Preparing for Health Care Reform: Examining Training Behavior Among Community Mental Health Clinics

Background and Purpose:The Affordable Care Act has changed the landscape for community mental health clinics with its aims of improving people’s experience of care while simultaneously reducing costs. To achieve these goals, clinics are adopting integrated health care models, which require close collaboration between primary, mental health and substance use providers and the adoption of evidence based practices. Providers need to acquire the skills to deliver person-centered care, administer screenings, help people manage their wellness, and work in interdisciplinary teams. To fund services, clinics will have to follow value based purchasing models where reimbursement is tied to quality and outcomes.  This study examines whether and how community mental health clinics make use of available technical assistance training to help them prepare for health care reform.          

Methods: The study matched two datasets to examine the organizational characteristics and use of training for 196 community mental health clinics in New York State. Organizational characteristics were drawn from SAMHSA’s National Mental Health Services Survey (N-MHSS). Training variables were drawn from the master training database maintained by Community Technical Assistance Center, a consultation and educational resource center available to all mental health clinics in New York State, which provides a variety of free trainings and resources to help improve clinic operations and services.  Chi-square analyses and multivariate logistic regression models were used to examine the proportion of organizations that make use of the available training, the organizational characteristics (size, services, resources and population served) that predicted participation in training, and for those who participated, the type (clinical or business) and intensity of training (webinar, learning collaborative, in-person) they received.

Results:  Overall 142 (72. 4%) of the sample participated in training. Clinics who pursued training were more likely to be larger (p=.02), serve children in addition to adults (p<.01), provide child evidence-based practices (p=.01), and use computerized scheduling (p=.01). Of those trained, 95% participated in webinars, 64% participated in learning collaboratives and 35% participated in in-person trainings. More organizations participated in clinical than business trainings (86.7% vs. 63.8%). Clinics serving children had higher odds of participating in both clinical training (OR=4.24, p<.01) and business training (OR=5.91, p<.01) than those that did not serve children.

Conclusions and Implications: The majority of clinics made use of available free trainings indicating their perceived need for technical assistance to prepare for health care reform. Larger clinics were more likely to pursue training supporting the notion they may be more interested and able to adapt to these changes than smaller clinics.  Clinics serving children were much more likely to seek training suggesting there may be more interest for training related to child services.  Although clinics made more use of clinical training, over half participated in business trainings highlighting the interest in learning new business models to provide efficient care. Overall, as health care reform brings about sweeping changes, we need to understand how to support organizational readiness among community mental health clinics.