appendix a - university of alaska anchorage...alaska center for rural health allied health survey...

Appendix A

Survey Instrument

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ALLIED HEALTH WORKFORCE ASSESSMENTAlaska Center for Rural Health

1. Name of Organization _______________________________ Location _____________________________________ Zip Code __________________

2. Contact Person______________________________________ Title ________________________________________

3. Phone Number ____________________________ Fax Number ____________________________ Email _____________________________

4. Which of the following best represents your organization? Check all that apply.

_____ Clinic (Rural)_____ Clinic (Urban)_____ Corrections/Criminal Justice Facility_____ Domestic Violence_____ EMS Services_____ Home Health Care Agency

_____ Hospital_____ Imaging Center_____ Laboratory_____ Long-term Care_____ Mental Health Center_____ Private Practice_____ Rehabilitation_____ Retail Store_____ School_____ Substance Abuse/Chemical Dependency_____ Other ________________

5. Approximately how many employees do you employ in your facility? (Round to the nearest ten if greater than 50) ____________

FOR OFFICE USE ONLY Survey number __________

Survey completed by _______________________________

Phone Number: ___________________________________

Email: __________________________________________

FOR OFFICE USE ONLY_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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6. In the table below please note the following:A & B) We seek the current number of people employed and the vacant positions within each applicable category for your organization, not FTEs.C) Turnover rate is defined as persons per 12 month period who must be replaced.D) Total number of projected people intended to be on staff in the next 12 months.E) Expected recruitment changes for the next 3-5 years. If specific numbers are known, please include.G & H) The degree of difficulty in recruiting for these positions and suspected reasons.• We do not intend to collect information on all employees, only the allied health professionals listed below.• We are not collecting information on MDs or nurses.

Note: We are not collecting FTE information, but total number of bodies.

A B C D E F G H

OCCUPATIONS

Currentnumber ofpeopleemployedin thesepositions

Currentnumberof vacantpositions

Turnoverrate(personsper 12monthperiod)

Totalnumberofprojectedstaff inthe next12months

What changes areexpected inrecruitment in the next3-5 years? Please usethe following codes1=Increase2=Decrease3=Stay the same4=Position eliminated9=Don’t knowIf known, fill in thenumber of people intheright-hand column

Code Number

What are yourcurrent andprojectedtraining needs?1= On the jobtraining2= Formaltraining (withpost-secondarycredit)

In the columnbelow, pleaseindicate howdifficult it isto recruit theapplicablepositions foryourorganization.1=Notdifficult2=Somewhatdifficult3=Verydifficult

For those positions which are difficult to recruit, please indicate withan “X” whether this is due to low pay or poor benefits, unwillingnessto relocate, training and/or comment on other suspected reasons.

Check all that apply.

Note: If training is checked, please indicate in the Please describecolumn if it is due to “not enough qualified people” or “no trainingin the area”

Pay/benefits Relocation Training Please describe

HEALTH INFORMATIONMANAGEMENTAnalystHealth Information 2 year degree (ART)

4 year degree (RRA)Medical Transcriptionist

MedicalRecords

Records ClerkCoderBiller

Combined Coder/Biller

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A B C D E F G H

OCCUPATIONS






Code Number







BEHAVIORAL HEALTHHumanServices

Entry level/certificated2 year degree4 year degree

Psychiatric Nurse AssistantUnlicensedMarriage and Family

Therapist LicensedLicensed Professional CounselorMental Health Counselor (masters degree)Psychological Associate (masters degree)Clinical Psychologist (doctoral degree)SocialWorker

4 year degree (BSW)6 year degree (MSW)

Licensed Clinical Social WorkerSubstanceAbuse

Technician-entry levelCounselor I-2 yr degree or equiv exp

Counselor II-4 yr degree or equiv expClinical Supervisor-4+year degree

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A B C D E F G H

OCCUPATIONS






Code Number







HOSPITAL ANCILLARY SERVICESBiomedical Equipment TechnicianECG/Treadmill/Holter TechnicianCardiovascular TechnicianCardiac SonographerDietitian (registered)Dietetic Technician

Radiologic TechnologistDiagnostic Medical SonographerNuclear Medicine Technologist

MRICAT

Imaging

MammographerLabTechnician

PhlebotomistClinical Lab Assistant

2 year MLT4 year MT

Patient Advocate/InterpreterPharmacistPharmacy TechnicianSurgical Technician

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A B C D E F G H

OCCUPATIONS






Code Number







LONG-TERM CARECertified Nursing AssistantMedical Foster Care ProviderPersonal Care Attendant

REHABILITATIONAudiologistOccupational TherapistOccupational Therapy Technician/AssistantOrthotist/ProsthetistPhysical TherapistPhysical Therapist AssistantRespiratory TechnicianRespiratory TherapistSpeech PathologistTherapeutic Recreation Specialist

OTHERCommunity Health AideCommunity Health Representative

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A B C D E F G H

OCCUPATIONS






Code Number







OTHER cont.Dental AssistantDental Hygienist

EMS System

EMT 1EMT 2EMT 3

ParamedicEMS DispatcherEMS Instructor

Environmental Health Technician/SanitarianHealth EducatorHome Health AideMedical AssistantOpticianOptometric Technician

7. If you have any additional comments on suspected reasons for recruiting difficulties, please add them here.

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8. Do you foresee any additional training needs, either now or in the near future for your organization?

9. Training staff to do one another’s job, called “cross-training”, is a common way of increasing efficiency within organizations. Please comment on any cross-training you currently use with youremployees.

What cross-training would be beneficial to your organization?

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10. Briefly describe trends in the health care workforce that you see developing for your organization (i.e. funding, changes in health care delivery, scarcity of qualified personnel, expansion plans).

11. Is there any other information you would like the University of Alaska to consider as they plan their coursework and programs for the Alaskan health care workforce?

Thank you for your participation in this survey!

Appendix B

Allied Health Survey Tips

Alaska Center for Rural Health

ALLIED HEALTH SURVEY TIPS

OVERALL

1. We do not intend to collect information on every employee in your organization; we arefocusing on Allied Health workers only.

2. We are not collecting information on physicians or nurses. That has been done by otherprojects and our efforts would be redundant at best.

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• On Question 4 you can check more than one. Check all that apply.

• Question 5: Include everyone in the facility even if they are not included on our list ofoccupations for the rest of the survey. We are just trying to get an idea of the size of yourorganization.

PAGE 2 (CHART)

We are counting the number of people with a specific level of training, not FTEs. The purposeof this assessment is to discover how many people need training within a particular occupationand not necessarily how many FTEs are needed within your organization

• When listing employees, treat contracted people like regular employees. Don’t distinguishbetween the two.

• If an employee is fulltime, but works in two different areas that are listed separately on ourchart (i.e. a Phlebotomist that works halftime as a Pharmacy Technician), count them ineach location (i.e. 1 phlebotomist and 1 pharmacy technician). They must be trained foreach job.

• For the Projected Training Needs column, the formal training should be read as Universityor Community College classes for credits. We aren’t collecting information on certificates.

• On the Reasons For Difficulty in Recruiting column, check all that apply. Relocation refers todifficulty in finding people who are willing to relocate to your community. If the Trainingcolumn is marked, please distinguish whether it is because 1) there are not enough peoplebeing trained in this occupation or 2) there is no training for the particular occupation in thecommunity. Write this in the Please describe column: “not enough people” or “no training inarea.” If other reasons are given which would not fit into one of the three categories listed,they can be noted on question number 7 on page six.

We have attempted to put positions into appropriate categories, but it is not alwayspossible. Some positions, like CNAs (Certified Nursing Assistant), exist in multiplecategories of care. Count the CNAs and enter the numbers. Don’t be hindered by ourefforts at categorization on this survey.

Appendix C

Cover Letter

Appendix D

Campus Categories

CAMPUS CATEGORIES

Main Campus CommunitiesAnchorageFairbanksJuneauNorth Pole

Branch Campus CommunitiesBethel KodiakChugiak KotzebueCopper Center McGrathCordova NikiskiDillingham NinilchikEagle River NomeEklutna PalmerFort Yukon Seward*Gakona SitkaGalena SoldotnaHomer TokKenai UnalaskaKetchikan ValdezKing Salmon Wasilla

Communities withNo Campus NearbyAniak St. GeorgeBarrow SeldoviaCraig SkagwayDelta Junction TalkeetnaHaines TananaHealy TyonekMetlakatla UnalakleetMt. Village WrangellNenana YakutatPetersburg

*Seward is included in the list of communities with a branch campus, though the University of Alaska doesnot have an official branch campus there. However, UAF has staff in Seward managing programs, andthey are electronically connected to the UA system.

University of AlaskaMain CampusesUniversity of Alaska AnchorageUniversity of Alaska FairbanksUniversity of Alaska Southeast (Juneau)

University of AlaskaBranch Campuses

UAA:Chugiak-Eagle River CampusKenai Peninsula CollegeKodiak CollegeMatanuska-Susitna CollegePrince William Sound Community College

UAF:Bristol Bay CampusChuckchi CampusInterior-Aleutians CampusKuskokwim CampusNorthwest CampusTanana Valley Campus

UAS:Ketchikan CampusSitka Campus

Appendix E

Data Limitations

DATA LIMITATIONS

Survey Question 4: “Which of the following best represents your organization? Check allthat apply.”

Initially, staff intended to sort occupational data using the categories marked on this question:clinic (rural), clinic (urban), corrections/criminal justice facility, domestic violence, EMS services,home health care agency, hospital, imaging center, laboratory, long-term care, mental healthcenter, private practice, rehabilitation, retail store, school, substance abuse/chemicaldependency. However, because of the wide variety of responses and interpretation of thecategories, it was not possible to use these data during the analysis. To illustrate: a very smallclinic might mark 7 or 8 categories (eg. Rural clinic, domestic violence, mental health center,imaging center, EMS services, laboratory, substance abuse), while a large organization mightcheck only 1 or 2 categories, though it may have been appropriate to list many more programs.As a result, more straightforward and clear categories were employed: hospital, native healthcorporation, dental clinic, medical clinic, pharmacy, vision clinic, behavioral health, corrections,school district, imaging, rehabilitation and EMS services.

