Transcript Open slide - CTN Dissemination Library

Exploration of the Substance Abuse Treatment Workforce: Education,
Preparation and Certification
Traci Rieckmann, Ph.D., Bret Fuller, Ph.D, Dennis McCarty, Ph.D., & Christiane Farentinos, MD, CADC II
Oregon Health & Science University
i
The National Drug Abuse Treatment Clinical
Trials Network (CTN) is a partnership of drug
abuse treatment programs and research centers
testing new therapies for drug disorders.
Previous research suggests that the majority of
counselors in the field are Caucasian, female,
and have a bachelors degree (Gallon, Gabriel &
Knudsen, 2003; Ball et al., 2002; NTIES, 2001;
Mulvey, Hubbard, Hayashi, 2003). High turnover
rates, a lack of career development pathways
and increasing use of evidence-based practices
provides the impetuous for understanding the
preparation and professional needs of this
workforce.
This presentation focuses on education,
certification, licensure and use of evidencebased practices of counselors, managers, and
supervisors in a sample of substance abuse
treatment providers.
Methods
A survey was distributed to direct service
providers in 344 treatment units participating in
the CTN. The sample for this presentation
included 1679 staff members (1328 counselors
and 351managers / supervisors) that provided
direct services within four treatment modalities,
outpatient (n = 543), methadone (n = 329),
residential (n = 618) and detoxification (n =
189).
Table 1: Demographics of Managers
and Counselors
Total
% Female
% Racial
Minority
Demographics
Table 1 shows that women represented 60% of
the sample and there was no significant gender
difference between supervisors and counselors.
Slightly less than 70% of the sample identified
as Caucasian. Twenty percent were AfricanAmerican (n = 299), 11% identified as Hispanic
(n=193), and 2% Native American (n =25).
Managers/supervisors were more likely to have
a master's degree or higher (61% managers vs.
43% counselors). Supervisors were significantly
more likely to be credentialed and/or licensed
(state: 55%, national 27%; professional
licensure: 58%) than counselors (state: 47%,
national 18% and professional licensure: 43%).
30.49
61.49
32.68
Supervisors
Sig. Test
State
Certification
50.25
56.11
47.76
45.36
48.81
22.22
24.69
24.22
15.52
20.25
Prof.
Licensure
39.85
52.69
52.07
44.75
46.32
= 14.32
p < .0002
% with MA
or higher
45.56
41.57
60.68
χ2 = 40.91
p < .0001
% with
State
Certification
48.88
47.13
55.19
χ2 = 6.93
p < .0085
% with
National
Certification
20.25
Prof.
Licensure
46.32
Hrs Worked
per Week
39.38
26.77
57.91
41.83
12.23
= 3.79
p < .0515
χ2 = 10.41
p < .0012
Table 4: Majors for those Professionally
Licensed.
337
67.94
Licensed Practical Nurse
79
15.93
F = 49.77
P < .0001
Clinical Psych
30
6.05
Nurse
26
5.24
Medical Degree
6
1.21
Physicians Assistant
2
0.40
Psychiatry
1
0.20
Clergy
4
0.81
Social work
8
1.61
Yrs as a
clinician
7.87
7.22
10.33
F = 58.19
P < .0001
Yrs at
present
agency
5.12
4.53
7.35
F = 81.36
P < .0001
Yrs at
current
position
3.68
3.51
4.36
F = 10.93
P < .0010
F = 109.64
P < .0001
62.05
33.66
55.85
22.22
38.62
58.96
20.81
62.46
χ2 = 3.37
p < .3379
45.29
χ2 =
67.01
p < .0001
44.68
χ2 =
85.45
p < .0001
34.63
% with State
or National
Certification
50.97
Hrs Worked
per Week
40.78ab
Yrs
employed in
Substance
Abuse
7.81 ab
Yrs as a
clinician
6.67 ab
8.96 a
8.26
8.84 b
F = 10.82
P < .0001
Yrs at present
agency
4.50 a
5.59
5.18
5.89 a
F = 5.58
P < .0008
Yrs at current
position
2.90 bc
3.82
3.86 ac
4.76 ab
F = 14.50
P < .0001
39.73
9.89 a
48.25
38.36 a
8.93
52.58
38.25 b
9.57 b
χ2 = 6.01
p < .1110
F = 13.61
P < .0001
How Familiar are you with the
American Psychiatric Guidelines for
the treatment of patients with
Substance Abuse Disorders.
1 = Not at all; 2= Somewhat; 3 = Very
Knowledge of ASAM Placement
Criteria
1 = Not at all; 2= Somewhat; 3 = Very
F = 6.48
P < .0002
Evidenced Based Practice
Guidelines are useful for care
1 = Strongly Disagree to 5 = Strongly
Agree
Perception that Evidenced Based
Practice Guidelines promote
oversimplified “cookbook” care.
1 = Strongly Disagree to 5 = Strongly
Agree
A National Institute on Drug Abuse Award (U10 DA 013036)
supported this research..
Evidence Based Practices
A MANOVA tested four evidence based practice items for differences on
gender, minority status and education (see Table 5).
Education
Mean Minority
on
Status
Item
Mean
on
item
Multivariate effects were found for minority status (Wilks’ Λ = .943. F(4,
1496) = 22.58, p < .0001) and education (Wilks’ Λ = .947. F(8, 2992) =
10.23, p < .0001) but not for gender.
High
school or
less
1.68
Caucasian
1.79
Ethnic/racial
Minority
1.85
AA or BA
1.84
MA or
higher
1.93
Higher educational attainment predicted greater knowledge of ASAM and
APA Practice Guidelines. Education also was related to perceptions that
evidence based practices were useful for care and were not nonindividualized “cookbook” treatments.
High
school or
less
1.74
Caucasian
2.04
Ethnic/racial
Minority
1.70
AA or BA
1.93
MA or
higher
1.94
High
school or
less
3.90
AA or BA
3.90
MA or
higher
4.12
High
school or
less
2.86
AA or BA
2.82
MA or
higher
2.60
Sig.
Tests
% with MA
or higher
42.33
60.96
Methadone
The majority of providers (849; 51%) had either state or national
certification. Table 4 shows that of the 700 (46%) managers and
counselors who had professional licensure, the majority (68%; n = 337)
were licensed as an alcohol and drug abuse counselor, 16% were licensed
professional counselors (n = 79), with 30 (6%) psychologists, 26 (5%)
nurses and the rest were licensed as physicians (n = 7), and social
workers (n = 8). Surprisingly, the greatest percent of minorities were
working in methadone programs.
About 35% of those with Master’s Degrees reported having Associates
degrees as well. Of these majors included psychology, addiction studies
and general studies. Table 4 presents the majors of those with professional
licensure and the most common degree was as an Alcohol and Drug
Counselor.
Table 5: Evidence Based Practice
Differences by Educational level and Minority
Status
Table 2: Counselor Demographics by
Setting
% Female
Percent
AOD Counselor
8.75
Detoxification Outpatient
Frequency
χ2 = 21.56
p < .0001
Yrs
employed in
Substance
Abuse
Residential
TOTAL
17.67
8.55
7.81
Methadone
National
Certification
12.27
38.73
Outpatient
χ2
11.50
43.26
Detoxification
χ2 = 2.93
p < .0869
% Ethnic
Minority
18.46
Residential
56.45
χ2
% Minority
Results
60.43
Counselors
Table 3: Type of Certification by Setting
Table 2 shows that counselors and managers with master's degrees were
more common in outpatient (67%) and methadone (51%) programs than
those in residential (40%) and detoxification (44%) programs. Further,
outpatient and methadone programs tended to have staff with more
experience on the job and as a clinician than those working in residential
programs. Residential counselors were in their current position less time
than those in methadone programs.
Minority counselors and supervisors were less likely to report knowledge
of ASAM placement criteria and were more likely to view evidence-based
practice guidelines as non-individualized cookbook care.
Conclusions
Caucasian
4.01
Ethnic/racial
Minoriry
3.93
Caucasian
2.64
Ethnic/racial
Minority
2.88
Means in Bold typeface indicate significant effects at p < .005
Individuals without graduate degrees remain an important component of
the counseling workforce. Managers/supervisors have more education and
experience and can provide guidance on implementation of evidencebased practices. Some work settings hire more educated staff which may
be due to the need for medical expertise in methadone treatment as well
as managed care network criteria for reimbursement. People with more
advanced education were more likely to support the use of evidencebased practices.