Resource Development Associates
description
Transcript of Resource Development Associates
WET Five-Year Plan:Evaluation of First WET Five Year Plan, Stakeholder Engagement, County Needs Assessment, and Literature ReviewInterim Findings
Resource Development Associates
January 17, 2014Amalia Freedman Kevin J. Wu, MPH
2
Topics State-Administered WET Program Evaluation,
2008-2013 OSHPD-led Stakeholder Engagement County-Reported Needs Assessments Literature Review: Public Mental Health Workforce
Demand and Supply Public Mental Health Workforce Supply Projections,
2014-2019 Literature Review: Educational Capacity Literature Review: Public Mental Health Graduation
to Workforce Participation
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Highlights
State-Administered WET Program Evaluation, 2008-2013
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State-Administered WET Program Evaluation, 2008-2013:Approach
Evaluated program impact by actions and direct outcomes: General capacity Cultural and linguistic competency Formal education structure and curricula People with lived experience in the workforce Filling gaps in the five regions
Data gathered via multiple methods: Baseline: 2008 needs assessment Progress: 2013 progress reports Impact: 2013 needs assessment and RDA
interviews and county survey
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State-Administered WET Program Evaluation, 2008-2013:Limitations
2008 Baseline data limitations: Only 28 counties submitted data for the baseline report
(2008) Cannot disaggregate (e.g., by county,
rural/urban/suburban, etc.) Very limited in baseline information pertaining to two
outcome areas: Formal Education Structure and Curricula and Filling Gaps in Five Regions
Progress data limitations: Inconsistent reporting from programs No consistent measures for looking at progress in Formal
Education Structure and Curricula and Filling Gaps in Five Regions
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State-Administered WET Program Evaluation, 2008-2013:Limitations
Impact data limitations: 2013 County follow-up survey that identified
perceived impact of state-administered WET programs was voluntary and resulted in low response rate of 26 counties compared to the first county needs survey that had 41 responses
2008 Baseline survey data were only available for 28 counties
Only 12 counties were represented in both baseline (2008) and county survey (2013) county lists 16 counties for which no data were collected at all
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State-Administered WET Program Evaluation, 2008-2013
Stipend Programs: increased the number of licensed mental health professionals in the Public Mental Health System (PMHS) via contracts with educational institutions to provide stipends to students and incorporates MHSA principles into graduate level curriculum. Graduate degrees disciplines receiving stipends include Master of Social Work, Marriage and Family Therapist, Clinical Psychology, and Psychiatric Mental Health Nurse Practitioner
*Song-Brown Program for Physician Assistants in Mental Health: funded Physician Assistants (PA) programs that add a mental health track so that PAs can sign mental health treatment plans, transmit orders for psychotropic medications on behalf of supervising psychiatrist, and prescribe and administer psychotropic medications
Psychiatric Residency Program: Funded Psychiatric Residency Programs to trains psychiatric residents in the PMHS, working with the populations prioritized by that community
*Mental Health Loan Assumption Program (MHLAP): offered loan repayment of up to $10,000 to mental health providers in hard-to-fill and/or hard-to-retain positions in the PMHS in exchange for a 12-month service obligation
Client and Family Member Statewide Technical Assistance Center: Funded Working Well Together (WWT) to engage in activities that promote the employment of mental health clients and family members in the public mental health system
Regional Partnerships: represents Bay Area counties, Central Valley counties, Southern counties, Los Angeles County, and Superior Region counties; includes representation from mental health, community agencies, educational/training entities, consumers, family members, and other partners to plan and implement programs that build and improve local workforce education and training strategies
*Shortage Designation: reviews and recommends Primary Care, Dental, and Mental Health Professional Shortage Area (HPSA) and Medically Underserved Area/Medically Underserved Population (MUA/MUP) applications to HRSA’s Shortage Designation Branch
* = Administered by OSHPD prior to July 1, 2012 transfer
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State-Administered WET Program Evaluation, 2008-2013:Key Findings
The vast majority of the statewide-administered WET programs align with needs identified at the beginning of the 2008 planning process. MHLAP, MFT stipend, MSW stipend programs rated
as effective in filling service needs with MHLAP being rated as most effective with an average rating of 3.42*
Physician Assistant MH program was not an identified need, rated as least effective
* Rating was on a scale of 1 (not at all effective) – 4 (very effective)
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State-Administered WET Program Evaluation, 2008-2013:Key Findings (continued)
Programs successfully recruited and engaged people of color and people with non-English language proficiency Sixty-six percent (66%) of MHLAP
participants reflected underrepresented populations in PMHS
Regional Partnerships collaborated with local colleges, strived to provide cultural/linguistic competency preparation for upcoming workforce
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State-Administered WET Program Evaluation, 2008-2013:Key Findings (continued)
Curriculum changes have been noted that demonstrate alignment with MHSA principles Universities expanded cultural competency training,
knowledge of evidence-based practices, recovery principles into teaching approaches
Regional Partnerships worked with local institutions to advance curricula corresponding to workforce needs within PMHS workforce
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State-Administered WET Program Evaluation, 2008-2013:Key Findings (continued)
WWT trainings, TA visits and webinars focused on increasing the participation of people with lived experience have been offered to counties in all regions Created tools, and reports including a report on peer
certification for use by professionals working in public mental health system
Developed training curricula, offered trainings to support the recruitment, employment, and integration of consumers and family members in workforce
Provided individualized TA to counties geared toward increasing representation of consumers and family members in their workforce
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State-Administered WET Program Evaluation, 2008-2013:Stipend Programs
Stipend Awardees 2008/09 - 2012/13
Discipline Individuals Awarded
Awardees of Under-
Represented Backgrounds
Awardees that Speak a Language
in Addition to English
Social Workers 1486 59% 50%
Marriage and Family
Therapists367 73% 65%
Psychiatric Nurse
Practitioners63 46% 59%
Clinical Psychologist 283 58% 52%
Total 2205 61% 53%
Funding is awarded to educational institutions to provide Stipends for graduate students in Social Work, Marriage and Family Therapy, Clinical Psychology, and Psychiatric Mental Health Nurse Practitioner who commit to working in the public mental health system for a 12-month period upon graduation A total of 21 California schools participate by providing stipends and
developing curricula that promotes the MHSA values of wellness, recovery and resilience
Source: OSHPD
Source: OSHPD
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State-Administered WET Program Evaluation, 2008-2013:Song-Brown Program for Physician Assistants in Mental Health
Physician Assistant (PA) programs are evaluated, in part, on whether they can demonstrate: Community collaboration: Cultural competence What client and family-driven services are Wellness, recovery, and resiliency Ability to provide an integrated service experience for clients and their families
One of the goals is to ensure that PA students perform their rotations in rural and underserved communities including the public mental health workforce
From FY 2008-09 to FY 2012-13, grants of $15,000 to $167,000 were awarded to six PA programs and have enabled 1,382 PA students to be trained in MHSA principles and perform 6,046 hours of mental health rotations
The following six programs revised their PA program curricula to include the values and principles of the Mental Health Services Act: Keck School of Medicine-USC; Moreno Valley College; Samuel Merritt University; San Joaquin Valley College; Touro University; University of California, Davis
The above PA programs partnered with the following County Departments of Health and Mental Health to ensure that PA students provide integrated care: Fresno County Department of Behavioral Health; Fresno County Health Department; Riverside County Department of Mental Health; Sacramento County Department of Behavioral Health Services; Stanislaus County Health Services Agency
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State-Administered WET Program Evaluation, 2008-2013:Psychiatric Residency Program
The psychiatric residency programs ensured that the psychiatric residents receive training in the County public mental health system, working with the populations prioritized by that community. Further, the psychiatric residents are encouraged to continue working in the California public mental health system after their rotations end
From FY 2008/09 to FY 2012/13, there were two psychiatric programs that supported 25 psychiatric residency rotations at the University of California, Davis and the University of California, Los Angeles-Kern
The Psychiatric Residency programs revised the curricula to include the values and principles of the MHSA: Community collaboration Cultural competence Client/Family-driven mental health system Wellness/Recovery and Resilience focus and Integrated service experience for clients and their families.
