CONTRA COSTA MENTAL HEALTH MENTAL HEALTH SERVICES ACT Workforce Education & Training Draft Plan December 2008 Background EXECUTIVE SUMMARY The Mental Health Services Act (Prop 63) passed by California voters in 2004 represents a comprehensive approach to the development of community based mental health services and supports for the residents of California. The Act addresses a broad continuum of community services and supports, prevention and early intervention, capital facilities, technological needs, and innovation, as well as workforce education and training that will effectively support this system. The Workforce Education and Training (WE&T) component of MHSA includes the requirement for the State Department of Mental Health to develop a Five Year Plan for Workforce Development. In order to receive WE&T funding on the local level, counties must develop a plan with stakeholder input to address: Identified shortages in occupations, skill sets, and individuals with unique cultural and linguistic competence in urban and rural county mental health programs and private organizations providing services in the Public Mental Health System. Education and training for all individuals who provide or support services in the Public Mental Health System, including fostering leadership skills. This education and training should contribute to developing and maintaining a culturally competent workforce. It should include clients and family members and provide client- and family-driven services that promote wellness, recovery and resilience, and lead to measurable, values-driven outcomes. Counties must also complete a workforce needs assessment of county operated and contracted mental health services, identifying specific shortages and needs. Page 1 of 7
Planning Process Building on its earlier planning process under MHSA for Community Services and Supports, CCMH worked with a variety of stakeholders including consumers, family members, providers, educators and other community members to develop priorities and activities for its WE&T plan. During spring and summer 2008 CCMH conducted a series of surveys, focus groups, and interviews. This culminated with a Community Summit in July 2008, to present findings to the public. Data Sources Data for determining the County s Workforce Education and Training needs was pooled from the following sources: Workforce Needs Assessment The Workforce Needs Assessment Survey (required by State DMH) was distributed to 36 community based organizations (CBO s) and organizational network providers and completed by 32 (88.9% response rate). Data from CCMH employee database on 352 County FTE s, and Data from the Independent Network Provider database on 195 individual providers. CCMH Staff Survey A survey on training needs and educational aspirations was distributed to 323 CCMH employees at 18 sites and completed by 234 (72% response rate) Focus Groups Five focus groups were conducted between March and May 2008; they included representatives from CBO s, as well as educators, consumers, family Members, and County staff. Altogether, a total of 54 participants. Key Informant Interviews Staff interviewed 13 subject matter experts for their specialized knowledge. Key Findings from the Workforce Needs Assessment A. Shortages by Occupational Category The following shortage areas were identified in the total workforce: Licensed mental health occupations: Page 2 of 7
licensed clinical social worker (LCSW) psychiatrist (particularly child/adolescent psychiatrist) licensed clinical psychologist marriage and family therapist (MFT) licensed supervising clinician Registered Nurse, and psychiatric nurse practitioner Unlicensed direct service positions: mental health rehabilitation specialist case manager/service coordinator consumer support staff, and family support staff Support staff positions: technical support/analysts clerical, secretary, and administrative assistants Findings indicate that the number of licensed and unlicensed direct service staff would need to increase by 44 percent and 12 percent, respectively, to be able to address the unmet need for public mental health services in Contra Costa County (including CCMH and CBO s/network staff). Support staff providing non-direct services would also need to increase by as much as 27 percent. Of the 100 authorized full-time equivalent (FTE) positions that were vacant at the time of assessment, almost all were located at CBO s/network organizations, reflecting the difficulties contract agencies experience recruiting direct service staff with the salary/benefits they can offer. B. Comparability of workforce, by race/ethnicity, to target population receiving public mental health services A breakdown of the racial/ethnic composition of the total workforce revealed significant discrepancies between the racial/ethnic composition of licensed and unlicensed staff and the mental health clients served. For instance, Licensed mental health staff and managerial/supervisory staff were almost twothirds White/Caucasian. The percentage of direct service staff and managerial/supervisory staff that were Hispanic/Latino was low relative to that of non-direct support staff and Hispanic/Latino clients who sought services. While African American/Black clients currently represent the second highest racial/ethnic group, only nine percent of licensed mental health staff and 12 percent of managerial/supervisory staff were African American/Black. Page 3 of 7
