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1 NCSL HHS CHAIRS MEETING | JUNE 26, 2019 HELP WANTED: BUILDING QUALIFIED AND SUSTAINABLE WORKFORCES IN HEALTH AND HUMAN SERVICES FIELDS
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NCSL HHS CHAIRS MEETING | JUNE 26, 2019
HELP WANTED:BUILDING QUALIFIED AND SUSTAINABLE WORKFORCES IN HEALTH AND HUMAN SERVICES FIELDS
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SO, WHAT’S THE PROBLEM?
Access to services like child care, child welfare and protective services and health care are essential and potentially life or death for many in this country.
Lack of access to these services can result in poorer outcomes, affect development, school readiness in children, etc.
▪ What are the challenges and opportunities to overall workforce recruitment and retention? ▪ Suzanne Hultin, Program Director, NCSL
▪ What are challenges and opportunities to building health and human services workforces?▪ Sydne Enlund, Policy Specialist, NCSL▪ Julie Poppe, Program Manager, NCSL
▪ How are individual fields addressing challenges? What is being done in the states?▪ Jennifer Stedron, PhD, Executive Director, Early Milestones Colorado▪ Nina Williams-Mbengue, Senior Policy Fellow, NCSL▪ Hannah Maxey, PhD, Director, Bowen Center for Health Workforce
Research and Policy
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WHAT ARE THE CHALLENGES AND OPPORTUNITIES TO OVERALL WORKFORCE RECRUITMENT AND RETENTION?
Suzanne HultinProgram Director
NCSL’s Employment, Labor and Retirement Program
NATIONAL LABOR MARKET
Unemployment rate is at a 49 year low: 3.6%
Workforce Projections 2016-2026:
➢ Employment expected to grow by 11.5 million
➢ Unemployed persons per job opening 0.8
➢ Labor force expected to be older and more diverse
BUREAU OF LABOR STATISTICS, 2018
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NATIONAL LABOR MARKET
WHAT DOES THIS MEAN FOR HEALTH AND HUMAN SERVICES SECTORS?
BUREAU OF LABOR STATISTICS, 2018
1. Home Health Aides2. Personal Care Aides3. Physician Assistants4. Nurse Practitioners5. Physical Therapist
Assistants
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FILLING WORKFORCE GAPS
❖WIOA State Plans❖Sector Partnerships❖Career Pathways❖Work-Based Learning❖Engaging the Non-
Traditional Workforce
WIOA STATE PLANS
Workforce Innovation and Opportunity Act-enacted in 2014 (2015-2020)• Reauthorization of Workforce Services• Expanded access to training for a variety of workers• More collaborative workforce service systems• Require the development of state plans (completed in 2016)• Apprenticeship Expansion Grants (2016 & 2018)
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SECTOR PARTNERSHIPS
Colorado-HB1274 (2015) Requires that sector partnerships drive and inform the creation and development of new career pathways
Maryland-SB278 (2013) Established the EARN (Employment Advancement Right Now) Program. Helps establish industry partnerships as a key element of the state’s overall workforce strategy.
NATIONAL SKILLS COALITION, 2019
CAREER PATHWAYS
California Career Pathways Trust—Through 2013 and 2014 Budget Acts, California allocated $500 million to be awarded towards the development of work-based learning infrastructure, innovative regional partnerships for career pathway support, and the expansion and improvement of career pathway programs statewide.
Iowa’s Pathways for Academic Career and Employment (PACE) – Enacted in 2013, provides funding through the state’s community colleges to implement pathways that provide integrated basic skills instruction and occupational training and counseling. Funds also support regional partnerships between community colleges and industries to ensure alignment of career pathways for in-demand jobs.
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WORK-BASED LEARNING
Registered Apprenticeship Programs
Pre-Apprenticeship Programs
Work Experience and Internships
Transitional Jobs
On-The-Job TrainingCustomized Training
Incumbent Worker Training
STATE ACTIONS ON WORK-BASED LEARNING
Business Incentives for Apprenticeships and Other Work-Based Learning: Income tax credits, tax credits for property or equipment, grant funding.
