This is a five year report on the workforce

istockphoto.com/laflor The Impact of Educational Stipends in Advancing Public Practice in the MFT Profession: A Five Year Report on the Los Angeles County Workforce Initiative José Luis Flores, MFT This is a five year report on the workforce initiative by the Los Angeles County Department of Mental Health to recruit Marriage and Family Therapists by awarding educational stipends to MFT students. The report concludes that this recruitment initiative was successful in hiring bilingual and multicultural clinicians in communities and specialized treatment programs designated by the County as high need for mental health practitioners. The report also examines how the stipend program had an impact on promoting public service to students entering the MFT profession in Los Angeles County and on advancing public practice as a career pathway throughout the state. Incentive programs have been used to recruit potential candidates in efforts to address workforce shortages in various health care professions and work settings. These programs have provided financial assistance to existing staff to advance their education and to lead to the retention of skillful personnel. These programs have also provided paid internships promoting specialized service to identified populations or as educational stipends to recruit students for a specific field of study. In the spring of 2005, the Department of Mental Health, County of Los Angeles initiated a workforce effort to recruit marriage and family therapy graduates in an effort to fill the need for bilingual and multicultural mental health providers in its underserved communities. The department partnered with the Southern California Consortium of MFT schools in promoting, recruiting, and awarding educational stipends to graduating MFT students. In receiving the stipends, the students agreed to work as MFT Interns at one of the agencies within the county s mental health delivery system for a minimum of 12 months. The County s MFT stipend program was inaugurated in the fall of 2005 and it targeted those students completing their graduate studies in the spring of 2006. The first year implementation of this recruitment program was reported in The Therapist (May-June 2006). This report examines the outcome of the County s stipend program in addressing its workforce needs and the impact the program has had in promoting public mental health practice to those entering the MFT profession. Incentive Program Objectives The goal of the Los Angeles County s MFT Stipend Program was to recruit MFT graduates who would be willing to work as MFT Interns in agencies serving communities in need of mental health providers. Towards that effort, the objectives of the program were the following: to recruit students with the capacity to provide mental health services in threshold languages other than English, such as Spanish, Korean, and the Chinese dialects; to recruit students with the capacity to work in impoverished ethnic or racial communities understaffed in the county s delivery system; to recruit students with familiarity with the county s mental health delivery system; and client population; to encourage students to complete practicum training at a public mental health agency. Ultimately, the County s stipend program sought to promote community and public practice to those entering the MFT profession where traditionally the interest had been in private practice. Stipends Address the County s Workforce Needs In addressing the workforce needs for mental health clinicians in the County s eight service areas (known as SPAs), the stipend program recruited students with any of the following qualifications: 1. They could provide clinical services in a language other than English; 2. They had previous experience that prepared them to work in diverse ethnic or racial communities; 3. They had knowledge and/or previous experience that prepared them to serve the mental health client population. In the first two years of the stipend program the students provided some evidence of having these qualifications by submitting a cover letter and résumé. By the third year of the stipend program, the County identified where it had its 42 THE THERAPIST September/October 2010 We re here for www.camft.org

greatest workforce needs. These high need areas included two service provider areas (SPAs), the Antelope Valley and South Los Angeles, and services provided in forensic mental health. The County also requested more specific information of students in its application form. The information requested included the following: 1. The student s level of proficiency in a second language; 2. The student s practicum training, specifically whether training occurred in a DMH agency; 3. The student s selection of the high need areas where the student would work to fulfill payback obligation. In addition, the application required that students respond to four essays as a way to further describe their preparation, experience and dedication to community service in general and public mental health practice in particular. Thus, the students awarded a stipend were limited to fulfilling employment payback at agencies and programs the County had designated as high