The Psychiatric Residency programs partnered with County Departments of Mental Health and Community-Based Organizations to ensure that residents perform their rotations in the County Public Mental Health System. Among them: Sacramento County Mental Health Services; Kern County Mental Health Services; UC Davis Medical Center; and West Kern Clinic (Wasco)
Source: OSHPD
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State-Administered WET Program Evaluation, 2008-2013:Mental Health Loan Assumption Program (MHLAP)
Provides those working or volunteering in hard-to-fill/hard-to-retain positions in the public mental health system with up to $10,000 in educational loan repayments in exchange for service in the community public mental health system
From Fiscal Year 2008-09 to 2012-13 : 2,373 public mental health workers have completed the loan repayment
program 56% of awardees spoke at least one language in addition to English 55% of awardees had a consumer/family member background
MHLAP Applications FY 2008-09 to FY 2012-13 Fiscal Year
Applications Received
Individuals Awarded
Funds Requested
Educational Debt Funds Awarded Counties
SupportedFY
2008-09
1,236 288 $15,454,813 $60,729,395 $2,285,277 44
FY 2009-
101,498 309 $12,683,961 $80,331,133 $2,469,239 52
FY 2010-
111,009 474 $10,030,983 $71,177,144 $4,523,757 50
FY 2011-
121,659 661 $16,581,901 $111,533,342 $5,365,680 55
FY 2012-
131,823 1,109 $17,968,953 $122,828,475 $9,383,649 53
Total 7,225 2,841 $72,720,611 $446,599,489 $24,027,602 58
Source: OSHPD
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State-Administered WET Program Evaluation, 2008-2013:Client and Family Member Statewide Technical Assistance Center
Working Well Together has developed the following resources: Assessment tools for agencies to recognize where they are in
terms of engaging consumers and family members in the workforce
Curricula for training individuals who identify as consumers and family members, and trainings to preparing the workforce for employing consumers and family members
A toolkit for recruiting, hiring and retaining employees with lived experience within the public mental health workforce
A white paper on how to successfully employ people with lived experience within the public mental health workforce
Peer certification standards and recommendations for a statewide plan
Working Well Together has completed 159 Technical Assistance visits, 34 training, which engaged a total of 3,677 participants
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State-Administered WET Program Evaluation, 2008-2013:Regional Partnerships
Region
al Partner-ship
Cultural
competenc
y trainin
gs
Curric. focuse
d efforts with
colleges
High school mental health career pathw
ay
Core competencie
s projec
t
Move towar
d recove
ry focus
in WET
Programs
targeting the under-served
Explicit
stigma
reduction
efforts
First respon
der training and MH First Aid
trainings
Central X X X X X X XGreater Bay Area
X X X X X
Los Angeles
X X X
Southern X X X X X Superior X X X
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State-Administered WET Program Evaluation, 2008-2013:Shortage Designation
As of November 2013 there are 153 designated Mental Health Professional Shortage Area (MHPSA)
4,382,209 residents live in a designated MHPSA
102 MHPSA applications have been approved by HRSA since 2009
MHSPA Application Type
MHPSA Applications Processed Since 2009
Reactive 86Proactive 36
Source: OSHPD
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State-Administered WET Program Evaluation, 2008-2013:Number of Mental Health Professionals Impacted by State WET Programs
Hard-to-fill/retain positions identified in 2008 MHLAP Stipend
Psychiatric Residency
Song-Brown PA Total Participants
Psychiatrist, General 230 -- -- -- 230Licensed Clinical Social Worker 255 1,838* -- -- 2,093*Marriage and Family Therapist 1259 474 -- -- 1,733Licensed Supervising Clinician 0 -- -- -- 0Psychiatrist, Child/Adolescent -- -- 10 -- 10Psychiatrist, Interdisciplinary Medicine Specialty
-- -- 15 -- 15
Registered Nurse 12 -- -- -- 12CEO or Manager above Direct Supervisor
3 -- -- -- 3
Psychiatric or Family Nurse Practitioner
8 92 -- -- 100
Licensed Clinical Psychologist 23 283 -- -- 306Analysts, tech support, quality assurance
0 -- -- -- 0
Family Member Support Staff 0 -- -- -- UnknownClinical Nurse Specialist 1 -- -- -- 1Psychiatrist, Geriatric -- -- -- -- UnknownConsumer Support Staff 4 -- -- -- 4(Unknown)
Positions not identified as hard to fill/retain in 2008Physician Assistant 0 -- -- 1,382 1,382Licensed Professional Clinical Counselor
14 14
Bachelors Social Worker 46 46Associate Clinical Social Worker 629 629Other 235 235TOTAL SERVED: 2,719 2,687 25 1,382 6,813*Includes Stipend Program for Social Work participants from beginning of program in 2005.
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State-Administered WET Program Evaluation, 2008-2013: Program Effectiveness
State-Administered WET Program* n
Average
Rating
% Rating the Program Somewhat or Very
EffectiveMHLAP 26 3.42 92%Social Worker Stipend Program
21 2.67 67%
MFT Stipend Program 20 2.55 70%PMHNP Stipend Program 17 2.24 53%Psychiatric Residency Program
19 1.68 26%
Clinical Psychologist Stipend Program
17 1.59 18%
Song-Brown Program for Physician Assistants
12 1.08 0%
Overall -- 2.32 --
Counties were asked to rate the effectiveness (impact) of each of the state-administered programs in placing or retaining personnel in hard-to-fill/retain positions
Scale: 1 (not at all effective) - 4 (very effective)* The survey did not include Regional Partnerships and WWT for this specific question.
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State-Administered WET Program Evaluation, 2008-2013:Cultural and Linguistic Competency
Baseline 2008 Progress 2013Licens
ed Direct
% Difference from target
Licensed
Direct
% Difference from Target
Caucasian/White 6,938 54% -20.6% 15,650 51% -18.00%Hispanic/Latino 2,417 19% +19.0% 6,558 21% +16.70%African American/ Black
1,072 8% +9.0% 2,538 8% +9.30%
Asian/Filipino/ Pacific Islander
1,342 10% -3.4% 3,252 11% -4.00%
American Indian/ Alaska Native
110 1% +0.1% 261 1% -0.10%
Multiple/Other 1,076 8% -4.2% 2,637 8% -3.90%Total 12,955 100
% -- 30,896 100% --
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State-Administered WET Program Evaluation, 2008-2013:Cultural and Linguistic Competency
Non-English Language
Number of public sector staff
needed in 2008
Adjusted estimate of need
Number served by all
state-administere
d WET programs 2008-2013
% of need potentially met by all
state-administer
ed WET programs 2008-2013
Spanish 6,092 12,671 1,708 13%Chinese
513 1,067109
10%Other Asian 974 2,026 283 14%Other 221 460 319 69%Total 7,800 16,224 2,419 15%
Linguistic Capacity of 2008 Workforce and WET Progress toward Targets across All State-
Administered Programs
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State-Administered WET Program Evaluation, 2008-2013:Cultural and Linguistic Competency
Program Impacts
n
Not at all
effective
Somewhat
effective
Very effectiv
e Don't know
How effective have state-administered WET programs been in increasing the cultural and linguistic competency of the workforce in your county?
26 12% 50% 35% 4%
How effective have state-administered WET programs been in increasing the diversity of the workforce in your county so that the workforce is more representative of the population served in terms of ethnicity, cultural tradition, religion, LGBT identification, etc.?
26 27% 39% 19% 15%
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State-Administered WET Program Evaluation, 2008-2013:Formal Education Structure and Curricula
Institutions reported many courses that highlighted Use of evidence-based practices Cultural competency across gender, race,
religion, sexual orientation, etc. Principles of wellness and recovery among adults
and resiliency among youth Several Regional Partnerships, in collaboration
with local colleges and agencies, are developing public mental health professional core competencies
25 Working Well Together:
Working Well Together has completed 159 Technical Assistance visits, 34 training, which engaged a total of 3,677 participants
MHLAP Provided loan repayment to 4 designated consumer and family
member positions 55% of awardees had a consumer/family member background
Regional Partnerships Two regional partnerships have engaged in stigma reduction
activities. Stipend
In FY 12/13 40% of MFT and Psych NP, and 26 % of Clinical Psychologist stipend recipients had a consumer and family member background
State-Administered WET Program Evaluation, 2008-2013:People with Lived Experience
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* Combines Southern/LA Region.
