Alaska Mental Health Trust Workforce Development Initiative

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Alaska Mental Health TrustWorkforce Development InitiativeAn Overview of Workforce Related Data & Strategies to Address the GapsPrepared by the Western Interstate Commission for Higher Education(WICHE) Mental Health ProgramFor: The Alaska Mental Health Trust Authority Steering CommitteeContacts: Mimi Bradley, Psy.D. (mbradley@wiche.edu)Scott Adams, Psy.D. (sadams@wiche.edu)

IntroductionAccess to health services in Alaska is seriously challenged by shortages across the professionaland paraprofessional workforce. Alaska shares this problem with other rural and frontier States,but the challenges are magnified by the diversity of populations and their wide dispersion acrossthe vast landmass of Alaska.The Alaska Mental Health Trust Authority (referred to as “the Trust” for the remainder of thisdocument) expressed the desire to develop a comprehensive workforce plan, serving all Trustbeneficiary areas, to articulate an agreed upon set of action steps to facilitate the preparation andcontinuing education of a qualified health workforce. The beneficiaries of The Trust areAlaskans who experience mental illness; developmental disabilities; chronic alcoholism; orAlzheimer's disease and related dementia. While the individuals in these beneficiary areas oftenexperience unique issues and require different approaches to treatment, workforce concerns spanall areas.The Mental Health Trust Authority, in partnership with the State Division of Behavioral Health,and the University of Alaska System brought stakeholders together to strategically discuss andexamine the workforce trends and demands in Alaska, including recruitment, retention,education, training, and career opportunities. The goal of this project is to expand upon thecurrent workforce efforts and to increase communication between systems and initiatives tofoster a more coordinated strategy that maximizes resources and decreases duplication.This document is not meant to be exhaustive but will attempt to provide an overview of currentworkforce efforts for Trust beneficiary areas. The data provided in this report was used to guidethe Workforce Steering Committee in identifying priorities for future resources and collaborationand to create a strategic implementation plan with specific deliverables and timelines.A Phased ApproachThe Trust asked the WICHE Mental Health Program (WICHE MHP) to help facilitate thisproject. The WICHE MHP has a history of work in Alaska, including working on behavioralhealth workforce initiatives, community readiness assessments, and system of care integrationprojects. This participatory project unfolded over the following three phases.Phase I: The Alaska Trust Workforce Development Steering Committee was formed to guidethis project and includes personnel from the Trust, as well as representatives from many leadinginstitutions and provider agencies that serve Trust beneficiary areas (see the Steering Committeelist in Appendix A). The Steering Committee is composed of leaders who are committed toimplementing a workforce plan. They bring experience, ideas, and resources to recruit colleaguesand execute the plan in their respective institutions.Phase II: In collaboration with the Alaska Trust Authority Workforce Development SteeringCommittee, the WICHE MHP prepared a report that provided an overview of the current statusof workforce development efforts in Alaska. This report describes available data reflecting thecurrent and projected workforce needs and review existing efforts. This narrative served to2

inform those engaged in the development of the Alaska Trust Authority Workforce DevelopmentPlan with essential background information to support the planning process.The Steering Committee met Tuesday, April 25, 2006 at the Alaska Psychiatric Institute (API).At this meeting, the Steering Committee discussed the goals and reached agreement regardingthe process for developing and vetting the Alaska Trust Workforce Development Plan. TheSteering Committee accomplished the following: Identified information sources for the data report.Identified key stakeholders for inclusion in the Phase III planning process.Determined the format for a Phase III Planning Meeting with broad stakeholderinvolvement.Determined the focus areas for Phase III planning.Phase III: WICHE MHP facilitated a day and a half small work group planning meeting, hostedby the Trust, to review the report. WICHE MHP facilitated a planning process to assist the Trustin developing a Workforce Development Plan with strong stakeholder support and consensus.The accomplishments of this phase include: WICHE MHP conducted a day and a half statewide meeting on May 24 and 25, 2006 inAnchorage, with a wide array of stakeholders concerned with health workforcedevelopment. This meeting developed a set of strategies for the Trust to include in thefinal plan document.The Steering Committee met for two working conference calls to review and edit thestrategies generated at the May meeting. Steering Committee members also providedbudget estimates for various workforce projects.Developed a final strategic planning document (this document) that the Trust can furthervet with its constituents and stakeholders prior to formal adoption.The next sections will cover available data regarding workforce trends in Alaska and results ofthe strategic planning process including goals, strategies, and action steps.3

