Shining a Spotlight on Frontline Workers in Health Care Hello to all of our Jobs to Careers

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1 IN THIS ISSUE Defining the Front Line in Health Care I Don t Want to Stop : Voices of Frontline Workers on Work-Based Learning Connecting with Adult Learners: The Importance of Non-Traditional Instruction Tools on the Web Jobs to Careers Out and About Shining a Spotlight on Frontline Workers in Health Care Hello to all of our Jobs to Careers colleagues. The Jobs to Careers initiative focuses on a critical yet often overlooked part of the U.S. health care workforce: the six million frontline workers who interact closely with patients and their families every day. Frontline workers do a wide variety of jobs in many settings: They are medical assistants in hospitals, mental health counselors in community health clinics, personal care aides in private homes, and much more. Although low paid, this workforce is expected to grow faster than all other U.S. occupational groups over the next several years. The rapidly increasing demand for their services is due largely to the growing health care needs of the aging Baby Boomer population. Extremely high turnover rates intensify the need for new workers. Jobs to Careers demonstrates a two-part solution to this crisis: meeting the demand for qualified employees by training current workers to advance into higher-skilled positions, and increasing retention by strengthening employee satisfaction. The Jobs to Careers model combines work-based learning with traditional classes often held at the workplace in specific occupational competencies and foundational skills. Jobs to Careers also provides a range of support services, such as coaching and tutoring, as well as opportunities for career advancement, wage increases, and academic credentials. This issue of Working for Health tells the moving stories of Jobs to Careers participants in their own words. Their powerful personal experiences highlight the importance of investing in professional development for frontline workers not only to help them improve their skills, advance in their careers, and support their families, but also to enhance the quality of care they deliver in health care facilities across the country. To quote a newly trained Certified Nursing Assistant who previously worked in the laundry of a Baltimore hospital: Participating in this program was the best decision I ve made in my life. This hospital is my second home; I love what I m doing and the patients love me. An emergency room transporter and mother of three who completed the same CNA program said, It was a life changing experience. They invested in me! MARIA FLYNN Director, Jobs to Careers National Program Office REBECCA STARR Deputy Director, Jobs to Careers National Program Office 1

2 Defining the Front Line in Health Care Frontline health care workers are a diverse group of professionals and paraprofessionals who provide a range of direct patient care and client services. Although less prominent than physicians and nurses, they play a vital role in the U.S. health care system. Overwhelmingly women and minorities, they hold jobs ranging from dental assistants to hospital cafeteria workers to nurse s aides. Earning less than $40,000 a year, most face numerous barriers to attaining the skills they need to advance in their careers and earn enough to support their families (see box, Examples of Frontline Workforce Occupational Roles ). In all, frontline workers represent about half of the total health care workforce almost 6.5 million of the 12 million total, according to the U.S. Bureau of Labor Statistics. These workers often receive limited formal training. Their positions often do not require advanced levels of education, and many learn only on the job. The wages of these workers are significantly lower than other health care occupations: the median starting wage is $9.26 per hour, barely more than the federal poverty level for a family of one or two. Turnover rates are startling: they average 40 to 90 percent annually. Frontline workers rarely have access to clear career ladders or training programs to improve their skills and enhance their roles. For more information, see Workers Who Care: A Graphical Profile of the Frontline Health and Health Care Workforce, published by the Robert Wood Johnson Foundation and available at www. jobs2careers.org/frontline_publications.php. Examples of Frontline Workforce Occupational Roles Medical Assistants Medical Records and Health Information Technicians Radiologic Technologists Social and Human Services Assistants Home Health Aides Nursing Aides, Orderlies, and Attendants Psychiatric Aides Substance Abuse and Behavioral Disorder Counselors Dental Assistants Licensed Practical and Licensed Vocational Nurses Pharmacy Aides Physical Therapist Aides I Don t Want To Stop : Voices of Frontline Workers on Work- Based Learning East Boston Neighborhood Health Center, East Boston, Massachusetts East Boston Neighborhood Health Center, one of the largest community health centers in the country, cares for more than 300,000 patients per year in more than 16 different languages. Meeting this need requires a huge team of highly trained interpreters available around the clock. To find enough qualified employees, EBNHC decided to grow its own. The health center partners with Bunker Hill Community College, Jewish Vocational Services, and World Education to help entry-level workers most of whom come from East Boston or surrounding neighborhoods gain skills and advance to better jobs within the health center as interpreters. The Jobs to Careers project, Pathways for Frontline Workers, combines formal classroom study with on-the-job education. Since January 2007, more than 70 employees have participated in pre-college education and/or professional 2 Working for Health Jobs to Careers

