While most of Montana fared well during the recent. recession, various rural areas have been strongly impacted by job

Transcription

1 Montana HealthCARE Project Narrative (1) Statement of Need While most of Montana fared well during the recent recession, various rural areas have been strongly impacted by job losses, with many TAA-eligible workers displaced and unemployed. For example, the mountainous northwest region, impacted by losses and slow recovery in the timber and mining industries, has unemployment surpassing 10%. Double-digit unemployment also challenges Montana s Native American community, and veterans returning from Afghanistan and Iraq also need reemployment opportunities to integrate back into their home communities. Despite these high needs, Montana faces impending workforce shortages in certain industries. The Montana Department of Labor and Industry s (DLI) employment forecasts state: About 27% of Montana s workforce is 55 or older and approaching retirement age. These impending retirements could potentially reduce Montana s labor force by 136,982 workers. With the segment of the population aged 16 to 24 totaling only 113,000, there are simply not enough young workers entering the labor force to accommodate those retirements. 1 As DLI points out, the unmet demand for healthcare workers is especially profound: Healthcare is expected to continue rapid job growth in the future as Montana s aging population continues to demand more healthcare services and Montana s overall population grows. Healthcare is expected to add about 1,300 jobs per year through This growth represents the largest growth in terms of jobs of any industry in Montana. Montana s widely dispersed population and diverse local economies intensify the challenge of unmet workforce development needs. The 3rd most frontier state in the nation, 90% of Montana s land mass and 45 of Montana s 56 counties are classified as frontier based on population density of 6 people 1 Montana Employment Projections , Montana Department of Labor & Industry

2 or less per square mile. Montana s eastern and western borders are 750 miles apart, with a travel time exceeding 13 hours. To meet the needs of unemployed and widely dispersed Montanans, as well as meet the human capital needs of a quickly growing healthcare industry, Montana s education and workforce system has an imperative to provide high quality, locally accessible, and industry-relevant training opportunities. MT HealthCARE will focus on retraining widely dispersed skilled but un-credentialed rural workers, veterans, and other unemployed persons in the high demand, high skill area of healthcare. It will employ strategies to increase access to nursing and allied health programs; reach new adult learners; use distance technology to serve adults across a population-sparse state; increase credential completion and placement into the workforce, including common curricula and pathways, technology enabled learning and support, distributed student supports, prior learning assessment, and employer-based clinical opportunities, including preceptorships and apprenticeships. This initiative, the MT HealthCARE (Creating Access to Rural Education), will bridge skills gap by connecting job seekers with training opportunities, ensuring their academic success and credential attainment, ultimately leading to gainful employment in the high-demand, high-paying healthcare industry. MT HealthCARE is a statewide, industry-driven partnership comprised of a 15-college consortium, the MT Department of Labor and Industry (DLI), the Office of the Commissioner of Higher Education (OCHE), and the Montana Area Health Education Center (MT AHEC), a US DPHHS funded program. (a) Serving the Education and Training Needs of TAA-Eligible Workers (i) Impact of Foreign Trade Montana suffers one of the highest per capita Trade Adjustment Assistance (TAA) populations among rural states. The loss of jobs for 2,178 TAA-eligible workers, has coupled with significant recession-related job loss to significantly impact the state, but the impact is not equally distributed. The 2

3 state s TAA-impacted workers effectively represent the downsizing of the timber and mining industries over the past two decades, a change that has negatively impacted the economic base of the forested western third of Montana. The average wage earned in the year before the claims made by TAA workers was $49,050 (1,145 workers with wage information available). Nearly 60% of the workers worked in the manufacturing industry (primarily wood product manufacturing), with 14% coming from the mining industry. Nearly 25% of the workers were previously employed in a production occupation, with 17% engaged in a transportation occupation, and 13% engaged in a construction or extraction occupation. Of the workers for whom wage information is available, 713 had wage earnings in 2013, meaning that roughly 38% of the workers were still unemployed in Companies Receiving TAA Certification in Montana Between 10/01/2010 and 12/24/2013 TAA Cert. Company Location Decision Date Workers Industrial Technology Corporation Missoula 7/8/ ILevel by Weyerhaeuser All Montana locations 11/9/ Sun Mountain Sports, Inc. Missoula 1/14/ T Interstate Brands Corporation Billings 10/28/ Lee Enterprises-Billings Gazette Billings 10/17/ Lee Enterprises-Helena IR Helena 12/27/ A Lee Enterprises-Butte MT Standard Butte 12/27/ X Interstate Brands Corporation Statewide 11/20/ A REC Advanced Silicon Materials, LLC Butte/SilverBow 11/21/ Total TAA Workers in Montana 361 Of those with earnings, only 27% had earnings higher than before they were unemployed. The profile of TAA-eligible workers demonstrates the fundamental shift in Montana s economy. Historically, MT relied on goods-producing and extractive industries to drive economic growth, but the state is shifting into a service-based economy, with extractive industries demonstrating slower growth than knowledge-based jobs, including the fast-growing healthcare field. 3

