1. Exploration of the Substance Abuse Treatment Workforce: Education, Preparation and Certification Traci Rieckmann, Ph.D., Bret Fuller, Ph.D, Dennis McCarty, Ph.D., & Christiane Farentinos, MD, CADC II Oregon Health & Science University i The National Drug Abuse Treatment Clinical Trials Network (CTN) is a partnership of drug abuse treatment programs and research centers testing new therapies for drug disorders. Previous research suggests that the majority of counselors in the field are Caucasian, female, and have a bachelors degree (Gallon, Gabriel & Knudsen, 2003; Ball et al., 2002; NTIES, 2001; Mulvey, Hubbard, Hayashi, 2003). High turnover rates, a lack of career development pathways and increasing use of evidence-based practices provides the impetuous for understanding the preparation and professional needs of this workforce. This presentation focuses on education, certification, licensure and use of evidence- based practices of counselors, managers, and supervisors in a sample of substance abuse treatment providers. Methods A survey was distributed to direct service providers in 344 treatment units participating in the CTN. The sample for this presentation included 1679 staff members (1328 counselors and 351managers / supervisors) that provided direct services within four treatment modalities, outpatient (n = 543), methadone (n = 329), residential (n = 618) and detoxification (n = 189). Results Demographics Table 1 shows that women represented 60% of the sample and there was no significant gender difference between supervisors and counselors. Slightly less than 70% of the sample identified as Caucasian. Twenty percent were African- American (n = 299), 11% identified as Hispanic (n=193), and 2% Native American (n =25). Managers/supervisors were more likely to have a master's degree or higher (61% managers vs. 43% counselors). Supervisors were significantly more likely to be credentialed and/or licensed (state: 55%, national 27%; professional licensure: 58%) than counselors (state: 47%, national 18% and professional licensure: 43%). Table 1: Demographics of Managers and Counselors Table 2: Counselor Demographics by Setting ResidentialDetoxificationOutpatientMethadone Sig. Tests % Female62.0555.8558.9662.46 χ 2 = 3.37 p <.3379 % Minority33.6622.2220.8145.29 χ 2 = 67.01 p <.0001 % with MA or higher 34.6338.6260.9644.68 χ 2 = 85.45 p <.0001 % with State or National Certification 50.9742.3348.2552.58 χ 2 = 6.01 p <.1110 Hrs Worked per Week 40.78 ab 39.7338.36 a 38.25 b F = 13.61 P <.0001 Yrs employed in Substance Abuse 7.81 ab 9.89 a 8.939.57 b F = 6.48 P <.0002 Yrs as a clinician 6.67 ab 8.96 a 8.268.84 b F = 10.82 P <.0001 Yrs at present agency 4.50 a 5.595.185.89 a F = 5.58 P <.0008 Yrs at current position 2.90 bc 3.823.86 ac 4.76 ab F = 14.50 P <.0001 Table 2 shows that counselors and managers with master's degrees were more common in outpatient (67%) and methadone (51%) programs than those in residential (40%) and detoxification (44%) programs. Further, outpatient and methadone programs tended to have staff with more experience on the job and as a clinician than those working in residential programs. Residential counselors were in their current position less time than those in methadone programs. The majority of providers (849; 51%) had either state or national certification. Table 4 shows that of the 700 (46%) managers and counselors who had professional licensure, the majority (68%; n = 337) were licensed as an alcohol and drug abuse counselor, 16% were licensed professional counselors (n = 79), with 30 (6%) psychologists, 26 (5%) nurses and the rest were licensed as physicians (n = 7), and social workers (n = 8). Surprisingly, the greatest percent of minorities were working in methadone programs. About 35% of those with Master’s Degrees reported having