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

2. Topics 2  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. Highlights State-Administered WET Program Evaluation, 2008-2013 3

4. State-Administered WET Program Evaluation, 2008-2013 : Approach 4  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 5  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 6  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 7  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 8  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) 9 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) 10  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) 11  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 12 Stipend Awardees 2008/09 - 2012/13 DisciplineIndividuals Awarded Awardees of Under- Represented Backgrounds Awardees that Speak a Language in Addition to English Social Workers148659%50% Marriage and Family Therapists 36773%65% Psychiatric Nurse Practitioners 6346%59% Clinical Psychologist 28358%52% Total220561%53% 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 13  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 14  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) 15  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 MHLAP Applications FY 2008-09 to FY 2012-13 Fiscal Year Applications Received Individuals AwardedFunds RequestedEducational DebtFunds AwardedCounties Supported FY 2008- 09 1,236288$15,454,813$60,729,395$2,285,27744 FY 2009- 10 1,498309$12,683,961$80,331,133$2,469,23952 FY 2010- 11 1,009474$10,030,983$71,177,144$4,523,75750 FY 2011- 12 1,659661$16,581,901$111,533,342$5,365,68055 FY 2012- 13 1,8231,109$17,968,953$122,828,475$9,383,64953 Total7,2252,841$72,720,611$446,599,489$24,027,60258 Source: OSHPD

16. State-Administered WET Program Evaluation, 2008-2013: Client and Family Member Statewide Technical Assistance Center 16 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 17 Regional Partner- ship Cultural compete ncy trainings Curric. focused efforts with colleges High school mental health career pathway Core competen cies project Move toward recovery focus in WET Programs targeting the under- served Explicit stigma reduction efforts First responder training and MH First Aid trainings Central XXXXXXX Greater Bay Area X XXX X Los Angeles XX X Southern XXXXX Superior XX X

18. State-Administered WET Program Evaluation, 2008-2013: Shortage Designation 18  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 MHSPA Application Type MHPSA Applications Processed Since 2009 Reactive86 Proactive36 Source: OSHPD

19. 19 State-Administered WET Program Evaluation, 2008-2013: Number of Mental Health Professionals Impacted by State WET Programs Hard-to-fill/retain positions identified in 2008MHLAPStipend Psychiatric ResidencySong-Brown PATotal Participants Psychiatrist, General230-- 230 Licensed Clinical Social Worker2551,838*-- 2,093* Marriage and Family Therapist1259474-- 1,733 Licensed Supervising Clinician0-- 0 Psychiatrist, Child/Adolescent-- 10--10 Psychiatrist, Interdisciplinary Medicine Specialty -- 15--15 Registered Nurse12-- 12 CEO or Manager above Direct Supervisor3-- 3 Psychiatric or Family Nurse Practitioner892-- 100 Licensed Clinical Psychologist23283-- 306 Analysts, tech support, quality assurance0-- 0 Family Member Support Staff0-- Unknown Clinical Nurse Specialist1-- 1 Psychiatrist, Geriatric-- Unknown Consumer Support Staff4-- 4(Unknown) Positions not identified as hard to fill/retain in 2008 Physician Assistant0-- 1,382 Licensed Professional Clinical Counselor14 Bachelors Social Worker46 Associate Clinical Social Worker629 Other235 TOTAL SERVED:2,7192,687251,3826,813 *Includes Stipend Program for Social Work participants from beginning of program in 2005.

20. State-Administered WET Program Evaluation, 2008-2013: Program Effectiveness 20 State-Administered WET Program*n Average Rating % Rating the Program Somewhat or Very Effective MHLAP263.4292% Social Worker Stipend Program212.6767% MFT Stipend Program202.5570% PMHNP Stipend Program172.2453% Psychiatric Residency Program191.6826% Clinical Psychologist Stipend Program171.5918% Song-Brown Program for Physician Assistants 121.080% Overall--2.32-- 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 Scale: 1 (not at all effective) - 4 (very effective) * The survey did not include Regional Partnerships and WWT for this specific question.

21. State-Administered WET Program Evaluation, 2008-2013: Cultural and Linguistic Competency 21 Baseline 2008Progress 2013 Licensed Direct % Difference from target Licensed Direct % Difference from Target Caucasian/White 6,93854%-20.6%15,65051%-18.00% Hispanic/Latino 2,41719%+19.0%6,55821%+16.70% African American/ Black 1,0728%+9.0%2,5388%+9.30% Asian/Filipino/ Pacific Islander 1,34210%-3.4%3,25211%-4.00% American Indian/ Alaska Native 1101%+0.1%2611%-0.10% Multiple/Other 1,0768%-4.2%2,6378%-3.90% Total 12,955100%--30,896100%--

