Oklahoma Behavioral Healthcare Workforce Study Presented to the Oklahoma Governor’s Transformation Advisory Board Governor s Transformation Advisory Board December 17, 2009 This research was supported by the Mental Health Transformation State This research was supported by the Mental Health Transformation State Incentive Grant, Karen Frensley, LMFT, Project Director. Contributors include John Hornik, Ph.D., Jen Carpenter, Ph.D., Jeanine Hanna, M.A., and Nicholas Huntington M A Advocates for Human Potential Albany NY Nicholas Huntington, M.A., Advocates for Human Potential, Albany, NY and David Wright, Ph.D. & Lorrie Byrum, M.A., Oklahoma Dept. of Mental 1 Health and Substance Abuse Services, Oklahoma City, OK.
Focus of this Briefing Focus of this Briefing Behavioral healthcare provider Sources of study data: survey findings: Surveys of behavioral Staff separation and vacancy healthcare providers rates and reasons Economic Modeling Systems Inc g y Staff work satisfaction (EMSI) Training needs HRSA study of professional Behavioral healthcare staffing needs by UNC g y workforce wage rates Regents of Higher Education Staffing needs Oklahoma OPM Flow of new graduates from g higher education 2
GOALS AND METHODS GOALS AND METHODS Project Background Project Background In 2005 Oklahoma was one of seven states (now nine) to receive a five‐ year Mental Health Transformation State Incentive Grant (TSIG) from the federal Center for Mental Health Services within the Substance Abuse and Mental Health Services Administration Advocates for Human Potential, Inc (AHP) has been working under contract and in partnership with the Oklahoma Department of Mental d i hi i h h Okl h D f M l Health and Substance Abuse Services (ODMHSAS) to conduct evaluation activities related to Oklahoma’s behavioral health transformation initiative 3
Project Goals Project Goals Respond to interests of Workforce Study Team convened through Oklahoma’s behavioral health transformation initiative Develop behavioral health complement to information gathered through Oklahoma Health Care Workforce Center and Oklahoma through Oklahoma Health Care Workforce Center and Oklahoma Hospital Association surveys Provide information that can be used for provider organization and Provide information that can be used for provider organization and state agency‐level planning, advocacy 4
Survey Objectives Survey Objectives Estimate rates of recruitment, retention and turnover by position category and geographic region g y g g p g Identify causes of staff turnover and barriers to recruitment Analyze current representation of adult peers and family members in the workforce Describe linguistic and cultural competency of the workforce Describe linguistic and cultural competency of the workforce Describe capacity of state workforce to address current & future needs of clients and employers p y Describe service settings and identify (types of) professionals delivering services 5
Structure of Surveys Structure of Surveys PROGRAM STAFF MANAGER SURVEY SURVEY PROGRAM ORGANIZATIONAL ORGANIZATIONAL STAFF MANAGER SURVEY SURVEY SURVEY PROGRAM STAFF MANAGER SURVEY SURVEY 6
Survey Procedures Survey Procedures Enrollment packets mailed to organizations in industry waves Organization designee completes organizational component online, providing program manager names and email addresses; sample reports mailed as an organizational incentive reports mailed as an organizational incentive. Program managers mailed invitational emails with attachments to be distributed to staff Regular reminders—at least six attempts‐‐sent to program managers, organizational designee and/or executive director OK State agencies made additional follow‐up calls with some organizations that did not respond to AHP requests In‐person visits made to key organizations for technical assistance 7
Organization, Program Manager and Staff Participation Rates Organizations Program Managers Direct Care Staff I ndustry Wave Number of Response Number of Response Number of Response Responses Rate Responses Rate Responses Rate Mental health providers p 24 71% 106 68% 449 20% OK Psychiatric Hospitals Association 11 41% 34 80% 363 26% member organizations OK Department of Human Services 9 75% 24 92% 150 33% contractors OK Office of Juvenile Affairs contractors OK Offi f J il Aff i t t 11 11 79% 79% 13 13 87% 87% 38 38 13% 13% Substance abuse providers 38 61% 56 80% 251 40% Department of Corrections providers - - 5 100% 40 63% Other Medicaid providers 9 39% 9 82% 9 6% Federally Qualified Health Centers 3 25% 2 67% 11 100% Child Guidance Clinics - - 8 89% 38 75% Total: 105 57% 257 76% 1349 26% 8
