WET Five-Year Plan: Evaluation of First WET Five Year Plan, Stakeholder Engagement, County Needs Assessment, and Literature Review Interim Findings Resource.

WET Five-Year Plan:Evaluation of First WET Five Year Plan, Stakeholder Engagement, County Needs Assessment, and Literature ReviewInterim Findings

Resource Development Associates

January 17, 2014Amalia Freedman

Kevin J. Wu, MPH

2

Topics

State-Administered WET Program Evaluation, 2008-2013

OSHPD-led Stakeholder Engagement County-Reported Needs Assessments Literature Review: Public Mental Health

Workforce Demand and Supply Public Mental Health Workforce Supply

Projections, 2014-2019 Literature Review: Educational Capacity Literature Review: Public Mental Health

Graduation to Workforce Participation

3

Highlights


4

State-Administered WET Program Evaluation, 2008-2013:Approach

Evaluated program impact by actions and direct outcomes: General capacity Cultural and linguistic competency Formal education structure and 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 and RDA

interviews and county survey

5

State-Administered WET Program Evaluation, 2008-2013:

Limitations

2008 Baseline data limitations: Only 28 counties submitted data for the baseline report

(2008) 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

6


Limitations

Impact data limitations: 2013 County follow-up survey that identified

perceived impact of state-administered WET programs was voluntary and resulted in low response rate of 26 counties compared to the first county needs survey that had 41 responses

2008 Baseline survey data were only available for 28 counties

Only 12 counties were represented in both baseline (2008) and county survey (2013) county lists 16 counties for which no data were collected at all

7


Stipend Programs: increased the number of licensed mental health professionals in the Public Mental Health System (PMHS) via contracts with educational institutions to provide stipends to students and incorporates MHSA principles into graduate level curriculum. Graduate degrees disciplines receiving stipends include Master of Social Work, Marriage and Family Therapist, Clinical Psychology, and Psychiatric Mental Health Nurse Practitioner

*Song-Brown Program for Physician Assistants in Mental Health: funded Physician Assistants (PA) programs that add a mental health track so that PAs can sign mental health treatment plans, transmit orders for psychotropic medications on behalf of supervising psychiatrist, and prescribe and administer psychotropic medications

Psychiatric Residency Program: Funded Psychiatric Residency Programs to trains psychiatric residents in the PMHS, working with the populations prioritized by that community

*Mental Health Loan Assumption Program (MHLAP): offered loan repayment of up to $10,000 to mental health providers in hard-to-fill and/or hard-to-retain positions in the PMHS in exchange for a 12-month service obligation

Client and Family Member Statewide Technical Assistance Center: Funded Working Well Together (WWT) to engage in activities that promote the employment of mental health clients and family members in the public mental health system

Regional Partnerships: represents Bay Area counties, Central Valley counties, Southern counties, Los Angeles County, and Superior Region counties; includes representation from mental health, community agencies, educational/training entities, consumers, family members, and other partners to plan and implement programs that build and improve local workforce education and training strategies

*Shortage Designation: reviews and recommends Primary Care, Dental, and Mental Health Professional Shortage Area (HPSA) and Medically Underserved Area/Medically Underserved Population (MUA/MUP) applications to HRSA’s Shortage Designation Branch

* = Administered by OSHPD prior to July 1, 2012 transfer

8


Key Findings

The vast majority of the statewide-administered WET programs align with needs identified at the beginning of the 2008 planning process. MHLAP, MFT stipend, MSW stipend programs

rated as effective in filling service needs with MHLAP being rated as most effective with an average rating of 3.42*

Physician Assistant MH program was not an identified need, rated as least effective

* Rating was on a scale of 1 (not at all effective) – 4 (very effective)

9


Key Findings (continued)

Programs successfully recruited and engaged people of color and people with non-English language proficiency Sixty-six percent (66%) of MHLAP

participants reflected underrepresented populations in PMHS

Regional Partnerships collaborated with local colleges, strived to provide cultural/linguistic competency preparation for upcoming workforce

10



Curriculum changes have been noted that demonstrate alignment with MHSA principles Universities expanded cultural competency training,

knowledge of evidence-based practices, recovery principles into teaching approaches

Regional Partnerships worked with local institutions to advance curricula corresponding to workforce needs within PMHS workforce

11



WWT trainings, TA visits and webinars focused on increasing the participation of people with lived experience have been offered to counties in all regions Created tools, and reports including a report on peer

certification for use by professionals working in public mental health system

Developed training curricula, offered trainings to support the recruitment, employment, and integration of consumers and family members in workforce

Provided individualized TA to counties geared toward increasing representation of consumers and family members in their workforce

12

State-Administered WET Program Evaluation, 2008-2013:Stipend Programs

Stipend Awardees 2008/09 - 2012/13

Discipline Individuals Awarded

Awardees of Under-

Represented Backgrounds

Awardees that Speak a Language

in Addition to English

Social Workers

1486 59% 50%

Marriage and Family

Therapists367 73% 65%

Psychiatric Nurse

Practitioners63 46% 59%

Clinical Psychologist

283 58% 52%

Total 2205 61% 53%

Funding is awarded to educational institutions to provide Stipends for graduate students in Social Work, Marriage and Family Therapy, Clinical Psychology, and Psychiatric Mental Health Nurse Practitioner who commit to working in the public mental health system for a 12-month period upon graduation A total of 21 California schools participate by providing stipends and

developing curricula that promotes the MHSA values of wellness, recovery and resilience

Source: OSHPD

Source: OSHPD

13

State-Administered WET Program Evaluation, 2008-2013:Song-Brown Program for Physician Assistants in Mental Health

Physician Assistant (PA) programs are evaluated, in part, on whether they can demonstrate: Community collaboration: Cultural competence What client and family-driven services are Wellness, recovery, and resiliency Ability to provide an integrated service experience for clients and their families

One of the goals is to ensure that PA students perform their rotations in rural and underserved communities including the public mental health workforce

From FY 2008-09 to FY 2012-13, grants of $15,000 to $167,000 were awarded to six PA programs and have enabled 1,382 PA students to be trained in MHSA principles and perform 6,046 hours of mental health rotations

The following six programs revised their PA program curricula to include the values and principles of the Mental Health Services Act: Keck School of Medicine-USC; Moreno Valley College; Samuel Merritt University; San Joaquin Valley College; Touro University; University of California, Davis

The above PA programs partnered with the following County Departments of Health and Mental Health to ensure that PA students provide integrated care: Fresno County Department of Behavioral Health; Fresno County Health Department; Riverside County Department of Mental Health; Sacramento County Department of Behavioral Health Services; Stanislaus County Health Services Agency

14

State-Administered WET Program Evaluation, 2008-2013:Psychiatric Residency Program

The psychiatric residency programs ensured that the psychiatric residents receive training in the County public mental health system, working with the populations prioritized by that community. Further, the psychiatric residents are encouraged to continue working in the California public mental health system after their rotations end

From FY 2008/09 to FY 2012/13, there were two psychiatric programs that supported 25 psychiatric residency rotations at the University of California, Davis and the University of California, Los Angeles-Kern

The Psychiatric Residency programs revised the curricula to include the values and principles of the MHSA: Community collaboration Cultural competence Client/Family-driven mental health system Wellness/Recovery and Resilience focus and Integrated service experience for clients and their families.