Survey Question 6 – Column E – “Numerical Change in Recruitment over 3-5 years”

The language in this question created some confusion. The original intent was for respondentsto record the number of positions by which their staff would increase or decrease beyondprojected staff positions listed in column D. However, in some cases, phone surveyors werelisting “total” number of staff expected in 3 to 5 years. Because it was not always possible todiscern how the question was interpreted, the information in this part of column E was notincorporated into the data analysis. For future surveys, more explicit instructions on the TipSheet and better communication with phone interviewers should result in useable data.

Survey Question 6 – Column F- “Current and Projected Training Needs”

The survey development team struggled with this variable during multiple meetings.Unfortunately, because of the various interpretations of this question and in many casesdiscrepant responses, the information recorded in this column was not used in the analysis.Some respondents recorded whether “formal training” or “on-the-job training” was needed to beable to work in a particular occupation, while others listed the type of training currently neededby their staff. Non-formal training, which results in a certificate, was purposely left out of thesurvey. The rationale behind excluding “certificate” training was the wide variety of certificatesavailable (eg. Upon completion of AA degree, day-long, seminar, etc.) and thus the limitedamount of information it could give us. By leaving out “certificate” training, however,respondents were often confused on what to record in this column. More thought needs to gointo the phrasing of this variable.

Appendix F

Detailed Analysis ofOpen-ended Questions

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ALLIED HEALTH THEMATIC ANALYSIS

Note: the numbers in the brackets that following the subheadings indicate the total number ofcomments provided by respondents on that particular topic.

Behavioral Health

Lack of funding is the most significant trend in the behavioral health care workforce.Other major trends include: expansion of treatment plans to include families and thecommunity, changes in insurance and billing regulations, increased need for homehealth care, and changes in the delivery of care.

Lack of Funding [40+]Behavioral health care organizations, even the small offices, are always responding to newtrends. However, a lack of funding often prevents these organizations (many of which maintaina non-profit status) from expanding and meeting demands. Respondents overwhelmingly listeda lack of funding as the most significant trend in behavioral health organizations. Many arerelying more and more on grant money from a variety of sources to meet costs and maintainservices, and these changes in funding streams require greater sophistication in financialmanagement. Because of the remote locations of Alaskan communities, organizations accruehigh costs in travel and training needs. "[We are] nickel and dimed to death." In addition, lack offunding and the scarcity of resources can lead to staff burnout and a high turnover.

Due to a growth in the patient population, there is a substantial need for additional funding toexpand services, staff, and facilities. Some organizations want to offer more services (i.e. long-term residential) and/or accommodate additional populations (i.e. youths). One organizationwould like to reach the entire state, but lacks the funding to increase/enhance workers, trainstaff, and provide benefits.

A lack of funding prevents many behavioral health organizations from offering competitivewages and stable jobs. Thus, they are often unable to attract qualified, high-level personnel,and are forced to recruit from outside the state. However, relocation costs and the danger ofturnover make this practice even more cost prohibitive.

Expansion: toward family and community involvement [6]A number of behavioral health organizations have observed areas of expansion. In particular,programs are growing to include families and the community, not just the individual, intreatment plans. “There is an inclusion trend in the field. Our program has a strong componentfor not having stand alone therapeutic activities.” Specifically, organizations are expandingprograms in the following ways: to assist neglected and abused children, to accommodate morefamily crisis intervention, and to provide a residential program.

Insurance/billing [5]Changes in Medicaid policies and insurance laws have impacted service delivery and thecontent of these services. In the past, the state gave money for services, but now Medicaidrequires them to be billed, thus dictating how these services are conducted (because onlycertain services can be billed). “[W]e are having to restructure programs in order to meet client

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needs and still keep our doors open.” One respondent said the impact of revised Medicaidregulations is uncertain for Assets.

Increase in home health care [4]There has been a trend toward home health care instead of institutional care. Because peopleare living longer and want to remain in their home and community, there is an increaseddemand for home health care delivery. "As the Home Care services are becoming more'popular' in Bush Alaska, I feel that it is our duty to maintain the services for those new familiesseeking services from us."

Changes in delivery of care [3]The delivery of behavioral health care has changed, moving toward an increased level andfrequency of care. Health care delivery also has a greater emphasis on culturally specifictreatment plans and a non-drug approach.

Other trendsRespondents also identified the following trends in the behavioral health field:

• Greater emphasis on vocational training and the welfare-to-work program;• A foreseeable change in transitional housing for youth at Assets--from institutions to more

traditional home settings;• An increase in the number of services being requested by new consumers with dual

diagnosis of mental illness and developmental disabilities;• A movement toward employing substance abuse staff with masters degrees (private sector

insurance requires this for reimbursement);• A greater in-state availability of pediatric specialties (pediatric opthamologist, neurologist,

etc.);• Aging of disabled people and the general population;• Women using more community based services rather than shelters;• Expansion of legal advocacy;• Overloading of children's services;• Emphasis on prevention rather than treatment; and• Increased use of psychotropic medications for substance abuse.

Respondents emphasized the need for flexible coursework in the behavioral health carefield, including distance learning options, continuing education, internships andpracticums, and training to keep up with new trends.

Respondents identified a strong need for ongoing training that is accessible to working adults."Make education programs more accessible...through evening and weekend module studies."Behavioral health care training should include a range of formal and informal training, as well asbasic, clinical, and specialized training. Training should enable behavioral health workers tostay current in their field, as well as provide them with the opportunity to advance--throughcertification, licensure, and college degrees (associate, bachelors, etc.). This training should beprovided by individuals who have a higher education and practical experience. Specifically,respondents listed a need for local training in Fairbanks and Juneau to help cut costs.

Distance learning [14]Respondents want more and better distance learning coursework and programs, particularly inhigher education (i.e. masters degree and higher), that would help them further their education,

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remain current, and obtain state licensure and certification. The preferred method of delivery isthrough the Internet. Specifically, respondents want courses that address the needs of theelderly and disabled.

Continuing Education [13]Ongoing continuing education courses are of top priority to respondents, but these courses areoften limited in Alaska. “It would be very helpful if more programs were offered to help usmaintain our licensure.” Many positions require CEUs for licensure training, but it is expensivefor organizations to fund out-of-state training for employees to retain their licenses. "Right noweveryone has to fly out of town for training. Time is lost and this is expensive." Someorganizations cannot pay for people to go out of state (especially therapists). One respondentsaid all counselors are required to take 20 hours per person of continuing education to keepcertified.

Internships/practicums [8]Respondents identified internships and practicums as educational priorities in the behavioralhealth field. This form of applied training is highly useful. One respondent said there is a needfor internships and practicums at the pre-masters level. Another said Interns need to be rotatedin and out.

Need training to keep up with new trends [5]Changes are always occurring in the behavioral health care field, especially in treatmentdelivery, and should be addressed through education. Individuals can also keep pace withtrends through conferencing and networking.

Don’t need training [4]Several respondents reported that there is not a significant need for additional training in theirorganization. "Training is not usually a problem. Most employees are retirees."

The following programs were listed as priorities: MSW, doctoral, PCA, and speechtherapy. The quality level of curricula should also be increased.

MSW programs [13] and doctoral programs [12]Respondents strongly urged the University to develop programs for higher levels of education(masters and doctoral degrees) in Alaska. In particular, they frequently mentioned a need formore and better Master of Social Work programs that are accredited and provide opportunitiesfor licensing. One respondent said programs should have a greater emphasis on familydynamics.

A need for doctoral programs was mentioned equally as often. These in-state programs wouldenable individuals to remain in Alaska, and may even be enough incentive to prevent studentsfrom leaving the state once they graduate. A university system this size should be betterstructured not just for the sake of the students, but for the sake of the state.

PCA programs [5]PCA programs are needed to accommodate the growing need for PCAs. "PCAs are severelyundertrained/underqualified." One respondent encouraged the University to view PCAs andCNAs as steppingstones to two and four-year nursing degrees, stating that PCAs and CNAsshould be allowed to challenge some beginning courses if they have training and experience inthe field. Another respondent discussed the PCA curriculum at BBNA (Bristol Bay Native

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Association), stating that it provides two PCA training sessions per year for the Home CareProgram and would like to incorporate the Lifetree Family Ways curriculum into its trainingprogram for Human Service Paraprofessionals (25 to 30 employees). In addition, respondentsalso mentioned that CNA classes would be helpful.

Speech therapy [5], occupational therapy [3], and physical therapy [2] programsA number of respondents stated that there is a desperate need for speech language therapyprograms in Alaska. They also mentioned a need for occupational therapy and physical therapyprograms. One respondent said at least fifty percent of his/her organization’s infant learningclients have a need for speech language pathologists and occupational therapists.

Programs that provide continuing education opportunities are also a priority, which wouldenable speech therapists, OTs, and PTs to update their training locally. One respondent saidthe University needs to consult with OTs, PTs and Speech Therapists when developingcontinuing education and training. “Find out their needs so that they will stay here and not getfrustrated and move out of state.”

Nursing program [2]Several respondents felt in-state nursing programs were a priority. One school of nursing andother programs should not limit the number of students so strictly.

Higher level curriculum [5]Respondents suggested increasing the curriculum level of behavioral health programs in orderto maintain a high level of quality. Stricter guidelines and better quality would encouragestudents to remain in the state. One respondent suggested using new competencies developedby CSAT and TIP21.

Other training needsRespondents listed a variety of other training needs in their organization, such as a program incommunity psychology and a paraprofessional certification. A paraprofessional certificationprogram “would help fill the gap between non-degreed and degreed-prepared workers.” Oneindividual suggested building and offering “career ladders” to health care workers (i.e. PCA toLPN to RN). This can begin with chore work, and can also include scholarships, child care, andtravel money for students.

Training is needed in the following areas: substance abuse, developmental disabilities,gerontological studies, cultural competency, domestic violence, dual diagnosis, mentalhealth counseling, ethics, and behavioral management.

Substance abuse [12]Respondents identified a substantial need for substance abuse training in the behavioral healthfield, reporting that it is difficult to find people who are certified in chemical dependency.Training should focus on the treatment of a variety of populations, such as women andadolescents, as well as address the relationship between substance abuse and cognitiveimpairment, child abuse, anger, and violence. Because substance abuse concerns areconstantly growing and changing, behavioral health care workers need to keep pace, andcontinuing education would help these individuals keep up-to-date. Suggestions were made todevelop a two-year program for an AA degree in Chemical Dependency Counseling, to providemore substance abuse training in the MSW program, and to incorporate alternative treatmentphilosophies to the 12-Step Program.

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Developmental Disabilities [12]Individuals in the behavioral health care field need enhanced and specialized training in workingwith developmentally disabled and special needs children and adults. Programs should have afocus on working with people who have disabilities. In particular, training should addressindividuals with FAS/FAE, severe mental illness, and learning disabilities. Respondentssuggested incorporating neurodevelopmental techniques with young children, and psychosocialrehabilitation with SED children and CMI adults in rural Alaska.

Dementia and Gerontological studies [8]Health care professionals need specialized and advanced training in how to enhance the livesof elderly patients. In particular, training should focus on the specific needs of individuals withAlzheimer’s or other forms of dementia. Training could address case management and plan-of-care writing, ethnic and cultural values of elders, and the activity needs of older people. Inaddition, training should incorporate information on the aging process and diseases affectingthe elderly, death and dying issues, and the federal funding programs available to elderlyindividuals.

Cultural training [6]In Alaska, cultural training for behavioral health care workers is extremely important. Workersneed to be competent in dealing with Tlingit and Haida Indians and other Alaska Natives. Thereis also a need for greater attention to the unique cultural needs of individuals who live in thebush, as well as a need for more non-traditional learning programs that emphasize spiritualaspects of healing.

Domestic violence [5], dual diagnosis [5], mental health counseling [4], ethics [3], andbehavior management [3]Respondents frequently listed a need for training in domestic violence, dual diagnosis, andmental health counseling that focus, in particular, on the family instead of just the individual.Mental health and developmental disability providers would benefit from programs such as theAAS in Human Services currently offered by Prince William Community College to obtain entry-level employees. Respondents also said health care workers need to be trained in behaviormanagement techniques, and to have better ethics and professionalism in the workplace.

Other training needsRespondents identified the following other specific training needs:

• Physical therapy;• Cranial-sacral therapy/myo-fascial release;• Sign language;• Sensory integration;• Use of hearing aids;• Oral-motor/feeding/swallowing techniques for OTs and SLPs;• Splinting and casting for orthotics;• The importance of medication for clients;• Parenting skills in order to provide parenting classes in the villages;• Teaching language skills to children with autism;• Assessment and referral procedures;• Risks and precautions around the transmission of HIV and hepatitis, as well as on

counseling individuals who have these diseases;

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• Care coordination, case noting, new assessment tools, and ASAM and PPCII (PatientPlacement Criteria); and

• Techniques for treating inpatient populations.

Specific technical training is needed in computers, insurance regulations, billing, andgeneral office skills.

Computers [8]As in any health care field, computers are an essential part of successful behavioral health careorganizations. Respondents reported a need for training in computer science and advancedcomputer applications, as well as training in database development and various computersoftware programs.

Management/administration [4], billing [3], and time management [2]Respondents said behavioral health care workers need more training in management andadministrative skills, such as in writing service plans, billing, and budgeting. Individuals alsoneed training in time management for larger caseloads, organizational skills, crisismanagement, legal/liability issues, goal setting, medical terminology, and Medicaid regulationsand basic disability information.

Consult with field [3]In addition, several respondents encouraged university educators in the behavioral health fieldto emphasize clinical work rather than book work, and to consult with providers who are alreadyworking in the field. Health care and education providers should be more aware of the viewpointof those who have been there.

Satisfied with UAAIt should be noted that several individuals reported that UAA is doing an excellent job. "Six ofour employees are UAA graduates."

Behavioral health organizations have difficulty recruiting personnel because they cannotoffer competitive wages and benefits, applicants lack experience and qualifications, andbehavioral health jobs are often undesirable.

Scarcity of qualified personnel [30]Respondents identified a substantial shortage of qualified personnel in the behavioral healthfield, as well as a shortage of the training necessary to increase qualifications. Education is thekey to growth in all areas of providing quality care. More personnel are being trained on-the-job,which is time consuming and stressful for the qualified staff who already carry a heavycaseload. One respondent said more clinicians will have to be proficient in administration,billing, and program development. The shortage of personnel is forcing service providers tolook at new and different ways to deliver services with less manpower.

Currently, there is a trend toward hiring individuals who are unlicensed and have lesserqualifications. As a result, Ph.D. level services are being handled by masters level staff andeven bachelor's level staff. People that are untrained and not as qualified are being put in moreresponsible positions due to funding. "Service will suffer as a result."

Respondents also see a high turnover rate in behavioral health organizations. The scarcity ofqualified personnel has forced organizations to hire personnel that are not staying in the

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positions due to their ability to find employment elsewhere. Competition from private and publicemployers is very intense. In small communities, the partners of individuals hired by behavioralhealth organizations often cannot find a job. Thus, these organizations end up hiring singlepeople who move on. "Good people will not stay--very transitory."

1) Non-competitive wages and benefits low unemployment [14]Respondents identified three main reasons their organization has problems recruiting qualifiedpersonnel. The first reason is a lack of competitive wages and benefits, especially forindividuals with a masters degree and above. Low salaries and a lack of benefits are mostlydue to a lack of funding, especially in rural areas. The unemployment rate is low, and manyorganizations are highly dependent on grant money and Medicaid reimbursements, so theirsource of dollars is highly regulated. One respondent reported that positions in his/herorganization are either in Head Start, which does not pay competitive wages for the trainingrequired, and/or in Supported Services for persons experiencing disabilities. With the latter,applicants must have a strong desire to work with a complex and challenging population.

2) Problems recruiting due to lack of experience/qualifications [12]The second reason behavioral health organizations have trouble recruiting qualified personnelis a lack of experience and qualifications in prospective employees. In particular, respondentshave trouble finding people who have experience working with severely emotionally disturbedchildren, people with disabilities, the elderly, and residents with dementia. Respondents alsolisted a need for the following personnel: more degreed counselors and therapists, speechpathologists, certified nursing assistants, male PCAs for elderly male clients, and individualsfamiliar with Christian-based therapy.

3) Undesirable job [8]The third main reason organizations have trouble recruiting qualified personnel is the lack ofdesirability of the job. Many behavioral health jobs require long hours and shift work, and theduties are unpleasant. There is often stigma around working with individuals who are chronicallymentally ill or disabled. "Most people want to work with children." Behavioral health carepositions are stressful and often lead to burnout. "There are not enough people willing to put inthe hours."

Other reasons for difficulty recruitingRespondents mentioned the following other reasons behavioral health organizations havetrouble recruiting qualified personnel: people don’t want to live in small towns, adverse weather,and loss of employees due to relocation (i.e. military transfers, the desire to be closer to otherfamily members).

Cross training is a common practice in behavioral health organizations. Clinical staff,particularly mental health counselors, are often cross trained with other staff members.Administrative, clerical, and billing staff may also be cross trained in various ways.

Cross training occurs frequently [19]Cross training is extremely common among behavioral health care staff, especially in smallfacilities. “Everyone pulls together.”

Mental health counselors [7]Mental health counselors are frequently cross trained in a variety of ways. Some are trained todo assessment intake, Joint-Team Evaluations and treatment, staff casings, sharing of

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strategies, in-service trainings, and to fill in or take over caseloads if necessary. Specifically,counselors are cross trained with counselor assistants, technicians, and Support StaffAttendants. This allows for consistency in the level of care, and also the ability to promote fromwithin the organization as positions become available. One respondent reported that they haveweekly cross training staff meetings for mental health counselors. Another said therapistsattend specific trainings, provide technical assistance, and 'consult' to other therapists and EarlyIntervention Specialists.

Administration/clerical staff [9]Cross training often occurs among and between administrative staff and clerical/ secretarialstaff. Administrative staff may also be cross trained with billers, clinical staff, and assisted livingservice staff. "Cross training of clericals is done quarterly." In one case, billing staff were crosstrained with data processors.

Supervisors, directors [4]Supervisors or directors may be cross trained with other staff members. "The executive directordoes everything." In one organization, supervisors are cross trained with case management. Inanother, the director does in-service trainings.

Other cross trainingRespondents reported that cross training occurs between the following positions: PCAs andCNAs; activity therapists and case managers; speech-language stimulation, movement therapy,and play therapy; clinician and trainers; case workers, Tribal Children's Services workers, andHealthy Families Home Visitors; and vocational and day rehabilitation staff--"so that clientshave two people available to them." Workers may be trained to do information and referral,advocate services, or teach cranial-sacral therapy and myo-fascial release.

In one facility, service providers, such as residential counselors and activity therapists, aretrained to work more than one program. “We are developing an emergency staffing program inwhich qualified staff may sign up to work in other departments when short staffing occurs. Thisis an incentive based program developed to help alleviate staffing crises when we are unable tofill a shift on short notice.” Another facility is in the process of implementing cross training ofEmployment Services personnel with adult and kids support personnel.

One respondent said, at AWRC, staff are cross trained in addiction, domestic violence,pregnancy, and parenting issues. Another reported that all clinical staff are trained to serve bothalcohol and drug addicted patients, as well as mental health patients. This individual stated thatthe Division of Mental Health and the Division of Alcohol and Drug Abuse retain standards thatdo not promote cross training, “[T]hey foolishly maintain documentation requirements whichdiscourage cross training.”

Very little or no cross training done [5]It is also important to note that a number of individuals reported that their offices use very littlecross training or no cross training at all. "Our agencies are diverse so we don't believe crosstraining would work."

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Dental Clinics

In dental offices, trends are leaning toward clients with less dental insurance coverage,fewer dental offices taking care of insurance billing, a lack of experienced applicants,and an increase in client knowledge of dental care.