Although the number of Asian/Pacific Islanders (API s) in the workforce appeared to be representative of the API client population, the low service utilization by API communities is not reflective of the true need for services. Comparability of Total Workforce to Client Population, By Race/Ethnicity PUBLIC MENTAL HEALTH CLIENTS 46 17 26 6 6 SUPPORT STAFF (NON- DIRECT SERVICE) 29 19 19 8 26 MANAGERIAL AND SUPERVISORY OTHER HEALTH CARE STAFF (DIRECT SERVICE) LICENSED MH STAFF (DIRECT SERVICE) 63 8 12 10 7 58 9 20 8 6 65 9 9 5 12 WHITE/CAUCASIAN HISPANIC/LATINO AFRICAN AMERICAN/BLACK ASIAN/PACIFIC ISLANDER MULT-RACE OR OTHER UNLICENSED MH DIRECT SERVICE STAFF 28 12 30 9 21 0% 20% 40% 60% 80% 100% PERCENT FTE-to-client ratios by race and ethnicity indicate a need for additional Hispanic/Latino, African American/Black, and Native American staff -- total and direct service only staff. Excluding Native Americans, CCMH had a greater staff-toclient imbalance with respect to African Americans/Blacks. CBO s and Network organizations, on the other hand, had a greater staff-to-client discrepancy with respect to Hispanics/Latinos. In Contra Costa County, current MediCal penetration rates for clients/eligibles that are Asian, Hispanic, and Pacific Islander are very low relative to that of Whites, Blacks, and Alaskan Natives/American Indians. C. Positions designated for individuals with consumer and/or family member experience Page 4 of 7
Almost one-third of CBO s/network organizations responded that they did not designate positions for individuals with consumer or family member experience. The positions that are designated were primarily unlicensed direct service positions. It was within this unlicensed category that the need for additional designated staff positions was the greatest. Overall, there was a perceived need for 34 percent more staff with consumer or family member experience to address the unmet need for services. D. Language proficiency Staff-to-client ratios compared staff that was proficient in a second language to clients who reported a preference for speaking a language other than English. High disparities were evident in the staff-to-client ratios for Farsi and Vietnamese. Of the top five languages spoken, Spanish speakers were most in demand. In fact, the number of Spanish-speaking staff would need to increase by 48 percent to meet the unmet need. Plan Overview Contra Costa Mental Health (CCMH) has developed a WE&T plan with the following objectives and activities: Increasing consumer and family member employment in the public mental health system, including expansion of its current SPIRIT consumer training program. Development of mental health career pathway programs to support high school students and community college students, including the development of a Psycho Social Rehabilitation Certificate Program. Training for county and contract agency staff that enhances clinical practice, with a focus on recovery and cultural competency. Specific initiatives that focus on staff training of co-occurring disorders and developing in-house experts to support program staff. Expanding the intern program to include the Adult/Older Adult Programs and contracted agencies (CBOs). A new internship program for psychiatric nurse practitioners, A Psychiatric Workforce Development initiative that includes exploring a new residency program/fellowship for psychiatrists and development of a local Psychiatric Technician program Training for local law enforcement staff on Critical Incident Training (CIT). A Growing our Own financial incentive program to offer scholarship support to expand diversity and cultural competency for staff for Bachelors and Masters-level (Social Work) degree programs to enhance the workforce. Spanish language courses for staff to enhance work with Spanish-speaking consumers and family members. Page 5 of 7
Contra Costa Mental Health (CCMH) is eligible for a total of $4.74 million that can be used over a ten year period. The WE&T plan is focused on maximizing the use of these limited funds. The stakeholder groups stressed the importance of improving our community collaborations with our contractors and educational institutions to support WE&T activities. Further, CCMH is partnering with institutions that are recipients of the Statewide WE&T initiatives funding from State Department of Mental Health. CCMH plans to build on these relationships to sustain the development of the public mental health workforce in Contra Costa County in the future. Review and Comment The draft WE&T Plan will be available on December 12, 2008 for the state-mandated 30-day public review and comment. To receive a full copy of the draft WE&T plan: Download the plan by going to: http://cchealth.org/services/mental_health/prop63/workforce_education.php Contact: Contra Costa Mental Health Administration 1340 Arnold Dr., Suite 200 Martinez CA 94553 Phone: (925) 957-5150 Fax: (925) 957-5156 Submit your comments in writing to mhsa@hsd.cccounty.org by completing the Public Comment Form (Ref. www.cchealth.org) no later than Thursday, January 12th, 2009. (Please cite the section and page number of the draft plan if you are making a specific comment or suggestion.) Contact Contra Costa Mental Health Administration if you would like the document in English and Spanish. Public Hearing on Workforce Education and Training Plan Date: Thursday, January 22, 2009 Time: 4:30 p.m. - 6:30 p.m. Location: Concord Police Dept. Community Room 1350 Galindo Street, Concord Page 6 of 7
Page 7 of 7