Getting and Keeping a Rural Workforce Lessons from

Getting and Keeping a Rural Workforce: Lessons from the WICHE West Dennis Mohatt Vice President for Behavioral Health - WICHE ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

WICHE region • • • • Alaska Arizona California Colorado Hawaii Idaho Montana Nevada New Mexico North Dakota Oregon South Dakota Utah Washington Wyoming ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

Workforce success is all about P. I. E. Proximity – Provide care close to home Immediacy – Identify and treat early Enthusiastically – Treat with hope ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

There is not one rural … ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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) ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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 ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

Mental health professional shortage areas ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

Health professional shortage areas: primary care State CO ID ND NM NV OR UT WA WY Total Counties 63 44 53 33 17 36 29 39 23 Primary Care HPSA 43 32 41 39 32 48 24 56 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. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

Community systems of care Entry & Exit Acute Need for Care Recovery Community Rehabilitation Services Inpatient 24 Hour Total Care ACT Partial Hosp. Etc. Formal System Informal Community Support Crisis & Assessment 7 days/week Outreach in acute short term Community Psychosocial Formal Based Treatment Rehab Services 7 days Rehabilitation Outreach Community Support Primary Care Specialty Care Outpatient Care Mgmt. Day Programs Group Homes Self-Help Primary Prevention Mentoring Etc. Residential Natural Support & Care ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

Defining mental health workforce § Mental health & Substance abuse § Wide range of ü ü Disciplines (psychiatry, psychology, social work, nursing) Providers (psychologists, counselors, psychiatric nurses) Professional levels (paraprofessional to graduate level) Services (treatment, prevention) ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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 ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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 ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

- Population of Focus + Behavioral health workforce – grow your own strategy logic model sssss Increase knowledge of behavioral health ssss Exchange knowledge about behavioral health careers sss Provide accessible behavioral health training ss s Applied training opportunities Job ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

Examples from the West … Alaska leads the way ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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 ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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 ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

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 § § ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

www. wiche. edu/mentalhealth § § § § § Dennis Mohatt Mimi Mc. Faul Deb Kupfer Jenny Shaw Chuck Mc. Gee Tamie De. Hay Maurene Flory Nicole Speer Jessica Tomasko ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING