Examining Substance Use Disorder Treatment Demand and Provider Capacity in a Changing Health Care System: Initial Findings Report. Appendix B. Recent Efforts to Assess Substance Use Disorder Workforce Capacity

09/30/2015

There have been numerous efforts over the last ten years to identify the limitations of the SUD treatment workforce and develop action steps to address those limitations. Although some efforts have been made to begin addressing the workforce limitations, the fundamental issues identified in these recent studies persist. The data required to monitor progress toward strengthening the workforce is limited. In particular, the most recent data available on the number of SUD treatment professionals were collected over 15 years ago. Although no recent data exist on the size of the workforce, more recent studies have analyzed other aspects of the workforce. In this section, we provide an overview of recent efforts to assess workforce capacity. The findings from these efforts are reported in earlier sections of this report.

1. Estimates of the Size of the Workforce

The most recent data available on the size of the SUD workforce is from the ISS, which collected data on the workforce at specialty SUD treatment facilities in 1999 (Lewin and NORC 2000). The facilities eligible for the ISS were those responding to the 1997 Uniform Facility Data Set (UFDS) survey that served more than ten clients. A stratified random sample of 276 facilities was selected to respond to the study questionnaire. Each of the responding facilities was asked to develop a list of the facility's practitioners in three strata: licensed counselors, master's-level behavioral health professionals who were not licensed in substance abuse treatment, and unlicensed substance abuse counselors with less than master's-level training in behavioral health. Sampling weights were used to estimate the number of practitioners at specialty SUD treatment nationally based on responses from the sampled facilities. Note that the sample of facilities included in this study was small relative to the overall 16,695 facilities included in the 1997 UFDS. Standard errors and confidence intervals were not reported with these estimates, but given the small sample size, the errors could be large, depending on the variation across the sample.

Three years before the ISS, the ADSS collected data on the SUD treatment workforce. The ADSS was designed to produce nationally representative estimates of specialty SUD treatment facilities. Data on staffing was collected in Phase I of the survey from December 1996 through June 1997. Facility directors at 2,395 facilities representing 12,387 SUD treatment facilities nationwide were asked to report the number of full-time, part-time, and contract staff in various professional categories. The following types of facilities were excluded from the ADSS: halfway houses without paid counselors, solo practitioners, correctional facilities, U.S. Department of Defense facilities, HHS Indian Health Service facilities, and facilities that were intake and referral only. Although the ADSS survey was conducted three years before the ISS, the estimates from the ADSS on the size of the workforce may be more reliable because the sample size was ten times larger than the ISS sample.

Given the lack of recent data on the size of the SUD treatment workforce, Advocates for Human Potential (2015) created a provider availability index for SUD treatment using data on behavioral health professionals more generally. The numerator of this index is the number of adults aged 17 and older with an SUD in a given geographic area estimated based on the National Survey on Drug Use and Health (NSDUH). The denominator is the number of behavioral health practitioners in the geographic area estimated based on the Occupational Employment Statistics (OES) from the BLS. The practitioners included in the denominator include the following OES occupational categories: clinical counseling and school psychologists, psychiatrists, mental health and SUD social workers, SUD and behavioral disorder counselors, mental health counselors, and rehabilitation counselors. The authors acknowledge that this denominator substantially overstates the number of professionals focused on SUD treatment, however the available data do not allow for identification of SUD professionals specifically. The inclusion of individuals focused on mental health severely limits the utility of these estimates for assessing capacity for SUD treatment.

2. Other Estimates of Workforce Capacity

Although, we did not identify any more recent studies estimating the size of the SUD treatment workforce, several recent studies have assessed other aspects of the SUD workforce.

SAMHSA has funded two projects to identify the limitations of the SUD treatment workforce and to develop recommendations and actions steps to address these limitations. In 2006, SAMHSA published the findings from a project that sought to gain stakeholder recommendations for approaches to strengthen the SUD treatment workforce (Whitter et al. 2006). The project began with an environmental scan of the recent research related to the workforce. Then, in January-May 2004, SAMHSA held nine separate meetings with 128 individuals representing diverse stakeholder groups. During these meetings, SAMHSA solicited information and recommendations from the participants. In total, the final report presented 21 stakeholder recommendations. In 2007, SAMHSA published an action plan for addressing the needs of the SUD treatment workforce prepared by the Annapolis Coalition (Hoge et al. 2007). The recommendations in this action plan were based on the work of 12 expert panels and work groups focused in different areas of the SUD treatment field such as rural, educators, cultural competencies and disparities, and SUD treatment. The work groups were responsible for gathering and reviewing available information and formulating a set of proposed goals, objectives, and actions in their area. The action plan identified seven goals for the workforce.

The CASA has conducted two recent studies focused on important areas for the workforce. The first study (2010) addressed SUD treatment need and receipt among the prison and jail population. The second study (2012) reviewed the evidence on effective screening, intervention, diagnosis, treatment, and disease management, and identified the gaps between the scientific evidence on best treatment practices and existing treatment practices. These studies provide evidence related to key aspects of the workforce not addressed in other studies.

Although no recent estimates exist on the size of the workforce, there is recent data on the characteristics of the workforce available from the Vital Signs survey (Ryan et al. 2012). The ATTC Network collected these data between November 2011 and May 2012. In addition to the information collected through responses to the standard survey, ATTC conducted key informant interviews to obtain qualitative information about the workforce. ATTC interviewed 27 clinical directors and 25 thought leaders. Clinical directors were interviewed about successful strategies employed to prepare and recruit individuals to enter the workforce and thought leaders were interviewed on the trends most pertinent to the workforce. ATTC selected clinical directors for these interviews based on responses to the standard survey instrument indicating that the clinical director was highly satisfied with their agency's recruitment and retention strategies. ATTC's thought leader interviews included academics, direct care providers, state and federal policymakers, leaders of national organizations, advocates, and other stakeholders

Finally, SAMHSA prepared a report on mental health and substance abuse workforce issues for Congress in 2013 (Hyde 2013). This report summarized the most current knowledge on workforce demographics and conditions, enumerated workforce needs, and provided information on SAMHSA initiatives to address workforce needs.

Thus, although there is limited information on the number of SUD treatment professionals, the available research addresses many aspects of SUD treatment capacity.

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