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The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? (2012)

Chapter: Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers

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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

CONTENTS

I.     PHYSICIANS

   Allopathic Physicians (MD)

   Family Medicine (MD)

   Geriatric Family Medicine (MD)

   Internal Medicine (MD)

   Geriatric Internal Medicine (MD)

   Psychiatry (MD)

   Geriatric Psychiatry (MD)

   Addiction Psychiatry (MD)

   Osteopathic Physicians (DO)

   Family Medicine (DO)

   Geriatrics in Family Medicine (DO)

   Addiction in Family Medicine

   Internal Medicine (DO)

   Geriatric Internal Medicine (DO)

   General Psychiatry (DO)

   Geriatric Psychiatry (DO)

   Addiction Psychiatry (DO)

II.    PHYSICIAN ASSISTANTS

III.   NURSES

   Licensed Practical Nurses/Licensed Vocational Nurses

   Registered Nurses (Diploma, Associate’s, and Baccalaureate)

   Gerontological Nurses

   Psychiatric and Mental Health Nurses

   Advanced Practice Registered Nurses (Master’s and Doctoral)

   Acute Care Nurse Practitioners

   Adult Psychiatric-Mental Health Nurse Practitioners

   Adult-Gerontology Primary Care Nurse Practitioners

   Adult-Gerontology Clinical Nurse Specialists

IV.   PSYCHOLOGISTS

   Clinical Psychology

   Counseling Psychology

   Couple and Family Psychology

   Rehabilitation Psychology

V.    LICENSED COUNSELORS

   Rehabilitation Counseling

   Addiction Counseling

   Clinical Mental Health Counseling

VI.   SOCIAL WORKERS

   Social Worker (Associate’s and Baccalaureate)

   Social Worker (Master’s)

   Clinical Social Work

Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

VII.  PHARMACISTS

    Psychiatric Pharmacy

VIII.  OCCUPATIONAL THERAPISTS

   Occupational Therapy Assistant

   Occupational Therapist (Master’s and Doctoral)

   Gerontology

   Mental Health

IX.    DIRECT CARE WORKERS

   Certified Nursing Assistant

   Home Health Aide

Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
I. PHYSICIANS
Allopathic Physicians (MD)a
Early identification and intervention of mental disorders (e.g., suicide potential, depression, alcohol/substance abuse, family involvement in schizophrenia); biologic markers of mental disorders and mental retardation syndromes; intended/unintended effects of therapeutic interventions for mental disorders, including effects of drugs on neurotransmitters; diagnosis of mental disorders usually first diagnosed in infancy, childhood, or adolescence, schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, somatoform disorders, other disorders/conditions; principles of mental disorder management (Pharmacotherapy only, Management decision, Treatment only). Diagnosis of substance-related disorders (e.g., alcohol and other substances). None
Family Medicine (MD)b
Responsibility for the total health care of the individual and family, taking into account behavioral dimensions; Family-oriented comprehensive care experience, including individual behavioral counseling and family counseling; knowledge and skills in human behavior and mental health should be acquired through a program in which behavioral science and psychiatry are integrated with all disciplines throughout the total educational experience; skills in the diagnosis and management of psychiatric disorders in children and adults, emotional aspects of nonpsychiatric disorders, psychopharmacology, the physician-patient relationship, patient interviewing skills, and counseling skills. Must have instruction and development of skills in the diagnosis and management of alcoholism and other substance abuse. None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GERIATRIC POPULATION
General Care Mental Health (MH) Substance Use
(SU)
Co-occurring MH
and SU
       
       
General principles of senescence (normal physical and mental changes associated with aging); medical ethics and jurisprudence regarding death and dying (e.g., diagnosing death, organ donation, euthanasia, physician-assisted suicide) and palliative care (e.g., hospice, pain management, family counseling, psychosocial and spiritual issues, fear, and loneliness). None None None
       
Resident panels must include continuity experience for patients requiring home care and care in long-term care facilities; nursing home experience must consist of at least two patients as a continuity experience over a minimum of 24 consecutive months, in addition to rotation; must perform at least two home visits with at least one being for an older adult continuity patient; educational experiences must be in both common and complex clinical problems of older patients; training must include the appropriate preventive modalities, functional assessment, and the physiologic and psychologic aspects of senescence; supervised clinical experiences dealing with common acute and chronic diseases of aging; learn about, and practically apply, a multidisciplinary approach to the care of older patients in the hospital, the family medicine center (FMC), Training must include the psychologic aspects of senescence. None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
     
Geriatric Family Medicine (MD)c
N/A N/A N/A
     
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GERIATRIC POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
the long-term care facility, and the home; competence in preventive health care, promotion of independent living, and maximizing function and quality of life; competency in assessing and meeting the health care needs of declining elders, episodic, illness-related care, delivery of health care in the home, FMC, hospital, and long-term facility, and end-of-life care.      
       
Primary specialty. Ambulatory care experience must be designed to provide care, in a geriatric clinic or family medicine center, to elderly patients who may require the services of multiple medical disciplines, including psychiatry and social work; experience in relevant ambulatory specialty and subspecialty clinics (e.g., geriatric psychiatry and neurology) strongly recommended; identifiable structured didactic and clinical experiences in geriatric psychiatry must be included in the program of each fellow; formal instruction in physical and mental examination, topics of special interest to geriatric medicine, including, but not limited to, cognitive impairment, depression and related disorders, psychosocial aspects of aging, including interpersonal and family relationships, living situations, adjustment disorders, depression, bereavement, and anxiety, and behavioral sciences such as psychology/social work. None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
Internal Medicine (MD)d
Clinical experience must include opportunities for experience in psychiatry. None None
Geriatric Internal Medicine (MD)e
N/A N/A N/A
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
Institution must have patients of a broad age range, including geriatric patients; clinical experience must include an assignment in geriatric medicine; clinical experience in outpatient chronic disease management, preventive health, patient counseling, and common acute ambulatory problems with a diversity of ages. None None None
       