Changes surrounding insurance policiesRespondents are seeing changes in insurance coverage and the way insurance is being billed.Employers are providing less dental insurance to their employees, or the employeesthemselves are requesting less dental insurance. The result is a decrease in the number andtype of services that clients are requesting.

Fewer dental offices are acting as insurance intermediaries. They are refusing to bill insurance,and are requiring payment at the time of services, thus leaving insurance reimbursement up tothe clients. One respondent estimates that about 70% of the offices in Anchorage are nowdoing this. The result is greater responsibility to the patients but fewer bills and less paperworkfor the dental offices.

Difficult to find qualified personnelRespondents reported having difficulty finding qualified personnel. "Experienced people arehard to find!" At certain times of the year in particular, some offices have trouble finding goodapplicants. One respondent said there aren’t enough people willing to go into dental assistingand dental hygienist work. Another said they haven’t had to recruit because the employees intheir office have been with them for 10-18 years.

Increase in prevention and patient knowledgeDental offices are seeing a trend toward "preventative" care rather than "repair." Respondentssaid people are asking more intelligent questions and are more knowledgeable about how theirdental health relates to their overall physical health. Even children are becoming moreknowledgeable about their teeth. One respondent also reported seeing a greater emphasis onone-on-one patient care, not a "cattle car."

Other trendsIn addition, the following trends in the dental health field were mentioned:

• PPOs and HMOs are going out,• More consistent care,• Getting busier,• Getting more part-time help,• Job sharing is more common, and• Dental terminology is changing.

Respondents want the University of Alaska to provide more dental assisting programs inother parts of the state, especially in Fairbanks. Some also want a dental hygienistprogram.

Dental assisting program [8]Respondents overwhelmingly said they want to have a dental assisting program andcoursework at UAA and in other parts of the state, particularly in Fairbanks. Many dental officeshave difficulty finding qualified dental assistants, and a local dental assisting program would

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help alleviate this. One respondent said dental assistants are not required to be certified inAlaska, but that offices prefer to hire dental assistants who have certification.

Respondents said dental assistant courses should be offered at flexible times, such as in theevenings. “It would help to have seminars or weekend courses so assistants could continue towork while they go to school.” Respondents stressed again the need to have a dental assistingprogram, or at least internships, in Fairbanks. There are “plenty of people (dentists and dentalassistants) who could teach that live in the area.”

Dental hygienist program [4]Dental hygienist programs are also important in Alaska. Respondents want to have a dentalhygienist program in other areas of the state, particularly in the interior. One suggesteddeveloping a program in Ketchikan so people do not have to leave town to receive training.Another recommended looking at a program down in Alabama where dental hygienists get on-the-job training with dentists. This would work well in our remote areas.

Respondents want the University to provide coursework that emphasizes hands-onexperiences, teamwork skills, and strong work ethics. Respondents also requestedcourses that focus on clerical skills in dental offices, such as billing, insurancecoverage, and medical terminology.

Hands-on training, teamwork skills, and strong work ethicsRespondents emphasized the importance of hands-on clinical experience (i.e. using a realperson when learning suction techniques as opposed to using typodonts). One said, "Whendental assistants leave the UAA program, they seem to have the knowledge, but not thepractical skills needed to work in an office." Another stressed the importance of gainingexperience interacting with patients. "It's important to provide a friendly atmosphere in anoffice."

Several respondents said dental students need to develop more teamwork skills, such as thosetaught in Blatchford seminars. “It would be nice for students from UAA to be able to work at adental school where they can develop teamwork attitudes.”

A common complaint among the respondents was the difficulty in finding qualified employeeswith a strong work ethic, such as “showing up on time and being willing to do things perhaps ina different way than what they were taught in school and so on.”

Coursework for deskRespondents want courses for people who work at the front desks in dental offices and clinics.They identified the need for courses that address dental medical terminology, dental insurance,verbal skills, financial management, and techniques and computer programs used for billing.“Get the sales reps to participate in classes.”

Most dental offices are providing training to their staff, but could use additional trainingin areas such as x-ray.

The dental offices try to stay updated in their field by providing in-house training, or by sendingtheir staff out of state for coursework. Several of the respondents reported a need for additionaltraining, particularly in the area of x-ray training. Other training needs include: increasing officeefficiency, dental cosmetics, and CME (continuing medical education).

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Cross training is a common practice in dental offices, particularly between the front deskstaff and dental assistants, and occasionally dental hygienists.

Cross training between clinical and administrative staff is a common practice in the dentaloffices surveyed. "Cross training is used within offices and between offices." Dental assistants,and occasionally dental hygienists, help with the front desk, including answering the phones.Conversely, front desk staff sometimes assist in the back, as well as help with billing andseating people. In one office, the owner rotates staff through the front desk on a regular basis."Everyone knows each other's jobs." In another office, the office manager is trained as a dentalassistant, and the three office staff are all cross trained in coding, billing, and records.

Use little or no cross trainingIt is also important to note that a number of the individuals surveyed reported that their officesuse very little cross training or no cross training at all.

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Emergency Medical Services

Lack of funding in EMS organizations is a significant trend that negatively impactstraining needs, especially in rural communities. Other significant trends include: anincrease in the paramedic’s level of skill and role in the community, and increased use oftechnology.

Funding [7]Lack of funding, particularly for training, is the most significant trend facing Emergency MedicalSystems, especially in rural communities. "It is cost prohibitive to get instructors to remotelocations." In the past, native corporations often funded training, but now communities have tocome up with the money on their own. These communities are faced with instructor fees,housing, and transportation. "It’s difficult to get instructors who want to go out to the villages."One department spent $50,000 to send an employee to paramedic school—“won't do thatagain!”

The University also used to be a large “player” in helping to provide EMS courses to ruralcommunities, but once funding levels dropped, these programs became dormant. Now, most ofthe courses are provided in the larger communities, and not in the places where they areneeded the most.

Respondents also reported difficulties receiving enough funding for upgrading equipment andhiring employees. One reported that Fairbanks built a third station but has yet to receivefunding to "man" this station.

Increased level of skill and role in community health [5]There has been an increase in the specialization and skill level of EMS workers, resulting in anincrease in their skill and knowledge. Consequently, training is becoming more and morerigorous, making it difficult to become an EMT because of the increased number of hoursrequired for certification. There is also an emphasis on getting a bachelor's degree for EMSworkers.

Paramedics are playing a larger role in community health, and their scope of practice isexpanding. They are doing tasks such as immunization clinics, well baby checks, and patienteducation and referral.

Increase in technology [2]Respondents reported an increase in technology in the EMS field over the past five years. Onerespondent said cardiovascular technology has improved, decreasing the time needed to get tothe hospital. Another said all police and fire departments are now on-line.

OtherOther trends in EMS-related health care include: a dwindling pool of paramedics, the unificationof borough-wide protocols, a nationwide decrease in insurance reimbursement, and more agerelated EMS responses (i.e. heart attacks and respiratory arrests) instead of trauma relatedresponses.

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Providing EMT1, EMT 2, EMT 3, paramedic, and dispatching courses to rural residents isof top priority to respondents--either in the form of a local program or through distanceeducation.

Need to make EMT courses [4] and paramedic courses [3] accessible to ruralcommunitiesThere is a substantial need for EMT and paramedic courses in rural areas, thus allowing localsto acquire and maintain certification and licenses, and to update credentials without leaving thecommunity. One respondent said larger campuses like UAA train a lot of EMTs, but most ofthese students do not go on to volunteer because there are no outlets in Anchorage. Thus,although a large number of students receive certification, very few actually use the training.

Respondents want the University to play a leading role in providing courses to ruralcommunities. Because it is costly to support EMT and paramedic courses in the bush, theUniversity may want to form partnerships with communities and health corporations to help withfunding.

One respondent suggested that the experience acquired by EMT3s in the field should berecognized and applied towards a paramedic license. Another wanted local EMS dispatchcourses, and suggested coming up with a standard course that would work in both rural andurban areas. Many of the national dispatch courses don't devote any attention to working inrural areas.

Need paramedic programs in rural communities [3]Several respondents reported a need for a paramedic program in rural areas. These programscould allow students to work toward an associate degree, as well as provide opportunities tomaintain licenses. One respondent acknowledged that it may be difficult to start a programbecause there is no teaching hospital. Another supported UAF’s plan to put together aparamedic program.

In addition, in-state paramedic internships would allow students to remain in Alaska. Onerespondent provided the following information about internships: the licensing board cannotallow internships in areas of low population. In Alaska, only Anchorage, Fairbanks, andSoldotna are allowed to have internships. Anchorage generally ends up doing most of theinternships. However, because of the staff commitment required for sponsoring internships,organizations are only willing to take on a few. Three quarters of the students usually end upgoing out of state for their internships.

Need distance education courses [2]Respondents suggested the University provide more distance education, such as prerequisitecourses in anatomy and physiology, to rural residents to help them work toward becoming anEMT or paramedic. One suggested providing more training for EMS management andleadership, stating that many good EMTs end up being promoted to leadership andmanagement position even though they have no training in the area.

Recruitment and retention in the EMS system is particularly difficult in ruralcommunities.

Recruitment and retention issues in the EMS system vary depending on the size of thecommunity. Generally, it is much easier to recruit and retain paramedics in urban regions than

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in rural regions. Rural communities have a smaller population from which to draw qualifiedpersonnel, and frequently these positions are non-paying. In urban areas (such as Anchorage,Juneau, and Fairbanks), employees are generally well paid and have good benefits. In addition,rural EMS jobs can be more stressful because staff members often do not have the backup orget the same level of on-the-job experience as they would get in busier urban areas, andbecause they often respond to calls involving people they know.

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Large Health Care Organizations

A scarcity of qualified personnel is an ongoing trend and serious problem in large healthcare organizations. Reasons for this include: location of employment (rural setting),noncompetitive wages and benefit packages, high demands and stress in health carejobs, and difficulty finding adequate housing.

