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Resource Development Associates

WET Five-Year Plan: Evaluation of First WET Five Year Plan, Stakeholder Engagement, County Needs Assessment, and Literature Review Interim Findings. January 17, 2014 Amalia Freedman Kevin J. Wu, MPH. Resource Development Associates. Topics.

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Resource Development Associates

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  1. WET Five-Year Plan:Evaluation of First WET Five Year Plan, Stakeholder Engagement, County Needs Assessment, and Literature ReviewInterim Findings January 17, 2014 Amalia Freedman Kevin J. Wu, MPH Resource Development Associates

  2. Topics State-Administered WET Program Evaluation, 2008-2013 OSHPD-led Stakeholder Engagement County-Reported Needs Assessments Literature Review: Public Mental Health Workforce Demand and Supply Public Mental Health Workforce Supply Projections, 2014-2019 Literature Review: Educational Capacity Literature Review: Public Mental Health Graduation to Workforce Participation

  3. State-Administered WET Program Evaluation, 2008-2013 Highlights

  4. State-Administered WET Program Evaluation, 2008-2013:Approach • Evaluated program impact by actions and direct outcomes: • General capacity • Cultural and linguistic competency • Formal education structure and curricula • People with lived experience in the workforce • Filling gaps in the five regions • Data gathered via multiple methods: • Baseline: 2008 needs assessment • Progress: 2013 progress reports • Impact: 2013 needs assessment and RDA interviews and county survey

  5. State-Administered WET Program Evaluation, 2008-2013:Limitations • 2008 Baseline data limitations: • Only 28 counties submitted data for the baseline report (2008) • Cannot disaggregate (e.g., by county, rural/urban/suburban, etc.) • Very limited in baseline information pertaining to two outcome areas: Formal Education Structure and Curricula and Filling Gaps in Five Regions • Progress data limitations: • Inconsistent reporting from programs • No consistent measures for looking at progress in Formal Education Structure and Curricula and Filling Gaps in Five Regions

  6. State-Administered WET Program Evaluation, 2008-2013:Limitations • Impact data limitations: • 2013 County follow-up survey that identified perceived impact of state-administered WET programs was voluntary and resulted in low response rate of 26 counties compared to the first county needs survey that had 41 responses • 2008 Baseline survey data were only available for 28 counties • Only 12 counties were represented in both baseline (2008) and county survey (2013) county lists • 16 counties for which no data were collected at all

  7. State-Administered WET Program Evaluation, 2008-2013 Stipend Programs: increased the number of licensed mental health professionals in the Public Mental Health System (PMHS) via contracts with educational institutions to provide stipends to students and incorporates MHSA principles into graduate level curriculum. Graduate degrees disciplines receiving stipends include Master of Social Work, Marriage and Family Therapist, Clinical Psychology, and Psychiatric Mental Health Nurse Practitioner *Song-Brown Program for Physician Assistants in Mental Health: funded Physician Assistants (PA) programs that add a mental health track so that PAs can sign mental health treatment plans, transmit orders for psychotropic medications on behalf of supervising psychiatrist, and prescribe and administer psychotropic medications Psychiatric Residency Program: Funded Psychiatric Residency Programs to trains psychiatric residents in the PMHS, working with the populations prioritized by that community *Mental Health Loan Assumption Program (MHLAP): offered loan repayment of up to $10,000 to mental health providers in hard-to-fill and/or hard-to-retain positions in the PMHS in exchange for a 12-month service obligation Client and Family Member Statewide Technical Assistance Center: Funded Working Well Together (WWT) to engage in activities that promote the employment of mental health clients and family members in the public mental health system Regional Partnerships: represents Bay Area counties, Central Valley counties, Southern counties, Los Angeles County, and Superior Region counties; includes representation from mental health, community agencies, educational/training entities, consumers, family members, and other partners to plan and implement programs that build and improve local workforce education and training strategies *Shortage Designation: reviews and recommends Primary Care, Dental, and Mental Health Professional Shortage Area (HPSA) and Medically Underserved Area/Medically Underserved Population (MUA/MUP) applications to HRSA’s Shortage Designation Branch * = Administered by OSHPD prior to July 1, 2012 transfer

  8. State-Administered WET Program Evaluation, 2008-2013:Key Findings • The vast majority of the statewide-administered WET programs align with needs identified at the beginning of the 2008 planning process. • MHLAP, MFT stipend, MSW stipend programs rated as effective in filling service needs with MHLAP being rated as most effective with an average rating of 3.42* • Physician Assistant MH program was not an identified need, rated as least effective * Rating was on a scale of 1 (not at all effective) – 4 (very effective)

