Workforce Development Expert Panel Meeting
April 7 & 8, 2008
SAMHSA/CSAT Office, Rockville MD
Attendees:
Dr. Anthony Floyd, University of Washington/Alcohol & Drug Abuse Institute
Dr. Thomas Hilton, National Institute on Drug Abuse
Dr. Robert Hubbard, National Development & Research Institutes, Inc.
Deann Jepson, ATTC National Office
Mary Beth Johnson, ATTC National Office
Dr. Hannah Knudsen, University of Kentucky
Laurie Krom, ATTC National Office
Cathy Nugent, Center for Substance Abuse Treatment
Nancy Roget, Mountain West ATTC
Dr. Michael Shafer, Pacific Southwest ATTC
Dr. Anne Helene Skinstad, Prairielands ATTC (Day 1)
Flo Stein, Department of Health and Human Services (Day 1)
Dr. Jack Stein, Center for Substance Abuse Treatment
Facilitator:
Dr. Robert Atanda, Center for Substance Abuse Treatment
Guest Attendees:
Deepa Avula, Center for Substance Abuse Treatment (Day 1)
Deb Trunso, Center for Substance Abuse Treatment (Day 1)
Welcome and Introductions - 8:30 am – 9:00 am
Cathy Nugent opened the meeting by introducing everyone in the room. She also defined the role of the Workforce Survey Expert Panel as advisory, offering insight and wisdom on how to move the National Survey forward. CSAT is looking for input on the demographics of the workforce; anticipated workforce development needs; and common strategies & methodologies to prepare, retain and maintain the workforce.
Mary Beth Johnson reviewed who the ATTC Network serves, where the ATTC Regional Centers are located and the role of the ATTC Network. Ms. Johnson also described the layout of the meeting agenda and timetable.
(See Welcome PowerPoint slides - Welcome.ppt)
CSAT Vision – 9:00 am – 9:30 am
After the day’s agenda was reviewed, Jack Stein began the meeting thanking everyone for their participation in this project, and he was glad to have both representation from the research and research applications side. He talked about the CSAT vision for the national workforce survey and how it should help describe the workforce. He envisioned this group to have conversations about the target audience; who will be surveyed; where those surveyed will be working and what data needs to be collected.
Dr. Stein first talked about the term Dr. Wesley Clark is using, Recovery-Oriented Systems of Care, which is a more strength-based approach and looks at addiction from a more comprehensive perspective. The substance abuse treatment experience is just one component in an ongoing continuum of care and recovery services and is an integral part of that whole continuum. In addition, the workforce challenges are multiple and the ROSC approach is a paradigm shift.
Dr. Stein stated, “For purposes of this project, the focus will be on the clinical treatment perspective, in terms of funding and providing support to the field.” He continued by saying the workforce currently is in dire straights, at least from our best guesses. There have been quite a lot of snap shot views, including the extensive work done by the ATTC Network on state workforce surveys and the work by Thomas McClellan, which surveyed the needs of the treatment system. Dr. McClellan reported there was at least a 50 percent turnover in counseling staff. Dr. Stein stated, “We’re not sure if this is still true.” There was also a report/study on the lack of IT conducted a few years ago. One goal of this project is to have some good benchmarks/foundational milestones in order to get a good grasp of our understanding of the field.
Dr. Stein looked at the US Department of Labor Occupational Outlook Handbook (2008-2009 edition). In this handbook there is a general category of counselors and a sub-component for substance abuse. According to this handbook, 635,000 people were identified as counselors and in the substance abuse category, there were 83,000 behavioral counselors. In addition, in the general counseling category, between the years 2006 through 2016, they’re expecting to see 21 percent growth and in the substance abuse counselor category, they’re expecting a 34 percent increase. The Department of Labor’s reasoning was that more people are seeking treatment and there’s a better attitude toward addiction treatment. Dr. Stein said CSAT typically talks about 13,000 treatment programs in the country. He also mentioned this is a field in which we need to be recognized from a strength-based perspective. The US Department of Labor is identifying substance abuse as an occupation possibility and those who are coming into this field should recognize there are a lot of opportunities here.