need areas. MFT students in the final year of their degree program as an incentive to have these students seek employment in mental health agencies upon graduating. Thus, the students that applied for the stipends were already enrolled and halfway to completing their degrees. The majority of those who applied had not considered public mental health for their post-degree training and employment. In a survey of the 2005-06 stipend recipients (71 Academic Year from 111 applications to 236 applications (see Table 1). This high rate of applications for the stipends remained constant each year regardless of the amount awarded, which was from $6,000 in year one to $18,500 in years four and five. Table 1 Number of MFT Stipend Applications, Awards and Amounts by Academic Year Applications Received Stipends Awarded Stipend Amounts Stipend Categories Schools Represented 2005-06 111 87 $8,000 Bilingual 14 $6,000 Multicultural 2006-07 122 0* ----- ----- 15 2007-08 116 97 $10,000 $8,000 $6,000 $1,000 Bilingual + HNA^ Multicultural + HNA Bilingual DMH Practicum^^ 2008-09 236 72 $18,500 All categories 16 2009-10 133 36 $18,500 All categories 17 * None awarded due to late approval of funding. ^ High Need Areas for mental health practitioners as designated by the County. ^^ This amount was awarded to stipend recipients regardless of category if they completed their practicum in a mental health agency of the County. 13 In years four and five of the stipend program, the County continued to designate high need areas for workforce adding the following to those already identified in year three: MHSA funded programs, Specialized Foster Care, and the service provider area of East Los Angeles. These high need areas and difficult-to-recruit service programs were included in the application form. Students were required to mark the areas they were willing to work to fulfill their employment payback if awarded a stipend. Stipend recipients had to submit written evidence of employment and the County approved the employment site as being within the required designated areas. The MFT Consortium kept track of employment compliance by stipend recipients and submitted reports to the County on the agency, SPA and program served by the employment payback of the recipients. Stipends Promote Post-Degree Employment in Public Settings The Los Angeles County s stipends recruited percent responding), 91 percent stated that the stipend program encouraged them to consider post-degree employment in public mental health. By the third year of the County s recruitment effort, this incentive program was attracting students who would not have otherwise opted for an internship in a public setting. In a survey of the 2007-08 stipend recipients (92 percent responding) similar to the 2005-06 survey, 88 percent agreed or highly agreed that the stipend program did encourage them to consider employment in a mental health agency. The number of stipend applications submitted during the five years of the County s recruitment of MFT graduates provides some evidence of the interest the stipend program generated from MFT students in considering public employment. A total of 718 applications were received in the past five years of the program ranging each year The recruitment was also extensive throughout the greater Los Angeles area as applications were submitted from students attending MFT schools not only within the County of Los Angeles but in neighboring counties. Table 1 provides the number of different MFT schools that were represented by the students who sent applications. These schools included state universities, private institutions, and professional graduate schools. For a list of schools that participated in recruiting students for the first year for the County s stipend program, see the May/June 2006 issue of The Therapist. All of the participating schools were members of the MFT Consortium of Southern California, later known as the MFT Stipends Recruit MFT Graduates with Bilingual Proficiency One of the objectives of the County s stipend program was to recruit bilingual students who could provide clinical services in a language other than English. Member Toll-Free Phone (888) 89-CAMFT September/October 2010 THE THERAPIST 43

Initially during the first three years of the program, higher stipend awards were given to applicants with bilingual capacity as noted in Table 1. In those first three years of the stipend program, all of the students who submitted applications and signed a payback agreement were awarded a stipend. In the latter years, the stipends were awarded by a committee who reviewed and scored the applications. Since the County sought bilingual professionals to address an identified need for linguistic services in predominately non-english speaking communities, additional points were given to applicants with the bilingual capacity to serve those communities. The County s stipend program did successfully recruit MFT graduates with bilingual proficiency and did fill clinical positions requiring second language skills, especially Spanish, Korean, Cantonese, Mandarin, Armenian, and Farsi. Table 2 shows that during the five years of the County s stipend program, a total of 269 bilingual MFT graduates were awarded a stipend