  9. State-Administered WET Program Evaluation, 2008-2013:Key Findings (continued) Programs successfully recruited and engaged people of color and people with non-English language proficiency Sixty-six percent (66%) of MHLAP participants reflected underrepresented populations in PMHS Regional Partnerships collaborated with local colleges, strived to provide cultural/linguistic competency preparation for upcoming workforce

  10. State-Administered WET Program Evaluation, 2008-2013:Key Findings (continued) • Curriculum changes have been noted that demonstrate alignment with MHSA principles • Universities expanded cultural competency training, knowledge of evidence-based practices, recovery principles into teaching approaches • Regional Partnerships worked with local institutions to advance curricula corresponding to workforce needs within PMHS workforce

  11. State-Administered WET Program Evaluation, 2008-2013:Key Findings (continued) • WWT trainings, TA visits and webinars focused on increasing the participation of people with lived experience have been offered to counties in all regions • Created tools, and reports including a report on peer certification for use by professionals working in public mental health system • Developed training curricula, offered trainings to support the recruitment, employment, and integration of consumers and family members in workforce • Provided individualized TA to counties geared toward increasing representation of consumers and family members in their workforce

  12. State-Administered WET Program Evaluation, 2008-2013:Stipend Programs • Funding is awarded to educational institutions to provide Stipends for graduate students in Social Work, Marriage and Family Therapy, Clinical Psychology, and Psychiatric Mental Health Nurse Practitioner who commit to working in the public mental health system for a 12-month period upon graduation • A total of 21 California schools participate by providing stipends and developing curricula that promotes the MHSA values of wellness, recovery and resilience Source: OSHPD

  13. State-Administered WET Program Evaluation, 2008-2013:Song-Brown Program for Physician Assistants in Mental Health • Physician Assistant (PA) programs are evaluated, in part, on whether they can demonstrate: • Community collaboration: • Cultural competence • What client and family-driven services are • Wellness, recovery, and resiliency • Ability to provide an integrated service experience for clients and their families • One of the goals is to ensure that PA students perform their rotations in rural and underserved communities including the public mental health workforce • From FY 2008-09 to FY 2012-13, grants of $15,000 to $167,000 were awarded to six PA programs and have enabled 1,382 PA students to be trained in MHSA principles and perform 6,046 hours of mental health rotations • The following six programs revised their PA program curricula to include the values and principles of the Mental Health Services Act: Keck School of Medicine-USC; Moreno Valley College; Samuel Merritt University; San Joaquin Valley College; Touro University; University of California, Davis • The above PA programs partnered with the following County Departments of Health and Mental Health to ensure that PA students provide integrated care: Fresno County Department of Behavioral Health; Fresno County Health Department; Riverside County Department of Mental Health; Sacramento County Department of Behavioral Health Services; Stanislaus County Health Services Agency Source: OSHPD

  14. State-Administered WET Program Evaluation, 2008-2013:Psychiatric Residency Program • The psychiatric residency programs ensured that the psychiatric residents receive training in the County public mental health system, working with the populations prioritized by that community. Further, the psychiatric residents are encouraged to continue working in the California public mental health system after their rotations end • From FY 2008/09 to FY 2012/13, there were two psychiatric programs that supported 25 psychiatric residency rotations at the University of California, Davis and the University of California, Los Angeles-Kern • The Psychiatric Residency programs revised the curricula to include the values and principles of the MHSA: • Community collaboration • Cultural competence • Client/Family-driven mental health system • Wellness/Recovery and Resilience focus and • Integrated service experience for clients and their families. • The Psychiatric Residency programs partnered with County Departments of Mental Health and Community-Based Organizations to ensure that residents perform their rotations in the County Public Mental Health System. Among them: Sacramento County Mental Health Services; Kern County Mental Health Services; UC Davis Medical Center; and West Kern Clinic (Wasco) Source: OSHPD

  15. State-Administered WET Program Evaluation, 2008-2013:Mental Health Loan Assumption Program (MHLAP) • Provides those working or volunteering in hard-to-fill/hard-to-retain positions in the public mental health system with up to $10,000 in educational loan repayments in exchange for service in the community public mental health system • From Fiscal Year 2008-09 to 2012-13 : • 2,373 public mental health workers have completed the loan repayment program • 56% of awardees spoke at least one language in addition to English • 55% of awardees had a consumer/family member background Source: OSHPD

