Angelina Barnes: Good morning. It's a beautiful day in Minnesota
the sun has finally joined us here.
My name is Angelina Barnes and I'm the
Executive Director of the Minnesota
Board of Psychology.
I've been the director of the board,
honored since 2009 and my role is
obviously Chief Administrative Officer
of the board. One of the things I get to
do that I find very exciting is be the
moderator or the host of this annual
conference. The Minnesota Board of
Psychology, as you know, is designed to
protect the public. We do that through
licensure regulation and education and
this is a key component of our
educational programming. We're very
pleased that you decided to spend this
morning with us and this afternoon and
we're really excited about the idea that
today we'll also be building upon and
taking actual action and making
contributions to the Minnesota mental
health workforce plan. Hundreds of hours
and work has gone into creating this
plan for the state of Minnesota. Today
we'll build on the work that they've
done from psychology perspective, you'll
be able to later in the afternoon
contribute thoughts ideas suggestions
recommendations. All so that we can
continue to make the progress and to
flow with the momentum that this project has
already had. As I mentioned when we
opened, I cited the board's mission and
the board's vision which includes being
an extensive participant in the
educational community and in doing
outreach and connecting with our
stakeholders. And we believe that this is
coming true we believe that after we
began in 2012 with this plan we
believe we've made significant progress
and covered significant ground
in developing those relationships and in
creating the type of agency we would like
to be. That success is attributable to
the hard work, resilience and
perseverance of many, not only our
stakeholders themselves as we develop
those relationships but our board
members and our staff members.
Conferences like this, the development of
the educational programming and the
other things that were able to
accomplish and offer to the public and to
our stakeholders wouldn't be possible
without the board and its staff
definitely. I certainly know they make me
look good when they're behind the scenes
pulling it off so I'd like to think my
entire team of internal staff members as
well as the board of psychology for
their contributions. So if we could just
give them a round of applause for all
the work they put in.
Thank you. And in terms of individuals
who contributed today we have so many
contributors across the entire state
today that built this mental health
workforce plan. The state plan wouldn't
have been possible without the
participation of hundreds of individuals,
associations, institutions, and state
agencies coming together in a
remarkable way for collaboration
and discussion about one of the state's
primary concerns; the shortage of mental
health services for the state of
Minnesota and how we will meet those
demands with our workforce. The state
plan also captured insights and
suggestions from over 290 forum
participants from Worthington to
Brainerd to Grand Rapids to Northfield.
The individuals and the creation of this
plan included personal conversations
with people who will make a difference
and their contributions and
recommendations will take action because
of the efforts of this group.
Additionally an online survey was
completed by more than 500 Minnesotans
in creating the statewide mental health
plan. The level of contribution and
participation has been greatly
appreciated by the leaders of this
project as well as has impressed the
Minnesota Board of psychology.
This is an incredible initiative and
we're so pleased to be able to give it
the forum and showcase it today. Out of
Minnesota's 11 geographic regions, nine
of those regions are designated by the
health resources and services
administration as mental health
professional shortage areas. Workforce
metrics used to understand access to
mental health services include: waiting
time for an appointment, number of
culturally diverse mental health
professionals and practitioners, and the
time it takes to recruit providers.
Primary shortages for Minnesota
identified as critical to address in
general include the shortage of
Psychiatrists, prescribers and our child
mental health professionals and
adolescence. Even more problematic mental
health professionals do not currently
adequately
represent Minnesota's diverse
population which is a serious concern
and a goal of the Minnesota mental
health workforce plan. Not only is
Minnesota on board to make these changes and to take action,  with the federal
action agenda for the president's new
freedom Commissioner of mental health
in 2002 reported that the mental health
delivery system can only be as good as
the efforts to train, educate,
recruit, retain and enhance an ethnically
culturally and linguistically competent
mental health workforce plan throughout
the country. That plan couldn't echo more
of what the work that took place for
this state mental health plan has done
and the recommendations it arrived at.
The field of psychology faces its own
challenges relating to recruitment
education training and diversity and
number of psychologists that can be
traced to the overarching issues
identified in the state of Minnesota
mental health workforce plan. In general
today we're going to examine in greater
detail through Mary Rosenthal's
presentation what was identified through
all the participants and what resulted.
According to the American Psychological
Association an article released in 2013
the internship match as we all know is
extremely problematic for training
individuals and for getting them into the
practice of psychology. This specific
article from the APA cited that for the
past seven years and this was in
2013 that for the past seven years about
one-quarter of psychology graduate
students who have gone through the
internship match programme have not
secured an internship. Significant
progress has been made in that area and
it continues to rise; the match levels
are increasing do the work of the APA
and APAGS the Graduate group, impressive
work. While we're pleased with that
progress it's not enough and
it's not enough until we can provide
those opportunities to help feed the
mental health workforce. The number of
students who matched with an internship
and phase one of the match sponsored by
the association of psychology
postdoctoral and internship centers
APIC has increased. APIC reported that
3,239 students or seventy-three percent
of applicants matched in 2015. One of the
steps taken to address the issues
identified with internship matching was
to advocate and build a toolkit through
APA and APAGS so that they could seek,
individuals could seek and entities could seek
Medicaid reimbursement of intern
services. As we know we have to follow
the money; if individuals aren't paid for
their services and contributions it's
very difficult for them to continue to
give. As you know even though we make
these progress as an internship there's
still other challenges that face
Minnesota. The availability of
Supervisors along with the costs
associated with obtaining supervision is
another frequently identified issues for
applicants preparing for psychology
licensure. But we're not just talking
about dollars and we'll talk a lot more
about this in our focus group and
through the information presented today
is there is opportunity cost
there's opportunity cost to the
applicant when they don't get licensed
and we certainly have made many many
efforts in the efficiency and reduction
in time and the efforts but we'll never
stop
we have continuous improvement on a
day-to-day basis until we can get
individuals into the system in the best
way possible and that changes daily.
We aren't just talking about dollars as I
said this opportunity cost of the
applicant to the providers are also
cited as concerns. Another primary issue
facing the field of psychology itself is
inconsistency in the entry-level
credentials in both education and
in requirements for licensure across the
United States. Minnesota is all too
familiar with the issues related to
entry-level into the field of psychology
and the transitions that it's gone
through. For masters level to doctoral
level is the entrance degree or the
terminal degree for this profession
there are issues related to being able
to use individuals their skills
education and training to the full
capacity and to fulfill the scope of
what those skills can provide. And there
are barriers, we are a licensing board we
believe fully in
licensing and regulation for the public
protection but we also believe in
partnering and making sure that we
aren't part of the problem that's stopping
individuals from entering this workforce
and we're committed to continuing to
have those conversations to contribute.
The educational inconsistencies across
the United States raised questions about
mobility as well; we're going to talk a
little bit about technology as a part of
this plan but the ability for
psychologists move from state to state
and do so in a timely manner is
sensitive and certainly as we're focused
inward today on Minnesota itself, it's
also worth mentioning that we need to
make sure that individuals coming to
Minnesota that it's easier for them to
do so that they can get here
currently the way the logs exists there's a
there's a postdoctoral requirement as we
all know and some of the individuals
coming here don't have that postdoctoral
requirement or would struggle with
licensure requirements. Again we're
committed to talking about those issues
and identifying what can be done.
The board is prioritized and focus on
increased efficiencies and licensors and
we also are looking at how variances to
educational requirements can
be used but still maintain public safety.
Technology solutions as the world's
geographical physical boundaries begin
to dissolve today we need to look at how
we can better use technology to provide
mental health services potentially with
a extremely rural state. Mobility and
technology are addressed a state and
national level for psychology, the
association of state and provincial
psychology boards as we discussed last
year in our conference offers an
e-passport as a mechanism to promote
standardization in criteria for
interjurisdictional tele-psychology
practice, and quoting the ASPB
they believe the e-passport
facilitates the process for licensed
psychologist to provide tele-psychological
services but this is across
interjurisdictional lines coupled with their
initiative to enact a
interjurisdictional compact known as
sci-pact. I will announce that one of
the first States the United States has
adopted sci-pact and
passed so there is one state who belongs
to the compact. I don't know if you've
ever been in a relationship but I
think that states a little lonely so I
think we should continue to talk about
how that can move forward for a compact
I think they need a partner state. And
so today we're going to focus on some
primary things here. We're going to - this
is our next individual that you're going
to be hearing from this is Senator Greg
Clausen. Senator Greg
Clausen was
a serious supporter and advocate for
this mental health plan.
Good morning and welcome to all of you
taking part in the Minnesota Board of
Psychology 2016 conference.
Thank you on behalf of Minnesotans
throughout the state for your work on
mental health issues. Unfortunately I'm
unable to be with you today due to
commitments with the Senate but I am
honored to join you via video as you
begin your conference.
My background is in education, for over
40 years I served as a high school
teacher, principal and central office
administraton. From my experiences
working with students and families in
crisis I became aware of shortcomings in
our mental health system. Waiting for
several weeks for an appointment and
evaluation was commonplace, creating
delays and treatment, uncertainty within
families and uncertain outcomes. In 2013
i authored legislation requiring the
Minnesota state colleges and
universities to develop a comprehensive
plan to increase the state's mental
health workforce at all levels.
A steering committee was formed and
conducted 20 community forums around the
state, surveyed over 500 mental health
stakeholders and in May 2014, held a
culminating mental health summit,
attracting more than a hundred and fifty
participants. I served on the steering
committee and want to thank the more
than 30 members for their professional
dedication. Today's conference focus on
the legislative report gearing up for
action mental health workforce plans for
Minnesota, outlines 24 recommendations to be acted upon by professional
organizations, educational institutions,
licensing
boards and the legislature. The conference
will provide an opportunity to learn
more about Minnesota's mental health
workforce needs, review recommendations
to address these needs and identify key
concepts critical to the mental health
workforce. Much has been accomplished
since the report was released in 2015
and yet there is much left undone. I
would like to challenge each of you to
join me in finding creative solutions to
address our mental health workforce
needs. Thank you for your ongoing
dedication and your work to make
Minnesota a better place to live and
grow.
Thank You Senator Clausen. With that
introduction we'll talk a little bit about
what will get us to our next speaker
Teri Fritsma. The American association
of child and adolescent
psychiatry reports the national average
wait time to see a child and adolescent
psychiatrist is 7.5 weeks. That that to
a family in need, a family in crisis and
a family who needs help now is too long.
Minnesota is worse. In Minnesota the wait
time can be longer providers reported
wait times up to 14 weeks for an
appointment with a child psychiatrist
There is a significant shortage but it's
not only psychiatrists, the state of
Minnesota through its Minnesota sex
offender program has had significant
struggles in recruiting individuals to engage at an appropriate level much
so that legislation has changed that
would allow either a psychiatrist or a
doctoral level psychologist to serve on
their special review board panel. There
simply aren't enough psychiatrist to go
around or other mental health
professionals. To further complicate
matters rural Minnesota is facing
pronounced challenges related to mental
health stigma, low wages and cost of
education and training. So I ask you
what can be done to support the efforts
to expand and broaden mental health
telemedicine? How can we use technology
and training programs
and technology related grant funding to
expand telemedicine capacity in
Minnesota?
How can we reach those families that
aren't getting the services, the social
support that their children deserve and
that their families deserve to succeed?
Diversity is also critical, psychologists
are particularly attuned to diversity we
have human diversity as a core component
of our educational requirements for
licensure but I was astounded when I saw
the statistic. Seventy-two percent of
non-white respondents to the survey
conducted in conjunction with the
Minnesota mental health workforce
identified cultural competence as a
critical area highest priority for
education and training, compared to
thirty-eight percent of white
respondents. I challenged everybody to
continue to consider cultural competence,
to give it the priority that it needs
and to recognize and listen to those who
are calling for diversity. Obviously
Minnesota needs to improve expand
cultural competency training.
Dr. Fritsma's going to share with us today
some extremely exciting information
which I will say you are the first group
besides myself and to my staff members
to ever see this data.
I'm very nerdy, I'm an attorney at heart
so this data is exciting me. It is
about you
it is about psychologists,  it is what you
told them and what you told us about
your field, about your work, about your
satisfaction, about your demographics. We
can't wait to share it with you and I
know Teri's more excited than I am.
Cultural competence needs to be a core
behavioral health education and training
requirement, so we're going to talk about
the responses we got and we are also
going to talk about how will Minnesota
increase the numbers of racial and
ethnic minorities as healthcare
professionals?
How do we get them to choose being a
mental health professional and I think
we've gotta few key suggestions today
from what we've seen in some of the data
in ways that you can leverage your
experience, your knowledge, your expertise
to help others see the value in being a
mental health provider. The demand for
mental health care is predicated on
increased strains on
the healthcare system, so I ask you
what can psychologist of the field of
psychology do to alleviate those strains
or meet the demands for this mental
health services. And with that I'm going
to provide you with the bio of Dr. Teri
Fritsma,  if Dr. Fritsma will join us on
the stage.
Teri Fritsma is a senior workforce
analysts in the Minnesota Department of
Health. She collects and analyzes data
and healthcare workers and has a special
interest in the mental health workforce
more glad she does. She provides data
analytical consulting to a variety of
mental health focus legislative groups
and task forces. Before coming to MDA to
the Minnesota Department of Health -
I never like to rely on our government
acronyms - Teri was a workforce
analyst at the Minnesota state colleges
and university system and with the
Department of Employment and economic
development.
I couldn't think of a better person to
share with you these complex and
intersecting issues. She has an MA and a
PhD in sociology from the University of
Iowa, welcome Dr. Teri Fritsma.
I'm a data analyst, I'm not used to talking for an hour, so just in case.
Thank you so much I am so extremely thrilled to be here and thank you so much to
Angelina and to the board for inviting me.
One of the reasons I'm so excited to be
here is that I work with a small group
of analysts at the Minnesota Department
of Health and we collect data - healthcare
workforce data on about a hundred and
fifty thousand different
licensed healthcare professionals and as
a matter of fact we share the data
very widely to all different sorts of
stakeholders but I don't believe we've
ever been invited to come and talk to
the people who have actually provided
the data to us so this is really kind of
fun and gratifying for me so I
appreciate being here thanks Angelina.
And the other thing is
Angelina mentioned we just recently
conducted a survey; the very first survey
we've ever done on psychologist. Can I
just see how many of you responded to
the survey in the room?
Oh thank you very much. Which I
like I said we collect so much data and
were you know we said in our cubes and
we analyze it and we never really get a
chance to say thank you to the people
who provide the data. We
study you guys so we are quite well
aware of the increasing level of
administrative work that you have to do
and we know that you know for you
responding to a survey is
just one more thing that you have to do
that adds to your your plate and so we
very much appreciate it and we very much
consider ourselves
careful stewards of the data that you
provide so thank you so much I
appreciate that.
I'm just going to give you kind of an
orientation to my presentation. I want to
start with a little bit of background so
that you understand some of the context
in which this data gets collected and
used and then I'll dive into our data
presentation and its kind of divided up
into two parts one is looking at
psychology the profession, so what it is
that you do, the services that you
provide, where you where you provide them, who you are and your work satisfaction
which should be fun to talk about and
then the second lens that I'm going to
look through is psychology more as a
workforce and I think this kind of sets
the stage for talking about some of the
issues around the the
mental health workforce plan. This presentation will be
fairly data-heavy which you know for
me is kind of fun but not necessarily
for everybody else and so I do hope to
not just bore you with a bunch of data
slides but to kind of weave a story
around the data that I'm presenting.
With that I'll give you a little bit of
background; I work for the Minnesota
Department of Health Division of health
policy office of rural health and
primary care and you probably can't see
it but my group is the health
workforce analysis unit the
organizational details don't matter but
I do I do just want to kind of give you
a sense of the context so kind of
starting from the bottom my group is the
health workforce analysis unit we are a
small but mighty group of three analysts
that analyze data like I said on a
hundred and fifty different
licensed healthcare workers in the state
we survey 17 different license
professions and we are adding more all
the time. We work within the context of
the office of rural health and primary
care and what this means for us is that
that we understand that there isn't just
one story about health care particularly
in Minnesota there's at least two stories.
One about you know the way health care
is delivered and organized in more
populated areas of the state and then of
course the rural areas of the state so
we're always kind of telling both
stories. we're in the division of health
policy which means everything that we
collect is actually collected with an
eye towards being able to inform policy;
not just to collect it for the sake of
collecting which I know I think
government has sort of a bad rap for
that and then finally, I don't know
how familiar I would expect people to be
familiar with the Department of Health
so much, but I'm actually
really proud of working for the
Department of Health I've worked for I
think five different state agencies in
Minnesota and I want to read you the
vision statement for the Department of
Health, and that is 'health equity in
Minnesota where all communities are
thriving and all people have what they
need to be healthy' and I can tell you
that this is a vision that you
know we don't just talk the talk we
really walk the walk, every single person
down from you know but the highest
levels of leadership all the way down to
you know us and and the even though the
administrative staff cares very, very
deeply about health equity in Minnesota
so making sure that people from all
walks of life have equal access to
healthcare including mental health care
and have better outcomes. So in summary
my group collects and analyzes data to understand
urban and rural challenges for the purpose
of informing policy and within the
context of improving health equity,
that's what we do.
So what professionals do we survey? Just
very briefly we survey we are
actually legislatively mandated to
survey all
licensed healthcare providers including
folks that deliver primary care so
physicians, physician assistants, all
three types of nursing licenses, we cover
oral health, so the for oral health
licensed professions
dentists, assistance hygienist
dental therapists, which is a newer
profession in Minnesota. We survey of a
handful of the therapist occupations;
physical therapists and respiratory
therapists as well as assistants.
Pharmacists and pharmacy technicians and
then finally this is sort of where my
heart is we collect data on all of the
licensed mental health workforce now
including you.
So social workers, all four of the social
work licenses LMFT's and then the
three counseling professions in
Minnesota so that would be the licensed
professional clinical
counselors, licensed professional
counselors and then the alcohol and drug
counselors. And then finally
psychologists we just were fortunate
enough to add you all to our list of of
professions that we survey and we're
really excited about that and I do just
want to mention we recently revamped our
survey so that we can start getting at
some of these new and emerging models of
care and new you know issues that the
healthcare workforce is facing and
though we've added psychologist last to our list
you guys are actually the first to hear
about your data, your very first ones
that we've completed the survey for so
kind of exciting.
So what data do we collect?  Basic
demographics including sex race and age
race is a big one and I'll come back
to that. We collect data on education and
preparation and particularly for nursing
and for mental health where there are
certain job laddering opportunities we
collect not just hey what's your highest
level of education but also are you
planning on getting more and where did
you start so we can kind of get a sense
of the Laddering in the profession.
We collect information on work location
which is how we're able to say
where care is actually being delivered
around the state. Hours worked which
helps us get a handle more on the FTEs
as opposed to just you know body counts.
Your future plans for work, which helps
us figure out what our workforce is
going to look like five, ten years down
the road and then finally we added in
our new survey redesign, we've added somequestions about some of these new and
emerging technologies like the use of
electronic health records, use of
telehealth equipment and then we added
job satisfaction questions which I
must say is I think a fantastic addition
we're able to really, really read your
responses and get a sense of what it is
that you're facing in your work every
single day and I'm excited present some
of that.
So why do we collect this information?
it's just very important,  I guess
I have a little chip on my shoulder,
I know that a lot of government agencies
collect data just to collect it and it
sits on a shelf and you know that's just
not who we want to be and so we do
collect it because we are legislatively
mandated to collect it
we have we have a job that we have to do
but if I put that in smaller face
font because I want to de-emphasize that.
Yo us the reason that we collect the
data is to make use of it - so we inform
specific legislative recommendations for
example the mental health workforce plan
that you're going to hear about actually
used quite a bit of our data to inform
it, we inform policy work groups so for
example last year there was a policy
work group that was focusing on how to
integrate international immigrant
physicians into the workforce it's very
difficult for them to enter the
workforce and so we provided some
baseline data there. To support
decision-making for post-secondary
program offerings - so just a few years
back MNSCU was looking to
the scope of practice rules changed
for LPNs and they were looking for how
to consolidate and or expand some of
their LPN programs and we were able to
supply some data there to help them make
those decisions. And finally
to respond to
special requests and these come in
all forms I think we probably respond to
you know maybe 10 different requests
every month about half of those come
from the media and we're getting more
and more media requests for information
on the mental health workforce which
does not surprise me given some of the
movement that's happening in the mental
health workforce you know policy
discussions so I expect that to increase.
Let me just dive into some
of the details on the psychology survey.
As you know the survey took
place at the tail end of april just into
the end of May. We surveyed all licensed
psychologist who had a valid email
address because we did reach out to
everyone through email in April. We got a
thirty-four percent response rate which
is twelve hundred and seventy responses,
I know I'm not talking to methodological
slouches in this room I think everybody
has an understanding of response rates
and the importance of getting a good
response rate and of course the danger
is not necessarily the low number of responses,
it's how representative is the group of
respondents for the overall population
so I was able to do a little bit of
diagnostic work to kind of figure that
out and I and I can tell you that there
were no response differences by gender
or by age so men and women were equally
likely to respond, all age groups were
equally likely to respond and we
did get out slightly lower response rate
from psychologists that
have an out-of-state address so that
could have some implications for our
findings - but I am satisfied that
what were what I'm going to present to
you is more than just you know some nice
qualitative data it's actually
safe to generalize some of this. Just
diving into some of the findings;
psychology the profession so who you are
and what you do.
Ok so just start with some simple counts,
this might be familiar to you, in
Minnesota there are 3824 psychologist
who have active licensure with
the board of psychology, and of those
3556 actually have a state of Minnesota
address so we're not I'm going to come
back to that actually that's an
important point. I also do want to
mention that I know that some
psychologists are dual licensed with
that with the Minnesota Department of
Education the school psychologist,
and also the board of psychology
here and for those folks that are duel
license they're counted in this number
for people who are only licensed by MDE
they're not counted here - I think that's
a relatively small number.
So starting off; we do ask folks what are
their psychological specialties?
Now I should point out that you were
able to report any specialty that applied
to so these numbers won't total up
to a hundred so half of all
psychologists if you can see reported
a specialty in clinical psychology.
34% counseling psychology and then another third and behavioral and cognitive
psychology, and then you know we see
Child and Family
kind of dropping off after that.
Now I relied on some expert input about
these categories so I would like to ask
two questions of you.
One is if you could just raise your
hands, does this list make intuitive
sense to you as a group of psychologists?
I feel I see a lot of overlap but that
might not be true so if it doesn't make
sense or if you see you know problems
please raise your hand. Okay
and maybe we can talk about that a
little bit within the panel discussion
and and as for the rest what does this
kind of jibe with your kind of intuitive
sense of what the field looks like, raise
your hand if that's true.
ok ok good
Just some more basic data on the highest
degree obtained this does not surprise
me probably, won't surprise you
sixty-seven percent, about two-thirds have a doctorate or professional degree
29-percent have a master's degree and four percent
have a post master certificate or certification
we thought it was
important to to capture those folks that
have continued their education after
their master's degree.
And I should mention too, I I broke
this down just to look to see how this
changes if you look at folks 55 and
older and even even at the age of 55
about fifty percent of folks have a
Doctorate degrees.
So forty-three percent of psychologists
own or co-own private practice and
sixty-five percent of psychologists are
female
so it didn't surprise me that the field
is female-dominated but actually what
surprised me was with the number of men
in the profession because when I go and
look at other mental health professions
they are far more heavily
female-dominated so for example marriage
and family therapists or eighty percent
female social workers are 87
percent female and then all of the three
types of the counselors, so the LPC's
LPCC's and LED's are seventy-three
percent female - so psychologists are
actually the most heavily male of the
Mental Health Professions with the
exception of psychiatry.
I thought that was kind of interesting
Okay I'm going to spend a little bit of
time talking about race,  so I mentioned
that the Department of Health and that
our work is - we're very much
concerned with health equity and making
sure that people of all walks of life
have access to good care and and have
good outcomes. So when it comes to
talking about workforce oftentimes that
gets translated into discussions about
cultural competency - but cultural
competency is a very, very difficult
concept to define, and an even more difficult
concept to measure. So as as Angelina
sort of hinted that earlier I think we can't really expect reliable
responses if we ask people, hey do you
feel that you're culturally competent?
And so we we start off at least with a
measure of you know the diversity of the
workforce and we really take
this pretty seriously; when we
redesigned our survey we consulted with
the state demographers office to try to
make sure we're asking about the right
the right mix of races, we allow
people to check more than one response
and so this is these are the results so:
about eighty eight percent of you
responded white, just under two percent
Hispanic Latino and kind of on down the list
So this is pretty much what
we expect, it's pretty much in line with
other mental health professions and
actually the healthcare workforce as a whole.
So the fact that this group is
heavily white, does this mean
that psychologists are not a culturally
competent group? I wouldn't necessarily
suggest that but we did want to start
getting at this concept of cultural
competence and so we asked a question on
our survey, I'll read you the question so
you can you can hear how we measure this.
Which of the following work or
educational experiences best prepared
you to work with people from a variety
of backgrounds when providing care
sometimes referred to as culturally
competent care? And then respondents were
instructed to choose just one of these options.
So as you can see a
third of you said informal learning on
the job was the thing that best prepared
you to provide culturally competent care.
