WORK FORCE DEVELOPMENT DEVELOPING AND ENHANCING THE WORKFORCE FOR CHEMICAL DEPENDENCY TREATMENT Robin Roberts David Jefferson
AGENDA • Status of the workforce • Competencies • Training • Current challenges • DASA updates • Legislation • Consideration for the future
OBJECTIVES • What skills and competencies do you need to prepare yourself for the future? • How does this information affect you?
WHAT IS WFD? • Webster does defines 1: the workers engaged in a specific activity or enterprise <the factory's workforce> 2: the number of workers potentially assignable for any purpose <the nation's workforce> de·vel·op·ment • Lawrence M. Anthony, EdD, LICDC University of Cincinnati 1: An integrated process requiring participation and cooperation of several employment related institutions whose goal is to help develop and maintain a viable workforce.
WHAT IS THE NUMBER ONE PUBLIC HEALTH ISSUE? • Addiction, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMSHA) 2002 Report • 19 million Americans need treatment • 25% are able to access treatment • 50% of those in treatment do not complete • The way services are delivered is a barrier to both access and retention • CESAR FAX: Annapolis Coalition on Behavioral Health Workforce SAMSHA Report: Critical Workforce Shortage, Narrow Focus on White Adults, Dissatisfaction Among Persons In Recovery, Inadequate and Irrelevant Training.
WORKFORCE DEVELOPMENT MISSION • Pride • Pay • Professionalism
WHAT ARE THE MAIN WORKFORCE ISSUES? • Recruitment • Retention • Education and Training
SHORTAGE OF CDP’S ? • Directors said: • 40% their agency are understaffed • There is a vacancy rate of 1.10 FTE per agency • 54% of shortages are budget related • 46% stated they would still be understaffed if all budgeted positions were filled • 49% reported an average of 1.92 FTE planned hires • CDP’s account for 79% of all planned hires • Agencies employ on average 10- 11 treatment staff • On average, agencies have 3- 5 CDPT’s for every 10 clinicians. • Substance abuse professionals will increase Nationally by 33% over the next decade, (U.S. Department of Labor)
WHAT IS THE NUMBER OF CDP’S NEEDED IN WA STATE? • Currently there are 2,562 active Chemical Dependency Professionals and 906 expired or otherwise loss of credentials in the state of Washington. • Directors said; 280 additional CDP’s are needed. Note: This does not include the 10% (256 CDP’s) who indicated that they plan on leaving the field soon. • The potential of an additional loss of 10% (256) in a worst case scenario could result in 536 CDP’s positions not filled. • The effect of Treatment Expansion further increases the need for CDP’s given an expected 5% to 10% increase in patients caseload each year.
AGING OUT OF THE WORKFORCE • 70% of directors and 37% of clinicians are 50 years old or older • 15% of clinicians are in their 60’s • 27% of directors are 60 years old
AGENCY LEVEL TURNOVER • 2002 turnover rate was 22% • 2005 turnover rate was 23% • 61% of clinicians leave for another agency, • 49% of clinicians leave for another allied field • Two factors appear to be statistically significant predictors of turnover: • (1) years experience of the director (more experience, less turnover) • (2) clinical supervision (more frequent clinical supervision, more turnover) • Most turnover in the state is agency to agency turnover • Nationally the turnover rate is approximately 11%
REASONS FOR DIRECTOR TURNOVER • Director and clinician report: • better salary, • better work opportunities (within the field) • burnout • Directors leave category: • level of job satisfaction is the lone significant predictor for membership in the changer category • Recovery status and second career status • Directors not in recovery and CD treatment is a second career are more likely to be considering (with high or definite probability) leaving the field • A statistically significant larger proportion of clinicians at agencies with 2 or fewer staff report their likelihood of changing agencies is “not at all” clinicians may find working in smaller agencies less stressful.