Alabama, Arkansas, Connecticut, Louisiana, Missouri, Montana, Nevada, South Carolina, Virginia, West Virginia
Apprenticeship Tuition Supports: Provide support for apprenticeship programs or individuals in apprenticeship programs to help cover costs of education and training.
Georgia, Indiana, Iowa, Maine, Texas, Washington, Wisconsin
State and Federal Alignment: Aligning state apprenticeships to the federal registered apprenticeship programs.
US DOL oversees programs in 25 states, other states rely on their State Apprenticeship Agencies. Maryland SB 317 (2017)
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NON-TRADITIONAL WORKERS
Employment for People with Disabilities: ODEP’s Apprenticeship Inclusion Model (Amazon, Microsoft, Healthcare Career Advancement Program, Industrial Manufacturing Technician Apprenticeship Program)
Long-Term Unemployed, Underemployed, Dislocated Workers: California Adult Education Grant Block Program
Reentry Population: Relevancy Limitations, Modification of Morality Clauses, Certification of Rehabilitation
NCSL’s Occupational Licensing Project: Barriers to Work Series (Low-Income and Dislocated Workers, People with a Criminal History, Immigrants with Work Authorization, Military Veterans and Spouses) www.ncsl.org/stateslicense
April 2019 Disability Employment Statistics
Ages 16 Years and Over
Labor Force Participation• People with
disabilities: 20.7%• People without
disabilities 68.3%
THE FUTURE OF WORK
With New Challenges Comes New Opportunities
• New opportunities for rural workforce development
• New workers to enter the labor market• Requires lifelong learning and constant upskilling• Continual, regular engagement with stakeholders
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HEALTH AND HUMAN SERVICES WORKFORCE
“Employment in the health care and social assistance sector is projected to add nearly 4 million jobs by 2026, about one third of all new jobs.”
-BLR Employment Projections 2018
Questions?
Suzanne Hultin
Employment, Labor & Retirement Program
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CHALLENGES TO RECRUITMENT AND RETENTION OF THE HEALTH AND HUMAN SERVICES WORKFORCE
• Meeting minimum preparation requirements• Low wages• Access to benefits• Casework burnout and stress• System fragmentation• Lack of providers and facilities • Rural and underserved areas• Location of medical residencies • Specialty care vs. primary care
OPPORTUNITIES TO BUILD A QUALIFIED AND SUSTAINABLE HEALTH AND HUMAN SERVICES WORKFORCE
• Financial incentives• Career pathways• Supporting higher education
• Loan forgiveness and scholarships• Articulation agreements
• Apprenticeships• Sector partnerships• Telework/flexible work environment• Emerging health care providers• Examining scope of practice• Telehealth
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WHAT ARE THE CHALLENGES AND OPPORTUNITIES TO OVERALL WORKFORCE RECRUITMENT AND RETENTION?How are individual fields addressing workforce challenges?
What is being done in the states?
Early care and educationJennifer Stedron, PhD, Executive Director, Early Milestones Colorado
Child welfareNina Williams-Mbengue, Senior Fellow, NCSL
Health, including primary care and behavioral healthHannah Maxey, PhD, Director, Bowen Center for Health Workforce Research and Policy
N C S L H E A LT H A N D H U M A N S E R V I C E S
C H A I R S 0 6 / 2 6 / 2 0 1 9
W E C AN D O BET T ER F O R O U R K I D S . AN D W E C AN D O
BET T ER , N O W.
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ABOUT EARLY
MILESTONESEarly Milestones Colorado is an independent organization helping to advance innovative solutions that improve policies and practices in early childhood development. We work with state and local partners to exchange ideas, share resources, and create lasting, positive change for children.
COLORADO IS THRIVING AND
GROWING.
Availability of high-quality early
childhood care and education is no small
matter.
W H AT W E A R E L E A R N I N G
6 3 % o f c h i l d r e n u n d e r a g e 5 l i ve i n
h o u s e h o l d s wh e r e a l l p a r e n t s wo r k .
T h e n u m b e r o f c h i l d r e n u n d e r a g e 5 i s
e x p e c t e d t o g r o w o ve r 2 1 % b y 2 0 2 6 .
Es t im a t e a 3 3–4 3 % i n c r e a s e i n t h e n u m b e r o f
EC e d u c a t o r s n e e d e d b y 2 0 2 5 ( f r o m 2 0 1 5 ) .