Difficulty recruiting qualified personnel [14]Large health care organizations have trouble finding qualified personnel. Recruitment isespecially difficult for positions requiring advanced training that is not available in the state.“[W]e are constantly advertising for qualified personnel.” One respondent said it is especiallydifficult to recruit Alaska Native applicants. Another said organizations need to refine therecruiting process to attract elders.

1) Location [12]Respondents identified four major reasons large health care organizations have troublerecruiting qualified personnel. The first is location. Small communities in particular have aminimal pool of potentially qualified employees, so organizations are often forced to recruitoutside the state. Many people, however, do not want to relocate to Alaska, especially to ruralareas. Feelings of isolation often lead to high turnover in bush communities. It is also expensiveto recruit outside the community or state, and costly to relocate people. In particular,organizations have the most trouble recruiting mid level staff. When positions are not filled,organizations may be forced to discontinue the service.

2) Low pay, lack of benefits [8]The second reason large health care organizations have trouble recruiting qualified personnel istheir inability to offer competitive wages and benefits. Many organizations simply do not havethe funds to be competitive. “Wages are increasing faster than funding.” Some health careworkers do not receive any benefits at all. Respondents reported that health care providers arereceiving higher salaries in other states; Alaska has fallen below the national average. “Alaskais not attractive and recruitable.”

3) Difficulty level of work [4]The third reason for recruitment problems is the high level of difficulty and stress in the healthcare field. Workers often deal with a large number of patients, heavy workloads, trauma, andafter-hours emergency care. “We must provide quality care in a shorter period of time and withless staff.” Home health aides, for example, have a very demanding job (both physically andemotionally), and are “at the lowest end of the nursing spectrum.” They are highly valued, butare not usually given incentive to remain in their job.

4) Housing [4]The fourth reason large health care organizations have trouble recruiting qualified personnel isthat it is difficult to find adequate, low cost housing. Housing can be especially expensive insmall communities, and choices are limited. For example, homes cannot be purchased onAnnette Island; residents must lease houses from the BIA.

Large health care organizations report an enormous shortage of qualified nurses. Theyalso have trouble finding pharmacists, counselors, social workers, radiologists, andrespiratory therapists.

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Shortage of nurses [18]A shortage of nurses, especially RNs, is one of the most significant problems facing largehealth care organizations in Alaska, and is expected to get worse over the next few years.There is a high demand for specialty nurses, such as OB, ICU/CCU, and OR nurses. However,small hospitals have a greater need for nurses who can work all areas. The shortage of RNshas resulted in the increased hiring of LPNs, CNAs, and medical assistants to take over RNduties. The nursing shortage also increases the organization’s reliance on other patient careand clerical positions.

Respondents also identified a shortage of nurse practitioners. One respondent said he/sheprefers to recruit nurse practitioners because they tend to see patient care holistically and havebetter skills, reporting that his/her organization is moving towards staffing only nursepractitioners due to quality of patient care issues.

Because of a decrease in nursing school enrollment (for RN, LPN, and BSN), respondentsurged the University to find ways to increase interest in this program. However, one respondentgave the following warning: “Caution should be exercised to prevent the typical and traditionalboom/bust Alaska solution. Too many RNs can be just as problematic as too few.”

Shortage of pharmacists [6]Large health care organization currently have trouble finding pharmacists, especially those whoare qualified to work in hospitals. Many pharmacists prefer to work in retail positions where payis higher. One respondent attributed the shortage of pharmacists to an expanding economy.

Shortage of counselors [2], radiologists [2], and respiratory therapists [2]Large health care organizations have trouble finding qualified respiratory therapists,radiologists, and counselors (especially male counselors). One respondent reported that it isfrustrating for counselors to maintain credentials through reduced regional training programs.

Other personnel shortagesIn addition, respondents identified the following additional shortages among medical personnel:physical therapists, occupational therapists, physician assistants, CNAs, dentists, and labpersonnel, and the following clerical and administrative staff shortages: administrativeassistants, receptionists, and records clerks. They also said there are shortages of staff whoare trained in the following areas: medical technology, ultrasound technology, andmammography. One respondent said his/her office has a need for planners and statisticians to“analyze and support our expanding services as well as addressing our behavioralhealth/human services staff needs.” Another said the organization has difficulty getting cooks.

Respondents identified a lack of funding as the most significant and serious trend inlarge health care organizations. The following other major trends were also identified:expansion of the number and type of health care services, increased use of telemedicineand computerized technology, an aging health care staff, and the increased need forcollaboration between large health care organizations.

Scarcity of funding [11]There is a major trend toward reduced funding for large health care organizations. “Funding willcontinue to flatten out.” Organizations are becoming increasingly dependent on grants, whichare time-consuming to apply for. Lack of funding appears to be hitting rural organizationsharder. “I fear that the funding and human resource gap between bush/urban mental health and

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substance abuse will continue to widen and the bush will lose.” Lack of funding is preventing anumber of organizations from hiring the staff they need. “With limited funding, we are unable tohire a mid-level practitioner during the crabbing season.”

1) Decreased insurance coverage and reimbursement [6]Decreased funding from Medicare/Medicaid and uncertain reimbursement from insurancecompanies puts an economic strain on health care organizations, which often results in reducedservices. Respondents said regulations for reimbursement have gotten stricter, which requiresadded work. “Reimbursement changes are making staying competitive more difficult.”

2) Rising expenses [4]Rising costs put a strain on already limited funds in health care organizations. Specific expenseconcerns include: pharmaceuticals, health equipment, electricity and fuel costs, and salaries.“Increased cost of labor is out of line with received revenue for services.”

Expanding services [8]Another significant trend in health care organizations is the expansion of services. Majorreasons given for this expansion are the growth and aging of the population. In somecommunities, the population base increases in the summer season when there is an influx ofpeople. One respondent said organizations are able to expand their services because medicalequipment is getting smaller and less expensive.

Respondents reported the following new services in their organizations: satellite imaging;laboratory services; CT and osteoporosis services; behavioral health services; and a residentialtreatment program. One organization has the following plans for expansion: 1) opening aprimary care clinic and 2) hiring a nurse practitioner, a medical records/billing assistant, and anurse practitioner who will have administrative and managerial skills.

The expansion of services in these organizations has resulted in the need for larger facilities.Specifically, respondents reported needing a bigger emergency facility, a new, larger medicalfacility, and more office space.

Increase in telemedicine [6]Changes are occurring in the delivery of primary health care, moving toward an increased useof computers and technology. “We expect an increase in telemedicine in the next few years.”Telemedicine improves access to health care, especially in rural communities. Imaging isbecoming more sophisticated and technical, and more and more radiology services are using adigital (filmless) system. This trend toward telemedicine increases the demand for personnelwho have strong technological skills.

Aging health care staff [3]A number of respondents pointed out a general trend toward aging among health care staff. “Isee many of our nurses hitting 50 this year...” Another reported that RN staff in his/herorganization average around 44 years of age, and many of these staff members work 12 hourshifts. “Hospitals will need to address productivity issues as the group ages...” Yet anotherindividual said health care staff in general average around 40 years of age. “[A]s our staff agesso does the general population resulting in a growing demand for services.”

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Emphasis on preventative care [2]Health care organizations are seeing a greater emphasis on preventative care. Rather thanfocusing on acute problems, organizations are helping people stay healthy through preventionefforts. Specifically, one respondent reported that the expanding and changing roles ofcommunity health representatives and dental hygienists has led to a greater emphasis onpreventative care.

Increased outpatient care [2]Respondents reported a general trend toward outpatient care. Not only is inpatient hospital caremoving toward outpatient care, but long-term care is shifting to home care providers. Financesplay a major part in this trend. Insurance companies are reducing payment, and wages andbenefits are skyrocketing. Outpatient care requires less overhead and fewer employees. “I thinkwe need to take a hard look at how we deliver quality care for less money.”

Need for collaboration between organizations [2]Several respondents reported a greater need for multiprofessional cooperation. One saidhospitals need to work with universities to provide education and employment with guaranteesto all parties (i.e. education/work contracts).

OtherRespondents also identified the following trends in large health care organizations: increase inupper respiratory infections, alcoholism, and drug addiction; increase in documentation andpaperwork; movement toward paperless charts; greater emphasis on coding and billing;increased privatization of health care; and higher levels of certification in EMS services. “EMT 1used to be the norm, but now it is more common to have higher levels of training.”

There is a strong need for university-level programs and courses for rural residents.Respondents want more distance delivery courses and continuing education forprofessionals. These courses should be more culturally relevant, especially for AlaskaNatives.

Greater accessibility to rural residents--Distance delivery [15]Rural residents need more distance delivery education options--in the form of courses andprograms. Distance education would enable individuals to stay at home and “advancethemselves,” rather than traveling outside the community, which is expensive for individuals andorganizations. “Some courses need prerequisites, but there is no way to get the prerequisites.People simply cannot go to Anchorage for 6 months to get them.”

Respondents suggested offering more distance delivery coursework in the following areas:mental health, substance abuse, advancement training EMT courses, geriatric/pediatric,advanced life support, ultrasound, radiology, medical technology, and general bachelor's leveltraining.

The University can make courses more accessible to rural residents by sending instructors tothe village or designing courses that are flexible and cater toward working adults, such asoffering classes on weekends and evenings.

Continuing education for certification [11]Accessible continuing education options is a priority for health care professionals, especially forthose who work in rural areas. Many positions require the completion of coursework to maintain

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competencies, and if courses are not available locally, individuals must go elsewhere, which isexpensive and time consuming. Respondents suggested continuing education be offeredthrough local courses, distance education, and specialty seminars.

In addition, respondents suggested offering more CME (Continuing Medical Education) andCEUs for physicians, pharmacists, dentists, RNs, LPNs, MSWs, CNAs, and chemicaldependency counselors. The latter are require to have 40 hours of CEUs every 2 years tomaintain state certification, and 60 hours of CEUs every 2 years to maintain nationalcertification. Various health care workers also need to maintain the following basic ongoingcertifications: ACLS (Advanced Cardiac Life Support), PALS (Pediatric Advanced Life Support),and TNCC (Trauma Nurse Care Course).