26 Working Well Together:
Stipend: full time equivalent recipients employed from 2007-2011
MHLAP Supported 58 out of 60 counties/municipalities
State-Administered WET Program Evaluation, 2008-2013:Meeting Regional Needs
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Region TA Visits Trainings ParticipantsCentral 39 6 1030Southern/ Los Angeles*
40 13 1579
Superior 29 7 576Bay Area 51 8 492Total 159 34 3,677
* Combines Southern/LA Region.
Profession Superior Bay Area Central Los Angeles
Southern
Clinical Psych
0 43 1 34 8
MFT 13 43 14 42 42Psych NP 3 32 9 7 5Social Work 74 307 209 365 303Total 90 425 233 448 358
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State-Administered WET Program Evaluation, 2008-2013:Meeting Regional Needs
Region
al Partner-ship
Cultural
competenc
y trainin
gs
Curric. focuse
d efforts with
colleges
High school mental health career pathw
ay
Core competencie
s projec
t
Move towar
d recove
ry focus
in WET
Programs
targeting the under-served
Explicit
stigma
reduction
efforts
First respon
der training and MH First Aid
trainings
Central X X X X X X XGreater Bay Area
X X X X X
Los Angeles
X X X
Southern X X X X X Superior X X X
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State-Administered WET Program Evaluation, 2008-2013:Recommendations for Future Practice
Ensure that programs correspond to current workforce needs
Ensure that the pathway to employment is considered so that programs can succeed in placing all graduates in the public mental health system workforce
Ensure a strategic approach to consumer and family member workforce development
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State-Administered WET Program Evaluation, 2008-2013:Recommendations for Future Evaluation
Track participation consistently Track LGBT and consumer/family
member identification Track progress of Regional Partnerships
with more consistent tools Monitor curricula with checklist
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Highlights
OSHPD-led Stakeholder Engagement
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OSHPD-led Stakeholder Engagement: Overview
Purpose: To obtain stakeholder feedback on priority issues, challenges, and recommendations, including: Public mental health workforce personnel needs Training and education Recruitment and retention Employing consumers and family members WET programs and partnerships
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OSHPD-led Stakeholder Engagement:
Data SourcesOSPHD led data collection efforts across multiple sources including:
Stakeholder Engagement Strategy
Number of Activities/Participants
Community Forums 14 Forums throughout the State with over 600 Participants
Focus Groups 13 Focus GroupsKey-Informant Interviews
13 Interviews
Online Survey 325 Responses
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OSHPD-led Stakeholder Engagement:Key Findings
Recommendations for increasing and sustaining the public mental health workforce: Expand programs including:
financial incentive programs and training and education programs
Strengthen opportunities for Consumer and/or Family Members by: Providing support for consumers Increasing training opportunities Providing a peer certification program
OSHPD-led Stakeholder Engagement:Most Referenced Public Mental Health Workforce Personnel Needs 34
Mental Health Profession
Community Forum
Focus Group
Key Informant Interview
Survey Total
Psychiatrists 11 5 3 19 38Consumer peer positions 14 2 1 20 37Marriage and Family Therapist (MFT) 6 2 0 28 36
Psychiatric Mental Health Nurse Practitioner 11 5 1 13 30
Alcohol and Other Drug Abuse Counselors 7 0 0 23 30Licensed Clinical Social Workers 5 0 0 24 29
Question to Stakeholders: Based on your knowledge and experience, what type of workforce will be needed to address the public mental health workforce needs in your county or region?
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OSHPD-led Stakeholder Engagement:Training and Education
Key ChallengeCommunity
Forum Focus Group
Key Informant Interview
Survey Total
Lack of training and education programs 9 4 1 30 44Lack of integration/collaboration 7 6 2 6 21Lack of supervision 10 2 1 3 16
Key RecommendationCommunity
Forum Focus Group
Key Informant Interview
Survey Total
Expand training and education programs 12 3 7 1 26Develop clear career pathway/ladder 13 3 2 3 21Promote training on integration 8 6 3 0 17
What actions would you recommend to overcome those challenges?
What are the challenges to increasing and sustaining the public mental health workforce in your region? (Training and Education)
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OSHPD-led Stakeholder Engagement: Recruitment and Retention
Key ChallengeCommunity
Forum Focus Group
Key Informant Interview
Survey Total
Low Wages 11 6 1 19 37Stigma 8 5 3 10 26Burnout 10 2 1 11 24Lack of job opportunities /growth potential 8 4 1 10 23
Key Recommendation Community
Forum Focus Group
Key Informant Interview
Survey Total
More financial incentives 9 2 6 4 21Conduct career awareness/recruitment efforts 12 5 3 0 20Increase stipends 8 4 0 1 13Increase reimbursement 10 1 1 0 12
What are the challenges and recommendations to increasing and sustaining the public mental health workforce in your region? (Recruitment and Retention)
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OSHPD-led Stakeholder Engagement:Employing Consumers and Family Members
Key ChallengeCommunity
Forum Focus Group Survey Total
Stigma 12 6 18 36
Lack of formal training or education 8 2 10 20
Lack of Employment Opportunities 11 3 5 19
Not enough support and accommodations for consumers 4 4 3 11
Do you feel an adequate number of mental health consumers and family members are being employed in the public mental health system? If not, why?
38
OSHPD-led Stakeholder Engagement:Employing Consumers and Family Members
What actions would you recommend to overcome those challenges (regarding consumer and family member employment)?
Key Recommendation Community
Forum Focus Group Total
More support for consumers 11 4 15More training for consumers 10 3 13Peer Certification 8 2 10Train staff in consumer movement 5 2 9Have consumers be part of training and be involved in curriculum development 5 2 7Education/Training public to reduce stigma 5 2 7
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OSHPD-led Stakeholder Engagement:WET Models and Partnerships
Models and Partnerships
Community Forum
Focus Group
Key Informant Interview Total
Mental Health First Aid 5 1 6 12NAMI 4 2 6 12WET Regional Partnership 5 1 6 12WRAP Program 5 0 5 10High School Pathways 3 1 4 8Stipends (CalSWEC) 4 0 4 8
What successful workforce education and training models and partnerships exist within your county or region that address the workforce challenges and you think could be used as a best practice?
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Highlights
County-Reported Needs Assessments
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County-Reported Needs Assessments:Overview Purpose: To identify key needs in the public
mental health workforce including: Users of Public Mental Health System Shortages and Hard-to-Fill, Hard-to-Retain
Positions Declining Needs/Needs Met Diversity and Language Needs State Administered WET Program
Need/Participation Data analysis presented according to:
Statewide MHSA WET region County size
42
County-Reported Needs Assessments:Data Sources
OSHPD-led 2013 County-Reported Needs Assessment
OSHPD/RDA-led County-Reported Needs Follow-Up Survey
43
County-Reported Needs Assessments:Limitations
Variability in consistency of County-Reported Assessments data
Burden of data collection and reporting on county agencies
Unclear if counties reported on behalf of contractors
County Reported Needs Follow-up Survey received responses from 26 counties.
