From student to provider and educator: Coming full circle to close care gaps for substance use disorders

Alyssa Hamel remembers how holistic and integrated the simulations were. While training under the School of Nursing’s ongoing Behavioral Health Workforce Education and Training (BHWET) grant, Hamel found it “refreshing” to work alongside students from rehabilitation counseling, mental health counseling, social work and psychology.

“There wasn’t any judgment during the simulation,” says Hamel, now clinical assistant professor, psychiatric mental health nurse practitioner and program coordinator for the nursing school. “In fact, it felt comforting knowing we were in a positive learning environment that was made for practice and constructive feedback.”

The multi-year, $1.92 million training grant was awarded to UB by the Health Resources and Services Administration, a major program designed to expand health services in underserved communities. In this case, the training targets expanding the workforce to address disparity in access to clinical care for substance use disorders.

Addressing opioid overdose deaths in Erie County is a priority, given the county’s overdose death rate is higher than anywhere else in Western New York. In addition, the rates of opioid overdoses, hospitalizations and deaths for Erie and Niagara counties are currently higher than in many other regions in New York State, according to School of Nursing administrators.

The grant specifically addresses the need to coordinate the way services for prevention and treatment of substance abuse are provided. “Most people with substance use disorders do not seek treatment on their own because they do not believe they are in need, are not ready to seek treatment or are unaware of how to access treatment,” researchers explain.

Traditionally, services for prevention and treatment of substance misuse and abuse disorders have been provided separately from other mental health and general care services.

“The ability to integrate prevention, treatment, recovery and follow-up services to address this issue remains key to improving access and quality of treatment,” researchers say.

The School of Nursing’s interprofessional collaboration grant places training in integrated care settings, which means forming a more holistic, less-specialized approach to treatment.

“Today’s social and political climate has undoubtedly exacerbated the racial and cultural disparities in our community,” says Hamel, who is now co-investigator of the BHWET grant, evidence of what nursing administrators call the “full circle” nature of the program. “As a practitioner of psychiatry and behavioral health within underrepresented areas of the community, it was a necessity to truly embrace the inclusive philosophy we vowed to practice upon completion of the BHWET scholars program.

“One of the primary tenants of the grant was to move away from the ‘siloed’ approach to treatment and infuse holistic, integrated methods for treating mental health and substance use disorders so we can move toward a more collaborative, patient-centered practice methodology,” Hamel says.

The grant provides another example of how simulations help in educating health care workers. “With the simulation, students have the opportunity to practice interventions they’ve learned in the classroom with trained actors playing the role of clients,” says Laura Lewis, clinical associate professor and assistant dean for global partnerships in the School of Social Work, who helps administer the grant program. “Students then receive feedback in support of their professional growth.”

A key component of the BHWET program is how it merges disciplines and educational perspectives.

“The fellowship is a tremendous opportunity for our MSW students,” says Lewis. “Our social work students learn to draw on the knowledge and expertise of other professionals. The training helps them better understand the complexities of substance use, and they leave the program better equipped to provide comprehensive and holistic care to individuals.”

The program, which so far has trained about 200 students, consists of weekly interprofessional workshops on mental health, addictions and integrated care. Trainings provide didactic instruction, faculty presentations, case scenarios and, what has now become common in the School of Nursing: application-based learning through simulations.

The presentations range from integrative care, trauma-informed care, screening, and brief intervention and treatment of substance use disorders to culturally informed care. The curriculum also stresses the consistent practice and supervision of motivational interviewing strategies.

“It is fair to say that the knowledge gained from these presentations carried their weight as I entered into professional clinical practice as a psychiatric provider,” Hamel says.

The interprofessional nature of the grant exposed Hamel to aspects of mental health care she would work with to collaborate and coordinate care in professional practice.

“Having an understanding of their role and how we all fit into the client’s wellness plan better prepared me to communicate effectively, delegate when necessary and defer to other disciplines regarding their unique specialty and skill set,” she says.

By CHARLES ANZALONE