Volume 1, Issue 3

Response to Issues Raised
By Robert Hubbard, Ph.D., and Deena Murphy, Ph.D.
National Development and Research Institutes, Inc. (NDRI)

The development of the ATTC national workforce survey appears to have generated renewed and important interest in the issues surrounding the capacity to deliver effective and efficient treatment. The issues raised in the comments of the reviewers are all important and critical to the field.

As Paul Roman states, it is critical to develop a framework in which to systematically consider these issues and to direct a research and practice agenda to obtain and apply the knowledge gained. Two approaches could facilitate this process. In 1999, the National Institute on Drug Abuse published the Principles of Drug Addiction Treatment with an organizing framework of the core and comprehensive components of treatment [as previously outlined in a paper by Etheridge and Hubbard (2000)]. This paper presented a heuristic model of treatment structure and process within the multiple levels of service, program, system and environment. The model helps organize the complex and interrelated components of treatment, each of which needs to be staffed by the workforce.

Second, two main data systems now exist that provide useful information on treatment at the program level, the Treatment Episode Data System (TEDS) describing patients/clients/consumers and the National Survey of Substance Abuse Treatment Services (NSSATS) describing the program structure and services. A key missing element is the description of the workforce. We view the ATTC national workforce survey as a necessary basic step in filling this void.

Clearly, the responses to the report in this issue as well as our ongoing meetings with stakeholders in the field raise critical and fundamental issues to the comprehensive understanding of the workforce. While it is critical to consider and address the many issues raised, our fundamental goal for the ATTC national workforce survey is to establish a sound useful base of information to begin to address the three key questions identified by the planning panel and discussed in the report.

To achieve this rather modest but fundamental first step, we view a comprehensive coverage of basic information as the essential element in informing future steps. The design of the survey is constrained in many ways by the diverse concepts in the field, the lack of comprehensive information on the workforce and the resources available to support the proposed survey. We have taken a pragmatic approach that focuses on achieving as complete information as possible on the key basic questions.

The recommendation of the NSSATS as the listing of programs is based on the need to provide a common definition of program and modality as well as maximize the potential of using the TEDS and NSSATS databases. The recommendation of the program director/administrator as the respondent is based on the need for high response rates to confidently describe the workforce at the national level given the resources available to implement the data collection by ATTC Regional Centers. Most workforce surveys have achieved high response rates at the program level, but McCarty reports even the NIDA CTN workforce survey was only able to obtain a 70 percent response rate for the workforce sample. The recommended medium will be a web based system with a time burden of approximately 30 minutes.

The first and fundamental area of inquiry will be the descriptive information on the workforce with the programs in the NSSATS listings. We would recommend assessing basic information on age, gender, ethnicity, education, certification, tenure and salary level. This can be accomplished following the rostering procedure used in the CTN workforce survey.

The second major area is the question of important issues for the field in the next five years. The issues being considered are (1) billing and payment systems, (2) assessment and electronic records, (3) incorporation of evidence based practice, (4) movement toward a recovery management model of care, (5) integration of medications for both addiction and co-occurring disorders, and (6) coordination of community based supports.

The third area will consider the approaches used at the program level to recruit, train and maintain the workforce. We will assess the extent to which program directors report using as many approaches as possible within each of these topics. At a minimum, we will ask about salary, job characteristics, work environment, supervision, career paths and linguistic and cultural competence. We would also consider the training and certification practices available to staff and supported by the programs including web-based, telemedicine and other distance learning approaches as well as traditional training approaches. The previous surveys conducted by the ATTC Regional Centers have developed very useful questions to assess the broad array of available options.

Once the meetings with key stakeholders are completed, the basic content of the survey will be recommended. We trust we will have the opportunity for the field to respond to the extent to which the survey covers the major questions. Based on these responses the final survey will be drafted, pre-tested and entered into the approval process. With the great interest in workforce issues and informed input of the field, we believe the ATTC National Workforce Survey will provide an important, albeit limited, base of information to answer some key questions as well as to inform the development of future research and practice that will expand and improve our understanding of the workforce.

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