And under a quarter of folks said
continuing education or professional
development course work. Another
22-percent formal educational coursework
formal on-the-job training 20-percent,
none 1%, and then some
some folks have jobs that don't involve
culturally competent care so we are
allowed them to specify that. What this
tells me you know this is really
interesting because we in doing this
sort of work care very much about
ensuring that our workforce our mental
health workforce and all of our
healthcare workforce is culturally
competent and
and can provide good care - and we
often think about the easiest places to
make those interventions, like is it in
you know the formal
educational programs or is it in kind of
continuing education and I think those
are good options but I also think
sometimes we tend to forget that so much
of this learning actually happens on the
job and maybe that's a good place to
think about doing some intervention. When
we were putting together
this survey we get some cognitive
testing and asked people, what is
cultural competence really mean to you?
And one of our
informants said yeah you know it means
being able to relate to those stoic
Minnesota farmers you know and I
realized you know - hey we what we're
thinking of cultural competence isn't
necessarily what applies to each person
on their job and so I think you know
it's worth kind of
considering where are the best places to
put those efforts.
So career satisfaction - I gotta tell
you this was one of my favorite bits of
information to analyze I felt very
inspired actually and I was kind of
questioning why did I change my my
college major from psychology to sociology,
you guys seem pretty happy? So we
asked two questions about career
satisfaction; one is how satisfied have
you been with your career overall and
then how satisfied have you been with
your career in the last 12 months.
Sixty-two percent of you said you were
very satisfied with your career overall
I took a quick look at some of the other
professions for which we have data and
you guys blow them away
I mean you're very satisfied - now I
don't know, I got to thinking about this
and I thought is this just is a
reflection of of your work or is this a
reflection of the type of people that
you are? Maybe you just you know have
great coping skills and know how to be
satisfied
but anyway that's wonderful
and then you know we asked how satisfied
have you been in your career in the last
12 months, now satisfaction drops off
quite a bit in the last 12 months, and we
tend to think, we analyst's tend to think
well yeah that's because of you know
oh my gosh all of this you know
administrative work and you know
the dealing with insurance and that kind
of thing - that's that's got to be making
people kind of grouchy, but it also
cursed me I'm I'm not a hundred percent
sure if that isn't just also partly the
way our minds tend to work - we tend to
kind of think about, you know the bad
stuff that's happened over the last year
and we made we just focus on that and
I'm looking at a room full of people
that probably have some insights more
insights than I do about that so
maybe we can leave that a little bit to
the panel discussion - but I will say this
is a pattern this kind of decreasing
satisfaction between overall and the
last 12 months that I've seen across all
of our healthcare professions so kind of
interesting. But you guys are very
satisfied overall. So then we got some
some great qualitative data, we asked you
to spend a little time telling us what
are the what are your you know greatest
sources of satisfaction and then what
are the things that really dissatisfied
you about your work? And far and away the
that the thing that was that made you
most satisfied in your work was your
direct client and patient care.
One of the things I saw over and over
was people articulating it's just so
nice to be able to see people who come
into my office, really kind of in a state
of disarray and then they managed to really make
improvements in their lives and that's
that's wonderful. People mentioned a lot
of these are sort of inter-tangled, but I pulled out some of the
themes that popped out,
but developing trusting relationships
with their clients was very meaningful
for people and they derived a lot of satisfaction.
An emphasis on psychotherapy over drugs
which is really timely right now so
that's something that quite a number of
you mentioned, a number of you mentioned
working with special populations - so
immigrants, children, veterans, teens, and
and severely mentally ill - that that gave you
quite a bit of satisfaction.
Other sources besides just working with your clients; a lot of people noted - that I took
this as being slightly different - but
that feeling of appreciation that you
get from your clients and feeling you
know through letters and through
feedback and through word-of-mouth
referrals that you know you really you
are appreciated and you're doing a
good job. You feel that your work is
meaningful you know we all want that - to
be able to go to work and feel like
we're making a contribution, and you
guys do. And then people mentioned rich
collaboration with their co-workers and
colleagues from other disciplines that
came up quite a bit, that was valuable to
you.
I actually think what people said more
about the reasons they were satisfied
then the reasons they were dissatisfied,
so that's kind of telling. A number of you
mentioned how satisfying it is to mentor
and train students. A lot of folks
mentioned kind of this combination of
being able to help people, but also have
that intellectual stimulation and that
constant, you know chance to learn, and I
got to thinking I'll bet this is - I don't
know how you all feel about the
myers-briggs, I imagine there might be some strong opinions one way or another about
that but I thought these are people that
are you know right on that line between
the T and the F
So... very thoughtful group and
caring. And then a lot of people
mentioned the autonomy and the
flexibility of their of their work and
some of you mentioned how satisfying it
was to own your own practice.
Ok, sources of dissatisfaction:
Are you guys surprised? That came up
over and over and over - insurance,
insurance, insurance it's just a pain and
I tried to kind of separate out some of
these different themes. So the
pre-authorization and particularly with
pre-authorization what's disturbing is
that you have to work to try to make
your case and you feel that you know
there's arbitrary oversight that really
overrides your own professional you know
discretion and expertise. Reimbursement
is a source of dissatisfaction. Many
legitimate activities are not
being reimbursed, a lot of people just
mentioned in general like the coding the
billing, it's just burdensome all
this documentation. Many people mentioned
how insurance companies - each insurance
company does something a little bit
different and so you have to kind of
figure out the rules for each one and
that's very time-consuming. Other sources;
just administrative tasks that are
diverting time from you're working
with clients and and being able to do
the most meaningful part of your job.
This was a big one; pay is low relative
to other highly educated professions
a number of people mentioned you know
student loans that, like, they mentioned
that it actually keeps them up at night -
to have the burden of all that student
loans and and having a relatively low pay
job and the reimbursement rates are
fairly stagnant and so that doesn't
appear to be changing. Electronic health
records people mentioned some concerns
about those, and then just a couple
comments about... not as many as I
would have thought but about just
feeling burned out and feeling a little
bit helpless overt ime in the face of all
of these kind of heavy problems and
issues that you deal with on a
day-to-day basis. Do these
resonate with all of you? Since so many
of you told me this I'm assuming so? Ok.
Psychology the workforce; so here we'll
kind of move away from you and move more
into kind of where you all are working
and access to care and issues around the
future of the profession and what that
means for the state. So just a reminder
3800 licensed psychologists in the state
3500 reporting a Minnesota address.
So okay, we don't actually
know exactly what this means
so some somebody could report that they
have an address in Hudson, Wisconsin but
they could be making the trek over the
border every day to provide
services in the metro area, so it's
difficult to say which is the right
number. We know the upper bound is about
3,800 we also know that of that 3800 or
3500 not all of you are actually
practicing most of you here probably
practicing but not not everybody who
maintains a license is still practicing.
So just put it in context, this is all of the licensed
mental health professionals; social
workers is the largest group at over
12,000 - I should mention we know that
about 60-percent of social workers are
not actually providing direct patient
care, so depending on your definition of
a mental health worker, I included all of
them here but if you're thinking about
the the folks that are you know kind of
sitting on one and providing direct
client care it's only about sixty
percent of that. Now we have
psychologists, and alcohol and drug
counselors, marriage and family
therapists at 1,800,  professional
counselors that includes the the
clinical counselors and the licensed
professional counselors and
psychiatrists only 867 and then
psychiatric nurses even smaller than
that at 303.
So the total licensed mental health
workforce is just under twenty-four
thousand but like I was saying we know
that this is probably a fairly
significant over count once you remove
the people that are maintaining
a license here but working out of state
maintaining a license but not actually
working, and also those that are
maintaining a license but are not
working providing direct client care.
Just to put this in context - I thought
you might like to know that there are
about 90,000 registered nurses working
in Minnesota and there are about 22,000
licensed physicians working in Minnesota.
Audience member: I'm very curious about the license to the non-license
and also how many people do each of
these serve? Do you have any of that data?
Dr. Fritsma: I can answer that.
My office does not
collect data on non-licensed. That data
does exist though DEED - Department of
Employment and economic development
collects the data and we do look at that
quite a bit, so it's there it's there
to be known - do we collect information on
the people you know kind of like
caseloads and that sort of thin? We
we have a few round-about ways of getting
at that which some of it some of what
I'm about to show you will get into that.
Audience: I just wondered when you
use the term psychiatric nurse
If you've already started breaking down
psychiatric nurse vs something like an advanced practice nurse?
Dr. Fritsma: Good question. This
number includes all of
them, because APRN is such
a new license we just started collecting
data on APRNs but this this number
includes everybody
So this is somewhat getting at
your question
not exactly directly but this is just
another way to kind of look at the
numbers here and it's the ratio of
population to provider.
Are folks familiar with with looking at this sort
of data I can kind of go into it.
So basically what this means is that for
every psychiatric nurse - this is
statewide so in Minnesota every
psychiatric nurse - there
are almost 18,000 people - that's not
obviously the number of people that that
nurse is caring for but it's just gives
you a sense if you compare across it
will give you a sense of the relative
size of these different professions but
what this is is is more interesting and
helps you
to
understand better some of the regional
kind of maldistribution of people
around the state. So this bottom line
here these are this the statewide ratios
of population to providers so for
example - for every psychiatrist in the
state of Minnesota there are ten
thousand nine hundred people
potentially sharing that one
psychiatrist
however when you look you know so i
colored in green anything where the
ratio is lower than the statewide ratio
and anything in red higher so like you
can see that in them in the metro area
I mean I reserve judgment on whether
the statewide ratio is what is what we want
maybe not, but at least in Minneapolis
St. Paul
you know we're doing a little bit
better than statewide and of course in
southeast this is the Mayo
effect, we do we do a little bit better
with some of the professions - but looking
at central Minnesota looking at
northeast the entire western side of the
state...
rather than
ten thousand people needing the service of one
psychiatrist, you're sharing that one
psychiatrist with you know four times
the number of people so it
really is you know a maldistribution
of services and that's one of the things
that our office works on quite a bit.
lThe rural loan forgiveness program
runs out of our office. One of the ways
as Angelina mentioned - one of the ways
that we talked about you know solving
this problem is through
telemedicine so we asked on our survey
how often do you diagnose or consult
with patients in real-time using
telemedicine equipment or software? And I
don't know if you can see that but
eighty-two percent of
psychologists say they never do.
How often do psychologists diagnosis or
consult with patients in real-time
using telemedicine equipment or software?
Eighty-two percent said never they never do it
twelve percent said occasionally, three
percent said frequently, and two percent
said all the time - so this is not a lot of folks providing
services  through telemedicine, I
have a feeling there's more here to
discuss and I know this is actually
really complicated legally and
reimbursement wise so maybe we can talk
about that a bit more in the afternoon.
Ok just talking a little bit about age -
more than half of all psychologists are
aged 55 and older and if you look at the
distribution if you can see the
distribution, you know the
younger cohorts are
proportionately much smaller which tells
me you're not adding in as
many of these younger folks - this is
probably not news to you.
I want to put this on a little
context so the median age of the US
workforce is 42, median age of US
psychologist is 46, the median age of the
Minnesota workforce is 41, marriage &
Family Therapist 45, social workers 43,
Minnesota psychiatrists 55, Minnesota
state colleges 57. 57 is the median age so
I actually took a quick look at most of our other healthcare
professions - psychology
is actually the oldest licensed
healthcare profession in the state. What
share of you are actually you know what
share of you licensed psychologists are
actually still working still practicing
in the field? Ninety-four percent that's
a very, very high - that sort of what we
think of as our labor force
participation rate - that's a very high
utilization rate of you guys.
This compares to about eighty-five
percent of of Marriage and Family
Therapist, ninety-one percent of social
workers and ninety-two percent of
physicians, so you guys are you know
being utilized for sure. Did you have a question?
Audience: Just a hunch on why the number of psychologists is so much
smaller below 55, I think that's about
the time that the licensing requirement
changed from a master's level to a
Phd-level and that's scaring away a few more of the younger potential psychologists.
Dr. Fritsma: Yeah and especially if the median wage which I
for people who don't have their own practice the
median wage for psychologists is about
$70,000 a year, so if
you invest in that much education
that's I can understand why people have
student loans. So looking at it by age
group I was curious to see of
those 34 and younger almost everybody is
working as a psychologist on down and so
if you look at even those age 65 and
older this is when a lot of us are
retiring and you know going off to the
beach and stuff
eighty-seven percent are still working
as psychologists. How much do
psychologists work? You work pretty hard.
Seventy-seven percent of you say that you
work full-time and twenty-three percent
say part-time and 40 hours is your
median work week. Now looking at age, ages
65 and older
oh my gosh - almost fifty percent of
people age 65 and an older are still
working full time. So I I'd love to hear
more from you about that, maybe
this afternoon and 30 hours is the
median work week so that's not just you
know put in 10 hours here and there.
This gets a little bit at the question
that was asked earlier about
the share of your time that you spend
actually on patient and client care.