22. State-Administered WET Program Evaluation, 2008-2013: Cultural and Linguistic Competency 22 Non-English Language Number of public sector staff needed in 2008 Adjusted estimate of need Number served by all state- administered WET programs 2008-2013 % of need potentially met by all state- administered WET programs 2008-2013 Spanish6,092 12,671 1,708 13% Chinese 5131,067 109 10% Other Asian 9742,026 283 14% Other 221460 319 69% Total7,800 16,224 2,419 15% 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 23 Program Impacts n Not at all effective Somewhat effective Very effective Don't know How effective have state-administered WET programs been in increasing the cultural and linguistic competency of the workforce in your county? 2612%50%35%4% How effective have state-administered WET programs been in increasing the diversity of the workforce in your county so that the workforce is more representative of the population served in terms of ethnicity, cultural tradition, religion, LGBT identification, etc.? 2627%39%19%15%

24. State-Administered WET Program Evaluation, 2008-2013: Formal Education Structure and Curricula 24  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. 25  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 State-Administered WET Program Evaluation, 2008-2013: People with Lived Experience 25 * Combines Southern/LA Region.

26. 26  Working Well Together:  Stipend: full time equivalent recipients employed from 2007-2011  MHLAP  Supported 58 out of 60 counties/municipalities State-Administered WET Program Evaluation, 2008-2013: Meeting Regional Needs 26 RegionTA VisitsTrainingsParticipants Central 3961030 Southern/ Los Angeles* 40131579 Superior 297576 Bay Area 518492 Total159343,677 * Combines Southern/LA Region. ProfessionSuperiorBay AreaCentralLos AngelesSouthern Clinical Psych0431348 MFT13431442 Psych NP332975 Social Work74307209365303 Total90425233448358

27. State-Administered WET Program Evaluation, 2008-2013: Meeting Regional Needs 27 Regional Partner- ship Cultural compete ncy trainings Curric. focused efforts with colleges High school mental health career pathway Core competen cies project Move toward recovery focus in WET Programs targeting the under- served Explicit stigma reduction efforts First responder training and MH First Aid trainings Central XXXXXXX Greater Bay Area X XXX X Los Angeles XX X Southern XXXXX Superior XX X

28. State-Administered WET Program Evaluation, 2008-2013: Recommendations for Future Practice 28  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 29  Track participation consistently  Track LGBT and consumer/family member identification  Track progress of Regional Partnerships with more consistent tools  Monitor curricula with checklist

30. Highlights OSHPD-led Stakeholder Engagement 30

31. OSHPD-led Stakeholder Engagement: Overview 31  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 32 OSPHD led data collection efforts across multiple sources including: Stakeholder Engagement Strategy Number of Activities/Participants Community Forums14 Forums throughout the State with over 600 Participants Focus Groups13 Focus Groups Key-Informant Interviews13 Interviews Online Survey325 Responses

33. OSHPD-led Stakeholder Engagement: Key Findings 33 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 34 Mental Health Profession Community Forum Focus Group Key Informant InterviewSurveyTotal Psychiatrists11531938 Consumer peer positions14212037 Marriage and Family Therapist (MFT)6202836 Psychiatric Mental Health Nurse Practitioner11511330 Alcohol and Other Drug Abuse Counselors7002330 Licensed Clinical Social Workers5002429 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 35 Key Challenge Community ForumFocus Group Key Informant InterviewSurveyTotal Lack of training and education programs9413044 Lack of integration/collaboration762621 Lack of supervision1021316 Key RecommendationCommunity ForumFocus Group Key Informant InterviewSurveyTotal Expand training and education programs1237126 Develop clear career pathway/ladder1332321 Promote training on integration863017 What actions would you recommend to overcome those challenges? What are the challenges to increasing and sustaining the public mental health workforce in your region? (Training and Education)

36. OSHPD-led Stakeholder Engagement: Recruitment and Retention 36 Key Challenge Community ForumFocus Group Key Informant InterviewSurveyTotal Low Wages11611937 Stigma8531026 Burnout10211124 Lack of job opportunities /growth potential8411023 Key Recommendation Community ForumFocus Group Key Informant InterviewSurveyTotal More financial incentives926421 Conduct career awareness/recruitment efforts1253020 Increase stipends840113 Increase reimbursement1011012 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 37 Key ChallengeCommunity ForumFocus GroupSurveyTotal Stigma1261836 Lack of formal training or education821020 Lack of Employment Opportunities113519 Not enough support and accommodations for consumers44311 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 38 What actions would you recommend to overcome those challenges (regarding consumer and family member employment)? Key Recommendation Community ForumFocus GroupTotal More support for consumers11415 More training for consumers10313 Peer Certification8210 Train staff in consumer movement529 Have consumers be part of training and be involved in curriculum development527 Education/Training public to reduce stigma527

39. OSHPD-led Stakeholder Engagement: WET Models and Partnerships 39 Models and Partnerships Community Forum Focus Group Key Informant InterviewTotal Mental Health First Aid51612 NAMI42612 WET Regional Partnership51612 WRAP Program50510 High School Pathways3148 Stipends (CalSWEC)4048 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. Highlights County-Reported Needs Assessments 40