Source: Bearing the Cost of Early Care and Education
in Colorado: An Economic Analysis (2017)
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• Workforce is key to the quality of
children’s care and learning
experience
• Long-term participant gains
dependent on a highly effective
workforce
• Consistent, high-quality care and
learning is linked to parent workforce
productivity
EARLY CHILDHOOD WORKFORCE IS
KEY
Recruitment Retention
70%Directors report difficulty finding qualified staff.
16 - 33%Averageturnover rate
46%Directors forced to hire unqualified staff
25%
Teachers who intend to leave their jobs in the next 2 years.
2.5 monthsAverage time to fill a vacant position
E C W O R K F O R C E R E C R U I T M E N T &
R E T E N T I O N
Source: Colorado’s Early Childhood Workforce Survey 2017
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• 62% Spanish
• 12% Mandarin
• 7% Vietnamese
• 5% Arabic
3 in 4 (78%) teach children whose primary
language is not English.
Only half (49%) of those speak the same language
of all children in their classroom.
Language mismatch rates:
E C W O R K F O R C E R E C R U I T M E N T: M I S M AT C H E D
L A N G U A G E
Source: Colorado’s Early Childhood Workforce Survey 2017
E C W O R K F O R C E R E C R U I T M E N T: E T H N I C I T Y B Y J O B
R O L E
Self-
sufficien
cy
Poverty
4% 5% 5% 3% 3%
6%8%
4% 5% 2%
10% 1%15%
25%
12%
3%
1%
4%
2%
4%
77%
72%
72%63%
79%
Director Assistant Director Lead Teacher Assistant Teacher Family Child Care Provider
African-American Other Latina Mixed White Non-LatinaLatin White/Non-
Latinx
Latinx more likely to be in assistant teacher
roles
Source: Colorado’s Early Childhood Workforce Survey 2017
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• Wages – sole predictor in this study
• Low morale
• Ever-changing staffing patterns, rules, reporting
requirements
• High ratios
• Children’s Challenging Behaviors
EC WORKFORCE RETENTION: PREDICTORS OF
TURNOVER
Source: Colorado’s Early Childhood Workforce Survey 2017
W A G E S C O M PA R I S O N
Self-
sufficien
cy
Poverty $25,065 $29,998
$48,795 $50,332 $51,117 $52,650
$0
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
Child CareWorker
PreschoolTeacher
KindergartenTeacher
ElementarySchool
Teacher
Middle SchoolTeacher
SecondarySchool
Teacher
Source: Bearing the Cost of Early Care and Education in Colorado: An Economic Analysis (2017)
Mean Colorado teacher salaries by child/student age (2015)
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$24,600 $25,065 $29,998
$50,332 $51,117
Poverty Level(Family of 4)
Child CareWorker
PreschoolTeacher
ElementaryTeacher
AverageIncome
Colorado
W A G E S C O M PA R E D T O P O V E R T Y
L E V E L
Self-
sufficien
cy
Poverty
Source: Bearing the Cost of Early Care and Education in Colorado: An Economic Analysis (2017)
Salaries are a large driver of cost.
0-8 workforce must be specialized and
stabilized in order to be most effective
E C W O R K F O R C E R E T E N T I O N - W H AT A B O U T
Q U A L I T Y ?
ED U C AT I O N & T R A I N I N G
Q U AL I T Y BU I L D I N G BL O C K S
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Current Desired
54% of lead teachers have at least a bachelor of arts
degree
87% of center teachers state a desire to pursue
higher education
Of those, only half have a degree in early childhood
or a related field
Of those, 75% center teachers say tuition
support would be essential
E C W O R K F O R C E E D U C AT I O N : C U R R E N T V S .
D E S I R E D
National Academy of Medicine recommends a bachelor’s degree for
lead teachers.
