Volume 1, Issue 3

Making Use of Classical Approaches to Workforce Analysis
By Paul M. Roman, Ph.D.
University of Georgia

The ATTC Network review monograph is an excellent platform on which to construct a nationwide study of the substance abuse treatment workforce. The monograph effectively captures the research that is already completed, and fully outlines its many shortcomings. These translate into unknowns about the workforce, and hopefully will translate further into opportunities to learn as much as possible in this well-planned step-wise data collection project.

As this specialty looks toward its future, there are two very dramatic events that are bound to happen, but about which we seem to have little, if any, control.

First is the implementation of parity for the treatment of substance abuse, scheduled to be implemented in less than 3 months. Second is national health care reform. One can envision explosive growth for this specialty over the next decade if several “stellar alignments” occur. These include the possibility of true parity opportunities for the general population, supported by health care reform. A surge of interest in substance abuse treatment within the primary care sector is possible if attractive remuneration emerges. An accompaniment could be a dramatic reduction in drug interdiction and punishment as the solutions for drug problems, and the emergence of greater support for treatment. All sorts of combinations of scenarios can be imagined, but no vision can point to what really will happen.

Regardless of what may happen tomorrow, we often lose sight of the potent opportunities that exist today. Specialty practitioners within substance abuse treatment often imply that this area of endeavor is underfunded, underappreciated, and trivial. For both practitioners and researchers, a culture of negativity, with an atmosphere of friendliness and informality, seem to suggest that this is a small, isolated, but highly dedicated specialty. Our well-honed talents at self-flagellation in the specialty help confirm a perception of marginality.

Yet in fact this is a very big business. Tom McLellan has estimated that a minimum of $15 billion changes hands each year within the substance abuse treatment industry. This includes not only significant proprietary activities but many, many “non-profits” that are incredibly entrepreneurial and aggressive in their organizational behavior. Thus substance abuse treatment is not minor league. But its workforce is its backbone, and the Murphy/Hubbard report makes it very clear that “there is trouble in River City.” A sound understanding of how to dramatically alter many features of our workforce is critically important.

Beyond these “big unknowns,” there are some questions that would seem to be traditionally asked in a workforce analysis that seem to be missing in the planned ATTC project. My principal concern about what might be missing is based on definitions.

First and foremost, it is critical that the project begin with a careful and consensually developed definition of what constitutes the workforce. Since most workforce projects have clearly devolved to equating the substance abuse treatment workforce with counselors, this error should not happen again. But I believe that more “spadework” may be necessary before the parameters around this workforce can be delimited. There is the need to enumerate all of the occupations and jobs that are involved in treatment delivery. McCarty and his colleagues, through their study of the CTN workforce, have made a good start in this direction. And McCarty and Reickmann point out that the “treatment center” is not the only place where substance abuse treatment happens, or where the substance abuse treatment workforce is employed. Thus, I would urge that before finalizing any survey design, the parameters of this workforce need to be very carefully defined, and to extend well beyond counselors.

Second is the need to define the counseling roles that comprise the treatment enterprise. While prior research recognizes diversity in training, background, and credentials among counselors, little has been done to construct either a catalog of counselor roles or a typology of the ways into which these roles are “bundled” into different counselor statuses. The clinical supervisor is well-recognized as a distinction among counseling roles, but counseling assistants and other roles that affect the engagement and retention in treatment need to be addressed. Overall, this might be seen as linking to a “job analysis” in the specialty of industrial psychology.

A third definition is complementary, namely defining the skills essential to each of the roles that are delineated in the job analysis. This in turn directs us toward the sources of skill learning, another black box in our understanding of the substance abuse treatment workforce. Rather than limit our understanding of acquired skills to recording years of education, degrees, in-house training, and continuing education, it could be of great importance to extract from individuals evidence of where they believe they acquired specific skills needed to perform counseling roles. This could aid immeasurably in specifying the kinds of formal and informal educational experiences that need to be made available for the workforces of the future.

Currently we have very few institutions that stand out as settings for specialized skill development for substance abuse counseling roles. We even lack the most basic tool of an emerging profession, namely consensually accepted textbooks that define the field of practice. While laudable in both their quality and availability, it’s a little cumbersome to imagine the 45-plus volumes of SAMSHA’s “TIPS” to cumulatively constitute the substance abuse treatment “textbook.” Yet when someone asks where they can learn “how to do it,” one or another “TIP” is a common recommendation. Thus the ATTC survey could help point to how these opportunities to effectively consolidate and diffuse professional knowledge could be effectively structured.

Considering roles and skills together could produce another badly needed product, namely the specification of dimensions of the core technology of substance abuse treatment. Such a definitional exercise establishes what is unique about substance abuse treatment in terms of techniques specific to this specialty that cannot be acquired through training or experience in the practice of a different specialty, no matter how “parallel” it might seem. This definitional exercise can also specify what is transferable from other bundles of techniques included in educational programs already in place for other specialties. Specification of core technologies and associated bundles of strategies leads to textbooks. I have no doubt that the ability to specify these techniques in a cogent way is readily available----it just seems that it has not been done.

I am not suggesting that these definitions be set as facts before the survey begins, but that the survey include enough detailed information about perceived current practice that it is able to have a skeleton upon which to place the empirical findings, and derive the differences between perceived reality and actual reality. Only if we know this can we move toward a “projected reality” that appears as central in the tasks of the ATTC-sponsored survey. In other words, I see the current approach as including too many “taken-for-granted’s” about the nature of the workforce and what kinds of roles different personnel perform.

The survey needs particular sensitivity to managerial roles within substance abuse treatment. As our own research has shown (Knudsen, Ducharme & Roman, 2009), retention of top managers is on one hand problematic in substance abuse treatment, but on the other hand is apparently avoidable. Our data clearly indicate qualities of managerial environments that affect turnover in substance abuse treatment, and monetary compensation is not singularly prominent. It is evident from other parts of our field research experience that management is probably the most neglected component of substance abuse treatment, yet also the issue most subject to denial by field leadership. Viewing managers, their roles, their development, and the retention of the best of them as vital to the workforce are important considerations for the survey.

Finally, a vital concept to workforce analysis is the career. There are essentially no data on the construction of careers in substance abuse treatment. The projected survey could definitely shed light on these careers, for they are the converse of the alleged pervasive problem of turnover. Research studies of turnover are in their relative infancy in this specialty, but a great deal of specification is needed in future studies. Different types of turnover need to be delineated, recognizing that turnover may be very positive for individuals and not always negative for organizations.

But the construction of a typology of careers within our specialty is a vital challenge. Given the sheer number of people who remain at this work for many decades, we know by inference that there must be stages of personal development, growing maturity, and changes in rewards. Understanding such careers, how they are fostered, and how they are blocked is very important for future recruitment, and perhaps for the more effective construction of a positive public image of the inner workings of substance abuse treatment.

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