41. County-Reported Needs Assessments: Overview 41  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 42  OSHPD-led 2013 County-Reported Needs Assessment  OSHPD/RDA-led County-Reported Needs Follow- Up Survey

43. County-Reported Needs Assessments: Limitations 43  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 44

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 45

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 46

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 47

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

49. County-Reported Needs Assessments: Workforce Shortages 49

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

51. County-Reported Needs Assessments: Workforce Shortages- Bay Area Region 51

52. County-Reported Needs Assessments: Workforce Shortages- Central Region 52

53. County-Reported Needs Assessments: Workforce Shortages- LA Region 53 Los Angeles County/Region Workforce Shortages (In Order of Rank) Psychiatrist (Child, Geriatric, Addiction) Clinical Supervisor Licensed Clinical Social Worker/ Marriage and Family Therapist/ Community Mental Health Psychologist Nurse, Other Designated Consumer/Family Member, Advocacy

54. County-Reported Needs Assessments: Workforce Shortages- Southern Region 54

55. County-Reported Needs Assessments: Diversity Needs 55

56. County-Reported Needs Assessments: MHSA WET Program Participation Rates by County Size 56 Size Breakdown Small (<200K people) Medium (200-800K people) Large (>800K people)

57. County Reported Needs Assessments Follow-up Survey Key Findings  The state’s top hardest-to-fill or hardest-to-retain positions are:  Psychiatrist  Licensed Clinical Social Worker  Marriage and Family Therapist  The primary reported reason staff vacated hard-to-fill or hard-to-retain positions is pay  Staff most frequently left for private mental health agencies  The top strategy employed to manage staff vacancies is reassigning duties to existing staff in similar/same positions  Labor substitution for hard-to- fill or hard-to-retain positions is challenging due to the specialized nature of the positions. Psychiatric NP were identified as preferred labor substitute for Psychiatrist.  Counties used a diverse range of strategies to recruit, orient, and train consumers and family members for county positions 57

58. County Reported Needs Assessments Follow-up Survey Reasons Positions Vacated across California 58

59. County Reported Needs Assessments Follow-up Survey Statewide Departure Agencies 59

60. County Reported Needs Assessments Follow-up Survey Statewide Staff Vacancy Management 60

61. County Reported Needs Assessments Follow-up Survey Large County Size Staff Vacancy Management 61

62. County Reported Needs Assessments Follow-up Survey Psychiatrist Substitutes 62 PositionCount of Responses% of Total Responses Other1033% Psychiatric Mental Health Nurse Practitioner 930% Licensed Clinical Social Worker27% Nurse Practitioner27% Physician Assistant27% Child/Adolescent Psychiatrist13% Clinical Nurse Specialist13% Licensed Professional Clinical Counselor 13% Marriage and Family Therapist13% Medical Doctor (not a Psychiatrist)13% Total30100%

63. County Reported Needs Assessments Follow-up Survey Statewide Recruitment, Orientation, and Training Strategies 63

64. Highlights Literature Review: Public Mental Health Workforce Demand and Supply 64

65. Literature Review Components 65  Demand  Affordable Care Act  Workforce Trends  Prevalence Rates  Supply  Workforce Trends

66. Literature Review: Impact of the Affordable Care Act 66  Medi-Cal recipients accessing public mental health services  In FY 2011-12, nearly 3 million children covered by Medi-Cal received specialty mental health services  Count is expected to rise to approximately 3.8 million children in FY 2012-13 and 4.1 million in FY 2013-14 Department of Health Care Services. Medi-Cal Specialty Mental Health Services May Revision Estimate. May 2013. Available from:http://www.dhcs.ca.gov/services/MH/Documents/DHCS- SMHS_May_2013_Estimate_Supplement.pdf

67. Literature Review: Impact of the Affordable Care Act 67  Impact of Medicaid Coverage Expansion (MCE)  Beginning January 1, 2014, individuals and families with household incomes up to 138% of the FPL will be eligible for Medi-Cal regardless of health status, age, gender, or parental status  An estimated 1.4 million Californians under age 65 will become newly eligible for Medi-Cal  In total, there is an expected enrollment increase of between 830,000 and 1.2 million individuals by 2019  Among the newly covered, studies anticipate a higher prevalence of serious mental illness and, therefore, a greater demand for public mental health services. Estimates range from 17% to 25% prevalence of serious mental illness amongst the MCE group Jacobs, K, and D. Graham-Squire, G. Kominski, D. Roby, N. Pourat, C. Kinane, G. Watson, D. Gans, and J. Needleman. Predicted Increase in Medi-Cal Enrollment Under the Affordable Care Act: Regional and County Estimates. UC Berkeley Labor Center. June 2012. Available from: http://laborcenter.berkeley.edu/healthcare/aca_fs_medi_cal.pdf http://laborcenter.berkeley.edu/healthcare/aca_fs_medi_cal.pdf Bazelon Center for Mental Health Law. Medicaid Lifeline for Children and Adults with Serious Mental Illness. Available from: http://www.bazelon.org/LinkClick.aspx?fileticket=ARq331Ujs3Q%3D&tabid=40 http://www.bazelon.org/LinkClick.aspx?fileticket=ARq331Ujs3Q%3D&tabid=40