The Psychiatric Residency programs partnered with County Departments of Mental Health and Community-Based Organizations to ensure that residents perform their rotations in the County Public Mental Health System. Among them: Sacramento County Mental Health Services; Kern County Mental Health Services; UC Davis Medical Center; and West Kern Clinic (Wasco)

Source: OSHPD

15

State-Administered WET Program Evaluation, 2008-2013:Mental Health Loan Assumption Program (MHLAP)

Provides those working or volunteering in hard-to-fill/hard-to-retain positions in the public mental health system with up to $10,000 in educational loan repayments in exchange for service in the community public mental health system

From Fiscal Year 2008-09 to 2012-13 :

2,373 public mental health workers have completed the loan repayment program

56% of awardees spoke at least one language in addition to English

55% of awardees had a consumer/family member background

MHLAP Applications FY 2008-09 to FY 2012-13 Fiscal Year

Applications Received

Individuals Awarded

Funds Requested

Educational Debt

Funds AwardedCounties

SupportedFY

2008-09

1,236 288 $15,454,813 $60,729,395 $2,285,277 44

FY 2009-

101,498 309 $12,683,961 $80,331,133 $2,469,239 52

FY 2010-

111,009 474 $10,030,983 $71,177,144 $4,523,757 50

FY 2011-

121,659 661 $16,581,901 $111,533,342 $5,365,680 55

FY 2012-

131,823 1,109 $17,968,953 $122,828,475 $9,383,649 53

Total 7,225 2,841 $72,720,611 $446,599,489 $24,027,602 58

Source: OSHPD

16

State-Administered WET Program Evaluation, 2008-2013:Client and Family Member Statewide Technical Assistance Center

Working Well Together has developed the following resources: 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

A toolkit for recruiting, hiring and retaining employees with lived experience within the public mental health workforce

A white paper on how to successfully employ people with lived experience within the public mental health workforce

Peer certification standards and recommendations for a statewide plan

Working Well Together has completed 159 Technical Assistance visits, 34 training, which engaged a total of 3,677 participants

17

State-Administered WET Program Evaluation, 2008-2013:Regional Partnerships

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

Greater Bay Area

X X X X X

Los Angeles

X X X

Southern

X X X X X

Superior

X X X

18

State-Administered WET Program Evaluation, 2008-2013:Shortage Designation

As of November 2013 there are 153 designated Mental Health Professional Shortage Area (MHPSA)

4,382,209 residents live in a designated MHPSA

102 MHPSA applications have been approved by HRSA since 2009

MHSPA Application Type

MHPSA Applications Processed Since 2009

Reactive 86

Proactive 36

Source: OSHPD

19

State-Administered WET Program Evaluation, 2008-2013:Number of Mental Health Professionals Impacted by State WET Programs

Hard-to-fill/retain positions identified in 2008 MHLAP Stipend

Psychiatric Residency

Song-Brown PA Total Participants

Psychiatrist, General 230 -- -- -- 230Licensed Clinical Social Worker 255 1,838* -- -- 2,093*Marriage and Family Therapist 1259 474 -- -- 1,733Licensed Supervising Clinician 0 -- -- -- 0Psychiatrist, Child/Adolescent -- -- 10 -- 10Psychiatrist, Interdisciplinary Medicine Specialty

-- -- 15 -- 15

Registered Nurse 12 -- -- -- 12CEO or Manager above Direct Supervisor

3 -- -- -- 3

Psychiatric or Family Nurse Practitioner

8 92 -- -- 100

Licensed Clinical Psychologist 23 283 -- -- 306Analysts, tech support, quality assurance

0 -- -- -- 0

Family Member Support Staff 0 -- -- -- UnknownClinical Nurse Specialist 1 -- -- -- 1Psychiatrist, Geriatric -- -- -- -- UnknownConsumer Support Staff 4 -- -- -- 4(Unknown)

Positions not identified as hard to fill/retain in 2008Physician Assistant 0 -- -- 1,382 1,382Licensed Professional Clinical Counselor

14 14

Bachelors Social Worker 46 46Associate Clinical Social Worker 629 629Other 235 235TOTAL SERVED: 2,719 2,687 25 1,382 6,813

*Includes Stipend Program for Social Work participants from beginning of program in 2005.

20

State-Administered WET Program Evaluation, 2008-

2013: Program Effectiveness

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 Program for Physician Assistants

12 1.08 0%

Overall -- 2.32 --

Counties were asked to rate the effectiveness (impact) of each of the state-administered programs in placing or retaining personnel in hard-to-fill/retain positions

Scale: 1 (not at all effective) - 4 (very effective)* The survey did not include Regional Partnerships and WWT for this specific question.

21


Cultural and Linguistic Competency

Baseline 2008 Progress 2013Licens

ed 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%

Total12,955

100%

-- 30,896 100% --

22



Non-English Language

Number of public sector staff

needed in 2008

Adjusted estimate of need

Number served by all

state-administere

d WET programs 2008-2013

% of need potentially met by all

state-administer

ed WET programs 2008-2013

Spanish 6,092 12,671 1,708 13%Chinese

513 1,067109

10%Other Asian 974 2,026 283 14%Other 221 460 319 69%Total 7,800 16,224 2,419 15%

Linguistic Capacity of 2008 Workforce and WET Progress toward Targets across All State-

Administered Programs

23



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%

24


Formal Education Structure and 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 public mental health professional core competencies

25

Working Well Together: Working Well Together has completed 159 Technical Assistance

visits, 34 training, which engaged a total of 3,677 participants MHLAP

Provided loan repayment to 4 designated consumer and family member positions

55% of awardees had a consumer/family member background Regional Partnerships

Two regional partnerships have engaged in stigma reduction activities.

Stipend In FY 12/13 40% of MFT and Psych NP, and 26 % of Clinical

Psychologist stipend recipients had a consumer and family member background


People with Lived Experience25

* Combines Southern/LA Region.

26 Working Well Together:

Stipend: full time equivalent recipients employed from 2007-2011

MHLAP Supported 58 out of 60 counties/municipalities


Meeting Regional Needs26

Region TA Visits Trainings Participants

Central 39 6 1030Southern/ Los Angeles*

40 13 1579

Superior 29 7 576Bay Area 51 8 492Total 159 34 3,677

* Combines Southern/LA Region.