Only half of you, less than half of you say
that you spend more than seventy-five
percent of your time on patient care and
we ask that question a really kind of
open-ended way we say you professional
you tell us what you think is client
care, so for you that might include
paperwork it might include some travel
it might include appointment scheduling
because you know that you have to track
these folks down - for others that might
not - you tell us what you consider
patient care and so even that
even allowing you to include paperwork
and things like that is your patient
care less than half are spending more
than seventy-five percent so you know
you're working hard
not everyone is seeing patients perhaps
as much as you might like, and we
can talk more about what that means.
How long do you plan to continue
practicing? 51-percent of you said more
than ten years. Twenty four percent said
six to ten more years and then
26-percent, so a quarter of your
profession plans to work five
years or less and of those
ninety percent of you said that you plan
to retire, that makes sense to me.
Just providing a little bit of maybe
some some baseline data to support some
of the rest of the conversation later
this morning
How often do psychologists provide
clinical training or supervision to
students are interns? So how much we kind
of bringing these folks along?
Almost 40 percent of you said never, eight percent said you do it all the time,
eighteen percent said frequently and
thirty-four percent said occasionally.
I'm just going to end our last little
bit of data is some supply and demand
data that I pulled together from our
friends over at the Department of
Economic Development. There's a statewide
annual market demand this is a market
demand so not even need, need I would
imagine is much greater than market
demand but a market demand for a 133
psychologists - we
produced in 2014, 106 phd-level
psychologists so we are not producing
psychologists we're not even you know
regardless of the of the post-graduation
internship and those sorts of you know
opportunities for people to be able to
enter the field,
we're not even producing enough to meet
the market demand, and I will actually
add that that market demand number does
not account very well for people working
in private practice - it just doesn't
count those folks so
this is probably even an undercount. Ok
I'm going to quickly wrap up. I'll give you a
couple summary points. So psychologists are
the second largest mental health
profession in the state. I think you guys -
reading through your comments and
looking at your data - I think you occupy
a very special and kind of unique niche
in the mental health workforce. You
derive great satisfaction from
intellectual challenges and working with
clients and seeing them succeed and
you're also not too surprisingly stymied
by some bureaucratic oversight this is
by the way not that particular to
psychologists we see this all over with
with all of our healthcare professionals.
Your group of professionals that are
fully utilized, you're mostly working
full-time well into your sixties. We see
a a maldistribution of professionals
across the state
telemedicine doesn't appear to be a
panacea it's not a clear solution least
not for now and postgraduate training
opportunities are perhaps not what we'd
like to see. The profession is aging and
can Minnesota produce enough new grads to
meet the demand for the need?
oh and that's it so, good thank you.
Angelina: Thank you Dr. Fritsma. Now we have an
opportunity to talk to Dr. Fritsma a
little bit we do have a mic in the
middle there if you want if you're able
to come up to the mic, we also have will
have some staff members in the audience
who can get it to you
I just ask that you make sure that
everybody can hear the question so that
she can respond. I'll start off just
really quick with three of the cards
One of the questions is that Dr. Fritsma
said psychologists were more satisfied
than other fields - can you tell us what
the satisfaction numbers are in other
professions that you know of?
Dr. Fritsma: Well so yeah
the quick answer is not really we just
fielded this brand new survey and the
site and the satisfaction questions are
new on this survey and so we're
we're seeing some data roll in and in
preparation for this presentation I took
just a really, really quick look I think
I did write down for social
workers for example which is you know
maybe a close comparison I believe that
forty-five percent of social workers
indicated that they were very satisfied
with their career overall where's you
guys were at sixty-two percent. So I think that's the only one I was able
to look at because not all that data is in yet.
Angelina: Thank you, the next question is which
state passed the SCI-Pact? Does anyone in
the audience know?
Arizona was the first state to pass the
SCI-Pact. And just as a reminder
their single right now and so until they
get a relationship partner we can't
practice into Arizona just yet we'd have
to hook up with them, so we look forward
to continuing to have that conversation.
The next question,  it says looks like a
random client satisfaction might be
quite different survey by degrees and by
license type.
And other potential dependent variables, I
don't think we look at outcomes enough
Dr. Fritsma, do you have any feedback on
outcomes and how that might be?
Dr. Fritsma: My group does not, we do not
look at patient outcome we do not survey
a patient's or you know review
patient outcomes but others in
our department in the Minnesota
Department of Health do so that would be
our health economics program - I tend to
agree though I mean we you know we could be looking at outcomes more and that's
something that that department of health
is really concerned about that obviously
that's our mission so thank you.
Angelina: Our next question from the audience is
what do you see a psychologist's unique
niche? As you know it's difficult,
we have an array of mental health
professionals and it's difficult to
explain to a client how psychologists
different from other mental health professionals.
Dr. Fritsma: Okay this is
the first year that we've collected data
on psychologists so it's really I mean
truly in the last two weeks is the first
time that I've had a chance to delve
into this profession but my and this is
so this is gut not data, which I am
not always comfortable talking about but
reading through your responses for your
work satisfaction questions I got a very
clear sense that  this is a
group of people who are caring and also
intellectual and I think if I had to
venture a guess - I think that when you're
focused more on kind of individual
outcomes as opposed to you know like in
social work we're looking more it kind
of how the how society however the
individual functions in society and so I
think that that's
such a valuable perspective to bring to the work of mental
health and I think it would be a
huge loss to see
those services dwindle in our state.
Angelina: We have an audience question and they
should have a mic go ahead.
Audience: Thank you, with regards to the inordinate
positive satisfaction of psychologist I
want to throw a little food for thought
and it's especially related to the
context of the fact that one of the main
dissatisfaction points was low rate of
pay with regards to the extreme student
debt and I wonder whether the positive
satisfaction may be reflective of
cognitive dissonance. We put so much in
especially those - you know younger people
coming out with six-figure debt and
going through a doctoral program they're
gonna be a little bit more apt to want
to put their profession and a positive
light because of that fact so any thoughts?
Dr. Fritsma:I oh that's so fascinating you know I was listening to
some show on NPR about how they
did an experiment where you know
people had to do with these meaningless
tasks you know like I don't know
stuffing envelopes or something like
that and they for one group they
paid people and for another group they
did not pay people
well guess who was more committed to the
task? The people who didn't get paid
and so yeah I mean that that could very
well be. I happen to believe that the
work that you do is very meaningful and
and would be very
satisfying to be able to see people make
improvements so I hope it's not just
cognitive dissonance but that's really
interesting point.
Audience: Well the one thing I'd say
with regard to your last comment, I
believe those LMFT's, licensed social
workers also see that same fact with
regards to the value of their work but
there's a dissonance between our level
of satisfaction and theirs, and it could be
explained by the great cost it takes us
financially and personally that we need
to get there.
Dr. Fritsma: That's yeah that's really interesting. My office is actually planning
on doing a a broader report on the
mental health workforce starting once we
get all of our data back, starting this
fall and we'll be
looking into that - that's very
interesting.
Angelina: Few more question from the audience - regarding telemedicine and skype, do you have any
information on how much psychologists
would use
tele-psychology and skype?
Fritsma:  I wish I did
you know I was checking with some folks
in my office before giving this
presentation and I know there's a
difference between the type of equipment
that you can use that's dedicated
telemedicine, telehealth equipment versus
something like Skype or FaceTime and
things like that and so, you know I
actually was hoping you all would
provide me with a little bit more
insight on how that works for you and
how that works with reimbursement and
things like that so maybe I don't know maybe others do?
Audience: You present really
interesting numbers on the percentage of
our career field that's looking at
retiring in the next several years and
it looks like we're already starting to
slip behind in terms of the demand for
psychologists, have you noticed that
trend in other career field in the past
and how they navigated sort of that
shortfall especially as it accelerates?
Fritsma: The answer is complicated.
Well one of the I guess maybe what I can
say is one of the, and I
think Mary and Glenice can
talk about this a little bit more too,
fortunately we have people that are
actually really looking into this and
trying to put some policy
teeth into this but I will say that
looking at the numbers it can be very
very difficult
not so much with psychology but with
other mental health professions, it can
be very difficult to document a shortage
it's very easy to document, you know, that
the need is not being met by looking at
things like wait times and
you know travel times and things like
that and so the way that
decisions get made around post-secondary
training and things like that is it's
oftentimes fairly data-driven and so if
you're looking at that demand it's a
little harder to make that case I think
fortunately with
mental-health we've been able to make
the case and so you know I think later on this morning we'll talk a
little bit more about how that'll work.
That answer your question?
Audience: I think you're getting at it, I think maybe a second part would be maybe if documenting a
lack is difficult but documenting the
need is easier in other career areas
where you've seen this high need and
maybe fewer practitioners I'm thinking
about parallel fields have you seen what
usually happens to do they let more
types of people provide services do you
see the demand get met in other ways I
guess I'm wondering about other fields
that might be paralleled the psychology?
Fritsma: I think this is probably  wind up getting
addressed a little bit more with the
plan you know team care is an area where
I think that's starting to happen a
little bit and hoping you'll talk about
some of the peer support specialists and
folks like that and those types of
solutions to that problem.
That's a great question my office
does not actually we do not do kind of
career outreach I think that's a that's
a piece of you know something that could
be done but that does happen in the
state so you know other offices and
folks over at MNSCU are doing things
like that and actually the the kind of
the the data side of it is happening as
well there's a large effort over at the
office of higher education should to
link you know student records all the
way up from kindergarten all the way on
into the labor market and when we're
where our data is actually gonna be a
part of that and so we're going to be
able to say
well what you know which type of people
are more likely to go into these sorts
of fields and what kind of interventions
can help them, can encourage them to
move into these fields.
Angelina: As we were wrapping up
our Q&A session I do have some
additional cards, feel free to write down
any more questions and pass them and
we're going to have a half-hour panel
session after our second presenter presents
One of the questions focused on the
marketing or encouraging people to
join the field, I'm excited to share that
part of the plan has a goal of
recruitment and we'll be talking more
about that in those focus groups and
you'll have the opportunity to perhaps
brainstorm and how perhaps the
psychologists as they move towards
retirement could serve as some of those
ambassadors for the field especially
with a high level of satisfaction that
they might convey to new individuals so
thank you so much Dr. Fritsma.
I'm again so pleased to be able to lead
this great group and to introduce our
next speaker. Mary Rosenthal is the
director of Workforce Development for
Healthforce Minnesota. Healthforce
Minnesota is one of Minnesota's 8
centers of excellence launched by the
Minnesota state college and university
system. For the past two years she has
spearheaded the legislative charge to
develop a statewide mental health
workforce development plan. So as Dr.
Fritsma talked about psychology and its
data we're now going to get into the
meat of what has been done what is
recommended to be done and then what we
might do in the future.
Mary came to Healthforce Minnesota from
her position as director of the Service
Employees International Union 1199
Northwest training and education fund, a
union management taft-hartley fund for
healthcare workers in the state of
Washington. Prior to the training fund she
directed the phillips and east metro
health career institutes in Twin Cities,
community-based workforce development
organizations, she built career ladders
for entry-level healthcare workers
created a partnership among employers, a
local workforce system, and colleges to
support entries into good-paying jobs.
Mary will be talking about the workforce
plan and I'm happy to introduce her.
Mary: So it's really an honor to be here to
talk to you today I just wanted to add
that in addition to a lot of experience
that I have with workforce development
and particularly healthcare workforce
development
I intimately know the mental health
system of Minnesota over the last 42
years, I unfortunately come from a family
that has been plagued by plenty of
mental health problems and I just want
to thank many of you in this room who
have helped numerous of my family
members get onto a much much better
place in life, so thank you very much for
the work you do. What I wanted to do in
today's presentation and it's going to
just go on until eleven-thirty - I'm gonna
talk pretty fast because I have a lot to
go over
but then we have a half hour for a lot
more detailed questions and answers so
please if you can just hold on to your
questions we'll get them at the panel
discussion. What I wanted to do today was
to follow up on some of the introductory
remarks that Angelina Barnes had made
about how this workforce plan got
developed, its genesis the public policy
the thinking that went into it, and then
I want to go over very specifically the
24recommendations that were
finally agreed upon and where we are in
the implementation of those
recommendations. So is Angelina said the
legislative charge to develop this
workforce plan was Senate file 1236 and
it charged the Minnesota state colleges
and universities to convene a mental
health workforce summit and the purpose
was threefold: to develop a plan to
increase the number of qualified people
working at all levels of our mental
health system, to ensure appropriate
coursework in training, and to create a
more culturally diverse mental health workforce.
The legislation also outlined whose
needed to be involved in the mental
health workforce summit and it also had
$50,000 attached to it and that's the
way that I always know that the
legislature is serious about getting
something done is that they attach money
to it to actually pay for it getting done.