Context: Workforce Components and TrendsAt any given time, the need for workforce development in healthcare is determined by theprevalence of disease or disorders and the number and location of professionals to provideservices. Prevalence rates are based on epidemiological studies of populations, while the numberand location of clinicians is based on the interplay of education and occupation trends.Additionally, a competent and adequate workforce has the right number of experienced andskilled people in the right jobs at the right time.Thus, establishing and sustaining an effective behavioral health workforce involves severalcomponents: A profile of present population and demographics;An estimation of the prevalence of mental illness;An analysis of the professional occupations available to serve the community;A picture of the higher education programs designed to supply well-trained professionals.Healthcare ach of these four components interrelates, and changes to one often affect the others. Forinstance, large and rapid increases in population can translate into greater numbers of peoplewith a behavioral health problem (even if percentage remains the same). But it can also meanmore people available to enter the behavioral health field as clinicians. Thus, it is important tostudy previous trends to project future courses. More importantly, these projections allowdecision-makers to identify potential avenues of growth, as well as barriers and means ofovercoming them.Alaska has been addressing workforce shortages for the past several years with variouscommittees and initiatives. For example, in 2003, the University of Alaska (UA) systemconvened a meeting of educators from disciplines spanning the behavioral health field to discusshow they can most effectively address workforce shortages, especially in rural areas. Despite anumber of productive efforts in the UA system to develop an effective workforce that is trainedin rural behavioral health, educators in Alaska see that more work needs to be done and arecommitted to formalizing workforce development activities that ensure the needs of Alaskans are4

met. Based on the meeting in 2003 regarding behavioral health workforce development inAlaska, educators in University of Alaska behavioral health programs developedrecommendations in the areas of collaboration, education, financing, and evaluation and research(See Appendix B). Considerable momentum and progress has been made following this meeting,with the help of the Alaska Mental Health Trust Authority, which supported seven of theprograms that were created or continued as a result of the meeting. These programs included theUAA/UAF Joint Ph.D. in Psychology, the Alaska Rural Behavioral Health Training Academy,UAA Masters in Social Work by Distance, UAF Bachelor of Social Work Rural Cohort, UAAHuman Services, UAF Human Services, and Residential Services Certificate programs.However, even with the creation of new programs, gaps in the workforce and training still exist.The Trust wanted to continue the momentum that exists in Alaska and to develop a focusedstrategic plan for the workforce serving Trust beneficiaries.The report includes data related to Alaska’s population, occupations, and educational system.Accordingly, the following sections cover different aspects of these workforce components. Thevast majority of data is quantitative, but qualitative data from in-state studies of the healthcareworkforce is included as appropriate and relevant. The table below summarizes the sources ofdata used in this report.This report also chronicles the planning process for this initiative. Following the data portion ofthis report, the reader will find the strategic planning document generated by the Trust, theSteering Committee, and multiple stakeholders throughout this process. This portion of the reportalso provides the final budget for which money will be allocated toward the different goals.5