Primary specialty. Formal instruction in physical and mental examination, topics of special interest to geriatric medicine, including, but not limited to, cognitive impairment, depression and related disorders, psychosocial aspects of aging, including interpersonal and family relationships, living situations, adjustment disorders, depression, bereavement, and anxiety, and behavioral sciences such as psychology/social work; ambulatory care experience must be designed to provide care in a geriatric clinic or internal medicine center to elderly patients who may require the services of multiple medical disciplines, including psychiatry and social work; experience in relevant ambulatory specialty and subspecialty clinics (e.g., geriatric psychiatry and neurology) strongly recommended; Fellows must develop clinical competence in assessment of cognitive status and affective states; clinical experience in the None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
     
Psychiatry (MD)f    
Primary specialty. One month full-time equivalent organized experience focused on the evaluation and clinical management of patients with substance abuse/ dependence problems, including dual diagnosis. Evaluation and clinical management of patients with substance abuse/ dependence problems, including dual diagnosis.
Geriatric Psychiatry (MD)g
N/A N/A N/A
Addiction Psychiatry (MD)h
Primary specialty. Primary specialty. Primary specialty.
Osteopathic Physicians (DO)i,j,k
Take a comprehensive history (including symptoms, psychological factors, and social factors); perform a standard history and physical examination, including mini-mental and basic neurologic examinations; understand the concepts and principles of social and behavioral sciences and apply these to the understanding, management, and treatment of patient presentations. Population health concepts and patients with presentations related to health promotion, chronic disease management, and human development, including detection and monitoring of None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
  management of elderly patients must include understanding of the behavioral aspects of illness; identifiable structured didactic and clinical experiences in geriatric psychiatry must be included in the program of each Fellow.    
       
N/A One month full-time equivalent organized experience focused on the specific competencies in areas that are unique to the care of the elderly. None None
       
N/A Primary specialty. Epidemiology, diagnosis, and treatment of all major psychiatric disorders seen in the elderly, seen alone and in combination, including substance-related disorders. Epidemiology, diagnosis, and treatment of all major psychiatric disorders seen in the elderly, seen alone and in combination, including substance-related disorders.
       
N/A Clinical experience must include the opportunity to evaluate and follow a variety of patients of both sexes, including geriatric age groups spanning a broad range of diagnoses. Clinical experience must include the opportunity to evaluate and follow a variety of patients of both sexes, including geriatric age groups spanning a broad range of diagnoses. Clinical experience must include the opportunity to evaluate and follow a variety of patients of both sexes, including geriatric age groups spanning a broad range of diagnoses.
       
Determine and monitor the nature of a patient’s concern or problem using a patient-centered approach that is appropriate to the age of the patient; provide effective patient care in the outpatient, inpatient, and home COMLEX-USA covers patients with presentations related to trauma, including elder abuse. None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
COMLEX-USA covers patients with presentations related to cognition and behavior, including anxiety, behavioral disturbances, confusion/disorientation, dementia, depression, eating disorders, learning difficulties, life adjustment, suicidal ideation; psychosocial management. substance abuse.
COMLEX-USA covers patients with presentations related to substance abuse, including alcohol abuse, controlled substance abuse, non-controlled drug abuse, and tobacco abuse.
 
Family Medicine (DO)l
Must maintain current knowledge of behavioral medicine that reflects the majority of patient care issues that present to osteopathic family practice settings; training in behavioral science, which at a minimum shall include psychiatric and psychological diagnoses common to family practice, didactic instruction and clinical experiences, interviewing skills, counseling skills, psychopharmacology, and physician well-being; 50 hours or 2 weeks of documented training in community medicine, which may include time spent in occupational health, mental health agencies, community-based screening programs, public health agencies, community health centers, free clinics, or homeless shelters. Program must include training in behavioral science, which at a minimum shall include the treatment of substance abuse; 50 hours or 2 weeks of documented training in community medicine, which may include time spent in drug and alcohol treatment centers.  
Geriatrics in Family Medicine (DO)m
N/A N/A N/A
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Cares Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
care settings, and across the lifecycle; recognize patient presentation of symptoms and disorders of human development; explore a patient’s beliefs, concerns, expectations, and literacy about health and illness, and provide care appropriate for contextual factors such as a patient’s age.      
COMLEX-USA covers population health concepts and patients with presentations related to health promotion, chronic disease management, and human development, including aging physiology; end-of-life management.      
       
At least 100 hours or 1 month of training in the care of the geriatric patient, in addition to training that occurs in the continuity of care site or general internal medicine rotations, which at a minimum shall include physiological changes of aging, pharmacokinetics in the elderly, functional assessment of the elderly, extended care facility management, hospice, home care; competencies in providing acute care, chronic care, and preventive care across the full spectrum of ages and genders; awareness and proper attention to issues of age; patient population of the continuity of care site must include a variety of patients in terms of age.      
       
Primary specialty. Maintain current knowledge of behavioral medicine that reflects None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
Addiction in Family Medicinen
Scope of training must include additional training in all branches of psychiatry that are of special concern in the addicted patient. Primary specialty. None
Internal Medicine (DO)o
None None None
Geriatric Internal Medicine (DO)p
N/A N/A N/A
General Psychiatry (DO)q
Primary specialty. Must be experienced with patients with substance abuse None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
the majority of patient care issues present in geriatric settings; programs must include didactic presentations on psychology of aging, and mental health concerns including loss of a spouse, death and dying, depression, dependency, caregiver burden, and sexuality in the elderly; programs must include clinical training in psychiatric and psychological needs and evaluation of the geriatrics patient.
       