3 training. The hallmark of the project is Certified Auxiliary Interpreter training, which has enabled the health center to substantially increase the availability of face-to-face interpretation services. Each year, more than 80,000 patient visits require an interpreter an impossible task for a professional staff of 25. The addition of 25 Certified Auxiliary Interpreters over three years has translated into hundreds of additional patients receiving culturally competent and linguistically sensitive care. collecting cash self-payments and collecting and tracking patient feedback received in the form of comment cards, phone calls, or by walk-ins. Rendon has since gone on to complete several prerequisites for the nursing program at Bunker Hill Community College, as well as the Jobs to Careers-funded BHCC course, Introduction to Medical Interpreting. She says her new language skills have been a great benefit to her work, her education, and her personal life. Her goal now is to become a nurse. Eventually, says Rendon, I see myself back in my country helping a lot of people. Charles B. Wang Community Health Center, New York City Diana Rendon Initial position: Patient Access Representative Training programs: English as a Second Language, Citizenship, Basic First Aid, Certified Auxiliary Interpreter, Career Coaching Current job: Member Services Advisor, Member Services Department Age: 29 After moving to the United States from Columbia in 2004 and then working at a Starbucks, Diana Rendon joined East Boston Neighborhood Health Center as a Patient Access Representative, doing clerical and reception work. During orientation three years ago, Rendon discovered that the health center offered English as a Second Language classes through Jewish Vocational Services and citizenship classes through Bunker Hill Community College. She jumped at the chance to join both and successfully completed the process necessary to become a U.S. citizen. After just eight months on the job, with her new English skills and with help from a career coach the health center provided, Rendon was promoted to Member Services Advisor. In this role, she performs a wide variety of duties in support of patients assignments, registration, and enrollment for primary care. This includes The mission of the Charles B. Wang Community Health Center is to provide high-quality and culturally competent health care for Asian Americans in New York City. Advancements in the health care field have required CBWCHC to increase its use of technology and take a multidisciplinary approach to improving the quality of care. To meet this challenge, the health center is implementing an electronic medical record system, and it has utilized the medical home model to better deliver services. These changes have required staff at all levels to acquire new skills. In response, the CBWCHC seized the opportunity through Jobs to Careers to enhance the training of frontline workers to improve the quality of care delivered to patients. The health center has partnered with the City College of New York to provide training and ongoing learning opportunities for skilled bilingual and bicultural health care workers who can better serve the city s growing Asian- American population. Previously, medical assistants had virtually no training. Now medical 3

4 assistants, dental assistants, and patient services representatives are learning medical terminology, customer service, communication, and other essential skills. The training program combines work-based learning, classroom training, and career development, leading to the opportunity to take an exam for a certificate as a Medical Administrative Assistant, earn higher wages, and get promotions. Since January 2008, CBWCHC and the City College of New York have trained more than 30 health center workers. In self-assessments, most participants reported that the program helped them communicate better with patients, and that they are more confident in their work. Feedback from supervisors corroborates these comments. CBWCHC began training its fourth Job to Careers cohort in January Trista Zeng Initial position: Medical Assistant Training program: Medical Administrative Assistant Current job: Family Health Worker Trista Zeng says that Jobs to Careers training encouraged her to pursue a college degree and enhance her career prospects. I like to work in the medical field. That is why I chose to be a Medical Assistant, but somehow, my current skills needed to be upgraded to accomplish more advanced duties, she said. So I need to thank the Jobs to Careers training because it has refreshed my skills, as well as inspired me to further my education. At the end of the training, Zeng decided to return to school to become a Licensed Practical Nurse. In the future, I ll use my medical knowledge to advance my career, she said. Canna Lay Position: Dental assistant Training program: Medical Administrative Assistant Canna Lay, who came to the United States at age 13 with barely more than an elementary education, completed high