BRING & KEEP OUR KIDS HOME KATHY CRAFT DHSS, THE TRUST & UA JUNE 15, 2009

Community systems of care Informal Community Support Self-Help Primary Prevention Mentoring Etc. Crisis & Assessment Entry & Exit 7 days Rehabilitation Outreach Group Homes Day Programs Residential 7 days/week Outreach in acute short term Community Based Treatment Services Primary Care Specialty Care Outpatient Care Mgmt. Psychosocial Rehab Formal Community Support Acute Need for Care Recovery Inpatient 24 Hour Total Care Community Rehabilitation Services ACT Partial Hosp. Etc. Formal System Natural Support & Care

DEFINING THE WORKFORCE  WIDE RANGE OF  DISCIPLINES (PSYCHIATRY, PSYCHOLOGY, SOCIAL WORK, NURSING)  PROVIDERS (PSYCHOLOGISTS, COUNSELORS, PSYCHIATRIC NURSES)  PROFESSIONAL LEVELS (PARAPROFESSIONALS TO GRADUATE LEVEL)  SERVICES (TREATMENT, PREVENTION, RECOVERY)

FINDINGS FROM THE ANNAPOLIS COALITION REPORT  WORKFORCE CRISIS WITH SPECIALITY POPULATIONS (GERIATRICS, CHILDREN, RURAL, SUBSTANCE ABUSE, PERSONS OF COLOR)  DISSATISFACTION AMONG PERSONS IN RECOVERY & FAMILIES  EMPLOYER DISSATISFACTION WITH THE PRE-SERVICE EDUCATION OF PROFESSIONALS  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  DELAY: SCIENCE TO SERVICE  POCKETS OF WORKFORCE INNOVATION: DIFFICULT TO SUSTAIN & DISSEMINATE SOURCE: ANNAPOLIS COALITION NATIONAL STRATEGIC PLAN FOR BEHAVIORAL HEALTH WORKFORCE DEVLEOPMENT

National Framework – Goals Broadening the concept of workforce 1. Significantly expand the role of individuals in recovery, and their families when appropriate, to participate in, ultimately direct or accept responsibility for their own care, provide care and supports to others, and educate the workforce. 2. Expand the role and capacity of communities to effectively identify their needs and promote behavioral health and wellness.

National Framework - Goals Strengthening the workforce 3. Implement systemic recruitment and retention strategies at the federal, state, and local levels. 4. Increase the relevance, effectiveness, and accessibility of training and education. 5. Actively foster leadership development among all segments of the workforce.

National Framework - Goals Structures to support the workforce 6. Enhance the infrastructure available to support and coordinate workforce development efforts. 7. Implement a national research and evaluation agenda on behavioral health workforce development.

WHAT WE KNOW FOR SURE  RURAL PROFESSIONALS SHORTAGE RATES UNCHANGED FOR PAST FIVE DECADES  MANY PUBLIC BH SYSTEMS AVERAGE 30% STAFF VACANCY  AVERAGE TIME TO RECRUIT PSYCHIATRIST TO RURAL PRACTICE IS 32 MONTHS; INCREASES WITH SOLO PRACTICES  PROVIDERS WITH CMHC TRAINING & PRACTICE MORE LIKELY TO BE RETAINED IN CMHC PRACTICE  CHILDREN DE-SELECT CAREERS BY THE 4 TH GRADE!  INADEQUATE SUPERVISION IS A MAJOR RETENTION FACTOR…EMPLOYEES LEAVE SUPERVISORS NOT JOBS!