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County-Reported Needs Assessments:Key Findings – Public Mental Health UsersPublic mental health system users are: Predominantly located in the southern part of
the state More likely to be of a minority race/ethnicity More likely to be adults
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County-Reported Needs Assessments:Key Findings – Public Mental Health Workforce Needs County-reported
workforce shortages align to hard-to-fill, hard-to-retain positions
Psychiatrists are consistently reported as the highest need position Reliable graduation
information is not available
The Superior Region, small counties, and medium counties consistently identified professionals with bilingual capabilities as a workforce need
Only the Southern Region counties identified any declining workforce needs These counties reported
sufficient access to non-licensed mental health staff
Identified workforce race/ethnic diversity needs align with the composition of the public mental health user population This is true across MHSA
Regions
46
County-Reported Needs Assessments:Key Findings – Public Mental Health Workforce Needs Identified workforce
language diversity needs reflect the race/ethnic composition of the public mental health user population This is true across MHSA
Regions The Southern Region
(including Los Angeles Co.) workforce is largely meeting the language needs of its Hispanic/Latino population
Counties’ designated positions for consumers and/or family members typically: Are largely reserved for
peer and administrative/clerical positions
Are not typically provider/professional positions
Are not full-time positions with set wages
47
County-Reported Needs Assessments:Key Findings – Statewide-Administered WET Programs Large counties are the
primary users of statewide-WET programs
WET Stipend Program participation reflects the distribution of graduates with mental health-related degrees or certificates This is true across MHSA
regions WET Psychiatric Residency
Program utilization underperforms county-reported need
The WET Mental Health Loan Assumption Program (MHLAP) is utilized by most counties, especially large counties
The WET Physician Assistant Program is utilized in few counties Usage is consistent with
low physician assistant graduate rates
Los Angeles County has the highest number of graduates with mental health-related degrees or certificates
Los Angeles County does not participate in the WET Psychiatric and Physician Assistant Residency Stipend Programs
48
County-Reported Needs Assessments:Hard-to-Fill and Hard-to-Retain Positions
Clinical Nurse Specialist
Psychiatrist, Child/Adolescent
Psychiatric Mental Health Nurse Practitioner
Marriage and Family Therapist
Licensed Clinical Social Worker
Psychiatrist
0 5 10 15 20 25 30 35 40 45 50
8
7
12
19
22
23
6
1
2
24
Highest Need Other Needs
Count of Reported Hard-to-Fill and Hard-to-Retain Positions
Occ
upat
iona
l Cat
egor
y
49
County-Reported Needs Assessments:Workforce Shortages
Substance Abuse Counselor
Psychiatrist, Child/Adolescent
Psychiatric Mental Health Nurse Practitioner
Marriage and Family Therapist
Licensed Clinical Social Worker
Psychiatrist
0 5 10 15 20 25 30 35 40 45 50
13
4
17
24
23
17
11
2
4
30
Highest Need Other Needs
Count of Reported Workforce Shortages
Occ
upat
iona
l Cat
egor
y
50
County-Reported Needs Assessments:Workforce Shortages- Superior Region
Case Manager/Service Coordinator
Other Non-Licensed Mental Health Staff
Psychiatric Mental Health Nurse Practitioner
Marriage and Family Therapist
Licensed Clinical Social Worker
Psychiatrist
0 1 2 3 4 5 6 7 8 9
3
3
4
5
5
4
1
1
4
Highest Need Other Needs
Count of Reported Workforce Shortages
Occ
upat
iona
l Cat
egor
y
51
County-Reported Needs Assessments:Workforce Shortages- Bay Area Region
Substance Abuse Counselor
Licensed Clinical Social Worker
Psychiatrist, Child/Adolescent
Psychiatric Mental Health Nurse Practitioner
Psychiatrist
0 2 4 6 8 10 12 14
3
3
1
8
4
1
5
8
Highest Need Other Needs
Count of Reported Workforce Shortages
Occ
upat
iona
l Cat
egor
y
52
County-Reported Needs Assessments:Workforce Shortages- Central Region
Clinical Nurse Specialist
Psychiatrist, Child/Adolescent
Substance Abuse Counselor
Psychiatric Mental Health Nurse Practitioner
Marriage and Family Therapist
Licensed Clinical Social Worker
Psychiatrist
0 2 4 6 8 10 12 14 16 185
2
5
7
12
12
6
3
1
11
Highest Need Other Needs
Number of Counties
Occ
upat
iona
l Cat
egor
y
53
County-Reported Needs Assessments:Workforce Shortages- LA Region
Los Angeles County/Region Workforce Shortages
(In Order of Rank)
Psychiatrist (Child, Geriatric, Addiction)
Clinical Supervisor
Licensed Clinical Social Worker/Marriage and Family Therapist/
Community Mental Health PsychologistNurse, Other
Designated Consumer/Family Member, Advocacy
54
County-Reported Needs Assessments:Workforce Shortages- Southern Region
Licensed Clinical Social Worker
Nurse, Other
Psychiatric Mental Health Nurse Practitioner
Marriage and Family Therapist
Psychologist
Psychiatrist
0 2 4 6 8 10 12
1
6
3
4
4
5
5
4
Highest Need Other Needs
Number of Counties
Occ
upat
iona
l Cat
egor
y
55
County-Reported Needs Assessments:Diversity Needs
Socio-Economic Status
Physical/Mental Abilities
Sexual Orientation
Age
Gender
Other
Language
Race/Ethnicity
0 10 20 30 40 50 60 70 80
2
3
2
12
34
4
10
17
17
17
26
24
37
Highest Need Other Needs
Count of Reported Diversity Needs
Type
of
Div
ersi
ty N
eed
56
County-Reported Needs Assessments:MHSA WET Program Participation Rates by County Size
Stipend Program
Physician Assistant Residency Program
Psychiatric Residency Program
Working Well Together
MHLAP 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
11%
0% 0%
56%
69%
36%
0%
27%
73% 73%
58%
42% 42%
83% 83%
Small Medium Large
Perc
ent
of C
ount
ies
Size BreakdownSmall (<200K people)
Medium (200-800K people)
Large (>800K people)
57
County Reported Needs Assessments Follow-up SurveyKey Findings
The state’s top hardest-to-fill or hardest-to-retain positions are: Psychiatrist Licensed Clinical Social
Worker Marriage and Family
Therapist The primary reported
reason staff vacated hard-to-fill or hard-to-retain positions is pay
Staff most frequently left for private mental health agencies
The top strategy employed to manage staff vacancies is reassigning duties to existing staff in similar/same positions
Labor substitution for hard-to-fill or hard-to-retain positions is challenging due to the specialized nature of the positions. Psychiatric NP were identified as preferred labor substitute for Psychiatrist.
