Current Workforce Skill Development Project OHSU-AFSCME Jobs and Ladders Program Final Report

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1 Worksystems Inc. 711 SW Alder St., Suite 200 Portland, OR Current Workforce Skill Development Project OHSU-AFSCME Jobs and Ladders Program Final Report Award: $82,610 Date of Award: 3/1/01 Expiration Date: 9/30/02 I. Executive Summary The Jobs and Ladders program represented a partnership between a union (AFSCME), an employer (OHSU), an industry consortium (Healthcare Workforce Consortium), a workforce board (Worksystems Inc.), and training institutions (Portland Community College, New Care Directions). The partnership focused on training entry-level employees for three high-vacancy occupations identified by the Consortium: Certified Nursing Assistant (CNA), Certified Medical Assistant (CMA), and Radiologic Technician. The program maximized opportunities for on-site training, and included ESL and preparatory classes to accommodate the targeted incumbent workers. II. Introduction The healthcare industry is the third largest employment sector in the Portland metropolitan area and has been one of the few sectors that consistently demonstrated growth through years of advancing and declining economic conditions. Worksystems Inc. (WSI), the workforce board for Region 2, has been working with members of the Consortium for several years on projects designed to meet the industry s growing need for a skilled workforce. Jobs and Ladders was piloted at OHSU because of its labor/management commitment to training and because it is Portland s largest employer, however, we anticipate that our experience and lessons learned will assist in the implementation of similar efforts in cooperation with other healthcare employers. Resources for the project included a State Current Workforce Grant, AFSCME training funds, ITA funds, and WIA funds. III. Goals The project s goals were to: Meet the need for skilled workers in CNA, CMA, and Radiologic Technician positions; and Provide enhanced healthcare career opportunities for entry-level workers. Performance Objectives included: Enrollment: 30 in CNA program, 15 in CMA program, 15 in Radiography. Completion of workforce/life skills training and basic skills upgrade: 65 (100% of enrollees) 1

2 Progress in English proficiency (ESL participants): 90% of ESL participants will demonstrate increased levels of proficiency in written and verbal communication skills. Completion of occupational skills training: 20 in CNA program (67%), 10 in CMA program (67%) Completion of AAS in Radiography: 10 (67%). Students will complete this two-year program as it continues beyond the initial grant year (supported by local funds and Individual Learning Accounts). IV. Target Population Recruitment for all training was focused on AFSCME-represented workers at OHSU. Recruitment for the CNA training focused on housekeepers, food service workers, and transportation aids, particularly people of color and recent immigrants. CMA recruiting targeted current CNAs, administrative support staff, and patient access services staff. Recruitment for Radiologic Technician training was more general and did not target specific occupations. Employees were recruited using a variety of methods. Notices were mailed or ed. Flyers were posted throughout several departments at OHSU and in satellite facilities. Temporary workers received inserts about the program with their paychecks. To reach ESL populations, we translated flyers and notices to Spanish and Russian. Multiple evening and morning meetings were held to explain the program to employees on a variety of shifts. Additional presentations were made during department meetings. V. Implementation Issues A. Identification of trainers: Early implementation work centered on identifying appropriate training providers for healthcare occupations and negotiating subcontracts that provided for as much on-site training as possible. This took somewhat longer than anticipated. B. Development of supplemental curricula: WSI and AFSCME project staff developed curriculum for interviewing skills workshops and basic skills classes geared to helping CMA candidates pass the prerequisite Asset Test. C. Development of ESL curricula: To meet the needs of limited proficiency English speakers interested in CNA training, WSI s Bilingual Projects Manager worked with IRCO to arrange a no-cost, on-site basic ESL class, supplemented with a specific ESL class designed for prospective CNAs. IRCO was able to accommodate our need through one of their grant-funded programs. D. Logistics: AFSCM staff worked with OHSU HR and Facilities staff to arrange for suitable classroom and training space. VI. Participant Flow Chart (general model) Recruitment Screening/Assessment Remediation Training Licensure/ Certification Placement Remediation 2