Attract Alaska Natives into health fields [6]Stronger efforts need to be made to attract more Alaska Natives into health fields. “Get moreNative nurses.” The University can accomplish this by targeting Alaska Natives with theirapplication outreach programs, and by offering more courses that are based on the holisticmodel and incorporate Native views of the world. “We would really like to see more [Native]students return to their rural communities to work.”

Training in cultural and rural issues [4]In Alaska, it is important to incorporate cultural relevancy into the content of health-relatedcourses, and to address issues regarding working in rural, isolated settings. Health careworkers should be trained to work with Alaska Natives and to “have a feeling for what it's like tolive in an isolated community.”

Respondents requested that the University of Alaska offer more programs in health carefields. In particular, they want a wider range of coursework and continuing educationtraining for nurses, CNAs, and CHAs. They also want training programs for radiologists,medical assistants, dentists, counselors, pharmacists, PAs, dietitians, andpolysomanographic technologists, as well as additional training in geriatrics, behavioralhealth, respiratory care, and phlebotomy.

Respondents urged the University to offer higher levels of education in health related fields,such as MPH programs for administrators, an MSW program with clinical courses, and a PhDprogram.

Nurses [12]There is a substantial shortage of nurses in Alaska. Encouraging individuals into the nursingfield, increasing the scope of nursing programs, and offering more training and courseworkcould help reduce this shortage. Respondents said having more nurses in large health careorganizations would improve the quality and quantity of care, improve employee jobsatisfaction, and allow staff to review care and performance, enhancing potential problemidentification and proactiveness. More nurses would also allow more time for coaching,mentoring, and education. “Nurses, nurses, nurses!”

Specifically, respondents urged the University to increase the number of LPN, RN, and CNAcourses, and to offer advanced training and generalist training in nursing. "Give me somegeneralist nurses." Nurses also want the opportunity to advance in the field, so CNAs canbecome RNs and RNs can become nurse practitioners. Local training sites have the potential toprovide students with real hands-on experience.

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Respondents were especially concerned about having a local nursing program, especially inFairbanks, so individuals do not have to leave the community. Several respondents saidFairbanks has the resources and desire to accommodate the training of nurses. One said, “Ihope the RN program can be developed into a yearly program. Many people want theeducation but they must leave home to obtain it.” Another said, “Please bring back your RNprogram.”

CNAs [7]CNA training was specifically identified as a priority. One respondent requested more entry-level coursework. Another said CNA training is need in Juneau, including grant and scholarshipopportunities for individuals enrolling in these classes. There is an increased need for CNAs inhealth care organizations, and many CNAs are seeking higher education. “We've lost three in12 months to PA schools, and five in 24 months.” Distance delivered CNA courses were alsoidentified as a priority.

Radiologists [9]There is a high demand for radiologic techs in Alaska, yet training is not available in the state.“We have the facilities around the state to warrant an educational expansion.”Training for imaging, x-ray, and ultrasound is a priority. One respondent said there is a highdemand for the use of CT or ultrasound modalities, yet very few employees are qualified tomeet that demand.

Behavioral health/counselors [8]There is a substantial need for behavioral health care training. One respondent said a proposedlong-term care facility will increase the need for additional behavioral health positions. Inparticular, respondents pointed out the need for increased training for counselors, especially inthe area of substance abuse (i.e. Certified Alcohol Counselors). Respondents also identified theneed for indigenous counselors and those who work with adolescents, children, and individualswith eating disorders.

Medical assistants [6]Programs and training are needed for medical assistants in Alaska. Respondents stated thatcertified medical assistants have a broad range of training and are thus highly useful in healthrelated fields. They suggested that the University create a medical assistant program thatincorporates the CNA program, so they are “piggy-backed” together. “This would provide abroader scope and a broader use of employees.”

CHAs [5]The community health aide is unique to Alaska and its rural communities, and training shouldbe accessible to individuals living in these remote areas. Specifically, respondents identified aneed for CHA Session 3 and 4 training, and additional radiology and basic lab training for mid-level community health aides.

In addition, respondents said health aides gain lots of training and knowledge on the job andshould have the opportunity to advance in the health field--to a physician assistant or nursepractitioner.

EMS training [3]EMS training is needed in rural communities. Training needs to be more extensive than theEmergency Technician training, but geared to the villages (rather than being trained to drive

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ambulances on the highway). Respondents identified the following specific training needs forEMS workers (many of which are CHAs): mental health and substance abuse, basic radiologytechnique and interpretation, emergency dental, physical therapy, home care, and advancedtraining in pediatric and geriatric trauma/health care.

Pharmacy [5], dietary [4], and geriatrics [4]Respondents requested programs and training for pharmacy techs and pharmacists; dietitiansand nutritional support staff; and health care professionals who work with elderly patients. Theneed for geriatric training is increasing due to the growth of the elderly population. Onerespondent said coursework should emphasize well-elderly maintenance rather than themedical model of care, which means a variety of long-term care professions need to bepromoted (i.e. pharmacy, social work, physical and occupational therapy, and clinicalpsychology).

Dental school [3] and training for dental assistants [3]Dental schools were listed as a priority for large health care organizations. In particular,respondents cited a need for dental assistants, but also mentioned needing dentists and dentalhygienists. One respondent said training should provide dental assistants with the opportunity tobecome dental hygienists.

PAs [3], phlebotomists [2], lab techs [2], respiratory therapists [2], polysomanographictechs [2], and CHRs [2]Several respondents requested programs and training for PAs; phlebotomists; laboratory techs;respiratory therapists; polysomagraphic technologists; and community health representatives.

Correctional health [2]Several respondents identified a need for training in correctional health care, such as treatingsexual offenders. “We need to send people to treatment instead of to jail...The prison systemtraining is not geared to village offenders.”

Other areas of training needed for specialized professionsRespondents identified the need for additional training for CMAs, physicians, mid-levels, healtheducators, and clerical staff. They also requested training in the following areas: sterileprocessing training; specific diseases such as diabetes, hepatitis and drug resistance TB;health prevention; physical therapy; assessment; chronic disease; and certification for personalcare attendants.

There is a need for administrative, management, and clerical training in health carefields. Most notably, respondents want computer training and courses in billing, coding,medical terminology, and grant writing.

Billing [10], coding [10], medical terminology [4], grant writing [4]Billing and coding were by far the most frequently mentioned areas of clerical training needed inlarge health care organizations, followed by training in medical terminology and grant writing.Medicaid and Medicare rules and regulations often change, so organizations need to be able tosend staff to regular training sessions to update their skills. “Training is the key to retention.”Respondent suggested having in-state correspondence training in coding, billing, and insuranceregulations. One individual said an alternative to a program could be a booklet designed toexplain how to fill out necessary cost report forms for rural clinics.

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Respondents identified a need for courses in the following other areas: medical dictation andtranscription, policy procedures, health systems information, and budgeting and financialmanagement. “Schools need to provide basic accounting accounts payable technician training--even one course for general business.” They also mentioned needing training in diagnosis andassessment, quality improvement, patient communication skills, and confidentiality issues. Onerespondent said a records clerk needs to know how to process a subpoena, and in doing soneeds training on what information to provide or not to provide.

Computer training [12]Health care organizations are relying more and more on technology. Thus, computer trainingfor employees is critical to the successful management of these offices. Specifically, employeesneed training in basic computer skills, data entry, statistical analysis, billing programs and otherspecific medical software, advanced medical office technology, and how to use the Internet.The use of telemedicine will also require additional training for all staff, including the medicalstaff, in order to become more computer proficient. One respondent suggested having anassociate degree in computer science and telecommunications that can be credited toward a 4-year degree.

Management, administration [7]There is a need for additional administrative and management/supervisory training for clericaland clinical staff. A suggestion was made to have a four-year Registered Health Administration(RHIA) degree and a two-year Registered Health Info Tech (RHIT) degree.

One individual reported that small clinics cannot afford to hire an experienced administrator.Consequently, most of the training occurs on-the-job. Another stated that his/her organizationwas able to adequately meet the administrative educational demands through a staffscholarship program. “We provide scholarship and staff training opportunities.”

Other suggestionsRespondents encouraged the University to incorporate on-the-job training with formaleducation, and to look at the impact of existing laws and regulations on health providers.

The majority of staff members in large health care organizations are cross trained insome way. Cross training frequently occurs among clerical and administrative staff,especially between billing clerks, accountants, medical records staff, and coders. In theclinical setting, the following were often cross trained in a variety of ways: counselors,nurses, lab techs, CNAs, CHAs, and respiratory therapists.

Cross training commonMost large health care organizations utilize some form of cross training. “Many if not all of ourpositions have cross trained other employees.” In general, cross training occurs more frequentlyin smaller offices, and is more prevalent among clerical or administrative staff than amongclinical staff.

Respondents felt cross training could improve efficiency in their organization, and fill gaps in thedelivery of care. “Cross training within departments has become a necessity to meet patientneeds, staff turnover, and scheduling demands.” Another said, “Cross training is becomingmore important in the tight job market and utilizes staff without additional cost. This will becomemore prevalent within our organization in the next few years.” However, some individuals did notfeel as positive about cross training. “I feel too much cross training can add havoc to an

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otherwise structured setting and should be done on an as needed basis.” In some cases,standards restrict an organization’s attempts to cross train.

Clerical staffIn health care organizations, it is extremely common for clerical desk staff to be cross trained.In particular, various degrees of cross training may occur between billing, coding, medicalrecords, transcriptionists, business office, payroll, accounting, or the front desk staff. In somecases, clerical staff are cross trained with clinical staff, such as with CNAs or CMAs.

Administrative staffAdministrative staff are often cross trained with clerical staff, which helps the office and itspersonnel keep up with daily issues, without interruptions or set backs due to absences. Someorganizations have only begun to cross train. “While we encourage department cross training,we have not had a large coordinated effort within programs and administration. Hence, we havejust initiated administrative cross training.”

Clinical staffCross training often takes place between various clinical positions. Counselors were mentionedmost frequently, and may be cross trained with the director or with other counselors (i.e. achemical dependency counselor with an inpatient mental health counselor).