Profession Superior Bay Area Central Los Angeles

Southern

Clinical Psych

0 43 1 34 8

MFT 13 43 14 42 42

Psych NP 3 32 9 7 5

Social Work 74 307 209 365 303

Total 90 425 233 448 358

27


Meeting Regional Needs

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

Greater Bay Area

X X X X X

Los Angeles

X X X

Southern

X X X X X

Superior

X X X

28


Recommendations for Future Practice

Ensure that programs correspond to current workforce needs

Ensure that the pathway to employment is considered so that programs can succeed in placing all graduates in the public mental health system workforce

Ensure a strategic approach to consumer and family member workforce development

29


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

30

Highlights

OSHPD-led Stakeholder Engagement

31

OSHPD-led Stakeholder Engagement: Overview

Purpose: To obtain stakeholder feedback on priority issues, challenges, and recommendations, including: Public mental health workforce personnel needs Training and education Recruitment and retention Employing consumers and family members WET programs and partnerships

32

OSHPD-led Stakeholder Engagement:

Data SourcesOSPHD led data collection efforts across multiple sources including:

Stakeholder Engagement Strategy

Number of Activities/Participants

Community Forums 14 Forums throughout the State with over 600 Participants

Focus Groups 13 Focus Groups

Key-Informant Interviews

13 Interviews

Online Survey 325 Responses

33

OSHPD-led Stakeholder Engagement:Key Findings

Recommendations for increasing and sustaining the public mental health workforce: Expand programs including:

financial incentive programs and training and education programs

Strengthen opportunities for Consumer and/or Family Members by: Providing support for consumers Increasing training opportunities Providing a peer certification program

OSHPD-led Stakeholder Engagement:Most Referenced Public Mental Health Workforce Personnel Needs

34

Mental Health Profession

Community Forum

Focus Group

Key Informant Interview

Survey Total

Psychiatrists 11 5 3 19 38Consumer peer positions 14 2 1 20 37Marriage and Family Therapist (MFT) 6 2 0 28 36

Psychiatric Mental Health Nurse Practitioner 11 5 1 13 30

Alcohol and Other Drug Abuse Counselors 7 0 0 23 30Licensed Clinical Social Workers 5 0 0 24 29

Question to Stakeholders: Based on your knowledge and experience, what type of workforce will be needed to address the public mental health workforce needs in your county or region?

35


Training and Education

Key ChallengeCommunity

Forum Focus Group


Survey Total

Lack of training and education programs 9 4 1 30 44Lack of integration/collaboration 7 6 2 6 21

Lack of supervision 10 2 1 3 16

Key RecommendationCommunity

Forum Focus Group


Survey Total

Expand training and education programs 12 3 7 1 26Develop clear career pathway/ladder 13 3 2 3 21Promote training on integration 8 6 3 0 17

What actions would you recommend to overcome those challenges?

What are the challenges to increasing and sustaining the public mental health workforce in your region? (Training and Education)

36


Recruitment and Retention


Forum Focus Group


Survey Total

Low Wages 11 6 1 19 37Stigma 8 5 3 10 26Burnout 10 2 1 11 24Lack of job opportunities /growth potential 8 4 1 10 23

Key Recommendation Community

Forum Focus Group


Survey Total

More financial incentives 9 2 6 4 21Conduct career awareness/recruitment efforts 12 5 3 0 20

Increase stipends 8 4 0 1 13Increase reimbursement 10 1 1 0 12

What are the challenges and recommendations to increasing and sustaining the public mental health workforce in your region? (Recruitment and Retention)

37


Employing Consumers and Family Members


Forum Focus Group Survey Total

Stigma 12 6 18 36

Lack of formal training or education 8 2 10 20

Lack of Employment Opportunities 11 3 5 19

Not enough support and accommodations for consumers 4 4 3 11

Do you feel an adequate number of mental health consumers and family members are being employed in the public mental health system? If not, why?

38


Employing Consumers and Family Members

What actions would you recommend to overcome those challenges (regarding consumer and family member employment)?

Key Recommendation Community

Forum Focus Group Total

More support for consumers 11 4 15More training for consumers 10 3 13

Peer Certification 8 2 10Train staff in consumer movement 5 2 9Have consumers be part of training and be involved in curriculum development 5 2 7Education/Training public to reduce stigma 5 2 7

39


WET Models and Partnerships

Models and Partnerships

Community Forum

Focus Group

Key Informant Interview Total

Mental Health First Aid 5 1 6 12NAMI 4 2 6 12WET Regional Partnership 5 1 6 12WRAP Program 5 0 5 10High School Pathways 3 1 4 8Stipends (CalSWEC) 4 0 4 8

What successful workforce education and training models and partnerships exist within your county or region that address the workforce challenges and you think could be used as a best practice?

40

Highlights

County-Reported Needs Assessments

41

County-Reported Needs Assessments:Overview

Purpose: To identify key needs in the public mental health workforce including: Users of Public Mental Health System Shortages and Hard-to-Fill, Hard-to-Retain

Positions Declining Needs/Needs Met Diversity and Language Needs State Administered WET Program

Need/Participation Data analysis presented according to:

Statewide MHSA WET region County size

42

County-Reported Needs Assessments:Data Sources

OSHPD-led 2013 County-Reported Needs Assessment

OSHPD/RDA-led County-Reported Needs Follow-Up Survey

43

County-Reported Needs 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

County Reported Needs Follow-up Survey received responses from 26 counties.

44

County-Reported Needs Assessments:Key Findings – Public Mental Health UsersPublic mental health system users are: Predominantly located in the southern part of

the state More likely to be of a minority race/ethnicity More likely to be adults

45

County-Reported Needs Assessments:Key Findings – Public Mental Health Workforce Needs County-reported

workforce shortages align to hard-to-fill, hard-to-retain positions

Psychiatrists are consistently reported as the highest need position Reliable graduation

information is not available

The Superior Region, small counties, and medium counties consistently identified professionals with bilingual capabilities as a workforce need

Only the Southern Region counties identified any declining workforce needs These counties reported

sufficient access to non-licensed mental health staff

Identified workforce race/ethnic diversity needs align with the composition of the public mental health user population This is true across MHSA

Regions

46

County-Reported Needs Assessments:Key Findings – Public Mental Health Workforce Needs Identified workforce

language diversity needs reflect the race/ethnic composition of the public mental health user population This is true across MHSA

Regions The Southern Region

(including Los Angeles Co.) workforce is largely meeting the language needs of its Hispanic/Latino population

Counties’ designated positions for consumers and/or family members typically: Are largely reserved for

peer and administrative/clerical positions

Are not typically provider/professional positions

Are not full-time positions with set wages

47

County-Reported Needs Assessments:Key Findings – Statewide-Administered WET Programs

Large counties are the primary users of statewide-WET programs

WET Stipend Program participation reflects the distribution of graduates with mental health-related degrees or certificates This is true across MHSA

regions WET Psychiatric Residency

Program utilization underperforms county-reported need

The WET Mental Health Loan Assumption Program (MHLAP) is utilized by most counties, especially large counties

The WET Physician Assistant Program is utilized in few counties Usage is consistent with

low physician assistant graduate rates

Los Angeles County has the highest number of graduates with mental health-related degrees or certificates

Los Angeles County does not participate in the WET Psychiatric and Physician Assistant Residency Stipend Programs

48

County-Reported Needs Assessments:Hard-to-Fill and 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 and Hard-to-Retain Positions