Source: Institute of Medicine and National Research Council. 2015. Transforming the Workforce
for Children Birth Through Age 8: A Unifying Foundation. Washington, DC: The National
Academies Press
$12.18 $13.26
$14.70 $15.25
$17.10
$-
$2.00
$4.00
$6.00
$8.00
$10.00
$12.00
$14.00
$16.00
$18.00
High School Some College A.A. Degree B.A. Degree Graduate Degree
E D U C AT I O N D O E S N ' T PAY
~ $3/hour
difference
$9.6
0
$17.3
0
National
Compariso
n1
1 Whitebook, M., Phillips, D., & Howes, C. (2014). Worthy Work, Still Unlivable Wages
Source: Colorado’s Early Childhood Workforce Survey 2017
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63%
46%
44%
35%
31%
INSTABILITY: QUALITY IMPACT
Teachers are “burned out”
Directors must higher unqualified staff
Staffing holes force frequent, destabilizing
moves of teachers and children
Program quality suffers
Child behavior problems increase
Source: Colorado’s Early Childhood Workforce Survey 2017
COLORADO’S QUALITY BUILDING
BLOCKS
Colorado’s Competencies for EC Educators and
Administrators (0-8)
Colorado Early Learning and Development
Guidelines (0-8)
Professional Development Information Systems
(PDIS)
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OPPORTUNITIES
Compensation
• HB 19-1005 Income Tax Credit for Early Childhood Educators
• Local Models of Wage Ladders
Quality
• CO Dept. of Education P-3 Office
• SB 17-103 Early Learning Strategies in Turnaround Schools – Early
Learning Needs Assessment
Systems
• SB 19-063 Infant and Family Child Care Action Plan
@ E A R LY M I L E S T O N E
S C O
@ E A R LY M I L E S T O N
E S
@ E A R LY M I L E S T O N
E S
Q U E S T I O N S
JENNIFER STEDRON,
PH.D.Executive Director, Early Milestones
Colorado
EMAIL [email protected]
PHONE 720.639.9001
ColoradoECWorkforce.org
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THANK YOU
E A R LY M I L E S T O N E S . O R G I N F O @ E A R L Y M I L E S T O N E S . O R
G
7 2 0 - 6 3 9 - 9 0 0 0
CHILD WELFARE WORKFORCE ISSUES OVERVIEWNCSL 2019 HEALTH AND HUMAN SERVICES CHAIRS MEETINGNINA WILLIAMS-MBENGUESENIOR FELLOW
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CHILD WELFARE WORKFORCE
CHILD WELFARE WORKFORCE
Challenges
Low pay
Risk of violence
Staff shortages
High caseloads
Administrative burdens
Inadequate supervision
Inadequate training
Retention
Average length of child welfare worker employment < 2 years
Only 75% of child welfare positions are regularly filled
Turnover
3.5% - across all jobs
21% - child welfare caseworkers (can vary 65% - 6%)
46-54% - child welfare trainees
20-40% - past 15 years
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FACTORS ASSOCIATED WITH TURNOVER IN CHILD WELFARE WORKFORCE
Personal
Psychological
Organizational Culture/Climate
Personal
• Age
• Tenure
• Race
• Urbanicity
• Education
Psychological
• Emotional exhaustion
• Depersonalization
• Stress
• Secondary traumatic stress*
• Satisfaction
Organizational Culture/Climate
Supervision
Job role/readiness
Salary
Training
Climate
Respect/fairness
Inclusion
Psychological safety
Commitment
Source: Colorado State University, College of Health and Human Sciences, School of Social Work. Caseworker Retention Survey Report. (July 2018). Applied Research in Child Welfare Project.
CHILD WELFARE WORKER SECONDARY TRAUMATIC STRESS
When a caseworker hears about the firsthand trauma
experiences of another.
May experience PTSD symptoms.
Affected by re-experiencing
previous personal trauma or may avoid clients.
Source: Colorado State University, College of Health and Human Sciences, School of Social Work. Caseworker Retention Survey Report. (July 2018). Applied Research in Child Welfare Project.
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High turnover rates associated with high caseloads - impact caseworkers’ levels of stress, emotional exhaustion,
and job satisfaction
Negative impact on: timeliness of services,
family engagement, safety and permanency
Staff burnout and stress lead to staff attrition-fewer contacts and
failure to meet professional standards
Increased: time to permanency, rates of
maltreatment recurrence, foster care placements
and re-entries into foster care
Source: Casey Family Programs
CHILD WELFARE WORKFORCE:HOW ALL THE FACTORS INTERACT
CHILD WELFARE WORKFORCE - SOLUTIONS
HOW ARE STATES ADDRESSING THE ISSUE??