and eventually hired as MFT Interns. The hired interns brought the needed linguistic skills to the County s delivery system. From the onset of this recruitment program, the County identified a need for Spanish speaking mental health providers in several of its service areas (SPAs). This demand for Spanish speaking services was significantly supplied by the stipend program because the majority, 71 percent of the bilingual stipend recipients, was proficient in Spanish. Stipends Promote Practicum Training in Mental Health Settings The Los Angeles County s workforce initiative included educational stipends for students in social work schools as well. A major difference with the social worker s stipend program was that those stipends were awarded to students when they started their social work education and only to those who completed practicum training in mental health settings during their two years of graduate training. Thus, these stipend recipients who committed to employment, Table 2 Second Language Capacity of MFT Stipend Recipients by Academic Year Year Spanish Korean Cantonese/ Mandarin Armenian Farsi Other* Total % of Stipend Recipients 2005-06 40 4 2 3 4 4 57.60 2006-07 45 4 6 4 4 5 68.55^ 2007-08 42 1 6 0 3 2 54.61 2008-09 40 4 1 1 7 2 55.71 2009-10 23 3 3 1 2 3 35.90 Total 190 16 18 9 20 16 269 *Includes Vietnamese, Tagalog, Russian, Thai, Japanese, American Sign and Hakka. ^ Percentage of total applicants; no stipends were awarded that year. upon graduation, in the County s service agencies upon graduating had the experience of working in mental health settings. As noted previously, the County s MFT stipend program recruited students in their final year of graduate studies with no requirement that the students had practicum experience in mental health settings. However, one of the objectives of the MFT stipend program was to recruit students who were familiar with the County s service delivery and client population as demonstrated through prior employment or practicum training in the directly operated or contracted mental health agencies. Accordingly, in the last two years of the stipend program when a committee awarded the stipends, additional points were given to those applicants with public mental health experience. Based on the applications submitted and on the data reflected in Table 3, there was an increase in the number of MFT applicants who had previous public mental health training from the first to the fifth years of the program. This increase was the result of two factors: 1. an increase in the number of MFT students who sought and received practicum training in county contracted mental health agencies; and, 2. an increase in the number of enrolled MFT students who had employment experience in mental health settings. In many respects, during the course of the five years, the County s stipend program not only recruited qualified graduates for employment in its numerous contracted agencies, but also increased retention of employed personnel who selected MFT graduate schools as their advanced education in the mental health field. Table 3 Public Mental Health Training of MFT Stipend Recipients by Academic Year Academic Year* Mental Health Training** Number of Total Stipend Recipients % of Recipients with Mental Health Training 2005-06 36 87.41 2007-08 43 97.44 2008-09 61 78^.78 2009-10 28 39^^.72 *Data for 2006-07 not available; stipends were not awarded that year. ** Mental health training included work experience or practicum placement in a County mental health agency. ^Includes 6 stipend alternates. ^^Includes 3 stipend alternates. Stipends Promote Public Practice as Career Option The short term goal of the County s stipend program was to recruit, hire, and train MFT graduates as entry clinicians in its vast delivery system. The long range objective was to retain stipend recipients beyond their one year of employment for the payback obligation and for extended service even after obtaining the MFT license. In fact, the County did initiate another incentive effort, the loan assumption program, to retain personnel working in difficult-to-hire positions. There hasn t been an attempt to collect evidence on how well the stipend recipients were retained as mental health providers in the County s delivery system beyond the 44 THE THERAPIST September/October 2010 We re here for www.camft.org

one year payback commitment. However, there were two online surveys conducted by the MFT Consortium that provided some evidence that the stipend recipients were satisfied with their first-year employment at a county mental health agency and were planning on remaining at the agency beyond the one year obligation. The surveys were conducted one year after the stipend information they received about working in such mental health settings was negative: too much paperwork, very difficult clients with huge caseloads, etc. Yet, the stipends were strong incentives for these students to consider mental health practice even when the awarded amounts, $6,000 to $10,000, were considerably less than the amount awarded in the subsequent two years, $18,500. multicultural clinicians working in diverse ethnic/racial communities and filling hard-tohire positions. * Conducted in the summer 2007; 