Training Future Leaders to Address Mental Health and Substance Use Issues in Older Adults—The Health and Aging Policy Fellows Program

Abstract:

The Health and Aging Policy Fellows (HAPF) Program aims to create a cadre of leaders to serve as “change agents” in health and aging policy. HAP Fellows come from a wide range of disciplines, backgrounds, and career stages. The cornerstone of the one-year fellowship is a placement with federal, state, or international agencies, congressional offices, consumer advocacy organizations, and think tanks, depending upon the Fellow’s interests.

Key Words:

Health and Aging Policy Fellows Program, HAPF, mental health, substance use

The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that nearly 1 million adults ages 65 and older in 2018 met criteria for a substance use disorder (SUD) (SAMSHA, 2018). Currently, the impact of COVID-19 on mental health and SUDs among older adults is unknown. However, it is clear that older adults are at significantly greater risk for serious illness and increased mortality as a result of COVID-19.

Older adults experience a range of stressors associated with major life transitions, including loss of loved ones, retirement, change in income, changes in living circumstances, and increased care needs. COVID-19 has added a further layer of social isolation for many older adults. For some of those older adults, addressing those stressors means drinking more alcohol or using other drugs.

Addressing the myriad consequences of the pandemic will require a multipronged and long-term approach. Research shows that older patients with diagnosed SUDs have better results with longer durations of care. Effective models of care for older adults with SUDs require careful assessment and comprehensive management of other chronic conditions with SUDs. Enhancing social supports, improving access to medical services, and tailoring care management are critical priorities for this patient group.

Given the particular needs of older adults, it is necessary to train care providers in evidence-based strategies that support health and recovery for this age group (Lehmann and Fingerhood, 2018). While some of these components can be addressed and implemented at the practice level, others, such as increasing access to clinical services or developing community support networks, point to more complex and systemic issues, which will require broader policy interventions at the federal, state, and local levels.

The Health and Aging Policy Fellows Program: Our Fellows

Established in 2008 and funded by The John A. Hartford Foundation, The Atlantic Philanthropies, and the West Health Policy Center, the Health and Aging Policy Fellows (HAPF) Program aims to create a cadre of leaders to serve as “change agents” in health and aging policy. The Program recognizes that protecting and promoting health depends upon policies that extend beyond healthcare. Thus, HAP Fellows engage in policy work across a broad spectrum of fields, from elder abuse to community gardens to improving access to care for SUDs. The common driving force is to contribute to policies that have the potential to improve the health and well-being of older adults.

HAP Fellows come from a wide range of disciplines, backgrounds, and career stages. Thirty-two of our 153 Fellows from diverse cohorts and disciplines have come to the fellowship with a strong background or interest in behavioral health practice, policy research, and advocacy. Notably, three of our former Fellows (Madeline Naegle, Pamela Cacchione, and Arlene Bierman) have contributed to this issue, shedding light on behavioral health issues of older Americans.

Table 1. Fellows’ Discipline (2008–09—2020–21)

During their fellowship year and beyond, Fellows have been at the forefront of addressing geriatric behavioral health and related policy issues, including geriatric workforce shortages, elder abuse, integration of behavioral healthcare, age discrimination in organ transplantation, value-based care, quality and patient safety, guardianship, end-of-life care, as well as housing, transportation, and nutrition policies (Pincus et al., 2017).

Given the centrality of behavioral health to overall health across the lifespan, the fellowship program is committed to increasing leadership capacity among behavioral health professionals and to providing a steady injection of valuable science and practice knowledge into the health and aging policy arena.

Training Future Leaders to Improve the Lives of Older Adults

The yearlong fellowship offers an extensive and unique training and enrichment program to create a cadre of leaders with the skills, experience, and networks to influence policies and improve the lives of older adults (Hinrichsen, 2010). The cornerstone of the one-year fellowship is a placement (residential or non-residential) with federal, state, or international agencies, congressional offices, consumer advocacy organizations, and think tanks, depending upon the Fellow’s interests. Key goals of a Fellow’s placement are to learn about current issues in health and aging policy, how best to frame these issues, and how to positively influence decision-making processes in the policy-making arena and facilitate policy implementation.

Placement sites include the Centers for Medicare/Medicaid Services, Administration for Community Living, SAMHSA, Health Resources and Services Administration, National Institutes of Health, Centers for Disease Control and Prevention, and multiple other agencies, Senate and House congressional offices, think tanks, and advocacy groups, as well as the Veterans Health Administration (VA; with which we have a formal VA track for Fellows who are VA employees).

Approximately 30 percent of our Fellows have had placements in Congress, 50 percent in the Executive branch, and the remainder have focused on some combination of the two or in state or non-governmental policy settings.

In their placements, Fellows have addressed behavioral health and SUD priorities across a wide range of communities, with a particular focus on economically disadvantaged groups, immigrant communities, ethnic minority populations, and veterans. Others have addressed behavioral health and SUD priorities while working to improve PACE programs, as well as palliative and hospice care. HAP Fellows have contributed significantly to advancing policies that focus on leveraging technology to extend independent living and enhance healthcare; improving care transitions and health homes and hospital-at-home programs; and developing and implementing the National Alzheimer’s Plan.

The Health and Aging Policy Fellows Program: Creating a Lasting Legacy

The program counts 153 Fellows and alumni to date who, individually and collectively, shape policies that address the complex health needs of older Americans. Many of our Fellows have pursued significant career changes after completion of their fellowship, holding positions with substantial responsibilities in healthcare organizations, academia, and policy settings inside and outside of government at local, state, and national levels.

Some of our Fellows continue to work at the forefront of policy making as congressional staff members. Many continue to publish key papers on major policy issues, often in collaboration with other HAP Fellows and alumni across cohorts. Upon completion of the fellowship year, HAP Fellows join a community of alumni engaged in an active network supported by the HAPF National Program Office.

Table 2: Post-Fellowship Pathways to Policy Impact

We are accepting applications for the 2021–22 cycle and would like to encourage  behavioral health professionals, at all career levels, who are interested in learning about policy making and committed to expanding their impact by advancing policy solutions to consider applying for the fellowship.

The overarching goal of the Health and Aging Policy Fellowship is to prepare talented and committed professionals as leaders, helping to create a world where health and quality of life are ever improving for older adults.  

Harold Alan Pincus, MD, is professor and vice chair of the Department of Psychiatry, co-director of the Irving Institute for Clinical and Translational Research at Columbia University and the New York State Psychiatric Institute. Kathleen M. Pike, PhD, is professor of Psychology in the Department of Psychiatry and The Mailman School of Public Health at Columbia University Medical Center. Brigitta Spaeth-Rublee, MA, is a research associate and program officer at the New York State Psychiatric Institute.

References

Hinrichsen, G. A., et al. 2010. “Influencing Public Policy to Improve the Lives of Older Americans.” The Gerontologist 50(6): 735–43. doi: 10.1093/geront/gnq034.

Lehmann, S., Fingerhood, M. 2018. “Substance-use Disorders in Later Life.” New England Journal of Medicine 379(24): 2351–60. doi: 10.1056/NEJMra1805981.

Pincus, H. A., et al. 2017. “Health and Aging Policy Fellows Program: Shaping a Healthy Future for Older Americans.” Journal of the American Geriatrics Society 65(9): 2088–93. doi: 10.1111/jgs.15036.

Substance Abuse and Mental Health Services Administration (SAMHSA). 2019. “Results from the 2018 National Survey on Drug Use and Health: Detailed Tables.” Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA. Retrieved January 7, 2021.