school but dropped out of college. A dental assistant at the Charles B. Wang Community Health Center, she enrolled in the Medical Administrative Assistant training program after both a supervisor and a coworker who had completed the program encouraged her to attend. She said she wanted to know more medical terminology so she could perform her job better Because I don t know a lot about it and I have to deal with it every day. She continued: To have this kind of training is really helpful to me to service the community and the patients.... If they need any help, I have more knowledge.... The stuff we learn, we use it every day.... In this community, most people speak Chinese, and since most patients are really educated, you have to be patient and listen to what they said first, then you ask your question or give your helpful hints. In the future, Lay added, she would like to advance beyond the position of dental assistant, and this is absolutely helpful to start. Stanley Street Treatment and Resources (SSTAR), Fall River, Massachusetts Stanley Street Treatment and Resources, a nonprofit healthcare organization specializing in substance abuse treatment, has partnered with Bristol Community College to advance the careers of SSTAR s frontline workers and increase the supply of credentialed addictions treatment professionals. With support from Jobs to Careers, the college and SSTAR provided work-based learning programs at the workplace. Together, they trained receptionists, administrative assistants, and other frontline SSTAR staff to become credentialed addictions treatment professionals. Forty-two frontline workers participated in the training program. Seventeen employees completed the training and qualified as addictions counselors. For many employees, earning certification as an addictions counselor gave them the self-confidence to keep climbing the career ladder. About half the students from the inaugural Jobs to Careers group at SSTAR continued their education, taking additional courses toward an Associate s degree in human services from Bristol Community College. 4 Working for Health Jobs to Careers

5 Laura Washington Initial position: Counselor Training programs: Substance Abuse Certification Training (CADAC); Substance Abuse Changing Behaviors through Group Process; pursuing Bachelor s degree through the University of Phoenix Current job: Counselor and Non-Violent Crisis Intervention Trainer Age: 28 Gail Fernandes Initial position: Administrative Assistant Training programs: Substance Abuse Certification Training (CADAC); ARISE Interventionist; Substance Abuse Changing Behaviors Through Group Process Current job: Substance Abuse Counselor, with a full-time caseload of individual clients and group sessions Age: 52 Laura Washington was one of the first to sign up for SSTAR s Jobs to Careers training program. She had desperately wanted to go back to school to further her education in the substance abuse field. But she had little money for tuition, worked full time, and had three children. The barriers to her dream seemed insurmountable. I had every good excuse not to go, Washington said. After completing the training, Washington now has her certification as an Alcohol and Drug Addition Counselor, earns a higher wage as a certified counselor, and has enrolled in college to get her Bachelor s degree. She has become an inspiration to other employees at SSTAR: she encourages colleagues to follow in her footsteps, leading both by example and by coaching. I was doing it and I liked it, and I was learning things and applying them, and I was impressed with myself that I was doing all this.... And I said I just need to keep going. I don t want to stop.... I want my kids to see that I finished school. It was SSTAR s innovative training program that made the difference, she said, including the support of colleagues taking the same courses and supportive supervisors. I don t think I would have done it if I didn t have that wonderful opportunity to go to school here, right on [SSTAR s] campus. Gail Fernandes says that going back to school at her age was nerve-wracking but well worth the time, worry, and effort. A big advantage of the Jobs to Careers training program was that she and her colleagues, of all ages, were in it together. They quickly grew close with one another and provided a great deal of mutual support. We helped each other. We formed study groups, Fernandes said. You d come to the exam, so there s another barrier, and think, Oh my God, how am I going to remember all this? Then you see that everybody else is going through it.... We all built that bond, that hey, we can do this! Supervisors and physicians at SSTAR also helped tremendously. She remembers clearly the day she and friends were studying about mental illness and the psychiatrist on staff walked by and overheard their conversation. He immediately stopped and helped them understand some of the challenging material. Where do you get that kind of help? she said. We had so many advantages being here. Fernandes now is a case manager, leading groups and seeing individual clients, which was my goal, which I absolutely love. 5