CSAT wants to get a national picture of the workforce. Keeping in mind our limited resources, this project is for CSAT and the ATTC Network to use and develop our own appropriate training for the future. This is not a research study. It’s not a large household survey which will answer every question.
While working on the survey, we also need to keep in mind upcoming therapies, such as medication and behavioral therapies, incorporation of SBIRT, etc. We need to try and answer the following questions:
1. What are the basic demographics (Keeping it to a bare minimum while still remaining useful.)?
2. What are the anticipated training needs around the time this survey comes out (covering 2010-2015)?
3. What strategies & methodologies work best to train and prepare the workforce (Keeping in mind where technology is going.)?
He further described our target focus, which includes direct or frontline providers and directors in treatment organizations. These organizations are the 13,000 listed in the SAMHSA Treatment Locator. They are both publically and privately funded. Most are licensed, but not all.
Jack Stein opened the floor for comments and questions:
· Nancy Roget stated that the SSAs in her region would be very interested in salary information.
· Anne Helene Skinstad requested that we ask questions regarding clinical supervision.
· Aaron Williams recommended making the survey relevant at the state level.
Review of ATTC Survey Activities – 9:30 am – 10 am
Cathy Nugent thanked Jack Stein for his comments and then invited Robert Hubbard to the podium to present his compiled report on the ATTC Survey activities.
(See Review ATTC Activities PowerPoint slides – Review ATTC Activities.ppt.)
Robert Hubbard made additional comments and posed some questions during his report.
They are as follows:
Dr. Hubbard commented that we need to understand the levels of care within the organization. Patients and staff float among different roles and treatment organizations. These organizations are linked with the SAMHSA Treatment Locator. In building the National survey, we need to know how well the sample represents the frame and get enough data for the sample. We must choose the sampling very carefully.
As for the ATTC workforce surveys, they were extremely variable. The picture of the staff is limited.
Dr. Hubbard also asked a few questions while he was presenting. The following questions were raised:
1. Are Agency Directors giving the survey to those who can fill it out?
2. Do we need to create a listing of all staff? Response rates would be labor intensive.
3. Are there resources already available?
4. What competencies are we looking for as a Network?
5. People will participate knowing what will happen after the survey. How can we help the workforce see this survey as valuable?
6. Should we consider training needs versus who are the workers?
7. Perhaps look at these sampling approaches. Can we extract some information from these databases?
8. How important is state buy-in?
9. What is the training at the state level?
10. What is our focus?
He also stated there are good measures out there for treatment but not in recovery. Areas to consider include demographics, credentials, and job satisfaction.
Overview of the National ATTC Evaluation – 10:00 am – 10:20 am
Next scheduled was Deepa Avula’s overview of the National ATTC Evaluation. She presented the information by PowerPoint. (See Overview of National ATTC Evaluation PowerPoint slides – Overview of National ATTC Evaluation.ppt)
After her presentation, there was a 15 minute break.
Workforce Survey Goal – 10:35 am – 11:30 am
Jack Stein spoke about the Workforce Survey Goal. He began by introducing a workforce survey goal originally stated by the National Association of Social Works (NASW):
To gather relevant data to support the development of effective workforce policies and strategies to assure
the availability of adequate numbers of providers prepared to respond to the growing needs of individual’s families and communities in need of treatment and recovery services.
Dr. Stein solicited comments regarding this goal. There was much discussion among the group and the following comments and suggestions were noted:
Nancy Roget suggested that the goal needed to mention something about training. The thrust of training and technical assistance is not embedded there. Cathy Nugent interjected by saying she saw the training piece embedded by the way the providers are prepared to meet the needs of individual’s families and communities.
Furthermore, Ms. Roget commented she will have less buy-in from SSA’s if CSAT asks what are the training needs rather than asking questions about where a worker plans to be working in the next 5 years, what is this person’s academic level, what is their salary status, have they used tobacco, do they have access to computers and are they using computers at work; or other questions which will give a snapshot of the workforce. She said there are questions in her workforce survey inquiring about online/internet use and how familiar an individual is with TAP 21 and TAP 21-A. The findings told her there’s more work to be done regarding TAP 21-A. She closed by saying her SSAs are interested in seeing any differences in, for instance Colorado’s workforce compared to Wyoming’s. They’re also interested in trends such as are these nationwide trends or does this apply only to the east and west coasts? With these findings, CSAT and the ATTC Network can develop different workforce development activities.
