A Minimum Data Set for the Behavioral Health Workforce

Transcription

1 A Minimum Data Set fr the Behaviral Health Wrkfrce Angela J. Beck, PhD, MPH, Phillip M. Singer, MHSA, Jessica Buche, MPH, MA, Rnald W. Manderscheid, PhD, Peter Buerhaus, PhD, Cynthia Mren Tuhy, NCAC II, CDC III, SAP, Matthew L. Bultn, MD, MPH KEY FINDINGS A behaviral health wrkfrce Minimum Data Set (MDS) was develped thrugh a cllabrative prcess with the Behaviral Health Wrkfrce Research Center (BHWRC) research team and partner Cnsrtium. An MDS instrument with five main themes was cnstructed t include numerus data elements t describe wrkfrce size, cmpsitin, and characteristics f the behaviral health wrkfrce, which was bradly defined t include any wrker respnsible fr preventin and/r treatment f mental health r substance use disrders. MDS data themes include: demgraphics; licensure and certificatin; educatin and training backgrund; ccupatin and area f practice; and practice characteristics and practice settings. The MDS instrument was refined based n feedback frm subject matter experts and fcus grup participants. Additinally, the research team gathered all natinal and state-based publicly available behaviral health wrkfrce data surces t assess cmpleteness f existing data. Variables frm 27 natinal data surces were mapped t the MDS data themes and assessed fr quality, while a ttal f 114 state-based data surces were identified. The findings f this study supprt the need fr a standardized methd fr cllecting behaviral health wrkfrce data, as n cmbinatin f natinal and state-based data surces has sufficient breadth and quality t fully infrm wrkfrce planning effrts. Future research will develp strategies fr: integrating the MDS int data cllectin prcesses, testing and refining the MDS, and develping an MDS t cllect data at the rganizatinal level. CONTENTS: Key Findings..1 Backgrund Develpment f a Minimum Data Set Methds... 3 Minimum Data Set Elements 3 Mapping Existing Wrkfrce Data Surces t the Minimum Data Set Methds..5 Results. 7 Cnclusin and Plicy Cnsideratins References. 12 Appendix: Minimum Data Set Instrument A Minimum Data Set fr the Behaviral Health Wrkfrce

2 BACKGROUND Effective wrkfrce planning is a key challenge in the field f behaviral health. A 2007 reprt released by the Annaplis Calitin stated that wrkfrce prblems have an impact n almst every aspect f preventin and treatment acrss all sectrs f the diverse behaviral health field. 1 Wrkfrce factrs impeding the prvisin f mental health and substance use disrder services include insufficient supply, maldistributin, and inadequate training f wrkers. 1 Mrever, the field lacks cmprehensive data accurately describing the size, cmpsitin, and characteristics f the numerus disciplines cmprising the behaviral health wrkfrce, which is a barrier t wrkfrce develpment and planning. Amng the challenges in cllecting behaviral health wrkfrce data in a reliable and reprducible manner is the lack f a cnsensus definitin that describes the types f ccupatins and vlunteer psitins which cntribute t behaviral health service delivery. The Health Resurces and Services Administratin (HRSA) and Substance Abuse and Mental Health Services Administratin (SAMHSA) feature different lists f ccupatins that cmprise the behaviral health wrkfrce, in part because the definitins are used fr different purpses. Fr example, HRSA uses the cre behaviral health prfessins f psychiatrists, clinical psychlgists, marriage and family therapists, clinical scial wrkers, and psychiatric nurse specialists t identify Health Prfessinal Shrtage Areas, 2 whereas SAMHSA cnsiders a brader grup f wrkers as part f their behaviral health wrkfrce initiatives. 3 In general, behaviral health wrkers can be defined alng several different dimensins: the specific prfessin r ccupatin (e.g. psychiatrist), the wrk setting (e.g. Cmmunity Mental Health Center), the wrker s educatin r training backgrund (e.g. Master f Scial Wrk degree), r the wrker s jb tasks r functin, which may be defined by Scpe f Practice. 4,5 T generate an accurate estimate f supply, these characteristics shuld all be cnsidered cncurrently. Several health prfessins have develped a discipline-specific Minimum Data Set (MDS) t facilitate the establishment f databases t cllect cmmn elements that can address questins related t wrker supply, practice setting, and care prvisin. 6 Many f these elements were cdified int an MDS by SAMHSA abut 15 years ag. 7 Building ff the previus SAMHSA wrk and data elements frm existing health prfessin MDSs, the Behaviral Health Wrkfrce Research Center (BHWRC) develped an MDS instrument t infrm wrkfrce planning effrts fr the brader behaviral health wrkfrce. The MDS, which is intended t cllect the minimum amunt f infrmatin needed abut wrkfrce cmpsitin and characteristics t infrm supply and demand mdeling, will benefit the behaviral health wrkfrce by A Minimum Data Set fr the Behaviral Health Wrkfrce

