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March 2010

ATTC National Office Publishes new "Summary Report” on SU Treatment Workforce
 
In November, 2009 the SAMHSA/CSAT funded Addiction Technology Transfer Center National Office published a new report entitled, "Understanding America’s Substance Use Disorders Treatment Workforce: A Summary Report.” The report was prepared by Deena M. Murphy and Robert L. Hubbard of the Institute for Community-Based Research, National Development and Research Institutes, Inc. In it we gain a current perspective of the substance use disorders treatment field’s workforce. The report will now be followed by a series of stakeholder discussions and the subsequent designing of a national survey instrument that will aid in an upcoming systematic collection of data on the workforce to be conducted by each regional ATTC in FY 2011. This most recent report follows many predecessor reports including the SAMHSA/CSAT Strengthening Professional Identity: Challenges of the Addictions Treatment Workforce (Abt Associates, 2006); the United States Department of Health and Human Services Report to Congress: Addictions Treatment Workforce Development (US DHHS, 2007), and the Annapolis Coalition’s own Report on the Behavioral Health Workforce (2007).
 
The ATTC report is divided into three sections: (1) basic demographics of the workforce; (2) anticipated workforce needs and (3) common methodologies used to prepare, retain and maintain the workforce. Each section is then divided into: (a) what we know; (b) what gaps exist and (c) recommendations for further discussion. Below is an overview:
 
1. What is known?
 
The substance use disorders workforce is diverse in discipline and setting
Data presented by Dr. H. Westley Clark at the Northeast ATTC 2004 Summit on workforce development revealed that the substance use disorders treatment workforce is comprised of some 135,000 full time employees, 45,000 part-time employees, and 22,000 contract employees (Northeast ATTC, 2004) of varying disciplines and training.
 
The workforce is older, white, and predominantly female
Data from an environmental scan conducted by Kaplan (2003) reports the substance use disorders workforce is at an average 45-50 years of age, 70-90 percent non-Hispanic whites, and over 50 percent female.
 
The workforce demographics do not reflect the treatment population
The SU treatment population is predominantly between the ages of 25-44, are 60 percent non Hispanic whites, and over 70 percent male (TEDS, 2007).
 
The workforce is well-educated, but … exact data is unclear
Studies reported in this work show a variance in degrees held based the unique study reporting and on other factors such as full time or part time employment status. Generally the report notes a range of about 50% holding graduate degrees (7% doctoral degrees), and 49% hold bachelors degrees or no degrees. No percentage of non-degreed is reported. The report does add that most academic preparation occurs at a community college level and goes on to underscore the need for more validation and accountability of the quality of all in-service education, clinical supervision and academic courses used in such preparation.
 
Turnover rates are high, but professionals seem to stay in the SU field         
The report summarizes an array of studies but concludes that annual turnover rates in SUD average around 25% annually in ALL staff and are as high as 54% in Program Directors and senior staff. The national average across all occupations traditionally with high turnover rates is 11%.
 
Salaries for SUD professionals are low and impact retention rates
After citing the rages of salaries for counselors and directors the report notes that salaries are identified in a plethora of cited studies as the major factor in recruitment, retention and turnover of staff.
 
2. Limitations of the Report
 
How accurately do the findings reflect the state of the field?
The report notes a need for more specific refinement in all reported data, e.g. is data from senior staff reflective of the true provider population? Is the data reflective of urban or rural providers and state, private or public agency employees alike?
 
The report also examines the anticipated needs for 2010-2015 projecting a 27% growth or a need for 5,000 new counselors annually over this period to meet the growing demand and replacement needs. This number of course will be impacted by many other factors such as the current insufficient capacity, changing profiles of those needing services, service/system integration, skills needed to deal with more complex and complicated clients and systems, need to meet special populations with ethnic, racial, age, rural needs, etc. In short, many areas already have acute needs for staffing. It is further suggested that treatment outcomes be studied for any potential relationship to education, training and turnover in staff, as well as other factors such as agency size, location (urban/rural) and, of course, client demographics.
 