Behavioral health workforce – grow your own strategy logic model - Population of Focus + Increase knowledge of behavioral health Exchange knowledge about behavioral health careers Provide accessible behavioral health training Applied training opportunities Job sssss ssss sss ss s

ALASKA LEADS THE WAY AND HAS IT ALL GOING….  STATEWIDE TV, RADIO, & PRINT PSA’S THAT EDUCATE ABOUT BEHAVIORAL HEALTH ISSUES AND THE WORTH OF RELATED JOBS- PROFESSIONALS  PIPELINE INITIATIVES FOCUSED ON INCREASING THE INTEREST OF SCHOOL-AGE YOUTH IN BEHAVIORAL HEALTH CAREERS  THINK ABOUT MENTAL HEALTH FIRST AID

AND THEN SOME….  THRESHOLD JOBS TO CAREERS:  APPRENTICESHIP PARTNERSHIPS (LABOR)  COMPETENCY WORKGROUP  RURAL HUMAN SERVICE PROGRAM  ROBERT WOOD JOHNSON (RWJ) JOB BASED LEARNING PILOT

NOT FINISHED YET  HIGHER EDUCATION PARTNERSHIPS  RURAL HUMAN SERVICE PROGRAM  ARTICULATED ACADEMIC LADDER  BEHAVIORAL HEALTH ALLIANCE  DISTANCE DELIVERED SOCIAL WORK DEGREES  ALASKA RURAL BEHAVIORAL HEALTH TRAINING ACADEMY  DOCTORAL PROGRAM IN COMMUNITY/CLINICAL PSYCHOLOGY WITH RURAL & INDIGENOUS PEOPLE FOCUS

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

LAST BUT NOT LEAST  STATE LOAN REPAYMENT PROGRAM  HOUSING STIPEND PROGRAM  TRAINING COOPERATIVE & LEARNING MANAGEMENT SYSTEMS  STATEWIDE CONFERENCE  STATEWIDE BEHAVIORAL HEALTH STRATEGIC PLAN

ALASKA STATE VISION BY 2015, BENEFICIARIES OF THE ALASKA MENTAL HEALTH TRUST AUTHORITY SHALL HAVE ACCESS TO A CAPABLE, CULTURALLY COMPETENT WORKFORCE TO SUPPORT THEIR COMMUNITIES AND FAMILIES ACROSS THE LIFESPAN

ALASKA STATEWIDE INFLUENCES  ADMINISTRATIVE/EXECUTIVE ORDER 234  HEALTH CARE STRATEGIC PLANNING COUNCIL  ALASKA HEALTH CARE COMMISSION  DEPARTMENT OF LABOR & ECONOMIC DEVELOPMENT – ALASKA WORKFORCE INVESTMENT BOARD  DEPARTMENT OF EDUCATION & EARLY DEVELOPMENT  AGIA – ALASKA GAS INDUCEMENT ACT  ASHNHA – ALASKA STATE HOSPITAL & NURSING ASSOCIATION  PRIMARY CARE COUNCIL  ASHPIN – ALASKA SMALL HOSPITAL PERFORMANCE IMPROVEMENT NETWORK

SETTING THE CONTEXT – KEY POINTS  HEALTH CARE IS BIG BUSINESS  SHORTAGES ARE WIDESPREAD AND EXPENSIVE  ITINERANTS ARE A COST TO EMPLOYERS, AND A DRAIN TO OUR LOCAL ECONOMIES  COLLABORATIONS ARE HAPPENING  SOLUTIONS MUST BE RESOURCED AT EVERY LEVEL  26,500 PEOPLE (8%) OF ALASKA’S WORKFORCE ARE IN HEALTH CARE  CONTINUUM RANGES FROM OJT TO PH.D.  SHORTAGES EXIST IN ALL 119 OCCUPATIONS

SETTING THE CONTEXT – KEY  ITINERANT PROVIDERS MEAN DOLLARS LOST TO EMPLOYERS, AND RESOURCES NOT INVESTED IN LOCAL ECONOMIES  IN 2005, WE KNOW:  80 HOSPITALS/THOs/MENTAL HEALTH CENTERS SPENT OVER $11 MILLION IN RECRUITMENT, $13 MILLION IN ITINERANTS ($24 TOTAL) IN 16 OCCUPATIONS  FMH SPENT OVER $640.0 IN RECRUITMENT AND $920 IN ITINERANTS  FMH HAS SAVED AT LEAST $1.5 MILLION IN NURSE RECRUITING SINCE LOCAL TRAINING STARTED

