Using Needs Assessment Data to Advance the Current State of Addiction Treatment

1. Using Needs Assessment Data to Advance the Current State of Addiction Treatment Preliminary Results from the Maryland Workforce Survey ADAA Management Conference, October 5-7, 2005

2. Context of Maryland Survey • In 2000 the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT) identified workforce development as one of five major issues to be addressed to improve the current state of treatment. • Over the past five years the Addiction Technology Transfer Center (ATTC) Regional Centers have collaborated with multiple states to implement workforce needs assessment surveys. • In the summer of 2004 the ATTC National Office assembled and piloted a nationally focused workforce survey for the ATTC network.

3. Context, cont. • In fall of 2004 Maryland’s Office of Education and Training for Addiction Services (OETAS) contacted the Central East ATTC about conducting a workforce survey in the state of Maryland. • The Central East ATTC, Mid-Atlantic ATTC and RMC Research Inc. partnered to begin the process of conducting a workforce survey in the state of Maryland.

4. Survey Development Process • ATTC National Survey was reviewed by OETAS staff. • Survey was modified to meet the needs of OETAS and the Maryland service delivery system. • Preliminary survey was sent out to all Maryland agencies to ascertain the number of clinical and medical staff at each agency.

5. Survey Development Process, cont. • Staff and Director inclusion criteria was developed for participation in survey. • Only full-time clinical or medical staff thatspend 50% or more of their time treating clients with substance abuse as their primary diagnosis were asked to participate. • Letter was sent to all agency directors by the Director of Maryland’s Alcohol & Drug Abuse Administration (ADAA) informing them about the survey process.

6. Survey Development Process, cont. • Due to the large number of agencies in the state, surveys were only sent to a representative sample of agencies and staff. • Surveys were mailed out to agencies included in the sample with stamped self-address return envelopes and instructions for completing the surveys. • To ensure an adequate response rate, agencies were followed-up with by letter and phone.

7. Sampling Plan • Sampling unit = agency. • The target final sample number was 138, 50% of 275 identified agencies in MD. • Agencies were stratified based on Level of Care, and then randomly selected within strata. • STAGE 1: 100% of agencies providing Level 0.5, Level I.D, Level II.5, Level III.3, Level III.5, Level III.7, or Level III.7.D were included in sample • STAGE 2: 67% of agencies providing Level II.D or Level III.1 were included to the sample • STAGE 3: 50% of agencies providing MAT were included in the sample • STAGE 4: The final sample was filled in by agencies providing Level I or Level II.1

8. Final Sample Composition

9. Sampling, cont. • Sampling list was then split by funded and non-funded status to assure equal representation of each (key variable of interest). • Since staff composition was not known for all agencies, 7 staff surveys were sent to each agency. • Staff were defined as clinical and/or medical staff thatspend 50% or more of their time treating clients with substance abuse as their primary diagnosis.

10. Response Rate • Surveys were received from: • 58/ 138 total agencies sampled (42%) • 31/ 70 funded agencies (44%) • 27/ 68 non-funded agencies (40%) • 261 staff (155 from funded agencies, 106 from non-funded agencies)

11. Survey Content • Two survey versions: Agency Director & Staff • Key content areas: • Demographics • Academic & Professional Background • Agency Setting (Agency Director only) • Staff Size & Turnover (Agency Director only) • Indicators of Turnover • Recruitment & Retention Issues • Job Satisfaction • Technology • Proficiency & Training Interests

12. Gender • While a higher proportion of staff than directors are female, this difference is not statistically significant.

13. Ethnicity • The difference in ethnicity of directors and staff at funded agencies is statistically significant (p<.05).

14. Age • Differences in age are not statistically significant.

15. Age of Entry Into Field

16. Reason for Entry Into Field • The two most frequent reasons cited for entering the field: • Previous experience with addictions (personal or family) • Personal interest • Approximately 40% of the workforce reports that substance abuse treatment is a second career

17. Recovery Status • Across the workforce, a higher percentage of males (45%) report being in recovery than females (24%), this difference is statistically significant (p<.001).

18. Years Experience • The fact that directors have spent less time in their current role than time in the field indicates that directors in Maryland may have entered the field in some other capacity. • The fact that years in position is significantly less than years in field validates the perception of movement within the field.

19. Degree Status • The differences in degree status of directors in funded and non-funded agencies is statistically significant (p<.05).

20. Degree Status & Recovery Status • A statistically significant (p<.001) larger proportion of non-recovering staff have a BA degree or above (84%) than do recovering staff (49%). This finding is present in both funded and non-funded agencies. • Interestingly, no differences in terms of years experience exist between recovering and non-recovering staff.