3 imprving the validity and quality f data, which can then be used t infrm plicy makers abut staffing patterns. Develpment f a Minimum Data Set METHODS The research team first gathered empirical and grey literature related t behaviral health human resurces t infrm the develpment f the MDS. Specifically, data elements frm the fllwing health prfessin MDS instruments were reviewed and incrprated int the behaviral health wrkfrce MDS: Physicians, Nurses, Licensed Prfessinal Cunselrs, Psychlgists, and Substance Use/Additin Cunselrs. 6 Based n this infrmatin, the Cnsrtium f partners were cnsulted in the develpment f a definitin fr the study ppulatin. BHWRC s Cnsrtium was cmpsed f individuals representing the Natinal Cuncil fr Behaviral Health, NAADAC, Cmmunity Partnership f Suthern Arizna, Suthwest Michigan Behaviral Health, as well as tw subject matter experts wh serve as cnsultant t the Center. Next, a cmprehensive behaviral health wrkfrce taxnmy f terms and ccupatinal categries and wrker characteristics was develped by the research team and reviewed by an MDS Wrking Grup, which included NAADAC and the BHWRC cnsultants. Finally, the BHWRC research team and Cnsrtium MDS Wrking Grup develped a draft MDS using the taxnmy categries, which went thrugh several runds f revisin. Once a full MDS draft was apprved by the Cnsrtium Wrking Grup, subject matter experts external t the research team and Cnsrtium prvided feedback n the draft MDS thrugh key infrmant interviews and requests fr review, especially frm prfessinal rganizatins representing different behaviral health prvider disciplines. The research team als cnducted a fcus grup by telecnference in July 2016 with 7 representatives frm cunty mental health agencies wh prvided feedback n the data elements, as well as the feasibility f cllecting MDS data frm the wrkfrce. The key infrmant interviews and fcus grup findings permitted preliminary pilt testing and refinement f the MDS instrument. MINIMUM DATA SET ELEMENTS The Cnsrtium partners defined the behaviral health wrkfrce as all wrkers invlved in treatment r preventin f mental health and/r substance use disrders. This definitin includes licensed and nnlicensed wrkers, peer supprt wrkers, and vlunteers. It als captures primary care wrkers wh may be A Minimum Data Set fr the Behaviral Health Wrkfrce

4 prviding behaviral health services. The definitin des nt include wrkers in behaviral health prvider rganizatins wh are nt directly cntributing t the prvisin f mental health r substance use disrder treatment r preventin services, such as clerical staff, business and human resurces persnnel, maintenance staff. The MDS includes five categrical data themes with data elements t describe wrker characteristics: demgraphics; licensure and certificatin; educatin and training; ccupatin and area f practice; and practice characteristics and settings (Table 1). It is intended t cllect infrmatin directly frm behaviral health wrkers. The full MDS instrument is presented in the Appendix. The MDS is nt intended t serve as a standalne survey instrument; rather, it prvides a suggested questin bank frm which survey researchers, licensing bards, and thers cllecting behaviral health wrkfrce data may extract data elements specific t their ppulatin f interest t ensure the field is using cnsistent, standardized metrics when addressing wrkfrce size, cmpsitin, and characteristics. Table 1. Summary f Minimum Data Set Data Elements fr Behaviral Health Wrkers MDS Theme Data Elements Demgraphics Name Age Race/ethnicity Sex and gender Sexual rientatin Place f birth and residence Military/veteran status Language skills Licensure and Certificatin Type f jb-related licenses held Type f jb-related certificates held Natinal Prvider Identificatin number State identificatin/registratin number Educatin and Training Degrees btained and years f cmpletin Field f study/specialty Cmpletin f ther educatinal prgrams (e.g. internships) Current enrllment in degree prgram Occupatin and Area f Practice Primary ccupatin Area f practice Practice Characteristics and Settings Emplyment status Number f current emplyment psitins Number f hurs and weeks wrked per year Emplyment arrangement Use f telehealth Emplyer practice setting Hurs per week spent n activities (e.g. clinical supervisin, diagnsis) Clinical r patient care prvisin Emplyment plans A Minimum Data Set fr the Behaviral Health Wrkfrce

5 The full MDS instrument underwent several revisins based n feedback frm key infrmants and fcus grup participants. In additin t prviding suggestins fr specific data elements, which were incrprated int the MDS by the research team, the qualitative findings frm interviews and fcus grups highlighted several imprtant cncepts. First, the MDS shuld be a mdular instrument; it is nt intended t be used in its entirety fr ne discipline as sme data elements will nt apply t sme categries f wrkers. The MDS will be mst useful when tailred t represent wrkfrce characteristics f each behaviral health discipline. Secnd, sme imprtant data elements abut the wrkfrce may be best cllected at the rganizatinal level frm emplyers, rather than frm individual wrkers. These include the ttal number f behaviral health wrkers, type f ppulatins served, and payment arrangements fr service prvisin. The research team will develp an rganizatinal-level MDS fr the behaviral health wrkfrce as a next step in this research plan. Finally, ffering technical supprt and getting buy-in frm rganizatins and researchers t use the MDS will be critical t its success. It can be challenging and cstly t mdify existing data cllectin instruments. The research team will wrk thrugh its partner Cnsrtium t encurage adptin f MDS data elements and prvide supprt as needed. Mapping Existing Wrkfrce Data Surces t the Minimum Data Set Once the MDS data elements were develped, the secnd phase f the prject invlved identifying existing behaviral health wrkfrce data resurces and assessing their functinality in a natinal study f behaviral health wrkfrce characteristics. Ideally, a data surce, r cmbinatin f data surces, wuld include data that are valid, reliable, publicly accessible, and cllected frequently enugh t prvide a cntinuus assessment f wrkfrce size and cmpsitin. This prject included fur steps: 1) identifying natinal and state-level data surces that prvide infrmatin n wrkfrce size and/r characteristics; 2) cding the variables that the data surces currently cllect and mapping them nt the behaviral health wrkfrce MDS; 3) assessing the quality f the data currently cllected alng fur dimensins; and 4) summarizing gaps in the behaviral health wrkfrce data cllectin effrts. METHODS Identifying Natinal and State-Level Data Surces BHWRC staff cnducted a systematic review f all accessible existing data surces n the behaviral health wrkfrce. Because there is n central cllectin r repsitry fr the behaviral health wrkfrce, ur review f existing data surces fllwed an iterative prcess. Our initial strategy emplyed a bradbased search criterin, leveraging databases and search engines t cllect existing data surces. We als A Minimum Data Set fr the Behaviral Health Wrkfrce

