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Remarks to the National Association of County Behavioral Health and Developmental Disability Directors

H R S A Speech

U.S. Department of Health & Human Services
Health Resources and Services Administration

HRSA Press Office: (301) 443-3376
http://newsroom.hrsa.gov


by HRSA Administrator Mary K. Wakefield

March 4, 2011
Washington, D.C. 


I’m pleased to have this opportunity to speak your annual conference.  I’ve looked at your agenda – it’s jam-packed with a breadth of issues.  Thanks for including HRSA.

From my perspective, The National Association of County Behavioral Health and Developmental Disability Directors is an important and active HRSA partner.  Our work together is a good example of how effective collaborations enable HRSA to accomplish its mission and goals on behalf of communities all across this country – and hopefully extend your reach as well.

HRSA is the primary Federal agency charged with improving access to health care services for people who are uninsured, isolated or medically vulnerable and we focus on that through a portfolio of 80 different grant programs.

While we do our work from the national level, all of it is done through partnerships with state and local partners. So, we continue to look to you, as representatives of our local mental health and substance use treatment partners, to play a significant role in transforming and improving our health and disability system – so that public health services are readily accessible to everyone who needs them.

I understand that Ron Manderscheid discussed the Affordable Care Act and its provisions in his presentation yesterday.  HRSA stands front and center in the implementation of the law, which will fundamentally improve the quality and access to health services available to people in need.  HRSA is the lead agency overseeing more than 50 different authorizations under the ACA – 35 of which extend well beyond 2011.

From HRSA’s vantage point, we have big investments and expansions that we’re engaged in and that play out at local community levels.  For example, one key way that the Affordable Care Act expands access to health care is by investing $12.5 billion in Community Health Centers and the National Health Service Corps over the next 5 years.

Let me say a word about each.  Community health centers serve nearly 19 million people a year, about 40 percent of whom have no health insurance. The health center funds will approximately double the size of the program and vastly increase the availability of primary care and behavioral health services.  More specifically, $9.5 billion of this funding was targeted to both creating new health center sites in medically underserved areas and to expanding preventive and primary health care services, including mental health and substance abuse services, at existing health center sites.

The ACA also requires that mental health and substance abuse services be included in the essential health benefits package that all qualified health plans provide through future State-based Health Benefits Exchanges. This parity will support patients seen by HRSA-funded safety net providers for mental health and substance abuse.

HRSA’s ACA dollars followed closely on the $2.5 billion we received last year under the Recovery Act: $2 billion to expand health centers; $300 million for NHSC; $200 million for workforce training.  
So ACA and ARRA are milestones in terms of access to care.  Together, they represent the largest expansion of primary care in this country in decades, an expansion that increasingly embraces comprehensive behavioral health services as core to primary care services.                     
In HRSA, we recognize the importance of behavioral health and the link between mental and emotional wellbeing across HRSA’s broad portfolio of programs and services. We work to provide access to high-quality behavioral health services to the many people we serve.
We know that mental and physical health problems are interwoven…that delivering mental health services in primary care settings reduces stigma and discrimination… and that the majority of people with mental disorders treated in collaborative primary care have good outcomes.  We know that many people with developmental disabilities receive a lot of their care in the primary care content.
The framework we use is built on efforts to deliberately position primary care within the broader context of population health, to align primary care and behavioral health seamlessly, and to consistently build relationships with stakeholders to improve the delivery and access of health services to vulnerable populations.  This includes those with behavioral health needs and developmental disabilities.

Let me give you a few examples of how we at HRSA are working to integrate health needs into some of our key programs.

HRSA’s Community Health Centers Program provides direct services through a network of more than 8,000 sites that range from large medical facilities to clinics and mobile vans. Today, two-thirds of these centers provide mental health treatment or counseling services that reach more than 750,000 people a year.

These services are provided in large part through over 3,000 mental health care providers in health centers.  This includes more than 300 psychologists, 346 psychiatrists, 1,070 social workers, 822 substance use disorder service providers, and 826 other licensed behavioral health providers
One-third of health centers now provide substance abuse counseling and treatment—touching 115,000 people in 2009 alone.  In 2009, HRSA’s Bureau of Primary Health Care awarded $4.3 million specifically to integrate behavioral health and primary care services at health centers.  

This funding strongly encouraged grantees to use an integrated primary behavioral health service care model on-site when developing and implementing behavioral health delivery plans.  This integrated model of care involves delivery of patient-centered behavioral health consultations and co-management of patients by behavioral health and medical care providers.  This approach was coupled with a revision of our health center reporting requirements that now includes SBIRT  (Screening, Brief Intervention and Referral to Treatment) as an option for community health centers’ to utilize in their integrated care models.

To staff these centers, we’re strengthening the behavioral workforce as a critically important component of our overall efforts to expand the Nation’s health care workforce.  HRSA’s National Health Service Corps has more than 2,000 mental health and substance abuse treatment providers in the field, including psychologists, psychiatric nurse specialists, social workers, psychiatrists, licensed professional counselors, and marriage and family therapists.  Still, more than 2,000 vacancies remain in behavioral health jobs within the Corps.

HRSA also supports the Graduate Psychology Education Program, which provides grants to train psychologists working with underserved populations.  Last year, we awarded 19 grants to accredited health professions schools and other public and private entities to improve access to mental health services.  The award amount of $2.6 million represents a 60-percent increase in funding over the previous year. Between 2009 and 2010, more than 400 graduates and trainees were supported through this program, which emphasizes an integrated approach to health services.