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CHILD WELFARE WORKFORCE ASSESSMENT STRATEGIES
Assessment
• Analysis of turnover
• Caseload/workload assessments
Comprehensive workforce
development
• Plan
• Home
• Task force
• Competency model
• Specialized positions
Identifying the right competencies
• Formal job analysis
CHILD WELFARE WORKFORCE SPECIFIC STRATEGIES TO ADDRESS
RECRUITMENT, BURNOUT, TURNOVER, RETENTION ISSUES
Hiring the right workers
• University/agency partnerships
• Predictive analytics for employee selection
• Bonuses and incentives
• Mentoring, coaching, peer learning
• Realistic job previews
Onboarding new staff
• Mentoring, coaching, peer learning
• Phased in training and case assignment
• Streamline paperwork
• Smart phones, tablets
• Casework teaming
• Addressing trauma
• Safety awareness training
• Peer mentor, crisis hotline, onsite crisis response
Providing incentives and case management support
• Additional positions to lower caseloads
• Telecommuting/telework
• Alternative schedules
• Formal job analysis
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FEDERAL QUALITY IMPROVEMENT CENTER (QIC) FOR WORKFORCE DEVELOPMENT
Staff recruitment and retention are persistent challenges for many child welfare agencies. In addition to being costly, staff turnover can negatively impact the relationship between families and the agency.
These challenges are compounded by a lack of research on effective strategies to attract and retain child welfare workers.
The QIC-WD will synthesize the current state of trends and research and generate new knowledge about effective strategies to improve workforce outcomes.
https://www.qic-wd.org/
FEDERAL QUALITY IMPROVEMENT CENTER (QIC) FOR WORKFORCE DEVELOPMENT
Oklahoma
• Inconsistent interviewing and hiring strategies across the state
• Develop and implement a standardized, competency-based employee selection process
Milwaukee County, Wisconsin
• An organizational culture and climate intervention: Availability, Responsiveness, & Continuity (ARC)
• Address organizational commitment, intent to stay, job satisfaction, stress/resiliency, staff turnover
Nebraska
• Annual turnover of 30%
• Address secondary traumatic stress (STS) among frontline staff and supervisors
Louisiana
• Redesign how frontline child welfare work is conducted
• Reevaluate tasks and requirements
• Teaming approach
• Improve worker retention
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FEDERAL QUALITY IMPROVEMENT CENTER FOR WORKFORCE DEVELOPMENT
Eastern Band of Cherokee Indians
• Addressing onboarding—the process of helping new hires adjust to their new job quickly and smoothly
• Opportunity to strengthen their workforce.
Ohio
• Supportive Coaching Model and Secondary Traumatic Stress
• Decrease the effects of burnout, secondary trauma, employee disengagement and disengagement from families and children
• All administrators, middle managers and caseworkers to complete 24 hours of sessions
Virginia
• Address paperwork overload
• Transcription service (caseworkers can verbally transmit their notes from case visits)
• Mobile app
• New child welfare data system to address paperwork overload.
