by Guest Author | Jul 15, 2024 | News, Playbook
We are excited to announce that 4C Health, a leading Community Mental Health Center in North Central Indiana, has made a significant commitment to support the Bowen Center for Health Workforce Research & Policy’s “Playbook for Enhancing Indiana’s Mental & Behavioral Health Workforce.” This commitment, announced on July 12, 2024, represents a crucial step towards addressing the pressing workforce challenges in Indiana’s mental health sector.
Dr. Carrie Cadwell, CEO and President of 4C Health, emphasized the importance of this commitment:
“The need in our rural communities is so great, and the critical factor in our ability to meet that need is workforce. We hope our transparent and public commitment to these Playbook strategies spurs others to do the same. Together we can be industry transforming!”
Read their full post here.
4C Health has outlined an impressive array of initiatives aligned with the Playbook’s strategies, including:
- Increasing the number of behavioral health students trained annually to 50
- Expanding their Peer Workforce from 12 to 30 peers
- Implementing a Doctoral Psychology Practicum program
- Developing an APA-approved psychology internship and post-doctoral program
- Collaborating with local educational institutions to create new pathways into behavioral health careers
- Continuing and expanding their Tuition Assistance and Loan Repayment Programs
- Implementing a 4-day work week model for all staff
These commitments demonstrate 4C Health’s dedication to not only enhancing their own workforce but also contributing to the broader goal of strengthening Indiana’s mental health services.
Indiana’s mental health care system faces significant challenges, with real-life impacts on millions of Hoosiers and long-term implications for our state’s economic outlook. The Bowen Center’s Playbook offers concrete solutions to increase the number of mental health care workers in Indiana. To learn more about the Playbook and its strategies, visit The Playbook home page.
Together, we’re building a stronger, more resilient mental health workforce for Indiana. We encourage other organizations to consider how they can contribute to this crucial effort and make their own commitments to the Playbook’s strategies.
by Guest Author | Feb 1, 2024 | Policy, Topics of Interest
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Total Bills introduced in Indiana’s 2024 Legislative Session
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Total Bills identified with direct impact on health, health workforce or workforce included in the 2024 B4
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Total bills identified with direct implications for health workforce & distinguished separately.
Top Health Workforce Themes in the 2024 Legislative Session
Let’s cut to the chase. What health workforce legislation has been introduced in the 2024 session? There were a few major themes that arose. We have conceptualized these themes and summarized the outcomes below.
Nursing Workforce
- This session has seen many legislative initiatives related to the nursing workforce. One such bill (SB 45) would establish additional training requirements in trauma-informed care for all licensed Registered Nurses (RN). One bill would modify certain licensure requirements for health facility administrators, allow NCLEX passage to satisfy English proficiency requirements for internationally-educated nurse applicants, and eliminate telehealth certification requirement for telehealth nurses and other telehealth providers (HB 132). The final nursing-focused bill making progress this session makes various changes to nurse licensing, education, and training regulations regarding requirements for clinical preceptors, and requirements for certain foreign nursing applicants (HB 1259).
- Bills under this theme that were introduced but did not progress include: a bill removing the collaborative practice agreement with physicians and APRNS, and allows a APRN with prescriptive authority to prescribe a schedule II substance (HB 1059); a requirement for nurses to complete implicit bias training as part of their continuing education requirements (HB 1167); establishment of nurse staffing councils within hospitals in order to develop nurse staffing plans (HB 1015); allowing Certified Registered Nurse Anesthetists to administer anesthesia under the immediate presence of a podiatrist or dentist, which is currently only allowed under the presence of a physician (HB 1371).
EMS
- There have been several bills introduced regarding Hoosier emergency medical services professionals (EMS) this session. HB 1142 would establish a program of recognition for first responders killed or injured in the line of duty. A new grant pilot program was introduced in SB 10 for the purpose of assisting in the costs of mobile integrated health care programs and mobile crisis teams across Indiana. Finally, SB 142 would require healthcare coverage for mobile integrated healthcare and emergency medical services for all state employees on the state employee health plan (and other insurers).
- Bills under this theme that were introduced but did not progress include: HB 1118 would establish a program to support the mental health of first responders through the Indiana first responders mental health wellness fund and program.
Regulatory Changes
- House Bill 1214 would add Indiana to the Dental and Dental Hygienist Licensure Compact.