  16. State-Administered WET Program Evaluation, 2008-2013:Client and Family Member Statewide Technical Assistance Center Working Well Together has developed the following resources: Assessment tools for agencies to recognize where they are in terms of engaging consumers and family members in the workforce Curricula for training individuals who identify as consumers and family members, and trainings to preparing the workforce for employing consumers and family members A toolkit for recruiting, hiring and retaining employees with lived experience within the public mental health workforce A white paper on how to successfully employ people with lived experience within the public mental health workforce Peer certification standards and recommendations for a statewide plan Working Well Together has completed 159 Technical Assistance visits, 34 training, which engaged a total of 3,677 participants

  17. State-Administered WET Program Evaluation, 2008-2013:Regional Partnerships

  18. State-Administered WET Program Evaluation, 2008-2013:Shortage Designation As of November 2013 there are 153 designated Mental Health Professional Shortage Area (MHPSA) 4,382,209 residents live in a designated MHPSA 102 MHPSA applications have been approved by HRSA since 2009 Source: OSHPD

  19. State-Administered WET Program Evaluation, 2008-2013:Number of Mental Health Professionals Impacted by State WET Programs *Includes Stipend Program for Social Work participants from beginning of program in 2005.

  20. State-Administered WET Program Evaluation, 2008-2013: Program Effectiveness Counties were asked to rate the effectiveness (impact) of each of the state-administered programs in placing or retaining personnel in hard-to-fill/retain positions * The survey did not include Regional Partnerships and WWT for this specific question. Scale: 1 (not at all effective) - 4 (very effective)

  21. State-Administered WET Program Evaluation, 2008-2013:Cultural and Linguistic Competency

  22. State-Administered WET Program Evaluation, 2008-2013:Cultural and Linguistic Competency Linguistic Capacity of 2008 Workforce and WET Progress toward Targets across All State-Administered Programs

  23. State-Administered WET Program Evaluation, 2008-2013:Cultural and Linguistic Competency

  24. State-Administered WET Program Evaluation, 2008-2013:Formal Education Structure and Curricula • Institutions reported many courses that highlighted • Use of evidence-based practices • Cultural competency across gender, race, religion, sexual orientation, etc. • Principles of wellness and recovery among adults and resiliency among youth • Several Regional Partnerships, in collaboration with local colleges and agencies, are developing public mental health professional core competencies

  25. State-Administered WET Program Evaluation, 2008-2013:People with Lived Experience 25 * Combines Southern/LA Region. • Working Well Together: • Working Well Together has completed 159 Technical Assistance visits, 34 training, which engaged a total of 3,677 participants • MHLAP • Provided loan repayment to 4 designated consumer and family member positions • 55% of awardees had a consumer/family member background • Regional Partnerships • Two regional partnerships have engaged in stigma reduction activities. • Stipend • In FY 12/13 40% of MFT and Psych NP, and 26 % of Clinical Psychologist stipend recipients had a consumer and family member background

  26. State-Administered WET Program Evaluation, 2008-2013:Meeting Regional Needs 26 * Combines Southern/LA Region. • Working Well Together: • Stipend: full time equivalent recipients employed from 2007-2011 • MHLAP • Supported 58 out of 60 counties/municipalities

  27. State-Administered WET Program Evaluation, 2008-2013:Meeting Regional Needs

  28. State-Administered WET Program Evaluation, 2008-2013:Recommendations for Future Practice Ensure that programs correspond to current workforce needs Ensure that the pathway to employment is considered so that programs can succeed in placing all graduates in the public mental health system workforce Ensure a strategic approach to consumer and family member workforce development

  29. State-Administered WET Program Evaluation, 2008-2013:Recommendations for Future Evaluation Track participation consistently Track LGBT and consumer/family member identification Track progress of Regional Partnerships with more consistent tools Monitor curricula with checklist

  30. OSHPD-led Stakeholder Engagement Highlights

  31. OSHPD-led Stakeholder Engagement: Overview • Purpose: To obtain stakeholder feedback on priority issues, challenges, and recommendations, including: • Public mental health workforce personnel needs • Training and education • Recruitment and retention • Employing consumers and family members • WET programs and partnerships

  32. OSHPD-led Stakeholder Engagement: Data Sources OSPHD led data collection efforts across multiple sources including:

  33. OSHPD-led Stakeholder Engagement:Key Findings Recommendations for increasing and sustaining the public mental health workforce: • Expand programs including: • financial incentive programs and • training and education programs • Strengthen opportunities for Consumer and/or Family Members by: • Providing support for consumers • Increasing training opportunities • Providing a peer certification program

  34. OSHPD-led Stakeholder Engagement:Most Referenced Public Mental Health Workforce Personnel Needs Question to Stakeholders: Based on your knowledge and experience, what type of workforce will be needed to address the public mental health workforce needs in your county or region?

