1. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Getting and Keeping a Rural Workforce: Lessons from the WICHE West Dennis Mohatt Vice President for Behavioral Health - WICHE

2. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING WICHE region Alaska Arizona California Colorado Hawaii Idaho Montana Nevada New Mexico North Dakota Oregon South Dakota Utah Washington Wyoming

3. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Workforce success is all about P.I.E. Proximity – Provide care close to home Immediacy – Identify and treat early Enthusiastically – Treat with hope

4. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING There is not one rural …

5. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING What’s different in the country?  Not prevalence – rural/urban rates of mental disorders are pretty much the same.  Accessibility (getting there and paying)  Availability (someone there when you are)  Acceptability (choice, quality, knowledge)

6. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING The cold, hard facts  > 60% of rural Americans live in mental health professional shortage areas  > 90% of all psychologists and psychiatrists, and 80% of MSWs, work in metropolitan areas  > 65% of rural Americans get their mental health care from their primary care provider  Rural Americans enter care later in the course of their disorders, with more advanced symptoms, resulting in more intensive & expensive interventions  EMS for Rural MH Crisis usually law enforcement

7. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Mental health professional shortage areas

8. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Health professional shortage areas: primary care HPSA designation can be given for a population group, single county, or a geographical area. As a result, a single county can have all three. Primary TotalCare State CountiesHPSA CO6343 ID4432 ND5341 NM3339 NV1732 OR3648 UT2924 WA3956 WY2318

9. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Community systems of care Informal Community Support Self-Help Primary Prevention Mentoring Etc. Crisis & Assessment Entry & Exit 7 days Rehabilitation Outreach Group Homes Day Programs Residential 7 days/week Outreach in acute short term Community Based Treatment Services Primary Care Specialty Care Outpatient Care Mgmt. Psychosocial Rehab Formal Community Support Acute Need for Care Recovery Inpatient 24 Hour Total Care Community Rehabilitation Services ACT Partial Hosp. Etc. Formal System Natural Support & Care

10. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Defining mental health workforce  Mental health & Substance abuse  Wide range of Disciplines (psychiatry, psychology, social work, nursing) Providers (psychologists, counselors, psychiatric nurses) Professional levels (paraprofessional to graduate level) Services (treatment, prevention)

11. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Findings from Annapolis Coalition Report  Workforce Crisis with Specialty Pops (e.g., children, geriatrics, substance abuse, persons of color, rural)  Dissatisfaction among Persons in Recovery and Families  Employer Dissatisfaction with the Pre-Service Education of Professionals  Delay: Science to Service  Multiple Silos & Absence of Coordination  Narrow Focus on Urban, White Adults  Need better Data & Tools  Propensity to do what is Affordable, Not What is Effective  Pockets of Workforce Innovation: Difficult to Sustain or Disseminate Source: Annapolis Coalition National Strategic Plan for Behavioral Health Workforce Development

12. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING What we know for sure  Rural professionals shortage rates unchanged for past five decades  Many rural BH systems average 30% staff vacancy  Average time to recruit psychiatrist to rural practice is 32 months; increases w/solo practice  Providers w/rural CMHC training and practice more likely to be retained in rural CMHC practice  The 100-Mile Rule: The majority of healthcare providers practice within 100 miles of where they trained  Inadequate supervision a major retention factor … employees leave supervisors not jobs

13. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Behavioral health workforce – grow your own strategy logic model - Population of Focus + Increase knowledge of behavioral health Exchange knowledge about behavioral health careers Provide accessible behavioral health training Applied training opportunities Job sssss ssss sss ss s

14. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Examples from the West … Alaska leads the way

15. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Alaska – has it all going  Statewide TV, Radio, & Print PSA’s that educate about behavioral health issues and the worth of related jobs-professions. (New Mexico also has great mental health public ed ads).  Pipeline Initiatives focused on increasing the interest of school-age youth in behavioral health careers.  Also think about Mental Health First Aid

16. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING And then some …  Threshold jobs to careers  Apprenticeship partnerships (Labor)  Competency workgroup  Rural human service program  RWJ job based learning pilot  Also check out Promotora and Community Health Worker models.

17. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Not finished yet  Higher education partnerships  Rural human service program  Articulated academic ladder  Behavioral health alliance  Distance delivered social work degree  Behavioral health academy  Doctoral program in community/clinical psychology with rural and indigenous people focus

18. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING And finally …  Development of APA Accredited Internship Consortium focused on Alaska practice  Emerging psychiatric residency and child psychiatry fellowships with UW focused on Alaska.  Cross university/cross discipline faculty training in children’s system of care to promote interdisciplinary curriculum change.

19. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING Last but not least  State loan repayment program  Housing stipend program  Regional training collaboratives  Statewide conference for direct care workers and front line supervisors  Statewide Addictions College  Statewide behavioral health strategic plan

20. ALASKA ARIZONA CALIFORNIA COLORADO HAWAII IDAHO MONTANA NEVADA NEW MEXICO NORTH DAKOTA OREGON SOUTH DAKOTA UTAH WASHINGTON WYOMING www.wiche.edu/mentalhealth  Dennis Mohatt  Mimi McFaul  Deb Kupfer  Jenny Shaw  Chuck McGee  Tamie DeHay  Maurene Flory  Nicole Speer  Jessica Tomasko