ALASKA LARGE HEALTH PROVIDERS  PROVIDENCE HEALTH SYSTEM – ALASKA’S LARGEST EMPLOYER SINCE 2001  FIVE OF THE TOP 20 EMPLOYERS ARE HEALTHCARE;  24 OF TOP 100 EMPLOYERS ARE IN HEALTH AND SOCIAL SERVICES  HEALTH TOPPED $5 BILLION IN 2005, 1/3 THE VALUE OF NORTH SLOPE OIL EXPORTS THAT YEAR 1-3 ALASKA DOL RESEARCH & ANALYSIS 4 DATA FROM INSTITUTE FOR SOCIAL & ECONOMIC RESEARCH, UAA

UNIVERSITY OF ALASKA HEALTH PROGRAMS  MORE THAN 70 PROGRAMS STATEWIDE IN ALLIED & BH, EMERGENCY SERVICES, HEALTH MANAGEMENT, MEDICAL OFFICE, NURSING, PRIMARY CARE, PUBLIC HEALTH…  OVER 4000 STUDENTS AT ALL LEVELS (TRAININGS TO DOCTORATES) IN MORE THAN 250 LOCATIONS; ABOUT 1200 PROGRAM AND DEGREE COMPLETERS PER YEAR  FROM AY01-AY08, 68% MORE HEALTH STUDENTS AND 66% MORE COMPLETERS  USING A VARIETY OF EDUCATIONAL MODALITIES  WORKING ON MAINTAINING GAINS AS WELL AS ENHANCING HEALTH PROFESSIONAL OFFERINGS (PA,OT, PT, PHARMACY)  DEVELOPING HEALTH SCIENCES CAMPUS AT UAA, IMPROVING OTHER FACILITIES ACROSS THE STATE

2007 Vacancy Study Findings Occupation Group# Vacancies Vacancy RatesMean/Longest Vacancy/months Physicians %18 months Registered Nurses4398%2 years Behavioral Health %17 months Allied Health4347.9%11 months Dentists7110.3%19 months Pharmacists9823.7%15 months Therapists (PT, OT, ST, SLP) %2 years Other occupations994 TOTAL3529

Workforce Development Focus Area Infrastructure Workforce Development Coordinator  Steering Committee  Recruitment and Retention Subcommittee  Training and Education Subcommittee  Policy Meetings  WICHE – Western Interstate Commission on Higher Education  Credentialing and Quality Standards – with the Annapolis Coalition  Ph.D. Clinical Internship  Focus Area Evaluation

HEALTH WORKFORCE DEVELOPMENT FOCUS AREA INFRASTRUCTURE  DHSS, UA & The Trust – shared institutional position  Primary point of contact and liaison  Provide direction and guidance  Ensure successful accomplishment of project and initiative goals and interim benchmarks  Ensure proper stewardship of public dollars and accountability for investments made; and,  Assist in charting new health workforce development and career building directions

WORKFORCE DEVELOPMENT FOCUS AREA  Concentrates on increasing the volume, caliber, and geographic breadth of professionals serving Trust beneficiaries in long-term care, developmental disabilities, and behavioral health.  An initiative of this breadth requires strong partners and a stable flow of resources.

HEALTH WORKFORCE DEVELOPMENT FOCUS AREA  Recruitment and Retention  Loan Repayment  Wages & Benefits  Alaska Alliance for Direct Care Services  Cash Stipends  Psychiatric Residency  “Grow Your Own” – Area Health Education Center (AHEC)  Vacancy Study  Marketing

Workforce Development Focus Area  Training and Education  Trust Training Cooperative/Learning Management System & Geriatric Training  Alaska Rural Behavioral Health Training Academy  Children’s Mental Health  Credential & Quality Standards  Disability Justice  BTKH – Bring the Kids Home  Peer Support  Brain Injury Training  Distance MSW Program Expansion  Ph.D. Clinical Internship  UAA/UAF Human Services  Children’s Residential

THE END Kathy Craft Workforce Development Coordinator