Background
The MH/MR Coalition* was reorganized and expanded in 1999 to focus on Pennsylvania;s crisis in staffing of community based mental health and mental retardation agencies. The MH/MR Coalition includes every major statewide provider association and has made a concerted effort to work with the Ridge administration, Department of Public Welfare officials, and the General Assembly to assure that the state;s clients receive the highest quality care when they transition from state institutions to community-based care.
Survey Purpose
In an effort to assist DPW in addressing the crisis, the MH/MR Coalition polled its member agencies in June – July 2000. The purpose of the informal survey was to:
- Ascertain staff recruitment and retention issues for community based agencies
- Identify the causes of any identified problems
- Ascertain providers' activities to address issues, especially those that had been successful, and
- Identify potential options to address providers' human resources concerns.
Composition of the Group Surveyed
There were 165 agencies that voluntarily responded to the survey. The composition of the agencies can be represented approximately as follows:
- 20% provide mental health (MH) services only
- 20% provide mental retardation (MR) services only
- 60% provide both MH and MR services
Survey Responses
Concerns
- 95% indicated that either recruitment or retention is a problem for their agency.
- Over 3/4 of the agencies indicated that both recruitment and retention are a problem.
- Agency direct care staff vacancy rates range from 0% to 50%.
- Agency yearly turnover rate for direct care staff ranges from 0% to 125%.
- 5 out of every 6 agencies singled out low salary and wages as the major barrier to staff recruitment and retention.
Additional recruitment and retention barriers to recruiting and retaining direct care staff included:
- Shrinking pool of available, qualified workers;
- Challenging and demanding nature of the work; and
- Restricted opportunities for advancement.
Quantity and quality of available workers was cited more than any other concern when respondents were asked to list their other concerns.
Results of Provider Activities
Providers have responded to these challenges in various ways, depending on local needs:
- Bonuses and increased salaries, when funding allows
- Expanded benefit packages, when funding allows
- Accommodating workers needs, including flexible scheduling whenever possible
- Innovative, aggressive recruitment practices, and
- Increased training.
Despite the variety and intensity of the efforts noted above, many providers noted that the successes that they have achieved in the staffing area have not kept pace with the problem. They also emphasized that the increased use of overtime to cover positions is a significant financial problem that consumes dollars that could and should be used for services.
Success Strategies
In ranking the most successful strategies, two of every three agencies responding to the survey question identified increased salary and benefits as the most successful effort in finding and keeping staff. When asked to list the barriers that remain after the agency’s efforts at improving recruitment and retention, the following were identified:
- 64% identified low wages
- 31% identified lack of qualified applicants
- 21% identified job requirements
Again, the response was low wages by a more than 2-to-1 over the next identified barrier.
Requested Coalition Activities
The Coalition Survey asked for ways in which it could assist respondents with their efforts, and the following responses were noted:
- Increase lobbying efforts with public officials (33%).
- Increase awareness of career opportunities in MH/MR field (27%).
- Offer training and certification programs for career development (21%).
- Promote collaboration among agencies in areas such as joint recruitment and job sharing (18%).
Providers were also given a chance to make additional comments, and their responses provided additional support for issues and strategies that had already been identified.
Conclusion
None of the conclusions from the MH/MR Coalition Staffing Survey are surprising. Providers, counties, advocates and state officials have been struggling with the ongoing problem in recruiting and retaining a qualified workforce to supporting the most vulnerable citizens of the Commonwealth. This is not a problem that will respond to a quick fix or a one-time infusion of funds.
The survey illustrates that this problem does not belong to any one group in terms of service delivery, but is shared by all stakeholders -- all of whom must work together to address it. The survey pints to the need for a long-term plan to address a variety of needs: higher wages, better career opportunities, improved awareness of staff needs, and accessible, affordable training.
*The MH/MR Coalition consists of statewide associations that represent mental health and/or mental retardation provider agencies and counties in Pennsylvania: The ARC-PA, Mental Health Associations of PA, MH/MR Program Administrators of PA, PA Association of Rehabilitation Facilities, PA Association of Resources for People with Mental Retardation, PA Community Providers Association, and United Cerebral Palsy of PA.