6 searched peer-reviewed and grey literature t determine the types f data surces previusly used in health wrkfrce studies. Existing data surces were divided int tw categries depending n whether the data are natinal in scpe r state-based. We fund fur different types f rganizatins that currently cllect data n the behaviral health wrkfrce at a natinal level: Federal gvernment agencies, including the Office f Persnnel Management Federal Emplyment Statistics, the Centers fr Disease Cntrl and Preventin, and the Bureau f Labr Statistics Discipline-specific accrediting bdies (e.g. American Nurses Credentialing Center) Prfessinal, discipline-specific natinal rganizatins, (e.g. American Assciatin fr Marriage and Family Therapy) Fr-prfit entities (e.g. Natinal Center fr Analysis f Healthcare Data) Similar t the natinal data surces, state-based surces were cllected frm state gvernment agencies, health systems, discipline-specific rganizatins, accrediting bdies, and nn-prfit rganizatins. Our search strategy at the state level fllwed a mre targeted apprach t cllecting data surces. We cnducted a Blean search fr specific gvernment agencies in each state, research universities lcated in the state, large health systems, and specific behaviral health disciplines fr each state, while including search criteria related t behaviral health, wrkfrce, data, and surveys. We included in the study any existing primary surce that cllected data related t the behaviral health wrkfrce. The expansive definitin used fr describing behaviral health wrkers permitted us t draw upn a brader selectin f existing data surces. We excluded reprts, briefs, r reviews which emply secndary data analysis frm the study. Fr example, the Cngressinal Research Service prduced a 2015 reprt, The Mental Health Wrkfrce: A Primer, where they reviewed different types f data surces withut any primary data cllectin. This reprt was nt included in ur analysis. Mapping Current Data-Surces nt the MDS T determine whether these existing data surces culd prvide data that aligns with the data elements f the behaviral health wrkfrce MDS, we lked at the main variables included in the data surces and mapped them t the MDS data themes f demgraphics, licensure and certificatin, educatin and training backgrund, ccupatinal categry, area f practice, and emplyment setting. We were als A Minimum Data Set fr the Behaviral Health Wrkfrce

7 interested in whether the data surce prvided an enumeratin estimate f ne r mre behaviral health wrkfrce disciplines. Assessing Quality f Data Surces We limited ur assessment f data quality t natinal data surces, which were reviewed alng fur criteria: validity, reliability, frequency, and accessibility. Fr each dimensin, we rated the natinal data surce as Gd (i.e. n majr methdlgy cncerns), Fair (i.e., a few methdlgy cncerns), Pr (i.e., several majr methdlgy cncerns), r Unknwn (i.e., culd nt determine frm the infrmatin prvided abut the data surce. Validity was defined as the extent t which the data surce prvides accurate behaviral health wrkfrce data. Majr challenges t validity in existing data surces include misclassified ccupatins, nn-cmprehensive ccupatin ptins, nnspecific ccupatin ptins, missing r incmplete data, and self-reprted data. We defined reliability as the extent t which the data surce prvides cnsistent measures f the behaviral health wrkfrce. Cmmn reliability challenges include unclear weighting estimates, changes in ccupatinal classificatins r ver the curse f data cllectin, changes in data cllectin methdlgy ver time, r undisclsed survey methdlgies. Frequency refers t hw ften the data surce cllects behaviral health wrkfrce infrmatin. Data cllected every 3 years r less were rated as Gd; 4 years r mre were rated as Fair. Data cllectin effrts which did nt indicate when the next scheduled survey wuld ccur were rated as Pr. Finally, the accessibility criterin cnsidered the extent t which data are available fr public use. Publicly available data surces were rated as Gd; data which required special permissin, lg-in, r registratin infrmatin that limits the public s ability t access the data were rated as Fair. Data unavailable t the public were rated as Pr. State-based data surces were nt mapped t the Minimum Data Set, nr were they rated fr data quality. Rather, we determined the number f existing data surces in each state t understand variatin in behaviral health wrkfrce data cllectin effrts acrss the cuntry. RESULTS Our review identified twenty-nine natinal data surces (Table 2). After mapping existing natinal data surces n t the MDS develped by the BHWRC, we fund that substantial gaps exist in the validity and reliability f behaviral health wrkfrce data, which suggests that existing data are inadequate t prvide all f the infrmatin required by the MDS A Minimum Data Set fr the Behaviral Health Wrkfrce