As Angelina told you Minnesota, of
its eleven areas, nine of them are
considered to be mental health workforce
shortage areas, the only areas of the
state that are not so designated are the
twin cities and then areas around
Rochester because of the Mayo
Clinic and I can tell you from the
community forums that we held in the
twin cities and in Rochester, they think
that they ought to be designated
shortage areas as well, given what wait
times are. 36 other states around the
country have mental health workforce
development plans that's one of the
reasons that NAMI Minnesota, several of
the providers and the MN
department of human services pushed so
hard at the legislature, they said this
is not going to happen without a
concrete plan, without concrete
recommendations that are followed up on.
We were also, and I just want to lay this
out at the beginning we were asked not
to go into the issue of the autism
workforce and its needs or the
substance abuse workforce and its needs
and it's not that there aren't big needs
it's not that there isn't a lot of
overlap, it was simply that just focusing
on the mental health workforce was
considered to be a large enough job, we
had 18 months to prepare the plan and
get it ready. To attach anything else to
it was to basically consign it to not
being able to be successful so I want to
acknowledge that that is work that
continues to need to be done and that
hopefully the work that we did on this
plan would help inform creating
workforce plans for both the autism
workforce as well as the substance
abuse workforce. You might ask why
I was MNSCU why was the Minnesota statecollege and university system given this
particular charge while a number of our
universities have social work programs?
It's really the private colleges and the
University of Minnesota that do a lot of
the training and education of mental
health professionals but MNSCU
has a wonderful track record in terms of
Workforce Development at all levels and
if you remember the charge of the
legislation it said mental health
workforce, not just at the professional
level but at all levels and we also in
particularly healthforce has an
extraordinary track record as a convener
in pulling together a variety of
different organizations and making
things happen as you will see. So the
genesis of the state plan was taking a
look at whether or not Minnesota's
mental health force was going to be able
to meet the needs of its citizens,
particularly with the passage of the
Affordable Care Act and the ability now
for thousands of more people to be able
to access the mental health care that
they needed. We have an aging mental
health workforce, ongoing discrimination
associated with mental illness, and I use
the word discrimination rather than
stigma because I believe it is
discrimination, low wages, increasing
regulations and the cost of education
and training. Little money had gone
into any sort of mental health work for
the previous decade until the shootings
at Sandy Hook in 2014 and I think it was
that as well as the improved economy and
as I said the passage of the Affordable
Care Act that really set the stage for
the 2013 legislation getting passed and
a really big shout-out needs to be
given to Senator Clausen who addressed
you at the beginning of this conference,
Senator Clausen authored and carried the
legislation,
he attended every one of our steering
committee meetings, which was I think
except one or two when he was in session,
and in 2014 really led the push for a
lot of the legislation that did get passed
to address some of our workforce needs
so he is a true champion of building the
kind of mental health workforce that we
need in this state. Clearly workforce
was not something that hadn't been
looked at before, I don't want people to
think that all of a sudden there was
2013 and nobody had taken a look at
mental health workforce before and this
just gives you sort of a overview of the
last 15 years and some of the mental
health work and focus on workforce but
focus on a number of other reforms that
have been attempted in the state and i
am sure that many of you have been
involved in these efforts, 1999 hearings
held by the state Advisory Council, the
mental health Minnesota Mental Health
Action Group, the acute care needs
subcommittee report, the workforce
shortage working group incentives,
what tends to happen in workforce
especially when its mental health
workforce is that there's so much that
needs to get done around mental health
and mental health care reform in general
that workforce get put off at the very
end, so a report is written of a
series of you know hearings are held
over the course of five days and it gets
to be friday afternoon and people
finally say oh we forgot to talk about
you know workforce and in point of
fact it's the workforce that is you know
I mean all of you know this, that is it
imperative to address that because who's
going to deliver the services so that is
part of what led up to this very
specific 2013 legislation, was it really
gotten short shrift. We formed
to a steering committee that was
comprised of all of the stakeholders
identified in the legislation so the
Department of Human Services, the
Department of Health, the Minnesota state
colleges and universities, university of
Minnesota, private colleges, mental health
professional, special education
representatives, child and adult mental
health advocates and providers, and
community mental health centers. You can
see all of that we tried to make it as
representative of the state as possible,
we tried to make it as representative of
diverse communities in the state as
possible, we made this as much of a
working group as possible so we told
everybody that we invited to be on the
steering committee that we wanted them
to meet with us monthly, preferably in
person for two hours up to the summit
and then for two-and-a-half hours to 3 hours after the summit to
actually draft the plan and I want to
thank the psychologists particularly who
volunteered their time, they were not
representatives of your board but we
have Dr. Glenace Edwall who really
played and extraordinarily important
role on our steering committee Dr. Bill
Robiner, Dr. Elissa Vang,
Dr. Tricia Stark and Dr. Willy Garrett
who are represented the Minnesota
Association of black psychologists, so
really good individual psychologist
representation in terms of this steering
committee and I want to thank you all
very much.
I think that that covers on the
stakeholders who were the steering
committee. The first thing that we did as
a steering committee, because none of us
had drafted a state plan before was to
try to figure out what was it that we
needed and we knew that we needed a data report, we knew that we had very very
little information
on the various mental health
professionals in the state and Dr. Terry
Fritsma ended up drafting that data
report for us and all of this
information can be found in our website
we've got the entire plan along with all
of the appendices along with updates on
our website in case this isn't enough
for you. But Dr. Fritsma took a look
at the supply and the demand of all of
the mental health professionals around
the state, broken down by region, what
schools are producing, how many, where
these people ending up working, how are
they broken down by both race and
ethnicity and by gender and so we had a
very good idea of the mental health
professionals but that left a huge swath
of people who work with people with
mental illnesses who are not
professionals and that is a very very
large part of the mental health
workforce and it was almost impossible
for us to really pull out that data so
that is some work that still badly needs
to be done. Minnesota is better in its
data collection than most states but i
am reminded that we measure what we want
to manage and we measure what matters
and to me the fact that we couldn't pull
out a lot of this data on the more
entry-level and paraprofessional level of
mental health professionals means that
once again this is just a
part of the stigma that goes along with
mental illness and all of the people who
work with people with mental illnesses.
So we got the data report, we took a
look as I showed you on the previous
slide of the other the previous efforts
that Minnesota had made 36 other states
had mental health workforce development
plan, some of them were great
some of them were not so great, we wanted to take a look at what were some of the
best ideas that came out. So for example
in New York state plan
they have a huge problem with
upper New York State, I think something
like ninety percent of the counties in
upper New York State had no psychiatrist
or psychiatric APRN's, so nobody who
could write a prescriptio. And so there
are a lot of ways to try to tackle this
issue and what New York decided that
they wanted to do was that they would go to the nurse's
already working in these counties who
had their RN or BSN and offer them an
online opportunity to get their
psychiatric APRN, they developed the
program in conjunction with the
university of Syracuse and then they
defrayed half the cost of the
tuition, so these were nurses who already
lived there, they were already committed
there, they have their families there,
they knew they liked their work, and so
it was just a question of
beafing up their
skill set, so those are the kinds of
things that we wanted to do by taking a
look at some of these other, some of
these other state plans. we wanted to get
some input from all over the state.
I used to live in Duluth and you have
no idea how much I resented all the
trips I had to make coming down to the
Twin Cities rather than the other way
around, so healthforce decided that we
wanted to hold community forums all
around the state to really talk about
mental health workforce ,so again as
Angelina told you we went to Worthington,
to Rochester to Bemidji to the White
Earth indian reservation, to Duluth to
Wilmar, we really spend about six months
putting on these to our forums and then
really trying to get people to hone in
on workforce and to try to generate
recommendations about what
would you like to see happen to your
mental health workforce and this is not
easy in a group of people who really
want to talk about all of the other
problems that are happening in mental
health and there are just a huge number
of other problems, so to try to get
people to really
think about workforce and then not
just answer every question about
workforce with we need to increase rates,
we need to increase rates. We increase
rates everything will be taken care of.
We wanted to acknowledge, yes rates need
to be increased but what else? Does that
end up taking care of cultural
competence, does that end up taking care
of ensuring appropriate education and
training? So these were really very
directed conversations where we tried to
elicit as many recommendations as
possible.
We knew that a lot of people weren't
going to be able to make it to the
summit, they weren't going to be able to
come to a community forum so we also had
a survey of more than 500 people
participated in the survey, giving us
some really excellent recommendations
but also some extremely interesting
insight as you saw from Angelina's slide
about how people of color perceive the
competence of mental health
professionals when it comes to cultural
competence compared to white people. So
we we got a lot of information out of
that survey and then at the tail end of
May we had a summit, did anybody in
this room come to the mental health
summit at Hennepin Technical? Glenace
okay, we very specifically wanted
to make sure that it was not overwhelmed
by people from the Twin Cities so we
made it and that it represented all of
the various stakeholders so we did make
it by invitation only
it was a hundred and fifty people and it
was an eight-hour working session so
this was not a conference where people
got to sit back and listen, this was a
conference where people had to sit at
tables and generate recommendations.
Recommendations: so the steering
committee then met with over 250
different kinds of recommendations from
the community forums and from the summit
and we decided what are the criteria for
these recommendations going to be?
And we said they have to be actionable,
they have to have somebody who is
accountable for making them happen, they
have to be measurable and the steering
committee has to have consensus on them.
So working backwards we said that we
wanted to have consensus because it is
so easy in groups to focus on the one
thing that they can't agree on and then
spend ninety percent of their time
trying to convince people why they're
right and we just said
we're gonna put those issues into a
parking place because there is so much
that needs to get done that surely we
can agree on some things that need to
get done and then come back and have
another summit in another two years and
tackle those issues. But we really wanted
some successes that we could build on,
this is an area that's been overlooked
for way too long and it needed some
momentum and it needed some success.
We also wanted the recommendations to be as concrete as possible.
It's one thing to say
that we need more diversity in our
mental health professional workforce. In
California they defined exactly what
that was going to be over a five-year
trajectory, it's going to be increasing
the number of african-americans who are
enrolled in this program by X percent in
year 1 by X percent in year 2 and when you start being very very
concrete, the steering
committee discovered the extent to which
a recommendation could actually be done
versus one that really couldn't be done.
That it's just we didn't have the time
to make it work or we couldn't figure
out concretely when we would know that
had actually succeeded.
We also wanted to build in somebody who
would drive it
our experiences that once something is
everybody's responsibility it becomes no
one's responsibility and it's not going
to get done so to the extent that we
could we tried to assign each one of our
recommendations, a driver for that
particular recommendation. And as a final
thought
there are some things in the delivery of
mental health care services in Minnesota
that really work and we were not
interested in creating things from
scratch if we had some things that
worked really well and it was just a
question of trying to marshal the
resources for them, so that was another
thing that the steering committee
thought about. We took those 250 +
recommendations and with the help of Dr.
Mark Schoenbom, who specializes in
workforce development, we organize them
into these big categories of recruitment
education and training, placement after
program completion, retention, and then we
wanted an assessment, we built in sort of
okay, we've got these recommendations,
what works, what doesn't work, and why. And this last part assessment was
really important to us, particularly as
we went around to the community forums.
The number of times that people in
Bemidji have been called together for a
community forum to discuss mental health, to discuss student loans, to discuss this
discuss that, and you know plans are
written and then they are shelved.
And they simply said, we don't want that to
happen, we want something that is
seriously actionable, and we want you to
go back and tell us how well this has
worked and how well
it hasn't worked. So we built in an
assessment component. So I have now got
20 minutes to walk you through the
recommendations and how we are faring on them.
Everybody ok with that? So, recruitment:
how do we expose middle and high school
students to mental health careers and
this was a comment that somebody had
brought up and we actually had a number
of very concrete subsections to
this recommendation. Healthforce
Minnesota runs a Scrubs camps, this is a
way to introduce middle and high school
students to various healthcare careers
and for exampl
we have aging suits and they put on
aging suits and they discover when you
fall down how hard it is to pick
yourself up when you're an older person,
they type their own blood, they
make sets of dentures or whatever, they
have a lot of people from the community,
providers as well as teachers who come
in and do these two hour classes to
introduce people to various careers.