Counties used a diverse range of strategies to recruit, orient, and train consumers and family members for county positions
58
County Reported Needs Assessments Follow-up SurveyReasons Positions Vacated across California
Workload
Unknown
Poor organizational fit
Pay
Location
Involuntary termination
Burnout
0 2 4 6 8 10 12 14 16 1810
26
93
716
610
61
35
Count of Responses
Reas
ons
Posi
tions
Vac
ated
59
County Reported Needs Assessments Follow-up SurveyStatewide Departure Agencies
UnknownPrivate Mental Health Agency
Other Public Mental Health AgencyOther
Non-Mental Health Related OrganizationMedical Facility
EducationCorrectional Facility
0 2 4 6 8 10 12 14 166
14
15
8
5
11
5
11
Count of Responses
Type
of D
epar
ture
Age
ncy
60
County Reported Needs Assessments Follow-up SurveyStatewide Staff Vacancy Management
Unknown
Triage consumers
Temporary or locum tenens staffing
Reassign duties to existing staff in similar/same position
Reassign duties to existing staff in different positions
Other
Longer wait times
0 5 10 15 20 250
10
17
20
11
2
15
Count of Responses
Staff
Vac
ancy
Man
agem
ent
Stra
tegy
61
County Reported Needs Assessments Follow-up SurveyLarge County Size Staff Vacancy Management
Unknown
Triage consumers
Temporary or locum tenens staffing
Reassign duties to existing staff in similar/same position
Reassign duties to existing staff in different positions
Other
Longer wait times
0 1 2 3 4 5 6 7 80
3
6
6
4
0
7
Count of Responses
Staff
Vac
ancy
Man
agem
ent
Stra
tegy
62
County Reported Needs Assessments Follow-up SurveyPsychiatrist Substitutes
Position Count of Responses
% of Total Responses
Other 10 33%Psychiatric Mental Health Nurse Practitioner
9 30%
Licensed Clinical Social Worker
2 7%
Nurse Practitioner 2 7%Physician Assistant 2 7%Child/Adolescent Psychiatrist
1 3%
Clinical Nurse Specialist 1 3%Licensed Professional Clinical Counselor
1 3%
Marriage and Family Therapist
1 3%
Medical Doctor (not a Psychiatrist)
1 3%
Total 30 100%
63
County Reported Needs Assessments Follow-up SurveyStatewide Recruitment, Orientation, and Training Strategies
Volunteer opportunities on advocacy and other boards
Vocational training program for mental health positions
Staff mentor program
Requirement for contracted agencies to have dedicated peer positions
Priority/Preference given to applicants with lived experience
Peer/Consumer internship program
Partnership with community college for peer/consumer training
Other
Meeting or job accomodations
Dedicated county peer positions
Contract(s) with peer run/led organizations
Anti-stigma training for all staff
0 2 4 6 8 10 12 14 16 1817
86
911
77
511
131516
Count of Responses
Recr
uitm
ent,
Ori
enta
tion
, and
Tr
aini
ng S
trat
egy
64
Highlights
Literature Review: Public Mental Health Workforce Demand and Supply
65
Literature Review Components Demand
Affordable Care Act Workforce Trends Prevalence Rates
Supply Workforce Trends
66
Literature Review: Impact of the Affordable Care Act
Medi-Cal recipients accessing public mental health services In FY 2011-12, nearly 3 million children
covered by Medi-Cal received specialty mental health services
Count is expected to rise to approximately 3.8 million children in FY 2012-13 and 4.1 million in FY 2013-14
Department of Health Care Services. Medi-Cal Specialty Mental Health Services May Revision Estimate. May 2013. Available from:http://www.dhcs.ca.gov/services/MH/Documents/DHCS-SMHS_May_2013_Estimate_Supplement.pdf
67
Literature Review:Impact of the Affordable Care Act Impact of Medicaid Coverage Expansion (MCE)
Beginning January 1, 2014, individuals and families with household incomes up to 138% of the FPL will be eligible for Medi-Cal regardless of health status, age, gender, or parental status
An estimated 1.4 million Californians under age 65 will become newly eligible for Medi-Cal
In total, there is an expected enrollment increase of between 830,000 and 1.2 million individuals by 2019
Among the newly covered, studies anticipate a higher prevalence of serious mental illness and, therefore, a greater demand for public mental health services. Estimates range from 17% to 25% prevalence of serious mental illness amongst the MCE group
Jacobs, K, and D. Graham-Squire, G. Kominski, D. Roby, N. Pourat, C. Kinane, G. Watson, D. Gans, and J. Needleman. Predicted Increase in Medi-Cal Enrollment Under the Affordable Care Act: Regional and County Estimates . UC Berkeley Labor Center. June 2012. Available from: http://laborcenter.berkeley.edu/healthcare/aca_fs_medi_cal.pdf Bazelon Center for Mental Health Law. Medicaid Lifeline for Children and Adults with Serious Mental Illness. Available from: http://www.bazelon.org/LinkClick.aspx?fileticket=ARq331Ujs3Q%3D&tabid=40
68
Literature Review: Skills Mix / Examining Provider Ratios Skills mix is a broad term and can refer to a wide
range of relationships: the skills needed to fulfill consumer needs, the skills currently available, the skills required by each type of provider, etc.
The concept of skills mixes can be used to categorize the demand for services, rather than considering specific professions individually Example: Nurse practitioners and physician assistants
may be able to offload some of the responsibilities of psychiatrists. Incorporating NPs and PAs increases the total capacity of licensed, prescribing providers
69
Literature Review: Years Required for Education, Licensing, and Training for Mental Health Occupations (1)
Occupational Category Minimum Years to
Completion
Training and Education Required for Service Provision
Benefits/Eligibility Specialist N/A N/ACase Manager/Service Coordinator
N/A N/A
Clinical Nurse Specialist 2 years 2 year Master’s Degree Program, Exam
Clinical Psychologist 5 years 4 year Doctorate Degree, 1 year Post-doctoral Training, Exam
Designated Consumer/Family Member
N/A N/A
Employment Service Staff N/A N/AHousing Support Services Staff
N/A N/A
Licensed Clinical Psychologist
5 years 4 year Doctorate Degree, 1 year Post-doctoral Training, Exam
Licensed Clinical Social Worker
4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam
Licensed Professional Clinical Counselors
4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam
Licensed Psychiatric Technician
1 year 12 months, Exam
70
Literature Review: Years Required for Education, Licensing, and Training for Mental Health Occupations (2)
Occupational Category Minimum Years to
Completion
Training and Education Required for Service Provision
Marriage and Family Therapist 4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam
Mental Health Rehabilitation Specialist
N/A N/A
Nurse, Other *Occupational Therapist 2 years 2 year Master’s Degree Program, ExamOther Non-Licensed Mental Health Staff
N/A N/A
Physician Assistant N/A 2 year Master’s Degree Program, ExamPromotora N/A N/APsychiatric Mental Health Nurse Practitioner
2 years 2 year Master’s Degree Program, Exam
Psychiatrist 8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams
Psychiatrist, Child/Adolescent 8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams
Psychiatrist, Geriatric 8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams
Psychologist 5 years 4 year Doctorate Degree, 1 year Post-doctoral Training, Exam
School Psychologist 2 years 2 Year Master’s Degree ProgramSubstance Abuse Counselor **
71
Literature Review: SMI PrevalenceKey Findings Of California’s total
population, 5.13% of individuals are estimated to have a SMI; amongst households below 200% of the federal poverty level, this rate increases to 8.11% of individuals
Across the state, youth are 75.8% more likely to have a SMI than adults; amongst households below 200% of the federal poverty level, youth are 15.7% more likely to have a SMI than adults
Adults residing in small counties are more likely to have a SMI
Amongst California’s youth, those residing in the Bay Area region have the lowest estimated SMI prevalence rates, whereas those residing in the Central and Los Angeles regions have the highest estimated SMI prevalence rates
Asian and Pacific Islander adults are the least likely to have a SMI, whereas African American, Native Hawaiian, and Multi-racial adults are the most likely to have a SMI
As adults grow in age from 18 to 44, their estimated SMI prevalence rates continually increase; the same rates gradually decrease from age 45 and on
http://www.dhcs.ca.gov/provgovpart/Documents/California%20Prevalence%20Estimates%20-%20Introduction.pdf
72
Literature Review:Estimated SMI Prevalence by MHSA Region
Bay Area Central Los Angeles Southern Superior0%1%2%3%4%5%6%7%8%9%
4.33%
5.64% 5.34% 5.18%5.87%
3.5%
4.8% 4.5% 4.3%5.3%
7.0%7.8% 7.8% 7.5% 7.8%
Total Adult Youth
MHSA Region
Esti
mat
ed P
erce
nt o
f Po
pula
tion
w
ith
SMI
http://www.dhcs.ca.gov/provgovpart/Documents/California%20Prevalence%20Estimates%20-%20Introduction.pdf
73
Literature Review: Estimated SMI Prevalence by County Size – Households Below 200% FPL
Small Medium Large6.5%
7.0%
7.5%
8.0%
8.5%
9.0%
9.5%
8.55%
8.19% 8.06%8.39%
7.83%7.62%
8.89% 8.89% 8.91%
Total Adult Youth
County Size
Esti
mat
ed P
erce
nt o
f Po
pula
tion
w
ith
SMI
http://www.dhcs.ca.gov/provgovpart/Documents/California%20Prevalence%20Estimates%20-%20Introduction.pdf
74
Literature Review: California Statewide Estimated SMI Prevalence for Youth by Race/Ethnicity
White
(n=2,7
89,42
3)
Asian
(n=96
5,715
)Mult
i
(n=32
7,350
)
Pacifi
c Islan
der
(n=32
,275)
Native
American
(n=43
,426)
African
American
(n=55
5,198
)Hisp
anic
(4,73
7,404
)6.2%6.4%6.6%6.8%7.0%7.2%7.4%7.6%7.8%8.0%8.2%
6.9%7.2% 7.3%
7.7%
8.0% 8.0% 8.0%
Race/Ethnicity
Esti
mat
ed P
erce
nt o
f Po
pula
tion
w
ith
SMI
California Employment Development Department (2012). Employment Projections, 2006-2016.
