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Investing in frontline workers

December 1, 2006
by Marta Frank, Jerry Rubin, and Kelley Spada
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Two projects aim to give entry-level behavioral health workers a promising future

In behavioral health, we expect that the professionals responsible for care—psychiatrists, psychologists, counselors, nurses, social workers—are well-trained and have the appropriate credentials. But what about the entry-level workers on the front lines of every type of healthcare setting, the people who deliver much of actual, “hands on” healthcare today? These are the psychiatric technicians, case workers, and counselors in behavioral and community health clinics, drug and alcohol treatment programs, and counseling centers and hospitals. Research and anecdotal evidence are coming to agree with common sense: The quality of care delivered by frontline workers plays a critical role in preventive and early intervention services, chronic illness management, and long-term and postacute care.

Yet few entry-level workers earn enough to support a family, many have less than a bachelor's-level education, and almost all lack credentials that make significant advancement possible. Their formal training often is limited; instead, they learn their jobs from peers and through “trial and error” experiences that may be valuable—but that also may limit the quality of care they provide and their chances to advance.

The costs to employers are high as well, including the lost potential for delivering the best care possible and the turnover among frontline workers. High turnover disrupts continuity of care, and it is expensive to train replacement employees, even at the entry level.

If healthcare employers are to remain competitive, their business models must address high turnover rates and the lack of advancement opportunities among frontline workers. In other words, improving healthcare requires finding ways to efficiently and effectively upgrade the skills and advancement opportunities of frontline workers.

That is the goal of Jobs to Careers, a national initiative of the Robert Wood Johnson Foundation in collaboration with the Hitachi Foundation. This four-year demonstration project seeks to change the way that healthcare employers train, advance, and reward frontline workers—and thereby to improve care and service delivery. Findings from the project will be made available during the course of the project and afterward through briefing papers, research reports, and an evaluation report.

On October 1, Jobs to Careers announced its first grants, including awards to two projects that will address workforce needs in behavioral health by investing in frontline workers: SSTARreach in Massachusetts and Rhode Island, and Bridging Jobs to Careers in Pennsylvania. Both represent broad-based partnerships that bring together healthcare employers, educational institutions, and public and community health organizations.

The lead partner in SSTARreach is SSTAR, a human services agency in Fall River, Massachusetts. SSTAR provides a full continuum of addiction treatment. Its sister program, SSTAR of Rhode Island, operates that state's only public detox facility and a residence for addicted mothers and their children. The national nursing shortage affects both employers, and the impact is even greater because the pay for detox nurses is not competitive with hospital-based nursing. SSTARreach is an innovative answer: Its work-based learning programs, delivered in collaboration with education partners, will help frontline employees in the addiction field prepare for professional careers.

Toward this goal, a central element in SSTARreach is to create career paths. As entry-level workers learn new skills, gain experience, and earn credentials, they will be able to rise, step by step, to professional positions, such as counselors and detox nurses. By addressing its professional staffing needs through this “grow your own” strategy, SSTAR expects to improve staff retention, in turn reducing recruitment and orientation costs.

In Pennsylvania, Bridging Jobs to Careers is supported by a partnership that includes a union, employers, educational institutions, and a workforce development agency. The District 1199C Training and Upgrading Fund is uniquely qualified to lead this initiative: A labor-management collaboration, it has directed similar partnerships to enhance educational and career opportunities for thousands of healthcare workers. The Training Fund had found, in interviews with employers in long-term care and other healthcare fields, that turnover among frontline workers ranged from 60% a year up to 120%.

With Bridging Jobs to Careers, the Training Fund will create career ladders for entry-level behavioral health workers in hospital and community-based settings. It also will address many of the challenges to advancement these workers face, including the lack of formal credentials. Participating workers will be able to earn a newly created certification and, ultimately, associate's and bachelor's degrees in behavioral and health sciences. The Training Fund's strategies will increase employee satisfaction, the number of workers benefiting from work-based learning, and the number of workers who are promoted and receive wage increases. They also will develop training that helps shift treatment from a narrow medical model to one focused on recovery from mental illness. As with SSTARreach, the resulting improvements in morale and employee skill levels will reduce turnover, lower training and recruitment costs, and raise the quality of care in the partnering institutions.

These and other partnerships funded through Jobs to Careers seek to make lasting improvements in how they provide career development and advancement opportunities for frontline workers. Developing new models of education and training that incorporate work-based learning will be integral to their success, as will their continued commitment to multisector partnerships.