Workforce 1
Final Report on Workforce Survey
(4/3/06)
by
William J. Payne, M.A., LADC
Mark Stasson, Ph.D
Metropolitan State University.
“Substance abuse treatment can only be as good as the workforce which delivers it.” (Harvatich, 2002)
Introduction
“There has been a growing recognition that the substance abuse field is facing a workforce crisis. Recruitment and retention of staff have surfaced as critical problems for many agencies and programs…couple these obstacles with the other pressures in the field, such as managed care, as well as the pressures to adopt new evidence-based practices…make the need to address workforce issues apparent and urgent.” (Kaplan, 2003)
Policy makers and researchers lament the lack of data pertaining to the substance abuse workforce and how this hampers workforce development efforts. As of 2002, it was estimated that there were more than 67,000 practitioners who provide psycho-social services for substance abuse treatment nationally. The workforce is a medley of counselors with a mixture of professional and experiential training. Their academic training is highly variable with a range of degree and certificate programs from many disciplines including psychology, social work, nursing, divinity and addiction counseling. This diversity, combined with lack of data about the workforce characteristics and attitudes, inhibits efforts to strengthen and improve this workforce (McCarty, 2002, Harwood, 2002).
“Inadequacy of quantitative workforce data…severely hampers analysis of supply and demand. In addition,…there is anecdotal evidence of this shortage of staff. Furthermore, the increasing ethno-cultural diversity in the treatment population calls for a workforce that is ethnically and culturally diverse and sensitive to the cultural concerns of different client groups.” (SAMHSA, 2000)
According to Kaplan (2003), by 2010, the number of mental health and behavioral health workers is projected to increase by 27%. The number or substance abuse clinicians are expected to grow to 116,000 by this time, making it a rapid growing profession. The impact of this projected growth is hard to determine from existing data.
It was in response to this lack of workforce data which led Metropolitan State University in collaboration with the Chemical Health Division of the Minnesota Department of Human Services (DHS) to conduct a Workforce Survey in conjunction with mandated state-wide training on co-occurring disorders.
The workforce data was collected in 60 training sessions delivered over a 12 month period in 2004-05. With nearly 1400 respondents, the results of workforce survey provided the most comprehensive and authoritative picture of the substance abuse treatment workforce ever collected in Minnesota.
This Co-occurring Training Project was directed by the Chemical Health Division of the MN Department of Human Services and delivered by Metropolitan State University in collaboration with the Division of Continuing Education and Training at Minneapolis Community and Technical College.
The workforce survey was one of the evaluation instruments of the Co-occurring
Training Project. This project delivered 60, 2-day (12 hour) training sessions from October 2004 to September 2005, for chemical dependency staff from Rule 31 programs from across the state of Minnesota, on the co-occurrence of mental health issues among their chemical dependency clients.
Respondents in these training sessions were clinical staff members from Rule 31 (Chemical Dependency Treatment) Programs in MN. Rule 31 requires, ”Treatment directors, supervisors, nurses, and counselors to obtain 12 hours of training in co-occurring mental problems and chemical dependency….” (MS 9539.6460, Personnel Policies and Procedure Subp. 2 Staff Development, paragraph E). So, training respondents (subjects) were mandated by DHS under this Rule 31 training requirement, to attend this training. As a result, they were recruited to fill-out the evaluation instruments which were related to it.
There were five evaluation components designed for this training Project. DHS required these evaluation components to be part of the training delivery to evaluate the training and to determine the make-up of the chemical dependency workforce in Minnesota. These evaluation components were as follows:
1. Pre/Post Tests: the Pretest was designed to first measure an initial base-line of information regarding workforce knowledge of co-occurring disorders. Then, to measure any increase in knowledge as a result of the training the Posttest was administered. Findings from the Pre/Post test results are included in a separate report. (See Report on Pre/Post Test Results)
2. Training Evaluation: the purpose of this evaluation component was to determine the respondents’ experience and satisfaction with the training sessions, the course content and the trainer. Findings from the training evaluations are included in a separate report. (See Report on Respondent Evaluation of Training)
3. There was also an evaluation which the trainer for each session filled out regarding their experience and satisfaction with delivery and respondent response to the training session. A summary of these evaluations are included in separate report. (See Report on Trainer Evaluation of Training)
4. Outcome Evaluation: A short outcome or follow-up evaluation of the training which was conducted 6 months after the last of the 60 training sessions were delivered. This was administered in March, 2006. This evaluation helped to determine the impact of the training sessions had on the knowledge, skills, attitudes, program changes and improvements in client outcomes. (See Report on Outcome Evaluation)
5. Workforce Survey: workforce development is a very important issue for the substance abuse field. Since it appeared no one had an up to date picture of our chemical dependency counseling workforce in Minnesota, DHS was very interested in supporting the survey which is the subject of this report.