4 (ii) Education and Training needs of TAA-Eligible Workers Data on the education and training needs of workers is based on 1,145 individuals in the TAA program from 2009 to Over 52 percent were over the age of 50, making the group slightly older than Montana s labor force as a whole 2. Roughly 60% had only a high school degree, with only 13 Educational Attainment of TAA Workers Number of TAA-eligible Workers Percent Less than HS % HS grad or GED % Some College or 2-Year Degree % Bachelor s or Higher % percent having a bachelor s degree or higher. In comparison, roughly 34 percent of Montana s labor force as a whole has a bachelor s degree, meaning that the group of TAA-certified workers are less educated on average than Montana s workers as a whole. Many of the TAA workers had multiple unemployment claims, some from non-taa certified employers, and some with multiple occupations. Workers with multiple occupations in the claims have a broader skill set than a worker with experience in just one occupation. There were a total of 230 occupations represented among the workers. The totals by occupational group are listed in the table below. Age of Participants Count Percent Less than % 30 to 49 years % 50 to 59 years % 60 and older % Previous Occupations of TAA-eligible Workers Occupational Group # TAA Workers Listing Occupation Percent Production % Construction and Extraction % Transportation % Installation, Maintenance, and Repair % Office and Administrative % Farming, Fishing, and Forestry % Management % Architecture and Engineering % Current Population Survey 4

5 Sales and Related % Life, Physical, and Social Science % Business and Financial % Building and Grounds Maintenance % Protective Service Occupations % Arts, Design, Entertainment, Sports, and Media % Healthcare Practitioners and Technical 8 0.4% Computer and Mathematical 7 0.3% Food Preparation 6 0.3% Community and Social Services 2 0.1% Education, Training, and Library 2 0.1% Personal Care and Service 2 0.1% Healthcare Support 1 0.0% To bridge the divide between dominant TAA occupations and healthcare occupations targeted in MT HealthCARE, DLI developed a program designed to match skills of the TAA population with skills required in the targeted high demand healthcare occupations. Occupations were matched with the skill levels using the O*Net skills database, which provides information on the level of skills needed to perform each occupation, including technical and soft skills and is critical in the retraining of TAA workers, veterans and other displaced workers in targeted healthcare occupations. Basic skills, system skills, and management skills will need to be improved in addition to healthcare-specific occupational skills before the TAA workers can fill the targeted medical occupations. A sample of the full analysis is found in the table on the following page, which compares skills of the average TAA-eligible worker to skills needed in target healthcare occupations. These workers have a science skill level that is higher than that needed to be a medical secretary; therefore, the cell is highlighted in green. Cells without a green highlight are skills gaps where the skill of the TAA workers will likely need to be improved before becoming a medical secretary. 5

6 Basic Skills Social Skills Technical Skills Systems Skills Management and Problem Solving Skills Gap Analysis for TAA workers and Targeted Medical Occupations Occupation Average, All TAA Workers Registered Nurses LPNs Nursing Assistants Medical Secretaries Expected Worker Demand Reading Comprehension Active Listening Writing Speaking Mathematics Science Critical Thinking Active Learning Learning Strategies Monitoring Social Perceptiveness Coordination Persuasion Negotiation Instructing Service Orientation Operations Analysis Technology Design Equipment Selection Installation Programming Operation Monitoring Operation and Control Equipment Maintenance Troubleshooting Repairing Quality Control Analysis Judgment and Decision Making Systems Analysis Systems Evaluation Time Management Management of Financial Resources Management of Material Resources Management of Personnel Resources Complex Problem Solving (iii) Partnerships with State agencies that Operate TAA for Workers The Montana Department of Labor and Industry (DLI) administers Montana s TAA programs and provides frontline services to TAA-eligible workers at its 23 local One-Stop Job Service Offices around the state. DLI has been an active partner with the HealthCARE college consortium from day one, providing essential information about the TAA population and other programs for displaced workers, preparing the skills gap analysis, and helping to prioritize industry focus and programmatic 6

7 strategies most likely to help fill skills gaps throughout the state. DLI also administers the Montana Career Information System (MCIS), which will help to facilitate this process through an online career planning platform. DLI houses the Montana Registered Apprenticeship Program (MRAP), and will develop a brand new healthcare apprenticeship program through the HealthCARE initiative. MT Board of Nursing, and MT Board of Medical Examiners, administratively attached to DLI, have also endorsed the project. (b) Evidence of Job Opportunities in the Targeted Industries and Occupations (i) Evidence of Employer Demand for Targeted Industries and Occupations Healthcare was the only industry in Montana that grew throughout the recession, and it is Montana s fastest growing industry, with 1300 jobs projected per year for the next ten years, according to DLI. The table (below) provides Labor Market Information (LMI) on targeted occupations. MHA- An Association of Montana Healthcare Providers and Billings Clinic, Montana s largest hospital system also conducted workforce need surveys. In addition, data from the Economic Modeling Specialists, Inc. (EMSI), consultation with the MT Nursing Association (MNA), input from the Area Health Information Center (AHEC) and employer interviews conducted specifically for this project, were utilized in targeting occupations within the healthcare field. The Corporation for a Skilled Workforce (CSW) worked with the Steering Committee and DLI to survey 201 healthcare industry employers. These employers indicated the healthcare occupations that had the greatest unmet need; and why these occupations have been difficult to fill. Respondents said demand over the next two years is similar to the labor market data provided in the following table, but that demand for Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nursing Assistants (CNA) may be much higher than projected. These surveys and data sources validated and refined the LMI provided by DLI and helped to further hone the HealthCARE project strategies. 7

