Empowering innovation in addiction care and counselor education
By Jeremiah Gardner
NOTE: This was published for the Hazelden Betty Ford Foundation’s monthly Recovery Advocacy Update. If you’d like to receive our advocacy emails, subscribe today.
Innovation requires the courage to change — the willingness to take calculated risks and move into new territory amid obstacles. Two recent examples: SAMHSA’s new rules governing a long-sought update to privacy regulations in addiction care, and the Hazelden Betty Ford Graduate School’s approval of a new Alternative Admissions Pathway for prospective students who don’t have bachelor’s degrees. Both were met with initial skepticism and, in the case of the privacy rules, strong opposition. And yet both ultimately found their way to becoming policy and now serve as fresh examples of the Hazelden Betty Ford Foundation’s 75-year history of innovation and influence.
Privacy Rules
In 2018, I had the opportunity to testify before a Congressional committee in support of a bill to streamline privacy regulations governing the addiction treatment industry. It’s a complex topic, philosophically and technically, and my task was especially nerve-wracking because many of my friends in the recovery advocacy world were strongly opposed to it. In fact, one sat next to me on the panel and testified in opposition. I, too, was skeptical of the idea at first. But after months of study and Socratic discussions with people who understood the issue inside and out, I came to support the legislation, in full alignment with my employer, the Hazelden Betty Ford Foundation.
What happened?
Few other leaders in the addiction treatment industry chose to speak up on the issue. Our allies were mostly hospitals and other mainstream healthcare interests. With some recovery advocacy leaders vocally opposed and saying it would lead to more discrimination against people with substance use disorders, it was uncomfortable. Hazelden Betty Ford has been fighting that kind of discrimination for 75 years ourselves. We felt strongly that the legislation would replace theoretical safeguards designed just for addiction treatment (in a policy called 42 CFR Part 2), which are heightened but never enforced, with clarity and alignment around the privacy law that governs all of healthcare (HIPAA) and is routinely enforced, while enabling important technology-driven advances in care, now and far into the future. Hazelden Betty Ford (and leaders like Emily Piper and Jenni Lohse) never wavered from our position and ultimately made an effective case; the bill passed and became law; and regulators issued a final regulatory rule last month — clearing the way for the law to take effect on April 16.
Why it matters
The new law is a big deal. It allows healthcare providers to obtain a single consent from patients permitting their information to be shared within healthcare entities for the purposes of treatment, payment, and operations. No longer will new consents be needed for every imaginable information-sharing need — easing the administrative burden on both providers and patients and, most importantly, enabling addiction treatment records systems to better integrate with other health care record systems, facilitating more comprehensive, informed and coordinated patient care.
Removing barriers to information sharing is a crucial step toward fostering collaboration among healthcare professionals. And the new law balances the necessity of information sharing for effective patient care with the imperative to protect patient privacy and deter discrimination. In fact, word is spreading fast among addiction treatment providers that they can expect greater enforcement of privacy rules under this law.
Reflections
Some fear that fewer consents will lead to patient records getting into the hands of healthcare providers who will discriminate against patients. Given that stigma and discrimination are unfortunately prevalent within healthcare, it’s an understandable concern we share. But the reality is 42 CFR Part 2 (with heightened privacy safeguards for addiction treatment) is rarely enforced. Why? Because all of healthcare is oriented around HIPAA; in fact, virtually all privacy breaches enforced against treatment providers are HIPAA violations. And the tradeoff, in this modern healthcare world, for providing mostly illusory extra protections to a few (those who withhold consents even when they need coordinated care and/or who are working with providers that don’t respect their preferences) is worse care for all. The status quo would have meant keeping addiction care separate and unequal from the rest of health care. It would have meant perpetuating institutional secrecy, stigma and discrimination in an effort to prevent individual discrimination. As I said in my testimony six years ago:
“If we want to take that next step as a culture and create an environment that produces less discrimination and addresses addiction more openly, we have to change the laws and institutions that unintentionally validate stigma. We cannot fight discrimination with stigma.”