  35. OSHPD-led Stakeholder Engagement:Training and Education What are the challenges to increasing and sustaining the public mental health workforce in your region? (Training and Education) What actions would you recommend to overcome those challenges?

  36. OSHPD-led Stakeholder Engagement: Recruitment and Retention What are the challenges and recommendations to increasing and sustaining the public mental health workforce in your region? (Recruitment and Retention)

  37. OSHPD-led Stakeholder Engagement:Employing Consumers and Family Members Do you feel an adequate number of mental health consumers and family members are being employed in the public mental health system? If not, why?

  38. OSHPD-led Stakeholder Engagement:Employing Consumers and Family Members What actions would you recommend to overcome those challenges (regarding consumer and family member employment)?

  39. OSHPD-led Stakeholder Engagement:WET Models and Partnerships What successful workforce education and training models and partnerships exist within your county or region that address the workforce challenges and you think could be used as a best practice?

  40. County-Reported Needs Assessments Highlights

  41. County-Reported Needs Assessments:Overview • Purpose: To identify key needs in the public mental health workforce including: • Users of Public Mental Health System • Shortages and Hard-to-Fill, Hard-to-Retain Positions • Declining Needs/Needs Met • Diversity and Language Needs • State Administered WET Program Need/Participation • Data analysis presented according to: • Statewide • MHSA WET region • County size

  42. County-Reported Needs Assessments:Data Sources • OSHPD-led 2013 County-Reported Needs Assessment • OSHPD/RDA-led County-Reported Needs Follow-Up Survey

  43. County-Reported Needs Assessments:Limitations Variability in consistency of County-Reported Assessments data Burden of data collection and reporting on county agencies Unclear if counties reported on behalf of contractors County Reported Needs Follow-up Survey received responses from 26 counties.

  44. County-Reported Needs Assessments:Key Findings – Public Mental Health Users Public mental health system users are: • Predominantly located in the southern part of the state • More likely to be of a minority race/ethnicity • More likely to be adults

  45. County-Reported Needs Assessments:Key Findings – Public Mental Health Workforce Needs • County-reported workforce shortages align to hard-to-fill, hard-to-retain positions • Psychiatrists are consistently reported as the highest need position • Reliable graduation information is not available • The Superior Region, small counties, and medium counties consistently identified professionals with bilingual capabilities as a workforce need • Only the Southern Region counties identified any declining workforce needs • These counties reported sufficient access to non-licensed mental health staff • Identified workforce race/ethnic diversity needs align with the composition of the public mental health user population • This is true across MHSA Regions

  46. County-Reported Needs Assessments:Key Findings – Public Mental Health Workforce Needs • Identified workforce language diversity needs reflect the race/ethnic composition of the public mental health user population • This is true across MHSA Regions • The Southern Region (including Los Angeles Co.) workforce is largely meeting the language needs of its Hispanic/Latino population • Counties’ designated positions for consumers and/or family members typically: • Are largely reserved for peer and administrative/clerical positions • Are not typically provider/professional positions • Are not full-time positions with set wages

  47. County-Reported Needs Assessments:Key Findings – Statewide-Administered WET Programs • Large counties are the primary users of statewide-WET programs • WET Stipend Program participation reflects the distribution of graduates with mental health-related degrees or certificates • This is true across MHSA regions • WET Psychiatric Residency Program utilization underperforms county-reported need • The WET Mental Health Loan Assumption Program (MHLAP) is utilized by most counties, especially large counties • The WET Physician Assistant Program is utilized in few counties • Usage is consistent with low physician assistant graduate rates • Los Angeles County has the highest number of graduates with mental health-related degrees or certificates • Los Angeles County does not participate in the WET Psychiatric and Physician Assistant Residency Stipend Programs

  48. County-Reported Needs Assessments:Hard-to-Fill and Hard-to-Retain Positions

  49. County-Reported Needs Assessments:Workforce Shortages

  50. County-Reported Needs Assessments:Workforce Shortages- Superior Region

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