8 Demand for Targeted Occupations Code Occupation Title Education* Work Experience or Job Training* New Jobs Replacements Total New Jobs Replacements Total Average Annual Wage Registered Nurses Associate's degree $59,914 Licensed Practical and Licensed Vocational Nurses Postsecondary award $37, Nursing Assistants Postsecondary award $24,425 Medical Records and Health Information Technicians Postsecondary award $31, Medical Secretaries HS or GED Moderate OJT $29, Pharmacy Aides HS or GED Short OJT $23, Pharmacy Technicians HS or GED Moderate OJT $32, Emergency Medical Technicians and Paramedics Dental Assistants Minimum Requirements to Enter Profession Postsecondary award $28,338 Postsecondary award $31, Medical Assistants Postsecondary award $30, Dental Hygienists Associate's degree $67, Medical Transcriptionists Postsecondary award $31,841 Total Demand in Targeted Occupations Annual Openings, 2014 & *Postsecondary award=post-secondary non-degree award, HS or GED = High school diploma or equivalent, OJT=on-the-job training Source: Montana Department of Labor and Industry Employment Projections. (ii) Understanding of Skills Required in the Targeted Industries and Occupations Annual Openings, Skills gap analysis on Montana s TAA population utilizing the O*Net skills data match methodology illustrates the need for enhanced basic skills, social skills and management and problem solving skills for TAA-impacted workers entering healthcare training. MT Center to Advance Health through Nursing (CAHN) hosted 11 meetings throughout the five AHEC regions in the state in April 2014, followed by a Nursing Summit in June, 2014 with 200 persons representing nursing employers, educators and students providing feedback on nursing workforce needs and education. The Summit report states that nursing is moving rapidly to an expanded skill set that requires advanced complex clinical skills, understanding information technology, data analysis, and critical thinking. The Summit recommended stacking of credentials and clear career ladders to move CNA, LPN and Associate 8

9 Degree RNs (ADRN) to the industry demand for higher level nursing skills; that 2-year colleges must engage in employer/educational partnerships to redesign the curriculum; and pathways that will allow learners to move seamlessly along the nursing pathway to an ultimate goal of baccalaureate nursing. Assessments for other clinical and administrative health occupations were completed by the AHEC Workforce Committee, DLI, OCHE, and the partner campuses. The assessments follow the structure developed by The National Consortium for Health Science Education (NCHSE), identifying industry skill needs for academic foundations, teamwork, communications, technical skills, information technology, employability skills, safety practices, legal, and ethics - skills common across the specific occupations targeted in this proposal. (c) Gap Analysis (i) Significant Gaps in Existing Education and Career Training Programs System-wide OCHE data shows that healthcare graduates find work quickly, stay and work in Montana after graduation at a higher rate than any other field in the postsecondary system, yet training gaps remain. Over 20 healthcare programs are offered across Montana s public two-year and Tribal colleges, but do not coordinate curricula, have small enrollments, and are offered primarily in the larger population centers of the state thus not serving the vast rural regions where the positions are in high demand. Nursing, the largest healthcare occupation is offered on 8 two-year campuses, but the last curriculum redesign occurred 8 years ago. To better identify gaps in Montana s healthcare training system, the Corporation for a Skilled Workforce (CSW) assisted the HealthCARE steering committee in gathering primary and secondary data through surveys and interviews of healthcare employers, associations, colleges and workforce service providers. Responding to the survey, 201 employers, 62 Job Service Career Specialists, and every campus in the HealthCARE consortium provided data. 9