N/A None None None
       
None None None None
       
Primary specialty. Base institution or an affiliate must have rehabilitation and psychiatry services; biopsychosocial components of aging, including normal physiological age changes, psychological models of late-life development and sexuality; assessment of older patients’ health status, including cognitive/ neuropsychologic status; preventive geriatric medicine, including the relationship between physical health/mental health status; common geriatric syndromes including dementia, delirium, depression, and elder abuse. Mental health disorders, including substance disorders and the appropriate treatment options. None
       
N/A Must be exposed to adequate numbers of patients of various ages; None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
problems, including experience with detoxification and management as well as an understanding of community resources.
Geriatric Psychiatry (DO)r
N/A N/A N/A
Addiction Psychiatry (DO)s
Primary specialty. Primary specialty. Must be fully trained in the techniques required in the treatment of the larger group of patients with the dual diagnosis of addictive disorders abuse.
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
must be experienced with geriatric patients with various psychiatric disorders in which residents have primary responsibility for diagnosis and treatment; didactic curriculum must include major theories of development through adulthood and old age.
       
N/A Primary specialty. Diagnosis, treatment, and epidemiology of all major psychiatric disorders seen in the elderly, including substance abuse disorders. Diagnosis, treatment, and epidemiology of all major psychiatric disorders seen in the elderly, typically including but not limited to affective disorders, dementia, delirium, late-onset psychoses, medical presentations of psychiatric disorders, iatrogenesis, adjustment disorders, anxiety disorders, sleep disorders, sexual disorders, substance abuse disorders, personality disorders, and continuation of psychiatric illnesses that began earlier in life. These disorders can present either singularly or in combination.
       
N/A Clinical experience must include the opportunity to evaluate and follow a variety of patients of both sexes, including geriatric age groups spanning a broad range of diagnoses; number None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
and other psychiatric disorders; clinical experience must include evaluation, consultation, and treatment of psychiatric inpatients and outpatients with chemical dependencies and comorbid psychopathology, to include a broad range of psychiatric diagnoses; curriculum should emphasize functional assessment, signs and symptoms of neuropsychiatric impairment associated with substance abuse; knowledge of the signs and symptoms of the social and psychological problems as well as the medical and psychiatric disorders that often accompany the chronic use and abuse of the major categories of drugs; experience in the use of psychoactive medications in the treatment of psychiatric disorders often accompanying the major categories of substance.
II. PHYSICIAN ASSISTANTSt
Instruction in the social and behavioral sciences as well as normal and abnormal development across the life span, including psychiatric/behavioral conditions; supervised clinical practice experiences must provide sufficient patient exposure to care for behavioral and mental health conditions; supervised clinical practice experiences should occur with preceptors practicing in behavioral and mental health care. Instruction in the social and behavioral sciences as well as normal and abnormal development across the life span, including detection and treatment of substance abuse. None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
and variety of new and follow-up patients spanning the lifecycle from adolescence to old age must be sufficient to ensure an adequate outpatient and inpatient experience.
       
Instruction in the provision of clinical medical care across the life span, including preventive, emergent, acute, chronic, rehabilitative, palliative, and end-of-life care relevant to adult and elderly populations; supervised clinical practice experiences must provide sufficient patient exposure to medical care across the life span, including the elderly. Instruction in the social and behavioral sciences as well as normal and abnormal development across the life span, including psychiatric/ behavioral conditions. Instruction in the social and behavioral sciences as well as normal and abnormal development across the life span, including detection and treatment of substance abuse. None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
III. NURSES    
Licensed Practical Nurses/Licensed Vocational Nursesu    
Identify client risk factors for abusing or neglecting others; identify signs and symptoms of physical, psychological, or financial abuse in client; recognize risk factors for domestic, child and/or elder abuse/neglect and sexual abuse; monitor client appearance, mood, and psychomotor behavior and observe for changes; assist client with achieving self-control of behavior; assist client in using behavioral strategies to decrease anxiety; assist in or reinforce education of caregivers/family on ways to manage client with behavioral disorders; participate in behavior management program by recognizing environmental stressors and/or providing therapeutic environment; participate in reminiscence therapy, validation therapy, or reality orientation; participate in client group session; reinforce client participation in therapy; use behavioral management techniques when caring for a client; evaluate client response to behavioral management interventions; collect data regarding client psychosocial functioning; identify client use of effective and ineffective coping mechanisms; use therapeutic techniques to assist client with coping ability; identify client in crisis; identify client risk for self-injury and/or violence; use crisis intervention techniques to assist client in coping; provide opportunities for client to understand why the crisis occurred; guide client to resources for recovery from crisis; reinforce client teaching on suicide/violence prevention; report changes in client behavior (indicating a developing crisis) to supervisor; recognize cultural issues that may impact client understanding/acceptance of psychiatric diagnosis; identify client reaction to loss; provide client with resources to adjust to loss/bereavement (e.g., individual counseling, support groups); identify expected behaviors of client with independent or dependent personality; identify client symptoms of acute or chronic mental illness (e.g., schizophrenia, depression, bipolar disorder); recognize change in client mental status; recognize client symptoms of relapse; explore why client is refusing or not following treatment plan; identify client emotional problems related to religious/spiritual beliefs; use therapeutic communication techniques with client. Identify signs and symptoms of substance abuse/chemical dependency, withdrawal or toxicity; plan and provide care to client experiencing substance-related withdrawal or toxicity (e.g., nicotine, opioid, sedative); reinforce provided information on substance abuse diagnosis and treatment plan to client; encourage client participation in support groups (e.g., Alcoholics Anonymous, Narcotics Anonymous); monitor client response to treatment plan and contribute to revision of plan as needed. None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
       
