OSHPD WET 5-Year Plan: 2013 Needs Assessment & 2008-2013 Evaluation Initial Findings Resource...
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Transcript of OSHPD WET 5-Year Plan: 2013 Needs Assessment & 2008-2013 Evaluation Initial Findings Resource...
OSHPD WET 5-Year Plan:2013 Needs Assessment & 2008-2013 Evaluation Initial Findings
Resource Development Associates
December 13, 2013Kevin J. Wu, MPH
Linda A. Hua, PhD
2
Topics
County-Reported Assessments Educational Capacity Program Evaluation Forthcoming Q&A
3
Highlights
County-Reported Assessments
4
County-Reported Assessments:Overview
Purpose: To identify key needs in the public mental health workforce including: Users of Public Mental Health System Shortages Hard-to-Fill, Hard-to-Retain Declining Needs/Needs Met Diversity Needs Language Needs State Administered WET Program
Need/Participation Analyses by:
Statewide MHSA WET Region County Size
5
County-Reported Assessments:Data Sources
OSHPD-led 2013 County-Reported Needs Assessment
MHSA Annual Updates OSHPD-led Community Forums, Surveys,
Key Informant Interviews RDA-led County Needs Follow-Up Survey
6
County-Reported Assessments:Hard-to-Fill & 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, Hard-to-Retain
Occu
pa
tio
na
l C
ate
go
ry
7
County-Reported 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 Workforce Shortages
Occu
pa
tio
na
l C
ate
go
ry
8
County-Reported 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
Typ
e o
f D
ive
rsit
y N
ee
d
9
County-Reported 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
Pe
rce
nt
of
Cou
nti
es
County SizesSmall (<200K people)
Medium (200-800K people)
Large (>800K people)
10
County-Reported Assessments:Key Findings – Public Mental Health Users Users of the public
mental health system are predominantly located in the southern part of the state, more likely to be of a minority race/ethnicity, and more likely to be adults.
11
County-Reported Assessments:Key Findings – Public Mental Health Workforce Needs Counties’ identification of
their workforce shortages is consistent with their hard-to-fill, hard-to-retain positions.
Psychiatrists are of highest need in the public mental health system, but educational graduation information regarding psychiatrists has not been available.
The Superior Region, small counties, and medium counties identified persons with bilingual capabilities as workforce shortages and hard-to-fill, hard-to-retain positions more often than any other MHSA region or large counties.
Most counties did not identify any declining workforce needs or needs met, except for the Southern Region counties.
Of those counties that identified declining workforce needs or needs met, non-licensed mental health staff members were most frequently noted.
Workforce race/ethnicity diversity needs identified by the counties coincide with the race/ethnicity compositions of the public mental health user populations across the state’s MHSA Regions.
12
County-Reported Assessments:Key Findings – Public Mental Health Workforce Needs Workforce language
diversity needs identified by the counties are reflective of the race/ethnicity compositions of the public mental health user populations across the state’s MHSA Regions.
The Southern Region (including Los Angeles County) has a workforce that is largely meeting the language needs of its Hispanic/Latino public mental health system user population.
Counties’ designated positions for consumers and/or family members are largely reserved for peer and administrative/clerical positions, not provider/professional positions, and do not come with set wages.
13
County-Reported Assessments:Key Findings – Statewide-Administered WET Programs
Statewide-WET programs are mostly being utilized by large counties.
The WET Stipend Program’s participation across the MHSA regions reflects the state’s distribution of graduates with mental health-related degrees or certificates.
The WET Psychiatric Residency Program is underutilized compared to the counties’ desire for psychiatrists.
The WET Mental Health Loan Assumption Program (MHLAP) is utilized by most counties, especially the large ones.
The WET Physician Assistant Program is being utilized in few counties throughout the state, but is consistent with the low rate of physician assistant graduates being produced across the state.
Los Angeles County has the highest number of graduates with mental health-related degrees or certificates, but it does not participate in the WET Psychiatric and Physician Assistant Residency Stipend Programs.