Occu

pa

tio

na

l C

ate

go

ry

49

County-Reported Needs Assessments:Workforce Shortages

Substance Abuse Counselor





Psychiatrist

0 5 10 15 20 25 30 35 40 45 50

13

4

17

24

23

17

11

2

4

30


Count of Reported Workforce Shortages

Occu

pa

tio

na

l C

ate

go

ry

50

County-Reported Needs Assessments:Workforce Shortages- Superior Region

Case Manager/Service Coordinator

Other Non-Licensed Mental Health Staff




Psychiatrist

0 1 2 3 4 5 6 7 8 9

3

3

4

5

5

4

1

1

4



Occu

pa

tio

na

l C

ate

go

ry

51

County-Reported Needs Assessments:Workforce Shortages- Bay Area Region





Psychiatrist

0 2 4 6 8 10 12 14

3

3

1

8

4

1

5

8



Occu

pa

tio

na

l C

ate

go

ry

52

County-Reported Needs Assessments:Workforce Shortages- Central Region







Psychiatrist

0 2 4 6 8 10 12 14 16 18

5

2

5

7

12

12

6

3

1

11


Number of Counties

Occu

pa

tio

na

l C

ate

go

ry

53

County-Reported Needs Assessments:Workforce Shortages- LA Region

Los Angeles County/Region Workforce Shortages

(In Order of Rank)

Psychiatrist (Child, Geriatric, Addiction)

Clinical Supervisor

Licensed Clinical Social Worker/Marriage and Family Therapist/

Community Mental Health Psychologist

Nurse, OtherDesignated Consumer/Family Member,

Advocacy

54

County-Reported Needs Assessments:Workforce Shortages- Southern Region


Nurse, Other



Psychologist

Psychiatrist

0 2 4 6 8 10 12

1

6

3

4

4

5

5

4


Number of Counties

Occu

pa

tio

na

l C

ate

go

ry

55

County-Reported Needs 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


Count of Reported Diversity Needs

Typ

e o

f D

ive

rsit

y N

ee

d

56

County-Reported Needs 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

Size BreakdownSmall (<200K people)

Medium (200-800K people)

Large (>800K people)

57

County Reported Needs Assessments Follow-up SurveyKey Findings

The state’s top hardest-to-fill or hardest-to-retain positions are: Psychiatrist Licensed Clinical Social

Worker Marriage and Family

Therapist The primary reported

reason staff vacated hard-to-fill or hard-to-retain positions is pay

Staff most frequently left for private mental health agencies

The top strategy employed to manage staff vacancies is reassigning duties to existing staff in similar/same positions

Labor substitution for hard-to-fill or hard-to-retain positions is challenging due to the specialized nature of the positions. Psychiatric NP were identified as preferred labor substitute for Psychiatrist.

Counties used a diverse range of strategies to recruit, orient, and train consumers and family members for county positions

58

County Reported Needs Assessments Follow-up SurveyReasons Positions Vacated across California

Workload

Unknown

Poor organizational fit

Pay

Location

Involuntary termination

Burnout

0 2 4 6 8 10 12 14 16 1810

2

6

9

3

7

16

6

10

6

1

3

5

Count of Responses

Reason

s P

osit

ion

s V

acate

d

59

County Reported Needs Assessments Follow-up Survey

Statewide Departure Agencies

Unknown

Private Mental Health Agency

Other Public Mental Health Agency

Other

Non-Mental Health Related Organization

Medical Facility

Education

Correctional Facility

0 2 4 6 8 10 12 14 16

6

14

15

8

5

11

5

11

Count of Responses

Typ

e o

f D

ep

art

ure

Ag

en

cy

60

County Reported Needs Assessments Follow-up SurveyStatewide Staff Vacancy Management

Unknown

Triage consumers

Temporary or locum tenens staffing

Reassign duties to existing staff in similar/same position

Reassign duties to existing staff in different positions

Other

Longer wait times

0 5 10 15 20 25

0

10

17

20

11

2

15

Count of Responses

Sta

ff V

aca

ncy

Man

ag

em

en

t S

trate

gy

61

County Reported Needs Assessments Follow-up SurveyLarge County Size Staff Vacancy Management

Unknown

Triage consumers

Temporary or locum tenens staffing

Reassign duties to existing staff in similar/same position

Reassign duties to existing staff in different positions

Other

Longer wait times

0 1 2 3 4 5 6 7 8

0

3

6

6

4

0

7

Count of Responses

Sta

ff V

aca

ncy

Man

ag

em

en

t S

trate

gy

62

County Reported Needs Assessments Follow-up SurveyPsychiatrist Substitutes

Position Count of Responses

% of Total Responses

Other 10 33%Psychiatric Mental Health Nurse Practitioner

9 30%


2 7%

Nurse Practitioner 2 7%Physician Assistant 2 7%Child/Adolescent Psychiatrist

1 3%

Clinical Nurse Specialist 1 3%Licensed Professional Clinical Counselor

1 3%


1 3%

Medical Doctor (not a Psychiatrist)

1 3%

Total 30 100%

63

County Reported Needs Assessments Follow-up SurveyStatewide Recruitment, Orientation, and Training Strategies

Volunteer opportunities on advocacy and other boards

Vocational training program for mental health positions

Staff mentor program

Requirement for contracted agencies to have dedicated peer positions

Priority/Preference given to applicants with lived experience

Peer/Consumer internship program

Partnership with community college for peer/consumer training

Other

Meeting or job accomodations

Dedicated county peer positions

Contract(s) with peer run/led organizations

Anti-stigma training for all staff

0 2 4 6 8 10 12 14 16 18

17

8

6

9

11

7

7

5

11

13

15

16

Count of Responses

Recr

uit

men

t, O

rien

tati

on

, an

d

Tra

inin

g S

trate

gy

64

Highlights

Literature Review: Public Mental Health Workforce Demand and Supply

65

Literature Review Components Demand

Affordable Care Act Workforce Trends Prevalence Rates

Supply Workforce Trends

66

Literature Review: Impact of the Affordable Care Act

Medi-Cal recipients accessing public mental health services In FY 2011-12, nearly 3 million children

covered by Medi-Cal received specialty mental health services

Count is expected to rise to approximately 3.8 million children in FY 2012-13 and 4.1 million in FY 2013-14

Department of Health Care Services. Medi-Cal Specialty Mental Health Services May Revision Estimate. May 2013. Available from:http://www.dhcs.ca.gov/services/MH/Documents/DHCS-SMHS_May_2013_Estimate_Supplement.pdf

67

Literature Review:Impact of the Affordable Care Act

Impact of Medicaid Coverage Expansion (MCE) Beginning January 1, 2014, individuals and families with

household incomes up to 138% of the FPL will be eligible for Medi-Cal regardless of health status, age, gender, or parental status

An estimated 1.4 million Californians under age 65 will become newly eligible for Medi-Cal

In total, there is an expected enrollment increase of between 830,000 and 1.2 million individuals by 2019

Among the newly covered, studies anticipate a higher prevalence of serious mental illness and, therefore, a greater demand for public mental health services. Estimates range from 17% to 25% prevalence of serious mental illness amongst the MCE group Jacobs, K, and D. Graham-Squire, G. Kominski, D. Roby, N. Pourat, C. Kinane, G. Watson, D. Gans, and J. Needleman. Predicted

Increase in Medi-Cal Enrollment Under the Affordable Care Act: Regional and County Estimates. UC Berkeley Labor Center. June 2012. Available from: http://laborcenter.berkeley.edu/healthcare/aca_fs_medi_cal.pdf Bazelon Center for Mental Health Law. Medicaid Lifeline for Children and Adults with Serious Mental Illness. Available from: http://www.bazelon.org/LinkClick.aspx?fileticket=ARq331Ujs3Q%3D&tabid=40

http://laborcenter.berkeley.edu/healthcare/aca_fs_medi_cal.pdf

http://www.bazelon.org/LinkClick.aspx?fileticket=ARq331Ujs3Q=&tabid=40

68

Literature Review: Skills Mix / Examining Provider Ratios

Skills mix is a broad term and can refer to a wide range of relationships: the skills needed to fulfill consumer needs, the skills currently available, the skills required by each type of provider, etc.