Identify client knowledge on aging process and assist in reinforcing teaching on expected changes related to aging; provide care that meets the special needs of adults ages 65 to 85; provide care that meets the special needs of adults greater than age 85; assist client with expected life transition (e.g., retirement); modify approaches to care in accordance with client development stage; identify client end-of-life needs; identify client ability to cope with end-of-life interventions; provide care or support for client/family at end of life; assist client in resolution of end-of-life issues. Recognize risk factors for elder abuse/neglect. None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
Registered Nurse (Diploma, Associate’s, and Baccalaureate)v
Recognize client who is socially or environmentally isolated; assess client for potential or actual abuse/neglect and intervene when appropriate; identify risk factors for domestic, child, elder abuse/neglect and sexual abuse; plan interventions for victims/suspected victims of abuse; counsel victims/ suspected victims of abuse and their families on coping strategies; assess client appearance, mood, and psychomotor behavior and identify/respond to inappropriate/abnormal behavior; assist client with achieving and maintaining self-control of behavior; assist client to develop and use strategies to decrease anxiety; orient client to reality; participate in group sessions; incorporate behavioral management techniques when caring for a client; evaluate client response to treatment plan; assess client reaction to diagnosis of acute or chronic mental illness; provide information to client on stress management techniques; assess the potential for violence and initiate/maintain safety precautions; identify client in crisis; use crisis intervention techniques to assist client in coping; apply knowledge of client psychopathology to crisis intervention; guide client to resources for recovery from crisis; recognize cultural issues that may impact client understanding/acceptance of psychiatric diagnosis; encourage client participation in group/family therapy; provide client with resources to adjust to loss/bereavement (e.g., individual counseling, support groups); evaluate client coping and fears related to grief and loss; recognize signs and symptoms of acute and chronic mental illness (e.g., schizophrenia, depression, bipolar disorder); explore why client is refusing/ not following treatment plan; assess client for alterations in mood, judgment, cognition, and reasoning; apply knowledge of client psychopathology to mental health concepts applied in individual/group/ family therapy; provide care and education for acute and chronic behavioral health issues (e.g., anxiety, depression, dementia, eating disorders); evaluate client ability to adhere to treatment plan; identify the emotional problems of client or client needs that are related to religious/ spiritual beliefs; recognize nonverbal cues to physical and/or psychological stressors; use therapeutic communication techniques to provide support to client; provide a therapeutic environment for clients with emotional/behavioral issues. Assess client reactions to the diagnosis/treatment of substance-related disorder; assess client for drug-/alcohol-related dependencies, withdrawal, or toxicities and intervene when appropriate; plan and provide care to client experiencing substance-related withdrawal or toxicity (e.g., nicotine, opioid, sedative); provide information on substance abuse diagnosis and treatment plan to client; encourage client to participate in support groups (e.g., Alcoholics Anonymous, Narcotics Anonymous); evaluate client response to treatment plan and revise as needed. None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
Assess client reactions to expected age-related changes; provide care and education that meets the special needs of adults ages 65 to 85; provide care and education that meets the special needs of adults greater than age 85; identify expected physical, cognitive, and psychosocial stages of development; identify expected body image changes associated with client developmental age (e.g., aging); compare client development to expected age/ developmental stage and report any deviations; assist client in coping with life transition (e.g., retirement); modify approaches to care in accordance with client developmental stage (use age-appropriate explanations of procedures and treatments); provide education to client/ staff members about expected age-related changes and age-specific growth and development; assess client ability to cope with end-of-life interventions; identify end-of-life needs of client; recognize need for and provide psychosocial support to family/caregiver; assist client in resolution of end-of-life issues; provide end-of-life care and education to clients (e.g., hospice). Identify risk factors for elder abuse/ neglect; evaluate client abnormal response to the aging process (e.g., depression). None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
Gerontological Nursesw
N/A N/A N/A
Psychiatric and Mental Health Nursesx
Primary specialty. None None
Advanced Practice Registered Nurses (Master’sy and Doctoralz )
Assumes mastery of baccalaureate essentials; advanced health/physical assessment, including psychological assessment; knowledge and skills to identify signs and symptoms of common emotional illnesses. None None
Acute Care Nurse Practitionersaa
Performs evaluations for substance use, violence, neglect, and abuse; assesses the impact of an acute, critical, and/or chronic illness or injury on the individual’s Diagnoses common substance use or addictive disorder/ disease, such as Diagnoses common mental health and substance use or addictive disorder/
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
Primary specialty. Evidence-based tools and techniques for history taking used with older adults (e.g., psychological); evidence-based tools and techniques for physical exams and psychosocial assessments used with older adults in many settings (e.g., mental status exam); pathophysiology and diagnostic tests (e.g., geriatric depression scale); identifying risk factors (e.g., abuse and neglect, suicide behavior, self-harm); norms and variances (e.g., psychosocial assessment, psychological); coordinating with others to implement the plan of care (e.g., occupational therapy, social work, spiritual care, family). Identifying risk factors (e.g., addiction). None
       
N/A Normal and abnormal mental changes across the life span; using age-appropriate, system-specific, evidence-based assessment instruments, tools, and techniques. None None
       
Assumes mastery of baccalaureate essentials; knowledge and skills to compare and contrast physiologic changes over the life span and analyze the relationship between normal physiology and pathological phenomena produced by altered states across the life span. Assumes mastery of baccalaureate essentials. None None
       
