Getting and Keeping a Rural Workforce: Lessons from the WICHE West

1. Getting and Keeping a Rural Workforce:Lessons from the WICHE West Dennis MohattVice President for Behavioral Health - WICHE

2. WICHE region • Alaska • Arizona • California • Colorado • Hawaii • Idaho • Montana • Nevada • New Mexico • North Dakota • Oregon • South Dakota • Utah • Washington • Wyoming

3. Workforce success is all about P.I.E. Proximity – Provide care close to home Immediacy – Identify and treat early Enthusiastically – Treat with hope

4. There is not one rural …

5. What’s different in the country? • Not prevalence – rural/urban rates of mental disorders are pretty much the same. • Accessibility (getting there and paying) • Availability (someone there when you are) • Acceptability (choice, quality, knowledge)

6. The cold, hard facts • > 60% of rural Americans live in mental health professional shortage areas • > 90% of all psychologists and psychiatrists, and 80% of MSWs, work in metropolitan areas • > 65% of rural Americans get their mental health care from their primary care provider • Rural Americans enter care later in the course of their disorders, with more advanced symptoms, resulting in more intensive & expensive interventions • EMS for Rural MH Crisis usually law enforcement

7. Mental health professional shortage areas

8. Health professional shortage areas: primary care Primary Total CareState Counties HPSA CO 63 43 ID 44 32 ND 53 41 NM 33 39 NV 17 32 OR 36 48 UT 29 24 WA 39 56 WY 23 18 HPSA designation can be given for a population group, single county, or a geographical area. As a result, a single county can have all three.

9. Community systems of care Entry&Exit Acute Need for Care Recovery Informal Community Support Self-Help Primary Prevention Mentoring Etc. Community Rehabilitation Services ACT Partial Hosp. Etc. Community Based Treatment Services Crisis &Assessment Psychosocial Rehab Formal CommunitySupport Inpatient 7 daysRehabilitationOutreach Group Homes Day Programs 7 days/weekOutreachin acuteshort term 24 Hour Total Care Primary Care Specialty Care Outpatient Care Mgmt. Residential Formal SystemNatural Support & Care

10. Defining mental health workforce • Mental health & Substance abuse • Wide range of • Disciplines (psychiatry, psychology, social work, nursing) • Providers (psychologists, counselors, psychiatric nurses) • Professional levels (paraprofessional to graduate level) • Services (treatment, prevention)

11. Findings from Annapolis Coalition Report • Workforce Crisis with Specialty Pops (e.g., children, geriatrics, substance abuse, persons of color, rural) • Dissatisfaction among Persons in Recovery and Families • Employer Dissatisfaction with the Pre-Service Education of Professionals • Delay: Science to Service • Multiple Silos & Absence of Coordination • Narrow Focus on Urban, White Adults • Need better Data & Tools • Propensity to do what is Affordable, Not What is Effective • Pockets of Workforce Innovation: Difficult to Sustain or Disseminate Source: Annapolis Coalition National Strategic Plan for Behavioral Health Workforce Development

12. What we know for sure • Rural professionals shortage rates unchanged for past five decades • Many rural BH systems average 30% staff vacancy • Average time to recruit psychiatrist to rural practice is 32 months; increases w/solo practice • Providers w/rural CMHC training and practice more likely to be retained in rural CMHC practice • The 100-Mile Rule: The majority of healthcare providers practice within 100 miles of where they trained • Inadequate supervision a major retention factor … employees leave supervisors not jobs

13. s s s s s s s s s s s s s s s Behavioral health workforce – grow your own strategy logic model Increase knowledge of behavioral health Exchange knowledge about behavioral health careers Provide accessible behavioral health training - Population of Focus + Applied trainingopportunities Job

14. Examples from the West … Alaska leads the way

15. Alaska – has it all going • Statewide TV, Radio, & Print PSA’s that educate about behavioral health issues and the worth of related jobs-professions. (New Mexico also has great mental health public ed ads). • Pipeline Initiatives focused on increasing the interest of school-age youth in behavioral health careers. • Also think about Mental Health First Aid

16. And then some … • Threshold jobs to careers • Apprenticeship partnerships (Labor) • Competency workgroup • Rural human service program • RWJ job based learning pilot • Also check out Promotora and Community Health Worker models.

17. Not finished yet • Higher education partnerships • Rural human service program • Articulated academic ladder • Behavioral health alliance • Distance delivered social work degree • Behavioral health academy • Doctoral program in community/clinical psychology with rural and indigenous people focus

18. And finally … • Development of APA Accredited Internship Consortium focused on Alaska practice • Emerging psychiatric residency and child psychiatry fellowships with UW focused on Alaska. • Cross university/cross discipline faculty training in children’s system of care to promote interdisciplinary curriculum change.

19. Last but not least • State loan repayment program • Housing stipend program • Regional training collaboratives • Statewide conference for direct care workers and front line supervisors • Statewide Addictions College • Statewide behavioral health strategic plan

20. www.wiche.edu/mentalhealth • Dennis Mohatt • Mimi McFaul • Deb Kupfer • Jenny Shaw • Chuck McGee • Tamie DeHay • Maurene Flory • Nicole Speer • Jessica Tomasko