14
County-Reported 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 as well
15
Highlights
Educational Capacity
16
Educational Capacity:Overview
Purpose: To identify the pipeline of future mental health providers
17
Educational Capacity: Data Sources
Integrated Postsecondary Education Data System (IPEDS)
California Postsecondary Education Commission (CPEC)
OSHPD-led Educational Institutions Survey
18
Educational Capacity:Graduates in All Mental Health Disciplines 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 GraduatesLinear (Female Graduates) Total Graduates Linear (Total Graduates)
2014
19
Educational Capacity:Distribution of Mental Health Graduates by Discipline (1999-2009)
Clinical Psychology7%
Counseling Psychology
4%Educational Psychology
0%Marriage and
Family Therapy2%
Other2%
Psychiatric Technician
2%
Psychology63%
School Psy-chology
1% Social Work 13%
Substance Abuse/Addiction Counseling
4%
198,424 total graduates
between 1999-2009
20
Educational Capacity:Distribution of Schools and Graduates
Educational Institutions Graduates
21
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
22
Highlights
Program Evaluation
23
Program Evaluation:Approach
Evaluated program impact by actions and direct outcomes: General Capacity Cultural & Linguistic Competency Formal Education Structure & 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 & RDA
interviews and county survey
24
Program Evaluation:General CapacityHardest-to-fill/retain
positions in 2008# MHLAP
Participants
Relevant State-Administered WET Programs
# Particip
antsTotal #
2009-2013Psychiatrist, General 228 Psychiatric
Residency25 253
Licensed Clinical Social Worker
884 Stipend 1,838* 2,722
Marriage and Family Therapist
1,251 Stipend 474 1,725
Licensed Supervising Clinician
0 -- 0 0
Psychiatrist, Child/Adolescent
0 Psychiatric Residency
Unknown --
Registered Nurse 0 -- 0 0CEO or Manager above Direct Supervisor
0 -- 0 0
Psychiatric or Family Nurse Practitioner
1 Stipend 92 92
Licensed Clinical Psychologist
0 Stipend 232 232
Analysts, tech support, quality assurance
0 -- 0 0
Family Member Support Staff
0 WWT Unknown Unknown
Clinical Nurse Specialist 0 -- 0 0Psychiatrist, Geriatric 0 Psychiatric
ResidencyUnknown Unknown
Consumer Support Staff 9 WWT Unknown UnknownPositions not identified as hard to fill/retain in 2008
Physician Assistant 0 Song Brown 1,382 517TOTAL SERVED: MHLAP:
2,363Stipend & Residency: 1,680
Overall: 4,043
*Includes Stipend Program for Social Work participants from beginning of program in 2005.
25
Program Evaluation:General Capacity
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 Residency for Physician’s Assistants
12 1.08 0%
Overall -- 2.32 --
Counties were asked to rate the effectiveness (impact) of each of the state-administered programs in meeting their WET needs
Scale: 1 (not at all effective) - 4 (very effective)
26
Program Evaluation:Cultural & Linguistic Competency
Baseline 2008 Progress 2013Licensed 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% --
27
Program Evaluation:Cultural & Linguistic Competency
Non-English Language
Number of public sector staff
needed in 2008
Adjusted estimate of need
Number served by statewide
WET programs
% of need potentially
met by statewide
WET programs
Spanish 6,092 12,671 1,708 13%Chinese
513 1,067109
10%Other Asian 974 20,26 283 14%Other 221 460 319 69%Total 7,800 16,224 2,419 15%
Linguistic Capacity of 2008 Workforce and WET Progress toward Targets
28
Program Evaluation:Cultural & 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%
29
Program Evaluation:Formal Education Structure & 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 PMH professional core competencies
30
Program Evaluation:People with Lived Experience
Working Well Together has developed the following: 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
Toolkit for recruiting, hiring and retaining employees with lived experience within the public mental health workforce,
White paper on how to successfully employing people with lived experience within public mental health
Peer Certification standards and recommendations for a statewide plan
31
Program Evaluation:People with Lived Experience
Working Well Together Accomplishments:
62 Networking calls and Webinars combined
Region TA Visits Trainings Participants
Central 39 6 159
Southern 40 13 343
Superior 29 7 79
Bay Area 51 8 104
Total 159 34 685
32
Insert matrix
Program Evaluation:Regional Partnerships Evaluation
32
Regional
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 X X
Greater Bay Area
X X X X X
Los Angeles
X X X
Southern
X X X X X
Superior
X X
33
Program Evaluation:Recommendations for Future Practice
Ensure that program offerings correspond to current workforce needs
Ensure that the pipeline to employment is considered so that programs can succeed in placing all graduates in the public mental health system workforce
Ensure a strategic and consistent approach to consumer and family member workforce development
34
Program Evaluation: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
35
Program Evaluation:Limitations
Baseline Data Limitations: Only 28 counties included in baseline report 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
36
Program Evaluation:Limitations
Impact Data Limitations: Voluntary participation resulted in poor
response rate Baseline survey data were only available for
28 counties Impact survey data were only available for
26 counties Only 12 counties were represented in both
baseline and impact county lists 16 counties for which no data were collected at
all
37
Program Evaluation:Strengths of the Programs
The vast majority of the work that the statewide-administered WET programs have been conducting aligns with needs identified at the beginning of the process
There are significant program components in place to build the general capacity of the workforce
Programs have been very successful in recruiting and engaging people of color and people with non-English language proficiency
Curriculum changes have been noted that demonstrate alignment with MHSA principles
Trainings, TA visits and webinars focused on increasing the participation of people with lived experience have been offered to counties in all regions
The Regional Partnerships have engaged in work specific to the needs of their regions
38 Forthcoming
39
Forthcoming Work
Workforce Projections Integrating controls to identify most important
influences in supply trends Acquiring and analyzing demand-side data to
identify trends amongst consumers of public mental health services
Gap Analysis Identify any anticipated shortages and surpluses
over the next five years Occupational type, prescribing authority, location,
demographic needs (where data is available)
40
Workforce Projections:Data Sources
Supply: Current Workforce National Provider Identification (NPI) Data California Professional Boards
Demand for Public Mental Health Services Client & Service Information (CSI)
41
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
42
Strengths of Overall Project
Reviewed extensive amount of county-reported data
Utilizing multiple data sources to inform needs assessment, evaluation, and projections
OSHPD support in prioritizing best possible data sources
43
Thank you!
Questions?