Distinguishes between normal and abnormal developmental and age-related physiologic and None None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
health status (physical and mental); provides for the promotion of health and protection from disease by assessing for risks associated with care of complex acute, critical, and chronically ill patients, such as psychological risk, including, but not limited to, impaired sleep and communication, and crisis related to threat to life, self-image, finances, medication side effects, home and educational environment, and altered family dynamics; diagnoses common mental health disorder/disease, such as anxiety and depression, in the presence of complex acute, critical, and chronic illness. alcohol and drug use, in the presence of complex acute, critical, and chronic illness; demonstrates effective communication skills in addressing sensitive topics with patients and families such as substance use. disease, such as anxiety, depression, and alcohol and drug use, in the presence of complex acute, critical, and chronic illness.
Adult Psychiatric-Mental Health Nurse Practitionersbb
Primary specialty. Because substance-related disorders are one of the DSM-IV-TR Axis I diagnoses, they have been included as a psychiatric disorder in these standards. None
Adult-Gerontology Primary Care Nurse Practitionerscc
N/A N/A N/A
Adult-Gerontology Clinical Nurse Specialistsdd
N/A N/A N/A
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
behavioral changes in complex acute, critical, and chronic illness; implements palliative and end-of-life care in collaboration with the family, patient (when possible), and other members of the multidisciplinary health care team; provides anticipatory guidance that is age and developmentally appropriate within the context of complex acute, critical, chronic illness.      
       
N/A Orders age-appropriate tests and other procedures that provide data that contribute to the treatment plan; detects and minimizes adverse drug reactions with knowledge of pharmacokinetics and dynamics with special attention to vulnerable populations such as older adults. Because substance-related disorders are one of the DSM-IV-TR Axis I diagnoses, they have been included as a psychiatric disorder in these standards. None
       
Primary specialty. Assesses mental health status using age, gender, and culturally appropriate standardized assessment instruments or processes; assesses for syndromes that may be manifestations of other common health problems (e.g., risk-taking behaviors, self-injury, stress, delirium, or depression); acute and chronic physical and mental illnesses; treats and manages geriatric syndromes such as delirium, depression, and dementia. Fosters a trusting relationship that facilitates discussion of sensitive issues with the individual, family, and other caregivers such as substance use/ abuse. Assesses individuals with complex health issues and comorbidities, including the interaction with acute and chronic physical and mental health problems.
       
Primary specialty. Assesses the interaction between acute and chronic physical and mental health problems; Evaluates for common mental health disorders such None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
     
IV. PSYCHOLOGISTSee
Primary specialty. Behavioral genetics, transmission and expression of genetic information and its modification and the role of this information in understanding diseases and disorders (e.g., substance abuse disorders) with consideration of comorbidities and Behavioral genetics, transmission and expression of genetic information and its modification and the role of this information in understanding diseases and disorders (e.g., substance abuse disorders), with consideration of comorbidities and
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
  uses reliable and valid age-appropriate assessment instruments to assess acute and chronic health concerns, including mental status, delirium, dementia, and pain; evaluates for common mental health disorders such as depression, dementia, anxiety, or substance-related disorders; manages or appropriately refers the patient with signs and symptoms of mental health disorders; uses behavioral, communication, and environmental-modification strategies with individuals who have cognitive and psychiatric impairments; advises patients, families, and caregivers on how to address sensitive issues such as suicide prevention, substance use, potential for abuse, and end-of-life concerns; modifies health information, patient education programs, and interventions for patients with mental illness limitations; provides education to patients, families, caregivers, and the community, including the interaction between physical and mental health. as depression, dementia, anxiety, or substance-related disorders; advises patients, families, and caregivers on how to address sensitive issues such as substance use.  
       
N/A Influence of psychosocial factors (e.g., life span development) on beliefs/cognitions and behaviors; normal growth and development across the full life span; family development and functioning and its impact on the individual across the full life span; normative and nonnormative life None Comorbidity of mental illness with substance abuse, comorbidity rates, age ranges affected.
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
  population differences in genetic information. population differences in genetic information; comorbidity of mental illness with substance abuse, comorbidity rates, age ranges affected.
Clinical Psychologyff
Primary specialty. None None
Counseling Psychologygg
Primary specialty. None None
Couple and Family Psychologyhh
Primary specialty. None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
  event changes (e.g., retirement) that can influence the normal course of development; disorders/diseases that impact expected course of development over the full life span.    
       
N/A Sensitivity to and skills in dealing with multicultural/diverse populations, including broad scope of age; conducts assessments of cases from any developmental level across the life span; performs interventions that may take the form of any modality of psychotherapy or environmental modification in cases from any developmental level across the life span. None None
       
N/A Sensitivity to and skills in dealing with multicultural/ diverse populations, including broad scope of age; perform interventions that may reflect any modality of psychotherapy or environmental modification and may come from any developmental level across the life span. None None
       
N/A Knowledge in life span human development; assessment procedures should be appropriate for the client’s developmental age and stage of lifecycle; use of instruments that have normative data from age-appropriate samples; interpretations and conclusions take into account couple/ family/identified patient uniqueness (developmental age and stage of lifecycle). None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
Rehabilitation Psychologyii
Primary specialty. Appropriate selection, administration, modification (where indicated), and interpretation of standardized tests, behavioral observations, and/ or clinical interviews, given the needs of the patient/ client, upon which recommendations are made and communicated to promote useful outcomes in the assessment of substance use/ abuse identification; effective consultation with other professionals appropriate to the needs of the client in ways that will promote useful outcomes for the patient/client in substance abuse identification and management. None
V. LICENSED COUNSELORS
Rehabilitation Counselingjj
Recognize individuals with a disability who demonstrate psychological or mental health-related problems and make appropriate referrals when appropriate; analyze diagnostic and assessment information (e.g., vocational and educational tests, records, and psychological and medical data) and communicate this information to the consumer; explain and use standard diagnostic classification systems for mental health conditions within the limits of the role and responsibilities of the rehabilitation counselor; recognize and communicate a basic understanding of how to assess individuals, groups, and families who exhibit suicide ideation, psychological and emotional crisis; identify and recommend treatment options that facilitate recovery and successful psychiatric rehabilitation outcomes. Describe different recovery models that apply to substance abuse treatment and rehabilitation; identify and recommend treatment options that facilitate recovery and successful rehabilitation outcomes. None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
N/A Sensitivity to and skills in dealing with multicultural/diverse populations, including broad scope of age; an awareness of science-based theories and research on individual and cultural diversity (i.e., age). None None
       