10 Through these surveys and interviews, the steering committee identified the following gaps: 1) lack of a statewide healthcare core curriculum that would allow students to lattice into and across healthcare credentials; 2) unmet remediation needs of adult learners; 3) limited healthcare training in rural areas of the state; 4) an outdated nursing curriculum which is under pressure to raise standards and promote academic progression to a bachelor s degree; 5) lack of student support systems for adult learners seeking new credentials; 6) absence of registered apprenticeship opportunities for students in the healthcare industry; 7) fragmented coordination among the State s two-year, community, and tribal colleges and the State s workforce system regarding health workforce development; and 8) limited distance education opportunities for core and basic skill development. (ii) How the Gaps Impact the Applicant s Ability to Effectively Serve Communities To better understand and contextualize the gaps identified through the steering committee gap analysis, HealthCARE utilized the Breaking Through (BT) initiative s evidence-based high leverage strategies as a framework for analysis (further detailed in Section 2(a) Evidence-based Design ). Results of the gap analysis (above) identified a number of healthcare workforce training needs, provided in the table below by their corresponding BT broad educational strategy. Utilizing the BT Framework has focused the development of MT HealthCARE s four strategies and will guide the implementation of this project to best meet the unique needs of adult learners and displaced workers. MT Healthcare Workforce Gap Analysis and the Breaking Through Framework Breaking Through High Areas of Focus to close Montana Healthcare Training Gaps Leverage Strategy Provide comprehensive support services Enhanced tutoring and remediation Enhanced success through a modularized approach to course delivery and assessment Accelerate pace of learning Reduced time to completion for adult learners enrolled in healthcare programs through the implementation of credit for prior learning Creation of a statewide accelerated nursing program model using a common nursing core to expedite time to completion and employment Create labor market payoffs Better utilization of Labor Market Information in training program design Creation of a statewide accelerated nursing program model using a common nursing core to expedite time to completion and employment to meet high employer demand and increasing skill requirements 10

11 Increasing pathways into college, particularly for lowskilled workers Creation of career pathways designed with stacked credentials for immediate employment or academic progression Access to training in rural areas through technology-based learning Improvement of the ability for students to transfer among colleges and career paths Development of healthcare apprenticeship programs (2) Methodology and Workplan The overarching vision of the HealthCARE initiative is the transformation from fragmented, localized workforce development in healthcare to a statewide system of healthcare workforce planning among the consortium; the state workforce system; the Montana Registered Apprenticeship Program; the AHECs; healthcare associations; and employers resulting in successful employment outcomes for all students, with attention to adult learners and veterans. This vision will be achieved through evidence-based strategies, outlined below and detailed in Section (2)(g). Objective 1 Objective 2 Objective 3 Objective 4 Four HealthCARE Objectives Create statewide healthcare pathways characterized by stacked and latticed credentials and contextualized curricula. Systemically address Montana s nursing shortages and provide accelerated pathways to completion of nursing programs and bridges to BSN for adult learners. Increase success for students by providing services that better prepare adult learners for success in the curriculum; accelerate credential completion; coach students in pathway navigation; and provide access to distance education. Engage the healthcare industry, education, workforce programs and other stakeholders in statewide healthcare workforce transformation and strategic planning; curriculum development; on-the-job training and apprenticeship opportunities; rapid response cycle regional planning; and data driven approaches for demanddriven workforce development and education strategies. (a) Evidence-Based Design (i) Review of Evidence for Program Design The most comprehensive evidence-based strategies to address challenges faced by low-skilled adult students are found within the Breaking Through 3 (BT) initative s framework of high leverage strategies, referenced above in the Gap Analysis, Section 1(c)(ii). BT currently works directly with 41 community colleges in 22 states, including some colleges in the HealthCARE consortium, to implement broad educational strategies: 1) providing comprehensive support services; 2) accelerating the pace of learning; 2) creating labor market payoffs; and 4) increasing pathways into colleges, 3 Liebowitz, M. and Taylor, J. (2004) Breaking Through: Helping Low-Skilled Adults Enter and Succeed in College and Careers. Boston, MA: Jobs for the Future. 11

12 particularly for low-skilled workers. Research demonstrates that implementation of individual BT strategies leads to significant gains in student retention, success and completion. The impact of the BT strategies is further enhanced when used in a collective synergistic approach. The MT HealthCARE evidence-based program design, described below, does this through the integration of evidence-based modularized and competency-based curricula, stacked and latticed credentials, accelerated learning, and remediation and support services for students. (ii) Description of Research Findings for the Program Design The description of research findings for the program design is detailed in the second column of each Evidence-based Program Design Charts, below. (iii) Use of Evidence in Program Design Objective 1: Create statewide healthcare pathways characterized by stacked and latticed credentials and contextualized curricula. Evidence from the long-standing I-BEST approach developed by the state of Washington demonstrates that career pathways successfully increase postsecondary credentials. MT HealthCARE faculty and employers will adapt the concept to help move learners from entry-level healthcare occupations to those requiring higher skills and credentials. Learning in the pathways will be enhanced by contextualizing the curricula based on analysis from 27 studies of contextualization. Objective 1: Create statewide healthcare pathways characterized by stacked and latticed credentials and contextualized curricula Strategies Description of Research Findings for the Program Design Use of Evidence in Design 1.1 Career and Educational Pathways with Stacked and Latticed Credentials and modularized curricula Strong Theory: Cabrillo College in Santa Cruz, California, has connected low-income individuals with limited English skills to local jobs and career opportunities. One career ladder strategy is focused on the health care industry. The Health Careers Partnership involves major healthcare employers and training providers in efforts to increase the region s supply of health care workers and ensure that low-income and under-represented populations have access to health careers. Of those who complete their training, 90 percent get jobs with an average hourly salary of $ Evidence of Promise: Every proposed I-BEST program must be part of a career pathway; that is, a course of study that leads to postsecondary credentials and career-path employment in a given field for which colleges Activities: 1.A.1-3, and 3.A.4 A major focus of this proposal is adapting evidence-based design for latticed and stackable certificate and degree programs, and modularizing curricula, which are strategies promoted by Breaking Through (BT) research, I- 4 Building a Career Pathways System: Promising Practices in Community College-Centered Workforce Development; The Workforce Strategy Center; August,