The concept of skills mixes can be used to categorize the demand for services, rather than considering specific professions individually Example: Nurse practitioners and physician

assistants may be able to offload some of the responsibilities of psychiatrists. Incorporating NPs and PAs increases the total capacity of licensed, prescribing providers

69

Literature Review: Years Required for Education, Licensing, and Training for Mental Health Occupations (1)

Occupational Category Minimum Years to

Completion

Training and Education Required for Service Provision

Benefits/Eligibility Specialist N/A N/ACase Manager/Service Coordinator

N/A N/A

Clinical Nurse Specialist 2 years 2 year Master’s Degree Program, Exam

Clinical Psychologist 5 years 4 year Doctorate Degree, 1 year Post-doctoral Training, Exam

Designated Consumer/Family Member

N/A N/A

Employment Service Staff N/A N/AHousing Support Services Staff

N/A N/A

Licensed Clinical Psychologist

5 years 4 year Doctorate Degree, 1 year Post-doctoral Training, Exam


4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam

Licensed Professional Clinical Counselors

4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam

Licensed Psychiatric Technician

1 year 12 months, Exam

70

Literature Review: Years Required for Education, Licensing, and Training for Mental Health Occupations (2)

Occupational Category Minimum Years to

Completion

Training and Education Required for Service Provision

Marriage and Family Therapist 4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam

Mental Health Rehabilitation Specialist

N/A N/A

Nurse, Other *Occupational Therapist 2 years 2 year Master’s Degree Program, ExamOther Non-Licensed Mental Health Staff

N/A N/A

Physician Assistant N/A 2 year Master’s Degree Program, ExamPromotora N/A N/APsychiatric Mental Health Nurse Practitioner

2 years 2 year Master’s Degree Program, Exam

Psychiatrist 8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams

Psychiatrist, Child/Adolescent 8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams

Psychiatrist, Geriatric 8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams

Psychologist 5 years 4 year Doctorate Degree, 1 year Post-doctoral Training, Exam

School Psychologist 2 years 2 Year Master’s Degree ProgramSubstance Abuse Counselor **

71

Literature Review: SMI PrevalenceKey Findings

Of California’s total population, 5.13% of individuals are estimated to have a SMI; amongst households below 200% of the federal poverty level, this rate increases to 8.11% of individuals

Across the state, youth are 75.8% more likely to have a SMI than adults; amongst households below 200% of the federal poverty level, youth are 15.7% more likely to have a SMI than adults

Adults residing in small counties are more likely to have a SMI

Amongst California’s youth, those residing in the Bay Area region have the lowest estimated SMI prevalence rates, whereas those residing in the Central and Los Angeles regions have the highest estimated SMI prevalence rates

Asian and Pacific Islander adults are the least likely to have a SMI, whereas African American, Native Hawaiian, and Multi-racial adults are the most likely to have a SMI

As adults grow in age from 18 to 44, their estimated SMI prevalence rates continually increase; the same rates gradually decrease from age 45 and on

http://www.dhcs.ca.gov/provgovpart/Documents/California%20Prevalence%20Estimates%20-%20Introduction.pdf

72

Literature Review:Estimated SMI Prevalence by MHSA Region

Bay Area Central Los Angeles Southern Superior0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

4.33%

5.64%5.34% 5.18%

5.87%

3.5%

4.8%4.5% 4.3%

5.3%

7.0%7.8% 7.8% 7.5% 7.8%

Total Adult Youth

MHSA Region

Esti

mate

d P

erc

en

t o

f P

op

ula

tio

n

wit

h S

MI


73

Literature Review: Estimated SMI Prevalence by County Size – Households Below 200% FPL

Small Medium Large6.5%

7.0%

7.5%

8.0%

8.5%

9.0%

9.5%

8.55%

8.19%8.06%

8.39%

7.83%7.62%

8.89% 8.89% 8.91%

Total Adult Youth

County Size

Esti

mate

d P

erc

en

t o

f P

op

ula

tio

n

wit

h S

MI


74

Literature Review: California Statewide Estimated SMI Prevalence for Youth by Race/Ethnicity

White

(n=2,

789,

423)

Asian

(n=96

5,71

5)

Multi

(n=32

7,35

0)

Pacifi

c Isl

ande

r

(n=32

,275

)

Native

Am

erica

n

(n=43

,426

)

Africa

n Am

erica

n

(n=55

5,19

8)

Hispan

ic

(4,7

37,4

04)

6.2%6.4%6.6%6.8%7.0%7.2%7.4%7.6%7.8%8.0%8.2%

6.9%

7.2%7.3%

7.7%

8.0% 8.0% 8.0%

Race/Ethnicity

Esti

mate

d P

erc

en

t o

f P

op

ula

tio

n

wit

h S

MI

California Employment Development Department (2012). Employment Projections, 2006-2016.

75

Literature Review:Employment, Projected Growth, and Mean Wages for Selected Professions in California’s Mental Health Workforce

Profession Mean Hourly and Annual Wages

Current Employment 2007

Percentage Growth (%) 2006- 2016

Ratio per 100,000

Population Mental Health and Substance Abuse Social Workers

$19.44/41,470

14,010 22.8 38.4

Clinical, Counseling, and School Psychologists

$36.67/78,213

12,560 20.1 34.5

Psychiatric Technicians

$19.89/42,434

10,390 15.1 28.5

Mental Health Counselors

$21.89/46,700

9,360 20.5 25.7

Substance Abuse and Behavioral Disorder Counselors

$16.96/36,189

8,300 35.4 22.8

Rehabilitation Counselors

$20.02/42,711

7,620 13.0 20.9

Marriage and Family Therapists

$20.50/43,716

6,130 21.9 16.8

Psychiatrists $72.92/NA 2,480 16.4 6.8

76

Literature Review: Distribution of Selected Licensed Mental Health Professionals in California by Region: 2008California Region

Licensed Clinical Social

Workers

MFT Psychologists

Psych Tech

Public Mental Health Nurses

Psychiatrist Total Regional Percentag

e

Bay Area 4,517 8,501 4,454 1,916 129 2,103 21,620

29.8

North Valley/Sierra

1,185 1,600 690 330 10 360 4,175 5.8

Central Valley/Sierra

279 490 167 323 3 93 1,355 1.9

Inland Empire 908 1,476 579 2,043 20 327 5,353 7.4 Orange 1,115 2,279 1,141 857 28 496 5,916 8.2 Central Coast 778 1,998 772 1,285 23 298 5,154 7.1 North Counties 432 814 210 172 7 69 1,704 2.4 South Valley/Sierra

630 792 437 1,377 4 205 3,445 4.8

Los Angeles 4,238 6,798 3,882 1,012 100 1,852 17,882

24.7

San Diego 1,477 2,022 1,513 137 44 636 5,829 8.0 Total 15,559 26,77

0 13,845 9,452 368 6,439 72,43

3 100.1

Percent Total 21.5 37.0 19.1 13.0 0.5 8.9 100.