68. Literature Review: Skills Mix / Examining Provider Ratios 68  Skills mix is a broad term and can refer to a wide range of relationships: the skills needed to fulfill consumer needs, the skills currently available, the skills required by each type of provider, etc.  The concept of skills mixes can be used to categorize the demand for services, rather than considering specific professions individually  Example: Nurse practitioners and physician assistants may be able to offload some of the responsibilities of psychiatrists. Incorporating NPs and PAs increases the total capacity of licensed, prescribing providers

69. Literature Review: Years Required for Education, Licensing, and Training for Mental Health Occupations (1) 69 Occupational Category Minimum Years to Completion Training and Education Required for Service Provision Benefits/Eligibility SpecialistN/A Case Manager/Service CoordinatorN/A Clinical Nurse Specialist2 years2 year Master’s Degree Program, Exam Clinical Psychologist5 years 4 year Doctorate Degree, 1 year Post- doctoral Training, Exam Designated Consumer/Family MemberN/A Employment Service StaffN/A Housing Support Services StaffN/A Licensed Clinical Psychologist5 years 4 year Doctorate Degree, 1 year Post- doctoral Training, Exam Licensed Clinical Social Worker4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam Licensed Professional Clinical Counselors 4 years 2 year Master’s Degree Program, 2 years Post-graduate Training, Exam Licensed Psychiatric Technician1 year12 months, Exam

70. Literature Review: Years Required for Education, Licensing, and Training for Mental Health Occupations (2) 70 Occupational Category Minimum Years to Completion Training and Education Required for Service Provision Marriage and Family Therapist4 years 2 year Master’s Degree Program, 2 years Post- graduate Training, Exam Mental Health Rehabilitation SpecialistN/A Nurse, Other* Occupational Therapist2 years2 year Master’s Degree Program, Exam Other Non-Licensed Mental Health StaffN/A Physician AssistantN/A2 year Master’s Degree Program, Exam PromotoraN/A Psychiatric Mental Health Nurse Practitioner2 years2 year Master’s Degree Program, Exam Psychiatrist8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams Psychiatrist, Child/Adolescent8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams Psychiatrist, Geriatric8 years 4 years Medical School, 4 years Post-graduate Training, Board and Specialty Board Exams Psychologist5 years 4 year Doctorate Degree, 1 year Post-doctoral Training, Exam School Psychologist2 years2 Year Master’s Degree Program Substance Abuse Counselor**

71. Literature Review: SMI Prevalence Key Findings  Of California’s total population, 5.13% of individuals are estimated to have a SMI; amongst households below 200% of the federal poverty level, this rate increases to 8.11% of individuals  Across the state, youth are 75.8% more likely to have a SMI than adults; amongst households below 200% of the federal poverty level, youth are 15.7% more likely to have a SMI than adults  Adults residing in small counties are more likely to have a SMI  Amongst California’s youth, those residing in the Bay Area region have the lowest estimated SMI prevalence rates, whereas those residing in the Central and Los Angeles regions have the highest estimated SMI prevalence rates  Asian and Pacific Islander adults are the least likely to have a SMI, whereas African American, Native Hawaiian, and Multi- racial adults are the most likely to have a SMI  As adults grow in age from 18 to 44, their estimated SMI prevalence rates continually increase; the same rates gradually decrease from age 45 and on 71

72. Literature Review: Estimated SMI Prevalence by MHSA Region 72 http://www.dhcs.ca.gov/provgovpart/Documents/California%20Prevale nce%20Estimates%20-%20Introduction.pdf

73. Literature Review: Estimated SMI Prevalence by County Size – Households Below 200% FPL 73 http://www.dhcs.ca.gov/provgovpart/Documents/California%20Prevale nce%20Estimates%20-%20Introduction.pdf

74. Literature Review: California Statewide Estimated SMI Prevalence for Youth by Race/Ethnicity 74 http://www.dhcs.ca.gov/provgovpart/Documents/California%20Prevale nce%20Estimates%20-%20Introduction.pdf

75. Literature Review: Employment, Projected Growth, and Mean Wages for Selected Professions in California’s Mental Health Workforce 75 Profession Mean Hourly and Annual Wages Current Employment 2007 Percentage Growth (%) 2006- 2016 Ratio per 100,000 Population Mental Health and Substance Abuse Social Workers $19.44/41,47014,01022.838.4 Clinical, Counseling, and School Psychologists $36.67/78,21312,56020.134.5 Psychiatric Technicians $19.89/42,434 10,39015.128.5 Mental Health Counselors $21.89/46,7009,36020.525.7 Substance Abuse and Behavioral Disorder Counselors $16.96/36,189 8,30035.422.8 Rehabilitation Counselors $20.02/42,7117,62013.020.9 Marriage and Family Therapists $20.50/43,7166,13021.916.8 Psychiatrists $72.92/NA2,48016.46.8 California Employment Development Department (2012). Employment Projections, 2006-2016.