We had never had a mental health component until two years ago and we started to
bring in a mental health component, we've
expanded our scrubs camps and so that
they are now being offered all over the
state of Minnesota in conjunction with
either MNSCU or a private college
and that's one way that we're trying to
attract more people to these careers. The
school linked mental health grant
recipients, and I think they're about 80
of them, wherever their high schools
have a career day they bring somebody in
to talk about mental health careers and
i think that the thing that's that some
tricky about this is how do you make
mental health is a career come alive to
a twelve-year-old or sixteen-year-old
because if what your job is mostly doing
is like talking and you're up talking to
a bunch of people for 40 minutes and I'm
discovering this myself people sort of start,
what's interesting about this? But Drexel
university offers a two-week mental
health camp introducing people to mental
health careers
over two week period and I got in
touch with them to talk to them about
some of the things that they do, and it's
just fascinating. They will hire an actor
and they will have two people from the
class and the actor will be somebody
who's seeking mental health care and
they'll have two people from the class
act as professionals and then they'll
have the rest of
class you know look and try to do you
know sort of a critique of it, so you
really get a sense of not you're telling
me what the work is like I'm getting the
experience of what the work might be
like. There are people who bring in
various, I know I was in Bemidji and the
psychology professor actually brought in
a couple of her family's pet white rats
and had all of the campers do
a psychological experiment on these
white rats because research is part of
something that people who study, you know
not everybody gets into you know
counseling, so anyway we approach
the cultural providers network and we
got 12 volunteers of mental health
professionals of color who are willing
to come and speak at any of the Twin
Cities high schools whenever they
have a career fair because we really
wanted to  have people who look
like the people that they're trying to
recruit and I know that Val DeFor,
who's the executive director at
healthforce told me that one of the most
poignant comments that she got from one
of our scrubs campers after a
presentation by a social worker at one of
our camps was, I never knew that social
workers did anything but take children
away from their families. So this is, I
mean there's an
incredible opportunity here to reach
into these groups of young people and
get them really excited about the
incredibly important work that you do.
There is one effort that I'd
like to see tried, I just haven't been able
to find a champion at the University of
Minnesota but the university of North
Dakota in conjunction with the Bureau of
Indian Affairs actually runs that
psychology Summer Institute where they
bus to a number of different
reservations and they take students who
are interested in studying psychology in
college and they bring them to this
two-week camp where they
already know that they want to be
psychologists and they beef up their
math skills and their science skills so
that they can be
much much more successful and at our summit we actually got to talk with
one of the graduates of that program. Now
something like that takes money and it
takes time but it has actual concrete
results of creating more native american
psychologist to serve the North Dakota
population and it would be very nice if
the University of Minnesota would take
that on. Improved collection of a
workforce data at all levels, that's
something that we're working with
Terry Fritsma on and this one is
probably going to be a five-year project.
What we would really like to get is
not just the data on mental health
professionals but get the data on
psychiatric technicians, get the data on
very entry-level workers who are coming
out of high school and are playing this
this role in adult foster care, and
security counselors at our state
hospitals and really an account on who
is doing what, where, and what are they
getting compensated and what is the
education and training that's required
for them. So that is a work in progress.
Ensure access to and affordability of
supervisory hours. This is an enormous
issue not just for mental health
professionals but for all healthcare
workers, I think all of you know that
providers whether their hospitals or
clinics are just getting financially
stretched farther and farther and so
their ability to provide either free
supervision or
any sort of supervision at all is
really getting compromised. Senator
Clausen had a bill in the Senate
unfortunately didn't make it into the
last budget bill but that would have
expanded these supervisory positions
around the state.
It's a terrible constriction in the
pipeline and I'm concerned that what has
started to happen at least amoung
social workers is that they are
getting jobs for supervision is not
being provided and they are now having
to pay for their own supervision. So you
get a Grand Rapids social worker who is
graduating with a master's degree,
seventy-five thousand dollars in debt,
now having to pay for her own
supervisory hours making thirty eight
thousand dollars a year.
I mean the shift of the funding it's
going almost exclusively to the
individual and it really requires us to
figure out what sort of a collective
action so that everybody's shouldering
the cost of this. We talked about getting
higher level mental health degree
programs in rural areas of the state
again, Bemidji they really they were very
very unhappy with the Twin Cities, you
know the fact that you have to come down
to the twin cities to get a lot of these
advanced degrees means that a lot of
people stay in the twin cities. We did an
informal survey of -
I can't remember what profession it was
but fifty percent of the people that
we surveyed tend to work within 50 miles
of the place where they completed school,
so being able to figure out how to get
education to people right where they're
at with just sort of the genius of that
New Yorkpsychiatric APRN program.
You're seeing a lot more online social
work programs that are happening but not
as much in the other mental health
professions so this question of how
we get mental health care into you know
parts of Greater Minnesota, you can have
telemedicine but it would be really nice
to have professionals actually living
there and in the community as well.
Increased by four the number of
psychiatric residency and fellowship
slots in Minnesota over the next two
years - we managed to get three million
dollars over the biennium for residency
slots psychiatric resident,
these are four years so we're going to
have to go back, we're going to have to get
more money but we did get two additional
residents as a result of this,
psychiatric residents as a result of
this so that was nice.
Expand and replicate the diversity
Social Work advancement program to
additional mental health disciplines
like married and family therapists,
psychologists and expand practice
locations.
This is a program that particularly
target social workers, immigrant social
workers, and social workers of color at
particular times in their program to
provide support so that they can make it
through their programs and we have been
funded by grants from DHS. It continues
to be funded, we really wanted to figure
out whether there was a way that this
could be expanded to other mental health
professionals and around the state we
didn't get as far as D swap being a
pilot for other professions but DHS did
give a lot of grants that basically
accomplished much of the same thing in
this last legislative cycle and I've got
a list of what those are for anybody
who's interested.
Expand the capacity to trained certified
peer specialist and family peer
specialists throughout the state with a
particular emphasis on recruitment from
communities of color.
There's a recent report that just came
out on February first 2016 about the
usefulness of the peer specialist
program. How many people are familiar
with peer specialists?
It was something that I had no
idea about but it's one of these
emerging professions that seems to
provide a lot of help for people who are
in crisis and to the teams were working
with people in crisis.
Support efforts to expand and broaden
mental health telemedicine, require
commercial health plans to cover
services delivered via telehealth
technology, 773 thousand dollars was
appropriated in the 2015 legislative
session to help fund that, so it's a
beginning, there's going to be a report
back in the next legislative session to
determine how well that's worked but it
was it was something that there was a
lot of bipartisan support for.
Promote a team based healthcare delivery model for mental health treatment and you probably
know a lot more about this than I do. I
was just recently reading about what
Sanford Health and Thief River Falls
community are trying to do in terms of
filling in the gaps, where they've got
very very limited resources and they're
trying to figure out through working
collectively how to stretch them as far
as they possibly can. I encourage
job-seeking in high-need areas and
mental health professionals to the
eligibility requirements for the
Minnesota health professionals loan
forgiveness program, increased funding
and make sure that fifty percent of this
additional funding be made to mental
health professionals from diverse ethnic
and or cultural backgrounds.
This was one of the real highlights of
the last legislative session the loan
forgiveness program expanded from
740,000 dollars a year to 3.24
million dollars a year, so it more than
tripled and they were l the
only mental health professionals that
could be funded were psychiatrists and
psychiatric APRNs and this has now
been expanded to include all mental
health professionals in the rural areas,
 it got implemented sort of the
third of the fourth
quarter of 2016
but there were four mental health
professionals that were funded in the
rural part of the state in 2016
and for next year they're already 25 who
are being funded, and in the urban area for
2016 there were five funded and next
year they're going to be nine funded
There are for loan forgiveness, there
are very particular parts of both the
twin cities and southeastern Minnesota
that are designated as shortage areas,
just very particular neighborhoods which
is why you see that there's some of
these urban grants that are being made.
Will Wilson who runs that program says
that about
I think it's eighty percent of the
people who take advantage of these
loans end up staying in their
communities so it is money that is
really well spent.
Continued funding of the foreign trained
healthcare professionals grant program.
We got two hundred thousand dollars to
continue that funding, identify and
address gaps in the educational
certification or licensing systems that
impede career movement from entry-level
para professional positions to terminal
degrees and licensure as an independent
professional. This is being tried in some
places like Philadelphia where they
have a consortium of hospitals and you
will have somebody who's worked in a
hospital or a clinic as a
paraprofessional, maybe with just one
year of college but loves working just
loves this work, is very very familiar
with it and trying to figure out how
somebody like that can move up a career
ladder and get a masters degree and
become a professional is something that
we've actually been able to figure out
how to do from in the nursing
professions from a nursing assistant to
an LPN to an RN. I don't know that I've
ever seen any profession where the gap
between a very entry-level worker and
the next step is quite as big as it is
in mental health. So you can be a
security counselor at st. Peter with a
high school degree and you get some you
know internal training and then the next
step is a bachelor's degree in
psychology and there's really sort of
like nothing in between, so one of the
things that we're really trying to
figure out is, what might that be and
we've been doing a lot of interviewing
of employers to try to figure out what
are the skill sets that maybe a two-year
degree could accommodate and embrace
that maybe the four-year psychology
degree doesn't go after and then
how do you provide financing and the
training and the employer buy-in to make
that kind of thing happening?
We're really trying to figure out how to
address the shortfall in the middle of
workforce and always possible. Increase
reimbursement rates, DHS has already
posted an RFP for a study and I think
the results on that are going to be out
the end of this year. I'm going to go
very quickly. And then assess
the recommendations. So July 2017,
hopefully we will have another summit
and we will assess the recommendations.
Now the ones that have yet to be
implemented - I talked about the Indians
in psychology doctoral education program,
not implemented. We asked for five
hundred thousand dollars to pilot
project lead the way biomedical science
curriculum in 10 schools in
Minnesota as a way to try to get more
people interested in science and from
there to mental health.
That's going to be introduced next year,
we couldn't find a house sponsor. Require
3rd party payers and commercial insurers
to reimburse the same way medical
assistance does, so for supervision and
internship, so that services provided by
mental health trainees under the
supervision of mental health
professionals are reimbursable - that
did not go anywhere.
So this is like your work, this is
what you get to get to discuss this
afternoon, how you're going to make that
go somewhere. Develop a faculty
fellowship model to engage faculty in
the newest understanding and treatment
of mental illness in both children youth
adults and older adults. So 42 years
ago when my brother was diagnosed with
very very serious schizophrenia it was
basically sort of a lost cause and I
remember the doctors at the Mayo Clinic
just saying, was just
heartbreaking you know for my parents.
Other members of my family more
recently have been diagnosed with
schizophrenia and the message that they
are getting is totally different, its
recovery and we've just got to make sure
that the education and teaching that we
are providing to people, whether it's at
the continuing education level or our
new graduates really understand that
this focus on recovery is absolutely
be critical. Charge the department of
human services with establishing a
criterion payment mechanism to
incentivize mental health settings
committed to providing students with a
practicum experience that features
evidence-based treatment interventions.
Again, that's something that we're going
to try to focus on and yet establish.
Improve and expand cultural competence
training, establish cultural awareness
as a core behavioral health education
and training requirement for all
licensure and certification disciplines.
I will tell you that this was the
hardest recommendation, we had a lot of
specifics attached to it and it always
ended up being the very last thing
discussed in our community forums, it was
the last recommendation addressed by our
steering committee. This is not
going away and we really need to figure
out how to be very concrete in what we
want and how to provide the resources to
make this happen, the most concrete that
we could get is that a variety of
organizations would hold a cultural
competence summit to showcase best
practices in the promotion of cultural
competence in delivering mental health
care services and provide access to
education and training resources. But all
 I can say is that when you have a survey
that shows that level of discrepancy
between what people of color want and
what people who are white think that we
need, thats the real disconnect that
I think that it's important to try to
figure out how to address and then how
to measure whether the way that we're
addressing it is actually making a
difference. Increase exposure to
psychiatric mental health experiences
for nursing and medical school students.
This is really you know getting at this
idea that a lot of mental health
diagnosis are made by primary care
doctors or are seen by nurses and they need
to know a lot more about mental health
and unfortunately what we are finding is
that in some of our nursing programs
it's the mental health residency over
2 -3 days that is being booted off in
favor of other things so that our nurses
aren't even getting that experience and
so we need to change that.
Utilize accreditation council this is another
way to try to expand access and
program funding by utilizing the ACGME
and APA standards for psychiatry
residency and accredited psychology
internship programs, we'll talk more about that.
Provide support so that all
psychology internships at state
institutions are accredited by the APA, there two of them that are run by state
institutions that are not accredited by
the APA, we asked for fifty thousand
dollars from the legislature because
this is really a question of money and
resources that these programs need and we
couldn't get that money. There are other
non-accredited APA internship programs
that are running in the state but these
are two that actually are run by the
state and we you know we need to address
that, unfortunately also need to keep
Anoka hospital open and so there are
priorities right? Department of Health
will evaluate work funding as the way of
getting more money into training sites,
we didn't get any money for that. Ways
that technology can be used to
streamline paperwork and ensure
necessary data capture, we are pushing
DHS to try to fund some pilots over and
over and over again from everybody we
heard the paperwork is killing us. So i
don't think that the paperwork is going
to go away but what are some creative
ways that paperwork that can be done so
that it isn't so all time consuming and
seen as being really sort of outside
the work.
Ok I think we're going to be discussing
on the recommendations is what
worked and why, what didn't work and why,
and what should be included in summit 2.0?
I think that's a nice segue
into what you're going to be talking
about at 1:15 so, thank you very much.
