ATTC Messenger August 2018- Building the Behavioral Health Care Workforce in Rural Areas
Building the Behavioral Health Care Workforce in Rural Areas
Dr. Christine Chasek
Director, Behavioral Health Education Center
University of Nebraska Kearney
Recruiting and retaining qualified behavioral health professionals to work in rural areas remains a persistent challenge. As SAMHSA reports:
“62 million people (20-23%) of the U.S. population live in rural or frontier counties; 75% of these counties have no advanced behavioral health practitioners.”
Many factors contribute to the rural behavioral health workforce gap: low salaries, geographic challenges, and limited options for housing, cultural attractions, and education. According to The National Rural Health Association Policy Brief, Treating the Rural Opioid Epidemic:
“Rural populations have long had poorer access to mental health services than their urban counterparts and patients living in rural areas face specific challenges accessing treatment for opioid use disorders. Rural-urban disparities in the supply of behavioral health providers include psychiatrists, clinical psychologists, psychiatric nurse practitioners, social workers, and counselors.”
Yet states can close the workforce gap by applying some of the strategies that the Behavioral Health Education Center of Nebraska (BHECN) is using to build Nebraska’s behavioral health workforce.
Dr. Christine Chasek, Director of BHECN, gave an overview of some of the Center’s workforce activities in the recent Great Lakes ATTC webinar, Workforce Recruitment and Retention – Part 3: Strategies for Rural Areas and Recruiting and Retaining Peer Support Workers.
Following is edited transcript of Dr.Chasek’s presentation.
Dr. Christine Chasek:
“In Nebraska, most counties are considered rural or frontier. In 2004, the state moved behavioral health resources from state institutions to community care. The need for more workforce at the community level sparked a rural workforce recruitment and retention effort and the formation of the Behavioral Health Education Center of Nebraska (BHECN), housed in the Medical Center at the University of Nebraska.
Nebraska is a small state in terms of population, and when you look at our geographic makeup, you see that we only have two urban areas in the state: Lincoln and Omaha; the rest of the state is considered rural. Eighty-eight of 93 counties meet criteria to be considered underserved for mental health; in addiction treatment, probably 90 or 93 are underserved. It becomes a real challenge to recruit and retain our behavioral workforce, mainly because when we get people interested, they go to training programs in our urban areas, where they tend to want to stay and are not willing to return or relocate to rural areas. We realized that we had to get creative in building the workforce.
The Behavioral Health Education Center of Nebraska (BHECN) is part of the Medical Center at the University of Nebraska. It’s located in our largest city, Omaha, which has a very urban focus, and it’s always curious to me, because I have a rural focus. When we discuss issues, it’s clear that my colleagues view the issues through a different lens and come from areas with lots of resources and specializations. Those of us in the rural areas know that we just don’t have a workforce that is very diverse in terms of specializations. We must work together with the resources we have and be creative. A provider is many things to many people.
Recruiting at the high school level
We began with an “ambassador program,” starting at the high school level. High school students came to some of the larger towns in Nebraska to learn about behavioral health professions. This was wildly successful—we hosted 300 high school students from 52 counties; 81 percent of them went on to enroll in college.
Starting at the high school level may seem to be a long way off from where you will need them in terms of hiring, so it is a slow process. But once it’s established, an ambassador program introduces kids to the careers and the different kinds of behavioral health professions. They start to understand what it would take to move on and get in to that career.
The Behavioral Health Education Center of Nebraska (BHECN) was established in 2009 to recruit, retain, and increase the competency of the state's behavioral health workforce.
Most career classes in high schools focus only on the medical—they’re looking at nurses and doctors—and many high school students don’t know what a licensed behavioral healthcare professional or a licensed addiction counselor does. This introduces them to the wide variety of options in the helping professions.
Now that we have established the ambassador program we’ve been able to hand it over to our state’s Area Health Education Center (AHEC), the health professions education and outreach program funded by federal grants and state funding. We also encourage other organizations to apply for mini grants we provide to develop programs throughout the state to introduce students to behavioral health careers.