Lok and Chapman. The Mental Health Workforce in California: Trends in Employment, Education, and Diversity. March 2009. Original source of table: American Medical Association (2006). AMA Physician Professional Data.

77

Literature Review: Aging of the Public Mental Health Workforce

California’s public mental health workforce will experience increased retirement rates in the coming years

By 2030, the nation will need an additional 3.5 million “formal” healthcare providers to maintain the existing ratio of providers to total population, a 35% increase from current levels

78

Highlights

Public Mental Health Workforce Supply Projections, 2014-2019

79

Supply Projections: Types of Data

Survey Occupational Board Licensure National Provider Identification (NPI) Controls

Wages (Quarterly Census Employment) California GDP California Population

80

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

81

Supply Projections: Classes of Providers

Licensed, Prescribing Psychiatrist, Physician with Addiction Specialty, Psychiatric

Mental Health Nurse Practitioner, Physician Assistant Licensed, Non-Prescribing, Clinical

Licensed Clinical Social Worker, Marriage and Family Therapist, Licensed Clinical Psychologist

Licensed, Non-Prescribing, Nursing Registered Nurse, Clinical Nurse Specialist, Licensed Practical

Nurse, Licensed Vocational Nurse, Licensed Psychiatric Technician

Alcohol and Other Drug Counselors Non-Licensed Professional

Case Manager, Community Health Worker, Counselor, Mental Health Counselor

82

Supply Projections:

Licensed, Prescribing Providers Key Findings

The total count of licensed, prescribing providers is anticipated to grow by 21% over the five-year period from 2014 to 2019

Most of the growth in the licensed, prescribing provider category can be attributed to the projected increases in the supply of Physician Assistants (PAs)

As of 2013, Psychiatrists represent the second largest share of licensed, prescribing providers in the NPI registry

The MHSA Bay Area region and large counties contained the highest percentages of licensed, prescribing positions

The MHSA Superior region and small counties contained the lowest percentages of licensed, prescribing positions

Psychiatrist and physician were male-dominated licensed, prescribing positions

83

Supply Projections: Licensed, Non-Prescribing, Nursing Providers Key Findings

The category of licensed, non-prescribing, nursing occupations is anticipated to grow by approximately 33% over five-year period from 2014 to 2019

In 2013, Registered Nurses represented 67% of licensed, non-prescribing nursing occupations in the NPI registry

The MHSA Southern region and large counties contained the highest percentages of licensed, non-prescribing, nursing positions

The MHSA Superior region and small counties contained the lowest percentages of licensed, non-prescribing, nursing positions

Females occupied all licensed, non-prescribing, nursing positions more than males

84

Supply Projections: Licensed, Non-Prescribing, Clinical Provider Key Findings

The total count of licensed, non-prescribing, clinical providers is anticipated to grow by approximately 20% over the five-year period from 2014 to 2019

Marriage and Family Therapists represent 45% of licensed, non-prescribing clinical providers in 2013

The MHSA Southern region and large counties contained the highest percentages of licensed, non-prescribing, clinical positions

The Superior MHSA region and small counties contained the lowest percentages of licensed, non-prescribing, clinical positions

Females held a large majority of licensed, non-prescribing, clinical positions

85

Supply Projections: Licensed, Non-Prescribing, Clinical Providers Key Findings MFTs constituted the largest share of providers.

LCSWs represented the second highest proportion of the licensed, non-prescribing, clinical provider population

While LCSWs were reported as a high need position, the overall count of MFTs is much higher The distribution of MFTs across different county sizes

does not appear to be as disproportionate as some other provider types

Future strategies could help prepare counties to capitalize on the growing supply of MFTs among the licensed, non-prescriber provider population

86

Supply Projections: Alcohol and Other Drugs Counseling Providers Key Findings The MHSA Southern region and large counties

contained the highest percentages of AOD counselors The MHSA Superior region and small counties

contained the lowest percentages of licensed, non-prescribing, clinical positions

Females filled the majority of AOD counseling positions. The total count of Alcohol and Other Drugs Counseling

public providers is slated to grow from 2014 through 2019

The ratio of AOD counseling public providers to the total California population is expected to increase in the next five-year period

87

Supply Projections: Alcohol and Other Drugs Counseling Providers Key Findings

The total count of public Alcohol and Other Drug Counseling providers is slated to grow from 2014 through 2019

The annual percent change in growth is forecasted to slow from approximately 8% per year to 6% growth in 2019

88

Supply Projections: Retirement Impact on Workforce Key Findings

Among the professions for which retirement rates were estimated, only Psychiatry was estimated to have a significant proportion of providers estimated to retire by 2019

According to the computations conducted for this report, assuming Psychiatrists would retire on average by 65 with average practice lengths of 35 years, 40% of the current Psychiatrist workforce would retire by 2019 After adjusting for this rate of retirement, the

incoming supply of Psychiatrists is still projected to increase (albeit at a slower pace) annually

89

Current Supply:

Licensed, Prescribing Professions

OccupationNumber in

NPI Registry

% of Total

Psychiatrist 6,573 49%Psychiatric Mental Health Nurse Practitioner

1631%

Physician Assistant* 6,599 49%Physicians with Addiction Specialties

1291%

Total 13,464 100%*This number includes all Physician Assistants in the NPI data set, not Physician Assistants serving in the public mental health system in particular.Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013

90

Supply Projections:

Licensed, Prescribing Providers

Psychiatrist


Physician Assistant Physician TOTAL

Count

Annual Change

Prov-to-Pop Ratio

Count Annual Change

Prov-to-Pop Ratio

Count Annual Change

Prov-to-Pop Ratio

Count Annual Change

Prov-to-Pop Ratio

Count Annual Change

Prov-to-Pop Ratio

Observed

2008 5839 16 96 0.3 4512 12.4 103 0.3 10550 28.92009 6070 4% 16.5 102 6% 0.3 4935 9% 13.4 112 9% 0.3 11219 6% 30.52010 6246 3% 16.7 115 13% 0.3 5402 9% 14.5 117 4% 0.3 11880 6% 31.82011 6387 2% 17 131 14% 0.3 5853 8% 15.6 120 3% 0.3 12491 5% 33.22012 6506 2% 17.2 146 11% 0.4 6291 7% 16.6 125 4% 0.3 13068 5% 34.52013 6574 1% 17.2 163 12% 0.4 6602 5% 17.3 129 3% 0.3 13468 3% 35.3