6 Connecting with Adult Learners: The Importance of Non-Traditional Instruction A staggering 30 million American adults have reading skills below the eighth-grade level. As our economy depends increasingly on knowledge work, job seekers need solid reading, writing, and math skills more than ever. Realizing that their lack of formal education prevents them from accessing family-sustaining employment, about two million adults participate in Adult Basic Education, Adult High School, or GED programs each year. Most are among the working poor or receive public assistance. They are disproportionately minorities, and more than half are women. Another two million adults who have immigrated to the United States and speak little English take classes in English for Speakers of Other Languages. The demand for these courses is so great that many wait months or even years to get in. Despite high levels of effort and motivation, many students who enroll in ABE and ESOL programs do not sty in them long enough to make significant progress. Up to 50 percent of ABE students drop out before receiving 10 weeks of instruction. They fail to finish because the course content, the instructional style, or other aspects of the program delivery do not meet their needs. To better meet the needs of today s adult learners, basic education should focus on two major areas: expanding the availability of online instruction and integrating learning with work. Get Digital For many adult learners, the challenges of acquiring basic academic skills or mastering another language are exacerbated by the realities of living in poverty. Unpredictable work schedules, unstable housing, and inconsistent access to transportation and child care interfere with the ability to complete traditional adult education programs. Although online education has proven to be an effective alternative for many adult college students, instructors of ABE and ESOL have long maintained that the digital divide made it impractical for them to offer courses online. But assumptions that the poor do not use computers regularly is becoming outdated. Research from 2007 found that more than half of individuals with incomes below $20,000 owned computers and that the poor use computers regularly. A significant number of adult education students could be reached electronically. Courses taught entirely online may be the best way for some adults to continue their education. For others, online coursework that supplements traditional classes would be preferable. It would allow them to maintain a connection to their classroom when they cannot attend, making it easier for them to keep up with coursework and reenter successfully when it is feasible for them. In addition, a variety of free online resources, such as freerice.com, can supplement in-class content, providing extra practice in math, vocabulary, grammar, and other subjects in a game-like format. At Owensboro Community College, a Jobs to Careers site in Kentucky, employee-students working at Owensboro Medication Health System all had access to a computer lab where they could do online research and take courses on the Internet. Midway through the program, organizers decided to videotape college lectures so that employees who could not attend during the day could catch up at night. In addition, all students could use this resource as a review. Integrating Learning with Work Most adult basic education students have clear professional goals: a majority cite the desire to find new or higher-paid work that can support their families as a reason for enrolling in school. However, traditional adult education programs measure progress through grades on standardized tests. Students often do not see how their classroom knowledge is drawing them closer to their goals. Embedding learning in the context of student experiences helps them see how they can apply new knowledge quickly and how they can 6 Working for Health Jobs to Careers

7 practice, and therefore reinforce, their new knowledge outside of the classroom. It also shows them how their classroom learning will help them to solve real-life problems. Adults are highly motivated when working on problems that have personal urgency or applicability for them. Encouraging students to suggest activities to mimic personal and workplace scenarios can help them see the applications of classroom material and keep them engaged. All Jobs to Careers programs do this in the form of work-based learning, combining on-the-job training with traditional classes often held at the workplace in specific occupational competencies and foundational skills. For example, at the East Boston Neighborhood Health Center in Massachusetts, frontline workers training to be medical interpreters shadow and learn from the professional interpreter staff who work there every day. As shown through the Jobs to Careers demonstration project, creativity in the design and delivery of coursework can help adult learners realize significant gains in their functional skills and competencies. For more information, see A Primer for Work- Based Learning: How to Make A Job the Basis for a College Education, by Randall Wilson with Kristina Cowan, Ed Phippen, and Rebecca Starr, available at publications.php. Tools on the Web These work-based learning resources are available on the Jobs to Careers Web site: wb_learning_resources_tools.php The Milestone Tool: Planning a Work-Based Learning Project Careful planning is critical to the success of any project; partners can use this tool to guide their efforts to develop effective workbased learning methodologies. By mapping out key elements and activities, partners create a shared vision for work-based learning and acknowledge the supports needed for successful implementation. The Work-Based