Resource NameYearResearch TeamAlaska Alliance for DirectService Careers Survey2006AADSCHuman Services DepartmentBehavioral Health InitiativeYear End Report2006Dr. Laura Kelly,Melodee MonsonStatus of RecruitmentResources and Strategies II(SORRAS II)2005Factors InfluencingRetention and Attrition ofCommunity HealthAide/PractitionersType ofData# of Agencies/RespondentsQuantitative40ACRH, UAAQuantitative802004ACRH, UAAQualitative41The Behavioral HealthWorkforce in Alaska: AStatus Report2004WICHE MentalHealth ProgramStatus of RecruitmentResources and Strategies I(SORRAS I)2003ACRH, UAA2003School of SocialWork, Departmentof Psychology,DHS, CHD; UAA20022001The 2002 Social ServicesJob SurveyAlaska Alliance for DirectService Careers – Wage andBenefit Research ReportAlaska’s Allied HealthWorkforce: A tativeAgency Survey – 70;Alumni Survey – 106;Focus Group – 22C&SManagementAssociatesQuantitative37ACRH, UAAQuantitativeQualitative369Purpose/ Information CollectedAgencies responded to a survey that included questions regardingturnover, challenges in recruitment efforts, AADSC media campaign,and use of the AADSC job posting systemProvided information on the increase in HUMS practicum enrollments,increase in placement agencies, new applicants, student enrollment, andgraduates from both AAS and BHS programs.SORRAS II collected the same data points from the original study,which surveyed all rural Alaskan health care facilities, but alsoincluded select urban facilities, including all the large hospitals inAnchorage, Fairbanks, and JuneauCo-worker support, Access to basic training, Fully staffed clinic,Community support, Family supportProvided an overview of workforce development efforts for behavioralhealth in 20report%20Executive%20summary.pdfStrategies used by small hospitals, rural clinics, and rural mental healthcenters to recruit physical, behavioral, and oral health providers.Documented the costs associated with recruiting these professionals.Identify and characterize the social services jobs market in SouthcentralAlaska to strengthen UAA educational programs and help Universitystudents make informed career decisions.(job types, salaries,educational requirements, and turnover rates; characteristics ofsuccessful employees)Existing wage and benefit levels for direct service professionals inAlaska; and strategies that other states have used to increasecompensation levels for direct service professional 1995 to 2025," Report PPL-47, U.S. Bureau of theCensus, Population Division. Most of these data are available in files found on the Population Projections section ofthe World Wide Web's Census Bureau Home Page (http://www.census.gov).8

In terms of ethnic/racial composition, the report estimated that: By 2025, non-Hispanic Whites are projected to compose 57.1% of Alaska's population, downfrom 73% in 1995.From 1995 to 2025, the non-Hispanic Asian and Pacific Islander population is expected togrow by 641.1%, leading to a projected to increase from 4.3% to 21.5% of the statepopulation.From 1995 to 2025, the Hispanic population is expected to increase by 162.7%, leading to anincrease from 3.8% to 6.7% of the state population.The non- Hispanic Asian and Pacific Islander growth rate ranks 1st largest, while theHispanic growth rate ranks 11th largest.Another significant trend that relates to those noted is the relative inmigration versusoutmigration of people to and from Alaska. A report3 from the Census Bureau describes state-tostate migration patterns for the years 1995 to 2000. During that period, Alaska had anoutmigration of 126,000, mainly to other states in the West. Specifically, Arizona, California,Oregon, Texas, and Washington all received inflows of more than 5,000 people from Alaska.Despite a significant number of people coming to the state, Alaska had a net outmigration of30,000, mostly concentrated in the western states of Arizona, Oregon, and Washington. As thetable below indicates, the largest inflow of population came from California, while the largestoutflow went to Washington.Table 2: Largest Migration Inflow and Outflow by State: 1995 to 2000AlaskaLargest inflow was from:Size of inflowCalifornia12,518Largest outflow was to:Size of outflowWashington16,635Source: U.S. Census Bureau, Census 2000. http://www.census.gov/prod/2003pubs/censr-8.pdfOn the positive side, more recent data indicates that outmigration was down significantly from2000 to 2004. Whereas Alaska had an annual average loss of 3,035 people from 1990 to 2000,the state’s annual loss from 2000 to 2004 was only 730 people. If this trend maintains for the restof the decade, then Alaska would have reduced its outmigration by over 400% in 10 years.Table 3: Total and Average Annual Domestic Net Migration for States: 1990–2000 and 2000–2004StateAlaskaTotal number1990–2000 2000–2004–30,354–2,918Average annual number1990–2000 2000–2004–3,035–730Source: U.S. Census Bureau, Population Estimates Program, 2004. rc J. Perry. State-to-State Migration Flows: 1995 to 2000; Census 2000 Special Reports; Issued August 20039

The map below shows annual rates of migration for Alaska in different areas of the .pdfSection II: Occupational Data and Trends for the Health ServicesSectorThis section will describe data and trends regarding the health service sector as a whole, a profileof the healthcare workforce, number of workers and projected needs, vacancy rates,qualifications and hiring issues, as well as data on recruitment and retention.Healthcare Services SectorIn terms of the health service sector overall, the Department of Labor in Alaska reported that thehealth services industry is the fastest growing, and one of the larger sectors of Alaska’seconomy. It’s a billion-dollar industry, and it employs about 22,000 people.4 As the pie charts onthe next page indicate, health services compose 7% of the states employment, with 60.9% of jobsin healthcare offered through hospitals or doctor’s offices. In terms of income, health servicesand hospitals are above the state average for annual average earnings.According to a Health Resources and Services Administration (HRSA) workforce profile onAlaska,5 health services employment in Alaska grew 74% between 1988 and 2000, while thestate’s population grew by 16% during that period. This is a net per capita growth of 50% inhealth services sector employment, more than double than the national rate of growth e/reports/statesummaries/alaska.htm10