75
Literature Review:Employment, Projected Growth, and Mean Wages for Selected Professions in California’s Mental Health Workforce
Profession Mean Hourly and Annual Wages
Current Employment 2007
Percentage Growth (%) 2006- 2016
Ratio per 100,000
Population Mental Health and Substance Abuse Social Workers
$19.44/41,470
14,010 22.8 38.4
Clinical, Counseling, and School Psychologists
$36.67/78,213
12,560 20.1 34.5
Psychiatric Technicians $19.89/42,4
34 10,390 15.1 28.5
Mental Health Counselors $21.89/46,7
00 9,360 20.5 25.7
Substance Abuse and Behavioral Disorder Counselors
$16.96/36,189
8,300 35.4 22.8
Rehabilitation Counselors $20.02/42,7
11 7,620 13.0 20.9
Marriage and Family Therapists $20.50/43,7
16 6,130 21.9 16.8
Psychiatrists $72.92/NA 2,480 16.4 6.8
76
Literature Review: Distribution of Selected Licensed Mental Health Professionals in California by Region: 2008California Region
Licensed Clinical Social
Workers
MFT Psychologists
Psych Tech
Public Mental Health Nurses
Psychiatrist Total Regional Percentag
e
Bay Area 4,517 8,501 4,454 1,916 129 2,103 21,620
29.8
North Valley/Sierra
1,185 1,600 690 330 10 360 4,175 5.8 Central Valley/Sierra
279 490 167 323 3 93 1,355 1.9 Inland Empire 908 1,476 579 2,043 20 327 5,353 7.4 Orange 1,115 2,279 1,141 857 28 496 5,916 8.2 Central Coast 778 1,998 772 1,285 23 298 5,154 7.1 North Counties 432 814 210 172 7 69 1,704 2.4 South Valley/Sierra
630 792 437 1,377 4 205 3,445 4.8 Los Angeles 4,238 6,798 3,882 1,012 100 1,852 17,88
2 24.7
San Diego 1,477 2,022 1,513 137 44 636 5,829 8.0 Total 15,559 26,77
0 13,845 9,452 368 6,439 72,43
3 100.1
Percent Total 21.5 37.0 19.1 13.0 0.5 8.9 100.
Lok and Chapman. The Mental Health Workforce in California: Trends in Employment, Education, and Diversity. March 2009. Original source of table: American Medical Association (2006). AMA Physician Professional Data.
77
Literature Review: Aging of the Public Mental Health Workforce
California’s public mental health workforce will experience increased retirement rates in the coming years
By 2030, the nation will need an additional 3.5 million “formal” healthcare providers to maintain the existing ratio of providers to total population, a 35% increase from current levels
78
Highlights
Public Mental Health Workforce Supply Projections, 2014-2019
79
Supply Projections: Types of Data
Survey Occupational Board Licensure National Provider Identification (NPI) Controls
Wages (Quarterly Census Employment) California GDP California Population
80
Workforce Projections:Limitations
No perfect data source with exact counts of individuals currently in public mental health workforce
Limited number of variables Time-intensive process of accessing
Client Service Information (CSI) data
81
Supply Projections: Classes of Providers Licensed, Prescribing
Psychiatrist, Physician with Addiction Specialty, Psychiatric Mental Health Nurse Practitioner, Physician Assistant
Licensed, Non-Prescribing, Clinical Licensed Clinical Social Worker, Marriage and Family Therapist,
Licensed Clinical Psychologist Licensed, Non-Prescribing, Nursing
Registered Nurse, Clinical Nurse Specialist, Licensed Practical Nurse, Licensed Vocational Nurse, Licensed Psychiatric Technician
Alcohol and Other Drug Counselors Non-Licensed Professional
Case Manager, Community Health Worker, Counselor, Mental Health Counselor
82
Supply Projections: Licensed, Prescribing Providers Key Findings
The total count of licensed, prescribing providers is anticipated to grow by 21% over the five-year period from 2014 to 2019
Most of the growth in the licensed, prescribing provider category can be attributed to the projected increases in the supply of Physician Assistants (PAs)
As of 2013, Psychiatrists represent the second largest share of licensed, prescribing providers in the NPI registry
The MHSA Bay Area region and large counties contained the highest percentages of licensed, prescribing positions
The MHSA Superior region and small counties contained the lowest percentages of licensed, prescribing positions
Psychiatrist and physician were male-dominated licensed, prescribing positions
83
Supply Projections: Licensed, Non-Prescribing, Nursing Providers Key Findings
The category of licensed, non-prescribing, nursing occupations is anticipated to grow by approximately 33% over five-year period from 2014 to 2019
In 2013, Registered Nurses represented 67% of licensed, non-prescribing nursing occupations in the NPI registry
The MHSA Southern region and large counties contained the highest percentages of licensed, non-prescribing, nursing positions
The MHSA Superior region and small counties contained the lowest percentages of licensed, non-prescribing, nursing positions
Females occupied all licensed, non-prescribing, nursing positions more than males
84
Supply Projections: Licensed, Non-Prescribing, Clinical Provider Key Findings
The total count of licensed, non-prescribing, clinical providers is anticipated to grow by approximately 20% over the five-year period from 2014 to 2019
Marriage and Family Therapists represent 45% of licensed, non-prescribing clinical providers in 2013
The MHSA Southern region and large counties contained the highest percentages of licensed, non-prescribing, clinical positions
The Superior MHSA region and small counties contained the lowest percentages of licensed, non-prescribing, clinical positions
Females held a large majority of licensed, non-prescribing, clinical positions
85
Supply Projections: Licensed, Non-Prescribing, Clinical Providers Key Findings MFTs constituted the largest share of providers.