3 VII. Description of Services A. CNA Program Model: The CNA program was a part-time program offered both on and off-site to OHSU employees and provided by New Care Directions. We offered evening and day classes to accommodate a variety of shifts. The program was free (included books, lab fees, uniform, test fee). The Oregon State Board of Nursing governs the CNA curriculum. Once students completed all of the requisite coursework they took the State Board Exam. After they passed the exam, they were eligible to work as a CNA. Assessment with New Care Directions: Applicants went through a half-hour assessment administered by New Care Directions staff. The assessment tested applicants basic reading comprehension, analytical, and English skills. Students who did not pass the assessment were given support to help them gain the required skills (see below). Screening and Interview with OHSU: The OHSU screening and interview determined whether participants would be offered employment at OHSU as a CNA. Screenings were administered on applicants before the interview. The screening determined whether the applicants met the minimum requirements for working as a CNA at OHSU and typically consisted of supervisor feedback. Interviews were originally scheduled to take place before the start of classes. We found, however, that students lacked an understanding of the profession, which would be obtained through the class. Therefore, students were interviewed after they have finished the 75 hours of classroom training. Students who were accepted by OHSU were guaranteed employment as a CNA at OHSU, if positions are available. Students, in turn, were required to accept the positions and retain them for six months. Students who did not pass the interview were able to continue with their training, but were required to look for CNA positions at other local hospitals or health care providers. ESL and Reading Comprehension Tutors: Non-native English speakers who were interested in applying for the CNA program could enroll in one of two classes delivered on-site at OHSU by IRCO: a general ESL class and a CNA/ESL class. Students who were non-native English speakers and had difficulty understanding English, or students who did not pass the New Care Directions English assessment, enrolled in the general ESL class to help them gain English proficiency. The CNA/ESL class was geared towards people with comfort in English, but who might need a little extra help preparing for the assessment. Students who were admitted to the CNA program, but who still had slight difficulties understanding the text, were provided with tutors. Tutors were available two days per week for two hours each day. We found that students rarely made use of the tutors. Interview Skills Workshops: To help people prepare for the OHSU interview, we offered workshops in interview skills. We worked closely with New Care Directions and OHSU to identify a set of standards necessary for becoming a CNA. We then 3

4 established a set of tools for a three-hour interview skills workshop. The class included exercises and questions for the students to use when practicing at home. B. CMA Program Model: The Certified Medical Assistant (CMA) program was an on-site certificate program offered by Portland Community College. The two-year program was modified from PCC s traditional one-year CMA certificate program to meet the needs of incumbent workers and to help students gain the skills to succeed in this rigorous program. With the exception of some books for prerequisites, the program was free to participants. Students who were accepted into the program and passed the interview with OHSU were guaranteed a position at OHSU as a CMA, if positions were available. Every effort was made to coordinate the program with applicants busy schedules. The last term consists of six weeks of clinical training. During this time students will take a leave of absence from their positions and will work full-time in the clinical setting. Students will receive a stipend equal to their current wage during this portion of the training. Program Prerequisites: To enter PCC s CMA program students must meet the following requirements: Achieve ASSET test scores of 45 in both reading and writing and 42 on numerical skills Must demonstrate proficiency in keyboarding, word processing, internet, Must have high school degree or equivalent When the program was first customized, students were expected to enter the program immediately, after meeting all of the PCC requirements. However, we found that students were having difficulty passing the ASSET test. We then decided to delay admission to the program to allow students to prepare for the ASSET test. Basic Skills and the ASSET Test: The ASSET test measures a student s aptitude in reading, writing and numerical skills. The test is a timed exam and is difficult to pass, especially for students who have been out of school for a while or have test-taking anxieties. To help students overcome these barriers we created a number of preparation tools, including a study guide and an ASSET test prep course. The study guide covers all of the subjects tested in the ASSET and provides extensive exercises for students to complete. The prep course was designed to help students achieve the necessary scores for admission into the CMA program and gave students the skills to handle the difficult CMA coursework. Students who achieved the required scores did not take the class. Computer and Keyboarding Skills: Students must demonstrate proficiency with computers, keyboarding, Internet and in order to achieve success in the program. Through the Career Center (developed at OHSU concurrently with this project) students received training in these areas and were able to practice their skills on Career Center computers. 4

5 Job Readiness and Interview Skills: Through PCC s seminars, students obtained general and CMA specific job readiness skills. Students were taught by instructors familiar with the role of a CMA. They were also given the opportunity to job shadow current CMAs. Additionally, students were offered extensive tools to prepare for the interview. C. Radiography Model: The Radiography program is a two-tiered program consisting of a prerequisite program and a full-time A.A.S. program. Through the Prerequisite Program, we provided funds for AFSCME represented OHSU employees to complete the prerequisites necessary for entry in PCC s Radiography program. The full-time A.A.S. program is the two-year Radiography program offered at PCC. The program was only offered at PCC; no on-site components were available. Students admitted to the program from OHSU were provided with stipends equal to half of their full-time wages. The stipend will be provided during the two years of the program. Incumbent workers who enrolled in this program did not require additional supports beyond financial assistance and prerequisite coursework. VIII. Issues Resulting in Changes A. Change in project management: Six months into the Jobs and Ladders program, WSI received state approval to shift project management responsibilities, and related grant funds, to AFSCME. This change reflected the belief of all project partners that the long-term success of workforce development strategies at OHSU required the full participation and commitment of AFSCME. Their involvement in this effort s project management would help them gain the experience necessary to manage the effort after expiration of the grant. B. No-cost extension: The state approved an extension of the grant from 2/28/2002 to 9/30/2002 to allow us additional time to meet our match obligation. C. Location of CNA clinical training: According to administrative law, the CNA curriculum must include 75 hours of classroom training and 75 hours of clinical practice. Forty of the clinical hours must take place in a long-term care facility. Our original design had students doing 40 hours of clinicals in a nursing home and 35 hours at OHSU. However, we learned that it is more difficult to pass the CNA test using this model because the test is geared toward nursing home work. The program was redesigned so that all 75 hours of clinicals were done in a nursing home and 35 additional paid orientation hours were provided at OHSU in the unit in which the CNA was hired. D. Flexible approach to prerequisites: Jobs and Ladders benefited from PCC s willingness to accommodate program and participant needs. We found that it was necessary to allow some CMA candidates to take the ASSET test more than twice (contrary to the usual practice) before they passed. We found that it was necessary to allow some participants to begin the CMA program while they concurrently prepared for (and eventually passed) the ASSET test so that we could maintain our training schedules with full classes. 5

