As behavioral health care providers confront the unrelenting opioid epidemic, in an environment of rapidly evolving reforms in health delivery and payment systems, one theme continues to resonate: the importance of a vital workforce. It comes as no surprise that compounding the reality of systems reform, our field is experiencing a number of workforce recruitment and retention challenges.
Across the country, there remains a critical shortage of sufficiently trained and credentialed health workers and clinical professionals to meet the growing population of individuals in need of behavioral health care, particularly with focus on addiction treatment. A 2016 report published by the Health Resources and Services Administration (HRSA) highlighted worker shortages as a key challenge for meeting the nationwide need for behavioral healthcare. There are over 123 million Americans living in designated Mental Health Professional Shortage Areas (HPSAs), and the report estimated it would take nearly 6,000 additional health workers to meet these needs.
A January 2019 publication provided by the Mental Health Association in New York State summarized statewide survey results of turnover and vacancy rates among behavioral health providers. New York’s average annual turnover rate was a staggering 34%. In its segmented data, results showed that regions with higher costs of living had higher rates (up to 42%). Rates across the country are comparable and equally concerning. Salary growth and compensation has largely stagnated, a factor that emerges as highly consequential for behavioral health non-profits. An inevitable consequence of these challenges is the increasing occurrence of worker “burnout” from high caseloads and more demanding and complicated cases.
Outreach’s Own Workforce
At Outreach, our programs directly experience these challenges, especially in our residential treatment programs. Our capacity to provide vital and accessible care to our clients expands or contracts drastically with the loss or addition of a clinician. With this in mind, we carefully examine and gauge workforce issues, with focus on employing best practices in recruiting and retaining a qualified, motivated, engaged and job-satisfied staff.
We have fortunately been able to, in some ways, go against the tide on some of these trends, specifically on retention. Of almost 200 full- and part-time employees eligible for one-year retention at Outreach, over 80% have been with us for 2 or more years. The average length of employment for full and part-time staff at Outreach is over 7 years, with almost a quarter with the agency for 10 or more years. Much of these retention trends can be attributed to Outreach’s focus on employee engagement.
Employee Engagement at Outreach
Ten years ago, Outreach embarked upon a culture change initiative. We commissioned experienced executive consultants to interview stakeholders key to our agency: our referral sources, board members, and most importantly, our staff. An opportunity was identified to “de-silo” Outreach’s leadership and programs through a major rebranding and internal organizational culture change. The biggest takeaway from this experience was the ability to establish systems to engage and listen to our employees across our programs.
An important initiative undertaken at Outreach was to participate in the Best Companies to Work for in New York program. Created by the NYS Society for Human Resource Management (SHRM), The Business Council and Best Companies Group, the effort recognizes outstanding places of employment by capturing data on employer benefits, HR policies, practices and demographics, and more crucially, employee engagement and satisfaction.
While designation as a ‘best company’ would enhance Outreach’s reputation as an employer, we were especially invested in the results of the anonymous, voluntary satisfaction surveys completed by our employees, the results of which are aggregated by Best Companies’ statisticians for our review, and highlight trends in key areas such as: trust and confidence in the agency’s leadership, professional development and career advancement, pay and benefits, and physical plant. Employees’ candid narrative comments offer even richer feedback, presented in a manner that further guarantees anonymity and confidentiality.
In order to decide what changes and investments need to be made by a company to retain its workers, leadership needs to create safe opportunities for staff voices to be heard. Workforce studies emphasize that employee engagement is critical in sustaining employee retention. Encouraging Outreach employees to participate in the survey process each year for Best Companies is one avenue. As a result of these surveys, creative staff initiatives, HR policies and practices have been implemented involving improved benefits, staff appreciation and recognition, and innovative ways for staff voices and ideas to be heard. Outreach continues to regularly and routinely assess and listen to our employees.
Professional Development Opportunities Within Outreach
Providing opportunities for workforce development through continuing education and training is not only essential for furnishing core skills to support good patient outcomes, but a key component of employee engagement. Outreach has the strategic benefit of operating an in-house training institute that offers a calendar of professional development and continuing education trainings year-round.
Known throughout New York for its Credentialed Alcoholism and Substance Abuse Counselor (CASAC) certificate program, Outreach’s training institute has advanced in recent years to also provide quality training to professionals already in the behavioral health field. Focused on enhancing skills and command of evidence-based practices and provide continuing education hours required for credentialed and licensed clinical staff. More importantly, the benefit of an in-house training institute is realized through an internal culture where supervisors encourage their staff to take part in professional development training opportunities.
Participating in evidence-based practice trainings, such as trauma informed care, motivational interviewing, and mapping-enhanced counseling, not only improves delivery of care, but expands the horizons of our staff. The opportunity to participate in professional development trainings has consistently been valued by staff across various ages and disciplines: Outreach observes these comments in the Best Companies surveys, and also from satisfaction surveys that are administered after each of the institute’s trainings.
While there is no universally definitive approach to employee engagement, recommendations ultimately encompass elements such as: inclusive hiring, accessible learning, and career advancement. Workforce training, skills-training, and a culture that permits these are paramount to employee engagement: they furnish much-needed core skills and competencies while steadily providing expansion of talent and career growth opportunities. Emphasis on a culture that promotes (and allows for) professional development of staff is only one strategy in which Outreach engages its employees, but a critical one that is more infrastructurally available to us than salary increases.
Though Outreach has maintained strides in retaining much of its workforce, we still share in experiencing our field’s workforce crisis. Our field continues to encounter a shortage of qualified health professionals, and just as important, the salaries with which behavioral health workers are paid are not enough to sustain our workforce. To preserve and expand our field’s ability to meet the needs of our communities, as providers, we need to fiercely advocate in unison for vital legislative items, such as Costs of Living Adjustments (COLAs) for our workers. It is incumbent upon us to continue to educate policymakers at the federal and local levels about the impact of these shortages on the availability and delivery of care, toward enacting legislative and policy initiatives that foster a lasting solution.