8 Table 2. Natinal Behaviral Health Wrkfrce Data Surces Data Surce American Cmmunity Survey American Psychlgical Assciatin Member Prfiles American Psychlgical Assciatin Survey f Psychlgy Health Service Prviders Area Resurce File Assciatin f State and Territrial Health Officials Prfile Survey Behaviral Health Wrkfrce Research Studies Centers fr Disease Cntrl and Preventin Persnnel Data Current Emplyment Statistics Survey Current Ppulatin Survey Demgraphics f the U.S. Psychlgy Wrkfrce Emplyment Prjectins Prgram Federal Emplyment Statistics Medicare Prvider Utilizatin and Payment Data NASP Member Survey Natinal Ambulatry Medical Care Survey Natinal Center fr Analysis f Healthcare Data Natinal Prvider Identifier Natinal Sample Survey f Nurse Practitiners Natinal Sample Survey f Registered Nurses Natinal Study f Lng-Term Care Prviders AAMFT Natinal Survey Natinal Wrkfrce Study Natinal Survey f Substance Abuse Treatment Services Occupatinal Emplyment Statistics Practice Analysis Practice Researcher Netwrk Survey Salary Survey TRAIN Wrkfrce Research Studies Organizatin Cllecting Data United States Census Bureau American Psychlgical Assciatin American Psychlgical Assciatin Health Resurces and Services Administratin Assciatin f State and Territrial Health Officials Natinal Assciatin Scial Wrkers Centers fr Disease Cntrl and Preventin Bureau f Labr Statistics Bureau f Labr Statistics American Psychlgical Assciatin Bureau f Labr Statistics Office f Persnnel Management Centers fr Medicare & Medicaid Services Natinal Assciatin f Schl Psychlgists Centers fr Disease Cntrl and Preventin Natinal Center fr Analysis f Healthcare Data Centers fr Medicare & Medicaid Services Health Resurces and Services Administratin Health Resurces and Services Administratin Centers fr Disease Cntrl and Preventin American Assciatin fr Marriage and Family Therapy Addictin Technlgy Transfer Center Netwrk Substance Abuse and Mental Health Services Administratin Bureau f Labr Statistics Assciatin f Scial Wrk Bards Natinal Assciatin f Scial Wrkers NAADAC Public Health Fundatin Natinal Assciatin Scial Wrkers Tw natinal data surces, the Centers fr Disease Cntrl and Preventin Persnnel Data and the Natinal Center fr Analysis f Healthcare Data, were unable t be btained by the research team s culd nt be mapped t the MDS elements. The mapping f variables t the MDS fr the ther twenty-seven data surces shwed that nly three cllected infrmatin n every majr data element cntained in the MDS, althugh there was wide variatin. On average, the identified data surces cllected five f the nine MDS data elements (range: 2-9). The number f data surces cllecting infrmatin n each MDS data element ranged frm a lw f seven fr Certificatin t a high f twenty-fur in the Enumeratin categry. Remving the Enumeratin data element which was cllected by each survey, the average number f data A Minimum Data Set fr the Behaviral Health Wrkfrce

9 surces which cllected data n an MDS data element was 15 (Table 3). N natinal data surce cllected infrmatin n the entire behaviral health wrkfrce and many cllected data n just a single ccupatin. Table 3. Summary f Natinal Behaviral Health Wrkfrce Data Surce Findings MDS Data Element Data Element Examples Number f Natinal Data Surces (n=27) Enumeratin Ttal cunt f prvider type 25 Demgraphics Gender, race, ethnicity 20 Educatin Highest degree attained 18 Training Residency prgram 9 Licensure Type f nursing degree 11 Certificatin Peer supprt certificatin 7 Occupatinal Categry Psychiatrist, Cunselr, Therapist, Scial 17 Wrker Area f Practice Scial wrk specialty area 9 Emplyment Setting Nn-prfit hspital, grup practice 20 Data quality is als a cncern. N data surces were rated as Gd acrss all fur categries, and n data surces received a Gd rating fr validity. Fair was the mst cmmn rating fr validity and reliability, whereas Gd was the mst cmmn rating fr frequency and accessibility. Fr each measure f data quality, at least ne data surce was rated as Pr (Table 4). T facilitate cmparisns acrss the fur measures f quality we assigned a numerical value (1=pr; 2= fair, 3= gd) t each rating. The average scre acrss all 27 natinal data surces fr Validity was 1.59, Reliability was 2.29, Frequency was 1.85, and Accessibility was Table 4. Assessment f Data Quality f Natinal Behaviral Health Wrkfrce Data Surces (n=27) Data Quality Measure Gd Fair Pr Average Scre Validity Reliability Frequency Accessibility We fund 114 state-based behaviral health wrkfrce data surces. The number f state-based data surces varied frm zer in three states (Alabama, Rhde Island, and Tennessee) t fur separate behaviral health wrkfrce data surces in eight states (Washingtn, Oregn, Califrnia, Arkansas, Wiscnsin, Indiana, New Jersey, and Cnnecticut). The majrity f states had tw r mre state-based data surces. In general, we fund a higher cncentratin f behaviral health wrkfrce data surces in the Pacific Nrthwest and New England (Figure 1) A Minimum Data Set fr the Behaviral Health Wrkfrce

