DEVELOPING AND ENHANCING THE WORKFORCE FOR CHEMICAL DEPENDENCY TREATMENT

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WORK FORCE DEVELOPMENT

• DEVELOPING AND ENHANCING THE WORKFORCE FOR
  CHEMICAL DEPENDENCY TREATMENT
• Robin Roberts
• David Jefferson

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AGENDA

• Status of the workforce
• Competencies
• Training
• Current challenges
• DASA updates
• Legislation
• Consideration for the future

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OBJECTIVES

• What skills and competencies do you need to
  prepare yourself for the future?
• How does this information affect you?

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WHAT IS WFD?

• Webster does defines
• 1 the workers engaged in a specific activity
  or enterprise ltthe factory's workforcegt
• 2 the number of workers potentially
  assignable for any purpose ltthe nation's
  workforcegt development
• 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.

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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.

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WORKFORCE DEVELOPMENT MISSION

• Pride
• Pay
• Professionalism

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WHAT ARE THE MAIN WORKFORCE ISSUES?

• Recruitment
• Retention
• Education and Training

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SHORTAGE OF CDPS ?

• 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
• CDPs account for 79 of all planned hires
• Agencies employ on average 10- 11 treatment staff
• On average, agencies have 3- 5 CDPTs for every
  10 clinicians.
• Substance abuse professionals will increase
  Nationally by 33 over the next decade, (U.S.
  Department of Labor)

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WHAT IS THE NUMBER OF CDPS 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 CDPs are needed.
  Note This does not include the 10 (256 CDPs)
  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
  CDPs positions not filled.
• The effect of Treatment Expansion further
  increases the need for CDPs given an expected 5
  to 10 increase in patients caseload each year.

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CDPS NEEDED
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AGING OUT OF THE WORKFORCE

• 70 of directors and 37 of clinicians are 50
  years old or older
• 15 of clinicians are in their 60s
• 27 of directors are 60 years old

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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

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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.

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RETENTION
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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)

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CHALLENGES AND CROSS-CUTTING ISSUES OF THE
TREATMENT WORKFORCE
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COMPETENCY OR?
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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/workforc
  eactionplan.pdf

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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

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COMPETENCY

• Education
• Standards
• Training

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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.

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COMPETENCY

• Training
• Use of evidence-based practices
• Outcome measurement
• New medications
• Addiction treatment (primary health care, allied
  health professions)

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CROSS-CUTTING ISSUES

• Stigma
• Noncompetitive compensation

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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

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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

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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)

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WFD POSITION UPDATES DASA DIRECTORS

• CDPT classification law, did not pass. DASA is
  proposing to revive the bill to include a
  separate category in DOH for CDPTs 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

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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
  (CDPTs) means a person assigned a trainee
  position by an administrator of a state of
  Washington certified chemical dependency service
  agency
• CDPTs are required to be registered as a
  counselor or have a current license issued by the
  DOH

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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!

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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 to
  https//fortress.wa.gov/doh/hpqa1/hps7/Chemical_De
  pendency/default.htm for a Chemical Dependency
  Professional License Application Packet or
  contact the Department of Health (D.O.H.) at
  (360) 2364700
• 1. Register with the D.O.H. as a registered
  counselor/CDPT. Call the D.O.H. Application
  Packet Line at [phone] 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.

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Proposed CDPT Legislation

• Submitted by Chemical Dependency Professionals
  SubgroupChemical Dependency Professional
  TraineesJuly 2006 to the Governors 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 RCCDP 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.

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KEY THEMES
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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.

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THE FUTURE
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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

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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/trainin
  g/training.shtml