RETENTION STRATEGIES • Increase salaries • Provide raises for increased education and training programs completed • Reducing paperwork • Creating incentive for personal growth and advancement • Flexible schedules • Hiring the best person in the first place (use of structured interviews, team interviews, writing & demonstration exercises, etc)
Work Force Environment • SAMHSA Center for Substance Abuse Research Report 6-18-2007 said, “Substance abuse and mental health care environments ‘Toxic” for persons in recovery and those working in the field.” • A critical workforce shortage • A narrow focus on Urban White Adults • Dissatisfaction among persons in recovery • Inadequate and irrelevant training • http://www.samhsa.gov/workforce/annapolis/workforceactionplan.pdf
COMPETENCY • “...a measurable human capability that is required for effective performance…” • “…comprised of knowledge, a single skill or ability, a personal characteristic, or a cluster of two or more of these…” • “…are the building blocks of work performance…” -- Marrelli et al
COMPETENCY • Education • Standards • Training
COMPETENCY • Challenges: • Variation and a lack of standardization in educational programs (curricula, degree programs) • Difficulty in transferring credits • DOH has to act as registrar for all applicants • NAADAC certification for all Community College CD programs • Special populations needs. • Statewide Adolescent Grant Stakeholders support the implementation of adolescent competencies and a voluntary credential. • Need more specialized training for older adults, ethnic minorities, criminal justice and other special populations.
COMPETENCY • Training • Use of evidence-based practices • Outcome measurement • New medications • Addiction treatment (primary health care, allied health professions)
CROSS-CUTTING ISSUES • Stigma • Noncompetitive compensation
STIGMA • Some negative perception associated with substance abuse professionals • Difficulty in recruitment and retention • Addiction professionals considered lower status than other professionals • Reluctance to enter the field • Contributes to noncompetitive salaries • Misconceptions about treatment, and the qualifications of a clinician
COMPENSATION • Low Salaries • In 2002, average salaries in low $30,000s • Majority of counselors (61%) earned between $15,000 and $34,000 • Majority of agency directors (68%) had salaries ranging from $40,000 - $75,000 • In 2005 67% of clinicians made less than $35,000 a yr. (88% less than $45,000) • In 2005 69% of clinicians report being the primary wage earner for their family • Factors associated with higher salaries: • graduate degrees • certification • years in the field
COMPENSATION • Inadequate health care coverage among professional staff • 30% had no medical coverage • 40% no dental coverage • 55% not covered for substance use or mental health services (Counselor, 2004)
WFD POSITION UPDATES DASA DIRECTOR’S • CDPT classification law, did not pass. DASA is proposing to revive the bill to include a separate category in DOH for CDPT’s and limiting the number of years that a person can be a CDPT. • Promote Substantial Equivalency: WA Accepts, • Alabama-Masters level addiction professional (MLAP) • Arizona-Substance Abuse Counselor (SAC) • Idaho-Advanced CADC • Oregon-CADCII & CADCIII • Continue collaboration with key partners, CDP Advisory Board, DOH, NCCDE, NAADAC, Tribes, and other State Agencies such as DOC. • New link on DASA WFD web page • CDP and CDPT certification information • Application process readiness • Course work description and criminal background checks • Research and updates on WFD. • Support the “National Certification” of Colleges • Early information to prospective CDP students • CDP recruitment brochure
TREATMENT STAFF • Chemical Dependency Professional (CDP) means a person certified by the Washington State Department of Health (DOH) Health Professions Quality Assurance Office • Chemical Dependency Professional Trainees (CDPT’s) means a person assigned a trainee position by an administrator of a state of Washington certified chemical dependency service agency • CDPT’s are required to be registered as a counselor or have a current license issued by the DOH
HOW DO I BECOME A CDPT? • There are five basic steps to becoming a CDPT listed below. For more detailed instructions obtain a Registered Counselor Application Packet or contact the Department of Health (D.O.H.). 1. Submit a completed application for Registered Counselor along with your personal explanation and documentation of any “yes” answers to the personal data questions; 2. Complete four (4) hours of AIDS/HIV training; 3. Submit the $40.00 application fee to the DOH; 4. Verify other credentials held in this or in other states even if credential is not currently active; 5. Receive your CDPT credentials!
