For Oregon’s behavioral health care providers, job openings can take months to fill — not to mention the problem of keeping staff once they’re hired.
It’s a well-worn challenge in Oregon — and it continues even as the state looks to spend more on behavioral health. For example, Measure 110 will plow millions of dollars of marijuana tax revenues into designated regional addiction treatment facilities for offenders who otherwise might head to jail for low-level violations.
But job candidates are in short supply.
Twenty percent of behavioral health providers reported it takes six months or longer to fill a position on average, according to a June survey by the Oregon Council for Behavioral Health, a trade group for the industry. Another 18% reported they had perpetual job openings due to lack of candidates.
Amid the shortage, patients, in some cases, have to wait longer for help. Providers with enough demand to expand services putting off growth and focusing on keeping existing programs and staff intact.
Low Reimbursement Rates
Lack of money to pay workers is one root of the staffing shortage. Low Medicaid and commercial insurance reimbursement rates to agencies for the work of behavioral health employees continue to hamper the industry’s ability to pay its workers a competitive wage. To meet the pent-up demand for workers, they need to find people with a passion for public service and community behavioral health.
The existing workforce shrank during the pandemic for a variety of reasons. Residential facilities cut back clients because of public health capacity restrictions. In-person counseling and programs largely went online to venues like Facebook and Zoom calls.
The Oregon Council for Behavioral Health in a survey said the workforce of its members shrank by 10% to 30%, including layoffs and other staff departures. The level varies among agencies.
Pay in the field can be low. Entry level caregivers in a residential facility at Portland-based Cascadia Behavioral Healthcare start at $15.15 an hour, according to one job posting. Candidates with a bachelor’s degree, three years of experience, or a combination of the two can start at $16.14 to $17.21 an hour.
Such pay rates are common throughout the industry.
More advanced jobs, like drug and alcohol counselors, can pay $20 to $23 an hour in the early years of a counselor’s career.
Before the pandemic, Oregon’s behavioral health workforce already faced shortages, including in advanced behavioral health jobs. A 2018 federal report estimated that Oregon would need 170 more psychiatrists to meet current demands, a 26% increase.
The crisis has providers looking for short- and long-term answers. Providers are turning to an arsenal of recruiting tools: sign-on bonuses, scholarships for college students and training for entry-level positions.
Lori Paris, CEO of Medford-based non-profit Addictions Recovery Center, helms a multi-faceted organization with residential facilities for men and women, outpatient treatment, an addiction medicine clinic, and other programs for people with gambling problems and education for people arrested for driving under the influence. The region faces a housing crisis after the Alameda fire last year burned down some of the area’s most affordable housing. The scarcity of housing discourages people from out of the region from applying for jobs.
The center has concluded that its recruits will come from within the community -- not through appeals to out-of-state residents, Paris said.
“We need to invest in our community and the people in our community if we hope to grow a workforce,” Paris said. “Down here there isn't housing. If we recruit from out of the area, they can't find a place to live.”
In coming months, the center plans to recruit and train 20 certified recovery mentors.
Certified recovery mentors, also called peer mentors, have experienced a substance use disorder or mental health issue. With training, they can work as advocates for patients.
The mentor knows the language and experience of the patient and can help a medical team understand a patient’s response. A mentor’s ability to relate to a patient can be a draw that keeps the person in the program.
“They are really important players in our world,” Paris said.
A Mentor’s Story
Leticia Welch, a certified recovery mentor supervisor at the center, has been clean for four years and 10 months. She supervises four certified recovery mentors assigned to the residential facilities
“More than anything, we share our stories and our lived experiences, that's how we help the clients,” Welch said.
When she was 21, Welch was treated for alcohol and marijuana use. Eventually, she started using meth and heroin. At times, she was homeless and shuttled in and out of jail, as she kept reverting to drug abuse.
In 2016, Welch’s life started to turn for the better. She was arrested for theft and her case went through a drug court program.
The court-ordered program’s combination of recovery and accountability worked. It included transitional housing, recovery support meetings, check-ins with a probation officer and a 12-step addiction recovery program.
Certified recovery mentors like Welch can share those experiences with their clients and motivate them.
They can help clients in a variety of practical ways. Mentors can accompany clients to court appointments, help them regain their driver’s license and apply for housing and food help. Mentors can even show clients how to do householding budgeting and monitor their credit reports.
In the long-term, the center plans to give five scholarships to students in the human services program at Rogue Community College in southern Oregon. The program is where would-be drug and alcohol counselors begin training. The scholarships include mentoring and an internship, an opportunity to cultivate future recruits. Those could start as early as this fall, with full scholarships to cover tuition, books and other expenses. Each scholarship is worth about $15,000.
Paris said there are long-term benefits to hiring local people: They’re already familiar with the area. If they remain in the field, they can pursue more education and advance into specialized behavioral health roles.
“There are people in our community that have not had the means or the opportunity to pursue careers that could be wonderful for them,” Paris said.
In the short-term, the center has offered sign-on and retention bonuses that start at $750 for employees.
At Cascadia Behavioral Healthcare, Oregon’s largest behavioral health provider, the Portland-based nonprofit has about 185 openings. About 160 are full-time positions. Many of them are entry-level jobs that don’t require a master’s degree, including residential and direct support positions, peer support workers and crisis counselors. At full strength, Cascadia has about 1,000 employees; currently, the provider has 831 active employees.
To remain competitive in the job market, Cascadia started to offer $2,000 sign-on bonuses in July to its first 50 new full-time employees. They get $1,000 after their first week of employment, $500 after their first six months and the final $500 after a year. That amount is pro-rated for part-time employees. So far, nearly 30 new employees have accepted.
It’s not a quick process. Beyond the standard task of screening applicants, providers also have to contend with other employers also on the hunt for workers.
It’s tough to rope in a qualified employee, even after extending a job offer and scheduling an orientation, said Beth Epps, chief community solutions officer at Cascadia.
“It's essentially a bidding war of who can pay them more," Epps said.
Competitors include hospitals, other medical providers and county public health programs.
Cascadia employees also can qualify for up to $150,000 in student loan forgiveness. It pays off student loans for mental health and behavioral healthcare providers and professionals through a state program.
The Oregon Office of Rural Health program is tax-free to employees and covers up to half of their student loan debt balance, up to $50,000 a year. Epps said that programs like that are critical for staff.
Epps and others hope incentives and programs will encourage entry-level staff to work their way up to a master’s degree and beyond. That’s the long-term goal of hiring bonuses, student loan repayment programs and other incentives.
For now, they’ll balance priorities, move staff around and continue the hunt for talent.
Longer Waiting Times
For patients, it means longer wait times to see a therapist -- or an even longer wait time if someone leaves and the clients are reassigned to the remaining staff.
"I hate to be totally without hope here and actually I'm not, but it's dire,” Epps said. “We have programs that have a third of the staff that are needed to run the program."
At Corvallis-based Milestones Family Recovery, high hiring standards can keep positions open longer. The provider screens potential hires for all drugs, including recreational marijuana.
“Maybe out of 10 resumes, maybe two will show up for an interview,” said Tanya Pritt, director of women’s services at the non-profit provider. “And those two will not pan out because they’re using marijuana.”
Pritt said people interested in the field don’t need a degree to get started and decide if it’s a career track they want to pursue. The agency employs cooks, administrative assistants who manage wait lists, and shift workers who help with safety and security.
You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.