2016 MN Board of Psychology CE Conference: Examining the Mental Health Workforce Plan for Minnesota

2016 MN Board of Psychology CE Conference: Examining the Mental Health Workforce Plan for Minnesota


Angelina Barnes: Good morning. It’s a beautiful day in Minnesota the sun has finally joined us here. My name is Angelina Barnes and I’m the
Executive Director of the Minnesota Board of Psychology. I’ve been the director of the board,
honored since 2009 and my role is obviously Chief Administrative Officer
of the board. One of the things I get to do that I find very exciting is be the
moderator or the host of this annual conference. The Minnesota Board of
Psychology, as you know, is designed to protect the public. We do that through
licensure regulation and education and this is a key component of our
educational programming. We’re very pleased that you decided to spend this
morning with us and this afternoon and we’re really excited about the idea that
today we’ll also be building upon and taking actual action and making
contributions to the Minnesota mental health workforce plan. Hundreds of hours
and work has gone into creating this plan for the state of Minnesota. Today
we’ll build on the work that they’ve done from psychology perspective, you’ll
be able to later in the afternoon contribute thoughts ideas suggestions
recommendations. All so that we can continue to make the progress and to
flow with the momentum that this project has already had. As I mentioned when we
opened, I cited the board’s mission and the board’s vision which includes being
an extensive participant in the educational community and in doing
outreach and connecting with our stakeholders. And we believe that this is
coming true we believe that after we began in 2012 with this plan we
believe we’ve made significant progress and covered significant ground in developing those relationships and in
creating the type of agency we would like to be. That success is attributable to
the hard work, resilience and perseverance of many, not only our
stakeholders themselves as we develop those relationships but our board
members and our staff members. Conferences like this, the development of
the educational programming and the other things that were able to
accomplish and offer to the public and to our stakeholders wouldn’t be possible
without the board and its staff definitely. I certainly know they make me
look good when they’re behind the scenes pulling it off so I’d like to think my
entire team of internal staff members as well as the board of psychology for
their contributions. So if we could just give them a round of applause for all
the work they put in. Thank you. And in terms of individuals
who contributed today we have so many contributors across the entire state
today that built this mental health workforce plan. The state plan wouldn’t
have been possible without the participation of hundreds of individuals,
associations, institutions, and state agencies coming together in a
remarkable way for collaboration and discussion about one of the state’s
primary concerns; the shortage of mental health services for the state of
Minnesota and how we will meet those demands with our workforce. The state
plan also captured insights and suggestions from over 290 forum
participants from Worthington to Brainerd to Grand Rapids to Northfield.
The individuals and the creation of this plan included personal conversations
with people who will make a difference and their contributions and
recommendations will take action because of the efforts of this group. Additionally an online survey was
completed by more than 500 Minnesotans in creating the statewide mental health
plan. The level of contribution and participation has been greatly
appreciated by the leaders of this project as well as has impressed the
Minnesota Board of psychology. This is an incredible initiative and
we’re so pleased to be able to give it the forum and showcase it today. Out of
Minnesota’s 11 geographic regions, nine of those regions are designated by the
health resources and services administration as mental health
professional shortage areas. Workforce metrics used to understand access to
mental health services include: waiting time for an appointment, number of
culturally diverse mental health professionals and practitioners, and the
time it takes to recruit providers. Primary shortages for Minnesota
identified as critical to address in general include the shortage of
Psychiatrists, prescribers and our child mental health professionals and
adolescence. Even more problematic mental health professionals do not currently
adequately represent Minnesota’s diverse
population which is a serious concern and a goal of the Minnesota mental
health workforce plan. Not only is Minnesota on board to make these changes and to take action, with the federal action agenda for the president’s new
freedom Commissioner of mental health in 2002 reported that the mental health
delivery system can only be as good as the efforts to train, educate,
recruit, retain and enhance an ethnically culturally and linguistically competent
mental health workforce plan throughout the country. That plan couldn’t echo more
of what the work that took place for this state mental health plan has done
and the recommendations it arrived at. The field of psychology faces its own
challenges relating to recruitment education training and diversity and
number of psychologists that can be traced to the overarching issues
identified in the state of Minnesota mental health workforce plan. In general
today we’re going to examine in greater detail through Mary Rosenthal’s
presentation what was identified through all the participants and what resulted. According to the American Psychological
Association an article released in 2013 the internship match as we all know is
extremely problematic for training individuals and for getting them into the
practice of psychology. This specific article from the APA cited that for the
past seven years and this was in 2013 that for the past seven years about
one-quarter of psychology graduate students who have gone through the
internship match programme have not secured an internship. Significant
progress has been made in that area and it continues to rise; the match levels
are increasing do the work of the APA and APAGS the Graduate group, impressive
work. While we’re pleased with that progress it’s not enough and
it’s not enough until we can provide those opportunities to help feed the
mental health workforce. The number of students who matched with an internship
and phase one of the match sponsored by the association of psychology
postdoctoral and internship centers APIC has increased. APIC reported that
3,239 students or seventy-three percent of applicants matched in 2015. One of the
steps taken to address the issues identified with internship matching was
to advocate and build a toolkit through APA and APAGS so that they could seek,
individuals could seek and entities could seek Medicaid reimbursement of intern
services. As we know we have to follow the money; if individuals aren’t paid for
their services and contributions it’s very difficult for them to continue to
give. As you know even though we make these progress as an internship there’s
still other challenges that face Minnesota. The availability of
Supervisors along with the costs associated with obtaining supervision is
another frequently identified issues for applicants preparing for psychology
licensure. But we’re not just talking about dollars and we’ll talk a lot more
about this in our focus group and through the information presented today
is there is opportunity cost there’s opportunity cost to the
applicant when they don’t get licensed and we certainly have made many many
efforts in the efficiency and reduction in time and the efforts but we’ll never
stop we have continuous improvement on a
day-to-day basis until we can get individuals into the system in the best
way possible and that changes daily. We aren’t just talking about dollars as I
said this opportunity cost of the applicant to the providers are also
cited as concerns. Another primary issue facing the field of psychology itself is
inconsistency in the entry-level credentials in both education and
in requirements for licensure across the United States. Minnesota is all too
familiar with the issues related to entry-level into the field of psychology
and the transitions that it’s gone through. For masters level to doctoral
level is the entrance degree or the terminal degree for this profession
there are issues related to being able to use individuals their skills
education and training to the full capacity and to fulfill the scope of
what those skills can provide. And there are barriers, we are a licensing board we
believe fully in licensing and regulation for the public
protection but we also believe in partnering and making sure that we
aren’t part of the problem that’s stopping individuals from entering this workforce
and we’re committed to continuing to have those conversations to contribute.
The educational inconsistencies across the United States raised questions about
mobility as well; we’re going to talk a little bit about technology as a part of
this plan but the ability for psychologists move from state to state
and do so in a timely manner is sensitive and certainly as we’re focused
inward today on Minnesota itself, it’s also worth mentioning that we need to
make sure that individuals coming to Minnesota that it’s easier for them to
do so that they can get here currently the way the logs exists there’s a
there’s a postdoctoral requirement as we all know and some of the individuals
coming here don’t have that postdoctoral requirement or would struggle with
licensure requirements. Again we’re committed to talking about those issues
and identifying what can be done. The board is prioritized and focus on
increased efficiencies and licensors and we also are looking at how variances to
educational requirements can be used but still maintain public safety.
Technology solutions as the world’s geographical physical boundaries begin
to dissolve today we need to look at how we can better use technology to provide
mental health services potentially with a extremely rural state. Mobility and
technology are addressed a state and national level for psychology, the
association of state and provincial psychology boards as we discussed last
year in our conference offers an e-passport as a mechanism to promote
standardization in criteria for interjurisdictional tele-psychology
practice, and quoting the ASPB they believe the e-passport
facilitates the process for licensed psychologist to provide tele-psychological
services but this is across interjurisdictional lines coupled with their
initiative to enact a interjurisdictional compact known as
sci-pact. I will announce that one of the first States the United States has
adopted sci-pact and passed so there is one state who belongs
to the compact. I don’t know if you’ve ever been in a relationship but I
think that states a little lonely so I think we should continue to talk about
how that can move forward for a compact I think they need a partner state. And
so today we’re going to focus on some primary things here. We’re going to – this
is our next individual that you’re going to be hearing from this is Senator Greg
Clausen. Senator Greg
Clausen was a serious supporter and advocate for
this mental health plan. Good morning and welcome to all of you
taking part in the Minnesota Board of Psychology 2016 conference. Thank you on behalf of Minnesotans
throughout the state for your work on mental health issues. Unfortunately I’m
unable to be with you today due to commitments with the Senate but I am
honored to join you via video as you begin your conference. My background is in education, for over
40 years I served as a high school teacher, principal and central office
administraton. From my experiences working with students and families in
crisis I became aware of shortcomings in our mental health system. Waiting for
several weeks for an appointment and evaluation was commonplace, creating
delays and treatment, uncertainty within families and uncertain outcomes. In 2013
i authored legislation requiring the Minnesota state colleges and
universities to develop a comprehensive plan to increase the state’s mental
health workforce at all levels. A steering committee was formed and
conducted 20 community forums around the state, surveyed over 500 mental health
stakeholders and in May 2014, held a culminating mental health summit,
attracting more than a hundred and fifty participants. I served on the steering
committee and want to thank the more than 30 members for their professional
dedication. Today’s conference focus on the legislative report gearing up for
action mental health workforce plans for Minnesota, outlines 24 recommendations to be acted upon by professional organizations, educational institutions,
licensing boards and the legislature. The conference
will provide an opportunity to learn more about Minnesota’s mental health
workforce needs, review recommendations to address these needs and identify key
concepts critical to the mental health workforce. Much has been accomplished
since the report was released in 2015 and yet there is much left undone. I
would like to challenge each of you to join me in finding creative solutions to
address our mental health workforce needs. Thank you for your ongoing
dedication and your work to make Minnesota a better place to live and
grow. Thank You Senator Clausen. With that
introduction we’ll talk a little bit about what will get us to our next speaker
Teri Fritsma. The American association of child and adolescent
psychiatry reports the national average wait time to see a child and adolescent
psychiatrist is 7.5 weeks. That that to a family in need, a family in crisis and
a family who needs help now is too long. Minnesota is worse. In Minnesota the wait
time can be longer providers reported wait times up to 14 weeks for an
appointment with a child psychiatrist There is a significant shortage but it’s
not only psychiatrists, the state of Minnesota through its Minnesota sex
offender program has had significant struggles in recruiting individuals to engage at an appropriate level much so that legislation has changed that
would allow either a psychiatrist or a doctoral level psychologist to serve on
their special review board panel. There simply aren’t enough psychiatrist to go
around or other mental health professionals. To further complicate
matters rural Minnesota is facing pronounced challenges related to mental
health stigma, low wages and cost of education and training. So I ask you
what can be done to support the efforts to expand and broaden mental health
telemedicine? How can we use technology and training programs and technology related grant funding to
expand telemedicine capacity in Minnesota? How can we reach those families that
aren’t getting the services, the social support that their children deserve and
that their families deserve to succeed? Diversity is also critical, psychologists
are particularly attuned to diversity we have human diversity as a core component
of our educational requirements for licensure but I was astounded when I saw
the statistic. Seventy-two percent of non-white respondents to the survey
conducted in conjunction with the Minnesota mental health workforce
identified cultural competence as a critical area highest priority for
education and training, compared to thirty-eight percent of white
respondents. I challenged everybody to continue to consider cultural competence,
to give it the priority that it needs and to recognize and listen to those who
are calling for diversity. Obviously Minnesota needs to improve expand
cultural competency training. Dr. Fritsma’s going to share with us today
some extremely exciting information which I will say you are the first group
besides myself and to my staff members to ever see this data. I’m very nerdy, I’m an attorney at heart
so this data is exciting me. It is about you it is about psychologists, it is what you
told them and what you told us about your field, about your work, about your
satisfaction, about your demographics. We can’t wait to share it with you and I
know Teri’s more excited than I am. Cultural competence needs to be a core
behavioral health education and training requirement, so we’re going to talk about
the responses we got and we are also going to talk about how will Minnesota
increase the numbers of racial and ethnic minorities as healthcare
professionals? How do we get them to choose being a
mental health professional and I think we’ve gotta few key suggestions today
from what we’ve seen in some of the data in ways that you can leverage your
experience, your knowledge, your expertise to help others see the value in being a
mental health provider. The demand for mental health care is predicated on
increased strains on the healthcare system, so I ask you
what can psychologist of the field of psychology do to alleviate those strains
or meet the demands for this mental health services. And with that I’m going
to provide you with the bio of Dr. Teri Fritsma, if Dr. Fritsma will join us on
the stage. Teri Fritsma is a senior workforce
analysts in the Minnesota Department of Health. She collects and analyzes data
and healthcare workers and has a special interest in the mental health workforce
more glad she does. She provides data analytical consulting to a variety of
mental health focus legislative groups and task forces. Before coming to MDA to
the Minnesota Department of Health – I never like to rely on our government
acronyms – Teri was a workforce analyst at the Minnesota state colleges
and university system and with the Department of Employment and economic
development. I couldn’t think of a better person to
share with you these complex and intersecting issues. She has an MA and a
PhD in sociology from the University of Iowa, welcome Dr. Teri Fritsma. I’m a data analyst, I’m not used to talking for an hour, so just in case. Thank you so much I am so extremely thrilled to be here and thank you so much to Angelina and to the board for inviting me. One of the reasons I’m so excited to be
here is that I work with a small group of analysts at the Minnesota Department
of Health and we collect data – healthcare workforce data on about a hundred and
fifty thousand different licensed healthcare professionals and as
a matter of fact we share the data very widely to all different sorts of
stakeholders but I don’t believe we’ve ever been invited to come and talk to
the people who have actually provided the data to us so this is really kind of
fun and gratifying for me so I appreciate being here thanks Angelina.
And the other thing is Angelina mentioned we just recently
conducted a survey; the very first survey we’ve ever done on psychologist. Can I
just see how many of you responded to the survey in the room? Oh thank you very much. Which I
like I said we collect so much data and were you know we said in our cubes and
we analyze it and we never really get a chance to say thank you to the people
who provide the data. We study you guys so we are quite well
aware of the increasing level of administrative work that you have to do
and we know that you know for you responding to a survey is
just one more thing that you have to do that adds to your your plate and so we
very much appreciate it and we very much consider ourselves careful stewards of the data that you
provide so thank you so much I appreciate that. I’m just going to give you kind of an
orientation to my presentation. I want to start with a little bit of background so
that you understand some of the context in which this data gets collected and
used and then I’ll dive into our data presentation and its kind of divided up
into two parts one is looking at psychology the profession, so what it is
that you do, the services that you provide, where you where you provide them, who you are and your work satisfaction which should be fun to talk about and
then the second lens that I’m going to look through is psychology more as a
workforce and I think this kind of sets the stage for talking about some of the
issues around the the mental health workforce plan. This presentation will be fairly data-heavy which you know for
me is kind of fun but not necessarily for everybody else and so I do hope to
not just bore you with a bunch of data slides but to kind of weave a story
around the data that I’m presenting. With that I’ll give you a little bit of
background; I work for the Minnesota Department of Health Division of health
policy office of rural health and primary care and you probably can’t see
it but my group is the health workforce analysis unit the
organizational details don’t matter but I do I do just want to kind of give you
a sense of the context so kind of starting from the bottom my group is the
health workforce analysis unit we are a small but mighty group of three analysts
that analyze data like I said on a hundred and fifty different
licensed healthcare workers in the state we survey 17 different license
professions and we are adding more all the time. We work within the context of
the office of rural health and primary care and what this means for us is that
that we understand that there isn’t just one story about health care particularly
in Minnesota there’s at least two stories. One about you know the way health care
is delivered and organized in more populated areas of the state and then of
course the rural areas of the state so we’re always kind of telling both
stories. we’re in the division of health policy which means everything that we
collect is actually collected with an eye towards being able to inform policy;
not just to collect it for the sake of collecting which I know I think
government has sort of a bad rap for that and then finally, I don’t know
how familiar I would expect people to be familiar with the Department of Health
so much, but I’m actually really proud of working for the
Department of Health I’ve worked for I think five different state agencies in
Minnesota and I want to read you the vision statement for the Department of
Health, and that is ‘health equity in Minnesota where all communities are
thriving and all people have what they need to be healthy’ and I can tell you
that this is a vision that you know we don’t just talk the talk we
really walk the walk, every single person down from you know but the highest
levels of leadership all the way down to you know us and and the even though the
administrative staff cares very, very deeply about health equity in Minnesota
so making sure that people from all walks of life have equal access to
healthcare including mental health care and have better outcomes. So in summary
my group collects and analyzes data to understand urban and rural challenges for the purpose
of informing policy and within the context of improving health equity,
that’s what we do. So what professionals do we survey? Just
very briefly we survey we are actually legislatively mandated to
survey all licensed healthcare providers including
folks that deliver primary care so physicians, physician assistants, all
three types of nursing licenses, we cover oral health, so the for oral health
licensed professions dentists, assistance hygienist
dental therapists, which is a newer profession in Minnesota. We survey of a
handful of the therapist occupations; physical therapists and respiratory
therapists as well as assistants. Pharmacists and pharmacy technicians and
then finally this is sort of where my heart is we collect data on all of the
licensed mental health workforce now including you. So social workers, all four of the social
work licenses LMFT’s and then the three counseling professions in
Minnesota so that would be the licensed professional clinical
counselors, licensed professional counselors and then the alcohol and drug
counselors. And then finally psychologists we just were fortunate
enough to add you all to our list of of professions that we survey and we’re
really excited about that and I do just want to mention we recently revamped our
survey so that we can start getting at some of these new and emerging models of
care and new you know issues that the healthcare workforce is facing and
though we’ve added psychologist last to our list you guys are actually the first to hear
about your data, your very first ones that we’ve completed the survey for so
kind of exciting. So what data do we collect? Basic
demographics including sex race and age race is a big one and I’ll come back
to that. We collect data on education and preparation and particularly for nursing
and for mental health where there are certain job laddering opportunities we
collect not just hey what’s your highest level of education but also are you
planning on getting more and where did you start so we can kind of get a sense
of the Laddering in the profession. We collect information on work location
which is how we’re able to say where care is actually being delivered
around the state. Hours worked which helps us get a handle more on the FTEs
as opposed to just you know body counts. Your future plans for work, which helps
us figure out what our workforce is going to look like five, ten years down
the road and then finally we added in our new survey redesign, we’ve added somequestions about some of these new and emerging technologies like the use of
electronic health records, use of telehealth equipment and then we added
job satisfaction questions which I must say is I think a fantastic addition
we’re able to really, really read your responses and get a sense of what it is
that you’re facing in your work every single day and I’m excited present some
of that. So why do we collect this information? it’s just very important, I guess
I have a little chip on my shoulder, I know that a lot of government agencies
collect data just to collect it and it sits on a shelf and you know that’s just
not who we want to be and so we do collect it because we are legislatively
mandated to collect it we have we have a job that we have to do
but if I put that in smaller face font because I want to de-emphasize that.
Yo us the reason that we collect the data is to make use of it – so we inform
specific legislative recommendations for example the mental health workforce plan
that you’re going to hear about actually used quite a bit of our data to inform
it, we inform policy work groups so for example last year there was a policy
work group that was focusing on how to integrate international immigrant
physicians into the workforce it’s very difficult for them to enter the
workforce and so we provided some baseline data there. To support
decision-making for post-secondary program offerings – so just a few years
back MNSCU was looking to the scope of practice rules changed
for LPNs and they were looking for how to consolidate and or expand some of
their LPN programs and we were able to supply some data there to help them make
those decisions. And finally to respond to
special requests and these come in all forms I think we probably respond to
you know maybe 10 different requests every month about half of those come
from the media and we’re getting more and more media requests for information
on the mental health workforce which does not surprise me given some of the
movement that’s happening in the mental health workforce you know policy
discussions so I expect that to increase. Let me just dive into some
of the details on the psychology survey. As you know the survey took
place at the tail end of april just into the end of May. We surveyed all licensed
psychologist who had a valid email address because we did reach out to
everyone through email in April. We got a thirty-four percent response rate which
is twelve hundred and seventy responses, I know I’m not talking to methodological
slouches in this room I think everybody has an understanding of response rates
and the importance of getting a good response rate and of course the danger
is not necessarily the low number of responses, it’s how representative is the group of
respondents for the overall population so I was able to do a little bit of
diagnostic work to kind of figure that out and I and I can tell you that there
were no response differences by gender or by age so men and women were equally
likely to respond, all age groups were equally likely to respond and we
did get out slightly lower response rate from psychologists that have an out-of-state address so that
could have some implications for our findings – but I am satisfied that
what were what I’m going to present to you is more than just you know some nice
qualitative data it’s actually safe to generalize some of this. Just
diving into some of the findings; psychology the profession so who you are
and what you do. Ok so just start with some simple counts, this might be familiar to you, in
Minnesota there are 3824 psychologist who have active licensure with
the board of psychology, and of those 3556 actually have a state of Minnesota
address so we’re not I’m going to come back to that actually that’s an
important point. I also do want to mention that I know that some
psychologists are dual licensed with that with the Minnesota Department of
Education the school psychologist, and also the board of psychology
here and for those folks that are duel license they’re counted in this number
for people who are only licensed by MDE they’re not counted here – I think that’s
a relatively small number. So starting off; we do ask folks what are
their psychological specialties? Now I should point out that you were
able to report any specialty that applied to so these numbers won’t total up
to a hundred so half of all psychologists if you can see reported
a specialty in clinical psychology. 34% counseling psychology and then another third and behavioral and cognitive psychology, and then you know we see
Child and Family kind of dropping off after that. Now I relied on some expert input about
these categories so I would like to ask two questions of you. One is if you could just raise your
hands, does this list make intuitive sense to you as a group of psychologists?
I feel I see a lot of overlap but that might not be true so if it doesn’t make
sense or if you see you know problems please raise your hand. Okay
and maybe we can talk about that a little bit within the panel discussion
and and as for the rest what does this kind of jibe with your kind of intuitive
sense of what the field looks like, raise your hand if that’s true. ok ok good Just some more basic data on the highest
degree obtained this does not surprise me probably, won’t surprise you sixty-seven percent, about two-thirds have a doctorate or professional degree 29-percent have a master’s degree and four percent
have a post master certificate or certification we thought it was
important to to capture those folks that have continued their education after
their master’s degree. And I should mention too, I I broke
this down just to look to see how this changes if you look at folks 55 and
older and even even at the age of 55 about fifty percent of folks have a
Doctorate degrees. So forty-three percent of psychologists
own or co-own private practice and sixty-five percent of psychologists are
female so it didn’t surprise me that the field
is female-dominated but actually what surprised me was with the number of men
in the profession because when I go and look at other mental health professions
they are far more heavily female-dominated so for example marriage
and family therapists or eighty percent female social workers are 87
percent female and then all of the three types of the counselors, so the LPC’s
LPCC’s and LED’s are seventy-three percent female – so psychologists are
actually the most heavily male of the Mental Health Professions with the
exception of psychiatry. I thought that was kind of interesting Okay I’m going to spend a little bit of
time talking about race, so I mentioned that the Department of Health and that
our work is – we’re very much concerned with health equity and making
sure that people of all walks of life have access to good care and and have
good outcomes. So when it comes to talking about workforce oftentimes that
gets translated into discussions about cultural competency – but cultural
competency is a very, very difficult concept to define, and an even more difficult
concept to measure. So as as Angelina sort of hinted that earlier I think we can’t really expect reliable responses if we ask people, hey do you
feel that you’re culturally competent? And so we we start off at least with a
measure of you know the diversity of the workforce and we really take
this pretty seriously; when we redesigned our survey we consulted with the state demographers office to try to
make sure we’re asking about the right the right mix of races, we allow
people to check more than one response and so this is these are the results so:
about eighty eight percent of you responded white, just under two percent
Hispanic Latino and kind of on down the list So this is pretty much what
we expect, it’s pretty much in line with other mental health professions and
actually the healthcare workforce as a whole. So the fact that this group is
heavily white, does this mean that psychologists are not a culturally
competent group? I wouldn’t necessarily suggest that but we did want to start
getting at this concept of cultural competence and so we asked a question on
our survey, I’ll read you the question so you can you can hear how we measure this.
