COUNTY WORKFORCE, EDUCATION, AND TRAINING PLANS: Preliminary Findings Gwen Foster, MSW Meghan Brenna Morris, M.A. MSW California Social Work Education Center Mental Health Program University of California at Berkeley 5/6/2011 COUNTY WORKFORCE, EDUCATION, AND TRAINING PLANS: PRELIMINARY FINDINGS Introduction The Mental Health Services Act (MHSA) provides funding for workforce, education, and training (WET) to support the transformation of the public mental health system. California’s public mental health workforce has been historically underfunded and suffered from a lack of cultural and linguistic diversity, a geographic misdistribution of mental health workers at all levels of services, and the lack of educational and training programs to develop and sustain a workforce that is required to meet the service demands of growing and aging un-served and underserved communities. In addition, the public mental system has struggled to include individuals with lived experience and family members by creating authentic career opportunities throughout the workforce. Approximately $450 million was made available statewide over 10 years to develop and deploy a qualified workforce; the Department of Mental Health (DMH) allocated $210 million to local counties, $210 million for statewide WET programs, such as CalSWEC, and $30 million for regional partnerships. Each eligible jurisdiction (58 counties, the City of Berkeley and Tri-City Mental Health) must develop a plan and submit it to DMH for approval to draw down its allocation of WET funds. The allocations range from $450,000 for each of the 23 smallest counties to $60 million for Los Angeles County. The California Social Work Education Center (CalSWEC) offers training and stipends to increase the availability of prepared social workers for the mental health and child welfare fields. CalSWEC also provides in-service training for child welfare workers, and supports curriculum development and capacity-building opportunities for faculty involved with CalSWEC programs. CalSWEC is a collaboration, founded in 1990, among the state's 20 accredited social work graduate schools, county departments of social service and mental health/behavioral health, the California Departments of Social Services (CDSS) and Mental Health (DMH), the California Chapter of the National Association of Social Workers, professional associations, and foundations. In 2003, the CalSWEC Mental Health Initiative Committee began to create and implement a set of core competencies for graduate schools of social work to build curricula designed to train new mental health social workers from diverse ethnic, linguistic, and geographic backgrounds. In 2005, DMH and CalSWEC negotiated an interagency agreement to 1 provide stipends and some operational support to schools of social work throughout California. The stipend program is one of the statewide WET programs. In 2010, as part of its planning process, the Mental Health Program undertook a scan of the “landscape” in which the program functions, including county and regional WET programs. CalSWEC staff reviewed documents to identify (1) how counties originally planned to use WET funds in the funding categories of internships and financial incentive programs, and (2) what programmatic “themes” in these categories are emerging regarding strategies for mental health workforce development, including social work. Documents included: Approved plans for 48 counties and the City of Berkeley. (Eleven counties did not yet have approved plans as of October 31, 2010.) California Department of Mental Health (2010). Mental Health Services Act Expenditure Report. Fiscal Year 2009-10 Addendum. A Report to the Legislature In Response to AB 131, Omnibus Health Budget Trailer Bill, Chapter 80, Statutes of 2005 California Department of Mental Health (2007). Planning Estimates California Department of Mental Health (2006) Proposed Guidelines: Workforce Education and Training Component of the Three-Year Program and Expenditure Plan. Shilton, Adrienne (2010). County Program Snapshot Regarding MHSA Workforce, Education, and Training (WET) Annual updates reflect changes in the plans as obstacles are overcome and mid-course corrections are made. This “point-in-time” report summarizes what jurisdictions submitted in their original WET plans. The Context of County WET Plans DMH distributed a set of guidelines in July, 2007 that shaped the development and terminology of the county plans. Counties may fund programs in any or all of five categories in developing plans: Workforce Staffing Support Training and Technical Assistance Mental Health Career Pathway Programs Residency, Internship Programs Financial Incentives For this report, CalSWEC chose to focus on “Residency, Internships,” and “Financial Incentives” because they are most similar to the current activities of the Mental Health Program (MHP). Proposed Guidelines: Workforce Education and Training Component 2 of the Three-Year Program and Expenditure Plan (pp 35-42) describes these categories as follows: Residency, Internship Programs MHSA funding for psychiatric residency programs, internship programs leading to licensure and physician assistant programs with a mental health specialty are designed to address workforce shortages by supplementing existing programs in order to increase the number of licensed professionals within a program who will practice in the Public Mental Health System and who • Specialize in child and geriatric psychiatry • Work on multidisciplinary teams providing services according to the fundamental concepts of the Act • Are recruited from underrepresented racial/ethnic and cultural groups in the workforce • Increase mental health awareness and expertise by working with primary care health care workers • Can prescribe and/or administer psychotropic medications • Work in