by Angie Berezny | Aug 19, 2024 | Other
I am most passionate about mental health in two ways. One is regarding the mental health of our children and everything they navigate through with technology and social media. As parents, we are watching our children grow up in a world that differs greatly from the world we grew up in as children. Children are being exposed to technology and devices at a young age, whether it be personally or through friends. Devices provide them with an entire online world, including social media. Our family experienced just how detrimental this can be to our children’s mental health.
Our personal story is one that I don’t share often but I will say, we are truly fortunate to have had a close-knit village of friends and family who helped us on our journey and without them, we wouldn’t have made it through. From a parent’s perspective, the biggest challenge we faced was trying to educate ourselves while also trying to afford therapists and additional resources. Therapy is costly, and many therapists do not accept insurance. Prior to joining the Bowen Center, my family struggled with mediocre health insurance, but without it, we would have gone broke trying to get our daughters the help they needed. Covering $125 weekly therapy sessions out of pocket was costly, but in our minds, absolutely necessary. We were willing to pay any amount to get our daughters the help they needed.
Second, is the story of my sister, Taylor Nielsen, a former police officer who began struggling with post-traumatic stress disorder in 2016, following a traumatic case. More information on her personal story is found in the 2018 article New Police Mental Health Awareness Law Celebrated. Taylor inspired the Law Enforcement Mental Health and Wellness Act. She was honored to attend President Trump’s January 30th, 2018 State of the Union address as Senator Donnelly’s guest.
While what she experienced was tragic, what transpired from that experience will be life-changing for so many. She has since left the department and moved to Arizona, where she is taking classes toward her Psychiatry license, focusing on working with first responders. In addition, our daughter is attending IU Bloomington this fall to major in Psychology. I am very proud of both of them for being strong enough to share their stories and for using their experiences to help others who are struggling!
by Hannah Maxey | Dec 18, 2019 | Other, Topics of Interest
I don’t know about you but when I hear or see the phrase “20/20 Vision,” I immediately think about eye exams. In that context the phrase is used to describe visual acuity (the clarity or sharpness of vision) at a distance of 20 feet. But VISION can be deeper than a physical ability to see the world around us. Vision can also mean the ability to see beyond the current state to future possibilities. This type of visioning is critical to advancing policy and improving health.
The Rearview Mirror
Ten years ago, Indiana did not have a clear “picture” of the health care workforce. We reactively identified workforce shortages if and when a community member/advocate came forward and requested assessment. From anecdotal information we knew we had shortages, but we just didn’t have the workforce data to prove it. (See map of Dental Shortage Areas from 2009.)
Workforce in Focus
Today Indiana is in a very different place. Because of investments in health workforce data infrastructure, we know where our health care workforce is and where it is not. (See 2019 map of Dental Shortage Areas). It took vision to get here. A vision that began with seeing past the problem (we don’t have the health workforce data we need to ID our shortage areas) to opportunities (collecting the data we need during health professional license renewal) and solutions (2018 Senate Enrolled Act 223, which ensures we get the data we need). As a state, we are now able to proactively identify workforce shortages. Other states are now looking to Indiana to learn how they too can craft a vision for bringing their workforce into focus.
The View Ahead
As the Bowen Center looks ahead to 2020, our line of sight has expanded and so has our vision. We’ve sharpened Indiana’s health care workforce lens, and now we have set our sights on informing broader health care policy. Workforce shortage identification is critical, but it is just the tip of the iceberg. We are excited to “pull-up” a chair in new conversations, use our expertise to bring problems into focus, and turn health improvement visions into reality.
by Courtney Randolph | Aug 7, 2019 | Other, Topics of Interest
What happened in health workforce policy and what’s on the docket?
The dust has settled from Indiana’s 2019 Legislative Session and we want to provide you with a recap of major changes in the health workforce policy realm. With 2019 being a “long session” (AKA a budget year), it was jam-packed with initiatives and much was accomplished. We hope you were able to follow along during the session using the Bowen Biweekly Bill Brief, or B4, Tracker. The B4 highlighted health workforce-specific bills and served to inform and update stakeholders on relevant initiatives. The latest version of the B4 is linked at the bottom of the post. (This was our first year implementing the B4 and we’d love to get your feedback on it. What worked? What didn’t? How can we make it better? Email us at bowenctr@iu.edu with your thoughts.)