Associates degrees as well. Of these majors included psychology, addiction studies and general studies. Table 4 presents the majors of those with professional licensure and the most common degree was as an Alcohol and Drug Counselor. Evidence Based Practices A MANOVA tested four evidence based practice items for differences on gender, minority status and education (see Table 5). Multivariate effects were found for minority status (Wilks’ Λ =.943. F(4, 1496) = 22.58, p <.0001) and education (Wilks’ Λ =.947. F(8, 2992) = 10.23, p <.0001) but not for gender. Higher educational attainment predicted greater knowledge of ASAM and APA Practice Guidelines. Education also was related to perceptions that evidence based practices were useful for care and were not non- individualized “cookbook” treatments. Minority counselors and supervisors were less likely to report knowledge of ASAM placement criteria and were more likely to view evidence-based practice guidelines as non-individualized cookbook care. Conclusions Individuals without graduate degrees remain an important component of the counseling workforce. Managers/supervisors have more education and experience and can provide guidance on implementation of evidence- based practices. Some work settings hire more educated staff which may be due to the need for medical expertise in methadone treatment as well as managed care network criteria for reimbursement. People with more advanced education were more likely to support the use of evidence- based practices. ResidentialDetoxificationOutpatientMethadoneTOTAL State Certification 50.2556.1147.7645.3648.81 National Certification 17.6724.6924.2215.5220.25 Prof. Licensure 39.8552.6952.0744.7546.32 Table 3: Type of Certification by Setting Table 4: Majors for those Professionally Licensed. FrequencyPercent AOD Counselor33767.94 Licensed Practical Nurse7915.93 Clinical Psych306.05 Nurse265.24 Medical Degree61.21 Physicians Assistant20.40 Psychiatry10.20 Clergy40.81 Social work81.61 Table 5: Evidence Based Practice Differences by Educational level and Minority Status TotalCounselorsSupervisorsSig. Test % Female60.4361.4956.45χ 2 = 2.93 p <.0869 % Racial Minority 30.4932.6822.22χ 2 = 14.32 p <.0002 % Ethnic Minority 11.5012.278.55χ 2 = 3.79 p <.0515 % with MA or higher 45.5641.5760.68χ 2 = 40.91 p <.0001 % with State Certification 48.8847.1355.19χ 2 = 6.93 p <.0085 % with National Certification 20.2518.4626.77χ 2 = 10.41 p <.0012 Prof. Licensure 46.3243.2657.91χ 2 = 21.56 p <.0001 Hrs Worked per Week 39.3838.7341.83F = 49.77 P <.0001 Yrs employed in Substance Abuse 8.757.8112.23F = 109.64 P <.0001 Yrs as a clinician 7.877.2210.33F = 58.19 P <.0001 Yrs at present agency 5.124.537.35F = 81.36 P <.0001 Yrs at current position 3.683.514.36F = 10.93 P <.0010 EducationMean on Item Minority Status Mean on item How Familiar are you with the American Psychiatric Guidelines for the treatment of patients with Substance Abuse Disorders. 1 = Not at all; 2= Somewhat; 3 = Very High school or less 1.68Caucasian1.79 Ethnic/racial Minority 1.85 AA or BA1.84 MA or higher 1.93 Knowledge of ASAM Placement Criteria 1 = Not at all; 2= Somewhat; 3 = Very High school or less 1.74Caucasian2.04 Ethnic/racial Minority 1.70 AA or BA1.93 MA or higher 1.94 Evidenced Based Practice Guidelines are useful for care 1 = Strongly Disagree to 5 = Strongly Agree High school or less 3.90Caucasian4.01 Ethnic/racial Minoriry 3.93 AA or BA3.90 MA or higher 4.12 Perception that Evidenced Based Practice Guidelines promote oversimplified “cookbook” care. 1 = Strongly Disagree to 5 = Strongly Agree High school or less 2.86Caucasian2.64 Ethnic/racial Minority 2.88 AA or BA2.82 MA or higher 2.60 Means in Bold typeface indicate significant effects at p <.005 A National Institute on Drug Abuse Award (U10 DA 013036) supported this research..