LCSWs represented the second highest proportion of the licensed, non-prescribing, clinical provider population
While LCSWs were reported as a high need position, the overall count of MFTs is much higher The distribution of MFTs across different county sizes
does not appear to be as disproportionate as some other provider types
Future strategies could help prepare counties to capitalize on the growing supply of MFTs among the licensed, non-prescriber provider population
86
Supply Projections: Alcohol and Other Drugs Counseling Providers Key Findings The MHSA Southern region and large counties
contained the highest percentages of AOD counselors The MHSA Superior region and small counties contained
the lowest percentages of licensed, non-prescribing, clinical positions
Females filled the majority of AOD counseling positions. The total count of Alcohol and Other Drugs Counseling
public providers is slated to grow from 2014 through 2019
The ratio of AOD counseling public providers to the total California population is expected to increase in the next five-year period
87
Supply Projections: Alcohol and Other Drugs Counseling Providers Key Findings
The total count of public Alcohol and Other Drug Counseling providers is slated to grow from 2014 through 2019
The annual percent change in growth is forecasted to slow from approximately 8% per year to 6% growth in 2019
88
Supply Projections: Retirement Impact on Workforce Key Findings Among the professions for which retirement rates
were estimated, only Psychiatry was estimated to have a significant proportion of providers estimated to retire by 2019
According to the computations conducted for this report, assuming Psychiatrists would retire on average by 65 with average practice lengths of 35 years, 40% of the current Psychiatrist workforce would retire by 2019 After adjusting for this rate of retirement, the incoming
supply of Psychiatrists is still projected to increase (albeit at a slower pace) annually
89
Current Supply: Licensed, Prescribing Professions
OccupationNumber in
NPI Registry
% of Total
Psychiatrist 6,573 49%Psychiatric Mental Health Nurse Practitioner 163 1%Physician Assistant* 6,599 49%Physicians with Addiction Specialties 129 1%Total 13,464 100%
*This number includes all Physician Assistants in the NPI data set, not Physician Assistants serving in the public mental health system in particular.Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013
90
Supply Projections: Licensed, Prescribing Providers
Psychiatrist
Psychiatric Mental Health Nurse Practitioner
Physician Assistant Physician TOTAL
Count
Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Observed
2008 5839 16 96 0.3 4512 12.4 103 0.3 10550 28.92009 6070 4% 16.5 102 6% 0.3 4935 9% 13.4 112 9% 0.3 11219 6% 30.52010 6246 3% 16.7 115 13% 0.3 5402 9% 14.5 117 4% 0.3 11880 6% 31.82011 6387 2% 17 131 14% 0.3 5853 8% 15.6 120 3% 0.3 12491 5% 33.22012 6506 2% 17.2 146 11% 0.4 6291 7% 16.6 125 4% 0.3 13068 5% 34.52013 6574 1% 17.2 163 12% 0.4 6602 5% 17.3 129 3% 0.3 13468 3% 35.3
2008 - 2013 Change 735 11% 1.2 67 41% 0.1 2090 32% 4.9 26 20% 0 2918 22% 6.4
Projected
2014 6481 -1% 16.9 177 9% 0.5 7141 8% 18.6 135 5% 0.4 13942 4% 36.32015 6687 3% 17.2 194 10% 0.5 7644 7% 19.7 141 4% 0.4 14673 5% 37.82016 6898 3% 17.6 212 9% 0.5 8158 7% 20.8 146 4% 0.4 15421 5% 39.42017 7110 3% 18 230 8% 0.6 8681 6% 22 152 4% 0.4 16181 5% 40.92018 7310 3% 18.3 247 7% 0.6 9186 6% 23 158 4% 0.4 16908 4% 42.42019 7513 3% 18.7 264 7% 0.7 9701 6% 24.1 164 4% 0.4 17649 4% 43.9
2014 - 2019 Change 1032 14% 1.8 87 33% 0.2 2560 26% 5.5 29 18% 0 3707 21% 7.6
91
Current Supply: Licensed, Non-Prescribing, Nursing Occupations
Occupation Number in NPI Registry % of Total
Registered Nurse 7,507 67%Clinical Nurse Specialist 92 1%Licensed Practical Nurse 206 2%Licensed Psychiatric Technician 825 7%Licensed Vocational Nurse 2,610 23%Total 11,240 100%
Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013
92
Supply Projections: Licensed, Non-Prescribing, Nursing Providers
Registered Nurse Clinical Nurse
Specialist Licensed
Practical Nurse Licensed
Psychiatric Technician
Licensed Vocational Nurse TOTAL
Count
Annual Change
Prov-to-Pop Ratio
Count
Annual Change
Prov-to-Pop Ratio
Count
Annual Change
Prov-to-Pop Ratio
Count
Annual Change
Prov-to-Pop Ratio
Count
Annual Change
Prov-to-Pop Ratio
Count
Annual Change
Prov-to-Pop Ratio
Observed
2008 4435 12.2 75 0.2 110 0.3 530 1.5 1284 3.5 6434 17.62009 5010 13% 13.6 78 4% 0.2 133 21% 0.4 587 11% 1.6 1524 19% 4.1 7332 14% 202010 5595 12% 15 80 3% 0.2 147 11% 0.4 636 8% 1.7 1804 18% 4.8 8262 13% 22.12011 6179 10% 16.4 86 8% 0.2 166 13% 0.4 685 8% 1.8 2081 15% 5.5 9197 11% 24.52012 6889 11% 18.2 89 3% 0.2 192 16% 0.5 750 9% 2 2396 15% 6.3 10316 12% 27.32013 7530 9% 19.8 92 3% 0.2 208 8% 0.5 825 10% 2.2 2614 9% 6.9 11269 9% 29.6
2008-2013 Change 3095 41% 7.6 17
18%0 98 47% 0.2 295 36% 0.7 1330 51% 3.4 4835 43% 12
Projected
2014 8213 9% 21.4 98 6% 0.3 233 12% 0.6 891 8% 2.3 2927 12% 7.6 12362 10% 32.12015 8994 10% 23.2 103 5% 0.3 260 12% 0.7 974 9% 2.5 3225 10% 8.3 13556 10% 34.92016 9796 9% 25 108 5% 0.3 288 10% 0.7 1059 9% 2.7 3529 9% 9 14779 9% 37.72017 10615 8% 26.9 114 5% 0.3 315 10% 0.8 1146 8% 2.9 3835 9% 9.7 16025 8% 40.52018 11440 8% 28.7 120 5% 0.3 341 8% 0.9 1230 7% 3.1 4126 8% 10.3 17257 8% 43.32019 12284 7% 30.5 126 5% 0.3 367 8% 0.9 1314 7% 3.3 4422 7% 11 18513 7% 46
2014-2019 Change 4071 33% 9.1 28 22% 0 134 37% 0.3 423 32% 1 1495 34% 3.4 6151 33% 13.9
93
Current Supply: Licensed, Non-Prescribing, Clinical Providers
Occupation Number in NPI Registry
% of Total
Psychologist 13,014 28%Marriage and Family Therapist 20,460 45%Licensed Clinical Social Worker 11,908 26%Licensed Professional Clinical Counselor 339 1%Occupational Therapist 10 0%Total 45,731 100%
Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013
94
Supply Projections: Licensed, Non-Prescribing, Clinical Provider Findings
Psychologist Marriage &
Family Therapist Licensed Clinical
Social Worker Licensed
Professional Clinical Counselor
TOTAL
Count
Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Count Annual Change
Prov-to-Pop Ratio
Observed
2008 10130 27.8 14656 40.2 9026 24.7 230 0.6 34042 93.32009 10919 8% 29.7 16065 10% 43.7 9719 8% 26.5 249 8% 0.7 36952 9% 100.62010 11487 5% 30.8 17220 7% 46.2 10297 6% 27.6 268 8% 0.7 39272 6% 105.32011 12029 5% 32 18354 7% 48.9 10877 6% 29 285 6% 0.8 41545 6% 110.62012 12558 4% 33.2 19555 7% 51.7 11455 5% 30.3 310 9% 0.8 43878 6% 1162013 13020 4% 34.2 20461 5% 53.7 11913 4% 31.3 339 9% 0.9 45733 4% 120
2008-2013 Change 2890
22%6.4 5805
28%13.5 2887
24%6.6 109
32%0.3 11691
26%26.7
Projected
2014 13605 4% 35.4 21983 7% 57.2 12606 6% 32.8 353 4% 0.9 48547 6% 126.32015 14194 4% 36.6 23097 5% 59.5 13219 5% 34.1 377 7% 1 50887 5% 131.12016 14795 4% 37.8 24207 5% 61.8 13844 5% 35.4 401 6% 1 53246 5% 1362017 15404 4% 39 25322 5% 64.1 14475 5% 36.6 424 6% 1.1 55624 4% 140.72018 15973 4% 40.1 26471 5% 66.4 15065 4% 37.8 447 5% 1.1 57956 4% 145.42019 16553 4% 41.2 27625 4% 68.7 15663 4% 38.9 469 5% 1.2 60311 4% 150
2014-2019 Change 2948 18% 5.8 5642 20% 11.5 3057 20% 6.1 116 25% 0.3 11764 20% 23.7
95
Supply Projections: Alcohol and Other Drugs Counseling Providers
AOD Counselor
Count
Annual Change
Prov-to-Pop Ratio
Observed
2008 1730 4.72009 1962 13% 5.32010 2149 10% 5.82011 2436 13% 6.52012 2744 13% 7.32013 3016 10% 7.9
2008-2013 Change 1286 43% 3.2
Projected
2014 3246 8% 8.42015 3539 9% 9.12016 3836 8% 9.82017 4133 8% 10.52018 4411 7% 11.12019 4690 6% 11.7
2014-2019 Change 1444 31% 3.3
96
Highlights
Literature Review: Educational Capacity
97
Educational Capacity:Overview
Purpose: To identify the pipeline of future mental health providers
Types of analysis: Geographic distribution Discipline/Degree Demographics
Gender Race/Ethnicity
98
Educational Capacity: Data Sources Program availability and capacity
Data sources: California Board-Licensed Programs OSHPD-led Educational Institutions Survey
Trends among graduates Data sources:
Integrated Postsecondary Education Data System (IPEDS)
California Postsecondary Education Commission (CPEC)
99
Educational Capacity:Limitations IPEDS data has incomplete reporting CPEC student pipeline data is truncated