76. Literature Review: Distribution of Selected Licensed Mental Health Professionals in California by Region: 2008 76 California Region Licensed Clinical Social Workers MFTPsychologists Psych Tech Public Mental Health Nurses PsychiatristTotal Regional Percentage Bay Area 4,5178,5014,4541,9161292,10321,62029.8 North Valley/Sierra 1,1851,600690330103604,1755.8 Central Valley/Sierra 2794901673233931,3551.9 Inland Empire 9081,4765792,043203275,3537.4 Orange 1,1152,2791,141857284965,9168.2 Central Coast 7781,9987721,285232985,1547.1 North Counties 4328142101727691,7042.4 South Valley/Sierra 6307924371,37742053,4454.8 Los Angeles 4,2386,7983,8821,0121001,85217,88224.7 San Diego 1,4772,0221,513137446365,8298.0 Total 15,55926,77013,8459,4523686,43972,433100.1 Percent Total 21.537.019.113.00.58.9100. Lok and Chapman. The Mental Health Workforce in California: Trends in Employment, Education, and Diversity. March 2009. Original source of table: American Medical Association (2006). AMA Physician Professional Data.

77. Literature Review: Aging of the Public Mental Health Workforce 77  California’s public mental health workforce will experience increased retirement rates in the coming years  By 2030, the nation will need an additional 3.5 million “formal” healthcare providers to maintain the existing ratio of providers to total population, a 35% increase from current levels

78. Highlights Public Mental Health Workforce Supply Projections, 2014-2019 78

79. Supply Projections: Types of Data 79  Survey  Occupational Board Licensure  National Provider Identification (NPI)  Controls  Wages (Quarterly Census Employment)  California GDP  California Population

80. Workforce Projections: Limitations 80  No perfect data source with exact counts of individuals currently in public mental health workforce  Limited number of variables  Time-intensive process of accessing Client Service Information (CSI) data

81. Supply Projections: Classes of Providers 81  Licensed, Prescribing  Psychiatrist, Physician with Addiction Specialty, Psychiatric Mental Health Nurse Practitioner, Physician Assistant  Licensed, Non-Prescribing, Clinical  Licensed Clinical Social Worker, Marriage and Family Therapist, Licensed Clinical Psychologist  Licensed, Non-Prescribing, Nursing  Registered Nurse, Clinical Nurse Specialist, Licensed Practical Nurse, Licensed Vocational Nurse, Licensed Psychiatric Technician  Alcohol and Other Drug Counselors  Non-Licensed Professional  Case Manager, Community Health Worker, Counselor, Mental Health Counselor

82. Supply Projections: Licensed, Prescribing Providers Key Findings 82  The total count of licensed, prescribing providers is anticipated to grow by 21% over the five-year period from 2014 to 2019  Most of the growth in the licensed, prescribing provider category can be attributed to the projected increases in the supply of Physician Assistants (PAs)  As of 2013, Psychiatrists represent the second largest share of licensed, prescribing providers in the NPI registry  The MHSA Bay Area region and large counties contained the highest percentages of licensed, prescribing positions  The MHSA Superior region and small counties contained the lowest percentages of licensed, prescribing positions  Psychiatrist and physician were male-dominated licensed, prescribing positions

83. Supply Projections: Licensed, Non-Prescribing, Nursing Providers Key Findings 83  The category of licensed, non-prescribing, nursing occupations is anticipated to grow by approximately 33% over five-year period from 2014 to 2019  In 2013, Registered Nurses represented 67% of licensed, non-prescribing nursing occupations in the NPI registry  The MHSA Southern region and large counties contained the highest percentages of licensed, non-prescribing, nursing positions  The MHSA Superior region and small counties contained the lowest percentages of licensed, non-prescribing, nursing positions  Females occupied all licensed, non-prescribing, nursing positions more than males

84. Supply Projections: Licensed, Non-Prescribing, Clinical Provider Key Findings 84  The total count of licensed, non-prescribing, clinical providers is anticipated to grow by approximately 20% over the five-year period from 2014 to 2019  Marriage and Family Therapists represent 45% of licensed, non-prescribing clinical providers in 2013  The MHSA Southern region and large counties contained the highest percentages of licensed, non-prescribing, clinical positions  The Superior MHSA region and small counties contained the lowest percentages of licensed, non-prescribing, clinical positions  Females held a large majority of licensed, non-prescribing, clinical positions

85. Supply Projections: Licensed, Non-Prescribing, Clinical Providers Key Findings 85  MFTs constituted the largest share of providers. LCSWs represented the second highest proportion of the licensed, non-prescribing, clinical provider population  While LCSWs were reported as a high need position, the overall count of MFTs is much higher  The distribution of MFTs across different county sizes does not appear to be as disproportionate as some other provider types  Future strategies could help prepare counties to capitalize on the growing supply of MFTs among the licensed, non-prescriber provider population