Mike Shafer asked, “What are the critical questions to ask about how do we get them into the field? How do we keep them in the field? What are the career ladder perspectives/opportunities for them?” He also said we should keep in mind those topical questions with a policy spin instead of just what are the training needs, given our limited funds. We should carefully consider the line of questioning. He mentioned the Arizona Provider Association (APA) Bi-Annual Salary Survey. This is a market adjusted salary survey done every 2 years. This helps APA see where their pay scale falls relative to their competitors. Seeing this data has been a huge driver toward recruitment and retention issues. Dr. Shafer would like to get a better handle on who is actually credentialed and licensed within each state too.
Cathy Nugent added clarification by saying she needs information which will help her (CSAT) write an ATTC program announcement and RFA, keeping in mind this survey can also be useful to other audiences. Also, she needs information to answer what does the ATTC Network need to know in order to identify workforce needs and which strategies should be used.
Hannah Knudsen stated she liked the idea of core competencies which address what we asking the counselor to do.
Aaron Williams would like to trace the migration of the workforce. He asked if this is something we can use 5, 10 years from now and actually track the migration of the workforce.
The discussion closed with a group consensus on the following questions
1. What are the demographics of the workforce?
2. What are the anticipated workforce development needs for 2010 – 2015?
3. What are the common strategies & methodologies to prepare, retain and maintain the workforce?
Break-Out Session Discussion – 11:30 am – 12 noon
Following this discussion, Robert Atanda introduced the agenda for the Break Out sessions. He divided everyone in to three groups to answer each of the above questions. Instructions were given out as to the process and format of the groups. Then lunch was served.
The I-SATS Data Set Presentation and Discussion – 12:45 pm – 2:30 pm
Subsequently, Robert Atanda presented an overview of the Drug and Alcohol Services Information System’s (DASIS) Inventory of Substance Abuse Treatment Services (I-SATS) data and National Survey of Substance Abuse Treatment Services (N-SSATS) survey. He also distributed a handout outlining the areas of the N-SSATS and what is collected. (see PowerPoint– N-SSATS_2.ppt.)
In addition to the information on the PowerPoint, Dr. Atanda made some additional comments. They are as follows:
In the I-SATS survey, 80% of the providers are approved. Those not approved are not licensed through the states.
In comparison, the N-SSATS survey has a 96.5 % response rate and is very labor intensive. With the first mailing, DASIS receives about a 30% response rate, which is followed by more mailings and telephone calls. Those that are out of scope (half-way houses, sole practitioners, jails, etc.) are not included in the N-SSATS survey analysis. On March 31st annually, hospitals are asked how many clients are at their facility. Eighty percent surveyed are outpatient facilities and 60 percent are private/non-profit, and the facilities are evenly distributed throughout the Network regions.
After his presentation, Dr. Atanda asked for questions and comments. Mike Shafer wanted to know the inclusion and exclusion criteria. Dr. Atanda answered by saying we need more clarification from Deb Trunso regarding the criteria. However, you can get I-SATs information through the state and updates are made through the state. This is a mail survey with follow-up. Facilities are also searched through the American Business Index and the American Hospitals Association.
There was discussion on how many provider agencies were in the survey and in which state. To practice in North Carolina, you have to be registered. Flo Stein mentioned that there is access to this data.
The following numbers were mentioned:
NC– 537 facilities in the survey.
DE – 49
MT – 77
CA – 2303
TX – 686
NY – 1200
MI – 612
FL – 1200
Every other state is under 500.
CO – 533, inflated number. The rest are assessments and DUI facilities.
The group then asked, “Do we go through agencies or licensing/certification boards and what constitutes a facility?”
Deb Trunso, CSAT staff member responsible for the ISATS and N-SSATS reports, came to the group to answer questions about the I-SATS data and N-SSATs survey. She said the survey covers specialty substance abuse units and every site where services are delivered. Within a site there can be more than one level of care. When asked about the definition of facility, she stated that it is difficult to come up with a definition of facility that suits every one’s needs. The core most of us can generally agree on, but along the fringes it can present complications, depending on the objectives.