10 Figure 1. Number f State-based Behaviral Health Wrkfrce Data Surces CONCLUSIONS AND POLICY CONSIDERATIONS Develpment f the behaviral health Minimum Data Set is a fundatinal step in standardizing cllectin f wrkfrce data. The BHWRC fllwed a multi-phase prcess t develp a behaviral health MDS instrument cllabratively with partners and refine it thrugh a qualitative prcess with key infrmants and fcus grup participants. The resulting dcument represents a cllectin f data elements that may be used t mdel wrker supply and demand t infrm behaviral health wrkfrce planning effrts n a natinal, reginal, and state level. MDS data elements may als be useful in assessing the cmprehensiveness f wrkfrce data sets. The exercise f mapping existing data surce study variables t the MDS data elements prvides further justificatin fr adptin f a standardized data cllectin system, as n cmbinatin f data surces prvide adequate data t infrm an MDS. Bth the breadth f wrkfrce data acrss the field and the quality f data, primarily in terms f validity and reliability, present serius limitatins. Much f the existing data are discipline-specific; few studies cllect cmparable measures and characteristics acrss multiple prfessins, making cmparisns difficult. Investment in state-based wrkfrce research effrts vary by state. This study fund that the Pacific Nrthwest and New England regins have prduced the mst statespecific behaviral health wrkfrce data in the U.S., while a few states lacked any accessible state-based behaviral health wrkfrce data. Wrkfrce planning effrts will cntinue t be challenged until valid, A Minimum Data Set fr the Behaviral Health Wrkfrce

11 reliable data are cllected in a cmparable and cntinuus manner acrss disciplines and gegraphic regins. Adptin f the MDS instrument requires resurces. The BHWRC research team is available t prvide technical assistance t researchers, licensing bards, and ther rganizatins. In general, the fllwing shuld be cnsidered when implementing the MDS: Sme data elements may nt apply t all types f behaviral health wrkers. The MDS is nt a survey in itself, but an instrument researchers and data cllectrs can use t infrm survey design. The MDS fcuses n data cllectin at the individual wrker level. A cnsensual prcess fr widely integrating MDS data elements int existing data cllectin instruments, such as thse facilitated by licensing bards and prfessinal rganizatins, must still be determined. An additinal MDS fcused n data cllectin at the rganizatinal level is under develpment. Example data elements include wrkfrce enumeratin, payment mechanisms fr services, and ppulatins served. The findings f this prject highlight the need fr greater resurces dedicated t behaviral health wrkfrce data cllectin and analysis at bth the state and natinal levels. Natinal data surces may be useful in prviding sme infrmatin n wrkfrce size and cmpsitin but a systematic mechanism fr mnitring the wrkfrce is still needed fr evidence-based wrkfrce planning decisins. The BHWRC will cntinue t wrk with partners t develp strategies fr integrating the MDS int data cllectin prcesses, testing and refining the MDS, and identifying existing data surces capturing MDS data elements. This wrk is funded thrugh HRSA Cperative Agreement U81HP29300: Health Wrkfrce Research Centers Prgram A Minimum Data Set fr the Behaviral Health Wrkfrce

12 REFERENCES 1. Annaplis Calitin. (2007). An Actin Plan fr Behaviral Health Wrkfrce Develpment. Cincinnati, OH: Annaplis Calitin. 2. Health Resurces and Services Administratin. Shrtage Designatin: Heath Prfessinal Shrtage Areas & Medically Underserved Areas/Ppulatins Substance Abuse and Mental Health Services Administratin. Wrkfrce University f Michigan/Center f Excellence in Public Health Wrkfrce Studies, University f Kentucky/Center f Excellence in Public Health Wrkfrce Research and Plicy. Strategies fr Enumerating the U.S. Gvernmental Public Health Wrkfrce. Atlanta, GA: US Department f Health and Human Resurces, Centers fr Disease Cntrl and Preventin; Gebbie K, Merrill J, Tilsn H. The public health wrkfrce. Health Aff (Millwd) 2002;21: Health Resurces and Services Administratin. Health Prfessins Minimum Data Set Hendersn MJ, Minden SL, Manderscheid RW. (n.d.) Decisin Supprt Rckville, MD: Center fr Mental Health Services, SAMHSA A Minimum Data Set fr the Behaviral Health Wrkfrce