We have now moved to the higher level educational systems for our pipeline development, and have secured funds through grants, legislative dollars, and creative funding to offer sponsored internships. Students who have completed a bachelor’s program in mental health and addictions counseling can apply for paid internships. We recruit the agencies and providers for our internship sites, and agencies get to take a “test run” to figure out if the intern is a good fit for the organization. Students get paid and can experience life in a rural community. Typically, these internships turn into full-time jobs.
Connecting with training programs statewide
When BHECN began in 2004 to help rural communities, we started to talk to all the training programs across the state. For example, we could reach out to people interested in becoming Licensed Clinical Social Workers and expose them to becoming licensed addiction counselors.
For workforce retention, we offer continuing education trainings for the existing workforce on topics such as compassion fatigue, burnout, and trauma-informed care. This training is available as distance education (webinars) for those who can’t travel.
Funding for our workforce development comes from many different sources, including:
Health Resources and Services Administration (HRSA) Behavioral Health Workforce Education and Training (BHWET) Program: With this grant, we received dollars to support education. Currently we can take 35 students each year for five years and train them to obtain their addiction counseling licenses.
AmeriCorps Funding: With this grant, we pay for sponsored internships. We have sites all over the state to help people receive their training in local communities.
U.S. Department of Agriculture (USDA): The USDA has funding for many efforts, including behavioral health and addiction counseling workforce initiatives. We have applied for USDA grants to support workforce development in rural areas specific to the opioid crisis. A lot of our rural folks don’t really understand the opioid crisis and by focusing on this issue we can get students interested in careers in addiction counseling.
1. Cast a wide net. In the beginning, we did not bring everyone to the table because we were focusing mainly on psychiatry and psychology; we did not involve substance use disorder counselors, other behavioral health providers, or the training programs. Once we engaged all the behavioral health training programs, our licensed workforce went up by 15%. We also learned to start our rural outreach by connecting with rural providers.
2. Connect with rural medical providers. We are placing interns in rural medical clinics to provide addiction services. We still have a long way to go with integrated care, but have established some successful partnerships.
3. Partner with universities, colleges, provider organizations and associations to build your pipeline. Be inclusive and bring all parties to the table.
4. Make it easy for employers to connect with job seekers: Nebraska Behavioral HealthJobs.com. We found that students didn’t know where to go to find jobs, and providers were using traditional networks for recruiting. There was nothing specific to behavioral health. Agencies can post openings for free, and all students enrolled in the training programs we partner with are required to register on this website. This has started to connect students and employers earlier in the process.”
About Dr. Chasek:
Dr. Christine Chasek is associate professor at the University of Nebraska in Kearney in the Department of Counseling in School Psychology. She is the director of the Behavioral Health Education Center of Nebraska -Kearney, which works to build the behavioral health care workforce for Nebraska. Dr. Chasek is also a practicing mental health and addictions counselor, chairman of the Nebraska Alcohol and Drug Licensing Board and president-elect of the International Association for Addiction and Offender Counseling.
About the Workforce Recruitment and Retention Webinar Series
Dr. Michael Hoge developed the three-part series for the Great Lakes ATTC. In the first webinar in the series, Dr. Hoge gave an overview of the issue; followed by a presentation on the Massachusetts Careers of Substance website by Jen Parks, Workforce Development and Training Coordinator for the Massachusetts DPH-Bureau of Substance Addiction Services. The second webinar in the series focused on recruitment and retention strategies presented by Dr. Hoge. Dr. Manuel Paris then offered strategies for recruiting and retaining people of color. In the third webinar, Dr. Christine Chasek presentation on rural workforce issues was followed by a presentation by Dr. Michael Flaherty on the peer support specialists and their potential to close the workforce gap.
All webinars were recorded and are available for viewing on the Great Lakes ATTC’s page, Recorded Webinars.
Bolin, J. N., Bellamy, G. R., Ferdinand, A. O., Vuong, A. M., Kash, B. A., Schulze, A., & Helduser, J. W. (2015). Rural healthy people 2020: new decade, same challenges. The Journal of Rural Health, 31(3), 326-333.
Mountain Plains ATTC: Addressing Prescription Opioid Misuse/Overdose Issues in Rural Areas