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Abstract
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Government estimates indicate the nation's behavioral health workforce, including those who treat patients with substance use disorders (SUD), will continue to experience staffing shortages and that it is imperative to address future workforce needs for several behavioral health occupations (USDHHS, 2023). Enhanced training is needed across medical, nursing, and physician associate (PA) professions to detect and treat patients with SUDs.
The 2022 National Drug Control Strategy (NDCS) includes, among other efforts, one activity to expand the SUD health professions workforce through development of a core curriculum on SUD for all medical and health professions programs so that so that every student is educated early in their academic careers on SUD and has basic knowledge of strategies to identify, assess, intervene in, and treat addiction, as well as support recovery. This activity builds on work started in 2019 by the American Association of Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) to support medical schools to develop core curriculum to advance educational content related to pain and addiction.
To achieve this goal, in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency responsible for training on SUD, and other federal partners, the Office of National Drug Control Policy (ONDCP) launched a "Cascade Of Care" initiative in 2023, an approach combining three National Drug Control Strategy (NDCS) workforce expansion efforts:
• Increasing SUD screening and case-finding by all health professionals;
• Increasing training on SUDs by a broader representation of all health professionals; and
• Developing core SUD curriculum elements for all health professions programs.
This report is designed to promote comprehensive education among those training in medical, physician associate, nurse practitioner, nurse, social worker, public health and counselor academic programs. Such programs are urged to:
• Provide training early in their students' academic careers about SUD to help address stigma related to addiction;
• Educate that SUD is a treatable, chronic disorder, akin to diabetes and heart disease, and
• Increase access to SUD screening, assessments and services for the approximately 46 million Americans with SUDs, who are family, friends, and neighbors, and deserve access to care.
The launch of the Cascade of Care initiative resulted in the foundation of an interagency group to implement workforce expansion efforts included as part of that initiative. An outgrowth from this interagency group was a convening of experts to draft Core Curriculum elements.
Incorporating SUD content into education programs, providing readily accessible training guides and resources, and increasing interprofessional collaboration across disciplines to create service-learning opportunities offer pathways for expanding the emerging workforce capable of providing SUD diagnoses and treatment services. Continued and expanded availability of educational opportunities in and beyond the classroom offer trainees greater opportunities to broaden their knowledge and expertise in SUD treatment. Some factors that facilitate SUD content integration include students' interest in learning how to treat SUDs, faculty development workshops, and OUD and faculty and stakeholder advocacy inclusion of SUD content in curriculum standards and SUD treatment competencies.
SAMHSA, in collaboration with ONDCP, convened a panel of experts (list of participants included in Appendices) in August 2023, to review draft Core Curriculum elements. These elements built on previous work by SAMHSA on Core Curriculum elements developed in response to Section 1263 of the Consolidated Appropriations Act, 2023 (CAA, 23), more commonly known as the Medication Access and Training Expansion (MATE Act). The overall goal was to gain concurrence on essential elements or categories of information that should be included in a SUD Core Curriculum, with a resulting deliverable that is publicly available, and through which any health profession academic program could adopt elements in full or in part to integrate into their programming.
Background on Curricular Recommendations On August 10 and 17, 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Office of National Drug Control Policy (ONDCP) hosted two meetings with subject matter experts to gain concurrence on essential elements or categories of information that should be included in core curriculum on substance use disorder (SUD) and integrated into graduate healthcare education programs. The first meeting focused on gathering input from the experts regarding content and materials to support incorporation into current curricula. The second meeting built upon the input from the initial meeting, identifying best practices and strategies for integrating content into existing curricula as well as at an institutional level.
Subject matter experts across disciplines agreed on several common themes and topics that should be considered as the curriculum is developed and implemented. Participants considered strategies for integrating SUD curriculum into existing clinical academic content from four perspectives: didactic content as required learning, clinical rotation, case review, and their respective expertise. Panelists noted the challenge of finding room for additional curricular elements alongside existing curriculum, and the need to assure adherence to curriculum standards and licensing exams. Suggestions for addressing these challenges emerged, such as reviews of current curriculum leading to discovery of outdated content that could then be replaced with SUD content. Above all, the experts highlighted that the needs of persons with SUD should be considered the primary priority, and stressed that interprofessional efforts, rather than one discipline practicing alone, are most effective at assisting people in attaining recovery as defined by the person.
The experts identified several key factors to affecting change in the curriculum content. This included the importance of having motivated practitioners to encourage and support the integration of SUD curricula, and who can act as peer leaders in their discipline, while also promoting the buy-in of academic leadership. This summary and the corresponding recommended outline for core SUD content are meant to support the efforts of both peer leaders and academic leadership. The summary will explain the experts' recommendations for key areas of the outline and offer suggestions for ways to incorporate the content into healthcare education programs.
Core Content Recommendations
The participants urged provision of content pertaining to SUDs beginning early and then throughout the students' educational journey, to address and minimize bias and stigma regarding use disorders. Perceptions about use of medications for the treatment of SUD is a primary barrier for people in need of treatment and in terms of practitioners' willingness to prescribe, especially for special populations such as adolescents and pregnant people. These perceptions feed into stigma, biases, stereotypes, and discrimination that discourages people from seeking or to follow through with care.
Introducing students to concepts pertaining to SUDs early in their clinical experience will empower them to see positive changes in patients and appreciate that SUD is as treatable as any other chronic disease. As an example, the Boston Medical Center provides multi-disciplinary early exposure to SUD and uses peer advocates to provide opportunities for integrating learning; this can help students experience the urgency of learning about SUD and help them recognize the impact they can have on someone's life ... |