13 APPENDIX: BEHAVIORAL HEALTH WORKFORCE MINIMUM DATA SET Demgraphics 1. What is yur legal name? First Name Middle Name Last Name(s) Maiden Name (if applicable) 2. What is yur birth date? Mnth Day Year 3. Please identify yur race (select all that apply.) American Indian r Alaska Native Asian Black r African American Native Hawaiian r Other Pacific Islander White r Caucasian Other (please specify) Prefer nt t answer 4. Are yu Hispanic, Latin/a, r f Spanish rigin? (One r mre categries may be selected.) N Yes, Mexican, Mexican American, Chican/a Yes, Puert Rican Yes, Cuban Yes, ther (please specify) Prefer nt t answer A Minimum Data Set fr the Behaviral Health Wrkfrce

14 5. What sex were yu assigned at birth (n yur riginal birth certificate)? Female Male Prefer nt t answer 6. Please identify yur gender. Female Male Transgender, male t female Transgender, female t male Other (please specify) Prefer nt t answer 7. What is yur sexual rientatin (select all that apply)? Hetersexual r straight Gay r lesbian Bisexual Other (please specify) Prefer nt t answer 8. Were yu brn in the United States? Yes, a U.S. state, please specify: City Yes, U.S. territry, please specify: State N, please specify cuntry f rigin: 9. Please enter the 5-digit zip cde f yur current primary residence. 10. What is yur U.S. residency status related t yur emplyment? U.S. Citizen Visa Legal Permanent Resident/Green Card Nt eligible t wrk in the US Prefer nt t answer A Minimum Data Set fr the Behaviral Health Wrkfrce

15 11. Are yu currently serving in the United States military? Yes N 12. Are yu a Veteran f the United States Armed Frces? Yes N 13. D yu have lived experience with a mental health r substance use disrder? Yes, mental health disrder Yes, substance use disrder Yes, c-ccurring mental health and substance use disrder N Prefer nt t answer 14. Are yu able t cmmunicate with patients/clients in a language ther than English? Yes N 14A. If yes, what language(s)? (Select all that apply.) Arabic Chinese (Cantnese, Mandarin, ther Chinese language) Filipin language (Tagalg, ther Filipin dialect) French German Greek Hindi-Urdu Italian Japanese Krean Plish Prtuguese Russian Sign language: American Sign Language Other sign language Smali r Cushitic Spanish Vietnamese Other (please specify) A Minimum Data Set fr the Behaviral Health Wrkfrce

16 Licensure and Certificatin 14. Have yu ever held a license r certificate related t yur jb in behaviral health? Yes N 14A. If yes, what jb-related licenses d yu currently pssess? License Type License Number Status (Active/Inactive) State, Regin r Cuntry f Issue Date f Initial Issue Expiratin Date 14B. What jb-related certificates d yu currently pssess? (Please include peer supprt/family supprt certificatins.) Credential Type Name f credentialing bdy Status (Active/Inactive) Date f Initial Issue Expiratin Date 15. D yu have a Natinal Prvider Identificatin (NPI) number? [NPI is a unique 10-digit identificatin number issued t health care prviders in the U.S. by the Centers fr Medicare and Medicaid Services.] Yes (please enter) N 16. D yu have a state identificatin/registratin number? Yes (please enter) N A Minimum Data Set fr the Behaviral Health Wrkfrce

17 Educatin and Training 17. Which f the fllwing describes yur highest level f educatin? Sme high schl cursewrk High schl r equivalent Sme cllege cursewrk Cllege r graduate degree (assciate, bachelr s, master s, r dctral degree) 18. If yu cmpleted a cllege degree, which degrees d yu currently hld? (Select all that apply. Please d nt include degrees yu are currently wrking twards.) Dctral degree Specialist degree (pst-master s academic degree such as EdS, PsyS, r SSP) Master s degree Bachelr s degree Assciate degree Other, please specify I did nt cmplete a cllege degree 18A. If yu hld a dctral degree, please select yur field(s) f study/specialty. (Select all that apply.) MD/DO: Psychiatry MD/DO: Family Practice MD/DO: Other PhD: Psychlgy PhD: Cunseling PhD: Marriage and Family Therapy PhD: Scial Wrk PhD: Scilgy PhD/DrPH: Public Health PhD: Nursing Dctr f Psychlgy (PsyD) Dctr f Scial Wrk (DSW) Dctr f Nursing Practice (DNP) Dctr f Pharmacy (PharmD) Dctr f Educatin (EdD) Juris Dctr (JD) Dctr f Thelgy in Pastral Cunseling Other dctral degree (please specify) 18B. If yu hld a master s degree, please select yur field(s) f study. (Select all that apply). Psychlgy Cunseling Marriage and Family Therapy Scilgy Scial Wrk (MSW r equivalent) A Minimum Data Set fr the Behaviral Health Wrkfrce

