OSHPD WET 5-Year Plan: 2013 Needs Assessment & 2008-2013 Evaluation Initial Findings

1. OSHPD WET 5-Year Plan:2013 Needs Assessment & 2008-2013 Evaluation Initial Findings December 13, 2013 Kevin J. Wu, MPH Linda A. Hua, PhD Resource Development Associates

2. Topics County-Reported Assessments Educational Capacity Program Evaluation Forthcoming Q&A

3. County-Reported Assessments Highlights

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 • Analysesby: • 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

7. County-Reported Assessments:Workforce Shortages

8. County-Reported Assessments:Diversity Needs

9. County-Reported Assessments:MHSA WET Program Participation Rates by County Size County Sizes Small (<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. Educational Capacity Highlights

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 2014

19. Educational Capacity:Distribution of Mental Health Graduates by Discipline (1999-2009) 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. Program Evaluation Highlights

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

25. Program Evaluation:General Capacity 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

27. Program Evaluation:Cultural & Linguistic Competency Linguistic Capacity of 2008 Workforce and WET Progress toward Targets

28. Program Evaluation:Cultural & Linguistic Competency

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

32. Program Evaluation: Regional Partnerships Evaluation 32 Insert matrix

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?