getting and keeping a rural workforce: lessons from the wiche west
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Getting and Keeping a Rural Workforce: Lessons from the WICHE West. Dennis Mohatt Vice President for Behavioral Health - WICHE. WICHE region. Alaska Arizona California Colorado Hawaii Idaho Montana Nevada New Mexico North Dakota Oregon South Dakota Utah Washington Wyoming. - PowerPoint PPT PresentationTRANSCRIPT
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Getting and Keeping a Rural Workforce:Lessons from the WICHE West
Dennis MohattVice President for Behavioral
Health - WICHE
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
WICHE region
• Alaska• Arizona• California• Colorado• Hawaii• Idaho• Montana• Nevada• New Mexico• North Dakota• Oregon• South Dakota• Utah• Washington• Wyoming
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Workforce success is all about P.I.E.
Proximity – Provide care close to home
Immediacy – Identify and treat early
Enthusiastically – Treat with hope
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
There is not one rural …
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
What’s different in the country?
Not prevalence – rural/urban rates of mental disorders are pretty much the same.
Accessibility (getting there and paying) Availability (someone there when you are) Acceptability (choice, quality, knowledge)
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
The cold, hard facts
> 60% of rural Americans live in mental health professional shortage areas
> 90% of all psychologists and psychiatrists, and 80% of MSWs, work in metropolitan areas
> 65% of rural Americans get their mental health care from their primary care provider
Rural Americans enter care later in the course of their disorders, with more advanced symptoms, resulting in more intensive & expensive interventions
EMS for Rural MH Crisis usually law enforcement
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Mental health professional shortage areas
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Health professional shortage areas: primary care
HPSA designation can be given for a population group, single county, or a geographical area.
As a result, a single county can have all three.
PrimaryTotal Care
State Counties HPSACO 63 43ID 44 32ND 53 41NM 33 39NV 17 32OR 36 48UT 29 24WA 39 56WY 23 18
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Community systems of care
Informal Community
Support
Self-HelpPrimary Prevention
MentoringEtc.
Crisis &Assessme
nt
Entry&
Exit
7 daysRehabilitation
Outreach
Group Homes
Day Programs Residential
7 days/weekOutreachin acute
short term
Community
Based Treatment
Services
Primary CareSpecialty Care
OutpatientCare Mgmt.
Psychosocial
Rehab
Formal
Community
Support
Acute Need for Care
Recovery
Inpatient
24 HourTotal Care
Community Rehabilitation
Services
ACTPartial Hosp.
Etc.
Formal System Natural Support & Care
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Defining mental health workforce
Mental health & Substance abuse Wide range of
Disciplines (psychiatry, psychology, social work, nursing)
Providers (psychologists, counselors, psychiatric nurses)
Professional levels (paraprofessional to graduate level)
Services (treatment, prevention)
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Findings from Annapolis Coalition Report
Workforce Crisis with Specialty Pops (e.g., children, geriatrics, substance abuse, persons of color, rural)
Dissatisfaction among Persons in Recovery and Families
Employer Dissatisfaction with the Pre-Service Education of Professionals
Delay: Science to Service Multiple Silos & Absence of Coordination Narrow Focus on Urban, White Adults Need better Data & Tools Propensity to do what is Affordable, Not What is Effective Pockets of Workforce Innovation: Difficult to Sustain or DisseminateSource: Annapolis Coalition National Strategic Plan for Behavioral Health Workforce Development
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
What we know for sure
Rural professionals shortage rates unchanged for past five decades
Many rural BH systems average 30% staff vacancy Average time to recruit psychiatrist to rural practice is 32
months; increases w/solo practice Providers w/rural CMHC training and practice more likely to
be retained in rural CMHC practice The 100-Mile Rule: The majority of healthcare providers
practice within 100 miles of where they trained Inadequate supervision a major retention factor … employees
leave supervisors not jobs
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Behavioral health workforce – grow your own strategy logic model
- P
opul
atio
n of
Foc
us +
Increase knowledge of behavioral health
Exchange knowledge about behavioral health careers
Provide accessible behavioral health training
Applied trainingopportunities
Job
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Examples from the West … Alaska leads the way
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Alaska – has it all going
Statewide TV, Radio, & Print PSA’s that educate about behavioral health issues and the worth of related jobs-professions. (New Mexico also has great mental health public ed ads).
Pipeline Initiatives focused on increasing the interest of school-age youth in behavioral health careers.
Also think about Mental Health First Aid
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
And then some …
Threshold jobs to careers Apprenticeship partnerships
(Labor) Competency workgroup Rural human service program RWJ job based learning pilot
Also check out Promotora and Community Health Worker models.
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Not finished yet
Higher education partnerships Rural human service program Articulated academic ladder Behavioral health alliance Distance delivered social work degree Behavioral health academy Doctoral program in community/clinical psychology
with rural and indigenous people focus
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
And finally …
Development of APA Accredited Internship Consortium focused on Alaska practice
Emerging psychiatric residency and child psychiatry fellowships with UW focused on Alaska.
Cross university/cross discipline faculty training in children’s system of care to promote interdisciplinary curriculum change.
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
Last but not least
State loan repayment program Housing stipend program Regional training collaboratives Statewide conference for direct care workers and front
line supervisors Statewide Addictions College Statewide behavioral health strategic plan
ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING
www.wiche.edu/mentalhealth
Dennis Mohatt Mimi McFaul Deb Kupfer Jenny Shaw Chuck McGee Tamie DeHay Maurene Flory Nicole Speer Jessica Tomasko