       
Identify the influences of aging differences and integrate this knowledge into practice; articulate a working knowledge of human development and the needs of individuals with disabilities across the life span. None None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
Addiction Counselingkk    
Primary specialty. Primary specialty. Recognize the potential for addictive disorders to mimic a variety of medical and psychological disorders and the potential for medical and psychological disorders to coexist with addiction and substance abuse; provide appropriate counseling strategies when working with clients with addiction and co-occurring disorders; screen for co-occurring mental and/or addictive disorders; knowledge of the impact of co-occurring addictive disorders on medical and psychological disorders; demonstrate appropriate use of diagnostic tools, including the current edition of the DSM-IV-TR, to describe the symptoms and clinical presentation of clients with addictive disorders and mental and emotional impairments.
Clinical Mental Health Counseling    
Primary specialty. Core curricula for all counselors should include theories and etiology of addictions and addictive behaviors, including strategies for prevention, intervention, and treatment.

In addition, identifies standard screening and assessment instruments for substance use disorders and process addictions.
Recognizes the potential for substance use disorders to mimic and coexist with a variety of medical and psychological disorders; knows the disease concept and etiology of addiction and co-occurring disorders; provides appropriate counseling strategies when working with clients with addiction and co-occurring disorders; screens for addiction, as well as co-occurring
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
N/A None Core curricula for all counselors should include theories of individual and family development and transitions across the life span; theories for facilitating optimal development and wellness over the life span. None
       
N/A Core curricula for all counselors should include theories of individual and family development and transitions across the life span; theories for facilitating optimal development and wellness over the life span. None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
    mental disorders; knows the impact of co-occurring substance use disorders on medical and psychological disorders.
VI. SOCIAL WORKERS
Social Worker (Associate’s and Baccalaureate)ll  
Typical and atypical emotional growth and development; the impact of physical, mental, and cognitive impairment on human development; the interplay of biological, psychological, social, and spiritual factors; assessing types of information available from psychological and psychiatric educational records; process of referring the client for additional evaluations (e.g., psychological); The dynamics and effects of life stage and lifecycle crises; the impact of physical and mental illness on crises; dynamics and effects of trauma; dynamics and effects of loss, separation, and grief; indicators of and response to client danger to self and others; stages of crises; processes and techniques for cognitive and/or behavioral interventions. Differentiating the use of, abuse of, and dependency on substances; the effects of addiction on the client; the effects of addiction on the family system and other relationships; eliciting sensitive information (e.g., substance abuse). The co-occurrence of addiction and other disorders.
Social Worker (Master’s)mm  
Behavioral, cognitive, and learning theories; impact of physical, mental, and cognitive disabilities on human development; interplay of biological, psychological, and social factors; dynamics of grief and loss; indicators and dynamics of abuse; psychopharmacology; components of a biopsychosocial history; symptoms of mental and emotional illness; indicators of psychosocial stress; indicators of traumatic stress and violence; current Diagnostic and Statistical Manual diagnostic framework and criteria; components and function of the mental status examination; indicators of client danger to self and others; use of cognitive behavioral techniques. Addiction theories and concepts; indicators of substance abuse and other addictions. None
Clinical Social Worknn  
Primary specialty. Substance abuse and/or dependence; the effects of substance abuse and/or dependence on relationships; the effects of substance abuse and/or dependence; addiction theories; Assessment and diagnosis of co-occurring disorders and conditions.
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
       
       
Older adult behavior and development; the interaction of age and/or disability with behaviors, attitudes, and identity. The symptoms of mental and emotional illness across the life span; the indicators, dynamics, and impact of sexual abuse, emotional abuse, neglect, physical abuse, intimate partner violence, and other forms of exploitation across the life span; the dynamics and effects of life stage and lifecycle crises; the effect of the client system’s life stage on the selection of an intervention. None None
       
Aging processes; influence of age on behaviors and attitudes. None None None
       
N/A Gerontology; differences in age and/ or disability factors and characteristics; the influences of age and/or disability; the impact of age and/or disability on self-image; the effects of discrimination based on age and/or disability; None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
  the effects of drugs and alcohol on behavior; other addictions; the effects of other addictions on behavior and relationships.  
VII. PHARMACISTSoo
None Science foundation should include acute and chronic toxic effect of xenobiotics on the body, including drug or chemical overdose and toxic signs of drugs of abuse. None
Psychiatric Pharmacypp    
Primary specialty. Substance-related disorders included in definition of psychiatric disorders; evaluate psychiatric services for compliance with standards established by national accrediting and regulatory agencies as related to practice in health care settings (e.g., mental health, substance abuse). Knowledge of pharmacologic treatment of psychiatric and neurologic disorders in special populations (e.g., comorbidity).
VIII. OCCUPATIONAL THERAPISTS
Occupational Therapy Assistantqq
Curriculum must prepare students to work with a variety of populations including, but not limited to, children, adolescents, adults, and elderly persons in areas None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
  the methods used to assess needed level of care (e.g., geriatrics); the impact of aging parents on adult children.    
       