Overall Description of the Workforce Survey Tool and Processes
The purpose of the workforce survey was to collect a database of information about the chemical dependency counseling profession in Minnesota. The instrument used to collect the information from training respondents was designed by Bill Payne (Co-occurring Training Project Coordinator and Assistant Professor, Human Services Department, College of Professional Studies) and Mark Stasson (Project Consultant and Professor, Psychology Department, College of Professional Studies). The university’s Institutional Research Department provided formatting of the survey instrument, data entry and output of the data.
The 12-page survey contained 92 items for respondents to respond to. The items were group into the following four data categories:
o Demographics: 35 items (1-35)
o Professional status: 6 items (36-41)
o Professional Development: 12 items (42-53)
o Attitudes about the Professional Practice of Alcohol and Drug Counseling: 39 items (54-92)
The workforce survey was reviewed by the Universities’ Human Subjects Review Committee and found to contain “Minimal Risk” of harm by asking respondents to complete it. (i.e. “not exposed to physical, psychological, or social risks in excess of that in normal daily life.” See Metropolitan State University Policy #2060 on Human Subjects Research Review)
The procedure used to administer the workforce survey to respondents was for the trainer to:
o Handout the survey to respondents at the beginning of the two-day training session,
o Read: a prepared script which described the purpose of this evaluation component (Training Manual p. 91), a statement to assure that respondents were aware of their rights and protections (i.e. confidentiality),
o The survey would be collected at the beginning of the next day’s training, i.e. “this is your homework.”
o Finally, trainer collected the workforce surveys from each of the respondents at the beginning of the second training day.
In order to comply with institutional human rights review standards the following chain of custody for the survey as adhered to:
o The collected surveys were then forwarded (hand delivered or mailed) by the trainer to the support staff person for the Co-occurring Training Project.
o The support person counted the surveys to determine if there were any missing from the training session. This information was tabulated into a “Training Log.”
o The support person then delivered the surveys to Institutional Research, who scanned each survey and then returned them to the support person for secure storage.
o Institutional Research then produced a summary report of the aggregate data using SPSS (Statistical Package for the Social Services) which was collected from the surveys.
o Each month, as the training sessions were being delivered and data collected, an evaluation meeting was held to monitor the data collection, processing, and outputs to assure quality control.
A Composite Picture of the Clinician Population
A sampling of the data from the workforce survey provided important insights into the characteristics, attitudes, and beliefs of clinicians who provide chemical dependency services in MN. It also revealed interesting and sometimes surprising information about the following questions: Are a majority of counselors in recovery from their own addiction? What is their educational background? How much do counselors get paid? What is the gender and cultural make-up of the workforce? Is this workforce really aging?
Summary of Demographic Characteristics (Part 1) – Data from respondents to the workforce survey indicated the following composite picture of the personal characteristics of the workforce in MN:
o Female (#1)
o Mean age 47 (#2)
o White (Caucasian): (#3)
o They have at least a BA/BS degree (#4)
o They are not in recovery from chemical dependency (#27)
o They are non-smokers (#32)
Summary of Professional Characteristics (attitudes, etc) (Parts 1, 2, 3) – Data from respondents to the workforce survey indicated the following composite picture related to the professional characteristics of the workforce:
o Employed full-time (#13), work “day” hours (#14), at a non-profit agency (#16), which is either an Outpatient or Inpatient program (#17).
o They have been employed in their current job for 7 years (#18) and worked in the field for 12 years (#23)
o Their median annual salary was in the $35-39,000 range (#19), plus health insurance, sick leave, a TSA/401K, and most likely get continuing education paid for (#20).
o They are licensed (#8).
o Participate in at least 25 hours of continuing education each year (#6).
o Their caseload averages 17-18 clients (#22).