Angelina: Now that we've heard a little bit about
psychology itself and we've heard about
the mental health workforce plan, we'd
like to take about 25 minutes and have a
panel discussion with our two presenters
Mary Reagan was originally going to join
us on the panel and was unable to do so.
We regret her not coming, but it resulted
in a very nice gift as well, and I have
to tell you I begged, I pleaded, I asked
five minutes before we started and so
with that disclaimer we are lucky to
have Glenace Edwall here who is going
to join our panel discussion.
Glenace is a PhD from the University of
Minnesota educational psychology,
she also has a psyd at the university of
denver in child and family focus. She is an
associate professor, director of clinical
training Baylor University from 1986 to
1991. University of Minnesota health
psychology program and the department of
pediatrics from 1991 to 1993.
Responsibilities there include
supervising interns and postdocs. She was
a psychology services supervisor at
Children's Hospital Minneapolis from
1993 to 1996. She's also the director of
the Fraser Child and Family Center in
Minneapolis from 1996 to 2000. She's the
director of the children's mental health
2000-2013 and the children's and adult
mental health departments from Minnesota
department of human services from 2013
to 2015. This position including
participating in the workforce
development plan, so that's how she got
integrated very closely with the
creation of this plan. Glenace has retired
in 2015, or she thought she did.
Until we pulled her out here so she's
currently consulting, supervising
postdocs and serving as an accreditation
site visitor for APA. Let's thank her and
Dr. Fritsma and Mary Rosenthal as we go
into the panel.
We also have with us today on the panel
Valerie Defor and somebody snapped up
my notes.
Defor: I'm Valorie Defor with healthforce
Minnesota, I'm the executive director and
I think you all are all probably feeling
the same thing I am in how lucky am I to
have Mary Rosenthal on my team and to
have led this work for us but that's
what we've been doing a lot of for the
last two years.
My background is actually, I've been
doing this type of work force
development work for the Minnesota state
colleges and universities since 2001.
Prior to that I was in healthcare
consulting for about 10 years with a
masters in health care administration
from Arizona State University.
Angelina: We'll start
off with some of the card questions that
we haven't gotten to yet and that have
been submitted and then we can also take
questions from the audience as we go along.
The first question is for Dr. Fritsmas for 5 points, can you discuss or describe
the non practitioner roles of
psychologists who responded to your
survey, settings, trends, differential
levels of satisfaction compared to practitioners?
Fritsma: Okay in my defense,
so actually I
cannot, and the reason is that we just
filled out the survey at the end of
april and I pulled out the
data at about May fifth so I've been
furiously analyzing the results
just for the purposes of this conference
and kind of making sure that we've got
all those t's crossed and i's doted,
but if you could read that
again that'll give me some good ideas
for future analyses.
Alright next up we'll start with
Valerie Defor. Having a more diverse
workforce is absolutely necessary.
Minnesota has a high rates of
segregation access to care and it seems
there's more to it, some data suggests
that people of color perceived
psychology as a white profession.
What are some ideas for expanding care
models that are inclusive of a variety
of cultural conceptions of mental health?
And obviously others can chime in too.
Defor: Well I think you know actually
Mary covered you know a little bit of
that as we discussed it in the
development of the mental health
workforce plan and how we were just so
intentional in kind of engaging and
having that discussion around cultural
and racial ethnic diversity and cultural
competency, it's a challenge not only -
it's across all of our healthcare
occupations and disciplines you know we
know empirically and I
say this a lot, that it makes a
difference in patient outcomes when the
healthcare providers look like the
patient's they serve, so we are dealing
with this with our nursing programs, with clinical labatory
with any of our healthcare programs, and I'm sure all the employers and any of their
occupations. You know one thing I guess, thinking more practically about
a response. I have personally worked with one of our federally qualified health centers.
The open door health center in Mankato
I was their board chair for six years, and
really got to see first hand what it meant to provide a welcomming enviroment
and to have care providers, interpreters, translated material, all of that available.
In Mankato, we served a lot of Somali and Hmong patients. So I think
too it goes kind of hand in hand,
we have to do our work in education with
recruitment, with support, with assisting
students and then on the employer and
the employment side there has to be that
welcoming environment, there has to be a
situation where you're perceived as
equal, as part of the team, you play that
important role. So I feel like that's
kind of a World Peace question, but you
know it's very important and I
think there's a lot of opportunities
it's just kind of done individually
oftentimes.
Rosenthal:  If I could just add
Dr. Willy Garrett made some really
interesting comments about this in terms
of when he went through his program that
he didn't necessarily get help from
other african-american
professors, that it was
a white professor who was actually able
to run interference for him but it was
just knowing that there was some actual
support and I think that this doesn't happen
sort of like automatically, I mean its a conscious and deliberate
reservation of resources that could go
someplace else that you are saying no
it's going to go here. I was down at
Roosevelt university my daughter-in-law
just graduated with a Psyd and I was
taking a look at the Roosevelt
graduating class in her department and
it was like there's sixty percent
people of color and that is a very
conscious deliberate move on the part of
it meant to provide a welcoming
environment and to have care providers
Roosevelt university in terms of who
they're going to recruit and how they're
going to support those students and what
the faculty is going to do and so I just
you know I think that where it happens
you can see that it works and where it
doesn't happen it's I say people don't
think that it's important that it happened.
Defor: You know one thing I might just
add, Mary talked a little bit about our
scrubs camp and some of that outreach to
our unit for pipeline development middle
and high school students, yesterday we
had about 240 girl scouts at three of
our MNSCU campuses and we had a
hundred and twenty a hundred and fifty
and 40 at RCTC north hennepin and
south-central Mankato, and they were
through a partnership that we're doing
with a special program that the girl
scouts has in place for high school
student girls of racial or ethnic
diversity backgrounds or on free and
reduced lunch, and so it was a day spent
learning about health careers and we had
a session on it was more related to
stress and mindfulness. So it wasn't you
know hardcore you know a mental health
occupation that was kind of shared with
them at North Hennepin but that's the
starting point you know on our end is
really just even increasing that the
exposure and the pool and those girls
loved, loved that day on campus
some of them wouldn't have been on a campus.
They got to sort of envision themselves
you know walking the corridors and
feeling like they were taking a class
and you know I think with the Girl
Scouts partnership will continue to
support those dreams and and we'll do
what we can too
Audience: Just as I have
been frustrated over the years when
people talk about the mentally ill
there's a schizophrenic, there's a person
with Alzheimer's, it torpedos the
conversation by using that and my
feeling is with a cultural culturally
diverse populations as people of color
there is a somali who is first
generation, very different. I am the work
that I did before I retired used to get
interpreters. I had a spanish-speaking
interpreter who we got what the patient
said he's from Cuba, I'm Mexican
I don't even understand the language is
he speaking. So I I guess I'm wondering
is there a way to frame the conversation that
gets around the generic thing - it's not
skin color,  it's very frustrating
because I don't see how one can make
progress unless we re conceptualize it.
Rosenthal: So let's have the summit
Mary: If I could just follow up on that, I held
it was the first-ever MNSCU nursing
faculty conference and we called it the
inclusivity and healthcare and it was
about supporting students and in our
minds it was diverse students. It was a
wonderful day,Ihad about a hundred
people, we learned from each other
it was a great day, everybody felt really
positive the very end of the day one of
our employer partners who is that the
conference who is herself
african-american, she just stood up and so
respectfully and eloquently stated you
know what this was a great day. She
appreciated it,
it was wonderful, most of the conversation
steered towards how do we support
immigrant and refugee students and
that leads to english as a second
language and medical terminology and the
stumbling blocks and all that she said
that's because that's an easy
conversation for us to have, we didn't
talk about... the nomenclature is so
hard to you know not stumble over but we
didn't talk about native african
americans in you know who live all
around us and have been in this country
for 200 years and and that's getting at
you know a bias and racism and prejudice
and so it just we have carried that
learning and that message forward in our
thinking and our work but it was really
important for her to call that out I
think and I just share that because I
think that might happen often when we
when we try to tackle this.
Edwall: Well I appreciate actually thinking
about that is a focus perhaps for a
summit too, because it was such an
important part of the legislation and of
the considerations, but it's clearly the
most important area going forward I
think for continued in examination. I
just wanted to offer before Dr. Long's
comment that actually as a profession
and doing a lot of accreditation site
visits, I'm really pleased to see how the next
generation is being trained with regard
to the standards in both graduate
programs and internships around
individual and cultural diversity that
really do push it down another level and
exactly what you're talking about,
but that's late in the game with regard
to actually developing a really diverse
workforce and so all of the the kinds of
learnings perhaps that we have gathered
in graduate education we need to start
now scratching our heads about how do we
apply that to these concepts of pipeline
and ladders so that we're also really
attracting people to the profession
who represent those communities
represent and come from communities and
would go back to those communities to
serve as well.
Fritsma: Can I just make
one more comment about that - I've done a
lot of thinking about cultural
competence especially because at the
Department of Health we do measure I
mean we measure the diversity of the
workforce and kind of you know by
default we compare the race of the
provider to the race of the population
and if we're often we say oh you know we
got a problem here and I think you know
the more I thought about that the more I
think it's just it's really so much more
nuanced than that I think I mean for
example by the time someone becomes a
physician or a psychologist or that sort
of thing I think you're also you're not
just you know you you may look like
physically like the person that you are
serving but you have you come from a
completely different socioeconomic
status so can you really are, you can you
really be expected to provide that
culturally competent care that we're
kind of thinking of when we we just
match people by race so I I mean I love
the idea of a summit I hope I really
hope we do it and I hope we give some
serious thought to some of the the
nuances around the issue it's it's not
so straightforward.
Angelina: Alright sticking with cultural
competence just for one more of these
questions here, in terms of cultural
competence we heard some of the efforts
that are being done by MNSCU and
some of the offerings
however this particular question speaks
to the perspectives of some of those groups
and we've heard a little bit about that from the rural farmer comment, and from
some other individuals about what diversity might mean.
So you said African Americans have a different perspective of white vs. African American
mental health professionals. Can you talk a little bit about their perceptions?
I think they were saying the African Americans health professionals
differed in how white mental health professionals
viewed cultural competence and do you know what the perspectives were of that minority group?
Audience: I think you said Mary, something about the perceptions of the therapists,
African Americans perceived their therapists differently
if they were African Americans or Caucasian.
Rosenthal: I'm sorry if that's what you heard, I think what I was referring to was
the survey results about what we did about cultural competence.
There was a question that we asked about
in what areas do you feel that mental
health professionals should get more
training and there were list of things
that they could check and one of them
was more training and cultural
competence and when we disaggregated
those responses we saw that only
thirty-eight percent of whites felt that
there ought to be more training and
cultural competence vs
seventy four percent in people of color
so there's just this big disconnect and
how people perceive, white people
perceive themselves versus meeting
training or white people feeling that
mental health professionals need
training versus people of color and
again this was this was not broken down
sir by quite specific ethnicity
I'm sorry I didn't make that clear.
hi my
name is  Kelly, a  psychologist from
st. peter and I would like to add some
command to get them self control and
competence training and I'm definitely
glad that that can be the topic of the
next summit
however I want to add to it is that from
the hiring recruitment to retention the
focus is really have to be intentional i
know that there is some issues with in
terms of EEO but you know we have really
to have a comparison with the population
we are serving you know whatever the
population that being self in that area
are in that setting the
recruitment and retention should be
focused bears on it now coming back to
the internship a post-op training
program and I have been always thinking
that often the program's only offer
separate like the country and competence
trending per se
instead of in integrating
the country and competence concept
across all curriculum not just one topic
not just one class but
everything from all presentation all
training the control and competence
concept should be incorporated I can
give an example in the psychology
department St. Peter is that
I'm with the support with the board of
psychology we were able to incorporate
in old didactic training for internship
program and possible program anything in
all didactic it should have mentioned
about concerned competence issue because
I'm really worried about the... not
just awareness.
Barnes: I just want to jump gears a little bit of cultural
competence we haven't touched any of the
other areas that some of the people were
asking about so we do have a short
period of time but we'll definitely be
digging into these issues and cultural
competence when we get into our focus
groups will be a lot of time to talk
about those so, one of the questions
changing over to recruitment is what two
recommendations in the area of
recruitment have been most effective
thus far?
Rosenthal: 'm just thinking then you know
we launched these recommended age we we
presented these recommendations to the
legislature in just january
of  2015 and so it's a little
early to be able to kind of track
anything that we've done and has it you
know has it made you know a difference
you know I'd like to give it at least um
you know another year as I've said this
isn't recruitment but I would definitely
say that what we saw by putting all of
that money into retention or into the
Minnesota loan forgiveness program you
can see that that may make a very big
difference if we take a look four or five
years down the road we take a look at
you know how many professionals are now
you know serving areas of Minnesota the
word served before but I think it's just
a little too too early
what I will say is that though these
young people they are just thirsty for
information about mental health careers
they are so curious so trying to figure
out how to get people really alive i
mean I'm interested because a lot of
people I run into who are like at the
augsburg social work department or their
master's degree programs, they're there
because of the the ones that I've talked
to they have a family member who has
been suffering from a mental illness or
they had a family member who for example
worked for a mental health provider i
mean there's a lot of like personal
connection but the largest major I think
in Minnesota of all of our colleges is
psychology and also people are very very
curious about this.