Which of the following work or educational experiences best prepared
you to work with people from a variety of backgrounds when providing care
sometimes referred to as culturally competent care? And then respondents were
instructed to choose just one of these options. So as you can see a
third of you said informal learning on the job was the thing that best prepared
you to provide culturally competent care. And under a quarter of folks said
continuing education or professional development course work. Another
22-percent formal educational coursework formal on-the-job training 20-percent,
none 1%, and then some some folks have jobs that don’t involve
culturally competent care so we are allowed them to specify that. What this
tells me you know this is really interesting because we in doing this
sort of work care very much about ensuring that our workforce our mental
health workforce and all of our healthcare workforce is culturally
competent and and can provide good care – and we
often think about the easiest places to make those interventions, like is it in
you know the formal educational programs or is it in kind of
continuing education and I think those are good options but I also think
sometimes we tend to forget that so much of this learning actually happens on the
job and maybe that’s a good place to think about doing some intervention. When
we were putting together this survey we get some cognitive
testing and asked people, what is cultural competence really mean to you?
And one of our informants said yeah you know it means
being able to relate to those stoic Minnesota farmers you know and I
realized you know – hey we what we’re thinking of cultural competence isn’t
necessarily what applies to each person on their job and so I think you know
it’s worth kind of considering where are the best places to
put those efforts. So career satisfaction – I gotta tell
you this was one of my favorite bits of information to analyze I felt very
inspired actually and I was kind of questioning why did I change my my
college major from psychology to sociology, you guys seem pretty happy? So we
asked two questions about career satisfaction; one is how satisfied have
you been with your career overall and then how satisfied have you been with
your career in the last 12 months. Sixty-two percent of you said you were
very satisfied with your career overall I took a quick look at some of the other
professions for which we have data and you guys blow them away I mean you’re very satisfied – now I
don’t know, I got to thinking about this and I thought is this just is a
reflection of of your work or is this a reflection of the type of people that
you are? Maybe you just you know have great coping skills and know how to be
satisfied but anyway that’s wonderful and then you know we asked how satisfied
have you been in your career in the last 12 months, now satisfaction drops off
quite a bit in the last 12 months, and we tend to think, we analyst’s tend to think
well yeah that’s because of you know oh my gosh all of this you know
administrative work and you know the dealing with insurance and that kind
of thing – that’s that’s got to be making people kind of grouchy, but it also
cursed me I’m I’m not a hundred percent sure if that isn’t just also partly the
way our minds tend to work – we tend to kind of think about, you know the bad
stuff that’s happened over the last year and we made we just focus on that and
I’m looking at a room full of people that probably have some insights more
insights than I do about that so maybe we can leave that a little bit to
the panel discussion – but I will say this is a pattern this kind of decreasing
satisfaction between overall and the last 12 months that I’ve seen across all
of our healthcare professions so kind of interesting. But you guys are very
satisfied overall. So then we got some some great qualitative data, we asked you
to spend a little time telling us what are the what are your you know greatest
sources of satisfaction and then what are the things that really dissatisfied
you about your work? And far and away the that the thing that was that made you
most satisfied in your work was your direct client and patient care. One of the things I saw over and over
was people articulating it’s just so nice to be able to see people who come
into my office, really kind of in a state of disarray and then they managed to really make improvements in their lives and that’s
that’s wonderful. People mentioned a lot of these are sort of inter-tangled, but I pulled out some of the themes that popped out,
but developing trusting relationships with their clients was very meaningful
for people and they derived a lot of satisfaction. An emphasis on psychotherapy over drugs
which is really timely right now so that’s something that quite a number of
you mentioned, a number of you mentioned working with special populations – so
immigrants, children, veterans, teens, and and severely mentally ill – that that gave you
quite a bit of satisfaction. Other sources besides just working with your clients; a lot of people noted – that I took this as being slightly different – but
that feeling of appreciation that you get from your clients and feeling you
know through letters and through feedback and through word-of-mouth
referrals that you know you really you are appreciated and you’re doing a
good job. You feel that your work is meaningful you know we all want that – to
be able to go to work and feel like we’re making a contribution, and you
guys do. And then people mentioned rich collaboration with their co-workers and
colleagues from other disciplines that came up quite a bit, that was valuable to
you. I actually think what people said more
about the reasons they were satisfied then the reasons they were dissatisfied,
so that’s kind of telling. A number of you mentioned how satisfying it is to mentor
and train students. A lot of folks mentioned kind of this combination of
being able to help people, but also have that intellectual stimulation and that
constant, you know chance to learn, and I got to thinking I’ll bet this is – I don’t
know how you all feel about the myers-briggs, I imagine there might be some strong opinions one way or another about that but I thought these are people that
are you know right on that line between the T and the F So… very thoughtful group and
caring. And then a lot of people mentioned the autonomy and the
flexibility of their of their work and some of you mentioned how satisfying it
was to own your own practice. Ok, sources of dissatisfaction: Are you guys surprised? That came up
over and over and over – insurance, insurance, insurance it’s just a pain and
I tried to kind of separate out some of these different themes. So the
pre-authorization and particularly with pre-authorization what’s disturbing is
that you have to work to try to make your case and you feel that you know
there’s arbitrary oversight that really overrides your own professional you know
discretion and expertise. Reimbursement is a source of dissatisfaction. Many
legitimate activities are not being reimbursed, a lot of people just
mentioned in general like the coding the billing, it’s just burdensome all
this documentation. Many people mentioned how insurance companies – each insurance
company does something a little bit different and so you have to kind of
figure out the rules for each one and that’s very time-consuming. Other sources;
just administrative tasks that are diverting time from you’re working
with clients and and being able to do the most meaningful part of your job. This was a big one; pay is low relative
to other highly educated professions a number of people mentioned you know
student loans that, like, they mentioned that it actually keeps them up at night –
to have the burden of all that student loans and and having a relatively low pay
job and the reimbursement rates are fairly stagnant and so that doesn’t
appear to be changing. Electronic health records people mentioned some concerns
about those, and then just a couple comments about… not as many as I
would have thought but about just feeling burned out and feeling a little
bit helpless overt ime in the face of all of these kind of heavy problems and
issues that you deal with on a day-to-day basis. Do these
resonate with all of you? Since so many of you told me this I’m assuming so? Ok. Psychology the workforce; so here we’ll
kind of move away from you and move more into kind of where you all are working
and access to care and issues around the future of the profession and what that
means for the state. So just a reminder 3800 licensed psychologists in the state
3500 reporting a Minnesota address. So okay, we don’t actually know exactly what this means so some somebody could report that they
have an address in Hudson, Wisconsin but they could be making the trek over the
border every day to provide services in the metro area, so it’s
difficult to say which is the right number. We know the upper bound is about
3,800 we also know that of that 3800 or 3500 not all of you are actually
practicing most of you here probably practicing but not not everybody who
maintains a license is still practicing. So just put it in context, this is all of the licensed mental health professionals; social
workers is the largest group at over 12,000 – I should mention we know that
about 60-percent of social workers are not actually providing direct patient
care, so depending on your definition of a mental health worker, I included all of
them here but if you’re thinking about the the folks that are you know kind of
sitting on one and providing direct client care it’s only about sixty
percent of that. Now we have psychologists, and alcohol and drug
counselors, marriage and family therapists at 1,800, professional
counselors that includes the the clinical counselors and the licensed
professional counselors and psychiatrists only 867 and then
psychiatric nurses even smaller than that at 303. So the total licensed mental health workforce is just under twenty-four
thousand but like I was saying we know that this is probably a fairly
significant over count once you remove the people that are maintaining
a license here but working out of state maintaining a license but not actually
working, and also those that are maintaining a license but are not
working providing direct client care. Just to put this in context – I thought
you might like to know that there are about 90,000 registered nurses working
in Minnesota and there are about 22,000 licensed physicians working in Minnesota. Audience member: I’m very curious about the license to the non-license and also how many people do each of
these serve? Do you have any of that data? Dr. Fritsma: I can answer that. My office does not
collect data on non-licensed. That data does exist though DEED – Department of
Employment and economic development collects the data and we do look at that
quite a bit, so it’s there it’s there to be known – do we collect information on
the people you know kind of like caseloads and that sort of thin? We
we have a few round-about ways of getting at that which some of it some of what
I’m about to show you will get into that. Audience: I just wondered when you
use the term psychiatric nurse If you’ve already started breaking down
psychiatric nurse vs something like an advanced practice nurse? Dr. Fritsma: Good question. This
number includes all of them, because APRN is such
a new license we just started collecting data on APRNs but this this number
includes everybody So this is somewhat getting at
your question not exactly directly but this is just
another way to kind of look at the numbers here and it’s the ratio of
population to provider. Are folks familiar with with looking at this sort
of data I can kind of go into it. So basically what this means is that for
every psychiatric nurse – this is statewide so in Minnesota every
psychiatric nurse – there are almost 18,000 people – that’s not
obviously the number of people that that nurse is caring for but it’s just gives
you a sense if you compare across it will give you a sense of the relative
size of these different professions but what this is is is more interesting and
helps you to
understand better some of the regional kind of maldistribution of people
around the state. So this bottom line here these are this the statewide ratios
of population to providers so for example – for every psychiatrist in the
state of Minnesota there are ten thousand nine hundred people
potentially sharing that one psychiatrist however when you look you know so i
colored in green anything where the ratio is lower than the statewide ratio
and anything in red higher so like you can see that in them in the metro area I mean I reserve judgment on whether
the statewide ratio is what is what we want maybe not, but at least in Minneapolis
St. Paul you know we’re doing a little bit
better than statewide and of course in southeast this is the Mayo
effect, we do we do a little bit better with some of the professions – but looking
at central Minnesota looking at northeast the entire western side of the
state… rather than ten thousand people needing the service of one psychiatrist, you’re sharing that one
psychiatrist with you know four times the number of people so it
really is you know a maldistribution of services and that’s one of the things
that our office works on quite a bit. lThe rural loan forgiveness program
runs out of our office. One of the ways as Angelina mentioned – one of the ways
that we talked about you know solving this problem is through
telemedicine so we asked on our survey how often do you diagnose or consult
with patients in real-time using telemedicine equipment or software? And I
don’t know if you can see that but eighty-two percent of psychologists say they never do. How often do psychologists diagnosis or
consult with patients in real-time using telemedicine equipment or software?
Eighty-two percent said never they never do it twelve percent said occasionally, three
percent said frequently, and two percent said all the time – so this is not a lot of folks providing services through telemedicine, I
have a feeling there’s more here to discuss and I know this is actually
really complicated legally and reimbursement wise so maybe we can talk
about that a bit more in the afternoon. Ok just talking a little bit about age –
more than half of all psychologists are aged 55 and older and if you look at the
distribution if you can see the distribution, you know the
younger cohorts are proportionately much smaller which tells
me you’re not adding in as many of these younger folks – this is
probably not news to you. I want to put this on a little
context so the median age of the US workforce is 42, median age of US
psychologist is 46, the median age of the Minnesota workforce is 41, marriage &
Family Therapist 45, social workers 43, Minnesota psychiatrists 55, Minnesota
state colleges 57. 57 is the median age so I actually took a quick look at most of our other healthcare professions – psychology
is actually the oldest licensed healthcare profession in the state. What
share of you are actually you know what share of you licensed psychologists are
actually still working still practicing in the field? Ninety-four percent that’s
a very, very high – that sort of what we think of as our labor force
participation rate – that’s a very high utilization rate of you guys. This compares to about eighty-five percent of of Marriage and Family
Therapist, ninety-one percent of social workers and ninety-two percent of
physicians, so you guys are you know being utilized for sure. Did you have a question? Audience: Just a hunch on why the number of psychologists is so much
smaller below 55, I think that’s about the time that the licensing requirement
changed from a master’s level to a Phd-level and that’s scaring away a few more of the younger potential psychologists. Dr. Fritsma: Yeah and especially if the median wage which I for people who don’t have their own practice the median wage for psychologists is about
$70,000 a year, so if you invest in that much education
that’s I can understand why people have student loans. So looking at it by age
group I was curious to see of those 34 and younger almost everybody is
working as a psychologist on down and so if you look at even those age 65 and
older this is when a lot of us are retiring and you know going off to the
beach and stuff eighty-seven percent are still working
as psychologists. How much do psychologists work? You work pretty hard. Seventy-seven percent of you say that you
work full-time and twenty-three percent say part-time and 40 hours is your
median work week. Now looking at age, ages 65 and older oh my gosh – almost fifty percent of
people age 65 and an older are still working full time. So I I’d love to hear
more from you about that, maybe this afternoon and 30 hours is the
median work week so that’s not just you know put in 10 hours here and there. This gets a little bit at the question
that was asked earlier about the share of your time that you spend
actually on patient and client care. Only half of you, less than half of you say
that you spend more than seventy-five percent of your time on patient care and
we ask that question a really kind of open-ended way we say you professional
you tell us what you think is client care, so for you that might include
paperwork it might include some travel it might include appointment scheduling
because you know that you have to track these folks down – for others that might
not – you tell us what you consider patient care and so even that
even allowing you to include paperwork and things like that is your patient
care less than half are spending more than seventy-five percent so you know
you’re working hard not everyone is seeing patients perhaps
as much as you might like, and we can talk more about what that means. How long do you plan to continue
practicing? 51-percent of you said more than ten years. Twenty four percent said
six to ten more years and then 26-percent, so a quarter of your
profession plans to work five years or less and of those
ninety percent of you said that you plan to retire, that makes sense to me. Just providing a little bit of maybe
some some baseline data to support some of the rest of the conversation later
this morning How often do psychologists provide
clinical training or supervision to students are interns? So how much we kind
of bringing these folks along? Almost 40 percent of you said never, eight percent said you do it all the time, eighteen percent said frequently and
thirty-four percent said occasionally. I’m just going to end our last little
bit of data is some supply and demand data that I pulled together from our
friends over at the Department of Economic Development. There’s a statewide
annual market demand this is a market demand so not even need, need I would
imagine is much greater than market demand but a market demand for a 133
psychologists – we produced in 2014, 106 phd-level
psychologists so we are not producing psychologists we’re not even you know
regardless of the of the post-graduation internship and those sorts of you know
opportunities for people to be able to enter the field, we’re not even producing enough to meet
the market demand, and I will actually add that that market demand number does
not account very well for people working in private practice – it just doesn’t
count those folks so this is probably even an undercount. Ok
I’m going to quickly wrap up. I’ll give you a couple summary points. So psychologists are
the second largest mental health profession in the state. I think you guys –
reading through your comments and looking at your data – I think you occupy
a very special and kind of unique niche in the mental health workforce. You
derive great satisfaction from intellectual challenges and working with
clients and seeing them succeed and you’re also not too surprisingly stymied
by some bureaucratic oversight this is by the way not that particular to
psychologists we see this all over with with all of our healthcare professionals.