- Bills under this theme that were introduced but did not progress include: A bill proposing the expansion of eligible clinical experience supervision to include physicians, and psychologists for the Clinical Social Work Licensure and expansion of supervision through telehealth (SB 261); bills that would establish new licenses – Professional Music Therapists (HB 1103) and Naturopathic Physicians (SB 262); and a bill (SB 110) that would add Indiana as a member of the Social Work Compact.
Behavioral Health Workforce
- A bill proposed in the House would allow a Social Worker licensee applicant to take the social worker examination during their last term of a program that meets educational requirements, and provides a letter of good standing from the director of the academic department (HB 1138). This bill would allow a student to sit for their professional exam early if all requirements in the bill are met. House Bill 1238 would add certain physician assistants and advanced practice nurses as potentially qualifying professionals to serve as competency evaluators in criminal proceedings (previously only psychiatrists and psychologists).
- Bills under this theme that were introduced but did not progress include: SB 166 which would have allowed community mental health center staff to provide social work services without a license and remove examination requirement for BHHS temporary permits; SB 261 which would have expanded the qualifications for clinical experience supervisors for clinical social workers and expanded tele-supervision.
Other health workforce themes from legislators that didn’t make it to the second chamber:
Health Workforce Incentives
- There were a few bills related to health workforce specific incentives, including a bill that would establish a medical school loan forgiveness pilot program (HB 1175). Another bill would establish an Indiana rural hospital and critical health care services fund, new health workforce student loan repayment program, and associated health workforce advisory board (advisory board (HB 1196).
There’s More on the B4!
One way we monitor health workforce trends is by tracking Indiana health workforce legislation through implementation of the Bowen Bi-Weekly Bill Brief or “B4.” There are many other health and workforce/education-related bills that have been introduced this session. Check out the full B4 to learn more about those bills and keep track of the active bills as they progress through the second half of session!
by Guest Author | May 4, 2023 | Policy, Topics of Interest
What is the B4?
The Bowen Center is committed to providing relevant and timely data to inform health workforce policy. A few years ago, we realized the best way to fulfill that commitment was to keep close tabs on the topics of interest by Indiana stakeholders. One way we monitor this is by tracking Indiana health workforce legislation through implementation of the Bowen Bi-Weekly Bill Brief or “B4.” When we first developed the B4, we kept it as an internal tracker to keep our team up-to-date on health workforce happenings. We quickly realized that this tracker could serve additional audiences and we could pivot its dissemination to a forward-facing tool.
Now in its fifth iteration, the B4 experienced a re-design in 2022 to enhance accessibility of customized information for users through the use of an interactive table hosted on the Bowen Portal. Users can now search for keywords of interest and filter by topic area. Below are this year’s topical categories for health workforce-related legislation: (Note: in the instance a bill may fall under multiple categories, it was assigned to a primary topic. We are already making plans for 2024’s B4 to allow for tagging of multiple topical areas.)
Topic Areas
- Behavioral Health (substance use and mental health),
- Corrections
- Direct Care Workforce
- Maternal/Child Health
- Nursing Workforce
- Oral health
- Other
- Physician Workforce
- Prevention & awareness (public health, infrastructure, and healthy and active living)
- Regulatory (Agency, Boards, PLA)
- Safety net (Medicaid, SNAP, TANF, SNAP, etc.)
- School Health
- Workforce Pipeline (Education)
- Workforce Incentive Program
What else did we do new in 2023?
In addition to making the B4 more interactive, we expanded its reach. Before 2023, we focused almost exclusively on bills with a primary focus on the health workforce. Think health workforce incentive program development, new license types, educational policy changes, etc. While planning for 2023, we realized that there are many instances where the bills that impact health care professionals the most are broader bills that impact both the health workforce and other sectors. In 2023, we developed a new structure that monitors bills with a primary focus on the health workforce (of course), but we began including bills that also impact health or workforce/education. These major category areas can be found within the 2023 B4.
Top Health Workforce Themes in the 2023 Legislative Session
Let’s cut to the chase. What health workforce legislation passed in the 2023 session? There were a few major themes that arose. We have conceptualized these themes, and summarized the outcomes below.