Now, let’s jump into a summary of enacted health workforce related legislation from the 2019 General Session:
Licensing/Regulation Changes
- Nurse Licensure Portability: The Nurse Licensure Compact was signed into law and is set to go into effect in 2020. This will allow participating nurses to practice in any compact state under a single compact license. (HEA 1344 [1])
- Behavioral Health Workforce License Requirements: Regulatory changes were made to select behavioral health professions. These changes impact education or experience requirements for licensure. (SEA 527 [2], HEA 1199 [3])
- Regulation of Physical Therapists: Physical therapy now has its own licensing board (it was previously a committee under the medical licensing board). (SEA 586 [4])
- Office-based Opioid Treatment Providers (OBOTs): Medication-Assisted Treatment, or MAT, is generally delivered in two types of settings:
1) Opioid Treatment Programs, which are organizations regulated at both the federal and state levels, and 2) OBOTs, which are community-based providers with a federal waiver to prescribe associated medications (DATA 2000 [5]). Before 2019, there was minimal state regulation for OBOTs. Rules will now be created by the Medical Licensing Board (in consultation with Indiana State Department of Health, Family and Social Services Administration) for office-based opioid treatment (SEA 141) [6]. Federal code for OTPs outline staffing requirements.[7] It is unclear whether Indiana seeks to adopt staffing requirements for OBOTs.
Delivery/Practice Changes
- Mobile Integration Programs: Emergency medical personnel are now permitted to provide (and be reimbursed through Medicaid for) expanded services including: transportation, acute care, chronic condition, or disease management services. This is consistent with national trends to allow and reimburse for community paramedicine services.[8] (SEA 498 [9])
- Addressing Infant Mortality through Perinatal Care: HEA 1007[10] requires health care providers to screen and treat pregnant women for/with substance use disorder and SEA 416[11] requires Medicaid reimbursement for doula providers.
- Telehealth: Psychologists may now deliver tele-psychology services to patients in Indiana (HEA 1200 [12]).
Summer Session Legislative Initiatives
Indiana’s 2019 policy work does not stop at the spring general session. There were a number of health workforce initiatives that spilled into summer session agendas. The 2019 Interim Study Committee topics were announced at the end of May and can be found at: https://iga.in.gov/documents/4500c157.
- Health Care Costs: There were a number of bills calling for a study of the contributing factors of health care costs. This topic made it onto the agenda of multiple interim study committees (Financial Institutions & Insurance; Fiscal Opportunities; Public Health, Behavioral Health, and Human Services)
- What does this have to do with the health workforce?
- Access to care in rural areas was one of the identified sub-topics. As Indiana seeks to address shortages of health care providers, wise allocation of workforce development funding will be critical.
- As Indiana seeks to reduce health care costs, it is likely that alternative payment and/or delivery models may be explored. Many new mechanisms for care delivery require that a workforce is trained and ready to deliver care in an innovative way. This could be applied to technology innovations (such as telehealth) or emerging care team models/members (such as community health workers, paramedics in community settings, doulas, etc.).
- Advanced Practice Registered Nurses (APRN) Operating without a Practice Agreement: Two bills this session sought to remove requirements for a practice agreement for APRNs delivering care (SB 394 [13], SB 343 [14]). There was a lot of discussion on both sides and from public testimony; ultimately, neither bill made it across the finish line. This topic will be studied by the Public Health, Behavioral Health, and Human Services Interim Committee.
- What does this have to do with the health workforce?
- This topic addresses the practice and supervisory provisions for advanced practice registered nurses in Indiana.
- For information on the Advanced Practice Registered Nurse workforce in Indiana, check out the Data Report and Brief linked at the bottom of the post.
by Hannah Maxey | Apr 22, 2019 | Other
At first blush you may wonder how workforce shortages and wellness could possibly be related. Workforce shortages contribute to the wellness of providers and the populations they serve. From the provider perspective, the symptoms of workforce shortages may sound like “I spend too many hours at work” or “I see too many patient appointments in a day.” Without sufficient support from peers and colleagues, providers are more likely to feel isolated, overwhelmed, and experience burnout. The bottom line: workforce shortages contribute to burnout and threaten provider wellness.
Now, you may be wondering how this impacts population wellness. Providers experiencing burnout are more likely to reduce the number of hours they work and/or leave practice all together. In underserved communities, provider burnout contributes to exacerbating existing workforce shortages and further threatens access to the health care services, including those critical to wellness (examples: vaccination, well-child visits, prenatal care.) It’s a vicious cycle.
How can we fix this problem? Policies to address workforce shortages are an important part of the solution. Loan Repayment Programs (LRP) support recruitment of providers in workforce shortage areas. These programs reduce provider debt burden and encourage practice in underserved communities. Over the last several legislative sessions in Indiana there have been more than 15 LRP bills proposed, and this year 4 bills are on the table. At the Bowen Center, we are keeping our finger on the pulse of these important initiatives and providing data and research to inform related conversations. Do you want more information? Contact us at Bowenctr@iu.edu.