Time will tell for sure, but I am confident history will show this change helped usher in a new era of addiction care that is integrated into the mainstream of health care, helping patients receive better, more modern and more effective care.
Grad School Alternative Admissions Pathway
Another leap into the deep end of innovation was the Hazelden Betty Ford Graduate School’s recent decision to permanently implement an Alternative Admissions Pathway for prospective students who do not have a bachelor’s degree, opening new doors to bolster the substance use and mental health workforce.
The equity-minded decision on Feb. 29 came on the heels of a successful pilot. It is aimed at expanding opportunities for those seeking work, or already working, in the treatment field — including many with a personal connection to addiction and recovery — who are prepared for graduate school success despite not having a traditional four-year undergraduate degree. By expanding access to master’s level opportunities, the school also hopes to attract greater diversity of professionals into this area of health care to better reflect the diversity of people who need help — which is one reason the Graduate School earned a 2024 Diversity, Equity and Inclusion Impact Award from the Hazelden Betty Ford DEI Committee. Research has shown that culturally specific care provided by people with similar identities of those seeking treatment improves patient satisfaction, retention, and engagement.
At the outset of the pilot, some, including me — an alum of the school — wondered if it was a lowering of standards. But the faculty and staff said the application process would remain rigorous and that successful applicants would have to demonstrate their ability to succeed at the graduate level.
As it turns out, nine students were admitted through the Alternative Admissions Pathway during the pilot period. And according to faculty, there has been no discernable difference between their performance and the performance of their peers who have bachelor’s degrees.
“Our hypothesis was that if we kept the application process rigorous and focused admission decisions on applicants’ readiness to succeed at the graduate level — as demonstrated in other ways — academic performance among our alternative pathway students would be comparable to other students’, and this has indeed been the case,” said Jorja Jamison, PhD, a professor at the school, which is celebrating its 25th anniversary in 2024 and will hold its annual commencement on April 19.
“The United States has an urgent need for well-trained, educated, caring substance use and mental health professionals, and two-thirds of our admissions inquiries are from people who do not have a bachelor’s degree,” added Kevin Doyle, EdD, the school’s president and CEO. “Even with decades of experience, many are held back from professional growth, earnings potential and opportunities to ascend into leadership roles and — most importantly — help save more lives. We want to open the doors wider for their future growth, as well as expand and diversify the workforce.”
LaCresha Dotson is one of the nine students admitted through the Alternative Admissions Pathway during the pilot period.
“To call the Alternative Pathway innovative and pioneering is an understatement,” Dotson said. “The reality is some people don’t or can’t pursue higher education before entering the workforce for many reasons. And for those who gain some combination of valuable work, military and/or other school experience, they may be ready to succeed in graduate school but not have the time or resources to go back to square one of obtaining a bachelor’s degree first. I, for example, have been working for many years and have completed some undergraduate courses but am still a long way from my bachelor’s degree. This new pilot pathway is enabling me to accelerate my educational path while I continue to work, demonstrate the value of my experience, advance my career, and bolster the workforce.”
“The new Alternative Admissions Pathway may be a model for all of higher education,” added retired Judge Susan Fox Gillis, who serves on the Graduate School’s Board of Governors. “It certainly helps address the biggest challenge facing the behavioral health field: the workforce. I’m proud that we’re creating more opportunities and helping great counselors advance in their career.”
Application deadlines for the fall 2024 semester via Alternative Admissions Pathway are due July 11 for the Online Master’s Program and Aug. 8 for the Hybrid/On-Campus Master’s Program.
For those interested in learning more about the Hazelden Betty Ford Graduate School — a part of the Hazelden Betty Ford Foundation — the school offers regular open houses and events. The admissions team can also be reached directly at graduateschool@hazeldenbettyford.edu to answer questions about admissions, federal financial aid, donor-supported scholarships, or any other related topic.
Jeremiah Gardner is director of communications and public affairs for the Hazelden Betty Ford Foundation.
