In recent editions of Behavioral Health News, we have written of sweeping transformations in services offered at The Mental Health Association of Westchester (MHA). These transformations require critical staff development – learning new skills and new processes of working. To manage these changes, “owners” of the Change Management Process are essential. Thus, we need owners of training and incorporation of new skills, of integrating new ways of working, of communicating about and keeping large changes on time and on track, as well as evolving infrastructure to support our work.
Change Management Champions: MHA has invested in developing change management leaders and an ongoing Project Management initiative. Meeting regularly with our Project Management team, Program Directors are responsible for keeping identified projects on track. They identify the action steps, the associated timelines and additional support required to move forward. Progress is tracked regularly, highlighting aspects that are moving forward as planned and especially those that require assistance. Examples of significant initiatives that are “project managed” include the expansion and integration of Substance Use Disorder (SUD) services into our clinics and development of a new residential site that integrates affordable housing with supported housing for individuals with behavioral health diagnoses.
Skill Development: Across all of our services, staff have been required to expand and deepen their skill sets. For example, as we incorporate SUD services, clinicians have learned new assessment tools as well as clinical approaches, such as Screening, Brief Intervention and Referral to Treatment (SBIRT), Integrated Harm Reduction, and Dialectical Behavior Therapy (DBT) for SUD. Physicians are now providing Medication Assisted Treatment (MAT). Our Peer Specialist training, which prepares participants for NYS certification through OMH, now includes Certified Recovery Peer Advocates (CRPA) training, enabling them to provide peer support through the lens of substance use as well as preparing them for NYS certification under OASAS. These certifications provide trained Peers with marketable skills and enhance capacity to obtain meaningful paid work. Throughout the agency, interested staff have participated in training to use Narcan to reverse opioid overdose. Care Managers assist individuals who experience complex and chronic medical and/or behavioral health conditions. To do their jobs effectively, Care Managers have required training in medical conditions, medications, and the interaction of multiple health conditions. Effecting change in life is difficult. Whether the change is related to use of substances or alcohol, developing wellness practices or developing new ways of managing life’s stresses, change requires significant personal commitment. To that end, staff across many of our services have been trained in Motivational Interviewing (MI). Beyond our clinic, our expanded Children’s Services and Home and Community Based Services staff train in the specific skills required to deliver those services.
In addition to training that we organize or that is provided by regulators, we strongly encourage staff to pursue learning in areas of particular interest to them. Staff are encouraged to apply internally for financial support and/or use of work time to hone specific skill sets that support their work. These opportunities are available not only to those who provide direct services, but those who support the work – e.g., those in Finance, Communications, and HR. To support our Licensed Social Workers and Mental Health Counselors to satisfy their NYS Continuing Education requirement, we deliver on-site courses that enable them to substantially or fully meet that need.
Train-the-Trainer Capacity: Expertise to deliver in-house training enables us to provide training when and as needed, flexibly meeting the needs of staff. In-house training is time and cost efficient and allows us to adapt training to our specific needs. MHA staff include credentialed trainers in, e.g., Suicide Awareness for All (safeTALK), Applied Suicide Intervention Skills Training (ASIST), Motivational Interviewing (MI), SBIRT and CRPA. We are currently developing Train-the-Trainer capacity for Peer Supported Open Dialog (POD). POD is a fully collaborative model that utilizes a family and peer “social network” model to address acute crises as well as ongoing concerns. To assure that those who have content expertise are also effective trainers, we have developed internal “Train-the-Trainer” preparation that teaches principles of adult learning and facilitation skills.
Leadership Development: As in many agencies, skilled providers are promoted to managerial positions. However, the knowledge and skills of managing program operations, budget, and staff are different than that required to do the work. We have invested in developing the next cohort of leaders in multiple ways. Groups of our middle managers have participated in a formal 3 ½ -day Middle Managers Academy training delivered by The National Council for Behavioral Health. The curriculum, specifically created for the behavioral health field, addresses developing leadership style, mastering key management tasks and responsibilities, managing and motivating employees, teamwork and accountability, as well as managing budgets and financial information. We consolidate these learnings through an ongoing peer-led monthly meeting for managers, which includes focused training delivered by executive staff. The goals of the initiative are to deepen managerial skills and provide peer support through challenging situations. Executive staff have participated in other leadership development programs, including those offered by Nonprofit Westchester and Manhattanville College.
Philosophy: MHA prides itself on maintaining its focus on delivering person-centered care based on principles of shared decision-making. All staff receive training on the philosophical framework within which our services are delivered. At orientation, and then in a more in-depth manner during their first year of employment, all staff participate in training about the principles of person-centered care, trauma informed care and aspects of cultural competence. These sessions are in addition to training required by regulation, including sexual harassment, compliance, and reporting of child abuse and neglect.
Challenges: Developing a well-trained staff and supervising implementation of new knowledge and skills presents numerous challenges. For example, as we expand the array of new services – such as incorporating SUD services into our more traditional mental health services – we must assure that staff are fully trained. Appropriate training programs must be built or identified and purchased. Taking staff away from daily responsibilities is costly: in many cases reducing delivery of billable services while staff participate in training sessions or requiring that services be delivered at other times. Our workflows and supervisory process must support the integration of new skills. At times, on-going scheduled consultation calls are built into the training schedule. The significant time and money dedicated to developing staff capacity is an investment in improved quality of services, greater efficiency of delivery, and ultimately improved outcomes and client satisfaction. High quality training is expensive. In recent years, government attention to workforce development has provided a significant source of financial support, e.g., through DSRIP and other initiatives. Going forward, alternative sources of funding will be required.
As staff size and training requirements grow, tracking training needs presents another challenge. The Excel spreadsheet which once met our needs is now outdated, inefficient and underpowered. Numerous Learning Management Systems are available for purchase. It is critical that we find the system that is the best ‘fit’ for our agency; a task that is still in process.
Historically, we have relied on face-to-face training sessions and highly value the opportunity for in-depth conversation. As we have embraced the many advantages of online training, especially appreciating the time flexibility of ‘on-demand’ training, we continue to explore the best hybrid model for our needs. Should staff participate in online training as it suits their schedule and then meet for discussion? Are we better served by participating as a group? Are there some topics that do not require discussion?
Finally, one of the most significant challenges is that of evaluating training. How do we assess that a training module has effectively delivered the essential content? Most importantly, how do we assess the degree to which staff have learned the material and subsequently incorporate it into their practice? How do we adequately supervise incorporation of new skills?
As we address these and other challenges, supporting staff through their specific professional development track and providing the highest quality service remains an ongoing priority and commitment at MHA.