71 percent response rate. Survey Year Highly Agree Agree Not Sure Disagree Highly Disagree THE IMPACT OF EDUCATIONAL STIPENDS 2005-06*.44.40.11.2.2 2007-08**.48.38.10.4.0 * Conducted in the summer 2007; 71 percent response rate. Table 5 Percentage of Responses by MFT Stipend Recipients to the Statement: I plan on continuing employment in a county-contracted mental health agency for a second year at my current employment of at another agency. y Stipend recipients were employed in the service areas (SPAs) the department designated as high need areas for mental health providers. This included the rural area of the Antelope Valley, the dense populated area of South Los Angeles and Table 4 the predominately Spanish-speaking area Percentage of Responses by MFT Stipend Recipients to the Statement: The stipends, in Overall, fact, did my weigh experience heavily working in the as a MFT of Intern East Los in a Angeles. county-contracted decision of those students in the mental first and health third agency yhas Stipend been favorable. recipients were employed in Table years 4 of the program to seek public mental programs funded through the Mental Survey Year Highly Agree Agree Not Sure Disagree Highly Disagree Percentage of Responses by MFT Stipend health Recipients internships. to the In the Statement: surveys mentioned Health Services Act to provide in-the- Overall, my experience working as a MFT Intern 2005-06* in a county-contracted.44.40.11.2.2 2007-08**.48.38.10.4.0 mental health agency has been favorable. recipients had graduated and were close Table 5 Survey Year Highly Agree Agree Not Sure Disagree Highly Disagree to completing Percentage their payback of Responses employment by MFT Stipend Recipients 2005-06* to the Statement:.53.24.18.4.0 obligation. I plan The on surveys continuing reached employment the stipend in a county-contracted 2007-08** mental health.52 agency for a.27.16.1.3 recipients for the first second year year of at the my program, current employment of at * Conducted another agency. in the summer 2007; 71 percent response rate. 2005-06, and the third year of the program, Survey Year Highly Agree Agree Not Sure Disagree Highly Disagree 2007-08. Only the stipend recipients who 2005-06*.53.24.18.4.0 had secured 2007-08** payback employment.52 and.27 had previously,.16 the stipend.1 recipients.3 were asked field services (such as the Full Service not withdrawn * Conducted from in the the summer program 2007; 71 percent were response if they rate. would have sought employment in a Partnerships), integrated services (such included in **Conducted the surveys. in the summer 2009; 92 percent response rate. mental health agency even if there were no as the Multidisciplinary Assessment stipends offered. The majority (58 percent) of Teams), or recovery driven services The results of the two surveys were similar the 2005-06 stipend recipients said they were (such as the Wellness Centers). with respect to the two items provided in not sure and 13 percent said they most likely y Stipend recipients with bilingual Tables 4 and 5. In the first statement, 84 would not have sought public employment. capacity, especially Spanish-speaking, percent of the 2005-06 stipend recipients In the 2007-08 stipend program, 30 percent were employed in service areas (SPAs) and 86 percent of the 2007-08 recipients of the stipend recipients said they were not throughout the county. agreed or highly agreed that their work sure and 11 percent said most likely not. The experience had been favorable. And in the majority of this group, 59 percent would The workforce need area where only a few second statement, 77 percent of the first have pursued employment in mental health stipend recipients were employed included respondents and 79 percent of the second settings even if there was no stipend program. the hard-to-hire positions in correctional respondents agreed or highly agreed that However, they most likely would not have mental health. As well, no stipend recipient they planned on continuing employment at sought employment in communities and was hired as an MFT Intern within the their work site beyond the one year payback programs targeted as high need areas by the County for payback employment in its commitment. County s stipend program. directly operated clinics. The significance of this data can best be understood within the context that the majority of these stipend recipients entered their graduate programs with little or no consideration of working in public mental health settings as interns. Most likely the Impact on County Workforce Needs The Los Angeles County s MFT Stipend Program made a significant contribution in addressing the workforce needs of the Department of Mental Health for bilingual, Impact on Pathway to Public Practice The County s MFT Stipend Program made a noticeable impact in promoting public practice to MFT students. Member Toll-Free Phone (888) 89-CAMFT September/October 2010 THE THERAPIST 45