underserved/unserved communities and rural areas. Counties are encouraged to partner with graduate mental health and psychiatric residency programs in their communities to establish programs that address one or more of the above, and use MHSA funding to both address workforce shortages and influence school curriculum. Funding may be used to add slots to an existing psychiatric residency program that enable fourth and/or fifth-year residents to specialize in child or geriatric psychiatry or work on multidisciplinary teams that include primary care physicians and health care workers. Funding may also be used for counties and their community based organizations to work with masters or doctoral level programs that enable graduates to become interns in their field and become licensed and authorized by the Department to sign mental health treatment plans. Financial Incentives Stipends, scholarships, and loan assumption programs are financial incentives to recruit and retain both prospective and current public mental health employees who can address workforce shortages of critical skills and under-representation of racial/ethnic, cultural or linguistic groups in the workforce. Financial incentive programs are also for promoting employment and career advancement opportunities for individuals with client and family member experience in the Public Mental Health System. Stipends: Stipends can be a used to create a program of educational funding for students similar to the federal Title IV-E stipend program for graduate level students, such as social workers or marriage and family therapists, where funds are provided to 3 an enrolled student in exchange for a commitment to work in the Public Mental health System for a specified period of time, usually one year. Counties can contract with a fiduciary entity, university or accredited educational institution for the establishment of such a program. Stipends can also be used to pay individuals with client and family member experience for participation and completion of an education or training program that leads to employment in the Public Mental Health System. These are often budgeted as part of the expenses of such a program. Scholarships: Counties and contract community based organizations can establish a scholarship fund to pay for the costs, such as tuition, registration fees, books and supplies, associated with employees participating in training and educational endeavors that are directly linked to: -Addressing occupational shortages or critical skills needed by the employer, such as language proficiency or licenses. -Integrating individuals with client and family member experience into all levels of the Public Mental Health System workforce, to include positions that require advanced degrees. -Addressing the under-representation of racial/ethnic, cultural and linguistic groups in the workforce. All education and training in which scholarship funds are provided must adhere to the fundamental principles embodied in the Act, and cannot supplant existing funds allocated for staff development activities. MHSA Loan Assumption Program: When the guidelines were promulgated, DMH was developing a program description and requirements for an MHSA Loan Assumption Program, in which individuals on an annual basis would have payments made on outstanding loan balances in exchange for a commitment to work in the Public Mental Health System for a specified time. Amounts paid can vary, depending upon the amount of educational debt incurred. Counties were instructed to wait until guidelines for the MHSA Loan Assumption Program were announced before developing local plans. The Mental Health Loan Assumption Program, a collaborative endeavor between the Health Professions Education Foundation (Office of Statewide Health Planning and Development) and DMH, started in 2009. 4 COUNTY WET PLAN SCAN FINDINGS Residency, Internships: Twenty-nine (29) counties’ plans included this program component, and the majority of these describe internship programs. Some counties planned to offer new paid internships for graduate and/or undergraduate mental health students. Butte, Contra Costa, Marin, Placer, San Benito, San Bernardino, San Francisco, San Luis Obispo, Santa Barbara, Solano, and Stanislaus all designated social work internships in this category. Cultural and ethnic diversity were mentioned as the most common eligibility priority for stipend recipients; people with lived experience with the mental health system as consumers or family members are also frequently mentioned as prioritized populations, as are transition-age youth. (Ten) 10 counties prioritized bilingual students: Spanish was identified through county assessments the most needed language. Also mentioned are: Arabic, Cambodian, Cantonese, Chaldean, Farsi, Hmong, Laotian, Native American languages, Somali, Swahili, Tagalog, and Vietnamese. At least 17 counties have used funds in this category for clinical supervision for interns and pre-licensure staff, primarily in psychiatry, social work and MFT fields. The majority of these positions are part-time contracts. A few counties offer reimbursement for travel or other expenses related to internships. Most of these encompass hard-to-reach communities without nearby universities. Ten (10) counties planned curriculum development and trainings for interns/fellows on topics such as: resiliency, recovery, license preparation, and supervision. Several planned to develop new sets of core competencies. Five (5) counties (Nevada, Placer, Riverside, Solano, and Ventura) planned to strengthen their internship programs through closer coordination with partner universities, increased trainings on MHSA-related topics, structured field placement experiences, etc. Financial Incentives Thirty-two (32) counties included this component in their WET Plan. 5 At least 15 counties included stipends and scholarships. Seven (7) counties identified scholarships/stipends for MSW students: Alameda, Calaveras, Contra Costa, LA, Santa Clara, Santa Cruz, Shasta, and Orange counties. Financial incentives for MSW students may also exist in other county plans, but many counties did not provide a breakdown by discipline. 