Workforce Needs in the Substance Abuse Field

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• Workforce Needs in the Substance Abuse Field
• Presented by
• Suzie Wilson, VDH, Div. of Alco. Drug Abuse
  Programs
• Michael Zacharius, Ph.D., Mapleleaf Farm
• Anna Marie Cioffari, Ph.D., Southern New
  Hampshire Univ.

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• Across the continuum of care, the strongest
  commonality is that people like the work they are
  doing. They like working with their clientele.
  They believe in the purpose of their work and
  serving the community as change agents. The
  majority would like to stay in this profession.
  However, there are substantial barriers in the
  substance abuse system that need to be addressed
  to support professionals currently in the field
  and to attract new people
• - 2004 The Status of the Vermont Substance
  Abuse Workforce Report

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• The Substance Abuse Workforce in Vermont
• Prevention
• Intervention
• Enforcement
• Treatment
• Recovery

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• Continuum of Substance Abuse Care - Adults

Prevention
Intervention (Public Inebriate, CRASH)
Outpatient - Individual/group/IOP
Transitional Housing
Case Managed Wraparound Services (Co-occurring
disorders, drug court cases, clients w/multiple
issues (homelessness, unemployment, mental
health, family, etc.)
Residential - Level 1

Residential - Level 2 (therapeutic community)
The different levels of residential care
reflect increasing quantity or intensity of
services, lengths of stay, and/or the addition of
other services, e.g. psychiatric services.
Medically managed level of care, e.g. specialty
hospital
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• Prevention
• The Promotion of Constructive lifestyles and
  norms that discourage drug use achieved through
  multiple strategies.
• Occupations
• Coalition Coordinators
• Youth Workers
• Outreach Workers
• Program Coordinators
• Executive Directors,
• Prevention Consultants
• Volunteers

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• Prevention Services are provided by ADAP, New
  Directions Coalitions, Community Organizations
  and Schools.
• Data from 38 Prevention Professionals
• Salary Range Education Required
• Exec dir 35-45,000 BA, MA preferred
• Coalition Coor 30-40,000 BA, MA preferred
• Health Educator 15-31,000 BA, MA, RN
• Prevention Spec. 14-40,000 BA
• Volunteers 0 n/a
• Length of time in field 10 years
• Aver age 42 years
• Educational Level BA 40 MA 40
• Percentage paying off loans 38
• Average size of loan 30,000
• Average Salary range 26-30,000

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• Intervention
• Support services to help people identify
  potential problems with substance abuse.
• Occupations
• Student Assistance Professionals (107 schools)
• CRASH Manager
• CRASH Evaluators
• Case Managers (Examples Court Diversion Drug
  Court)

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• Intervention services are provided through
  community health centers, treatment agencies and
  schools.
• Data from 49 intervention professionals.
• Salary Range Education Required
• Student Asst. Prof 24-34,000 CSAC, LADC with
• Apprentice within 6 mo.
• CRASH Managers 32-40,000 LADC, CADC
• Length of Time in field 9 years
• Average Age 44 years
• Education Level BA 33 MA 52
• Percent paying off loans 35
• Average Size of Loan 30,000
• Average Salary Range 26-30,000

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• Enforcement
• Systems and services that enforce Vermont laws
  regarding substance use, distribution and sales.
  Community Resource Officers, Stop Teen Alcohol
  Risk Teams (START) and community task forces
  support these efforts.
• Occupations
• Police Officers
• Inspectors
• Fed. Agents

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• Treatment
• Services to address substance abuse and
  addiction through assessment and the application
  of evidence based counseling modalities. These
  services range from short to long term
  residential programs to community based
  outpatient services. Some programs are targeted
  at a defined population and many deal with both
  SA addiction and Mental Health disorders.
• Occupations
• Apprentice
• Certified or Licensed Substance Abuse Counselors
• Case Managers
• Program Coordinators
• Nurses
• Psychologists
• Directors