18 Nursing (MSN) Public Health/Health Services Administratin (MPH, MSPH, MHSA) Educatin (MEd) Business Administratin (MBA) Public Administratin (MPA) Criminal Justice Thelgy Other master s degree (please specify) 18C. If yu hld a bachelr s degree, please select yur field(s) f study. (Select all that apply.) Psychlgy Cunseling Scial Wrk (BSW r equivalent) Nursing (BSN) Scilgy Criminal Justice Thelgy Public Health Other bachelr s/baccalaureate degree (please specify) 19. In what year did yu cmplete yur highest earned degree? 20. Where did yu cmplete yur highest earned degree? State/Prvince/area utside U.S. r Canada (please specify): Institutin f Higher Educatin Attended: Prgram Title r Area f Cncentratin: 21. Did yu cmplete any f the fllwing as part f yur highest level educatinal prgram? (Select all that apply.) Internship/field placement/practicum Residency Fellwship Other pstgraduate clinical training prgram/supervised training 21A. Please enter infrmatin abut yur training prgram(s). Lcatin (State) Number f Years f Training Date f Cmpletin A Minimum Data Set fr the Behaviral Health Wrkfrce

19 Prgram Type IF YOU ARE A PHYSICIAN, PLEASE COMPLETE Q22. OTHERWISE SKIP TO Q Please prvide infrmatin abut yur residency training/graduate medical educatin. Prgram Type Lcatin (State) Years f Training Cmpleted? Bard Certified? First Specialty Training - Yes N Yes N Nt applicable Subspecialty Training - Yes N Yes N Nt applicable Additinal Training - Yes N Yes N Nt applicable 23. Are yu currently enrlled in a frmal educatin prgram leading t an academic degree? Yes N 23A. If yes, in what field is this frmal educatin prgram? (Please mark the single best answer) Addictin Cunseling Cunseling Criminal Justice Educatin Marriage and Family Therapy Medicine Psychiatry Medicine Other Nursing Pastral Cunseling Pharmacy Psychlgy Public Administratin Public Health Scial Wrk Scilgy A Minimum Data Set fr the Behaviral Health Wrkfrce

20 Thelgy Other (please specify) 23B. What type f degree have yu been wrking tward in this prgram? Dctral degree Master s degree Bachelr s degree Assciate degree Occupatin and Area f Practice 24. Primary ccupatin and area(s) f practice Cunselr Area(s) f Practice: (select all that apply) Addictin Disrder/Substance Use Disrder Cunseling Behaviral Health Cunseling Child/Adlescent Cunseling Clinical Mental Health Cunseling Clinical Supervisr Pastral Cunseling Rehabilitatin Cunseling Schl Cunseling Scial Services Cunseling Other Cunseling, please specify Physician Area(s) f Practice: (select all that apply) Addictin Psychiatry Adult Psychiatry Child/Adlescent Psychiatry Geriatric Psychiatry Other Psychiatry, please specify Family Practice/General Practice Geriatrics Pediatrics Primary Care Other (please specify) Psychlgist Area(s) f Practice: (select all that apply) Clinical Child and Adlescent Psychlgy Clinical Health Psychlgy Clinical Neurpsychlgy Clinical Psychlgy A Minimum Data Set fr the Behaviral Health Wrkfrce

21 Cgnitive Behaviral Psychlgy Cunseling Psychlgy Cuple and Family Psychlgy Frensic Psychlgy Grup Psychlgy Organizatinal and Business Cnsulting Psychlgy Plice and Public Safety Psychlgy Prfessinal Gerpsychlgy Psychanalytic Psychlgy Rehabilitatin Psychlgy Schl Psychlgy Other Psychlgy (please specify) Scial Wrker Area(s) f Practice: (select all that apply) Addictins Adlescents Child and Family Scial Wrk Clinical Scial Wrk Cmmunity Develpment Criminal Justice Develpmental Disabilities/Rehabilitatin Displaced Persns/Hmeless/Refugees Gerntlgy Healthcare Scial Wrk Internatinal Scial Wrk Mental Health Scial Wrk Military and Veterans Affairs Scial Wrk Occupatin Scial Wrk/EAP Philanthrpy Psychiatric Scial Wrk Plitical Scial Wrk Public Health Schl Scial Wrk Substance Use Disrder Scial Wrk Vilence Other, please specify Nurse Chse the ptin that best describes yur ccupatin (select ne): Addictin Nurse Advanced Practice Advanced Practice Registered Nurse Licensed Practical Nurse Psychiatric Mental Health Nurse Psychiatric Registered Nurse/Psychiatric Nurse Specialists (APRN) A Minimum Data Set fr the Behaviral Health Wrkfrce

22 Public Health/Cmmunity Health Nurse Other Nurse, please specify Aide/Technician Chse the ptin that best describes yur ccupatin (select ne): Hme Health Aide Nursing Aide Orderly Psychiatric Aide/Technician Other Aide/Technician, please specify Peer Supprt Chse the ptin that best describes yur ccupatin (select ne): Peer Cunselr Peer Supprt Specialist Peer Recvery Specialist/Cach Peer Health and Wellness Cach Emplyment/Jb Cach Peer Navigatr Other peer supprt ccupatin, please specify Other Behaviral Health Wrker Chse the ptin that best describes yur ccupatin (select ne): Behaviral Health Specialist Case Manager Cmmunity Health Wrker Frensic Mental Health/Frensic Services Wrker Health Navigatr Marriage and Family Therapist Physician Assistant Psychiatric Pharmacist Psychiatric Rehabilitatin Practitiner Recvery Specialist Scilgist Other ccupatin, please specify Practice Characteristics and Settings 25. What is yur emplyment status? (Select all that apply.) (Behaviral health refers t the preventin and/r treatment f mental health r substance use disrders.) Actively wrking in a behaviral health psitin that requires a prfessinal license Actively wrking in a behaviral health psitin that des nt require a prfessinal license Actively wrking in mre than ne behaviral health psitin (under the same r different emplyer) Actively wrking in a field ther than behaviral health (i.e. prviding behaviral health services in a nn-behaviral health setting) Nt currently wrking A Minimum Data Set fr the Behaviral Health Wrkfrce