19 counties gave stipend priority to ethnic and/or linguistic diversity; 11 counties gave stipend priority to current employees; 12 counties gave stipend priority to consumers and/or family members of consumers. There was some overlap, with counties giving priority to several of the above categories, such as “bilingual employees,” etc. The number of scholarships planned by counties to be given to students for graduate education in mental health (which could include MSWs) varies from three in Colusa (a small county with a $450,000 allocation) to 200 in LA County (the largest county in the State with $60 million). Most cluster around 10-20. The amount per scholarship/stipend per year varied from $1000-$18,500. There were 9 counties offering scholarships/stipends of approximately $5000 each. Several counties, including Contra Costa, El Dorado, Fresno, Monterey, Placer, Stanislaus, and Ventura covered operational costs, including staffing and supervision for their stipend/scholarship program through Financial Incentive funds. There does not seem to be a particular pattern to how counties are paying for operational costs, but the WET Workforce Staffing component provides funding for new staff positions for oversight and coordination across the planned program components At least seven (7) counties - Alameda, Colusa, El Dorado, Siskiyou, Solano, Sonoma, and Yolo – have implemented or were planning to develop loan assumption programs. DMH now has started the Mental Health Loan Assumption Program for licensed mental health professionals who are employed in county or contract mental health agencies. All counties have the option of participating in this program, and in 2010, $2.28 million was awarded to 309 individuals. Discussion Since the passage of MHSA, California’s public mental health workforce has taken an historic step toward overturning years of struggle to build and sustain a system capable of comprehensively addressing the mental health needs of the population from prevention to recovery. This step includes significant dedicated resources to resolve long-standing problems of workforce shortages and capacity limitations for working with highly diverse, vulnerable populations across the lifespan. There is clearly a great deal of positive energy and innovation in the development and implementation of plans for programs supported by the MHSA WET funding component. Fundamentally, the plans share the goals of building and rapidly expanding a new, 6 inclusive, multidisciplinary workforce and re-tooling the existing workforce to actualize recovery-oriented systems of care. Some counties are collaborating to address these goals in unique ways. For example, MSW graduate programs have been launched in several California State Universities (CSUs) in response to workforce development needs. Santa Cruz, San Benito, and Monterey Counties along with the Greater Bay Area Mental Health and Workforce Collaborative each provided funding to CSU Monterey Bay to launch an MSW program, which opened its doors in Fall 2010. The new MSW program is a three-year program, with a focus on working adults. Calaveras, Amador, Tuolumne, and El Dorado counties, along with the Central Regional Partnership, pooled WET funds to launch a part-time, weekend MSW program with a rural mental health focus through CSU Sacramento Division of Social Work. The program is open to employees and non-employees. This scan did not closely examine the Career Pathways component of each plan, but that would be informative. Many counties are using MHSA resources to build ladders of learning from high school through graduate programs, and many have prioritized consumers and family members as primary candidates for such programs. The CalSWEC Mental Health Program does not currently focus on secondary education or undergraduate preparation for mental health careers, but recognizes that collaboration with and among counties, regional partnerships, and schools is a critical component of workforce development. Recommendations 1. Use the scan results to inform the development of goals and strategies for social work workforce development in the Mental Health Program plan for 2011-14. 2. Strengthen collaboration among CalSWEC MHP schools, other statewide WET programs, county WET programs, and Regional Partnerships to leverage the rich diversity of training and career development that is now underway. 3. Ensure that program evaluation is expected of WET-funded programs, is tailored to the needs and size of each program, and routinely collects statewide data for maximum learning about progress toward workforce development goals for the behavioral health field and solutions to policy and programmatic barriers. 4. Develop and implement ways to disseminate information to stakeholders about the achievements and challenges of local, regional, and statewide WET programs. Conclusion The infusion of new resources for workforce development creates many short- and longterm opportunities for innovation. It also creates the potential for duplication of effort, gaps in infrastructure to support programs, and limited attention to learning from start-up and expansion processes. These risks are part of the “life cycle” of large-scale system change, and there are opportunities to develop new or strengthen existing collaborations that will accelerate workforce development to meet the need for multidisciplinary staff 7 for the public mental health system, as well as for the next large-scale system changes called for in health care reform. 8