Your group of professionals that are fully utilized, you’re mostly working
full-time well into your sixties. We see a a maldistribution of professionals
across the state telemedicine doesn’t appear to be a
panacea it’s not a clear solution least not for now and postgraduate training
opportunities are perhaps not what we’d like to see. The profession is aging and
can Minnesota produce enough new grads to meet the demand for the need? oh and that’s it so, good thank you. Angelina: Thank you Dr. Fritsma. Now we have an
opportunity to talk to Dr. Fritsma a little bit we do have a mic in the
middle there if you want if you’re able to come up to the mic, we also have will
have some staff members in the audience who can get it to you I just ask that you make sure that
everybody can hear the question so that she can respond. I’ll start off just
really quick with three of the cards One of the questions is that Dr. Fritsma
said psychologists were more satisfied than other fields – can you tell us what
the satisfaction numbers are in other professions that you know of? Dr. Fritsma: Well so yeah
the quick answer is not really we just fielded this brand new survey and the
site and the satisfaction questions are new on this survey and so we’re
we’re seeing some data roll in and in preparation for this presentation I took
just a really, really quick look I think I did write down for social
workers for example which is you know maybe a close comparison I believe that
forty-five percent of social workers indicated that they were very satisfied
with their career overall where’s you guys were at sixty-two percent. So I think that’s the only one I was able to look at because not all that data is in yet. Angelina: Thank you, the next question is which
state passed the SCI-Pact? Does anyone in the audience know? Arizona was the first state to pass the
SCI-Pact. And just as a reminder their single right now and so until they
get a relationship partner we can’t practice into Arizona just yet we’d have
to hook up with them, so we look forward to continuing to have that conversation. The next question, it says looks like a random client satisfaction might be
quite different survey by degrees and by license type. And other potential dependent variables, I
don’t think we look at outcomes enough Dr. Fritsma, do you have any feedback on
outcomes and how that might be? Dr. Fritsma: My group does not, we do not look at patient outcome we do not survey
a patient’s or you know review patient outcomes but others in
our department in the Minnesota Department of Health do so that would be
our health economics program – I tend to agree though I mean we you know we could be looking at outcomes more and that’s something that that department of health
is really concerned about that obviously that’s our mission so thank you. Angelina: Our next question from the audience is
what do you see a psychologist’s unique niche? As you know it’s difficult, we have an array of mental health
professionals and it’s difficult to explain to a client how psychologists
different from other mental health professionals. Dr. Fritsma: Okay this is
the first year that we’ve collected data on psychologists so it’s really I mean
truly in the last two weeks is the first time that I’ve had a chance to delve
into this profession but my and this is so this is gut not data, which I am
not always comfortable talking about but reading through your responses for your
work satisfaction questions I got a very clear sense that this is a
group of people who are caring and also intellectual and I think if I had to
venture a guess – I think that when you’re focused more on kind of individual
outcomes as opposed to you know like in social work we’re looking more it kind
of how the how society however the individual functions in society and so I
think that that’s such a valuable perspective to bring to the work of mental health and I think it would be a
huge loss to see those services dwindle in our state. Angelina: We have an audience question and they
should have a mic go ahead. Audience: Thank you, with regards to the inordinate
positive satisfaction of psychologist I want to throw a little food for thought
and it’s especially related to the context of the fact that one of the main
dissatisfaction points was low rate of pay with regards to the extreme student
debt and I wonder whether the positive satisfaction may be reflective of
cognitive dissonance. We put so much in especially those – you know younger people
coming out with six-figure debt and going through a doctoral program they’re
gonna be a little bit more apt to want to put their profession and a positive
light because of that fact so any thoughts? Dr. Fritsma:I oh that’s so fascinating you know I was listening to some show on NPR about how they
did an experiment where you know people had to do with these meaningless
tasks you know like I don’t know stuffing envelopes or something like
that and they for one group they paid people and for another group they
did not pay people well guess who was more committed to the
task? The people who didn’t get paid and so yeah I mean that that could very
well be. I happen to believe that the work that you do is very meaningful and
and would be very satisfying to be able to see people make
improvements so I hope it’s not just cognitive dissonance but that’s really
interesting point. Audience: Well the one thing I’d say with regard to your last comment, I
believe those LMFT’s, licensed social workers also see that same fact with
regards to the value of their work but there’s a dissonance between our level
of satisfaction and theirs, and it could be explained by the great cost it takes us
financially and personally that we need to get there. Dr. Fritsma: That’s yeah that’s really interesting. My office is actually planning on doing a a broader report on the
mental health workforce starting once we get all of our data back, starting this
fall and we’ll be looking into that – that’s very
interesting. Angelina: Few more question from the audience – regarding telemedicine and skype, do you have any information on how much psychologists
would use tele-psychology and skype? Fritsma: I wish I did
you know I was checking with some folks in my office before giving this
presentation and I know there’s a difference between the type of equipment
that you can use that’s dedicated telemedicine, telehealth equipment versus
something like Skype or FaceTime and things like that and so, you know I
actually was hoping you all would provide me with a little bit more
insight on how that works for you and how that works with reimbursement and
things like that so maybe I don’t know maybe others do? Audience: You present really
interesting numbers on the percentage of our career field that’s looking at
retiring in the next several years and it looks like we’re already starting to
slip behind in terms of the demand for psychologists, have you noticed that
trend in other career field in the past and how they navigated sort of that
shortfall especially as it accelerates? Fritsma: The answer is complicated. Well one of the I guess maybe what I can
say is one of the, and I think Mary and Glenice can
talk about this a little bit more too, fortunately we have people that are
actually really looking into this and trying to put some policy
teeth into this but I will say that looking at the numbers it can be very
very difficult not so much with psychology but with
other mental health professions, it can be very difficult to document a shortage it’s very easy to document, you know, that
the need is not being met by looking at things like wait times and you know travel times and things like
that and so the way that decisions get made around post-secondary
training and things like that is it’s oftentimes fairly data-driven and so if you’re looking at that demand it’s a
little harder to make that case I think fortunately with
mental-health we’ve been able to make the case and so you know I think later on this morning we’ll talk a little bit more about how that’ll work.
That answer your question? Audience: I think you’re getting at it, I think maybe a second part would be maybe if documenting a lack is difficult but documenting the
need is easier in other career areas where you’ve seen this high need and
maybe fewer practitioners I’m thinking about parallel fields have you seen what
usually happens to do they let more types of people provide services do you
see the demand get met in other ways I guess I’m wondering about other fields
that might be paralleled the psychology? Fritsma: I think this is probably wind up getting addressed a little bit more with the
plan you know team care is an area where I think that’s starting to happen a
little bit and hoping you’ll talk about some of the peer support specialists and
folks like that and those types of solutions to that problem. That’s a great question my office
does not actually we do not do kind of career outreach I think that’s a that’s
a piece of you know something that could be done but that does happen in the
state so you know other offices and folks over at MNSCU are doing things
like that and actually the the kind of the the data side of it is happening as
well there’s a large effort over at the office of higher education should to
link you know student records all the way up from kindergarten all the way on
into the labor market and when we’re where our data is actually gonna be a
part of that and so we’re going to be able to say well what you know which type of people
are more likely to go into these sorts of fields and what kind of interventions
can help them, can encourage them to move into these fields. Angelina: As we were wrapping up
our Q&A session I do have some additional cards, feel free to write down
any more questions and pass them and we’re going to have a half-hour panel
session after our second presenter presents One of the questions focused on the
marketing or encouraging people to join the field, I’m excited to share that
part of the plan has a goal of recruitment and we’ll be talking more
about that in those focus groups and you’ll have the opportunity to perhaps
brainstorm and how perhaps the psychologists as they move towards
retirement could serve as some of those ambassadors for the field especially
with a high level of satisfaction that they might convey to new individuals so
thank you so much Dr. Fritsma. I’m again so pleased to be able to lead
this great group and to introduce our next speaker. Mary Rosenthal is the
director of Workforce Development for Healthforce Minnesota. Healthforce
Minnesota is one of Minnesota’s 8 centers of excellence launched by the
Minnesota state college and university system. For the past two years she has
spearheaded the legislative charge to develop a statewide mental health
workforce development plan. So as Dr. Fritsma talked about psychology and its
data we’re now going to get into the meat of what has been done what is
recommended to be done and then what we might do in the future. Mary came to Healthforce Minnesota from
her position as director of the Service Employees International Union 1199
Northwest training and education fund, a union management taft-hartley fund for
healthcare workers in the state of Washington. Prior to the training fund she
directed the phillips and east metro health career institutes in Twin Cities,
community-based workforce development organizations, she built career ladders
for entry-level healthcare workers created a partnership among employers, a
local workforce system, and colleges to support entries into good-paying jobs.
