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Publications: Peer-ReviewedTracking 5-Year Trends in the Workforce Prescribing Psychotropics and Medications for
Opioid Use Disorder: A Cross-Sectional Study (Journal of General Internal Medicine) The United States is facing a behavioral health crisis, compounded by increased depression and anxiety due to the COVID-19 pandemic, rises in opioid use and overdose deaths, and the declaration of a national pediatric mental health emergency. As demand for behavioral health services grow, it is more important than ever to have an adequate behavioral health workforce that is prepared to address these issues. Understanding longitudinal trends in this workforce could help inform future policy decisions on workforce investment, training, and retention We analyzed the number of prescriptions and prescribers by year, month, drug type, specialty type, payor type, and clinician county rurality. Citation: Shenk E, Luo Q, Erikson CE. Tracking 5-Year Trends in the Workforce Prescribing Psychotropics and Medications for Opioid Use Disorder: A Cross-Sectional Study. J Gen Intern Med. 2024. Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit (JAMA)
Increasing the workforce available to treat opioid use disorder (OUD) remains a priority in light of high opioid mortality and percentages of people with OUD who do not receive treatment. The Drug Addiction Treatment Act (DATA) of 2000 created a pathway for clinicians to obtain waivers (“DATA waivers”) to simultaneously treat up to 30, 100, or 275 patients with OUD outside of an opioid treatment program, provided the clinicians met certification and training requirements. Policies in 2021 reduced waiver requirements and in 2023 removed waiver requirements, leading to expectations of increased OUD treatment. It is important to understand historical clinician prescribing patterns prior to these policy changes to track the specific effects going forward. Prior research mainly relies on DATA-waiver status or prescription data alone to estimate the workforce, leading to likely overestimates. To address these limitations, this study examined trends in DATA-waivered clinicians’ active participation in prescribing buprenorphine, overall and by patient limits, between January 2017 and May 2021. Citation: Luo Q, Erikson CE. Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit. JAMA. 2023;329(20):1792–1794. Documenting a Decade of Exponential Growth in Employer Demand for Peer Support Providers (JOurnal of Behavioral Health Services Research)
The past decade has seen peer support providers increasingly incorporated as part of a recovery-oriented approach to behavioral health (BH) services for mental illness and substance use disorder. Despite this, there are few data sources to track this sector of the BH workforce, and understanding of peer support provider supply, demand, distribution, and associated factors is limited. In this retrospective, observational study, the authors analyzed job postings from 2010 to 2020 to assess employer demand for peer support providers and the factors associated with its growth, using a labor market data set from Emsi Burning Glass. The authors identified peer support job postings using a three-pronged, stepwise approach. Then, bivariate regression analyses using robust standard errors were conducted to examine state-level relationships between the number of peer support job postings per 100,000 population and Medicaid policies and indicators of states’ BH infrastructure. The authors identified approximately 35,000 unique postings, finding the number increased 17-fold between 2010 and 2020. Bivariate analysis found significant state-level associations between peer support job postings and Medicaid expansion, as well as states’ mean number of mental health facilities. This analysis represents the first to quantify employer demand for peer support providers, clearly demonstrating robust growth over time. Findings underscore the importance of continuing to develop data on this workforce to better understand factors driving its growth. Citation: Ziemann MP, Dent RB, Schenk ED, et al. Documenting a Decade of Exponential Growth in Employer Demand for Peer Support Providers. J Behav Health Serv Res. 2023;50: 413–424. New Behavioral Health Workforce Database Paints A Stark Picture (health affairs forefront)
Using novel data sources, the Mullan Institute now has a Behavioral Health Workforce Tracker. Learn about how we identified 1.2 million behavioral health providers and how you can use our Behavioral Health Workforce Tracker to study the workforce. Citation: Erikson C, Schenk E, Westergaard S, Salsberg ES. "New Behavioral Health Workforce Database Paints A Stark Picture". Health Affairs Forefront. August 30, 2023. Historic Redlining and Contemporary Behavioral Health Workforce Disparities (jama network open)
As the nation continues to confront the lasting legacy of Jim Crow–era structural racism, attention is increasingly turning to the association between historical redlining policies and contemporary racial disparities in access to health care, including behavioral health. This exploratory cross-sectional study used 2 counties designated as mental health professional shortage areas to investigate whether behavioral health specialists are equitably allocated across redlined neighborhoods in Richmond City County, Virginia (Richmond), and Guilford County, North Carolina (Greensboro). We compare clinician-to-population ratios and other neighborhood characteristics by HOLC grade to assess the association between redlining and current clinician supply, racial and ethnic demographics, and the area deprivation index measuring income, education, employment, and housing quality. Citation: Erikson CE, Dent RB, Park YH, Luo Q. Historic Redlining and Contemporary Behavioral Health Workforce Disparities. JAMA Netw Open. 2022;5(4):e229494. Publications: White PapersCharacteristics of the Behavioral Health Nursing Workforce: A Secondary Analysis of the National Sample Survey of Registered Nurses
It is crucial to understand the current state of the BH nursing workforce and identify the characteristics and pathways that nurses take to become licensed and certified to continuously recruit and support future cohorts of BH nurses.To provide an overview of the current BH nursing workforce, this paper presents a secondary analysis of the 2018 NSSRN to enumerate the number of BH nurses and compare the professional and demographic characteristics of BH and non-BH nurses across all settings. This study further expands upon the current literature by assessing how the pathways to becoming an RN differ by race and ethnicity, illuminating strategies and policies supporting recruiting diverse BH nurses. Citation: Schoebel V, Erikson C, Salsberg E, Muñoz L. Characteristics of the Behavioral Health Nursing Workforce: A Secondary Analysis of the National Sample Survey of Registered Nurses. Washington, DC: Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University; 2024. Provision of Mental and Behavioral Health Services by Primary Care Providers: The Role of Medicaid Payment Generosity
A key challenge for states is a low PCP-to-beneficiary ratio in Medicaid, which can impact access to critical behavioral health care. Medicaid has historically paid physicians less than private insurance and Medicare for the same services. We examine the heterogenous effect of Medicaid payment for primary care services and its association with PCPs' prescription for mental and behavioral health (referred to as prescriptions henceforth) to Medicaid patients. We utilize prescription claims by PCPs for psychotropic medications and/or medications for opioid use disorder (MOUD) from a nationwide multi-payer dataset. Citation: Vichare A, Luo Q, Erikson C. Provision of Mental and Behavioral Health Services by Primary Care Providers: The Role of Medicaid Payment Generosity. Washington, DC: Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University; 2024. Assessing the Relationship between Social Vulnerability Index and Behavioral Health Provider Supply
Equitable workforce allocation is important to improving access to behavioral health, as the imbalance between the growing demand and the low supply of behavioral health providers remains a significant policy challenge. We expand on past research to examine the practice location of all available behavioral health prescribers, including primary care physicians, nurse practitioners, and physician assistants who represent a large and growing part of the behavioral health workforce Citation: Herring J, Vichare Anushree, Westergaard S, Luo Q, Erikson C. Assessing the Relationship between Social Vulnerability Index and Behavioral Health Provider Supply. Washington, DC: Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University; 2024. The Behavioral Health Workforce Tracker was created in partnership with HealthLandscape and was funded under grant number FG000028 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies, and opinions expressed do not necessarily reflect those of SAMHSA or HHS and should not be construed as such.
Last Update: August 2024 |
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