2008 - 2013 Change 735 11% 1.2 67 41% 0.1 2090 32% 4.9 26 20% 0 2918 22% 6.4

Projected

2014 6481 -1% 16.9 177 9% 0.5 7141 8% 18.6 135 5% 0.4 13942 4% 36.32015 6687 3% 17.2 194 10% 0.5 7644 7% 19.7 141 4% 0.4 14673 5% 37.82016 6898 3% 17.6 212 9% 0.5 8158 7% 20.8 146 4% 0.4 15421 5% 39.42017 7110 3% 18 230 8% 0.6 8681 6% 22 152 4% 0.4 16181 5% 40.92018 7310 3% 18.3 247 7% 0.6 9186 6% 23 158 4% 0.4 16908 4% 42.42019 7513 3% 18.7 264 7% 0.7 9701 6% 24.1 164 4% 0.4 17649 4% 43.9

2014 - 2019 Change 1032 14% 1.8 87 33% 0.2 2560 26% 5.5 29 18% 0 3707 21% 7.6

91

Current Supply: Licensed, Non-Prescribing, Nursing Occupations

OccupationNumber in NPI

Registry % of TotalRegistered Nurse 7,507 67%Clinical Nurse Specialist

921%

Licensed Practical Nurse

2062%


8257%

Licensed Vocational Nurse

2,61023%

Total 11,240 100%Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013

92

Supply Projections: Licensed, Non-Prescribing, Nursing Providers

Registered Nurse


Licensed Practical Nurse


Licensed Vocational Nurse

TOTAL

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Observed

2008 4435 12.2 75 0.2 110 0.3 530 1.5 1284 3.5 6434 17.62009 5010 13% 13.6 78 4% 0.2 133 21% 0.4 587 11% 1.6 1524 19% 4.1 7332 14% 202010 5595 12% 15 80 3% 0.2 147 11% 0.4 636 8% 1.7 1804 18% 4.8 8262 13% 22.12011 6179 10% 16.4 86 8% 0.2 166 13% 0.4 685 8% 1.8 2081 15% 5.5 9197 11% 24.52012 6889 11% 18.2 89 3% 0.2 192 16% 0.5 750 9% 2 2396 15% 6.3 10316 12% 27.32013 7530 9% 19.8 92 3% 0.2 208 8% 0.5 825 10% 2.2 2614 9% 6.9 11269 9% 29.6

2008-2013 Change 3095 41% 7.6 17

18%

0 98 47% 0.2 295 36% 0.7 1330 51% 3.4 4835 43% 12

Projected

2014 8213 9% 21.4 98 6% 0.3 233 12% 0.6 891 8% 2.3 2927 12% 7.6 12362 10% 32.12015 8994 10% 23.2 103 5% 0.3 260 12% 0.7 974 9% 2.5 3225 10% 8.3 13556 10% 34.92016 9796 9% 25 108 5% 0.3 288 10% 0.7 1059 9% 2.7 3529 9% 9 14779 9% 37.72017 10615 8% 26.9 114 5% 0.3 315 10% 0.8 1146 8% 2.9 3835 9% 9.7 16025 8% 40.52018 11440 8% 28.7 120 5% 0.3 341 8% 0.9 1230 7% 3.1 4126 8% 10.3 17257 8% 43.32019 12284 7% 30.5 126 5% 0.3 367 8% 0.9 1314 7% 3.3 4422 7% 11 18513 7% 46

2014-2019 Change 4071 33% 9.1 28 22% 0 134 37% 0.3 423 32% 1 1495 34% 3.4 6151 33% 13.9

93

Current Supply: Licensed, Non-Prescribing, Clinical Providers

OccupationNumber in NPI

Registry% of Total

Psychologist 13,014 28%Marriage and Family Therapist

20,460 45%


11,908 26%

Licensed Professional Clinical Counselor

339 1%

Occupational Therapist 10 0%Total 45,731 100%

Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013

94

Supply Projections: Licensed, Non-Prescribing, Clinical Provider Findings

Psychologist

Marriage & Family Therapist


Licensed Professional

Clinical Counselor TOTAL

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Count

Annual Change

Prov-to-Pop Ratio

Observed

2008 10130 27.8 14656 40.2 9026 24.7 230 0.6 34042 93.32009 10919 8% 29.7 16065 10% 43.7 9719 8% 26.5 249 8% 0.7 36952 9% 100.62010 11487 5% 30.8 17220 7% 46.2 10297 6% 27.6 268 8% 0.7 39272 6% 105.32011 12029 5% 32 18354 7% 48.9 10877 6% 29 285 6% 0.8 41545 6% 110.62012 12558 4% 33.2 19555 7% 51.7 11455 5% 30.3 310 9% 0.8 43878 6% 1162013 13020 4% 34.2 20461 5% 53.7 11913 4% 31.3 339 9% 0.9 45733 4% 120

2008-2013 Change 2890

22%6.4 5805

28%13.5 2887

24%6.6 109

32%0.3 11691

26%26.7

Projected

2014 13605 4% 35.4 21983 7% 57.2 12606 6% 32.8 353 4% 0.9 48547 6% 126.32015 14194 4% 36.6 23097 5% 59.5 13219 5% 34.1 377 7% 1 50887 5% 131.12016 14795 4% 37.8 24207 5% 61.8 13844 5% 35.4 401 6% 1 53246 5% 1362017 15404 4% 39 25322 5% 64.1 14475 5% 36.6 424 6% 1.1 55624 4% 140.72018 15973 4% 40.1 26471 5% 66.4 15065 4% 37.8 447 5% 1.1 57956 4% 145.42019 16553 4% 41.2 27625 4% 68.7 15663 4% 38.9 469 5% 1.2 60311 4% 150

2014-2019 Change 2948 18% 5.8 5642 20% 11.5 3057 20% 6.1 116 25% 0.3 11764 20% 23.7

95

Supply Projections: Alcohol and Other Drugs Counseling Providers

AOD Counselor

Count

Annual Change

Prov-to-Pop Ratio

Observed

2008 1730 4.72009 1962 13% 5.32010 2149 10% 5.82011 2436 13% 6.52012 2744 13% 7.32013 3016 10% 7.9

2008-2013 Change 1286 43% 3.2

Projected

2014 3246 8% 8.42015 3539 9% 9.12016 3836 8% 9.82017 4133 8% 10.52018 4411 7% 11.12019 4690 6% 11.7

2014-2019 Change 1444 31% 3.3

96

Highlights

Literature Review: Educational Capacity

97

Educational Capacity:Overview

Purpose: To identify the pipeline of future mental health providers

Types of analysis: Geographic distribution Discipline/Degree Demographics

Gender Race/Ethnicity

98

Educational Capacity: Data Sources

Program availability and capacity Data sources:

California Board-Licensed Programs OSHPD-led Educational Institutions Survey

Trends among graduates Data sources:

Integrated Postsecondary Education Data System (IPEDS)

California Postsecondary Education Commission (CPEC)

99

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

100

Educational Capacity: Key Findings

Overall and across most areas of analysis, graduation counts rose over the 1999-2009 period

Graduates are heavily concentrated in the Southern Region, which accounts for approximately 43% of all total graduates in the state

Graduate growth rates in the Southern region are increasing faster than the statewide average, and considerably faster than in other MHSA regions

Large counties account for 80% of all graduates in the state, and have held this proportion steadily from 1999-2009

Female graduates account for approximately two-thirds of the total graduates in California

White graduates comprise the largest share of all graduates in mental health disciplines

Graduates of minority race/ethnicities constitute an aggregated majority of all graduates