Mary will be talking about the workforce plan and I’m happy to introduce her. Mary: So it’s really an honor to be here to
talk to you today I just wanted to add that in addition to a lot of experience
that I have with workforce development and particularly healthcare workforce
development I intimately know the mental health
system of Minnesota over the last 42 years, I unfortunately come from a family
that has been plagued by plenty of mental health problems and I just want
to thank many of you in this room who have helped numerous of my family
members get onto a much much better place in life, so thank you very much for
the work you do. What I wanted to do in today’s presentation and it’s going to
just go on until eleven-thirty – I’m gonna talk pretty fast because I have a lot to
go over but then we have a half hour for a lot
more detailed questions and answers so please if you can just hold on to your
questions we’ll get them at the panel discussion. What I wanted to do today was
to follow up on some of the introductory remarks that Angelina Barnes had made
about how this workforce plan got developed, its genesis the public policy
the thinking that went into it, and then I want to go over very specifically the
24recommendations that were finally agreed upon and where we are in
the implementation of those recommendations. So is Angelina said the
legislative charge to develop this workforce plan was Senate file 1236 and
it charged the Minnesota state colleges and universities to convene a mental
health workforce summit and the purpose was threefold: to develop a plan to
increase the number of qualified people working at all levels of our mental
health system, to ensure appropriate coursework in training, and to create a
more culturally diverse mental health workforce. The legislation also outlined whose
needed to be involved in the mental health workforce summit and it also had
$50,000 attached to it and that’s the way that I always know that the
legislature is serious about getting something done is that they attach money
to it to actually pay for it getting done. As Angelina told you Minnesota, of
its eleven areas, nine of them are considered to be mental health workforce
shortage areas, the only areas of the state that are not so designated are the
twin cities and then areas around Rochester because of the Mayo
Clinic and I can tell you from the community forums that we held in the
twin cities and in Rochester, they think that they ought to be designated
shortage areas as well, given what wait times are. 36 other states around the
country have mental health workforce development plans that’s one of the
reasons that NAMI Minnesota, several of the providers and the MN
department of human services pushed so hard at the legislature, they said this
is not going to happen without a concrete plan, without concrete
recommendations that are followed up on. We were also, and I just want to lay this
out at the beginning we were asked not to go into the issue of the autism
workforce and its needs or the substance abuse workforce and its needs
and it’s not that there aren’t big needs it’s not that there isn’t a lot of
overlap, it was simply that just focusing on the mental health workforce was
considered to be a large enough job, we had 18 months to prepare the plan and
get it ready. To attach anything else to it was to basically consign it to not
being able to be successful so I want to acknowledge that that is work that
continues to need to be done and that hopefully the work that we did on this
plan would help inform creating workforce plans for both the autism
workforce as well as the substance abuse workforce. You might ask why I was MNSCU why was the Minnesota statecollege and university system given this particular charge while a number of our
universities have social work programs? It’s really the private colleges and the
University of Minnesota that do a lot of the training and education of mental
health professionals but MNSCU has a wonderful track record in terms of
Workforce Development at all levels and if you remember the charge of the
legislation it said mental health workforce, not just at the professional
level but at all levels and we also in particularly healthforce has an
extraordinary track record as a convener in pulling together a variety of
different organizations and making things happen as you will see. So the
genesis of the state plan was taking a look at whether or not Minnesota’s
mental health force was going to be able to meet the needs of its citizens,
particularly with the passage of the Affordable Care Act and the ability now
for thousands of more people to be able to access the mental health care that
they needed. We have an aging mental health workforce, ongoing discrimination
associated with mental illness, and I use the word discrimination rather than
stigma because I believe it is discrimination, low wages, increasing
regulations and the cost of education and training. Little money had gone
into any sort of mental health work for the previous decade until the shootings
at Sandy Hook in 2014 and I think it was that as well as the improved economy and
as I said the passage of the Affordable Care Act that really set the stage for
the 2013 legislation getting passed and a really big shout-out needs to be
given to Senator Clausen who addressed you at the beginning of this conference,
Senator Clausen authored and carried the legislation, he attended every one of our steering
committee meetings, which was I think except one or two when he was in session,
and in 2014 really led the push for a lot of the legislation that did get passed
to address some of our workforce needs so he is a true champion of building the
kind of mental health workforce that we need in this state. Clearly workforce
was not something that hadn’t been looked at before, I don’t want people to
think that all of a sudden there was 2013 and nobody had taken a look at
mental health workforce before and this just gives you sort of a overview of the
last 15 years and some of the mental health work and focus on workforce but
focus on a number of other reforms that have been attempted in the state and i
am sure that many of you have been involved in these efforts, 1999 hearings
held by the state Advisory Council, the mental health Minnesota Mental Health
Action Group, the acute care needs subcommittee report, the workforce
shortage working group incentives, what tends to happen in workforce
especially when its mental health workforce is that there’s so much that
needs to get done around mental health and mental health care reform in general
that workforce get put off at the very end, so a report is written of a
series of you know hearings are held over the course of five days and it gets
to be friday afternoon and people finally say oh we forgot to talk about
you know workforce and in point of fact it’s the workforce that is you know
I mean all of you know this, that is it imperative to address that because who’s
going to deliver the services so that is part of what led up to this very
specific 2013 legislation, was it really gotten short shrift. We formed to a steering committee that was
comprised of all of the stakeholders identified in the legislation so the
Department of Human Services, the Department of Health, the Minnesota state
colleges and universities, university of Minnesota, private colleges, mental health
professional, special education representatives, child and adult mental
health advocates and providers, and community mental health centers. You can
see all of that we tried to make it as representative of the state as possible, we tried to make it as representative of
diverse communities in the state as possible, we made this as much of a
working group as possible so we told everybody that we invited to be on the
steering committee that we wanted them to meet with us monthly, preferably in
person for two hours up to the summit and then for two-and-a-half hours to 3 hours after the summit to actually draft the plan and I want to
thank the psychologists particularly who volunteered their time, they were not
representatives of your board but we have Dr. Glenace Edwall who really
played and extraordinarily important role on our steering committee Dr. Bill
Robiner, Dr. Elissa Vang, Dr. Tricia Stark and Dr. Willy Garrett
who are represented the Minnesota Association of black psychologists, so
really good individual psychologist representation in terms of this steering
committee and I want to thank you all very much. I think that that covers on the
stakeholders who were the steering committee. The first thing that we did as
a steering committee, because none of us had drafted a state plan before was to
try to figure out what was it that we needed and we knew that we needed a data report, we knew that we had very very little information on the various mental health
professionals in the state and Dr. Terry Fritsma ended up drafting that data
report for us and all of this information can be found in our website
we’ve got the entire plan along with all of the appendices along with updates on
our website in case this isn’t enough for you. But Dr. Fritsma took a look
at the supply and the demand of all of the mental health professionals around
the state, broken down by region, what schools are producing, how many, where
these people ending up working, how are they broken down by both race and
ethnicity and by gender and so we had a very good idea of the mental health
professionals but that left a huge swath of people who work with people with
mental illnesses who are not professionals and that is a very very
large part of the mental health workforce and it was almost impossible
for us to really pull out that data so that is some work that still badly needs
to be done. Minnesota is better in its data collection than most states but i
am reminded that we measure what we want to manage and we measure what matters
and to me the fact that we couldn’t pull out a lot of this data on the more
entry-level and paraprofessional level of mental health professionals means that
once again this is just a part of the stigma that goes along with
mental illness and all of the people who work with people with mental illnesses.
So we got the data report, we took a look as I showed you on the previous
slide of the other the previous efforts that Minnesota had made 36 other states
had mental health workforce development plan, some of them were great some of them were not so great, we wanted to take a look at what were some of the best ideas that came out. So for example
in New York state plan they have a huge problem with
upper New York State, I think something like ninety percent of the counties in
upper New York State had no psychiatrist or psychiatric APRN’s, so nobody who
could write a prescriptio. And so there are a lot of ways to try to tackle this
issue and what New York decided that they wanted to do was that they would go to the nurse’s already working in these counties who
had their RN or BSN and offer them an online opportunity to get their
psychiatric APRN, they developed the program in conjunction with the
university of Syracuse and then they defrayed half the cost of the
tuition, so these were nurses who already lived there, they were already committed
there, they have their families there, they knew they liked their work, and so
it was just a question of beafing up their
skill set, so those are the kinds of things that we wanted to do by taking a
look at some of these other, some of these other state plans. we wanted to get
some input from all over the state. I used to live in Duluth and you have
no idea how much I resented all the trips I had to make coming down to the
Twin Cities rather than the other way around, so healthforce decided that we
wanted to hold community forums all around the state to really talk about
mental health workforce ,so again as Angelina told you we went to Worthington,
to Rochester to Bemidji to the White Earth indian reservation, to Duluth to
Wilmar, we really spend about six months putting on these to our forums and then
really trying to get people to hone in on workforce and to try to generate
recommendations about what would you like to see happen to your
mental health workforce and this is not easy in a group of people who really
want to talk about all of the other problems that are happening in mental
health and there are just a huge number of other problems, so to try to get
people to really think about workforce and then not
just answer every question about workforce with we need to increase rates,
we need to increase rates. We increase rates everything will be taken care of.
We wanted to acknowledge, yes rates need to be increased but what else? Does that
end up taking care of cultural competence, does that end up taking care
of ensuring appropriate education and training? So these were really very
directed conversations where we tried to elicit as many recommendations as
possible. We knew that a lot of people weren’t
going to be able to make it to the summit, they weren’t going to be able to
come to a community forum so we also had a survey of more than 500 people
participated in the survey, giving us some really excellent recommendations
but also some extremely interesting insight as you saw from Angelina’s slide
about how people of color perceive the competence of mental health
professionals when it comes to cultural competence compared to white people. So
we we got a lot of information out of that survey and then at the tail end of
May we had a summit, did anybody in this room come to the mental health
summit at Hennepin Technical? Glenace okay, we very specifically wanted
to make sure that it was not overwhelmed by people from the Twin Cities so we
made it and that it represented all of the various stakeholders so we did make
it by invitation only it was a hundred and fifty people and it
was an eight-hour working session so this was not a conference where people
got to sit back and listen, this was a conference where people had to sit at
tables and generate recommendations. Recommendations: so the steering
committee then met with over 250 different kinds of recommendations from
the community forums and from the summit and we decided what are the criteria for
these recommendations going to be? And we said they have to be actionable, they have to have somebody who is
accountable for making them happen, they have to be measurable and the steering
committee has to have consensus on them. So working backwards we said that we
wanted to have consensus because it is so easy in groups to focus on the one
thing that they can’t agree on and then spend ninety percent of their time
trying to convince people why they’re right and we just said
we’re gonna put those issues into a parking place because there is so much
that needs to get done that surely we can agree on some things that need to
get done and then come back and have another summit in another two years and
tackle those issues. But we really wanted some successes that we could build on,
this is an area that’s been overlooked for way too long and it needed some
momentum and it needed some success. We also wanted the recommendations to be as concrete as possible. It’s one thing to say
that we need more diversity in our mental health professional workforce. In
California they defined exactly what that was going to be over a five-year
trajectory, it’s going to be increasing the number of african-americans who are
enrolled in this program by X percent in year 1 by X percent in year 2 and when you start being very very concrete, the steering
committee discovered the extent to which a recommendation could actually be done
versus one that really couldn’t be done. That it’s just we didn’t have the time
to make it work or we couldn’t figure out concretely when we would know that
had actually succeeded. We also wanted to build in somebody who
would drive it our experiences that once something is
everybody’s responsibility it becomes no one’s responsibility and it’s not going
to get done so to the extent that we could we tried to assign each one of our
recommendations, a driver for that particular recommendation. And as a final
thought there are some things in the delivery of
mental health care services in Minnesota that really work and we were not
interested in creating things from scratch if we had some things that
worked really well and it was just a question of trying to marshal the
resources for them, so that was another thing that the steering committee
thought about. We took those 250 + recommendations and with the help of Dr.