CHILD WELFARE WORKFORCETEXAS’ EXPERIENCE (AS OF 2018)
Reduced caseworker turnover by 27.5 percent in one year
Drove down caseloads
New resources from the legislature to reduce caseloads
2017 SB 497 - Office of Data Analytics to evaluate employee retention efforts, handle employee complaints, predict workforce shortages and identify areas with high turnover
New worker training model
Enhanced promotion practices
Improvement in organizational culture
Staff recognition
Revised safety protocols
Mentorship
Self-care for frontline workers
Leadership priority
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CHILD WELFARE WORKFORCE COLORADO RESILIENCY TASK FORCE
90% of workers admit to having been threatened or felt physically at risk while on the job;
Of those, 10% described having been held at gunpoint or knifepoint
60% of rural workforce feel limited in resources for families or his/herself
100% of workers identify greatest support system as being their peers
90% of workers experiencing short or long term anxiety and physiological impact
100% of workers want improved support in accessing mental health services
2017 CO House Bill1283 Resiliency
Task Force Recommendations:
Training at all levels to mitigate trauma
Caseload variability
Creative scheduling
Employee well-being
Post-crisis debriefings
Formal peer-support groups for all levels
Strengthen supervisors
Positive work environment
Leadership support
CHILD WELFARE WORKFORCE RESOURCES
Casey Family Programs. (2017). How does turnover affect outcomes and what can be done to address retention?https://www.casey.org/turnover-costs-and-retention-strategies/
Casey Family Programs. (2018). How did Texas decrease caseworker turnover and stabilize its workforce?https://www.casey.org/texas-turnover-reduction/
National Child Traumatic Stress Network, Secondary Traumatic Stress Committee. (2011). Secondary traumatic stress: A fact sheet for child-serving professionals. Los Angeles, CA, and Durham, NC: National Center for Child Traumatic Stress.https://www.nctsn.org/sites/default/files/resources/fact-sheet/secondary_traumatic_stress_child_serving_professionals.pdf
Colorado State University, College of Health and Human Sciences, School of Social Work (2018). Caseworker Retention Survey Report. Applied Research in Child Welfare Project. https://www.chhs.colostate.edu/ssw/wp-content/uploads/sites/7/2018/11/arch-caseworker-retention-survey-final-report.pdf
Federal Quality Improvement Center (QIC) for Workforce Development: https://www.qic-wd.org/
National Child Welfare Workforce Institute: https://www.ncwwi.org/
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Contact NCSL
Nina Williams-Mbengue at 303-856-1559 or [email protected]
NCSL Child Welfare Webpage:
http://www.ncsl.org/issues-research/human-services.aspx?tabs=858,51,16#16
B WE CE TE E T
SC E C E
W CE ESE C C
HEALTH CARE WORKFORCE SHORTAGES: DIAGNOSING THE ISSUES AND FORMULATING THE (POLICY) TREATMENT PLAN
Hannah Maxey
Assistant Professor and Director
Bowen Center for Health Workforce Research and Policy
Indiana University
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B WE CE TE E T
SC E C E
W CE ESE C C
HEALTH WORKFORCE SHORTAGES: UNDERSTANDING THE PROBLEM
Symptoms of shortage• High cost health care utilization
• Unmet health care needs/Poor population health outcomes
• Excessive travel times to reach needed services
• Federal shortage area designations (HPSAs and MUA/Ps)
• Inability to find qualified workers to fill positions
Potential Causes• Professionals not practicing to the top of training
• Lack of alignment between supply and demand/inadequate pipeline planning
• Mal-distribution of workers (rural especially)
• Loss of talent
B WE CE TE E T
SC E C E
W CE ESE C C
INFORMING THE DIAGNOSIS AND TREATMENT: A CALL TO ACTION FOR HEALTH WORKFORCE DATA INFRASTRUCTURE
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B WE CE TE E T
SC E C E
W CE ESE C C
POLICY OPTIONS FOR ENSURING STATE HEALTH WORKFORCE DATA
Requiring information to be provided at time of license application/renewal• Indiana 2018 Senate Enrolled Act 223
Coordinating information that is already available• Inter-agency data sharing
• Employer partnerships
https://scholarworks.iupui.edu/bitstream/handle/1805/18489/Req.%20Data%20Collection_Examples%20of%20State%20Statute%20Verbiage.docx.pdf?sequence=1&isAllowed=y
B WE CE TE E T
SC E C E
W CE ESE C C
ONCE THE “DIAGNOSIS” IS CONFIRMED, TREATMENT PLANS CAN BE ESTABLISHED. . .
Top Policy Options for Addressing Health Workforce Shortages
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B WE CE TE E T
SC E C E
W CE ESE C C
TREATMENT PLAN/POLICY OPTIONS: GETTING THE RIGHT PEOPLE, WITH THE RIGHT SKILLS, INTO
JOBS WHERE THEY ARE NEEDED
Building Capacity through Incentives• Loan Repayment Programs (multi-state review:
https://www.in.gov/dwd/files/Directory%20of%20Current%20SLRP%20Programs%20in%20United%20States.pdf)
• Tax Credit
• Scholarships
Right Sizing the Pipeline• Area Health Education Centers (increasing representation of minority/geography in workforce)
• Graduate Medical Education (distribution and quantity of slots)
B WE CE TE E T
SC E C E
W CE ESE C C
TREATMENT PLANS/POLICY OPTIONS: EXTENDING EXISTING CAPACITY (WHILE THE PIPELINE
CATCHES UP)
Leveraging tech to get services where they are needed• Telemedicine/telehealth/teleprescribing
Flexing the existing workforce • Balanced occupational regulation
Aligning payments to support new delivery models• Reimbursement policy
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B WE CE TE E T
SC E C E
W CE ESE C C
TREATMENT PLAN/POLICY OPTIONS: TELEMEDICINE
Broadband • Tech solutions require infrastructure
Telemedicine• Who, what, how?