WHAT ARE THE BASIC STEPS TO BECOMING A CDP? • There are five basic steps to becoming a CDP. For more detailed instructions, on the web go tohttps://fortress.wa.gov/doh/hpqa1/hps7/Chemical_Dependency/default.htm for a Chemical Dependency Professional License Application Packet or contact the Department of Health (D.O.H.) at (360) 236–4700 1. Register with the D.O.H. as a registered counselor/CDPT. Call the D.O.H. Application Packet Line at (360) 236-4700 and press option 1 to request an application. Leave your name and address and a packet will be automatically sent to you. 2. Complete the Chemical Dependency college course work and the supervised (2,500-AA, 1,500-BA, 1,000-Graduate Level) internship hours. 3. Submit the application with a fee of $40 to D.O.H. 4. Submit an application to D.O.H. for "Chemical Dependency Professional" status with a $100 application fee and a $125 initial certification fee, both non-refundable. 5. Take and pass the written examination.
Proposed CDPT Legislation • Submitted by Chemical Dependency Professionals SubgroupChemical Dependency Professional TraineesJuly 2006 to the Governor’s office for review the following: • Revise RCW 18.205 - Chemical Dependency Professionals, to create a new RC certificate aligned with CDP certification. The new credential might be RC-CDP Trainee or CDP Trainee. • An RC-CDP Trainee must attest annually, after receiving a certificate, to actively pursue the educational requirements per WAC 246-811-030 to become a CDP. • Should CDP Trainees demonstrate certain core competencies before providing specific counseling services to patients? Yes but that has not been defined yet. • Should they take an exam? While a state exam for RC-CDP Trainee is not required, the RC-CDP Trainee is required to take and pass a number of exams in core competency counseling areas while completing the education requirements to become a CDP. • How should they be supervised? CDP Trainees are supervised under the authority of DOH WAC 246-811 and DASA WAC 388-805. WAC 246-811 describes supervisor qualifications while WAC 388-805 describes elements of supervision. • Should there be an interim permit for those intending to become licensed or certified? Yes The new RC–CDP Trainee certificate should be time limited, e.g., five – six years, at which time the RC-CDP Trainee will be expected to complete his/her education, training, and experience to become a CDP.
KEY THEMES • Compensation, Competitive Salaries and Benefits • Aging out of the workforce • Integrated strategic planning by key entities • Improve clinical supervision • Training for clinical and recovery support supervisors • Investigate loan forgiveness and repayment programs • Develop career paths and establish national core competencies • Develop leadership and management initiatives • Provide support related to relapse in the workforce • Provide education on addiction treatment within other disciplines • Standardize Education CDP programs in the state • Recommend that all CDP programs in the state become NADDAC certified.
ARE YOU BE READY FOR THE FUTURE? • Preparing for integrated treatment of Co-Occurring Disorders • Preparing for working with other special populations • Expertise in Evidenced Based Program, Practices and Implementation • Connecting to the systems that further WFD • Have the leadership skills needed in a changing work world • Have the clinical supervision skills to adequately supervise those in training and those with advanced skills
Work Force Development Resources • NFATTC Workforce Development Survey Report 2006 (PDF) • DASA Workforce Development Presentation 2007 (PPT) • Annapolis Coalition: History of Planning Process and Overview of WFD Plan (PPT) • Annapolis Coalition: A Thousand Voices – National Action Plan on Behavioral Health WFD (PDF) • Annapolis Coalition: A Framework for Discussion – Action Plan for Behavioral Health WFD (PDF) • Department of Health Chemical Dependency Forum Results (Word) • Department of Health Chemical Dependency Advisory Board Minutes ( • NAADAC Workforce Development Presentation (PPT) • SAMSHA Substance Abuse Workforce Development Environment Scan (PDF) • Ohio Workforce Development Article (PDF) • DASA Training and Workforce Development Website link http://www1.dshs.wa.gov/dasa/services/training/training.shtml