Mark Schoenbom, who specializes in workforce development, we organize them
into these big categories of recruitment education and training, placement after
program completion, retention, and then we wanted an assessment, we built in sort of
okay, we’ve got these recommendations, what works, what doesn’t work, and why. And this last part assessment was really important to us, particularly as
we went around to the community forums. The number of times that people in
Bemidji have been called together for a community forum to discuss mental health, to discuss student loans, to discuss this discuss that, and you know plans are
written and then they are shelved. And they simply said, we don’t want that to
happen, we want something that is seriously actionable, and we want you to
go back and tell us how well this has worked and how well
it hasn’t worked. So we built in an assessment component. So I have now got
20 minutes to walk you through the recommendations and how we are faring on them. Everybody ok with that? So, recruitment:
how do we expose middle and high school students to mental health careers and
this was a comment that somebody had brought up and we actually had a number
of very concrete subsections to this recommendation. Healthforce
Minnesota runs a Scrubs camps, this is a way to introduce middle and high school students to various healthcare careers
and for exampl we have aging suits and they put on
aging suits and they discover when you fall down how hard it is to pick
yourself up when you’re an older person, they type their own blood, they
make sets of dentures or whatever, they have a lot of people from the community,
providers as well as teachers who come in and do these two hour classes to
introduce people to various careers. We had never had a mental health component until two years ago and we started to bring in a mental health component, we’ve
expanded our scrubs camps and so that they are now being offered all over the
state of Minnesota in conjunction with either MNSCU or a private college
and that’s one way that we’re trying to attract more people to these careers. The
school linked mental health grant recipients, and I think they’re about 80
of them, wherever their high schools have a career day they bring somebody in
to talk about mental health careers and i think that the thing that’s that some
tricky about this is how do you make mental health is a career come alive to
a twelve-year-old or sixteen-year-old because if what your job is mostly doing
is like talking and you’re up talking to a bunch of people for 40 minutes and I’m
discovering this myself people sort of start, what’s interesting about this? But Drexel university offers a two-week mental
health camp introducing people to mental health careers over two week period and I got in
touch with them to talk to them about some of the things that they do, and it’s
just fascinating. They will hire an actor and they will have two people from the
class and the actor will be somebody who’s seeking mental health care and
they’ll have two people from the class act as professionals and then they’ll
have the rest of class you know look and try to do you
know sort of a critique of it, so you really get a sense of not you’re telling
me what the work is like I’m getting the experience of what the work might be
like. There are people who bring in various, I know I was in Bemidji and the
psychology professor actually brought in a couple of her family’s pet white rats
and had all of the campers do a psychological experiment on these
white rats because research is part of something that people who study, you know
not everybody gets into you know counseling, so anyway we approach
the cultural providers network and we got 12 volunteers of mental health
professionals of color who are willing to come and speak at any of the Twin
Cities high schools whenever they have a career fair because we really
wanted to have people who look like the people that they’re trying to
recruit and I know that Val DeFor, who’s the executive director at
healthforce told me that one of the most poignant comments that she got from one
of our scrubs campers after a presentation by a social worker at one of
our camps was, I never knew that social workers did anything but take children
away from their families. So this is, I mean there’s an
incredible opportunity here to reach into these groups of young people and
get them really excited about the incredibly important work that you do. There is one effort that I’d
like to see tried, I just haven’t been able to find a champion at the University of
Minnesota but the university of North Dakota in conjunction with the Bureau of
Indian Affairs actually runs that psychology Summer Institute where they
bus to a number of different reservations and they take students who
are interested in studying psychology in college and they bring them to this
two-week camp where they already know that they want to be
psychologists and they beef up their math skills and their science skills so
that they can be much much more successful and at our summit we actually got to talk with one of the graduates of that program. Now
something like that takes money and it takes time but it has actual concrete
results of creating more native american psychologist to serve the North Dakota
population and it would be very nice if the University of Minnesota would take
that on. Improved collection of a workforce data at all levels, that’s
something that we’re working with Terry Fritsma on and this one is
probably going to be a five-year project. What we would really like to get is
not just the data on mental health professionals but get the data on
psychiatric technicians, get the data on very entry-level workers who are coming
out of high school and are playing this this role in adult foster care, and
security counselors at our state hospitals and really an account on who
is doing what, where, and what are they getting compensated and what is the
education and training that’s required for them. So that is a work in progress.
Ensure access to and affordability of supervisory hours. This is an enormous
issue not just for mental health professionals but for all healthcare
workers, I think all of you know that providers whether their hospitals or
clinics are just getting financially stretched farther and farther and so
their ability to provide either free supervision or
any sort of supervision at all is really getting compromised. Senator
Clausen had a bill in the Senate unfortunately didn’t make it into the
last budget bill but that would have expanded these supervisory positions
around the state. It’s a terrible constriction in the
pipeline and I’m concerned that what has started to happen at least amoung social workers is that they are
getting jobs for supervision is not being provided and they are now having
to pay for their own supervision. So you get a Grand Rapids social worker who is
graduating with a master’s degree, seventy-five thousand dollars in debt,
now having to pay for her own supervisory hours making thirty eight
thousand dollars a year. I mean the shift of the funding it’s
going almost exclusively to the individual and it really requires us to
figure out what sort of a collective action so that everybody’s shouldering
the cost of this. We talked about getting higher level mental health degree
programs in rural areas of the state again, Bemidji they really they were very
very unhappy with the Twin Cities, you know the fact that you have to come down
to the twin cities to get a lot of these advanced degrees means that a lot of
people stay in the twin cities. We did an informal survey of –
I can’t remember what profession it was but fifty percent of the people that
we surveyed tend to work within 50 miles of the place where they completed school,
so being able to figure out how to get education to people right where they’re
at with just sort of the genius of that New Yorkpsychiatric APRN program.
You’re seeing a lot more online social work programs that are happening but not
as much in the other mental health professions so this question of how
we get mental health care into you know parts of Greater Minnesota, you can have
telemedicine but it would be really nice to have professionals actually living
there and in the community as well. Increased by four the number of
psychiatric residency and fellowship slots in Minnesota over the next two
years – we managed to get three million dollars over the biennium for residency
slots psychiatric resident, these are four years so we’re going to
have to go back, we’re going to have to get more money but we did get two additional
residents as a result of this, psychiatric residents as a result of
this so that was nice. Expand and replicate the diversity
Social Work advancement program to additional mental health disciplines
like married and family therapists, psychologists and expand practice
locations. This is a program that particularly
target social workers, immigrant social workers, and social workers of color at
particular times in their program to provide support so that they can make it
through their programs and we have been funded by grants from DHS. It continues
to be funded, we really wanted to figure out whether there was a way that this
could be expanded to other mental health professionals and around the state we
didn’t get as far as D swap being a pilot for other professions but DHS did
give a lot of grants that basically accomplished much of the same thing in
this last legislative cycle and I’ve got a list of what those are for anybody
who’s interested. Expand the capacity to trained certified
peer specialist and family peer specialists throughout the state with a
particular emphasis on recruitment from communities of color. There’s a recent report that just came
out on February first 2016 about the usefulness of the peer specialist
program. How many people are familiar with peer specialists? It was something that I had no
idea about but it’s one of these emerging professions that seems to
provide a lot of help for people who are in crisis and to the teams were working
with people in crisis. Support efforts to expand and broaden
mental health telemedicine, require commercial health plans to cover
services delivered via telehealth technology, 773 thousand dollars was
appropriated in the 2015 legislative session to help fund that, so it’s a
beginning, there’s going to be a report back in the next legislative session to
determine how well that’s worked but it was it was something that there was a
lot of bipartisan support for. Promote a team based healthcare delivery model for mental health treatment and you probably know a lot more about this than I do. I
was just recently reading about what Sanford Health and Thief River Falls
community are trying to do in terms of filling in the gaps, where they’ve got
very very limited resources and they’re trying to figure out through working
collectively how to stretch them as far as they possibly can. I encourage
job-seeking in high-need areas and mental health professionals to the
eligibility requirements for the Minnesota health professionals loan
forgiveness program, increased funding and make sure that fifty percent of this
additional funding be made to mental health professionals from diverse ethnic
and or cultural backgrounds. This was one of the real highlights of
the last legislative session the loan forgiveness program expanded from
740,000 dollars a year to 3.24 million dollars a year, so it more than
tripled and they were l the only mental health professionals that
could be funded were psychiatrists and psychiatric APRNs and this has now
been expanded to include all mental health professionals in the rural areas,
it got implemented sort of the third of the fourth
quarter of 2016 but there were four mental health
professionals that were funded in the rural part of the state in 2016 and for next year they’re already 25 who
are being funded, and in the urban area for 2016 there were five funded and next
year they’re going to be nine funded There are for loan forgiveness, there
are very particular parts of both the twin cities and southeastern Minnesota
that are designated as shortage areas, just very particular neighborhoods which
is why you see that there’s some of these urban grants that are being made.
Will Wilson who runs that program says that about I think it’s eighty percent of the
people who take advantage of these loans end up staying in their
communities so it is money that is really well spent. Continued funding of the foreign trained
healthcare professionals grant program. We got two hundred thousand dollars to
continue that funding, identify and address gaps in the educational
certification or licensing systems that impede career movement from entry-level
para professional positions to terminal degrees and licensure as an independent
professional. This is being tried in some places like Philadelphia where they
have a consortium of hospitals and you will have somebody who’s worked in a
hospital or a clinic as a paraprofessional, maybe with just one
year of college but loves working just loves this work, is very very familiar
with it and trying to figure out how somebody like that can move up a career
ladder and get a masters degree and become a professional is something that
we’ve actually been able to figure out how to do from in the nursing
professions from a nursing assistant to an LPN to an RN. I don’t know that I’ve
ever seen any profession where the gap between a very entry-level worker and
the next step is quite as big as it is in mental health. So you can be a
security counselor at st. Peter with a high school degree and you get some you
know internal training and then the next step is a bachelor’s degree in
psychology and there’s really sort of like nothing in between, so one of the
things that we’re really trying to figure out is, what might that be and
we’ve been doing a lot of interviewing of employers to try to figure out what
are the skill sets that maybe a two-year degree could accommodate and embrace
that maybe the four-year psychology degree doesn’t go after and then
how do you provide financing and the training and the employer buy-in to make
that kind of thing happening? We’re really trying to figure out how to
address the shortfall in the middle of workforce and always possible. Increase
reimbursement rates, DHS has already posted an RFP for a study and I think
the results on that are going to be out the end of this year. I’m going to go
very quickly. And then assess the recommendations. So July 2017,
hopefully we will have another summit and we will assess the recommendations. Now the ones that have yet to be
implemented – I talked about the Indians in psychology doctoral education program,
not implemented. We asked for five hundred thousand dollars to pilot
project lead the way biomedical science curriculum in 10 schools in
Minnesota as a way to try to get more people interested in science and from
there to mental health. That’s going to be introduced next year,
we couldn’t find a house sponsor. Require 3rd party payers and commercial insurers
to reimburse the same way medical assistance does, so for supervision and
internship, so that services provided by mental health trainees under the
supervision of mental health professionals are reimbursable – that
did not go anywhere. So this is like your work, this is
what you get to get to discuss this afternoon, how you’re going to make that
go somewhere. Develop a faculty fellowship model to engage faculty in
the newest understanding and treatment of mental illness in both children youth
adults and older adults. So 42 years ago when my brother was diagnosed with
very very serious schizophrenia it was basically sort of a lost cause and I
remember the doctors at the Mayo Clinic just saying, was just
heartbreaking you know for my parents. Other members of my family more
recently have been diagnosed with schizophrenia and the message that they
are getting is totally different, its recovery and we’ve just got to make sure
that the education and teaching that we are providing to people, whether it’s at
the continuing education level or our new graduates really understand that
this focus on recovery is absolutely be critical. Charge the department of
human services with establishing a criterion payment mechanism to
incentivize mental health settings committed to providing students with a
practicum experience that features evidence-based treatment interventions.
Again, that’s something that we’re going to try to focus on and yet establish.
Improve and expand cultural competence training, establish cultural awareness
as a core behavioral health education and training requirement for all
licensure and certification disciplines. I will tell you that this was the
hardest recommendation, we had a lot of specifics attached to it and it always
ended up being the very last thing discussed in our community forums, it was
the last recommendation addressed by our steering committee. This is not
going away and we really need to figure out how to be very concrete in what we
want and how to provide the resources to make this happen, the most concrete that
we could get is that a variety of organizations would hold a cultural
competence summit to showcase best practices in the promotion of cultural
competence in delivering mental health care services and provide access to
education and training resources. But all I can say is that when you have a survey
that shows that level of discrepancy between what people of color want and
what people who are white think that we need, thats the real disconnect that
I think that it’s important to try to figure out how to address and then how
to measure whether the way that we’re addressing it is actually making a
difference. Increase exposure to psychiatric mental health experiences
for nursing and medical school students. This is really you know getting at this
idea that a lot of mental health diagnosis are made by primary care
doctors or are seen by nurses and they need to know a lot more about mental health
and unfortunately what we are finding is that in some of our nursing programs
it’s the mental health residency over 2 -3 days that is being booted off in
favor of other things so that our nurses aren’t even getting that experience and
so we need to change that. Utilize accreditation council this is another
way to try to expand access and program funding by utilizing the ACGME
and APA standards for psychiatry residency and accredited psychology
internship programs, we’ll talk more about that. Provide support so that all
psychology internships at state institutions are accredited by the APA, there two of them that are run by state institutions that are not accredited by
the APA, we asked for fifty thousand dollars from the legislature because
this is really a question of money and resources that these programs need and we
couldn’t get that money. There are other non-accredited APA internship programs
that are running in the state but these are two that actually are run by the
state and we you know we need to address that, unfortunately also need to keep Anoka hospital open and so there are
priorities right? Department of Health will evaluate work funding as the way of
getting more money into training sites, we didn’t get any money for that. Ways
that technology can be used to streamline paperwork and ensure
necessary data capture, we are pushing DHS to try to fund some pilots over and
over and over again from everybody we heard the paperwork is killing us. So i
don’t think that the paperwork is going to go away but what are some creative
ways that paperwork that can be done so that it isn’t so all time consuming and
seen as being really sort of outside the work. Ok I think we’re going to be discussing
on the recommendations is what worked and why, what didn’t work and why,
and what should be included in summit 2.0? I think that’s a nice segue
into what you’re going to be talking about at 1:15 so, thank you very much. Angelina: Now that we’ve heard a little bit about
psychology itself and we’ve heard about the mental health workforce plan, we’d
like to take about 25 minutes and have a panel discussion with our two presenters
Mary Reagan was originally going to join us on the panel and was unable to do so.