Note: Nationally, the “typical” clinician is a white, middle-aged woman with master’s-level training, about 10 years of experience in substance abuse counseling, and less than 5 years tenure at her current position (Harwood, 2002).
Professional Status - With regard to professional status respondents believe that:
o Chemical dependency counselors have a lower status when compared to other professions (#36)
o The best way to improve employment or retention is to raise salaries (#38)
o The biggest challenges to the field today are; client funding, more difficult clients, politics, licensure, and better client outcomes (#39)
Satisfaction - This section of the survey reflect some interesting issues related to respondent with the work that they do. A factor analysis was used to group the 16 of the 17 items in this section into four factors related to their satisfaction. They were:
o Factor 1: Satisfaction with Work Environment (items: b, e, f, g, h, i)
o Factor 2: Satisfaction with Quality of Care (items: n, o, p, q)
o Factor 3: Satisfaction with Case Load Management (items: j, k, l, m)
o Factor 4: Satisfaction with Pay and Benefits (item: c, d)
Overall, respondents are satisfied with their jobs. Furthermore, they are most satisfied with the “quality of care” they provide and their “work environments” and least satisfied with “case load management.”
Professional development - Regarding their professional development, respondents indicated the following highlights:
o Most have access to a computer (#42), it several times per day (#44), but could use more skill in using it (#45)
o Respondents have only “some” familiarity with evidence-based practices (#47)
o They rate themselves as having a high degree of competence in “ethics” (#48), but lower with regard to “cultural competence,” (#49)
o They keep up to date on counselor or treatment practices mostly by attending continuing education workshops and conferences (#51), but read only 3 books or 10 journal articles per year on counseling practice (#52, #53)
Attitudes about professional practice - This section of the survey reflect some interesting issues related to respondent attitudes, values and believes about their practice of chemical dependency counseling, A factor analysis was used to group the 39 items in this section into six core areas of professional attitudes. They were:
o Core Area 1: Evidence-Based Practices should be used more often (items: 77, 79, 80, 81, 82, 83, 54, 60, 61)
o Core Area 2: Medications should be used more often (items: 73, 74, 75, 76)
o Core Area 3: Traditional Approaches should be used more often (items: 65, 66, 89, 90, 68, 69, 70, 88, 58, 71)
o Core Area 4: Research in Chemical Dependency has little value (items: 55, 56, 57, 59)
o Core Area 5: Evaluation and Assessment Tools are valuable (items: 84, 85, 86, 87)
o Core Area 6: Chemical Dependency Education is valuable (items: 62, 63, 64)
In general, respondents were most positive in their attitudes about “Evidence-Based Practices” (Core Area #1) and “CD Education is Valuable.”(Core Area #6) Core Area #4, which is an assessment of whether CD research has value, yielded a negative response, which is essentially an endorsement of the benefits of research.
Workforce Development Issues
As a result of review and analysis of the data from this Workforce Survey, the authors would make the following seven recommendations, as the top priorities for chemical dependency workforce development in MN. These items are not listed in priority order.
o Recruit and train a more culturally diverse and bi-lingual workforce (Q #3 & Q #10).
o Raise salaries to improve recruitment and staff retention. This will increase job satisfaction and reduce turnover (Q #38)
o Raise education and training standards for counselors, MN has a lower educational standard than the national workforce, i.e. MA degree (Q #38).
o Improve supervision, a significant number of clinical staff receive little or no clinical supervision (Q # 38).
o Improve the cultural competence of the workforce (Q #48).
o Improve the awareness and use of Evidence-Based Practices to improve client outcomes (Q #47 and Attitudes section).
o Improve the skills of workforce related to computer technology (Q #45).
Part 1: Demographic, Workplace, and Recovery Information (35 items, 1-35)
The chemical dependency workforce includes a wide array of practitioners who address a range of client problems in a variety of settings. The professionals who provide care to people with substance abuse problems are a diverse lot. Part 1 of the survey attempts to present a picture of some of the personal and professional characteristics of our workforce.