86. Supply Projections: Alcohol and Other Drugs Counseling Providers Key Findings 86  The MHSA Southern region and large counties contained the highest percentages of AOD counselors  The MHSA Superior region and small counties contained the lowest percentages of licensed, non-prescribing, clinical positions  Females filled the majority of AOD counseling positions.  The total count of Alcohol and Other Drugs Counseling public providers is slated to grow from 2014 through 2019  The ratio of AOD counseling public providers to the total California population is expected to increase in the next five-year period

87. Supply Projections: Alcohol and Other Drugs Counseling Providers Key Findings 87  The total count of public Alcohol and Other Drug Counseling providers is slated to grow from 2014 through 2019  The annual percent change in growth is forecasted to slow from approximately 8% per year to 6% growth in 2019

88. Supply Projections: Retirement Impact on Workforce Key Findings 88  Among the professions for which retirement rates were estimated, only Psychiatry was estimated to have a significant proportion of providers estimated to retire by 2019  According to the computations conducted for this report, assuming Psychiatrists would retire on average by 65 with average practice lengths of 35 years, 40% of the current Psychiatrist workforce would retire by 2019  After adjusting for this rate of retirement, the incoming supply of Psychiatrists is still projected to increase (albeit at a slower pace) annually

89. Current Supply: Licensed, Prescribing Professions 89 Occupation Number in NPI Registry % of Total Psychiatrist6,573 49% Psychiatric Mental Health Nurse Practitioner163 1% Physician Assistant*6,599 49% Physicians with Addiction Specialties129 1% Total13,464 100% *This number includes all Physician Assistants in the NPI data set, not Physician Assistants serving in the public mental health system in particular. Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013

90. Supply Projections: Licensed, Prescribing Providers 90 Psychiatrist Psychiatric Mental Health Nurse Practitioner Physician Assistant Physician TOTAL Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Observed 20085839 1696 0.34512 12.4103 0.310550 28.9 200960704%16.51026%0.349359%13.41129%0.3112196%30.5 201062463%16.711513%0.354029%14.51174%0.3118806%31.8 201163872%1713114%0.358538%15.61203%0.3124915%33.2 201265062%17.214611%0.462917%16.61254%0.3130685%34.5 201365741%17.216312%0.466025%17.31293%0.3134683%35.3 2008 - 2013 Change 73511%1.26741%0.1209032%4.92620%0291822%6.4 Projected 20146481-1%16.91779%0.571418%18.61355%0.4139424%36.3 201566873%17.219410%0.576447%19.71414%0.4146735%37.8 201668983%17.62129%0.581587%20.81464%0.4154215%39.4 201771103%182308%0.686816%221524%0.4161815%40.9 201873103%18.32477%0.691866%231584%0.4169084%42.4 201975133%18.72647%0.797016%24.11644%0.4176494%43.9 2014 - 2019 Change 103214%1.88733%0.2256026%5.52918%0370721%7.6

91. Current Supply: Licensed, Non-Prescribing, Nursing Occupations 91 OccupationNumber in NPI Registry % of Total Registered Nurse7,507 67% Clinical Nurse Specialist92 1% Licensed Practical Nurse206 2% Licensed Psychiatric Technician825 7% Licensed Vocational Nurse2,610 23% Total11,240 100% Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013

92. Supply Projections: Licensed, Non- Prescribing, Nursing Providers 92 Registered Nurse Clinical Nurse Specialist Licensed Practical Nurse Licensed Psychiatric Technician Licensed Vocational Nurse TOTAL Count Annual Change Prov- to-Pop Ratio Count Annual Change Prov- to-Pop Ratio Count Annual Change Prov- to-Pop Ratio Count Annual Change Prov- to-Pop Ratio Count Annual Change Prov- to-Pop Ratio Count Annual Change Prov- to-Pop Ratio Observed 20084435 12.275 0.2110 0.3530 1.51284 3.56434 17.6 2009501013%13.678 4% 0.213321%0.458711%1.6152419%4.1733214%20 2010559512%15803%0.214711%0.46368%1.7180418%4.8826213%22.1 2011617910%16.4868%0.216613%0.46858%1.8208115%5.5919711%24.5 2012688911%18.2893%0.219216%0.57509%2239615%6.31031612%27.3 201375309%19.8923%0.22088%0.582510%2.226149%6.9112699%29.6 2008- 2013 Change 309541%7.617 18% 09847%0.229536%0.7133051%3.4483543%12 Projected 201482139%21.4986%0.3233 12% 0.6891 8% 2.32927 12% 7.612362 10% 32.1 2015899410%23.21035%0.326012%0.79749%2.5322510%8.31355610%34.9 201697969%251085%0.328810%0.710599%2.735299%9147799%37.7 2017106158%26.91145%0.331510%0.811468%2.938359%9.7160258%40.5 2018114408%28.71205%0.33418%0.912307%3.141268%10.3172578%43.3 2019122847%30.51265%0.3367 8% 0.91314 7% 3.34422 7% 1118513 7% 46 2014- 2019 Change 407133%9.12822%013437%0.342332%1149534%3.4615133%13.9