Long-term Supports and Services Workforce
- Outlines that a home health agency is not required to conduct a preemployment physical on prospective staff prior to patient contact; Allows home health aides to administer g- or j-tube feedings if certain criteria are met (Senate Enrolled Act 474)
- Outlines requirements for a direct support professional registry which direct support professionals must be on in order to provide direct support services, and describes requirements for the creation of a training curriculum and growth opportunities for direct support professionals (House Enrolled Act 1342)
- Provides that the Family and Social Services Agency Division of Aging may hire a dementia care coordinator to establish a “dementia care specialist” program to establish training requirements for dementia care specialists employed by area agencies (House Enrolled Act 1422)
- Sets the professional requirements for an individual to serve as a residential care facility administrator and creates notification requirements to the Indiana department of health when there is a vacancy or new hire of a residential care administrator. (House Enrolled Act 1461)
Licensure Compacts
- Establishes Indiana’s participation in Occupational Therapy Licensure Compact to allow occupational therapists and occupational therapy assistants to practice in Indiana under an out-of-state license if certain criteria are met (Senate Enrolled Act 73)
- Professional Counselors Licensure Compact to allow professional counselors to practice in Indiana under an out-of-state license if certain criteria are met (Senate Enrolled Act 160)
- Recommendation for interim study committee to study whether Indiana should adopt an interstate mobility to allow individuals with licenses in another state to practice in Indiana (Senate Enrolled Act 400)
Removal or Reduction of Noncompetitive Agreements:
- Beginning July 1, 2023, primary care physicians and employers may not enter into a noncompete agreement. This legislation also outlines procedures for eligible physicians to purchase a release from a noncompete agreement for agreements entered into after July 1, 2023. The legislation also establishes circumstances under which an agreement is not enforceable (Senate Enrolled Act 7)
Regulatory Changes
- Modifies field experience requirements for marriage and family therapist or a therapist associate licenses (Senate Enrolled Act 11)
- The Office of Medicaid Policy and Planning may not require telehealth providers to have a physical address in Indiana in order to be enrolled in Medicaid. (House Enrolled Act 1352)
- Would allow nursing practice (RN and LPN) under a temporary permit while pending application review. Would allow information to be collected from IDOH consumer services occupations (home health aides, qualified medication aides, certified nurse aides) and state board of physical therapy. Transitions nearly all initial licenses and registrations from paper to electronic. Removes provisional license language and requires issuance of license by endorsement (if license held in other state or jurisdiction) in 30 days (House Enrolled Act 1460)
- Establishment of a “Temporary Health Care Services Agencies” registration (under Indiana Department of Health), including outlining which Indiana licensed health professions met its criteria, services provided, regulatory requirements, and prohibited services (ex. restricting employment opportunities) (House Enrolled Act 1461)
- Removal of requirement for dentist and dental hygiene licensees pay a $20 compliance fee (House Enrolled Act 1113)
- Pharmacists are able to prescribe and dispense certain hormonal contraceptives if certain criteria are met (House Enrolled Act 1568)
There were many other health and workforce/education related bills that also made it into law. Check out the full B4 to learn more about those bills.
What other resources do you have that might be of interest to me?
The Bowen Bi-Weekly Bill Brief is just one way the Bowen Center seeks to provide stakeholders with high-quality, objective information about Indiana’s health workforce. Through the Bowen Library, you can stay in the know about Indiana’s health workforce professions through bi-annual health workforce data reports, policy briefs, and more.
by Guest Author | Apr 6, 2023 | Data, Policy, Topics of Interest
Black maternal health has been a professional passion of mine since completing an internship focused on data informed policy solutions to Black maternal health issues while in graduate school. As a Black woman, it has also been a personal passion. When I became a mother in August of 2022, this issue only became dearer to my heart. I wanted to keep myself safe during pregnancy, labor, and postpartum and I want to find solutions that will keep my daughter safe once it’s time for her to become a mother.
Black Maternal Health Week was first implemented by President Biden in 2021 (1). This week is focused on bring awareness to the pregnancy-associated health issues experienced by Black women in the United States. Maternal mortality, or pregnancy-related deaths, refer to any death during pregnancy or within the first year after birth that is caused by or exacerbated by pregnancy (2). National trends in the U.S. show that Black women have a maternal mortality rate 2.9 times higher than the maternal mortality rates for white or Hispanic women and, alarmingly, rates have increased since 2019 (3). In 2020, Indiana had the third highest maternal mortality rate in the entire country. Black Hoosier women had maternal mortality rates almost twice as high as white Hoosier women and almost three times as high as Hispanic Hoosier women (2). As a response, the Indiana state legislature passed SB 142 in 2018 (4) which established the maternal mortality review committee (MMRC). This committee is responsible for investigating the deaths of pregnant women or women up to 1 year postpartum, which are required to be reported by all health care providers in Indiana. Indiana cares about Black Maternal Health and has implemented state policies to improve it. The theme for Black Maternal Health Week this year is “Our Bodies Belong to Us: Restoring Black Autonomy and Joy”, and it is true – Black mothers can take control of their birthing experience.