The second half of the report focuses on the common strategies and methodologies to prepare, retain, and maintain the workforce. Not to anyone’s surprise the report notes a general consensus for a national focus on workforce development with initial emphasis on retaining and maintaining our workers while we recruit new workers and build the "infrastructure” to address the needs in substance use. Leadership is underscored as critical and opportunities in management practices and staff education/training, while key to keeping workers, do not negate the need to address other factors such as salary and new workers feeling job satisfaction. The report references the reader to previous SAMHSA/CSAT recommendations/reports still seen as valid and a need for states to be actively involved in any response to workforce development.
 
The full report is available HERE.
 
Michael T. Flaherty, Ph.D. is a Clinical Psychologist with APA Certification in the Addictions. He is also the Executive Director of the Institute for Research, Education and Training in the Addictions in Pittsburgh, Pa. and the SAMHSA/CSAT funded Northeast Addictions Technology Transfer Center serving New York and Pennsylvania. He is a current Board Member of the Annapolis Coalition and serves as co-lead of its Substance Use Treatment Panel in preparing the "AC Action Plan for Behavioral Workforce Development in 2007. He can be reached at flahertym@ireta.org.
 
Alaskan Core Competencies Released
 
The Alaskan Core Competencies for Direct Care Workers in Health & Human Services have been released and can be downloaded at www.annapoliscoalition.org. The Alaska Mental Health Trust Authority, in collaboration with the University of Alaska and the State of Alaska Department of Health & Social Services sponsored the development process, which was managed by the WICHE Mental Health Program and the Annapolis Coalition.
                                                                                                           
The competencies are designed to guide skill development with direct care workers, who are also referred to as direct support workers, direct support professionals, para-professionals, or technicians.  These individuals provide a large portion of the health and human services delivered in the United States, but too seldom receive training that is competency-based.  The Alaskan Core Competencies are designed to guide the initial training and the continuing education of direct care workers, shaping both the selection of educational topics and the development of training content.  The competencies can also serve as the basis for assessing the performance of direct care workers or individuals being trained for direct care positions.  Tools for assessing trainee and worker performance on these competencies are under development and will be released in 2010.
 
These competencies are "core” in the sense that they include the basic skills that are necessary to work in most areas of health and human services including, but not limited to: mental health, addictions, developmental disabilities, child development, long-term care, traumatic brain injury, and community based juvenile justice.  While they are relevant to providing services in all geographic regions of the country, these core competencies explicitly incorporate skills that are essential in the rural and frontier areas of states such as Alaska where direct care workers may function with limited support or supervision and face unique challenges.
 
For comments or questions about the competencies, contact Michael Hoge at michael.hoge@yale.edu.
 
The Annapolis Coalition Welcomes Wayne Dailey
 
We are delighted to welcome to the Annapolis Coalition Dr. Wayne F. Dailey.  Wayne will be working with us as project coordinator for the Annapolis Coalition/Hitachi Foundation project "Better Jobs, Better Services, and Better Business.”  This year long project is designed to identify and recognize the achievements of organizations that measurably demonstrate all three core criteria:
  • Improved workforce practices that strengthen business performance and bottom line results
  • Improved work life, skills, and economic advancement among direct support employees
  • Improved client outcomes based on the organization’s delivery of high quality services and supports.

For more information on the "Better Jobs, Better Services and Better Business" check our February 2010 Newsletter.
 
Wayne is a licensed clinical psychologist with over 30 years experience in public sector behavioral health administration and management. During his career he has served in many capacities, including as Deputy Commissioner of the Connecticut Department of Mental Health.  In recent years, he has played a pivotal role in promoting development of a recovery-oriented system of care in Connecticut.  Connecticut’s public-sector behavioral health system is now considered among the best in the nation.  He also serves as Assistant Clinical Professor in Psychiatry at the Yale University School of Medicine.
 
We are pleased to have him on board to guide this exciting initiative.