11

Other data from the HRSA Profile breaks down certain trends for different professionals.Presented here are some data for healthcare workers6:MedicineThere were more than 1,000 active patient care physicians in Alaska in 2000, or 166 physiciansper 100,000. This falls well below the national ratio of 198 physicians per 100,000 (40th in U.S.).Alaska had 71 active primary care physicians per 100,000 population in 2000, slightly higherthan the rate of 69 per 100,000 for the entire country. The number of physicians in Alaska grew49% between 1989 and 2000, while the population grew 15% over this period. This is a net percapita growth of 30%, compared to the national per capita increase of 17%. There were 95physician assistants practicing in Alaska in 2000. This was equal to 15.1 physician assistants per100,000 population, slightly higher than the national rate of 14.4. Alaska ranked 22nd in thenation in physician assistants per capita.NursingThere were 782.9 RNs per 100,000 population in2000, higher than the national rate of 780.2. However,Alaska ranked last among the states in the per capitaemployment of Licensed Practical/Vocational Nurses(LPNs), with 66.9 LPNs per 100,000 population ascompared to the national rate of 240.8 per 100,000.Alaska also ranked last in the number of LPNsemployed in the state in 2000 with 420 workers.There were 420 nurse practitioners in Alaska in 2000.This was equal to 66.9 per 100,000 population, givingAlaska one of the highest ratio of nurse practitionersper capita in the nation.PharmacyThere were 320 pharmacists and 320 pharmacytechnicians and aides practicing in Alaska in 2000.Alaska had 51 pharmacists and 51 pharmacytechnicians and aides per 100,000 population in2000, which ranked them 49th and 50th,respectively, among the 50 states.AidesThere were 630 home health aides and 1,370 nursing aides, orderlies, and attendants working inAlaska in 2000. Alaska had 100.4 home health aides and 218.3 nursing aides, orderlies, andattendants per 100,000 population in 2000 (44th and 50th, respectively, among the 50 rts/statesummaries/alaska.htm12

Healthcare Workforce Projections and Non-Resident WorkersTable 4 (below) presents data from the Alaska Department of Labor on 30 healthcare professionsin terms of number of professionals in 2002, projected workforce changes by 2012, as well as thenumber and percent of nonresident workers in a given occupation. This table is arrangedalphabetically. Tables 5 through 8 present the top 10 professions organized by 1) highest actual(“numeric”) number of workers by 2012, 2) percent of change in workforce, 3) number ofnonresident workers, and 4) percent of occupation that is nonresident (for all 30 occupations, seethe tables in Appendix C).Overall, in the period between 2002 and 2012, Alaska is projected to have an increase of 5,454professionals across the 30 occupations indicated. This equates to a 28% increase. The largestnumeric change (1,666) in this period is for registered nurses, followed by personal and homecare aides (621) and home health aides (473). Educational, vocational, and school counselors areexpected to have a decrease in positions of 13, followed by general pediatricians (10), socialscientists and related workers (15), and psychiatrists (17). The top three occupations with thehighest percent of change are pharmacists (48.6%), personal and home care aides (41.7%), andhome health aides (40.3%). The lowest percents of changes are for educational, vocational, andschool counselors (-2.7%) and social scientists and related workers (6.3%).The report indicated that there were 2,479 nonresident workers across the 30 occupations. Theprofession with the highest number of non-resident workers is registered nurses (685), while thelowest number is for marriage and family therapists (2), followed closely by social scientists andrelated workers (3), psychiatric aides (4), medical and public health social workers (7), andpsychiatrists (8). The top three highest percents of nonresident workers is general pediatricians(34.1%), pharmacists (25.8%), and physician assistants (23.9%); the lowest three percents werefor psychiatric aides (3.3%), marriage and family therapists (3.9%), and medical and publichealth social workers (4.0%).Table 9 summarizes data from tables 5 to 8 and presents the occupations that occur mostfrequently in the top 10 in terms of highest numeric increase and percent by 2012, as well as thehighest number and percent of nonresident workers. Four professions appeared in all four top 10lists: pharmacists (avg. rank 3.0), home health aides (avg. rank 4.0), registered nurses (avg.rank 4.8), and social and human service assistants (avg. rank 7.0). Two occupations appearedin three out of the four top ten lists: personal and home care aides (avg. rank 2.7) and physicianassistants (avg. rank 5.7).13