at 2009 Low response rates to RDA’s educational
institutions survey
100
Educational Capacity: Key Findings Overall and across most areas of
analysis, graduation counts rose over the 1999-2009 period
Graduates are heavily concentrated in the Southern Region, which accounts for approximately 43% of all total graduates in the state
Graduate growth rates in the Southern region are increasing faster than the statewide average, and considerably faster than in other MHSA regions
Large counties account for 80% of all graduates in the state, and have held this proportion steadily from 1999-2009
Female graduates account for approximately two-thirds of the total graduates in California
White graduates comprise the largest share of all graduates in mental health disciplines
Graduates of minority race/ethnicities constitute an aggregated majority of all graduates
101
Educational Capacity: Distribution of Programs by MHSA Region
MHSA Region
Count of Programs % of Total
Bay Area 88 24%Central 26 7%Los Angeles 99 27%Online 20 5%Southern 125 34%Superior 7 2%Total 365 100%
102
Educational Capacity:Distribution of Programs by Institution Type
Type of Institution
Count of Program
s% of Total Programs
Community College 18 5%California State University 75 21%Private 224 61%Public, Other 3 1%University of California 45 12%Total 365 100%
103
Educational Capacity:Distribution of Programs by Discipline and MHSA Region
DisciplineBay Area
Central
Los Angel
esSouth
ernSuperi
or Online Total Child Psychiatry Fellowship 4 2 1 7Clinical Nurse Specialist 11 1 10 11 33Clinical Psychology 2 9 10 3 24Doctorate in Psychology 2 1 4 2 9Educational Psychology 1 1Geriatric Psychiatry Fellowship 2 2 1 5Licensed Professional Clinical Counselor 8 3 6 14 9 40Marriage and Family Therapy 36 8 28 43 3 8 126Physician Assistant 3 1 2 3 9Psychiatric Mental Health Nurse Practitioner 1 4 1 6Psychiatric Residency 4 4 8 6 22Psychiatric Technician 5 3 2 9 19School Psychology 5 3 12 18 2 40Social Work 5 2 9 6 2 24Total 88 26 99 125 7 20 365
104
Educational Capacity:Graduates in All Mental Health Disciplines, with Projections
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 20090
5000
10000
15000
20000
25000
f(x) = 124.272727272727 x + 3498.54545454545R² = 0.934080528842549
f(x) = 535.090909090909 x + 10573.1818181818R² = 0.940893740904704
f(x) = 660.672727272727 x + 14074.5090909091R² = 0.946974700976847
Male Graduates Linear (Male Graduates)Female Graduates Linear (Female Graduates)Total Graduates Linear (Total Graduates)
2014
105
Educational Capacity:Distribution of Mental Health Graduates by Discipline (1999-2009)
Clinical Psychology8% Counseling
Psychology 4%
Educational Psychology
0%Marriage and
Family Therapy2%
Other2%
Psychiatric Technician
2%
Psychology63%
School Psy-chology
1%
Social Work 13%
Substance Abuse/Addic-tion Counseling
4%
198,424 total graduates
between 1999-2009
106
Educational Capacity: Count of Graduates by Race/Ethnicity Grouping (1999-2009)
Race/Ethnicity Group
Count of Graduates
% of Total Graduates
Asian/Pacific Islander 18,303 10%Black 14,535 8%
Hispanic/Latino 38,485 20%Native American 1,937 1%Other 3,576 2%Unknown 20,902 11%White 91,459 48%Total 189,197 100%
107
Educational Capacity:Distribution of Schools and Graduates
Educational Institutions Graduates
108
Educational Capacity: Total Graduates by County Size (1999-2009)
Large82%
Medium15%
Small2%
198,424 total graduates
between 1999-2009
109 Literature Review: Graduation to Workforce Participation
110
Literature Review: Graduation to Workforce ParticipationPsychology Graduate Trends – Key Findings
Masters Level Survey Results Sixty-four percent (64%) of graduates with Master’s,
Specialist’s, and related degrees who had full-time employment were working in a health services discipline
Doctoral Level Survey Results Sixty-three percent (63%) of new doctoral graduates were
employed full-time, 24% were pursuing post-doctorate degrees, 8% were employed part-time, and 6% were unemployed
Almost 30% of doctoral survey respondents were employed three months after the completion of their degree; 38% of doctoral graduate respondents had found employment prior to completion of their doctoral degree
Men were employed full-time at a rate of 67%, compared to women at 62%
White doctoral graduate respondents reported full-time employment at a lower rate than ethnic minorities (62% and 65%, respectively)
111
Literature Review: Graduation to Workforce ParticipationKey Findings
Overall, the reported supply of new graduates into the mental health workforce increased over the past five years
A majority of undergraduate students interested in psychology expressed interest in pursuing graduate and post-graduate education
Among post-graduates in psychiatry, a slight majority commit to U.S.-based Medical Doctor Programs
Federal programs supporting nurses have helped to increase the nursing supply and help drive portions of the workforce to medically underserved communities
Social workers participating the Title IV-E program in California have a 78.8% retention rate
Rural communities are in need of mental healthcare professionals
“American Psychological Association Center for Workforce Studies.” 2008 APA student affiliate survey [survey with tables].” Retrieved from http://www.apa.org/workforce/publications/08-student/index.aspx
112
Literature Review: Graduation to Workforce ParticipationGraduates’ Intent to Pursue Doctoral Degree in Psychology
Intent to Pursue Psychology Doctoral Degree
Female(n= 1,461)
Male(n=344) Total
N % N % N %Yes, currently in terminal Master’s program
198 14% 44 14% 242 14%
Yes, currently in a doctoral program in psychology
1,032 74% 252 78% 1,284 74%
No 60 4% 8 3% 68 4%
Not Sure 111 8% 21 7% 132 8%
Total 1,401 100% 325 100% 1,726 100%
113
Literature Review: Graduation to Workforce ParticipationEmployment Settings for Psychology Master’s, Specialist’s, and Related Degree Graduate Students
University or Col-lege setting
13%
School or Other Educational Set-
tings25%
Hospitals and Clinics19%
Independent Practice
3%
Other Human Services Settings
20%
Business, Government,
or Other20%
“American Psychological Association Center for Workforce Studies.” 2008 APA student affiliate survey [survey with tables].” Retrieved from http://www.apa.org/workforce/publications/08-student/index.aspx
114
Literature Review: Graduation to Workforce ParticipationOther Professions Graduation Trends
Registered Nurses 59% hire rate into entry-level positions with
the Bachelors of Nursing (BSN) degree 67% hire rate into entry-level positions with
the Master’s of Nursing (MSN) degree Psychiatry
The number of post-graduate psychiatry residents has increased slowly since the shortage in the late 1990sAmerican Association of Colleges of Nursing. (2013).
Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses [research brief]. American Psychiatric Association. (2013). Resident census: Characteristics and distribution of psychiatry residents in the U.S. 2011-2012 [Survey with tables].
115WET Five-Year Plan Needs Assessment Strengths and Next Steps
116
Strengths of Overall Project
Reviewed extensive amount of county-reported data
Utilizing many data sources to inform needs assessment, evaluation, and projections including: Literature Reviews Stakeholder Feedback State and National Data Sources Educational Institution Surveys State Administered WET Program Evaluation
OSHPD support in prioritizing best possible data sources
117
Forthcoming Work Demand Projections
Acquire and analyze demand-side data to identify trends amongst consumers of public mental health services
Primary data source is the Client and Service Information (CSI)
Gap Analysis Identify any anticipated shortages and surpluses over
the next five years Occupational type, prescribing authority, location,
demographic needs (where data is available) Needs Assessment Report Finalization
Reports including findings from all assessment completed will be posted to the OSHPD website and distributed to stakeholders
118
Thank you!
Resource Development Associates Amalia Freedman (
[email protected]) Kevin Wu ([email protected])