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• Treatment Services are provided by short and long
  term residential facilities, out-patient clinics,
  community mental health agencies and by
  independent counselors, known as private
  providers. There are currently 325 Licensed
  Alcohol Drug Counselors (LADC) Statewide.
• Data from 102 Treatment professionals
• Salary Range Education Required
• Director 39-55,000 LADC, LMHC or n/a
• Clinician 25-40,000 LADC or in process
• Clinical Supervisor 30-36,000 LADC
• Counselor 24-35,000 CADC/CASAC
• Therapist 41-47,000 LADC, LMHC
• Nurse 35-55,000 RN, LPN
• Case Manager 23-35,000 LADC
• Average years in field 14
• Average Age 49
• Educational Level BA 13 MA 76
• Percentage paying off loans 28
• Average size of loan 21-30,000
• Average Salary Range 31-35,000

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• Recovery
• Support services to facilitate the ongoing
  process of leading a meaningful, productive life
  within the limits imposed by a history of
  addiction to alcohol and/or other drugs (Deegan,
  1998). Recovery efforts are grass roots that
  range from mutual support group programs to
  community-based recovery centers that offer a
  local meeting place for people to get support and
  attend to the process of recovery.
• Occupations
• Recovery Center Coordinators
• Recovery Center Directors
• Group Facilitators
• Volunteers

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• Recovery services are offered through mutual
  support groups and grassroots initiatives, and
  recovery centers, with support and education
  provided by a non-profit, Friends of Recovery.
• 5 Organizations surveyed. Note 6 recovery
  professionals responded to survey, thus
  statistically insignificant. Most people working
  in recovery are volunteers who do not identify
  themselves as a part of the workforce.
• Salary Range (starting salaries are at the lower
  end of the range) Education
• Directors 25-40,000 HS/BA
• Recovery Center Coordinators 17,000 (pt) HS
• Consultants a range BA
• Group Facilitators 30/hour LADC
• Board of Directors no n/a
• Volunteers on site no n/a
• Community Volunteers no n/a
• Information from Recovery Professionals - Note
  There are relatively few people working
  professionally in recovery. Much of this work is
  done by volunteers
• Length of time in field 10
• Age 48
• Educational level HS-MA
• Certification not required

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• What Constitutes Treatment?
• Individualized
• Screening (CAGE)
• Standardized assessment
• Diagnosis DSM-IV
• Evaluation leads to Treatment Plan
• (Done in collaboration with the Patient What
  are you willing/able to do?)
• Treatment strategies
• Bio (Medically Assisted Treatment)
• Psycho-social
• Adjunctive therapies
• Auricular Acupuncture (Acudetox)
• Health and Wellness
• Recovery Support Groups (AA, NA, Alanon)

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• CAGE Questions
• Have you ever felt that you should cut down on
  your drinking?
• Have people annoyed you by criticizing your
  drinking?
• Have you ever felt bad or guilty about your
  drinking?
• Have you ever had a drink first thing in the
  morning to steady your nerves or to get rid of a
  hang-over? (an eye opener)

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• Project CRASH
• Drinking Driver Rehabilitation Program
• GOAL Intervene with First and Multiple DWI
  Offenders
• Intake Evaluation
• First or Second Offenders referred to the CRASH
  Education School
• Third or More Offenders referred to appropriate
  level of treatment
• Intervention CRASH Educational School
• Information re alcohol impairment and
  consequences
• Opportunity to examine ones own drinking
  behavior
• Evaluate ones own relationship to alcohol or
  other drugs
• Information re resources available to assist
  the individual to change his/her behavior

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• Treatment Providers
• 12 Core Functions of Certified or Licensed
  Alcohol and Drug Counselors (CADCs and LADCs)
• Screening
• Intake
• Orientation
• Assessment
• Treatment Planning
• Counseling
• Case Management
• Crisis Intervention
• Client Education
• Referral
• Report and Record Keeping
• Consultation with other Professionals

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• Treatment Providers (continued)
• Categories of Competence for CADCs and LADCs
• Data Collection
• Diagnosis of Alcohol/Drug Dependence
• Initializing Treatment
• Crisis Response
• Human Growth and Development
• Counseling
• Therapeutic Relationship
• Evaluation
• Termination and Follow-up
• Record Keeping
• Verbal Communication
• Regulatory Issues
• Community Utilization
• Alcohol and Drugs
• Sociological Factors