93. Current Supply: Licensed, Non-Prescribing, Clinical Providers 93 Occupation Number in NPI Registry % of Total Psychologist13,01428% Marriage and Family Therapist20,46045% Licensed Clinical Social Worker11,90826% Licensed Professional Clinical Counselor 3391% Occupational Therapist100% Total45,731100% Source: National Provider Identification Data Dissemination File (Centers for Medicare Services), 2013

94. Supply Projections: Licensed, Non- Prescribing, Clinical Provider Findings 94 Psychologist Marriage & Family Therapist Licensed Clinical Social Worker Licensed Professional Clinical Counselor TOTAL Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Count Annual Change Prov-to- Pop Ratio Observed 200810130 27.814656 40.29026 24.7230 0.634042 93.3 2009109198%29.71606510%43.797198%26.52498%0.7369529%100.6 2010114875%30.8172207%46.2102976%27.62688%0.7392726%105.3 2011120295%32183547%48.9108776%292856%0.8415456%110.6 2012125584%33.2195557%51.7114555%30.33109%0.8438786%116 2013130204%34.2204615%53.7119134%31.33399%0.9457334%120 2008- 2013 Change 2890 22% 6.45805 28% 13.52887 24% 6.6109 32% 0.311691 26% 26.7 Projected 201413605 4% 35.421983 7% 57.212606 6% 32.8353 4% 0.948547 6% 126.3 2015141944%36.6230975%59.5132195%34.13777%1508875%131.1 2016147954%37.8242075%61.8138445%35.44016%1532465%136 2017154044%39253225%64.1144755%36.64246%1.1556244%140.7 2018159734%40.1264715%66.4150654%37.84475%1.1579564%145.4 2019165534%41.2276254%68.7156634%38.94695%1.2603114%150 2014- 2019 Change 294818%5.8564220%11.5305720%6.111625%0.31176420%23.7

95. Supply Projections: Alcohol and Other Drugs Counseling Providers 95 AOD Counselor Count Annual Change Prov- to-Pop Ratio Observed 20081730 4.7 20091962 13% 5.3 20102149 10% 5.8 20112436 13% 6.5 20122744 13% 7.3 20133016 10% 7.9 2008-2013 Change 128643%3.2 Projected 20143246 8% 8.4 20153539 9% 9.1 20163836 8% 9.8 20174133 8% 10.5 20184411 7% 11.1 20194690 6% 11.7 2014-2019 Change 144431%3.3

96. Highlights Literature Review: Educational Capacity 96

97. Educational Capacity: Overview 97  Purpose: To identify the pipeline of future mental health providers  Types of analysis:  Geographic distribution  Discipline/Degree  Demographics Gender Race/Ethnicity

98. Educational Capacity: Data Sources 98  Program availability and capacity  Data sources: California Board-Licensed Programs OSHPD-led Educational Institutions Survey  Trends among graduates  Data sources: Integrated Postsecondary Education Data System (IPEDS) California Postsecondary Education Commission (CPEC)

99. Educational Capacity: Limitations 99  IPEDS data has incomplete reporting  CPEC student pipeline data is truncated at 2009  Low response rates to RDA’s educational institutions survey

100. Educational Capacity: Key Findings  Overall and across most areas of analysis, graduation counts rose over the 1999-2009 period  Graduates are heavily concentrated in the Southern Region, which accounts for approximately 43% of all total graduates in the state  Graduate growth rates in the Southern region are increasing faster than the statewide average, and considerably faster than in other MHSA regions  Large counties account for 80% of all graduates in the state, and have held this proportion steadily from 1999-2009  Female graduates account for approximately two-thirds of the total graduates in California  White graduates comprise the largest share of all graduates in mental health disciplines  Graduates of minority race/ethnicities constitute an aggregated majority of all graduates 100

101. Educational Capacity: Distribution of Programs by MHSA Region 101 MHSA RegionCount of Programs% of Total Bay Area8824% Central267% Los Angeles9927% Online205% Southern12534% Superior72% Total365100%

102. Educational Capacity: Distribution of Programs by Institution Type 102 Type of Institution Count of Programs % of Total Programs Community College185% California State University7521% Private22461% Public, Other31% University of California4512% Total365100%

103. Educational Capacity: Distribution of Programs by Discipline and MHSA Region 103 Discipline Bay AreaCentral Los AngelesSouthernSuperiorOnlineTotal Child Psychiatry Fellowship4 21 7 Clinical Nurse Specialist1111011 33 Clinical Psychology2 910 324 Doctorate in Psychology2142 9 Educational Psychology 1 1 Geriatric Psychiatry Fellowship2 21 5 Licensed Professional Clinical Counselor83614 940 Marriage and Family Therapy368284338126 Physician Assistant3123 9 Psychiatric Mental Health Nurse Practitioner1 41 6 Psychiatric Residency4486 22 Psychiatric Technician5329 19 School Psychology5312182 40 Social Work52962 24 Total882699125720365