21. AOD Coursework/ Training • When asked if have ever attended a college or university and completed specialized AOD coursework: • 52% of directors & 54% of staff at funded agencies reported ‘yes’ • 63% of directors & 60% of staff at non-funded agencies reported ‘yes’ • Over 90% of the workforce reports participating in AOD workshops/ training in the past 2 years, attending on average 5- 8 workshops.

22. Certification/ Licensure

23. Salary

24. Salary, cont. • Across the entire workforce, 78% of staff report making under $45,000 a year while 74% of directors report making over $45,000 a year (p<.001). • A significantly larger proportion of directors in non-funded agencies report making under $45,000 than do directors at funded agencies (p<.01). Significant variations also exist in staff salaries across agency type. • 66% of the workforce reports being the primary wage earner in their family unit. • Preliminary results show a linear relationship between salary and degree status.

25. Benefits • A statistically significant larger proportion of directors and staff in funded agencies have health insurance and retirement benefits than do directors & staff in non-funded agencies.

26. Benefits, cont. • The majority of the workforce receives sick leave and vacation/ paid leave benefits. • A statistically significant larger proportion of staff at funded agencies receive maternity leave and tuition assistance benefits than staff at non-funded agencies.

27. Time Spent- Directors

28. Time Spent- Staff

29. Time Spent- Client or Admin? • While directors in both funded and non-funded agencies spend the majority of their time on administrative tasks, differences exist in how much time is spent on client related tasks. • The amount of time directors spend on client related tasks is negatively related to the size of their agency. • Staff spend over one third of their time on admin. tasks.

30. Agency Staffing Numbers • Turnover rate for the entire workforce is 12%, which appears to be lower than other state reports (17- 25%). • Range of turnover is large (0%- 60%) across agencies, so additional analysis will be completed to determine what factors may contribute to turnover issues.

31. Future in Field the Next 2 Yrs • Workforce members report having worked for an average of 2- 3 agencies, voluntarily changing jobs an average of 1- 2 times.

32. Indicators of Turnover • Salary, benefits, & better management were the most frequently cited reasons for why workforce members have voluntarily changed agencies in the past • Better pay/ benefits & better management were the most frequently cited reasons for why workforce members are considering changing agencies in the future • Better pay/ benefits, a different client population, and a less stressful work culture were the most frequently cited reasons for why workforce members are considering leaving the field • Those considering leaving the field vary in terms of age, gender, yrs experience, & academic degree

33. More frequent salary increases More individual recognition & appreciation Make staff feel ideas are valued Better benefits Lessen/ provide assistance with paperwork Promote career growth More/ improved ongoing training Formal steps to reduce emotional burnout Retention Ideas

34. Satisfaction & Job Stress • Most frequently cited sources of satisfaction: role as change agent; commitment to treatment; 1-to-1 interaction w/ clients; opportunities for personal learning & growth; & agency/ coworkers • Most frequently cited sources of dissatisfaction: salary & benefits; inability to influence agency decisions (staff only); too many external regulations on agency

35. Major Models in Use

36. Training Priority Matrix Proficiency: High  Low Interest: Low  High

37. Funded Agencies Client, family, & community education COD Drug pharmacology Gender specific Racial/ ethnic specific treatment Relationship between SA & medical problems Staff recruitment Tx Engagement Non-funded Agencies Clinical Supervision Drug pharmacology Gender specific Staff recruitment Level 1 Priorities: Directors

38. Funded Agencies Drug pharmacology Gender specific Marriage & family therapy Non-funded Agencies COD Drug pharmacology Level 1 Priorities: Staff

39. Future Analysis • Further Description of Agencies & Services • Recruitment Issues • Use of Technology • Status of AOD Tx Professionals • Predictors of Salary • Predictors of Turnover  . . . and much more.

40. Next Steps • Completion of Preliminary Analysis • Create Secondary Analysis Plan • Summarize Results in a Final Report • Create a Findings Brief Distilling Key Points • Disseminate Results . . .  • Repeat Needs Assessment Process to Monitor Change

41. This Process Needs Your Input • To generate questions/ comments/ concerns regarding dataset. • To ascertain what findings are interesting, and to determine what findings are important to stakeholders. • To determine where secondary analysis is useful/desired.

42. Jeffrey R.W. Knudsen RMC Research Corp. 522 S.W. Fifth Ave, Suite 1407 Portland, OR 97204 (503) 223-8248 jknudsen@rmccorp.com Aaron M. Williams Danya Institute, Inc. 8737 Colesville Rd., Suite 300 Silver Spring, MD, 20910 (240) 645-1143 awilliams@danyainstitute.org Who to Contact