Edwall:  The evidence that
people stay where they are trained
ought to really give us some pause
about our paucity of accredited
internship programs in psychology in
this state and that certainly is an area
where collectively we have work to do.
Barnes: So what I want to do this afternoon sort
of has a very specific goal and we
wanted ultimately kind of in just
general terms we want to be able to take
the feedback that we get in these groups
and put it to action
we want to share it with the health
force Minnesota group and we actually
want psychologist to play into how these
recommendations come out. I didn't
originally have the opportunity to
attend the summit and so one of the
things I recognize when we started
meeting, all the four executive director
started meeting from the mental health
boards, with Dr. Fritsma and Mary
Rosenthal, I realized that these
recommendations on some of them very
closely play into a lot of primary
issues that were already looking at as
psychologist and as a board and that we
needed to have this conversation so I'm
really excited that we have everybody
here to do that
and so just to get us started ultimately
like I said we're going to go for 1:15
to 3:15 but our goal is to gather some
responses to some focus questions and
have a discussion and we're going to
retain that information here
Barnes: Alright if we could come back together
to reach the end. If I could have the
representatives of the other groups the
individuals are facilitators who are
going to present their focus group
findings come up to the front
number one is here number two arrived
oh yes please come on up
where's number three
I want to thank everybody for staying through the session, for providing feedback and comments.
I'm blown away by the suggestions,
the feedback, the input,
the ways that we can come on to some of these issues and approach them
and at how many of them overlap
and how they do support each other in what the board and state can do.
So thank you.
As we jump in here, we're going to have each of the groups
through their facilitator
report on some key points from their primary were, and being number one
will go first.
In terms of group number one
we had a robust discussion, kept me running with the mic so it's great I got
a lot of exercise one of the things i
heard as a reoccurring theme and what I
see in the notes is prevention. This
group we talked a lot about prevention
about getting into educational settings
training sessions, starting young
getting one of the suggestions was
getting into the kindergartens and
teaching some of the social-emotional
interpersonal skills at a very young age
get them recognizing that - which could
work to de-stigmatize mental health as
well as start before you know it'sit's
developed along on the road, and also to
move away from just having your first
mental health contact be based on a
diagnosis or some sort of crisis issue
but it starts early and that it's all
integrated part of health. I also heard a
lot about primary care and having
integrated care and how care is
provided. That integrated care would go a
long ways towards de-stigmatizing mental
health and it needs to reach actual
parity with physical health of
individuals one of the the comments that
really struck me was about walking into
that building and going there and sitting
in sharing waiting room with people who
could be there for any head-to-toe
purpose as opposed to sitting in the
mental health or the counselor's office
and what that might do for mental health
and the stigmas, and we heard some
suggestions for board improvement and
for things that the board might support
or do. One of those things about being a
resource and being continuing to offer
education be proactive, help people and
support people with training specialized
training, and we definitely do that you can
request that anytime and we'll see what
we can do to work that out.
The other thing in the board bucket was
fees and we talked a lot about expense,
getting licenses and expense, what the
board's budget is, and that was an
engaging issue, we definitely the message
I got was doing a better job at
educating our own licensese as to
what funds the board and how does it run
and where the fees go and
what is it giving you? Number one is
giving you this event as part of it but
it's doing so many more things, and
as we're asked to be that resource and
to make those changes and priorities
fees do play a role in that and so we
want to make it less expensive but we
want to do that also in a responsible
way so that we can continue to meet
those needs. Also necessity of the
postdoc, we talked about the postdoctoral
experience and is it necessary? What
is it doing? Is it adding value? Should it
be there, should be integrated
into education, and there were lots of
thoughts about that, lots of sort of
drive to see why we have it, be
evidence-based about why we have it, and
the last sort of general point is
getting people employed quicker. You know
getting them into working and being able
to see patients and a lot of it came
back the money, you know what it water
what's reimbursable - we learned that
tele services or
telepsychology or telemedical services in
our beginning on the reimbursement track
and that that's a necessity in order to
make it possible and then some questions
were asked around the sci-pact and what
Minnesota can do to provide guidance and
and take action towards getting telepsychology in place.
Fischer: I think group number who was probably the
best group
we had a we had a really good, we had a
really good, freewheeling but focused
when it needed to be discussion it was a
really good way to spend a couple hours.
A few of the things that came up for us
one of them was the issue of culture
came up in a number of different ways on
both in terms of cultural competence and
in recruiting people from the non
majority culture into the profession and
when we talked about cultural competence
we really came around to a point of view
that what's important is to bring up
particular stance to working with people
from different cultures rather than
focusing on learning content and really
to take a stance that acknowledges
whatever privilege that you might have
that comes in with some humility and is
an extension of our our general clinical
skills. We we talked about recruiting
people from different cultures and had
some discussion about the way that that
intersects with the cost of graduate
education so if you're going to take on
a hundred and fifty thousand dollars
worth of debt and make seventy thousand
dollars, that is much easier for you to
do if you're from a middle-class family
and have some backup support, and so
that's going to be an impediment and there's
not a real obvious and easy solution to
that that doesn't cost a lot of money.
We talked about our professional identity
and we were really aware that the
recommendations go across mental
health professions with those of the
other mental health professions and
sometimes don't and that we do have a
unique identity and the way our group
thought about that was really our
training in science and critical
thinking as a big part of that.
It came up a lot in the one of the last
questions was about supervision and the
particular recommendations about
cross-discipline supervision and
reducing the hours that you essentially
reducing the hours that you would need
in order to be licensed and so we
started by kind of rolling our eyes and
being horrified by it, but
we also took into account the fact that
the cross disciplines supervision could
be a really good opportunity for
psychologists - not in psychologist being
supervised by other professions but a
role that we might be able to take on
you know in supervising social workers
LMFTs, other professionals as appropriate.
And that that seemed especially
important given that as we learned from
the slide earlier today we're really
really old, and people are
moving into doing different kinds of
things with their professional life other than
direct service and so that that was a
way that that those two questions and
findings kind of intersected. We talked a
little bit about the service delivery to
to underserved areas underserved
populations and the potential use of
technology to help with that and the
sci-pact and Angelina mentioned and we
also talked about service delivery
models that are outside of the box
either technologically or otherwise
so you know there are suicide prevention
services that are using texting as a
primary means of communication, there's
in-home therapy their services delivered
in schools, those kinds of things and so
really thinking about service delivery
methods as a partial solution to
the underserved populations so Rachel
may have a little bit to add to my
observations and I'll let her take it
from here.
Kolles: So the only thing that I have listed
here, you've touched on every other one
so far, is the impact of media and social
media - how mental health say 20 years ago
was almost a very touchy topic to even
mention, we're now you see some
celebrities even talking about bipolar
disorder and things like that where more
people can relate to that. Our group
talked a lot about that and more of the
openness, on how people are feeling more
comfortable that other individuals that
are more in the limelight are coming out
and be more open about those topics when
they are a little little touchy
so that was a big topic and it was great
to chat about, so that's about it for group two.
Versland: So in regards to the first question in regarding which areas we need to focus
on first in terms of the plan
folks felt that first of all, a good thing that retention is not
necessary an issue for psychologists because we are a happy lot that like our profession.
Like every good psychologist we feel like we need a good assessment
of what the problem is before we can dive into interventions.
So that was a common theme.
Folks also felt that recruitment is
where it starts and that there's also training and education opportunities to do more
but without knowing the problem, we'd be hesitant to have specific
recommendations.
We also looked at the data of licensed
professionals, but there's a lot of
individuals out there that are
practicing at bachelor's levels in arms
and and in other disciplines and we
would want to better understand that
workforce too going forward. A theme in
our group was reimbursement issues and
that there is not good reimbursement for
folks who have done a lot of education
and are
practicing as interns or fellows and that
they incur an incredible amount of debt
much more so than folks who have
master's degrees and so that doing more
there to reimburse them as important.
Similarly there is not a lot of
incentives for supervisors to do this
work because there is not payment behind
their supervision and therefore
expanding the supervisory field would
need to include having more
psychologists being paid for that.
There was a discussion around
supervision and there was a lot of views
it's nice to have more diversity in
terms of other disciplines contributing
to supervision at the same time there is
a socialization process into the field
of psychology that only psychologist can
do and there are a lot of roles that
psychologists play that only
psychologists truly can supervise,
whether it be assessment research or
interpreting research findings and
certain roles we talked about
even from a legal standpoint things like
placing holds our are things that
psychologists do that not all mid-level
providers can do. The theme that came
up was very similar to group group twos,
that psychology is really having
somewhat of an identity crisis right now,
and that came up many times that
there isn't a good understanding of how
psychologist is different than other
mid-level providers and that as a
profession more needs to be done to help
the public and help others in mental
health just be able to understand the
different role that we play and there
was a lot of thoughts that you know for
students who are looking at a profession
in mental health
why would they go into psychology if
psychology is being lumped in with other
professions and not seen as unique
given the expense in the time that goes
into earning a PhD or PsyD?
There is also discussion around
paperwork and bureaucracy, third-party
payers, a lot of the themes that came out
in the survey and how that impedes
people's ability to actually do work
with patients and so that being a
barrier as well. In talking about the
aging population and we have an
incredible wealth of expertise that we
could tap into but again everyone is
very constrained by financial
responsibilities but certainly
supervision and other areas of
consultation would be something that our
older psychologist could play in the in
the field and that we're seeing many of
them and administration positions as
well. As we look at different changes to
how supervision is done, there was
the viewpoint that some of these
potential recommendations that are being
considered conflict with accrediting
agencies so regardless of kind of where
people fell on the issues that it also
might lead to accrediting problems for
institutions and internships. And let's
see, I also in regards to stigma our
group talked about how more needs to be
done to decrease stigma because when I
you know the population we serve are
stigmatized it also leads people to be
less inclined to go into this profession
and to be devalued in the work that they
provide the stigmatized populations.
Rural communities - and just one other
comment on that was that there are a lot
of challenges to working in rural
communities and that especially in terms
of trying to work through bureaucracy
with third-party payers who like to
contact with large organizations and not
private parties that that can be
especially challenging
and resources for their clients are
especially sparse in those areas.
Campero: As the other facilitator of what
now has been established as the best
group
Two things that resonated with me when we
talked about rural areas was the issue
of transportation. I think that was that
was a very practical suggestion, how
sometimes the issue is not necessarily
that the person don't want to seek out
help but that they just don't have the
means to get to where the provider is or
vice versa and and so that was a very
practical suggestion that I thought was
very it was very useful and one thing
that another comment that I was very
surprised about was using telepsychology
tele-electronic means to
provide services, which are my formal
educational background is in IT so I'm a
big proponent of technology but then the
person was making the comment that
yeah given no other choice that is a
good choice but at some point it is
important to see the person face-to-face
in the same being in the same room
and and I thought that there was very
valuable insight in that too as well.
Barnes: I did miss two things that I
think are really important to mention
for our group to represent as well. We
also talked about cultural humility. We
were told and discussed and really dug
into the idea that perhaps it's not
cultural competency but what about the
concept of cultural humility. Recognizing
that you're different and they're
different and I'm not going to do it
justice because I'm a lawyer not a
psychologist but Ann Williams
did a very nice job explaining to that
and we spent a lot of time on that and
kind of reframing what it means and what
culture is
from city to urban to rural and in
various different ways in which you can
be competent from the island of hawaii
to various other ways of life.
The last part which I thought was another
really neat coupling was taking that
cultural piece so perhaps we better
connect with communities
and seek these representatives of
different levels of diversity and
perhaps we put together a training video
or some sort of memorialized
representation of information on all of,
well we'll never hit all
but a fair representative of those
various areas of cultural knowledge that
these communities and people and
different walks of life have to share
and how we can use that as a training
resource. And when asked about the
seminar that, I really like that
response, our group was - one of our
members was really quick to say, well out of everything we've talked about, coming to
the job fair or the seminar doesn't seem
like you know, if you had to pick
wouldn't be the high priority but we did
return to that and in where psychologist
would be willing to participate
perhaps gathering that institutional
knowledge or that field knowledge and
again using a video or an electronic
means to share that with our lower
education levels in terms of high school,
undergrad, telling them yeah you might
like psychology - a lot of people think
it's going to be interesting, but where
can you go, where can psychology take you
and why would you want to do this.
Have a great day and thanks again.