Table 4: Workforce Projections and Nonresident WorkersHealth Care Occupations Working in All IndustriesProjectedEmployment EmploymentOccupationTotalTotal(2012)7(2002)Child, Family, and School Social Workers764894Clinical, Counseling, and School Psychologists315384Counselors, All Other683843Educational, Vocational, and School Counselors476463Healthcare Support Workers, All Other470614Home Health Aides1,1731,646Licensed Practical and Licensed Vocational Nurses521609Marriage and Family Therapists7391Medical and Public Health Social Workers253340Mental Health and Substance Abuse Social Workers469648Mental Health Counselors302396Nursing Aides, Orderlies, and Attendants1,7042,148Occupational Therapists155186Pediatricians, General6474Personal and Home Care Aides1,4882,109Personal Care and Service Workers, All Other266344Pharmacists364541Physician Assistants185251Psychiatric Aides379411Psychiatric Technicians125151Psychiatrists83100Registered Nurses (Only some in BH)5,0046,670Rehabilitation Counselors346460Social and Community Service Managers626738Social and Human Service Assistants1,1231,501Social Scientists and Related Workers, All Other238253Special Education Teachers, Middle School232251Special Education Teachers, Preschool, Kindergarten, and Elementary School604664Special Education Teachers, Secondary School327354Substance Abuse and Behavioral Disorder 11.49.47.39.37.510.3

Table 5: Workforce Projections and Nonresident Workers by Numeric ChangeHealth Care Occupations Working in All Change%10WorkersRegistered Nurses (Only some in BH)5,0046,67033.36851,666Personal and Home Care Aides1,4882,10941.7216621Home Health Aides1,1731,64640.3246473Nursing Aides, Orderlies, and Attendants1,7042,14826.114444480Social and Human Service Assistants1,1231,50133.737834Mental Health and Substance Abuse Social 3.4Counselors, All Other683843160Healthcare Support Workers, All Other47061430.61421443825.7Substance Abuse and Behavioral Disorder Counselors513645132Table 6: Workforce Projections and Nonresident Workers by Growth Rate %Health Care Occupations Working in All IndustriesProjectedEmployment 454117726248.6Personal and Home Care Aides1,4882,10962121641.7Home Health Aides1,1731,64647324640.334Mental Health and Substance Abuse Social Workers46964817938.279Physician Assistants1852516635.77Medical and Public Health Social Workers2533408734.480Social and Human Service Assistants1,1231,50137833.7Registered Nurses (Only some in BH)5,0046,6701,66668533.329Rehabilitation Counselors34646011432.916Mental Health 1325.88.911.96.923.94.011.414.87.06.2

Table 7: Workforce Projections and Nonresident Workers Organized by Nonresident WorkersHealth Care Occupations Working in All IndustriesProjectedEmployment resident(2012)7(2002)Change%10WorkersRegistered Nurses (Only some in 62Home Health Aides1,1731,64647340.3246Personal and Home Care Aides1,4882,10962141.7216Nursing Aides, Orderlies, and Attendants1,7042,14844426.1144Healthcare Support Workers, All Other47061414430.6142Personal Care and Service Workers, All Other2663447829.311580Social and Human Service Assistants1,1231,50137833.7Physician Assistants1852516635.779Licensed Practical and Licensed Vocational 1.98.97.06.811.311.423.913.7Table 8: Workforce Projections and Nonresident Workers Organized by % Nonresident WorkersHealth Care Occupations Working in All IndustriesProjectedEmployment , ician Assistants1852516635.779Registered Nurses (Only some in BH)5,0046,6701,66633.3685Licensed Practical and Licensed Vocational Nurses5216098816.97211Clinical, Counseling, and School Psychologists3153846921.9Home Health Aides1,1731,64647340.324680Social and Human Service Assistants1,1231,50137833.7Personal C

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