bodies, the federal government, and purchasers, is needed to increase the M/SU workforce’s competencies to deliver high-quality care.


Previous reports of the Institute of Medicine (IOM) and other authoritative bodies have documented the critical roles played by the health care workforce in the delivery of high-quality health care. Crossing the Quality Chasm identifies the health care workforce as the health system’s most important resource, and critical to improving the quality of care (IOM, 2001). All of the recommendations of the previous chapters—providing patient-centered, safe, effective, and coordinated care and taking advantages of the opportunities offered by information technology—require a workforce sufficient in numbers, with the necessary competencies, and enabled by the environments in which they practice to deliver care consistent with these competencies. However, the entire health care workforce—including those who provide care for mental and substance-use conditions—faces numerous obstacles to delivering high-quality care. These include a shortage and geographic maldistribution of workers (see Box 7-1), work environments that thwart clinicians’ delivery of quality health care (AHRQ, 2003; IOM, 2004b), a lack of ethnic diversity and cultural expertise (IOM, 2004a) (see Box 7-2), outdated education and training content and methods (IOM, 2003), state-to-state variation in scopes of practice and assurance of competency, and concerns about legal liability (IOM, 2001).

Although the M/SU health care workforce faces all of the same problems as the health care workforce overall, building its capacity to deliver higher-quality care for M/SU conditions is particularly problematic because of the greater variety of types of M/SU health care providers and an even greater variation in how they are educated, licensed, and certified/credentialed for practice. While recognizing the importance of such problems as workforce shortages, geographic maldistribution, and insufficient diversity that afflict the M/SU and general health care workforces alike, this chapter focuses on the special problems resulting from the greater diversity of the M/SU health care workforce, their varying education and training, and the difficulties of delivering high-quality patient care in the solo practices that are more typical among those who treat M/SU conditions.


Caregivers who provide care to individuals with M/SU problems and illnesses, like those who care for those with general health care problems

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