FINDINGS* FINDINGS* “It is hard to find staff and it takes six months before It is hard to find staff and it takes six months before they are good at it. Then they leave.” ‐‐ Staff interviewee during needs assessment Staff interviewee during needs assessment *Note: The findings reported here are limited to five industry groups, ODMHSAS (MH only), OPHA, OKDHS, OJA, and DOC. 9
Plans to Leave Plans to Leave Among program managers, 94% reported that Among program managers, 94% reported that they did not intend to leave their present position within the next year. Only 79% of direct care staff reported that they y p y did not intend to leave their present position within the next year. Twenty‐one percent do expect to separate; nearly one quarter of those expect to leave the behavioral healthcare field. 10
Staff Separation Rates Staff Separation Rates The statewide separation rate is 35 percent p p Industry group separation rates range from 13 to y g p p g 59 percent Highest rate is among techs or paraprofessional staff SOURCE: program manager survey 11
Statewide Separation Rates by Industry Group Separation Rates by Industry Group 70 60 50 aration 40 Percent Sep 30 20 10 0 CMHC OPHA OJA DHS DOC I d Industry Group t G 12
Statewide Separation Rates by Position Type T Separation Rates by Position Type Separation Rates by Position Type 45% 40% 35% Separated 30% 25% Percent S 20% 15% 10% 5% % 0% Techs Masters LPNs MDs PhDs RNs Position Type 13
U.S. Bureau of Labor Statistics Standard Occupational Classification System Positions Categorized According to Six- y g g Position Structure Masters level professionals Aids/Techs Substance abuse counselors Psychiatric technicians Psychiatric technicians Behavioral disorder counselors Psychiatric aides Marriage and family therapists Social and human service assistants Mental health counselors Home health aides All other counselors Nursing aides, orderlies and attendants Child, family and school social workers Child family and school social workers Occupational therapist assistants O l h Mental health and substance abuse social Occupational therapist aides workers Medical assistants All other social workers Dietetic technicians All other community and social service specialists specialists LPNs Licensed practical and licensed vocational Psychologists nurses Clinical, counseling and school psychologists All other psychologists RNs RNs Registered nurses Psychiatrists/Other Physicians Psychiatrists Family and General Practitioners General Internists General Internists General Pediatricians All other physicians and surgeons 14
Frequently Cited Causes of Turnover Frequently Cited Causes of Turnover 15
Staff Vacancy Rates Staff Vacancy Rates The statewide vacancy rate is 12 percent The statewide vacancy rate is 12 percent Industry group vacancy rates range from 2 to 14 Industry group vacancy rates range from 2 to 14 percent The highest rate is among master’s‐level professionals. p o ess o a s 16
Statewide Vacancy Rates by Industry Group Vacancy Rates by Industry Group 16 14 14 12 Vacant 10 Percent V 8 6 4 2 0 CMHC OPHA OJA DHS DOC Industry Group y p 17
Statewide Vacancy Rates by Position Type T Vacancy Rates by Position Type 18% 16% 14% 14% 12% ent Vacant 10% 8% 8% Perce 6% 4% 2% 0% Techs Masters LPNs MDs PhDs RNs Position Type 18
Frequently Cited Barriers to Recruitment R i 19
Barriers to Recruitment Barriers to Recruitment The primary barrier to recruitment The primary barrier to recruitment of new staff is that salary rates are unattractive. 20
Comparisons of average hourly wage rates by national, regional, state rates by national regional state norms for behavioral healthcare positions positions For all position types, Oklahoma pays at a lower rates than ll kl h l h the average of states in this region. (See chart below.) The disparity between Oklahoma wage rates and national averages is even greater. i Tulsa and Oklahoma City tend to have higher wage rates than the four rural quadrants of the State. SOURCE: EMSI data from Department of Commerce 21
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