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

The Advisory Committee on Interdisciplinary, Community-Based Linkages (Advisory Committee) provides advice and recommendations on programs authorized under Title VII, Part D of the Public Health Service (PHS) Act, as amended. The Advisory Committee is governed by provisions of Public law 92-463, as amended (5 U.S.C. Appendix 2).

In November 2001, the Advisory Committee published its First Annual Report, "Review and Recommendations: Interdisciplinary, Community-Based Linkages, Title VII, Part D, Public Health Service Act". The report summarized the relevant grant programs and made several recommendations based on the Advisory Committee's understanding of the original intent of the Federal legislation and current national health professions workforce needs.

Of prime importance, the Advisory Committee concluded, "... that Congress and the Secretary make every effort to maintain these clearly effective approaches to building the workforce that provide health care services to unserved, underserved, and vulnerable populations." Further, the Advisory Committee recommended "...reauthorization of the Federal interdisciplinary, community-based grant programs ... and ...increasing appropriations ... in order to continue and expand preparation of a workforce that can meet the health care needs of older Americans, minority and immigrant populations, and people who reside in this Nation's rural and inner city areas."

In this Second Annual Report, the Advisory Committee restates its previous position, strongly recommending that Congress and the Secretary continue these grant programs and that they be funded at a level no less than the FY 2002 amount. The tragic events of September 11, 2001 and subsequent challenges to the Nation have required that only those efforts that address the country's most critical needs be given positive consideration by policy makers. The Advisory Committee firmly believes that these grant programs meet such national needs through local initiatives implemented in both an effective and efficient manner.

The interdisciplinary, community-based grant programs are uniquely focused on training a health care workforce that meet the vital needs of the Nation's poor and vulnerable populations. Programs such as Area Health Education Centers (AHECs), Health Education and Training Centers (HETCs), and Geriatric Education Centers (GECs) have organizational infrastructures located throughout most of the Nation that are immediately responsive to changing health care priorities, such as the ones associated with chemical and biological terrorism as well as public health preparedness in general. Other community-based, interdisciplinary grant programs also meet important health needs by preparing the allied health and behavioral health workforce and addressing special vulnerable populations such as the Nation's rural residents and the elderly.

The Federal investment in these grant programs leverages enormous returns through matching funds and in-kind services contributed by State and local governments, private foundations, corporate sponsors, educational institutions, as well as health facilities and care providers. This is a particularly important trait of these programs that magnifies their value to the Nation, particularly during a period of time when there are great economic demands (e.g., protecting against terrorism).

The Advisory Committee considers the interdisciplinary, community-based grant programs described in Title VII, Part D of the Public Health Service Act as national resources that must be preserved, protected, and improved for the betterment of the Nation's health. In the Second Annual Report, the Advisory Committee provides further compelling evidence in support of these grant programs.

The Advisory Committee makes several recommendations in this Report that are designed to "improve" and "focus" the Federal government's and grantees' capacity to meet critical and emerging training needs of the Nation's health care workforce. These recommendations are presented in two parts, "Recommendations for Statutory Change (Section IV)" and "Strategic Recommendations for Present Action and Future Considerations (Section V)."

The Advisory Committee addresses several statutory matters pertaining to Allied Health. Several suggestions are made that better define terminology regarding Allied Health professions and affiliated educational programs. It is believed that these changes will better align the original intent of the legislative initiative and its administration by the Health Resources and Services Administration's Bureau of Health Professions with those schools and programs that provide Allied Health professions training. The Advisory Committee also believes that the recommendations will open opportunities for participation by more disciplines, increase the number of underrepresented minorities in the Allied Health professions, and focus training on delivery of services to the Nation's populations who are in greatest need for health care.

Currently, the authorizing legislation for the Chiropractic Demonstration Projects restricts funding to research purposes. While this activity is noteworthy, the Advisory Committee recommends statutory changes that would expand the scope of allowable activities to include training chiropractic physicians. Such action should increase the number and diversity of chiropractic graduates who are prepared to practice in underserved and unserved areas of the Nation as well as to serve other vulnerable populations.

The Advisory Committee endorses recent Federal legislation that supports Graduate Psychology Education but proposes that the scope of legislative authority be broadened to also include training for social workers. In the Advisory Committee's estimate, such action is consistent with the original intent of the legislation and more directly addresses the larger geographic needs in the Nation for improving access to behavioral and mental health services.

Another recommendation suggests moving the current section for the Podiatric Medicine training grant program from Title VII, Part D, to another part of Title VII. The proposal endorses Federal funding for training podiatrists but recognizes that the intent of this legislation is not in concert with "interdisciplinary" health professions education but is a "discipline-specific" activity more like those grant programs that train physicians and nurses.

Finally, the Advisory Committee proposes that its own life be extended when Title VII, Part D programs are reauthorized. The community-based, interdisciplinary nature of the Advisory Committee's membership represents a valuable tool for Federal policy makers in exploring the future needs and options for meeting the Nation's needs for a health care workforce. Members have substantial, "first-hand" knowledge of health care services and the training, recruitment, and retention of health care workers. Also, many members have skills and experience with policy development at the local and national level.

Section V describes a series of "administrative actions" that the Advisory Committee believes will improve the outcomes of the grant programs. In particular, the recommendations address:

• Improving Diversity in the Health Care Professions - The Secretary should encourage collaboration between grant recipients and institutions that train and/or serve largely minority populations.
• Enhancing the Status of Allied Health and Improving Program Effectiveness - Congress and the Secretary should provide a more appropriate description of "allied health" to broaden the pool of eligible applicants for Federal funding and focus limited funding resources on meeting new, emerging allied health professions and addressing existing workforce shortages.
• Partnering with Other Agencies and Using Existing Section 751-755 Programs to Enhance Bioterrorism Preparedness - Grant programs authorized under Title VII, Part D, Sections 751 through 755 of the Public Health Service Act should be eligible for funding under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, and these grant programs should be specifically allocated a portion of these funds to develop curriculum and perform continuing professional education.
• Strengthening Linkages with Other DHHS Initiatives - The Secretary and Congress should strengthen the capacity of the grant programs to meet the needs of training the health care workforce, including NHSC providers, in the Nation's network of Federally qualified community health centers and rural health clinics.
• Representation of the Advisory Committee on the Rural Task Force - The Secretary should appoint a member of the Advisory Committee to the DHHS Rural Task Force.

The Advisory Committee presents specific strategies including future legislative actions to enact the recommendations. In some instances, the Advisory Committee suggests that it will take future action to develop more specific recommendations to the Secretary and Congress.

Section VI forecasts some of the topics for its future activities, including more detailed recommendations on matters described in Section V. The Advisory Committee also describes its intent to alter its work practice in a manner that permits it to be responsive to emerging issues. For example, the Advisory Committee met in December 2002 to focus on the topic of "Bioterrorism and Public Health Emergencies." It is hoped that such sessions will result in the Advisory Committee providing "interim reports" that can be more immediately useful to the Secretary and Congress.

Section VII recognizes the Advisory Committee members and the Federal staff who have most ably assisted with every aspect of the Committee's work. It also acknowledges the many experts in a variety of disciplines who have contributed to the work of the Advisory Committee by providing expert testimony.