The views expressed in this document are solely those of the Advisory Committee on Interdisciplinary, Community-Based Linkages and do not necessarily represent the views of the Health Resources and Services Administration or the U.S. Government.

Executive Summary

Previous Findings and Recommendations

The National Advisory Committee on Interdisciplinary, Community-Based Linkages (the Committee) views community-based, interdisciplinary training as the most effective way to prepare the Nation's health care workforce to meet the needs of our most vulnerable populations including the socioeconomically disadvantaged and geographically isolated as well as the elderly, children, and disabled people. The Federal Community-based, Interdisciplinary Training Grant Programs can also help providers learn how to overcome cultural and linguistic barriers with patients and prepare workers to deal with emerging health needs associated with contemporary issues such as chemical and biological terrorism.

Committee members have diligently reviewed the Programs under the auspices of its authorization. The Committee has made recommendations aimed at strengthening the capacity of these programs to meet the needs for a highly qualified, culturally competent health care workforce that is also geographically well distributed in the Nation's shortage areas.

In previous Annual Reports, the Committee's recommendations were based on findings gleaned from expert testimony, various data and information provided by the Health Resources and Services Administration (HRSA), as well as the personal observations and experiences of Committee Members who are well acquainted with the grant programs and the nation's needs for health care. The Committee feels that these past recommendations are as relevant today as they were at the time of their original publication. Priority findings and recommendations published in the initial Annual Reports are summarized below.

• Congress and the Secretary should reauthorize the Title VII, Part D, Section 751-756 Grant Programs and provide funding at a level that is no less than and even more than appropriated in Fiscal Year 2003.
• The Secretary should use the administrative tools of "preferences and priorities" for making grant awards that are "truly interdisciplinary," and Congress should authorize a new grant program that demonstrates model interdisciplinary training that addresses the Nation's most pressing needs in health care.
• Federal health agencies such as the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and others should establish formal agreements with funding arrangements with HRSA to engage the participation of the Programs' grantees in disseminating emerging health information and practice guidelines that will ensure the competency of the Nation's health care workforce.
• HRSA and Congress should find new ways to recognize the critical need for training "Allied Health" professionals through better recognition in legislative and administrative language, and inclusion of Allied Health training in other currently authorized grant programs.
• The "diversity" of the health care workforce must be improved through measures that enhance the capacity of these Programs to achieve such outcomes.
• In the Committee's review of the statutes governing the administration of the Community-based, Interdisciplinary Training Grant Programs, the Committee found that there were several changes that would strengthen these Federal efforts. These statutory changes are discussed in greater detail in the Second Annual Report, but can simply be described as the following proposed actions.
• Redefine and expand the list of "Allied Health" professions that are eligible for Federal sponsorship described in the administrative language of Allied Health grant awards.
• Expand the legislative authority dealing with Chiropractic research to include interdisciplinary training for Chiropractic students so as to increase the number of individuals trained in Chiropractic medicine and the number of other health workers who are familiar with Chiropractic medicine.
• Develop a new legislative initiative that authorizes support for graduate training for behavioral and mental health providers. This new section should incorporate the current Federal support for Graduate Clinical or Counseling Psychology and should also be broadened to include other disciplines such as Clinical Social Work.
• Move the current legislative section defining the grant program for training Podiatric physicians to that part of the Public Health Service Act that includes training grants in family medicine, general internal medicine, and other discipline-specific medical practices. The relocated section in Podiatric Medicine should receive a separate appropriation, apart from that which currently funds Allied Health programs.
• Reauthorize the National Advisory Committee for Interdisciplinary, Community-Based Linkages. The Committee's authority expires with Title VII and its continuation requires Congressional action by including it in the renewal of the law.
• In the Second Annual Report, the Committee also recommended various strategic directions in training health professionals and students that improve health care in the nation. These matters necessitate both legislative and administrative actions. The Committee plans to address the following "strategic directions" in its future meetings:
• Improvement of the racial and ethnic diversity of the health care professions;
• Enhancement of the status of Allied Health; and
• Greater coordination of the work of this National Advisory Committee with other Federal Advisory Committees and Task Forces, in part by seeking cross-representation on each other's groups, perhaps in an ex-officio capacity.

In the present report, the Committee addresses two important matters: 1) outcomes and performance measures; and 2) the role of the grant programs in training health care workers to cope with the effects of chemical and biological terrorism.

The Committee's findings and recommendations regarding measurement of outcomes and grantee performance apply generally to all those training grants managed within HRSA's Bureau of Health Professions (BHPr). In brief, these recommendations are listed below.

• Report performance measures that more completely describe changes in outcomes associated with the status of a community's health and economic impact.
• BHPr should work with monitoring agencies such as the Office of Management and Budget (OMB) and the Congressional Budget Office (CBO) to agree upon performance measures that also include the use of qualitative data.
• HRSA and BHPr should develop a mechanism for sharing performance measure data within the Bureau, HRSA, and across Department of Health and Human Services agencies, and with grantees in order to promote more effective and efficient approaches to meeting the health needs of the nation.
• Congress should appropriate funding for evaluation, the development of educational research models, and tracking long-term outcomes associated with the Grant Programs.

With respect to curriculum development and training related to bioterrorism, the Committee makes the following recommendations:

• The HRSA Administrator should ensure development of a national consensus regarding core competencies for the curricular objectives and necessary elements in teaching bioterrorism and emergency preparedness.
• Funding should be made available to provide quality continuing professional education to a wide range of practicing health care professionals in every state.
• Grants should be made to Academic Health Centers and/or consortia of health professions schools or programs to develop new or adapt existing curricula to train students and medical residents in bioterrorism preparedness.
• Other DHHS and HRSA "bioterrorism and emergency preparedness" initiatives should be linked with BHPr Division programs.