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• Levels of Care
• Detoxification (Medical and Non-medical)
• Outpatient Therapy
• Intensive Outpatient (IOP)
• Residential Treatment
• Partial Hospitalization Programs
• Pharmacological Treatment

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• Principles of Effective Treatment
• No single treatment is appropriate for all
  individuals
• Treatment needs to be readily available
• Effective treatment attends to multiple needs of
  the individual, not just his or her drug use
• An individuals treatment and services plan must
  be assessed continually and modified as necessary
  to ensure that the persons changing needs are
  met
• Remaining in treatment for an adequate period of
  time is critical

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• Principles (continued)
• Counseling (individual and/or group) and other
  behavioral therapies are critical components
• Medications are an important element of treatment
  for many patients, especially in combination with
  counseling and other behavioral therapies
• Persons with addictions who present with
  co-occurring mental illness needs integrated
  treatment for all disorders
• Medical detoxification is only the first stage of
  addiction treatment and, by itself, does little
  to change long-term drug use.

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• Principles (continued)
• Treatment does not need to be voluntary to be
  effective
• Possible drug use during treatment must be
  monitored continuously
• Treatment programs need to provide assessment for
  HIV/AIDS, Hepatitis B and C, tuberculosis and
  other infectious diseases and counseling to help
  patients change behaviors that place themselves
  or others at risk of infection
• Recovery from drug addiction can be a long-term
  process and often requires multiple treatment
  episodes

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• What may constitute a Persons
• Multiple Needs?
• Medical
• Hepatitis
• HIV/AIDS
• STDs
• Tuberculosis
• Housing
• Halfway House
• Safe Sober
• Child care
• Transportation
• Legal
• Co-occurring Disorders
• Psychiatric
• PTSD

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• Workforce Development Report
• Overall Trends
• People like the work they are doing.
• They like working with their clientele.
• They believe in the purpose of their work and
  serving the community as change agents.
• The majority would like to stay in this
  profession.
• However, there are substantial barriers in the
  substance abuse system that need to be addressed
  to support professionals currently in the field
  and to attract new people.

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• Barriers
• Themes across the continuum of care include
• Lack of secure and adequate resources to support
  a healthy workforce and substance abuse services
• The continued need for quality, accessible
  training and education
• Barriers to entering and growing professionally
  in the field of substance abuse, including cost
  of education in relation to potential salary
  level, lack of understanding of the field as a
  career choice, limitations on career and salary
  growth.
• Foundational issues and systems impact the future
  stability of the field.
• Professionals in the field report that for the
  most part, they enjoy the work and are drawn to
  the field in order to support change, and/or
  well-being. They are either passionate about
  youth, community development, wellness or
  recovery. While salaries and benefits are a
  limitation and a deterrent, they also are
  committed to the work they are doing. Systems
  change needs to be addressed to support the
  important work they are doing in communities
  around the state.

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• Recommendations
• FUNDING secure adequate funding to support a
  healthy workforce and substance abuse services
• Study salary ranges in comparable professions in
  Vermont.
• Research longer-term funding streams to support
  prevention and recovery initiatives.
• Investigate models and funding options from
  private industry (ie. health insurance companies
  or alcohol producers) to support substance abuse
  services.
• Encourage parity in reimbursement rates among
  mental health and substance abuse services
  through the legislative process.

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• TRAINING Offer on-going high quality, accessible
  training and education
• Conduct a needs assessment of the substance abuse
  field develop and guide degree, non-degree,
  certificate, and continuing education unit
  courses through higher education and training
  programs.
• Build collaborative initiatives and course
  offerings to meet professional development needs
  across the continuum of care through on-going
  support of the Substance Abuse Workforce
  Development Committee, fostering connections
  between higher education, substance abuse
  training programs, practitioners and hiring
  agencies.
• Expand internship opportunities from the high
  school to graduate school levels to introduce
  people to the field. Investigate the possibility
  of offering stipends for internships.