y Based on the number of stipend applications each year and the extensive participation of numerous MFT schools, the stipend program promoted post-degree training and employment in public settings. y Based on the increase of student applicants who had previous employment in an agency within the County s mental health system, the stipends promoted graduate study in MFT schools to those already employed in mental health service. y Based on the increase from year one to year five of the County s stipend program in the number of student applicants who completed their practicum training in public mental health agencies, the stipend program promoted practicum training (traineeships) in agencies affiliated with the County s mental health delivery system. y The County created in 2007, for the first time, an employment classification for licensed MFTs. Previously, there was no entry in County employment for licensed MFTs as clinicians. Employment for licensed MFTs was only available at the County s contracted mental health organizations. y The County created in 2008, for the first time, an employment classification for MFT Interns. Previously, MFT graduates could not be hired as County employees, which is why stipend recipients completed their employment obligation working in agencies contracted by the County s Department of Mental Health. y The County included MFT representation in its Workforce, Education, and Training Ad Hoc Task Force along with the other mental health professions. Members of the MFT Consortium of Greater Los Angeles represented the MFT profession on this task force. Impact on the MFT Profession The County s MFT Stipend Program had an impact on the profession of Marriage and Family Therapists in California. y There was a considerable increase in the number of MFT schools joining the MFT Prior to the County s first year of the stipend program in 2005, the number of active schools in the Consortium was 10. By the end of 2009 the number of MFT schools in the Consortium was 24. Consortium membership was required of schools recruiting students for the County s stipends which, of course, prompted membership interest in the Consortium. Yet, once these schools became members, they participated in the Consortium s attention to issues impacting the profession at the state and national levels. (For more information on the MFT Consortium, see the May/ June 2006 issue of The Therapist.) y The County s MFT Stipend Program was the first service contract between a county and a consortium of MFT schools using a school member of that consortium as its legal entity. With the enactment of the Mental Health Services Act in 2004 and the projected need for mental health practitioners in the public sector, similar partnerships between counties and MFT schools were discussed. This interest initiated the formation of consortia of MFT schools in other regions of the state. Aside from the already established consortia of MFT schools in greater Los Angeles, Orange County, and the Bay Area, regional MFT consortia were formed in San Diego/Imperial Counties, Sacramento and surrounding counties and the central coast counties, around Santa Barbara. y The partnership between the Los Angeles County and the MFT Consortium of Greater Los Angeles that created a successful incentive program for the recruitment of MFT students into public practice was replicated by the California Department of Mental Health in its inaugural implementation of a statewide incentive program for MFT students. In delivering a similar statewide stipend program for MFT students, the State s Department of Mental Health partnered with the MFT Consortium of California, which is a network of the six regional MFT Consortia including the MFT (For a report on the statewide stipend program see the May/June 2010 issue of The Therapist.) Recognition of School Participation The success of the partnership between the Los Angeles County Department of Mental Health and the MFT Consortium of Greater Los Angeles in successfully recruiting qualified MFT students for employment in the County s mental health system is greatly attributed to the commitment MFT school administrators made toward this endeavor. Not only did the MFT schools participate in the general Consortium meetings, they also attended ad hoc meetings and school orientations on the County s stipend program. In addition, each of the participating schools designated a stipend representative who disseminated information on the stipend program to their student population, mentored students in the application process, and submitted verification of enrollment reports. The schools and their stipend representatives are commended for their investment in providing their students with the option to serve as MFT practitioners in public mental health through this incentive program. José Luis Flores, MA, is on the faculty of the MFT Program at Phillips Graduate Institute, Encino, CA, and has served as the administrator of the Institute s stipend contracts for both the Los Angeles County Department of Mental Health and the California Department of Mental Health. Since 1995 he has been the host and organizer of the Southern California Consortium of MFT Educators and Directors (now known as the MFT Consortium of Greater Los Angeles). He is a founding member of the MFT Leadership Collaborative which includes the host schools of the six regional MFT Consortia and the executive directors of CAMFT and AAMFT-CA. 46 THE THERAPIST September/October 2010 We re here for www.camft.org