104. Educational Capacity: Graduates in All Mental Health Disciplines, with Projections 104 2014

105. Educational Capacity: Distribution of Mental Health Graduates by Discipline (1999-2009) 105 198,424 total graduates between 1999-2009

106. Educational Capacity: Count of Graduates by Race/Ethnicity Grouping (1999-2009) 106 Race/Ethnicity Group Count of Graduates % of Total Graduates Asian/Pacific Islander18,30310% Black14,5358% Hispanic/Latino38,48520% Native American1,9371% Other3,5762% Unknown20,90211% White91,45948% Total189,197100%

107. Educational Capacity: Distribution of Schools and Graduates 107 Educational InstitutionsGraduates

108. Educational Capacity: Total Graduates by County Size (1999-2009) 108

109. Literature Review: Graduation to Workforce Participation 109

110. Literature Review: Graduation to Workforce Participation Psychology Graduate Trends – Key Findings 110 Masters Level Survey Results  Sixty-four percent (64%) of graduates with Master’s, Specialist’s, and related degrees who had full-time employment were working in a health services discipline Doctoral Level Survey Results  Sixty-three percent (63%) of new doctoral graduates were employed full-time, 24% were pursuing post-doctorate degrees, 8% were employed part-time, and 6% were unemployed  Almost 30% of doctoral survey respondents were employed three months after the completion of their degree; 38% of doctoral graduate respondents had found employment prior to completion of their doctoral degree  Men were employed full-time at a rate of 67%, compared to women at 62%  White doctoral graduate respondents reported full-time employment at a lower rate than ethnic minorities (62% and 65%, respectively)

111. Literature Review: Graduation to Workforce Participation Key Findings 111  Overall, the reported supply of new graduates into the mental health workforce increased over the past five years  A majority of undergraduate students interested in psychology expressed interest in pursuing graduate and post-graduate education  Among post-graduates in psychiatry, a slight majority commit to U.S.- based Medical Doctor Programs  Federal programs supporting nurses have helped to increase the nursing supply and help drive portions of the workforce to medically underserved communities  Social workers participating the Title IV-E program in California have a 78.8% retention rate  Rural communities are in need of mental healthcare professionals

112. Literature Review: Graduation to Workforce Participation Graduates’ Intent to Pursue Doctoral Degree in Psychology 112 Intent to Pursue Psychology Doctoral Degree Female (n= 1,461) Male (n=344)Total N%N%N% Yes, currently in terminal Master’s program 19814%4414%24214% Yes, currently in a doctoral program in psychology 1,03274%25278%1,28474% No604%83%684% Not Sure1118%217%1328% Total1,401100%325100%1,726100% “American Psychological Association Center for Workforce Studies.” 2008 APA student affiliate survey [survey with tables].” Retrieved from http://www.apa.org/workforce/publications/08-student/index.aspx

113. Literature Review: Graduation to Workforce Participation Employment Settings for Psychology Master’s, Specialist’s, and Related Degree Graduate Students 113 “American Psychological Association Center for Workforce Studies.” 2008 APA student affiliate survey [survey with tables].” Retrieved from http://www.apa.org/workforce/publications/08-student/index.aspxhttp://www.apa.org/workforce/publications/08-student/index.aspx

114. Literature Review: Graduation to Workforce Participation Other Professions Graduation Trends 114  Registered Nurses  59% hire rate into entry-level positions with the Bachelors of Nursing (BSN) degree  67% hire rate into entry-level positions with the Master’s of Nursing (MSN) degree  Psychiatry  The number of post-graduate psychiatry residents has increased slowly since the shortage in the late 1990s American Association of Colleges of Nursing. (2013). Employment of new nurse graduates and employer preferences for baccalaureate-prepared nurses [research brief]. American Psychiatric Association. (2013). Resident census: Characteristics and distribution of psychiatry residents in the U.S. 2011-2012 [Survey with tables].

115. WET Five-Year Plan Needs Assessment Strengths and Next Steps 115

116. Strengths of Overall Project 116  Reviewed extensive amount of county-reported data  Utilizing many data sources to inform needs assessment, evaluation, and projections including:  Literature Reviews  Stakeholder Feedback  State and National Data Sources  Educational Institution Surveys  State Administered WET Program Evaluation  OSHPD support in prioritizing best possible data sources

117. Forthcoming Work 117  Demand Projections  Acquire and analyze demand-side data to identify trends amongst consumers of public mental health services  Primary data source is the Client and Service Information (CSI)  Gap Analysis  Identify any anticipated shortages and surpluses over the next five years  Occupational type, prescribing authority, location, demographic needs (where data is available)  Needs Assessment Report Finalization  Reports including findings from all assessment completed will be posted to the OSHPD website and distributed to stakeholders

118. Thank you! 118 Resource Development Associates Amalia Freedman (afreedman@resourcedevelopment.net)afreedman@resourcedevelopment.net Kevin Wu (kwu@resourcedevelopment.net)kwu@resourcedevelopment.net