Science foundation should include principles of end-of-life care; pathophysiologic and pharmacotherapy alterations, dosage calculation, and adjustments, and drug monitoring for positive/negative outcomes specific for special population patients (e.g., geriatric) for prescription and nonprescription medications; advanced pharmacy practice experiences must include primary, acute, chronic, and preventive care among patients of all ages; in general, each site used for required pharmacy practice experiences should have a patient population that exhibits diversity in age. None None None
       
N/A Knowledge of pharmacologic treatment of psychiatric and neurologic disorders in special populations (e.g., age); disorders in the elderly (including medication use and other psychiatric disorders not included in general list of psychiatric disorders). Substance-related disorders included in definition of psychiatric disorders. Knowledge of pharmacologic treatment of psychiatric and neurologic disorders in special populations (e.g., comorbidity, age).
       
       
Demonstrate knowledge and understanding of human development throughout the life span Curriculum must prepare students to work with a variety of populations, including None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
of physical and mental health; course content must include, but is not limited to, developmental psychology; demonstrate knowledge and understanding of the concepts of human behavior to include the behavioral and social sciences (e.g., principles of psychology, sociology, abnormal psychology); demonstrate knowledge and appreciation of the role of sociocultural, socioeconomic, and diversity factors and lifestyle choices in contemporary society (e.g., principles of psychology, sociology, and abnormal psychology); understand the effects of physical and mental health, heritable diseases and predisposing genetic conditions, disability, disease processes, and traumatic injury to the individual within the cultural context of family and society on occupational performance; express support for the quality of life, well-being, and occupation of the individual, group, or population to promote physical and mental health; consider client factors, including body functions (e.g., cognitive, mental) and body structures in occupational performance evaluation; interventions must address client factors, including body functions (e.g., cognitive, mental).    
Occupational Therapist (Master’srrand Doctoralss )    
The curriculum must prepare students to work with a variety of populations, including, but not limited to, children, adolescents, adults, and elderly persons in areas of physical and mental health; course content must include, but is not limited to, developmental psychology; demonstrate knowledge and understanding of the concepts of human behavior to include the behavioral and social sciences. Course content must include, but is not limited to, introductory psychology, abnormal psychology, and introductory sociology or introductory anthropology; analyze the effects of physical and mental health, heritable diseases, and predisposing genetic conditions, disability, disease processes, and traumatic injury to the individual within the cultural context of family and society on occupational performance; express support for the quality of life, well-being, and occupation of the individual, group, or population to promote physical and mental health; consider client factors, including body functions (e.g., cognitive, mental) and body structures in occupational performance evaluation; interventions must address client factors, including body functions (e.g., cognitive, mental). None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
(including elderly persons); recommended that the student be exposed to a variety of clients across the life span and to a variety of settings in Level II feldwork. elderly persons, in areas of physical and mental health.    
       
Demonstrate knowledge and understanding of human development throughout the life span (including elderly persons); select appropriate assessment tools based on client needs, contextual factors, and psychometric properties of tests. These must be relevant to a variety of populations across the life span, culturally relevant, based on available evidence, and incorporate use of occupation in the assessment process; recommended that the student be exposed to a variety of clients across the life span and to a variety of settings in Level II fieldwork. The curriculum must prepare students to work with a variety of populations, including elderly persons, in areas of physical and mental health. None None
Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
Gerontologytt
N/A N/A N/A
Mental Healthuu
Primary specialty. None None
IX. DIRECT CARE WORKERS    
Certified Nursing Assistantvv    
Mental health and social service needs, including modifying aide’s behavior in response to residents’ behavior, awareness of developmental tasks associated with the aging process, how to respond to resident behavior, allowing the resident to make personal choices, providing and reinforcing other behavior consistent with the resident’s dignity, and using the resident’s family as a source of emotional support. None None
Home Health Aideww    
None None None

aStep 2 Clinical Knowledge (CK) Content Description and General Information, USMLE 2011.

bProgram Requirements for Graduate Medical Education in Family Medicine, ACGME 2007.

cProgram Requirements for Graduate Medical Education in Geriatric Medicine, ACGME 2006.

dProgram Requirements for Graduate Medical Education in Internal Medicine, ACGME 2009.

eProgram Requirements for Graduate Medical Education in Geriatric Medicine, ACGME 2007.

Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
GENERAL POPULATION
General Care Mental Health (MH) Substance Use (SU) Co-occurring MH and SU
       
Primary specialty. Knowledge of relevant evidence, including theories regarding age-related changes or pathology that affect cognitive and psychological function. None None
       
N/A Synthesizes knowledge of how occupational performance and context influence life satisfaction, quality of life, and mental health across the life span in the design and delivery of services. None None
       
       
  Mental health and social service needs, including awareness of developmental tasks associated with the aging process; care of cognitively impaired residents, including techniques for addressing the unique needs and behaviors of individuals with dementia (Alzheimer’s and others), communicating with cognitively impaired residents, understanding the behavior of cognitively impaired residents, appropriate responses to the behavior of cognitively impaired residents; and methods of reducing the effects of cognitive impairments. None None
       
None None None None

fProgram Requirements for Graduate Medical Education in Psychiatry, ACGME 2007.

gProgram Requirements for Graduate Medical Education in Geriatric Psychiatry, ACGME 2003.

hProgram Requirements for Graduate Medical Education in Addiction Psychiatry, ACMGE 2003.

Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

i American Osteopathic Association. 2011. Basic standards for fellowship training in geriatrics in osteopathic family medicine and manipulative treatment. http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/basic-standards-for-fellowship-training-in-geriatrics-osteopathic-family-practice.pdf.

j NBOME 2009. Fundamental Osteopathic Medical Competencies: Guidelines for Osteopathic Medical Licensure and the Practice of Osteopathic Medicine. AOA. 2011. Specific Basic Standards for Osteopathic Fellowship Training in Internal Medicine Geriatrics. http://www.osteopathic.org/inside-aoa/accreditation/postdoctoral-training-approval/postdoctoral-training-standards/Documents/specific-requirements-for-fellowship-training-in-geriatric-medicine.pdf.

k NBOME 2011, Computer-Based COMLEX Content Outline, http://www.nbome.org/intro/m_outline.html.

l Basic Standards for Residency Training in Family Practice and Manipulative Treatment, AOA and ACOFP 2011.

m Basic Standards for Fellowship Training in Geriatrics in Family Practice and Manipulative Treatment, AOA and ACOFP 2011.

n Basic Standards for Fellowship Training in Addiction Medicine in Family Practice and Manipulative Treatment, AOA and ACOFP 2008.

o Basic Standards for Residency Training in Internal Medicine, AOA and ACOI 2011.

p Specific Basic Standards for Osteopathic Fellowship Training in Internal Medicine Geriatrics, AOA and ACOI 2011.

q Basic Standards for Residency Training in General Psychiatry, AOA and ACONP 2009.

r Basic Standards for Residency Training in Geriatric Psychiatry, AOA and ACONP 2008.

s Basic Standards for Addiction Psychiatry, AOA and ACONP 2007.

t Accreditation Standards for Physician Assistant Education, Fourth Edition, ARCEPA March 2010.

u 2011 NCLEX-PN ® Detailed Test Plan: Item Writer/Item Reviewer/Nurse Educator Version, NCSBN April 2011.

v 2010 NCLEX-RN ® Detailed Test Plan: Item Writer/Item Reviewer/Nurse Educator Version, NCSBN April 2010.

w Gerontological Nursing Board Certification Test Content Outline, ANCC 2010.

x Psychiatric and Mental Health Nursing Board Certification Test Content Outline, ANCC 2010.

y The Essentials of Master’s Education for Advanced Practice Nursing, AACN 1996.

z The Essentials of Doctoral Education for Advanced Nursing Practice, AACN October 2006 (standards do not differ between Master’s and Doctoral levels in these areas).

aa Acute Care Nurse Practitioner Competencies, National Panel for Acute Care Nurse Practitioner Competencies 2004.

bb National Panel for Psychiatric-Mental Health NP Competencies, September 2003, http://www.aacn.nche.edu/leading-initiatives/education-resources/PMHNP.pdf.

cc Adult-Gerontology Primary Care Nurse Practitioner Competencies, AACN 2010.

dd Adult-Gerontology Clinical Nurse Specialist Competencies, AACN March 2010.

ee ASPPB Information for EPPP Candidates: Examination for Professional Practice in Psychology (EPPP), ASPPB 2011.

ff Examination Manual for Board Certification in Clinical Psychology for the American Board Of Professional Psychology, ABPP 2011.

gg Examination Manual for Board Certification in Counseling Psychology for the American Board of Professional Psychology, ABPP 2010.

hh Manual for Obtaining Board Certification, American Board of Couple and Family Psychology 2011.

ii Certification Guidelines and Procedures Candidate’s Manual, American Board of Rehabilitation Psychology 2011.

jj Accreditation Manual for Master’s Level Rehabilitation Counselor Education Programs, CORE 2011.

Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

kk Council for Accreditation of Counseling and Related Educational Programs 2009 Standards, CACREP 2009.

ll ASWB Examination program Knowledge, Skills and Abilities: Bachelor’s Examination, ASWB 2011. (Note: Associate candidates also take Bachelor’s Examination.)

mm Examination program Knowledge, Skills and Abilities: Masters Examination, ASWB 2011.

nn ASWB Examination program Knowledge, Skills and Abilities: Clinical Examination, ASWB 2011.

oo Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree, ACPE 2011.

pp Content Outline for the Psychiatric Pharmacy Specialty Certification Examination, Board of Pharmacy Specialties, May 2005.

qq Accreditation Standards for an Educational Program for the Occupational Therapy Assistant, ACOTE 2006.

rr Accreditation Standards for a Master’s Degree-Level Educational Program for the Occupational Therapist, ACOTE 2006.

ss Accreditation Standards for a Doctoral Degree-Level Educational Program for the Occupational Therapist, ACOTE 2006 (standards do not differ between master’s and doctoral levels in these areas).

tt Competencies, Criteria, and Client Outcomes: Gerontology Board Certification, AOTA 2009.

uu Competencies, Criteria, and Client Outcomes: Mental Health Board Certification, AOTA 2009.

vv C.F.R. Part 483 (Requirements for States and Long-Term Care Facilities), October 1, 2001.

ww C.F.R. Part 484 (Conditions of Participation: Home Health Agencies), October 1, 2001.

Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×

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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
×
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Suggested Citation:"Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers." Institute of Medicine. 2012. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?. Washington, DC: The National Academies Press. doi: 10.17226/13400.
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Next: Appendix D: IOM Recommendations from Retooling for an Aging America: Building the Health Care Workforce (2008) »
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At least 5.6 million to 8 million--nearly one in five--older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care. With the number of adults age 65 and older projected to soar from 40.3 million in 2010 to 72.1 million by 2030, the aging of America holds profound consequences for the nation.

For decades, policymakers have been warned that the nation's health care workforce is ill-equipped to care for a rapidly growing and increasingly diverse population. In the specific disciplines of mental health and substance use, there have been similar warnings about serious workforce shortages, insufficient workforce diversity, and lack of basic competence and core knowledge in key areas.

Following its 2008 report highlighting the urgency of expanding and strengthening the geriatric health care workforce, the IOM was asked by the Department of Health and Human Services to undertake a complementary study on the geriatric mental health and substance use workforce. The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? assesses the needs of this population and the workforce that serves it. The breadth and magnitude of inadequate workforce training and personnel shortages have grown to such proportions, says the committee, that no single approach, nor a few isolated changes in disparate federal agencies or programs, can adequately address the issue. Overcoming these challenges will require focused and coordinated action by all.

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