13 1.2 Contextualized Curricula must document demand. Thus, I-BEST provides a structured pathway to college credentials and employment so that students do not have to find their way on their own. In the first study, on all of these measures, I-BEST students performed moderately or substantially better than non-i-best basic skills students who enrolled at the same time. Enrollment in I-BEST had positive impacts on all but one of the educational outcomes (persistence was not affected), but no impact on the two labor market outcomes. However, it is likely that I-BEST students did not fare better than the comparison group in the labor market because they were entering the market just as the economy was entering the recent major recession. 5 Strong Evidence: A decade of research conducted by the National Center for Developmental Education examining best practices in developmental education indicates that modularized instruction helps move students through developmental education more quickly and cost-effectively. 6 Strong Evidence: Columbia University s Community College Research Center and its researchers have published several working papers and briefs on contextualized learning, one of which is the research synthesis Facilitating Student learning through Contextualization. A review of evidence (2011). For this research synthesis, Deloris Perin, a senior research associate, analyzed 27 studies of contextualization conducted between 1990 and Perin s study found positive outcomes of contextualization. 7 8 Best success rates, the U.S. Department of Labor, and the National Center for Developmental Education. MT HealthCARE will adapt existing evidence-based development of contextualized curricula, a strategy promoted by BT and University research, and large national nonprofits. Strategy 2: Systemically address Montana s nursing shortages and provide accelerated pathways to completion of nursing programs and bridges to BSN for adult learners. Research shows that students in an accelerated nursing program had a higher passing rate (92.3%) than the traditional students (89.5%). The fact that there was no statistically significant difference in the NCLEX-RN pass rates for the 2 groups demonstrates that accelerated learning, which saves time and money for students, does not equate to fewer skills. Objective 2: Systemically address Montana s nursing shortages and provide accelerated pathways to completion of nursing programs and bridges to BSN for adult learners Strategies Description of Research Findings for the Program Design Use of Evidence in Design 2.1 Accelerated Nursing Education Moderate Evidence: A study was developed to determine if there is a significant relationship among selected variables and success on the NCLEX-RN licensure exam in the traditional nursing students and accelerated nursing degree students and also if there were significant differences in the academic achievement of accelerated and traditional nursing students in selected variables and NCLEX-RN performance. Students in the accelerated program have a higher passing rate (92.3%) Activities 2.A.1-2, 2.B.1-3 Adapting models developed by nursing schools around the country, Montana HealthCARE will increase capacity to reach the TAA and unemployed 5 Zeidenberg, Cho, Jenkins; Washington State s Integrated Basic Education and Skills Training Program (I-EST): New Evidence of Effectiveness; Community College Research Center, September Boylan, H. What works: Research-based best practices in developmental education. Boone, NC: Continuous Quality Improvement Network, Appalachian State University, (2002). 7 Models of Contextualization ; Education Development Center, Inc. (EDC), July, Preciosa Fernandes, Carlinda Leite, Ana Mouraz, Carla Figueiredo; Curricular Contextualization: Tracking the meanings of a concept; Faculty of Psychology and Education Sciences, University of Porto, (2012). 13

14 than the traditional students (89.5%). There was no statistically significant difference in the NCLEX-RN pass rates for the 2 groups 9 Evidence of Promise: Findings provide evidence that 5 years postgraduation an overwhelming percentage of accelerated, second-degree graduates were active in the nursing workforce and demonstrate a positive response pattern to their career transition. A majority were in direct patient care roles, thereby validating the intention of the program, which was to increase the number of nurses at the bedside. 10 population by accelerating nursing education with certificate and degree stepouts along the path of CNA to LPN to RN to ADRN to BSN providing ample opportunity for employment. Objective 3: Accelerate success for students by providing services that support adult learners and integrate work and learning through services that include: Remedial Support for Curriculum Readiness, EdReady: Montana s own evaluation of experience with EdReady shows there is sufficient promise to expand the tool statewide and to adult populations not currently being served by this program. Online Tutoring: SmarThinking is an online tutoring service is available 24 hours a day, 7 days per week. The Division of Florida Colleges hired a private contractor to investigate SmarThinking impact and students who used SmarThinking had a higher GPA than did those who did not participate. This promising practice is thus being adopted for use across the MT HealthCARE consortium. Healthcare Professional Career Coaches (HPCC): Coaching has been shown to be a costeffective method of achieving retention and completion gains by research found in the US Dept. of Education s What Works Clearinghouse. Adapting findings from this solid research, HPCCs will be housed at Montana s five regional AHECs and assigned to coordinate with local Job Service Offices to utilize advising, financial aid services, admissions, tutoring and other student support services to achieve goals for healthcare education. Assessment and credit for prior learning: Research shows that students with Prior Learning Assessment (PLA) credit had higher graduation rates, better persistence and lower time to degree, 9 Regina Bentley, EdD, RN; Comparison of Traditional and Accelerated Baccalaureate Nursing Graduates; CIN: Computers, Informatics, Nursing; June 2006; Volume 24 Number 3 - Supplement: HESI Exams Pages 65S - 68S. 10 Deborah A. Raines; Five Years Later: Are Accelerated, Second-Degree Program Graduates Still in the Workforce? International Journal of Nursing Education Scholarship 2013; 10(1): 1 14

