Conducted by Northern Nebraska AHEC
Northern Nebraska AHEC (NNAHEC) as contracted by the Behavioral Health Education Center of Nebraska (BHECN) surveyed behavioral/mental health practitioners in Region 4. A tested survey was utilized with no modifications. To insure the most accurate listing of practitioners NNAHEC purchased a new listing of all licensed behavioral/mental health professionals, community mental health centers, community health centers, physician assistants and nurse practitioners. A comprehensive mailing list was developed to include the counties covered by Region 4.
The survey was mailed via first class mail to 300licensed professionals; four surveys were returned with address changes and resent to the new addresses. Six surveys were returned with expired forwarding addresses. Additionally emails with the survey link were sent to thirty (30) providers who had email addresses (these practitioners received both email and regular mailed survey links). One organization requested paper survey’s which were provided and then returned to NNAHEC for input. An incentive of a drawing for one of two $50.00 gift cards was utilized to encourage participation.
Forty-five (45) surveys were completed for a response rate of 15%. While low, average mail survey response rates fall between 1% and 20%, and increase to 5% to 40% for members of a selected group. Different strategies could be used for future surveys to increase response rate. Additionally acquiring additional emails may assist in improving the response rate.
Females were the largest group of respondents (81%). Over 60% were over age 46, but a good distribution of other ages was noted. Most respondents (83%) were white, similar to the population demographics of the region.
The survey was completed by behavioral health professions who have worked in the field from less than one year to over 20 years. The largest percentages of respondents have worked in the field for 6 to 15 years with the smallest percentages, 6.7% having worked less than one year. Almost 70% of the respondents work in direct service (70%) in a variety of job titles. Respondents have worked in their current position for an average of 8 years, with a range from 3 months to 22 years.
Respondents came from the key counties with the large populations and/or behavioral health/medical facilities. The largest percentage was from Madison and Platte counties, followed by Antelope and Wayne counties.
Only 16% of the respondents were multi-lingual, with Spanish as the most common second language. A good mix of Nebraska professional licenses was included, with Licensed Mental Health Professionals-53.8% and Licensed Alcohol and Drug Counselor-36%.
Fifty-five (55%) of respondents noted that their agency has difficulties filling open positions. The top three reasons noted for the difficulty included, insufficient number of applicants meeting minimum qualifications (57%), Small applicant pool (55%), and Lack of interest in rural location (48%). It should be noted that the reputation of the agency was not a factor in filling vacancies. Respondents noted that when applicants did not meet minimum qualifications their lack of experience in behavioral health (31%) and lack of practical skills (25%) were most common qualifications not met.
A variety of retention issues were indicated as possible ways to improve retention including more salary increases, burn out prevention, paying for continuing education, shorter/flexible hours and individual recognition were the top five. Relocation (which may have included a spouse’s job change) and burnout were the most common reasons for staff to leave.
When asked about the system issues that should be implemented in Nebraska a variety of response were provided in addition to over 54% indicating a less restrictive reimbursement requirements as most important, and changes to the state’s child welfare system.
Respondents were asked if their graduate program prepared them for their practice. Over 69% indicated yes. Respondents were able to add additional comments which included concerns with limited exposure to billing, paperwork and practical application as part of their training.
The three top continuing education (CE) topics requested provided an extensive listing of subjects. Topics included; Crisis prevention, Lesbian/Gay/Bisexual/Transgender issues, Burn out, Self-help and Ethics to name just a few. This listing provides a good foundation to develop a schedule of CE programs. The additional listings would also be a starting point for additional discussions with providers as their preferences. A listing of general training topics provided similar results with all topics receiving at least 15% of the response. Specific evidence based programs were listed as training topics and the top five (all receiving over 25.6%) included: Motivational Interviewing, Dialectical Behavior Therapy, Alcohol Behavioral Couple Therapy, Family Behavior Therapy and Brief Strategic Family Therapy.
Seventy percent (70%) of the respondents were satisfied (63%) or very satisfied (7%), with 30% dissatisfied (25.6%) or very dissatisfied (4.7%) with the training provided to them. Time and cost were the most common barriers to attending trainings, with location and availability very close. Organization support received only 2 responses (4.8%)
Training (62.9%) and medication management (42.9%) were the top two responses for uses of telehealth connections. Most were currently not using telehealth (67.5%), with equipment and accessibility being the biggest barrier.
Webinars (90%) were the most common online meeting, and again accessibility (71.4%) again a barrier
The survey provided a good foundation for NNAHEC to work closely with BHECN. NNAHEC’s work to continue to promote health careers including behavioral/mental health should continue with additional support from BHECN’s work with health profession students and residents.
With respondents noting that retention is the most important strategy, work to meet the continuing education needs of the professional in the region is key. The data provided from this survey provides an opportunity of a minimum of monthly training with in the region based on the listing provided. Additional information on telehealth locations and accessibility by providers would be a key step in providing training for many of the rural and frontier counties in the region. While equipment may be in a location its availability may be limited (housed in a room not conducive to training, small in size, facility is used by other practitioners at other times, etc.). A comprehensive look at not only available locations but availability is needed. It would also be key to determine the best time of day for trainings again to meet the needs of practitioners throughout the region.
By working together both organizations can make a significant impact on the professions and the region to improve the behavioral health workforce in Region 4.