Learning Worksheet The Work-Based Learning Worksheet identifies the job competencies and tasks that are necessary for frontline workers to master in order for educators and employers to implement work-based learning. The Work-Based Learning Self-Assessment Tool This tool is designed to help education and employer partners determine how well they have implemented work-based learning. It also suggests steps for strengthening current practices. The Sustainability Tool This set of worksheets provides educators and employers with sound methods and practices that they can use to sustain their commitment to career advancement for frontline workers. The tool also challenges administrators to think long term about the organizational and budgetary implications of continued workforce development for frontline workers. Working for Health is a publication of Jobs to Careers: Promoting Work-Based Learning for Quality Care. It is produced by Jobs for the Future, the National Program Office of Jobs to Careers initiative. To Subscribe to Working for Health, Monique Sheen, editor, at msheen@jff.org. Jobs to Careers National Program Office c/o Jobs for the Future 88 Broad Street, 8th floor, Boston, MA TEL FAX

8 Jobs to Careers Out and About National Association of Community Health Centers: Policies & Issues Forum February 25, 2010, Washington, DC Topic: The Resource Within: Growing Your Own Employees as Your Future Labor Force Presenters: Rebecca Starr, Jobs for the Future; Jason Patnosh, National Association of Community Health Centers; Lili Silva, East Boston Neighborhood Health Center National Network of Sector Partners, National Conference November 10-13, 2009, Washington, DC Topic: From Jobs to Careers and Credentials: Work-based Learning at the Front Lines of Health Care Presenters: Randall Wilson, Jobs for the Future; Cheryl Feldman, District 1199C Training and Upgrading Fund; Kristina Miller, Humility of Mary Health Partners National Council for Workforce Education, Fall Conference October 18, 2009, Seattle, Washington Topic: Building the Health Information Technology Workforce Presenters: Randall Wilson, Jobs for the Future; Mark Bony and Trish Hersh, Asante Health Systems/Rogue Community College; Bill Hersh and Marcy Jacobs, Oregon Health and Science University. Randall Wilson organized and moderated a panel discussion focused on the labor-market implications of medical informatics and other areas of health information technology. He drew on current program models and emerging research findings on occupations, training needs, and potential career pathways to middleand higher-skilled jobs. Topic: Expanding Access, Improving Quality, and Reducing Costs: Work-based Learning in Health Professions Education Presenters: Ed Phippen, Health Work Force Institute, Washington State; Erin Reid, Virginia Mason Medical Center, Washington State; Heather Stephen-Selby, Health Sciences, Renton Technical College, Washington State Panelists discussed how Renton Technical College and Virginia Mason Medical Center have partnered through Jobs to Careers to use new educational methods and to award credit for learning that occurs in the health care workplace. Pathways into Health 2009: Innovation Powered by Partnerships to Transform Health Professions in American Indian and Alaska Native Communities October 7-9, 2009, Big Sky, Montana Topic: Opportunities in Healthcare Workforce Development Presenters: Rebecca Starr, Jobs for the Future This conference brought together tribal, federal, and state officials, community organizations, and educators from across the United States to discuss solutions to the shortage of American Indian and Native Alaskan health professionals. Rebecca Starr, is a talk on opportunities in health care workforce development, explained JFF s success in helping employers to develop Grow Your Own models for advancing entry-level workers. She also discussed the importance of forging meaningful connections between employers and educational institutions to do so. Earning Apprenticeship Credentials for Work-based Learning August 19, 2009, Jobs to Careers Online Roundtable Engaging Community Colleges in the Advancement of Frontline Health Care Workers and Job-Seekers Engaging Community Colleges in the Advancement of Frontline Health Care Workers and Job-Seekers, the next Jobs to Careers peer learning conference, will take place March 3-4 in Washington, DC. It will be the first Jobs to Careers peer learning meeting held jointly with a partner initiative, the National Fund for Workforce Solutions, which seeks to improve employment, training, and labor market outcomes for low-income individuals. The conference will feature sessions on the vital role of community colleges in advancing the careers of lower-skilled adults and, specifically, how community colleges can implement work-based learning programs. Breakout session topics will include building employer partnerships with community colleges, curricular innovations in preparing low-skilled adults for college, finding innovative funding sources to finance health career education, and more. Facilitators: Ann Fitzgerald, Kristina Miller, and Joanne Law, Humility of Mary Health Partners Peer-to-Peer Exchange on Sustainability November 18, 2009, Jobs to Careers Online Roundtable Facilitators: Liz Begley, Capital Workforce Partners; Neil Silverston, WorkSource Partners For more information, contact Grace Ausick, gausick@jff.org. 8 Working for Health Jobs to Careers