23 Retired 26. In hw many psitins are yu currently emplyed as a behaviral health wrker? r mre 27. Please prvide the fllwing infrmatin fr up t 3 emplyment lcatins, beginning with the lcatin in which yu spend the mst time. Please d nt include lcatins that are utside f the U.S. Principal Lcatin (lcatin in which yu spend the mst time) 27A. Name f facility 27B. Zip cde 27C. Average hurs wrked at this lcatin per week 27D. Number f weeks wrked at this lcatin in past year 27E. Which f the fllwing best describes yur current emplyment arrangement at this lcatin? Self-emplyed (including grup independent practice assciatin, private practice, and cnsulting) Permanent salaried staff emplyed directly by the rganizatin Permanent hurly staff emplyed directly by the rganizatin Temprary staff emplyed directly by the rganizatin r Lcum Tenens Cntractr emplyed by a third party rendering services t the rganizatin Cnsultant paid fr services prvided t the rganizatin Resident Pst-degree fellw emplyed directly by the rganizatin Student, intern, r trainee Vlunteer staff Other, please specify 27F. D yu use telehealth/telemedicine at this lcatin as part f yur jb respnsibilities? Yes N 27G. Which f the fllwing best describes yur emplyer s practice setting? Ambulatry Care Facility/Clinic Cmmunity health center Mental health clinic Primary r specialist medical care Substance use/addictin treatment center A Minimum Data Set fr the Behaviral Health Wrkfrce

24 Methadne clinic Detx facility Rural health clinic Tribal health clinic Independent Practice Independent grup practice Independent sl practice Hspital/In-patient facility Federal Gvernment hspital Nn-federal hspital: inpatient Nn-federal hspital: psychiatric Hspital emergency department Hspice Lng-term care facility (e.g. nursing hme, assisted living) Veterans Facility (Veteran s Administratin Facility) Scial service/crrectinal facilities Child welfare agency Scial service agency Public assistance agency Crrectinal/criminal justice facility (adult r juvenile) Educatinal setting Cllege/university cunseling/health center Schl-based mental health service Residential schl Other setting Business/Industry Emplyee Assistance Prgram/Cmpany Faith-based setting Fundatin Managed care rganizatin (dmestic) Managed care rganizatin (internatinal) Prfessinal/Trade Assciatin Public health department Recvery supprt services Rehabilitatin Residential facility- adults (Grup Hme, etc.) Residential facility- children (Grup Hme, etc.) Other (please specify) A Minimum Data Set fr the Behaviral Health Wrkfrce

25 27H. What are the average number f hurs yu spend per week (excluding call) n each majr jb activity at this emplyment lcatin? Activity Number f Hurs Per Week Administratin/business r prgram management Clinical supervisin (receiving) Clinical supervisin (prviding) Direct Patient Care/Clinical Services Case management (including wrk with ther human/scial supprt services such as lcal husing, jb supprt and scial netwrks) Clinical r cmmunity cnsultatin and preventin Disease preventin and health prmtin Treatment planning and team cnsultatin Treatment (including assessment/evaluatin) Medicatin prescriptin and management Indirect (cllateral) patient care (e.g. phne calls, reviewing labs, charting) Other Outreach and engagement Research-related activities Wrkfrce develpment: teaching and training Other human services (e.g. frensics, cnsulting) Other (please specify) [REPEAT QUESTIONS FOR SECONDARY AND TERTIARY EMPLOYMENT LOCATIONS] 28. If yu did nt reprt currently prviding direct clinical r patient care at any f yur emplyment lcatins, have yu ever prvided direct clinical r patient care? Yes N 28A. If yes, hw many years has it been since yu last prvided clinical r patient care? Less than 2 years 2 t 5 years A Minimum Data Set fr the Behaviral Health Wrkfrce

26 6 t 10 years Mre than 10 years I have never prvided direct clinical r patient care 29. D yu prvide services t individuals with develpmental disabilities? Yes N 30. Hw many years have yu been wrking in behaviral health? (Please include emplyed, vlunteer, and retirement wrk.) Years 30a. If retired, hw many years have yu been wrking in behaviral health since yur retirement? Years 31. What are yur shrt and lnger term emplyment plans? (Select all that apply.) Emplyment plans fr next 12 mnths Emplyment plans fr next 5 years Emplyment plans fr next 10 years Maintain hurs Increase hurs Decrease hurs Seek a nn-clinical jb Seek career advancement Mve t anther practice lcatin within the same state Mve t anther practice lcatin in a different state Mve t anther cuntry Military service Return t schl r training prgram Leave the field Retire Other Unsure A Minimum Data Set fr the Behaviral Health Wrkfrce