We regret her not coming, but it resulted in a very nice gift as well, and I have
to tell you I begged, I pleaded, I asked five minutes before we started and so
with that disclaimer we are lucky to have Glenace Edwall here who is going
to join our panel discussion. Glenace is a PhD from the University of
Minnesota educational psychology, she also has a psyd at the university of
denver in child and family focus. She is an associate professor, director of clinical
training Baylor University from 1986 to 1991. University of Minnesota health
psychology program and the department of pediatrics from 1991 to 1993.
Responsibilities there include supervising interns and postdocs. She was
a psychology services supervisor at Children’s Hospital Minneapolis from
1993 to 1996. She’s also the director of the Fraser Child and Family Center in
Minneapolis from 1996 to 2000. She’s the director of the children’s mental health
2000-2013 and the children’s and adult mental health departments from Minnesota
department of human services from 2013 to 2015. This position including
participating in the workforce development plan, so that’s how she got
integrated very closely with the creation of this plan. Glenace has retired
in 2015, or she thought she did. Until we pulled her out here so she’s
currently consulting, supervising postdocs and serving as an accreditation
site visitor for APA. Let’s thank her and Dr. Fritsma and Mary Rosenthal as we go
into the panel. We also have with us today on the panel
Valerie Defor and somebody snapped up my notes. Defor: I’m Valorie Defor with healthforce
Minnesota, I’m the executive director and I think you all are all probably feeling
the same thing I am in how lucky am I to have Mary Rosenthal on my team and to
have led this work for us but that’s what we’ve been doing a lot of for the
last two years. My background is actually, I’ve been
doing this type of work force development work for the Minnesota state
colleges and universities since 2001. Prior to that I was in healthcare
consulting for about 10 years with a masters in health care administration
from Arizona State University. Angelina: We’ll start
off with some of the card questions that we haven’t gotten to yet and that have
been submitted and then we can also take questions from the audience as we go along. The first question is for Dr. Fritsmas for 5 points, can you discuss or describe the non practitioner roles of
psychologists who responded to your survey, settings, trends, differential
levels of satisfaction compared to practitioners? Fritsma: Okay in my defense,
so actually I cannot, and the reason is that we just
filled out the survey at the end of april and I pulled out the
data at about May fifth so I’ve been furiously analyzing the results
just for the purposes of this conference and kind of making sure that we’ve got
all those t’s crossed and i’s doted, but if you could read that
again that’ll give me some good ideas for future analyses. Alright next up we’ll start with
Valerie Defor. Having a more diverse workforce is absolutely necessary. Minnesota has a high rates of
segregation access to care and it seems there’s more to it, some data suggests
that people of color perceived psychology as a white profession. What are some ideas for expanding care
models that are inclusive of a variety of cultural conceptions of mental health?
And obviously others can chime in too. Defor: Well I think you know actually
Mary covered you know a little bit of that as we discussed it in the
development of the mental health workforce plan and how we were just so
intentional in kind of engaging and having that discussion around cultural
and racial ethnic diversity and cultural competency, it’s a challenge not only –
it’s across all of our healthcare occupations and disciplines you know we
know empirically and I say this a lot, that it makes a
difference in patient outcomes when the healthcare providers look like the
patient’s they serve, so we are dealing with this with our nursing programs, with clinical labatory with any of our healthcare programs, and I’m sure all the employers and any of their occupations. You know one thing I guess, thinking more practically about a response. I have personally worked with one of our federally qualified health centers. The open door health center in Mankato I was their board chair for six years, and really got to see first hand what it meant to provide a welcomming enviroment and to have care providers, interpreters, translated material, all of that available. In Mankato, we served a lot of Somali and Hmong patients. So I think too it goes kind of hand in hand,
we have to do our work in education with recruitment, with support, with assisting
students and then on the employer and the employment side there has to be that
welcoming environment, there has to be a situation where you’re perceived as
equal, as part of the team, you play that important role. So I feel like that’s
kind of a World Peace question, but you know it’s very important and I
think there’s a lot of opportunities it’s just kind of done individually
oftentimes. Rosenthal: If I could just add Dr. Willy Garrett made some really
interesting comments about this in terms of when he went through his program that
he didn’t necessarily get help from other african-american
professors, that it was a white professor who was actually able
to run interference for him but it was just knowing that there was some actual support and I think that this doesn’t happen sort of like automatically, I mean its a conscious and deliberate reservation of resources that could go
someplace else that you are saying no it’s going to go here. I was down at
Roosevelt university my daughter-in-law just graduated with a Psyd and I was
taking a look at the Roosevelt graduating class in her department and
it was like there’s sixty percent people of color and that is a very
conscious deliberate move on the part of it meant to provide a welcoming
environment and to have care providers Roosevelt university in terms of who
they’re going to recruit and how they’re going to support those students and what
the faculty is going to do and so I just you know I think that where it happens
you can see that it works and where it doesn’t happen it’s I say people don’t
think that it’s important that it happened. Defor: You know one thing I might just
add, Mary talked a little bit about our scrubs camp and some of that outreach to
our unit for pipeline development middle and high school students, yesterday we
had about 240 girl scouts at three of our MNSCU campuses and we had a
hundred and twenty a hundred and fifty and 40 at RCTC north hennepin and
south-central Mankato, and they were through a partnership that we’re doing
with a special program that the girl scouts has in place for high school
student girls of racial or ethnic diversity backgrounds or on free and
reduced lunch, and so it was a day spent learning about health careers and we had
a session on it was more related to stress and mindfulness. So it wasn’t you
know hardcore you know a mental health occupation that was kind of shared with
them at North Hennepin but that’s the starting point you know on our end is
really just even increasing that the exposure and the pool and those girls
loved, loved that day on campus some of them wouldn’t have been on a campus.
They got to sort of envision themselves you know walking the corridors and
feeling like they were taking a class and you know I think with the Girl
Scouts partnership will continue to support those dreams and and we’ll do
what we can too Audience: Just as I have
been frustrated over the years when people talk about the mentally ill
there’s a schizophrenic, there’s a person with Alzheimer’s, it torpedos the
conversation by using that and my feeling is with a cultural culturally
diverse populations as people of color there is a somali who is first
generation, very different. I am the work that I did before I retired used to get
interpreters. I had a spanish-speaking interpreter who we got what the patient
said he’s from Cuba, I’m Mexican I don’t even understand the language is
he speaking. So I I guess I’m wondering is there a way to frame the conversation that
gets around the generic thing – it’s not skin color, it’s very frustrating
because I don’t see how one can make progress unless we re conceptualize it. Rosenthal: So let’s have the summit Mary: If I could just follow up on that, I held
it was the first-ever MNSCU nursing faculty conference and we called it the
inclusivity and healthcare and it was about supporting students and in our
minds it was diverse students. It was a wonderful day,Ihad about a hundred
people, we learned from each other it was a great day, everybody felt really
positive the very end of the day one of our employer partners who is that the
conference who is herself african-american, she just stood up and so
respectfully and eloquently stated you know what this was a great day. She
appreciated it, it was wonderful, most of the conversation
steered towards how do we support immigrant and refugee students and
that leads to english as a second language and medical terminology and the
stumbling blocks and all that she said that’s because that’s an easy
conversation for us to have, we didn’t talk about… the nomenclature is so
hard to you know not stumble over but we didn’t talk about native african
americans in you know who live all around us and have been in this country
for 200 years and and that’s getting at you know a bias and racism and prejudice
and so it just we have carried that learning and that message forward in our
thinking and our work but it was really important for her to call that out I
think and I just share that because I think that might happen often when we
when we try to tackle this. Edwall: Well I appreciate actually thinking
about that is a focus perhaps for a summit too, because it was such an
important part of the legislation and of the considerations, but it’s clearly the
most important area going forward I think for continued in examination. I
just wanted to offer before Dr. Long’s comment that actually as a profession
and doing a lot of accreditation site visits, I’m really pleased to see how the next generation is being trained with regard
to the standards in both graduate programs and internships around
individual and cultural diversity that really do push it down another level and
exactly what you’re talking about, but that’s late in the game with regard
to actually developing a really diverse workforce and so all of the the kinds of
learnings perhaps that we have gathered in graduate education we need to start
now scratching our heads about how do we apply that to these concepts of pipeline
and ladders so that we’re also really attracting people to the profession
who represent those communities represent and come from communities and
would go back to those communities to serve as well. Fritsma: Can I just make
one more comment about that – I’ve done a lot of thinking about cultural
competence especially because at the Department of Health we do measure I
mean we measure the diversity of the workforce and kind of you know by
default we compare the race of the provider to the race of the population
and if we’re often we say oh you know we got a problem here and I think you know
the more I thought about that the more I think it’s just it’s really so much more
nuanced than that I think I mean for example by the time someone becomes a
physician or a psychologist or that sort of thing I think you’re also you’re not
just you know you you may look like physically like the person that you are
serving but you have you come from a completely different socioeconomic
status so can you really are, you can you really be expected to provide that
culturally competent care that we’re kind of thinking of when we we just
match people by race so I I mean I love the idea of a summit I hope I really
hope we do it and I hope we give some serious thought to some of the the
nuances around the issue it’s it’s not so straightforward. Angelina: Alright sticking with cultural
competence just for one more of these questions here, in terms of cultural
competence we heard some of the efforts that are being done by MNSCU and
some of the offerings however this particular question speaks
to the perspectives of some of those groups and we’ve heard a little bit about that from the rural farmer comment, and from some other individuals about what diversity might mean. So you said African Americans have a different perspective of white vs. African American mental health professionals. Can you talk a little bit about their perceptions? I think they were saying the African Americans health professionals differed in how white mental health professionals viewed cultural competence and do you know what the perspectives were of that minority group? Audience: I think you said Mary, something about the perceptions of the therapists, African Americans perceived their therapists differently if they were African Americans or Caucasian. Rosenthal: I’m sorry if that’s what you heard, I think what I was referring to was the survey results about what we did about cultural competence. There was a question that we asked about
in what areas do you feel that mental health professionals should get more
training and there were list of things that they could check and one of them
was more training and cultural competence and when we disaggregated
those responses we saw that only thirty-eight percent of whites felt that
there ought to be more training and cultural competence vs
seventy four percent in people of color so there’s just this big disconnect and
how people perceive, white people perceive themselves versus meeting
training or white people feeling that mental health professionals need
training versus people of color and again this was this was not broken down
sir by quite specific ethnicity I’m sorry I didn’t make that clear. hi my
name is Kelly, a psychologist from st. peter and I would like to add some
command to get them self control and competence training and I’m definitely
glad that that can be the topic of the next summit however I want to add to it is that from
the hiring recruitment to retention the focus is really have to be intentional i
know that there is some issues with in terms of EEO but you know we have really
to have a comparison with the population we are serving you know whatever the
population that being self in that area are in that setting the
recruitment and retention should be focused bears on it now coming back to
the internship a post-op training program and I have been always thinking
that often the program’s only offer separate like the country and competence
trending per se instead of in integrating the country and competence concept
across all curriculum not just one topic not just one class but
everything from all presentation all training the control and competence
concept should be incorporated I can give an example in the psychology
department St. Peter is that I’m with the support with the board of
psychology we were able to incorporate in old didactic training for internship
program and possible program anything in all didactic it should have mentioned
about concerned competence issue because I’m really worried about the… not
just awareness. Barnes: I just want to jump gears a little bit of cultural
competence we haven’t touched any of the other areas that some of the people were
asking about so we do have a short period of time but we’ll definitely be
digging into these issues and cultural competence when we get into our focus
groups will be a lot of time to talk about those so, one of the questions
changing over to recruitment is what two recommendations in the area of
recruitment have been most effective thus far? Rosenthal: ‘m just thinking then you know
we launched these recommended age we we presented these recommendations to the
legislature in just january of 2015 and so it’s a little
early to be able to kind of track anything that we’ve done and has it you
know has it made you know a difference you know I’d like to give it at least um
you know another year as I’ve said this isn’t recruitment but I would definitely
say that what we saw by putting all of that money into retention or into the
Minnesota loan forgiveness program you can see that that may make a very big
difference if we take a look four or five years down the road we take a look at
you know how many professionals are now you know serving areas of Minnesota the
word served before but I think it’s just a little too too early what I will say is that though these
young people they are just thirsty for information about mental health careers
they are so curious so trying to figure out how to get people really alive i
mean I’m interested because a lot of people I run into who are like at the
augsburg social work department or their master’s degree programs, they’re there
because of the the ones that I’ve talked to they have a family member who has
been suffering from a mental illness or they had a family member who for example
worked for a mental health provider i mean there’s a lot of like personal
