrated care, such as the Health Resources and Services Administration’s Behavioral Health Workforce Education and Training Program, we need more investment in older adults’ behavioral health— specifically (in areas) for social workers to engage in directly. UNC does have a Geriatric Workforce Enhancement Program, but this is an area where social work students should see the demand for their future work and services.”
Additionally, the study notes the decline in physician interest in gerontology and the need to increase excitement in geriatric care.
While it is encouraging that most family medicine and internal medicine geriatric fellows are receiving behavioral and mental health care training, invigorating geriatric training could help prepare the workforce to better meet the health and behavioral health needs of older adults.
by Matthew Smith
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