15 compared to students without PLA credits. Thus, MT HealthCARE Leadership Committee will adapt the approach by developing policies and procedures for PLA. Distance education: A recent meta-analysis of high-quality studies suggested that online learning yields similar or better outcomes than does face-to-face learning. MT HealthCARE will carefully adapt distance education for the core healthcare curriculum, contextualized pre-academic preparatory programs, common courses in nursing, delivery of didactic curriculum for apprenticeship programs, and allied health clinical and administrative track programs. Objective 3: Increase success for students by providing services that better prepare adult learners for success in the curriculum; accelerate credential completion; coach students in pathway navigation; and provide access to distance education Strategies Description of Research Findings for Program Design Use of Evidence in Design 3.1 Remedial and Tutoring Support for Curriculum Readiness (EdReady and SmartThinking) 3.2 Healthcare Professional Career Coaches (HPCC) Evidence of Promise: EdReady: During the Summer of 2013, the MTDA, in partnership with the University of Montana (UM), launched an online EdReady pilot involving 66 students. The results were significant, with 86% (44) of the students who finished the EdReady program increasing their ALEKS placement test score and subsequently enrolling in a higher math course at UM. This pilot demonstrates potential for scalability across the MUS and the State s seven tribally controlled colleges. Evidence of Promise: SmarThinking: The Division of Florida Colleges hired a private contractor to investigate the effect of using the SmarThinking tutorial services on student grades and to determine if the amount of use had any impact. Grade point averages (GPA) for SmarThinking and non-smarthinking students showed that overall, the SmarThinking group had a higher GPA than did those who did not participate in the program during the year. 11 Strong Evidence: Coaching is a more cost-effective method of achieving retention and completion gains compared to other intervention strategies. In a key large- scale study involving more than 8,000 coached students, across years and a variety of institutions, coaching has been shown to increase retention and completion rates consistently by more than 10%. The research on the subset of seven well-executed lotteries (described in the key study) meets the Dept. of Education s What Works Clearinghouse evidence standards without reservation. 12 Activities 3.A.1-2. Montana HealthCARE will adapt existing evidence-based design, development, and delivery strategies for remedial and tutoring support using proven software and professional tutors. Activity 3.A.3. Montana HealthCARE will adapt existing evidence-based remote delivery (following Alabama PAVES consortium model) to assist students in successfully navigating 11 Dr. John Hughes, Associate Vice Chancellor for Evaluation; A Review Of The Use Of SmarThinking Tutorial Products In The Florida College System 12 U.S. Dept. of Ed., Institute of Education Sciences, What Works Clearinghouse, WWC Review of the Report The Effects of Student Coaching in College: An Evaluation of a Randomized Experiment in Student Mentoring. (2012) 15

16 3.3 Prior Learning Assessment 3.4 Distance Education Moderate Evidence: 13 Research shows that students with Prior Learning Assessment (PLA) credit had higher graduation rates, better persistence and lower time to degree, compared to students without PLA credit. Moderate Evidence: Review of moderate to strong findings from 34 papers reach different conclusions about online learning with some studies finding that online coursework may hinder progression for low-income students, and a recent metaanalysis of high-quality studies suggested that online learning yields similar or better outcomes than does face-to-face learning. 14 Capitalizing on Montana s PLA Task Force efforts, CAEL s evidence-based Ten Standards will be adapted for healthcare students Activity 3.B.3. Adapting open online course delivery and hybrid courses of study will allow rural Montanans access to healthcare courses without traveling great distances. Objective 4: Engage the healthcare industry, education, workforce programs and other stakeholders in statewide healthcare workforce transformation and strategic planning; curriculum development; onthe-job training and apprenticeship opportunities; rapid response cycle regional planning; and data driven approaches for demand-driven workforce development and education Statewide sector planning and partnerships: A three-site random assignment study of sectorfocused training found participants earned 18% more than controls over a 24-month period. MT HealthCARE will adapt the sector strategy approach through MT AHEC s MT Healthcare Workforce Advisory Council (MHWAC), whose role will expand to act as a sector partner with postsecondary education at the state level. Five regional Healthcare Workforce Advisory Councils (HWACS) will serve the function at the regional level. Apprenticeships: Apprenticeship and pre-apprenticeship opportunities have been demonstrated to both reduce unemployment through better employer alignment and to increase opportunities for underserved populations. MT HealthCARE will adapt the apprenticeship model for use in the healthcare field by creating a Registered Apprenticeship College Consortium (RACC). Clinical coordination: The clinical experience collaborative model has been demonstrated to increase needed space required for clinicals and increase the numbers of healthcare graduates. MT 13 Brigham, C. and Klein-Collins, R. (2010). Availability, Use and Value of Prior Learning Assessment within Community Colleges. CAEL. 14 Jaggars, S. (2011). Online learning: Does it help low-income and underprepared students? Community College Research Center. 16