Cross training of nurses was mentioned second most frequently. The following scenarios werelisted: nurses with radiologists, RNs with CMAs, RNs with MSWs, medical surgery RNs with OBor OR or ER/ICU nurses, or nurses with counselors. “Nurses do some group therapy-evaluationsessions.”

Laboratory staff may be cross trained with the front office staff, with x-ray staff, or with somenursing staff. CNAs may be cross trained with home health aides, acute care staff,phlebotomists, or pharmacy techs.

Community health aides may be trained to fill in when physicians and PAs leave, or when anorganization is unable to recruit temporary hires. CHAs may also be trained in computers, wordprocessing, billing, and ordering supplies.

Pharmacy technicians were listed as being cross trained with OR techs or with patientadvocates/interpreters. Respiratory therapists may be cross trained with the pulmonaryfunctions lab or the sleep disorders lab.

Respondents listed several other ways clinical staff members are cross trained. These include:the EEG tech with the EKG tech, medical techs with radiologists, acute care staff with long-termcare staff, PAs with NPs, and CHRs with EMS staff.

Other cross trainingRespondents listed the various ways non-clerical, non-clinical staff are cross trained in largehealth care organizations: ward clerks with CNAs, van drivers, appointment aides, or nursingassistants; housekeeping with residential assistance, laundry, or food services; cooks withsanitation or distribution clerks; nutrition support assistant with cashier; and diet tech with officecoordinator or team leader.

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Respondents reported needing further cross training in their organization, especially forclerical staff, administration, EMS staff, Lab techs, and CHAs.

Respondents identified a need for more cross training among clerical staff. They would likebillers, nurses, medical records staff, and, in one case, a utilization review analyst to be crosstrained with coders.

In administration, there is a need for the following cross training: accounting with budgeting,medical administrator assistants with other areas, and managers with managers from otherdepartments. The latter would enable managers to cover for those who are traveling or onleave. This form of cross training would also allow staff to grow and transition withorganizational growth.

There is also a need for cross training among clinical staff. Specifically, respondents want tocross train EMTs with Community Health Reps, and EMTs with other EMTs--“because it allowsEMT employees to take a vacation and have someone fill in for them.” They also want to crosstrain laboratory techs with radiology techs and phlebotomists, and Community Health Aides withCHRs, dental assistants, or dental hygienists.

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Medical Clinics

The most frequently mentioned trend in medical health clinics is the shortage ofqualified personnel, especially CMAs and nurses. Other noteworthy trends include: theuse of electronic (rather than paper) medical records, increased regulations andcomplications in coding, and the influence of insurance companies, which are limitingservice coverage and advocating the use of preferred providers.

Difficulty recruiting qualified personnel [6], particularly CMAs [2] and nurses [2]Problems recruiting qualified personnel was listed as the most significant trend in medicalorganizations. "It’s getting more and more difficult to find qualified people." In particular,respondents identified a shortage of CMAs and nurses in the field. One respondent reported anincrease in the use of CMAs in private practices. Another said there is a national shortage ofnurses, which will increase labor costs and decrease the efficiency of health care organizationsbecause physicians won’t have the needed support staff. A shortage of health aides andphysicians were also reported in Alaska.

Increased complications due to changes in insurance company policies [2], greater useof electronic records [2], and increased coding regulations [2]

Respondents reported that insurance companies are not providing full reimbursement forservices, which often dictate where patients can go for services. Patients are also using morepreferred providers, which complicates billing procedures.

Medical offices are using more electronic medical records and moving toward a “paperless”office.

More coding reviews and auditing are being done, and the federal government is imposingmore regulations on coding, so more training is needed for compliance. "It will cost more moneyto hire, train, and keep employees that work in the coding field."

Other trendsRespondents identified a number of other trends. These include: more people wanting to workat home, fewer transcriptionists in the future, more patients requesting female providers, amovement towards outpatient surgical services, an increase in care coordination andconsulting, and a greater emphasis on documentation. SOAP notes are no longer being used,and older doctors are becoming frustrated with the emphasis on documentation. Onerespondent said there is a current trend toward using Medical Assistants instead of RNs, andanother said the quality of medical assistants has been decreasing lately.

Respondents were highly concerned about enhancing clerical training. Coding was themost frequently mentioned area of clerical training needed in medical offices. Otherfrequently listed training needs include: legal issues, insurance billing, medicalterminology, and customer service.

Need training in coding [10]Training for front desk staff is needed in medical organizations. Specifically, respondents listedcoding as the greatest training need. Courses in coding would help alleviate this need, andcontinuing education courses would help staff members keep up with new coding regulations.

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One respondent suggested developing courses in medical office procedures that emphasizeCPT and ICD9 codes. Another suggested creating a two-year ART coding program. "Thiswould really help with needed employees."

Legal issues [4]Respondents expressed a need for training in legal issues, particularly regarding newregulations for HPPA, compliance in Health Care Finance Administration (HCFA) laws,and legal issues relating to medical records and confidentiality.

Insurance billing [4]Respondents also reported a significant need for general and continuing educationopportunities for billers. Specifically, instruction should provide guidelines on insurance billing(such as Medicare) and other general billing.

Medical terminology [2] and customer service [2]In addition, several respondents identified the need to educate front desk staff in medicalterminology and customer service and organization skills. One respondent suggested providingworkshops that incorporated role playing, and gave the following example: teach receptionistshow to handle difficult questions on the phone or what to do if someone passes out at thecounter. Respondents want the University to offer specific medical programs and training. Inparticular, they requested a PA program, a medical assisting program, an x-ray programand training, and a more accessible nursing program that graduates more nurses.Respondents also requested courses in cardiology and phlebotomy. Offer a PA program [2] and Medical Assisting program [2] Several respondents encouraged UAA to offer a physician assistant program and medicalassisting program. These programs should be well advertised, and the PA program should offersome specializations. One respondent reported that patients often prefer to see PAs than MDs.Many nurses have decided to become PAs, but need to go to school outside. Respondents alsosuggested offering a Dental Assisting program and an MLT (Medical Laboratory Tech)program. Increase opportunities for x-ray training in Alaska [4] Respondents said x-ray training is needed in Alaska, in the form of a program, courses, andcontinuing education. One respondent wanted to see an ultrasound technology programoffered. Enhance interest in and accessibility of nursing program [3] Respondents want more nursing educational opportunities offered through the University. Onerespondent said the nursing program should be accessible to Juneau students, such as throughcorrespondence courses/distance learning. Another reported that nurses are burning out andfewer people are going into the field. "We need to 'percolate' more interest in the nursing field." Cardiology [2] and phlebotomy [2] courses Respondents suggested the University offer courses in phlebotomy and cardiology. Onerespondent reported that the nurse practitioners in her organization would be willing to helpteach the courses.

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Other training needs In addition, respondents listed the following programs they would like UAA to offer: physicaltherapy, radiology, and sonography. They also mentioned the following areas of training orcoursework needed: drug and alcohol testing, CPR, and vaccinations and diseases (i.e. HIVand hepatitis). Increase accessibility of courses [2] Respondents encouraged UAA to make courses accessible to people who have fulltime jobs orlive in small communities. Courses should be offered in the evenings and on weekends, as wellas through distance education. UAA should consider having more flexibility with programs sonot all courses need to be taken in Anchorage. Pleased with graduates [2] Several respondents reported hiring externs from the University and graduates from the CareerAcademy that were well rounded, well prepared, and had a “good knowledge of terminology.”

Cross training occurs frequently in medical offices, particularly among clerical or frontdesk staff members. Many are cross trained to deal with medical records, billing, andcoding. Cross training also occurs between nurses, x-ray techs, and medical assistants.

Clerical and administrative staffMedical organizations report lots of cross training in their offices. Cross training occurs mostfrequently among the following positions: medical records, billing, coding, administration, andthe front desk. Cross training is more extensive in smaller offices. Respondents reported thattheir offices want more staff members to be trained to do coding.

Medical staffMedical staff, such as CMAs, CNAs, RNs, and LPNs, are frequently trained to work at the frontdesk. In one case, a lab manager was being trained to work in the front reception area. Inanother instance, RNs were cross trained with CMAs and other RNs in different specialty areas.

In a number of offices, x-ray staff frequently did more than one job. They were also crosstrained with nurses and medical assistants, who often drew blood and took x-rays.

Use little or no cross trainingIt is also important to note that a number of individuals reported that their offices use very littlecross training or no cross training at all.

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Pharmacies

The most significant trend among pharmacies is a shortage of pharmacists in Alaskaand nationwide. Another important trend is a foreseeable increase in the number ofpharmacy tech positions and an expansion of the pharmacy tech’s role. Respondentsalso said the pharmacist’s role is changing--toward more direct patient care.

Shortage of pharmacists [10]A national shortage of pharmacists has made recruiting extremely difficult in Alaska, especiallyfor pharmacies that require specialized qualifications (such as infusions). One pharmacy hashad a pharmacist position open for two years, and another reported a vacancy for 3 months.The retirement rate for pharmacists may be exceeding the rate of new entries into the field. Ashortage is especially apparent in Alaska due to the location and higher workload required oforganizations with smaller staff. One respondent said the number of pharmacists graduatingfrom schools equals the number who are retiring, so there is little net gain. This may becomeincreasingly more serious as the age of the baby boomer population increases, requiring moredrug usage.

Increase of pharmacy tech positions [6]Respondents predict a substantial increase in pharmacy tech positions in the future. Onereason for this is the growing shortage of pharmacists, and another is the changing role of thepharmacist--toward more primary patient care. With an increase in prescription drugs and adecrease in the number of pharmacists, the trend will be toward making more and better use ofpharmacy technicians, and to use pharmacists more efficiently.

Expanding roles will increase job standards for pharmacy techs. One respondent suspectsthere will be different levels of pharmacy tech positions. Currently, there is a nationalcertification for pharmacy technicians which hasn't been acknowledged much in the past. "Isuspect this will change in the future so that more importance is given to this certification."