• Is it regulated separately from licensure, if so how (certification)?
• Is tele-prescribing considered separately?
• MAT, what provisions?
Reimbursement• Are public and private payers reimbursing for telemedicine service?
B WE CE TE E T
SC E C E
W CE ESE C C
TREATMENT PLAN/POLICY OPTIONS: OCCUPATION REGULATION (AMONG THE MOST
CONTENTIOUS ISSUES LEGISLATORS FACE)
Training requirements (Entry and Continuing Education)
Regulation of practice (TOOL: Minnesota tool for SOP review https://www.health.state.mn.us/data/workforce/scope.html) • Professional Supervision
• Scope of Practice
Enhancing Portability• Reciprocity agreements
• Interstate licensure compact
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B WE CE TE E T
SC E C E
W CE ESE C C
TREATMENT PLAN/POLICY OPTIONS: REIMBURSEMENT
Addressing shortage through reimbursement reforms• Tiered reimbursement for tiered services
• Example: Addition Counseling Services (Ohio - http://codes.ohio.gov/oac/5160-8-05)
• New reimbursement models
• Services
• Integrated Mobile Health Care Teams/Community Paramedicine
• Providers
• Community Health Worker
B WE CE TE E T
SC E C E
W CE ESE C C
CLOSING THOUGHTS. . .
• Data is needed to identify root causes and inform policy solutions
• One “treatment” will not fit all states
• Implementation is critical to effective policy
• States can learn from and with each other
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Questions?
Jennifer Stedron, PhDExecutive DirectorEarly Milestones
Hannah Maxey, PhDDirector
Bowen Center for Health Workforce Research and [email protected]
Suzanne HultinProgram Director
NCSL Employment, Labor an Retirement [email protected]
Nina Williams-MbengueSenior Fellow
NCSL Children and Families Program
Activity!• Remember your number! Bring your challenges sheet from the beginning of the
session and find the easel with your number on it.
• Choose ONE of the 3 challenges you wrote down and reflect on speakers and slides. Write down ONE solution to that challenge.
• Go around the table and share your challenge and solution and have a chance to discuss with your table mates.
• When you hear the chime, rotate to your left and reflect on the group’s challenges and solutions. (if time allows)• What are the similarities and differences? • Are there innovative ideas that you had not thought about?• Anything surprising or anything that resonated with you?
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Activity Report Out• What did your group
identify as challenges and solutions?
• What were your similarities and differences?
• What did you learn from another group’s priorities?
KEY TAKE-AWAYS
Many health and human services fields face significant challenges in recruiting and retaining qualified workers resulting in disparities to accessing essential services.
Opportunities to improve capacity can crosscut both health and human services workforces.
Policy options are sometimes not a “one-size fits all” solution.
Use your colleagues from other states as resources!
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RESOURCES
Building a Qualified and Supported Early Care and Education Workforce, NCSL
Increasing Access to Health Care Through Telehealth, NCSL
Improving Access to Care in Rural and Underserved Communities: State Workforce Strategies, NCSL
Promoting Greater Health and Well-Being, APHSA
How Does Turnover Affect Outcomes and What Can Be Done to Address Retention, Casey Family Programs
Thank you!
Jennifer Stedron, PhDExecutive DirectorEarly Milestones
Hannah Maxey, PhDDirector
Bowen Center for Health Workforce Research and [email protected]
Julie PoppeProgram Manager
NCSL Children & Families [email protected]
Nina Williams-MbengueSenior Policy Fellow
Sydne EnlundPolicy Specialist
NCSL Health [email protected]