Lessons Learned
I’ve learned some things through my journey to motherhood that I’d like to share.
1. Know Your Options. There are many different maternity care providers in Indiana, from traditional OB-GYNs to Advanced Practice Registered Nurses or Certified Nurse Midwives. Along with different providers, there are a variety of settings within which maternity care can be provided such as hospitals, birth centers and even within your own home. Don’t be afraid to shop around to find a provider that aligns with your values and your desires for your birth.
The Bowen Center has published a detailed Maternity Care Workforce Assessment, which can be found here, and an accompanying brief, here. This resource details characteristics of all physicians or Advanced Practice Registered Nurses who report providing maternity care services. I personally chose to deliver in a hospital setting with a Certified Nurse Midwife. I also chose to have a doula as research seems to indicate the presence of a doula can reduce risk of maternal mortality and adverse birth outcomes (5,6).
2. Be persistent. Diversity in medical providers can reduce risk of maternal mortality which led me to personally prioritize finding a provider that was from a racial minority group that is underrepresented in medicine (2,7). The Bowen Center has recently published a series of reports and briefs detailing diversity in a variety of healthcare professions. You can currently find the methodology here and the report on physicians here. Reports for registered nurses, pharmacists, dentists and other healthcare professionals are forthcoming.
In my own experience, I found it difficult to find a provider who accepted my insurance, was from a minority group and could see me without a long wait. I even switched my provider when I was 8 months pregnant because I felt I wasn’t in alignment with my first one. Be persistent, and don’t be afraid of uncomfortable conversations. The payoff of having a maternity care provider who aligns with your values is worth the effort required for your best experience during pregnancy and childbirth.
3. Prepare for postpartum. I spent a lot of time preparing for birth and preparing for bringing my sweet baby home, but not a lot of time preparing for my postpartum experience. The postpartum experience can be very difficult as you physically heal from giving birth, deal with sleeping less than before, adjust to your new role as a mother AND learn to care for a baby! It’s imperative that mothers have access to resources to deal with these changes. In 2022, Indiana passed HB 1140 which extended pregnancy Medicaid coverage to 1 year past birth to help ensure access to healthcare services during this sensitive time (8). Each legislative session, the Bowen Center posts bi-weekly updates on the progress of bills, like HB 1140, that are related to health or the health workforce. Whether it’s a health care provider to check on you physically or mentally, or a postpartum doula to help with laundry and the dishes, don’t be afraid to ask for help. There are options available for you.
Becoming a mother has been the most joyful and fulfilling experience of my life and getting to watch my beautiful baby girl learn and grow is the best part of my life. Every mother deserves to experience that. I am very thankful to work on projects that highlight opportunities to enhance health workforce diversity. In fact, I am honored to have the opportunity to speak on this topic at my first national conference in Washington D. C. in May. I hope that the health workforce research I am involved in will improve Black maternal health enough that my daughter will not face the challenges that I faced when searching for a Black maternity care provider who shared my same vision for my birth.
Be well.
-Mykayla Tobin
by Guest Author | Apr 3, 2023 | Events, News, Policy
Bowen Director Dr. Hannah Maxey
Bowen Director Dr. Hannah Maxey provided expert testimony to the United States Senate Special Committee on Aging on March 9, 2023. Her presentation focused on strengthening the home and community-based care workforce, a critical component of support for aging Americans. Dr. Maxey highlighted various state-led initiatives to improve home care services, including standardizing worker titles and training, implementing portable credentials, and enhancing wages and benefits.
Emphasizing the crucial role of states in this effort, Dr. Maxey stated, “States have a critical role in reinforcing the front line of our nation’s communities of care.” She stressed the importance of data collection to inform workforce planning and policy decisions, noting that “Data is the foundation of informed workforce policy.” Dr. Maxey also addressed the challenges faced by the workforce, including low wages and the potential loss of benefits as wages increase, known as the “benefits cliff.”
Reflecting on the universal importance of this issue, Dr. Maxey remarked, “Time waits for no man. The issues of the aging are the issues of us all.” She concluded by underlining the significance of the home care workforce in supporting seniors and the ongoing need for efforts to bolster this essential component of community care, saying, “At some point in our lives, many of us will rely on this workforce, for a loved one or even for ourselves.”
Read Dr. Maxey’s full testimony here
Watch Dr. Maxey’s testimony here on the U.S. Senate Special Committee on Aging website (begins around the 43:00 minute mark)