connection but the largest major I think in Minnesota of all of our colleges is
psychology and also people are very very curious about this. Edwall: The evidence that
people stay where they are trained ought to really give us some pause
about our paucity of accredited internship programs in psychology in
this state and that certainly is an area where collectively we have work to do. Barnes: So what I want to do this afternoon sort
of has a very specific goal and we wanted ultimately kind of in just
general terms we want to be able to take the feedback that we get in these groups
and put it to action we want to share it with the health
force Minnesota group and we actually want psychologist to play into how these
recommendations come out. I didn’t originally have the opportunity to
attend the summit and so one of the things I recognize when we started
meeting, all the four executive director started meeting from the mental health
boards, with Dr. Fritsma and Mary Rosenthal, I realized that these
recommendations on some of them very closely play into a lot of primary
issues that were already looking at as psychologist and as a board and that we
needed to have this conversation so I’m really excited that we have everybody
here to do that and so just to get us started ultimately
like I said we’re going to go for 1:15 to 3:15 but our goal is to gather some
responses to some focus questions and have a discussion and we’re going to
retain that information here Barnes: Alright if we could come back together
to reach the end. If I could have the representatives of the other groups the
individuals are facilitators who are going to present their focus group
findings come up to the front number one is here number two arrived oh yes please come on up where’s number three I want to thank everybody for staying through the session, for providing feedback and comments. I’m blown away by the suggestions, the feedback, the input, the ways that we can come on to some of these issues and approach them and at how many of them overlap and how they do support each other in what the board and state can do. So thank you. As we jump in here, we’re going to have each of the groups through their facilitator report on some key points from their primary were, and being number one will go first. In terms of group number one we had a robust discussion, kept me running with the mic so it’s great I got
a lot of exercise one of the things i heard as a reoccurring theme and what I
see in the notes is prevention. This group we talked a lot about prevention
about getting into educational settings training sessions, starting young getting one of the suggestions was
getting into the kindergartens and teaching some of the social-emotional
interpersonal skills at a very young age get them recognizing that – which could
work to de-stigmatize mental health as well as start before you know it’sit’s
developed along on the road, and also to move away from just having your first
mental health contact be based on a diagnosis or some sort of crisis issue
but it starts early and that it’s all integrated part of health. I also heard a
lot about primary care and having integrated care and how care is
provided. That integrated care would go a long ways towards de-stigmatizing mental
health and it needs to reach actual parity with physical health of
individuals one of the the comments that really struck me was about walking into
that building and going there and sitting in sharing waiting room with people who
could be there for any head-to-toe purpose as opposed to sitting in the
mental health or the counselor’s office and what that might do for mental health
and the stigmas, and we heard some suggestions for board improvement and
for things that the board might support or do. One of those things about being a
resource and being continuing to offer education be proactive, help people and
support people with training specialized training, and we definitely do that you can
request that anytime and we’ll see what we can do to work that out. The other thing in the board bucket was
fees and we talked a lot about expense, getting licenses and expense, what the
board’s budget is, and that was an engaging issue, we definitely the message
I got was doing a better job at educating our own licensese as to
what funds the board and how does it run and where the fees go and what is it giving you? Number one is
giving you this event as part of it but it’s doing so many more things, and as we’re asked to be that resource and
to make those changes and priorities fees do play a role in that and so we
want to make it less expensive but we want to do that also in a responsible
way so that we can continue to meet those needs. Also necessity of the
postdoc, we talked about the postdoctoral experience and is it necessary? What
is it doing? Is it adding value? Should it be there, should be integrated
into education, and there were lots of thoughts about that, lots of sort of
drive to see why we have it, be evidence-based about why we have it, and
the last sort of general point is getting people employed quicker. You know
getting them into working and being able to see patients and a lot of it came
back the money, you know what it water what’s reimbursable – we learned that
tele services or telepsychology or telemedical services in
our beginning on the reimbursement track and that that’s a necessity in order to
make it possible and then some questions were asked around the sci-pact and what
Minnesota can do to provide guidance and and take action towards getting telepsychology in place. Fischer: I think group number who was probably the
best group we had a we had a really good, we had a
really good, freewheeling but focused when it needed to be discussion it was a
really good way to spend a couple hours. A few of the things that came up for us one of them was the issue of culture
came up in a number of different ways on both in terms of cultural competence and
in recruiting people from the non majority culture into the profession and
when we talked about cultural competence we really came around to a point of view
that what’s important is to bring up particular stance to working with people
from different cultures rather than focusing on learning content and really
to take a stance that acknowledges whatever privilege that you might have
that comes in with some humility and is an extension of our our general clinical
skills. We we talked about recruiting people from different cultures and had
some discussion about the way that that intersects with the cost of graduate
education so if you’re going to take on a hundred and fifty thousand dollars
worth of debt and make seventy thousand dollars, that is much easier for you to
do if you’re from a middle-class family and have some backup support, and so
that’s going to be an impediment and there’s not a real obvious and easy solution to
that that doesn’t cost a lot of money. We talked about our professional identity
and we were really aware that the recommendations go across mental
health professions with those of the other mental health professions and
sometimes don’t and that we do have a unique identity and the way our group
thought about that was really our training in science and critical
thinking as a big part of that. It came up a lot in the one of the last
questions was about supervision and the particular recommendations about
cross-discipline supervision and reducing the hours that you essentially
reducing the hours that you would need in order to be licensed and so we
started by kind of rolling our eyes and being horrified by it, but we also took into account the fact that
the cross disciplines supervision could be a really good opportunity for
psychologists – not in psychologist being supervised by other professions but a
role that we might be able to take on you know in supervising social workers
LMFTs, other professionals as appropriate. And that that seemed especially
important given that as we learned from the slide earlier today we’re really
really old, and people are moving into doing different kinds of
things with their professional life other than direct service and so that that was a
way that that those two questions and findings kind of intersected. We talked a
little bit about the service delivery to to underserved areas underserved
populations and the potential use of technology to help with that and the
sci-pact and Angelina mentioned and we also talked about service delivery
models that are outside of the box either technologically or otherwise so you know there are suicide prevention
services that are using texting as a primary means of communication, there’s
in-home therapy their services delivered in schools, those kinds of things and so
really thinking about service delivery methods as a partial solution to
the underserved populations so Rachel may have a little bit to add to my
observations and I’ll let her take it from here. Kolles: So the only thing that I have listed
here, you’ve touched on every other one so far, is the impact of media and social
media – how mental health say 20 years ago was almost a very touchy topic to even
mention, we’re now you see some celebrities even talking about bipolar
disorder and things like that where more people can relate to that. Our group
talked a lot about that and more of the openness, on how people are feeling more
comfortable that other individuals that are more in the limelight are coming out
and be more open about those topics when they are a little little touchy so that was a big topic and it was great
to chat about, so that’s about it for group two. Versland: So in regards to the first question in regarding which areas we need to focus on first in terms of the plan folks felt that first of all, a good thing that retention is not necessary an issue for psychologists because we are a happy lot that like our profession. Like every good psychologist we feel like we need a good assessment of what the problem is before we can dive into interventions. So that was a common theme. Folks also felt that recruitment is where it starts and that there’s also training and education opportunities to do more but without knowing the problem, we’d be hesitant to have specific recommendations. We also looked at the data of licensed professionals, but there’s a lot of
individuals out there that are practicing at bachelor’s levels in arms
and and in other disciplines and we would want to better understand that
workforce too going forward. A theme in our group was reimbursement issues and
that there is not good reimbursement for folks who have done a lot of education
and are practicing as interns or fellows and that
they incur an incredible amount of debt much more so than folks who have
master’s degrees and so that doing more there to reimburse them as important. Similarly there is not a lot of
incentives for supervisors to do this work because there is not payment behind
their supervision and therefore expanding the supervisory field would
need to include having more psychologists being paid for that.
There was a discussion around supervision and there was a lot of views
it’s nice to have more diversity in terms of other disciplines contributing
to supervision at the same time there is a socialization process into the field
of psychology that only psychologist can do and there are a lot of roles that
psychologists play that only psychologists truly can supervise,
whether it be assessment research or interpreting research findings and
certain roles we talked about even from a legal standpoint things like
placing holds our are things that psychologists do that not all mid-level
providers can do. The theme that came up was very similar to group group twos,
that psychology is really having somewhat of an identity crisis right now,
and that came up many times that there isn’t a good understanding of how
psychologist is different than other mid-level providers and that as a
profession more needs to be done to help the public and help others in mental
health just be able to understand the different role that we play and there
was a lot of thoughts that you know for students who are looking at a profession
in mental health why would they go into psychology if
psychology is being lumped in with other professions and not seen as unique
given the expense in the time that goes into earning a PhD or PsyD? There is also discussion around
paperwork and bureaucracy, third-party payers, a lot of the themes that came out
in the survey and how that impedes people’s ability to actually do work
with patients and so that being a barrier as well. In talking about the
aging population and we have an incredible wealth of expertise that we
could tap into but again everyone is very constrained by financial
responsibilities but certainly supervision and other areas of
consultation would be something that our older psychologist could play in the in
the field and that we’re seeing many of them and administration positions as
well. As we look at different changes to how supervision is done, there was
the viewpoint that some of these potential recommendations that are being
considered conflict with accrediting agencies so regardless of kind of where
people fell on the issues that it also might lead to accrediting problems for
institutions and internships. And let’s see, I also in regards to stigma our
group talked about how more needs to be done to decrease stigma because when I
you know the population we serve are stigmatized it also leads people to be
less inclined to go into this profession and to be devalued in the work that they
provide the stigmatized populations. Rural communities – and just one other
comment on that was that there are a lot of challenges to working in rural
communities and that especially in terms of trying to work through bureaucracy
with third-party payers who like to contact with large organizations and not
private parties that that can be especially challenging and resources for their clients are
especially sparse in those areas. Campero: As the other facilitator of what
now has been established as the best group Two things that resonated with me when we talked about rural areas was the issue
of transportation. I think that was that was a very practical suggestion, how
sometimes the issue is not necessarily that the person don’t want to seek out
help but that they just don’t have the means to get to where the provider is or
vice versa and and so that was a very practical suggestion that I thought was
very it was very useful and one thing that another comment that I was very
surprised about was using telepsychology tele-electronic means to
provide services, which are my formal educational background is in IT so I’m a
big proponent of technology but then the person was making the comment that yeah given no other choice that is a
good choice but at some point it is important to see the person face-to-face
in the same being in the same room and and I thought that there was very
valuable insight in that too as well. Barnes: I did miss two things that I
think are really important to mention for our group to represent as well. We
also talked about cultural humility. We were told and discussed and really dug
into the idea that perhaps it’s not cultural competency but what about the
concept of cultural humility. Recognizing that you’re different and they’re
different and I’m not going to do it justice because I’m a lawyer not a
psychologist but Ann Williams did a very nice job explaining to that
and we spent a lot of time on that and kind of reframing what it means and what
culture is from city to urban to rural and in
various different ways in which you can be competent from the island of hawaii
to various other ways of life. The last part which I thought was another
really neat coupling was taking that cultural piece so perhaps we better
connect with communities and seek these representatives of
different levels of diversity and perhaps we put together a training video
or some sort of memorialized representation of information on all of,
well we’ll never hit all but a fair representative of those
various areas of cultural knowledge that these communities and people and
different walks of life have to share and how we can use that as a training
resource. And when asked about the seminar that, I really like that
response, our group was – one of our members was really quick to say, well out of everything we’ve talked about, coming to the job fair or the seminar doesn’t seem
like you know, if you had to pick wouldn’t be the high priority but we did
return to that and in where psychologist would be willing to participate perhaps gathering that institutional
knowledge or that field knowledge and again using a video or an electronic
means to share that with our lower education levels in terms of high school,
undergrad, telling them yeah you might like psychology – a lot of people think
it’s going to be interesting, but where can you go, where can psychology take you
and why would you want to do this. Have a great day and thanks again.

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