6 PCC added an additional Medical Terminology class so that participants who failed the initial class were given an opportunity to pass. These participants were allowed to take the added Medical Terminology class concurrently with the classes that would normally follow in sequence so that they were not left behind. IX. Project Outcomes A. Completion of Training TRAINING PLANNED ENROLLMENT ACTUAL ENROLLMENT PLANNED COMPLETION ACTUAL COMPLETION CNA * CMA Pending** RADIOGRAPHY *** * 3 more students are waiting to take their tests and are expected to complete the program. We expect to have 30 completions within a few months.. ** 12 students are progressing toward completion. These students are doing extremely well and are receiving excellent grades. *** Students were expected to complete this 2-year program after the grant period. The first graduate was hired in September Two more students were accepted into the Radiography program in September Fifteen students continue to work on their prerequisites in preparation for application to the Radiography program in future years. B. Placement and Wage Gain To date, 8 of the 27 CNA graduates have been placed. 19 are waiting for a preferred shift or work location to become available. Placed CNA graduates went from an average pre-training wage of $9.89/hr to an average post-training wage of $11.52/hr. This represents an average wage gain of 16.5%. 12 CMA participants are expected to complete training in The one Radiography graduate who was placed went from a pre-training wage of $10.54/hr to a post-training wage of $18.66/hr. This represents a wage gain of 77.0%. C. Development of the AFSCME-OHSU Career Center Concurrent with the implementation of Jobs and Ladders, WSI, AFSCME, OHSU, SE Works, and the Healthcare Consortium collaborated in the development of a Career Center at OHSU. With support from a State Current Workforce Skill Development grant and a DOL Sectoral Employment Demonstration grant, we opened the Center in March Incumbent workers can access administrative support and information 6

7 services training options (most of which are on-site), a range of assessment tools, online tutorials, and career counseling. We also implemented JobLink, a website based on career mapping tools that helps users find OHSU jobs for which they are qualified and identify the skills and training they need to pursue career goals. Staff was initially grant-funded, but are now budgeted by OHSU, an indication of the value of their efforts to the employer. X. Lessons Learned and Pitfalls To Be Avoided A. Partnership with an industry consortium. Working with the Metropolitan Healthcare Workforce Consortium helped us identify healthcare sector workforce needs and gain employer support for this and other sectoral initiatives. Working with industry consortia can also help guarantee the availability of placements for program completers. B. Customized training. We found that it was essential to customize training to be successful with our target population. Our training partners, PCC and New Care Directions, were quite flexible and innovative in that regard. In collaboration with OHSU and AFSCME, they were able to make training more accessible to incumbent workers through flexible scheduling and by maximizing classroom and clinical instruction on-site at the workplace. They also customized curricula to meet state licensing and certification standards while also meeting the particular needs of the employer. Development of an ESL class focused specifically on the CNA curriculum was very helpful and we were fortunate to partner with IRCO in that effort. C. Responsiveness to target populations. We found it necessary to develop strategies for basic skills training, soft skills training, and assistance for workers whose native language is other than English in order for participants to meet course prerequisites and enhance their placement potential. Flexibility on the part of training providers, particularly in regard to prerequisites, was invaluable. The fact that participants were paid their salaries while engaged in training helped many in our target population maintain their commitment to the program. D. Labor-management partnerships. The commitment of AFSCME and OHSU to this training initiative was essential for recruitment, curriculum development, logistical assistance, and budget support. Their collaboration led to the development of the AFSCME-OHSU Career Center. XI. Recommendations and Conclusions The project demonstrated the feasibility and value of on-site customized training designed to help incumbent workers advance their careers while meeting the needs of employers for skilled workers in high-vacancy occupations. This project was designed as a pilot for similar programs at other large healthcare systems and we intend to share our findings (and this report) with the membership of the Healthcare Workforce Consortium. Jobs and Ladders has already been replicated (to an extent) in a CNA program that targets residents of low-income housing. Careers in Healthcare, operated by WSI in partnership with several hospitals, New Care Directions and affordable housing providers, draws on the lessons learned in this project. For example, basic skills classes are offered so that successful students will be able to pass the 7

8 ASSET exam if they subsequently wish to advance their careers by applying for PCC s CMA program. Jobs and Ladders, and related initiatives, also demonstrated the potential impact of sector or employer-specific one-stops. With links to traditional one-stop resources and easy access to specialized industry or employer resources, programs such as the AFSCME-OHSU Career Center may be able to meet the workforce needs of large employers or industry consortia more cost effectively than broadly based programs tasked with responding to the workforces needs of an entire region. 8

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