Using the complex care core competencies to support treatment for substance use disorders

Author
Dayna Fondell, Shelby Kehoe, Rebecca Koppel, Mouy Pan
Date
February 19, 2021
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In response to the opioid epidemic and rising overdoses, New Jersey, like many other states, has invested in a range of interventions to provide additional support to individuals with substance use disorder. These new programs often include roles like peer recovery specialists, case managers, and navigators. As these programs have grown, a common challenge has been the lack of specific core competencies that reflected the knowledge, skills, and attitudes required to successfully perform and develop in these newer roles.

Complex care teams around the country identified the same gap: while there was growing awareness that complex care has its own foundational knowledge, skills, and attitudes, there was no defined, comprehensive set of core competencies.

In October of 2020, our National Center for Complex Health and Social Needs published Core competencies for frontline complex care providers, which captures the necessary knowledge, skills, and attitudes for all practitioners that coordinate and provide services for people with complex needs.

The complex care core competencies were being finalized and the report drafted by the Camden Coalition’s National Center staff just as the Camden Coalition’s Clinical Redesign Initiatives (CRI) team was being asked to identify core competencies for two substance use disorder (SUD) navigation programs in New Jersey. We realized that this was a great opportunity to collaborate across teams, and to show how the complex care core competency framework could be applied and customized to reflect a program’s specific needs.

Applying the competencies to a substance use disorder navigation program in NJ

The two New Jersey SUD navigation programs we worked with had both evolved rapidly in response to New Jersey’s changing opioid epidemic. While each program focused on a different care setting, both aimed to provide holistic care through multi-disciplinary teams. These teams included newly created roles of navigators and case managers, which were filled by staff from a variety of backgrounds. The CRI team used the complex care core competencies as a framework to create core competencies specific to these roles.

Our process for adapting the complex care core competencies to the SUD navigation programs included a literature review, as well as a survey and interviews with providers and program staff. We wanted to first define the knowledge, skills, and attitudes needed across program roles, and then map and adapt them to the complex care core competencies.

The literature review incorporated research gathered for the creation of the complex care core competencies, including frameworks from disciplines across complex care. We also reviewed program-specific requests for proposals, job descriptions, and research literature related to SUD care team roles and core competencies. We found that the complex care core competencies that focused on a respect for lived experience, inclusion of participant perspectives, and acknowledgement of disparities and stigma were particularly helpful to look at when structuring interdisciplinary competencies for SUD navigators in New Jersey.

The CRI team also wanted to ensure that these new competencies were emerging from staff on the ground and from those with lived experience. We interviewed program staff and other stakeholders, including program supervisors and healthcare providers, and conducted a survey to get to know the team roles and the knowledge, skills, and attitudes needed for each role.

After gathering the program- and specialization-specific information we needed, we mapped our findings to each of the complex care core competencies.

During the mapping process, we found that the knowledge, skills, and attitudes that emerged from the SUD navigation programs each aligned with at least one of the complex care core competencies. This showed that not only were the complex care core competencies a strong framework for our SUD navigator core competencies, but also that staff in these care coordination roles must be competent in the philosophy of providing complex care.

Through the mapping process, we identified fourteen of the complex care core competencies to focus on for the SUD navigator programs. We put the specific knowledge, attitudes, and skills needed for each program and role into sub-categories called functional competencies under each core competency. The creation of these functional competencies was essential in identifying the training and support needed to implement the competencies in each program, and was received well by SUD navigation program staff. We then worked with our stakeholder advisory group, which included program staff and supervisors, healthcare providers, workforce development trainers, state government and employees, to ensure that the core competency language resonated with frontline staff, and modified as needed. An example is shown below.

Example:

Original complex care core competency: Partner with individuals and families to address challenges in implementing care plans, including navigating complex systems and nonlinear pathways, while fostering resilience, ability, and self-efficacy in high-stakes moments and ability to navigate setbacks, barriers, complex systems)

Modified SUD navigator core competency: Partner with individuals (and as appropriate families) to foster resilience and self-efficacy to implement care plans including navigating setbacks, barriers, complex systems, and nonlinear pathways.

The table below shows how the CRI team broke down a shared core competency of the two different SUD navigation programs into functional competencies to allow for tailored mapping of knowledge, skills and attitudes to workforce development and training courses for each program.

 

Program A functional competencies Program B functional competencies
Reinforce multiple pathways to care and belief in nonlinear pathways Reinforce multiple pathways to care and belief in nonlinear pathways
Provide support and education to families regarding substance use disorder, treatment options, and available resources Provide support and education to families regarding substance use disorder, treatment options, and available resources
Empower and coach clients toward self-efficacy in navigating resources:

  • Model behavior
  • Help patient work through next steps for them to take action
  • Highlight client’s effort over outcomes
Empower and coach clients toward self-efficacy by working with them to:

  • Understand treatment choices
  • Ask questions of treatment providers
  • Self-advocate for medical care
Provide barrier-specific education on navigation of specific areas of care, or specific client situations such as HIV, legal involvement, etc. Maintain a flexible approach
Maintain a flexible approach

Adopting the competencies in your workplace

Are you considering using the complex care core competencies in your setting? Here are a few suggestions for adopting the competencies to your team, from our experience in New Jersey:

  • You do not need to use all the core competencies, but it is helpful to review all of them and to be intentional about what is included.
  • Test out the language and see what makes sense to your staff.
  • View the core competencies as broad categories with the ability to customize the specific skills that fall under each competency for your program.
  • Use the competencies as a training and development map to help identify what trainings should or could be organizational- or program-wide versus which might be role-specific.

See Five ways to use the complex care core competencies in practice and Five ways for educators and practitioners to use the complex care core competencies in education to learn about more ways that you can use the competencies in your setting.

We are excited to see how you use the complex care competencies to advance your own practice at the individual, team, and programmatic levels. Please share with us how you’re using the competencies, what tools you would like to see, and if you’re interested in partnering with the National Center to implement the core competencies in your setting.

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