17 HealthCare will adapt the Clinical Coordination Partnership, a collaborative approach to coordinating clinical space, and support these efforts with a scheduling database. Objective 4: Engage the healthcare industry, education, workforce programs and other stakeholders in statewide healthcare workforce transformation and strategic planning; curriculum development; on-the-job training and apprenticeship opportunities; rapid response cycle regional planning; and data driven approaches for demand-driven workforce development and education strategies Strategies Description of Research Findings for Program Design Use of Evidence in Design 4.1 Statewide sector planning and partnerships 4.2 Apprenticeships 4.3 Clinical Coordination Strong Evidence: a three-site random assignment study of sector-focused training found participants earned 18% more than controls over a 24-month period. Results led the authors to recommend that states invest in employment-linked job training programs. Partnerships among workforce system, educational institutions and employers enhance employment and wages. 15 Moderate Evidence: Apprenticeship and preapprenticeship opportunities have been demonstrated to both reduce unemployment through better employer alignment and to increase opportunities for underserved populations. 16 Strong Theory: The clinical experience collaborative model has been successful in many states; namely Oregon, Colorado, Tennessee, Mississippi and Ohio. All have reported that this new approach has greatly assisted their state to clarify clinical experiences and provided the needed space required to maintain and expand their graduate rates. 17 Activities 4.A.-C. MT HealthCARE will adapt and augment an existing, influential statewide advisory committee with industry and educational members for sector analysis, planning and evaluation. Five regional healthcare advisory committees will be utilized to address regional differences (economic, geographic) within the sector. Activity 3.B.1. Adapting Montana s successful RAAC program in the labor industry, apprenticeships will be integrated into stacked and latticed healthcare credentials. Activity 3.B.4. Montana HealthCARE will adapt existing evidence-based design, development, and delivery strategies to maximize the ability of education and healthcare partners to coordinate resources that meet clinical experiential learning needs. (b) Career Pathways The four MT HealthCARE Strategies build upon one another to create and improve industry-relevant career pathways and support student success and achievement of credentials in high demand healthcare fields. 15 Maguire, Freely, Clymer, Conway (2009). Job Training that works: Findings from the sectoral employment impact study. Public/Provate Ventures 16 Lerman, Robert. (2009)Training Tomorrow s Workforce Community College and Apprenticeship as Collaborative Routes to Rewarding Careers. Center for American Progress

18 Objective 1 aligns career pathways across the healthcare industry in patient care and administrative support occupations, which are illustrated here. Objective 2 further hones the career pathways efforts to align, improve, and bring efficiencies to the nursing occupations where industry has identified the greatest workforce needs. Objective 3 incorporates activities to promote student success and facilitate achievement in this unique adult-learner population, and Objective 4 ensures continuous industry engagement to drive decision-making that will meet and anticipate employer workforce demands. Each career pathway will include: a) clearly defined industry career ladders; b) modularized curriculum; c) stacked and latticed credentials; and d) credit for prior learning as well as job and military experience. Healthcare registered apprenticeship models will be built into these pathways as additional alternative routes to credential attainment. Healthcare transformation specialists will be hired at each campus to coordinate, integrate and focus each campus s work toward achieving the four HealthCARE objectives and provide vital linkages back to the HealthCARE Leadership Team and lead campus. This management structure will ensure statewide focus with significant local input. 18

19 (i) How Education and Career-focused Training Programs will Enable Students to Accelerate Completion of Remedial Coursework Adult-learners, including TAA-eligible workers pursuing career transitions into new industries, require specialized remediation programming to ensure success and credential completion. MT HealthCARE will leverage, adapt, and build upon current programs to meet these remediation needs. Currently, the Montana University System (MUS) partners with MT Digital Academy (MTDA) on a web-based pilot to help students test for college readiness, create a personalized study path to fill knowledge gaps, and more rapidly enter into college-level math and writing. MT HealthCARE will leverage a $2.4m grant from the Dennis and Phyllis Washington Foundation and a grant from the Bill & Melinda Gates Foundation to implement EdReady across the consortium. MT HealthCARE will fund expansions to this program for adult learners who have been away from school many years. In the first six months of the grant, work will begin on competency identification and alignment in key math courses. A group of math faculty from consortium campuses will convene a working group, over time expanded to all consortia members, under the guidance of the MUS Developmental Education Council. This group will delineate competencies needed for entrance into key remedial and gateway math courses required for the target healthcare training programs. The scaling of EdReady will begin with 10 of the 15 consortium campuses during the 1 st year of the grant with expansion to the remaining five during the 2 nd year of the grant. To further support student success in both developmental and program coursework, MT HealthCARE will engage online tutoring programming through SmarThinking. Described in more detail in Section (2)(c)(i) on technology-enabled learning, SmarThinking will work with 15 consortium campuses to implement SmarThinking across the consortium. 19