101

Educational Capacity: Distribution of Programs by MHSA Region

MHSA Region

Count of Programs % of Total

Bay Area 88 24%

Central 26 7%

Los Angeles 99 27%

Online 20 5%

Southern 125 34%

Superior 7 2%

Total 365 100%

102

Educational Capacity:Distribution of Programs by Institution Type

Type of Institution

Count of Program

s% of Total Programs

Community College 18 5%

California State University 75 21%

Private 224 61%

Public, Other 3 1%University of California 45 12%

Total 365 100%

103

Educational Capacity:Distribution of Programs by Discipline and MHSA Region

DisciplineBay Area

Central

Los Angel

esSouth

ernSuperi

or Online Total Child Psychiatry Fellowship 4 2 1 7Clinical Nurse Specialist 11 1 10 11 33Clinical Psychology 2 9 10 3 24Doctorate in Psychology 2 1 4 2 9Educational Psychology 1 1Geriatric Psychiatry Fellowship 2 2 1 5Licensed Professional Clinical Counselor 8 3 6 14 9 40Marriage and Family Therapy 36 8 28 43 3 8 126Physician Assistant 3 1 2 3 9Psychiatric Mental Health Nurse Practitioner 1 4 1 6Psychiatric Residency 4 4 8 6 22Psychiatric Technician 5 3 2 9 19School Psychology 5 3 12 18 2 40Social Work 5 2 9 6 2 24Total 88 26 99 125 7 20 365

104

Educational Capacity:Graduates in All Mental Health Disciplines, with 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 Graduates Linear (Female Graduates)Total Graduates Linear (Total Graduates)

2014

105

Educational Capacity:Distribution of Mental Health Graduates by Discipline (1999-2009)

Clinical Psychology8%

Counseling Psychology

4%Educational Psychology

0%Marriage and

Family Therapy2%

Other2%

Psychiatric Technician

2%

Psychology63%

School Psy-chology

1%

Social Work 13%

Substance Abuse/Addic-tion Counseling

4%

198,424 total graduates

between 1999-2009

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Educational Capacity: Count of Graduates by Race/Ethnicity Grouping (1999-2009)

Race/Ethnicity Group

Count of Graduates

% of Total Graduates

Asian/Pacific Islander 18,303 10%Black 14,535 8%

Hispanic/Latino 38,485 20%Native American 1,937 1%Other 3,576 2%Unknown 20,902 11%White 91,459 48%Total 189,197 100%

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Educational Capacity:Distribution of Schools and Graduates

Educational Institutions Graduates

108

Educational Capacity: Total Graduates by County Size (1999-2009)

Large82%

Medium15%

Small2%

198,424 total graduates

between 1999-2009

109Literature Review: Graduation to Workforce Participation

110

Literature Review: Graduation to Workforce Participation

Psychology Graduate Trends – Key Findings

Masters Level Survey Results Sixty-four percent (64%) of graduates with Master’s,

Specialist’s, and related degrees who had full-time employment were working in a health services discipline

Doctoral Level Survey Results Sixty-three percent (63%) of new doctoral graduates were

employed full-time, 24% were pursuing post-doctorate degrees, 8% were employed part-time, and 6% were unemployed

Almost 30% of doctoral survey respondents were employed three months after the completion of their degree; 38% of doctoral graduate respondents had found employment prior to completion of their doctoral degree

Men were employed full-time at a rate of 67%, compared to women at 62%

White doctoral graduate respondents reported full-time employment at a lower rate than ethnic minorities (62% and 65%, respectively)

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Key Findings

Overall, the reported supply of new graduates into the mental health workforce increased over the past five years

A majority of undergraduate students interested in psychology expressed interest in pursuing graduate and post-graduate education

Among post-graduates in psychiatry, a slight majority commit to U.S.-based Medical Doctor Programs

Federal programs supporting nurses have helped to increase the nursing supply and help drive portions of the workforce to medically underserved communities

Social workers participating the Title IV-E program in California have a 78.8% retention rate

Rural communities are in need of mental healthcare professionals

“American Psychological Association Center for Workforce Studies.” 2008 APA student affiliate survey [survey with tables].” Retrieved from http://www.apa.org/workforce/publications/08-student/index.aspx

112

Literature Review: Graduation to Workforce ParticipationGraduates’ Intent to Pursue Doctoral Degree in Psychology

Intent to Pursue Psychology Doctoral Degree

Female(n= 1,461)

Male(n=344) Total

N % N % N %Yes, currently in terminal Master’s program

198 14% 44 14% 242 14%

Yes, currently in a doctoral program in psychology

1,032 74% 252 78% 1,284 74%

No 60 4% 8 3% 68 4%

Not Sure 111 8% 21 7% 132 8%

Total 1,401 100% 325 100% 1,726 100%

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Literature Review: Graduation to Workforce ParticipationEmployment Settings for Psychology Master’s, Specialist’s, and Related Degree Graduate Students

University or Col-lege setting

13%

School or Other Educational Set-

tings25%

Hospitals and Clinics19%

Independent Practice

3%

Other Human Services Settings

20%

Business, Government,

or Other20%

“American Psychological Association Center for Workforce Studies.” 2008 APA student affiliate survey [survey with tables].” Retrieved from http://www.apa.org/workforce/publications/08-student/index.aspx

http://www.apa.org/workforce/publications/08-student/index.aspx

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Other Professions Graduation Trends

Registered Nurses 59% hire rate into entry-level positions with

the Bachelors of Nursing (BSN) degree 67% hire rate into entry-level positions with

the Master’s of Nursing (MSN) degree Psychiatry

The number of post-graduate psychiatry residents has increased slowly since the shortage in the late 1990sAmerican Association of Colleges of Nursing. (2013).

Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses [research brief]. American Psychiatric Association. (2013). Resident census: Characteristics and distribution of psychiatry residents in the U.S. 2011-2012 [Survey with tables].

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WET Five-Year Plan Needs Assessment Strengths and Next Steps

116

Strengths of Overall Project

Reviewed extensive amount of county-reported data

Utilizing many data sources to inform needs assessment, evaluation, and projections including: Literature Reviews Stakeholder Feedback State and National Data Sources Educational Institution Surveys State Administered WET Program Evaluation

OSHPD support in prioritizing best possible data sources

117

Forthcoming Work

Demand Projections Acquire and analyze demand-side data to identify trends

amongst consumers of public mental health services Primary data source is the Client and Service

Information (CSI) Gap Analysis

Identify any anticipated shortages and surpluses over the next five years

Occupational type, prescribing authority, location, demographic needs (where data is available)

Needs Assessment Report Finalization Reports including findings from all assessment

completed will be posted to the OSHPD website and distributed to stakeholders

118

Thank you!

Resource Development Associates Amalia Freedman (

[email protected]) Kevin Wu ([email protected])

mailto:[email protected]

mailto:[email protected]

WET Five-Year Plan: Evaluation of First WET Five Year Plan, Stakeholder Engagement, County Needs Assessment, and Literature Review Interim Findings Resource.

Documents

wet program evaluation

county needs survey

county survey

county needs assessment

wet programs

needs assessmentprogress

baseline report

workforce projections