Additionally, HRSA’s Ryan White HIV/AIDS Program also actively provides support for primary and behavioral health care.  It provides support services to more than 500,000 uninsured and low-income people, approximately half of all people in the United States living with the disease.

In 2008, $69.8 million in Ryan White HIV/AIDS Program (specifically, Part A and Part B) funds were allocated to mental health and substance abuse services.  These funds touched the lives of 116,279 program clients, some of whom received both mental health and substance abuse services.

These services ranged from education programs and an initiative to prevent stigma and discrimination against people with HIV/AIDS, to a Special Project of National Significance for integrated mental health services for Native Americans and Alaska Natives that are HIV-positive.  

HRSA also supports more than 100 Healthy Start sites in communities with high rates of infant mortality. These sites provide community-based outreach, case management, depression screening and other risk reduction screenings for women and their families. In fact, Healthy Start funded a three-year project last year to address intimate partner violence and perinatal depression.

Additionally, in terms of developmental disabilities, we’ve been working on one of the President’s priorities – the Combating Autism Initiative.

With the passage of the Combating Autism Act of 2006, we were given a mandate to launch a multi-agency response to fight autism.  And the President has honored that call to action by increasing the program’s budget every year since he took office.

Our Maternal and Child Health Bureau saw funding for its autism program increase from $36 million in 2008 to $42 million the following year; then $48 million by 2010.  This year, the President has requested $55 million.

We’ve been making some progress in a relatively short period of time, which bodes well for reauthorization of the autism legislation next fall.  Major achievements include:

  • Four new one-year planning grants were added in FY 2010 to the Leadership Education in Neurodevelopmental and Related Disabilities program (LEND), and we currently have 39 LEND programs (and 10 more in Developmental-Behavioral Pediatrics) in 32 states and the District of Columbia that train clinicians in autism screening, detection and treatment;

  • Through these programs, 46,000 infants and children were screened last year, and more than 35,000 received diagnostic evaluation services;

  • We also have increased from six to 13 the number of states working to improve their autism service systems through demonstration projects;

  • We now have 27 research institutions nationwide linked together to answer the toughest challenge we continue to face – that is, the search for evidence-based interventions that work best among the 400 currently in use in physical, medical, behavioral, mental, cognitive and social therapies;

  • And we also have 17 distinct studies underway, and another seven awaiting publication in respected mainstream journals, furthering our mission of spreading the latest and best information on autism to the clinical community – particularly as it pertains to disadvantaged and underserved children;

I offer these examples simply to illustrate the scope of this endeavor at the federal level, and to give you a clearer sense of our shared urgency and the comprehensive nature of this effort.

We don’t know yet precisely how or why an average of one in every 110 children born in the U.S. has an Autism Spectrum Disorder. But we do know that our screening, diagnostics and treatment capabilities prior to the Act were not meeting the level of need. That is now changing.

Even as we are building our ASD-specific capacity, the Maternal and Child Health Bureau also is on track to vastly expand our general outreach and intervention capacity.  Here are just two examples:

  • Under the Affordable Care Act, the Bureau has been charged with overseeing a Maternal, Infant, and Early Childhood Home Visitation Program that will put hundreds of nurses, social workers and others into the field to provide counseling and intervention services to expectant mothers in communities where health services are scarce;

  • The Act also extends annual funding of $5 million until 2015 for 41 Family-To-Family Health Information Centers, which are staffed by parents of kids with special health needs. So far, the centers have linked more than 170,000 families to federal and state programs, clinics, special insurance pools and rehabilitation services for children with disabilities.

To maximize our behavioral health efforts as an agency, we are also fully aware of the need to collaborate and cooperate fully with our federal partners. For example, we are working with the Substance Abuse and Mental Health Services Administration to fund a joint initiative – the Center for Integrated Health Solutions.  This center will provide services to improve the effectiveness and sustainability of work to address the needs of individuals with mental illness or substance use disorders by improving the coordination of care.  

HRSA is contributing $350,000 a year for four years to fund this joint initiative, which will provide training and technical services on behavioral health and its integration in HRSA-funded health centers.  

The Center recently convened the first of four planned webinars for primary care providers.  The topic was Motivational Interviewing, and more than 4,000 persons – four times capacity – registered for the event.  More webinars are planned later this year, along with a full range of additional trainings and tools to bring primary care into behavioral health settings.

Also, HRSA and the Agency for Healthcare Research and Quality are co-chairing a primary care/behavioral health subcommittee on the HHS Behavioral Health Coordinating Committee, which is led by Assistant Secretary of Health Dr. Howard Koh and SAMHSA Administrator Pam Hyde. The subcommittee has been asked to look for opportunities to expand on existing and new integration initiatives across HHS agencies.     

In addition, we are working closely with the White House Office of National Drug Control Policy to develop performance measures for the integration of substance abuse care with primary care for the National Drug Control Strategy.  And we are helping them study ways to better integrate substance abuse prevention and treatment into the training of primary care providers.                                              

In closing, I can assure you that we at HRSA are continuing to work to achieve the most effective systems possible for the delivery of integrated behavioral health care/primary care services on behalf of all the people we serve.

You and HRSA share a common vision that someday soon behavioral health professionals will be represented on every primary care team and behavioral health and developmental disability needs reflected in every treatment plan.

Working together, we will make it happen.  Thank you for all the work you do – especially now in these challenging times.

I’m happy to take your questions.