20 (ii) Specific Services and Career Guidance that will be Provided; Barriers Adult learners, particularly those transitioning into new careers and industries, face unique barriers that challenge their access to and completion of industry-recognized credentials. These barriers include significant skills gaps, remediation needs, and financial and family constraints causing these learners to be place-bound. Through student support services, MT HealthCARE will address barriers to retention, completion and employment with multiple activities that integrate work, learning and life. The foundation of these services will be the Health Professions Career Coaches (HPCCs) who will be housed with the regional AHECs and work closely with Montana s 23 Job Service Offices who provide in-person TAA services and are the point of entry for adult job seekers, particularly in remote, rural communities. Guided the HPCCs (remotely or through in person assistance from Job Service Career Specialists coordinating with the HPCCs), adult learners will access career guidance through the Montana Career Information System (MCIS), EdReady, enrollment strategies using the stacked credentials, earning credit for prior learning, accessing apprenticeships, transferring credits, and moving through career ladders and lattices in the most time and cost effective manner. HPCCs will ensure program and campus neutrality as well as a live and coordinated presence throughout the state. The HPCCs will be trained in collaborating with all postsecondary partners in the state to utilize advising, financial aid services, admissions, tutoring and other student support services to achieve goals for healthcare education. (iii) How Prior Learning for Adults Entering the Program will be Assessed The MT HealthCARE Leadership Committee will work with OCHE in the development of policies and procedures to facilitate the expedition of prior learning assessments (PLA) as a means for adult learners to demonstrated learning that has occurred, receive credit, and shorten the time required to obtain industry-recognized credentials. MT HealthCARE will implement PLA practices including 20

21 electronic portfolio assessment, ACE and CLEP examination. The intent is to increase adult student recruitment, persistence, and success. MT HealthCARE will develop recommendations for PLA policy and standards in order to ensure academic rigor; provide appropriate recognition of PLA credit awards on transcripts and in transfer among Montana s institutions; provide policy oversight, PLA faculty development and administrative/staff training; assist all campuses in improving awareness and visibility for PLA with improved communication and outreach to students, faculty and staff; integrate PLA framework into apprenticeship program development and delivery; and ensure Montana s military service members and veterans receive PLA credit recognition (as applicable to degree and certificate requirements) to the extent possible, while assuring academic integrity. The policies and procedures will be developed during year one of the grant and implemented in year two at each of the 15 consortium colleges. (iv) Identification of the Specific Programs that will be Competency-Based and the Observational Methods Used for Measuring Proficiency Proficiency measurement through nationally developed tests and observational methods in clinical education are already well-integrated into healthcare training programs. It is essential to maintain the quality of these assessments for patient safety and the provision of high quality health care. Through the HealthCARE initiative, competencies will be measured and credentials awarded by pass rates on national licensing exams, and assessments throughout each pathway will adhere to current healthcare training standards which require laboratory and clinical training for graduation directly observed by faculty and professional preceptors. 21

22 Education Program Clinical Pathway Occupations Clinical & Laboratory Observation Hours National Licensure/Registration/Certification Exam Nursing Assistant 36 Certified Nursing Assistant Dental Assistant 270 Dental Assisting National Board, Inc. Emergency Medical Provider 135 National Registry of EMTs (Technician) Pharmacy Technician 400 Pharmacy Technician Certification Board Physical Therapy Assistant 570 Federation of State Boards of Physical Therapy Practical Nurse 405 National Council of State Boards of Nursing (NCLEX) - Practical Nurse Radiologic Technologist 1438 American Registry of Radiologic Technologists Licensed Practical Nurse to Registered Nurse 360 National Council of State Boards of Nursing (NCLEX) - Registered Nurse ASN - RN 765 National Council of State Boards of Nursing (NCLEX) - Registered Nurse Respiratory Therapy Technician 900 National Board for Respiratory Care Surgical Technologist 744 National Board of Surgical Technology & Surgical Assisting Education Program Administrative Pathway Occupations Clinical & Laboratory Observation Hours National Licensure/Registration/Certification Exam Medical Assistant 320 American Association of Medical Assistants Health Information Tech 90 American Health Information Management Association Medical Coder 200 American Health Information Management Association Medical Office Assistant 160 National Healthcareer Association Billing Technician 200 National Healthcareer Association Medical Transcriptionist 120 Association for Healthcare Documentation Integrity The challenge for expansion of healthcare training delivery and capacity will not be in developing new assessment models; the challenge will be in better coordinating and bringing efficiencies to the process of clinical placement. MT HealthCARE will expand access to clinical experiences by improving coordination of clinical education through an online clinical coordination system, increased use of community based clinical settings, and training of rural preceptors and clinical faculty. MT HealthCare will implement the Clinical Coordination Partnership, a collaborative approach to coordinating clinical space and supporting these efforts with a scheduling database. The process and 22