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• INCENTIVES Develop incentives to invite
  professionals into the field and avenues for
  career development.
• Advocate with the Vermont Alcohol and Drug Abuse
  Certification Board to simplify the treatment
  certification process.
• Create a study group to make recommendations on
  incentives for people to enter the field,
  including scholarships, loan repayment or
  forgiveness, and tuition reimbursement.
• Create marketing materials to promote educational
  programs and career opportunities in the
  substance abuse field for high schools,
  healthcare career academies, and
  education/employment services.
• Support the Vermont Alcohol and Drug Abuse
  Certification and Mental Health Certification
  Boards to investigate a streamlined or dual
  licensure process between alcohol and drug abuse
  and mental health.
• Study issues facing substance abuse workplaces to
  enhance workplace environments that model
  wellness and communication to increase worker
  satisfaction.

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• SUSTAINABILITY Develop systems to support
  workforce development initiatives.
• Create a position to support workforce
  development initiatives, including marketing and
  public relations, developing and maintaining a
  job website, networking with other workforce
  initiatives and developing operational support
  systems to continue data collection to assess
  future workforce needs.
• Simplify the state grant application process.
  Offer on-going training in grant writing to
  encourage representation statewide.
• Identify recommended best practices for the
  prevention and recovery workforce to service as
  guidelines for professional development.
• Create a substance abuse field report on
  retention rates that is regularly updated for use
  in ascertaining future programming and workforce
  needs.
• Offer training on social marketing to
  administrators and stakeholders to guide a
  marketing plan for the field of substance abuse.

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• Higher Education
• The Substance Abuse Workforce Development
  Committee surveyed the Vermont and nearby New
  Hampshire institutes of higher education to
  understand the available course and program
  offerings for students interested in pursuing
  substance abuse education.
• 41 colleges and universities were surveyed and 14
  institutions responded.
• Some colleges integrate substance abuse addiction
  into their social work, counseling or family
  systems courses.
• Other institutions offer specific courses in the
  core competency areas and a few have programs
  that focus on substance abuse addiction studies.
• The goal of this research is to increase
  awareness of educational
• opportunities support the efforts of higher
  education institutions to work with substance
  abuse agencies to increase offerings visibility
  of the field.

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• Education Institutions Offering Substance Abuse
  Courses
• (Based on information gathered from a 2004 survey
  by VDH/ADAP/WDC)
• Undergraduate Level Coursework
• Burlington College Burlington Addictions
  Workshop
• Community College Montpelier Intro to Substance
  Abuse
• Substance Abuse/Family Society
• Substance Abuse/Services and Treatment
• Lyndon State College Lyndonville Intro to
  Substance Abuse
• College of St. Joseph Rutland Drugs and Behavior
• St. Michaels College Colchester Drugs and
  Behavior
• Southern Vermont College Bennington Chemical
  Dependency
• Counseling Alcoholic Dependency

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• Graduate Level Coursework
• Antioch Keene, N.H. Theories of Addiction
• Integrative Approaches to Addiction
• Family Therapy Approaches
  to Addiction
• Johnson State College Johnson Counseling
  Addictive Behaviors
• College of St. Joseph Rutland Foundations of
  Addiction
• Diagnosis Treatment of Addictive
  Disorders
• Southern New Hampshire Colchester Physiology of
  Addictions
• University, Vermont Center Psychopharmacology
• (Offers a Master of Science Co-Occurring
  Issues Affecting
• In Community Mental Health, Children and
  Families
• Program in Co-Occurring Clinical Skills I II
  (Co-Occurring)
• Disorders) Clinical Skills I and II
• University of Vermont
• Dept. of Social Work Burlington Masters in
  Social Work (See catalog
• for specific courses)

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• Training
• In addition to higher education, there are
  several institutions that offer substance abuse
  training to professionals new to the field and at
  an advanced skill level. These include
• Vermont Department of Healths Division on
  Alcohol and Drug Abuse Programs (ADAP),
• The Vermont Addictions Professionals Association
  (VAPA)
• Howard Mental Health
• Brattleboro Retreat Healthcare
• Green Mountain Training Center