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

Getting and Keeping a Rural Workforce:Lessons from the WICHE West

Dennis MohattVice President for Behavioral

Health - WICHE

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

There is not one rural …

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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 NEVADANEW 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 NEVADANEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING

Mental health professional shortage areas

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

Health professional shortage areas: primary care

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.

PrimaryTotal Care

State Counties HPSACO 63 43ID 44 32ND 53 41NM 33 39NV 17 32OR 36 48UT 29 24WA 39 56WY 23 18

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

Community systems of care

Informal Community

Support

Self-HelpPrimary Prevention

MentoringEtc.

Crisis &Assessme

nt

Entry&

Exit

7 daysRehabilitation

Outreach

Group Homes

Day Programs Residential

7 days/weekOutreachin acute

short term

Community

Based Treatment

Services

Primary CareSpecialty Care

OutpatientCare Mgmt.

Psychosocial

Rehab

Formal

Community

Support

Acute Need for Care

Recovery

Inpatient

24 HourTotal Care

Community Rehabilitation

Services

ACTPartial Hosp.

Etc.

Formal System Natural Support & Care

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

Defining mental health workforce

Mental health & Substance abuse Wide range of

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 NEVADANEW 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 DisseminateSource: Annapolis Coalition National Strategic Plan for Behavioral Health Workforce Development

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

Behavioral health workforce – grow your own strategy logic model

- P

opul

atio

n of

Foc

us +

Increase knowledge of behavioral health

Exchange knowledge about behavioral health careers

Provide accessible behavioral health training

Applied trainingopportunities

Job

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Examples from the West … Alaska leads the way

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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

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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.

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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 NEVADANEW 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.

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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

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www.wiche.edu/mentalhealth

Dennis Mohatt Mimi McFaul Deb Kupfer Jenny Shaw Chuck McGee Tamie DeHay Maurene Flory Nicole Speer Jessica Tomasko