Trend toward direct patient care [4]In the past ten years, respondents have seen the pharmacist’s duties move toward directpatient care, and the offering of more primary care provider type service. This trend mayincrease the need for more training in basic primary healthcare.

OtherIn addition, respondents identified the following other trends: an increase in counseling byappointment; more insurance companies going to on-line billing and not accepting secondaryclaims; an increase in the clinical training of pharmacists, home health care, robotics, and theuse of medboxes; and independent pharmacies shutting down and shifting toward pharmaciesin hospitals and big retail stores.

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Many respondents want to see a university pharmacy and pharmacy technician programin Alaska. They also want to see more continuing education courses for updatinglicenses.

Need a pharmacy program [8] (do not need [2]) and a pharmacy tech program [7] (do notneed [1])A pharmacy program and pharmacy technician program in Alaska would help alleviate theserious shortage of pharmacists. Many respondents felt strongly that a pharmacy program wasneeded. However, one individual wasn’t sure, and a few did not think it was necessary. Onerespondent said UAA might want to consider offering a pre-pharmacy curriculum if they can'thave a full pharmacy program. Prerequisite and supplementary coursework would be helpful.

Respondents also strongly urged UAA to create a pharmacy tech program that enabled them togain certification. However, if this wasn’t feasible, UAA should at least provide training forpharmacy techs for the first six months, since the learning curve is quite steep during the firstsix months. One respondent suggested UAA consider taking over the certification program forpharmacy technicians from the State Pharmacy Association. Another respondent saidpharmacy techs, in particular, get the training they need on-the-job.

Need continuing education [3] and distance learning courses [2]Pharmacists and pharmacy technicians want greater access to continuing education courses tohelp them maintain their licenses. Continuing education may be acquired through universities orcorrespondence programs. Currently, only continuing education credits are needed to berelicensed. One respondent said there has been some discussion about requiring relicensuretesting for pharmacists.

Several respondents also said they are interested in take pharmacy-related courses throughdistance education.

Practical experience in coursework [3]Pharmacy-related coursework should be supplemented with more practical experience andsocial contact. One respondent has found that many of the technicians that pass certificationmay know some of the terminology, but have very little practical experience. One suggestion isto develop a program that includes lab work or internships as part of the class.

Need training for insurance billing [2]Two respondents identified the need for training staff members in methods of Medicare andMedicaid billing and reimbursements.

Other training needsIn addition, one respondent said "compounding" training may be needed, and anotherencouraged the University to do community assessments. "Be in tune with the community andtheir needs."

Three individuals responded to the question on cross training. One reported limitedcross training, another said all employees do cross training, and the third said thepharmacy techs “do it all.” It takes 6 months to 1 year to learn skills.

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Rehabilitation

Trends in the physical rehabilitation field are leaning toward a decreased number ofphysical therapists being hired due to changes in Medicare policies. Other major trendsinclude a lack of nurses and an emphasis on improved working conditions andergonomics.

Fewer physical therapists are being hired due to changes in MedicareChanges in Medicare reimbursement policies have resulted in fewer physical therapists beinghired, and has increased the difficulty of the billing process. In the past, Medicarereimbursement paid the wages of therapists, but now reimbursement is done per patient, so it ismore advantageous for organizations to have fewer therapists seeing more patients. Onerespondent reported that insurance companies are less willing to pay for physical therapyservices. Another respondent speculated, as the baby boomer population increases, there maybe an increase in the need for physical therapists.

In addition, one respondent said the field of physical therapy is changing and becoming moretechnical, which requires more specific training. More physical therapists and other allied healthworkers are doing orthotics now. Another said that more physical therapy shops are openingand that physicians now have more options in which to refer patients.

Not enough nursesMany rehabilitation organizations have difficulty finding and hiring nurses. One respondent saidnurses are wanting to work part-time and stay home with children. "Seven year burnout" iscommon with nurses.

ErgonomicsRespondents reported a current trend toward improved working conditions and ergonomics.One respondent said business has doubled and will probably double again as new OSHAregulations and guidelines are implemented. Another said that when the OSHA rules areinstituted, it could have major impacts on the physical therapy field.

OtherRespondents also identified the following trends in physical rehabilitation organizations: theincreased pursuit of grants and funding, the approach of managed care in Alaska, and thescarcity and higher demand for health care workers. People have more choices of places towork and can demand more money.

Respondents requested a physical therapy program and speech pathology program inAlaska. They also want more continuing education courses to help them maintain theirlicenses.

Need continuing education courses for licensing [8]The availability of continuing education courses is a priority for individuals in the physicalrehabilitation field. "We are constantly taking courses to maintain our licensure." Becausephysical therapists and speech pathologists are required to take courses each year to keeptheir licenses, they frequently have to leave the state to do this. If the University offeredcontinuing education in these areas, physical rehabilitation professionals could remain in thestate.

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Need programs in physical therapy [4] (do not need [2]), physical therapy assistant [3],and speech pathology [3]Respondents felt that UAA needs to offer physical therapy, physical therapy assistant, andspeech pathology programs. "We have to advertise for these positions in the lower 48 becausethere is not a school in Alaska." However, several individuals said a physical therapy programwas not necessary in Alaska. "There seem to be a lot of physical therapists around."

In addition, respondents suggested UAA create an athletic training program and an orthoticsprogram similar to WAMI. "It would be nice if Alaskans could do some courses here or maybedo telecourses. Consider offering a residency program here for people studying orthotics."

Specific classes neededRespondents also suggested UAA offer the following: a medical coding class that introducesthe new ICD-10 system, more ergonomics courses in the OT program, manual therapycourses, computer classes that keep people in the technological forefront, and Medicaid billingeducation. They have an increasing number of rules to follow for billing.

Other training issues or needsOne respondent said UAA courses should educate students on providing health care in ruralsettings. Another said instructors should have practical experience in the field in order to passthis information on to their students. "Health care workers are being trained by people who don'twork in the field and never have." Lastly, one respondent wants to see fresh cadavers providedfor training physical therapists. (“[T]his comment was sincere!”)

Cross training is a common practice among staff members in rehabilitation offices,particularly between clinical and clerical staff.

Cross training is a common practice between physical therapists, nurses, and the office staff.This is especially true in the small business offices. Many staff members can help at the frontoffice. "Everyone can sit in for the receptionist." Physical therapists, physical therapistassistants, and occupational therapists are sometimes cross trained. In one case, a physicaltherapist assistant was also a fitness trainer. Nurses are occasionally trained to doadministration work or allergy testing. In one office, the audiologists sometimes answer phonesand do billing.

Use little or no cross trainingIt is also important to note that a number of the individuals surveyed reported that their officesuse very little cross training or no cross training at all.

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School Districts

There is currently a shortage of qualified personnel in the schools, especially specialistssuch as speech pathologists, school psychologists, and counselors. Reasons for thisshortage include: undesirable travel requirements, lack of funding, and lack ofcompetitive wages.

Difficulty recruiting qualified personnel [5]It is difficult to recruit qualified personnel into the schools, especially in rural areas. In general,allied health positions are difficult to fill. One school had a nurse position open for two monthsand had to contract out with the hospital for nursing aides. A suggestion was made for theschool districts to work cooperatively with outside agencies (like the Infant Learning Program) toshare resources.

Reasons for recruiting difficulties: travel [3], competition [2], and funding [1]A number of reasons were given for recruiting difficulties. Being required to travel wasmentioned most frequently. It's hard to find people who want to travel to all the differentvillages; they have to overnight in lots of different accommodations. Competition betweenagencies, especially regarding pay, was a second reason for having recruiting difficulties,followed by a lack of funding. One respondent said there is a general lack of funding forpositions in allied health. One organization, however, does not find recruiting difficult becausethey can always contract out with SESA or SERRC for the needed positions.

Shortage of speech pathologists [2], psychologists [3], and counselors [2]Schools identified a shortage and increased need for speech pathologists, psychologists, andcounselors. "We're seeing a trend toward mental health services working in the schools."However, one respondent said decreasing budgets have led to resistance to spend money onspecial education programs. "Some staff in the district see special education as taking moneyaway from the larger pool of money."

In addition, one respondent said Mt. Edgecumbe needs counselors and social workers thathave experience working with native youth. A shortage of occupational therapists and physicaltherapists was also mentioned.

Other issues around psychologists and counselors [3]One respondent said there is an increased demand for school psychologists to do counseling inorder to help with behavioral support plans, which may in turn double their work loads. Anothersaid the potential of reduced funding for counseling and psychological services may bring aboutthe need to recruit social workers to fill these roles. One school plans to hire a social worker towork with school psychologists and counselors on an outreach basis. The social worker willhelp identify behavioral problems in kids at the elementary level in order to help increase theirsuccess in school.

There is a trend toward increased medical needs of school children, yet a number ofschools in the state do not have school nurses.

Increased medical needs in school childrenSchools are seeing an increase in the medical needs of school children. Higher levels ofmedication are often needed for diseases such as diabetes and heart diseases. The number of

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severely handicapped students is also increasing. "We have been identifying more FASstudents in the district." One school district used to have school nurses, but can no longerafford them. "School secretaries are acting as nurses." In another district, the schools cannotprovide special health care services to their students, so a clinic in the village offers them theschools. These services include physicals, drug and alcohol prevention youth services, andeducation and tutoring programs.

There is a substantial need for in-state programs in speech pathology, occupationaltherapy, and physical therapy. Respondents want local programs in these areas so theycan recruit individuals from within Alaska.

Speech pathology [9], occupational therapy [7], and physical therapy [7]Respondents identified a strong need for special education programs within the state of Alaska.Frequently, school districts are forced to go outside of Alaska to recruit special educationprofessionals. “Would like to see us "home-grow" our own.” Respondents mentioned needing aspeech pathology program most frequently, followed closely by programs in occupationaltherapy and physical therapy. "I would like to see UAA offer bachelor and master degreeprograms in these areas."

The following suggestions were made regarding creating programs at the University: 1) addressthe diversity and cultural needs of Native populations, 2) build relationships with otheruniversities that provide speech pathology, OT, and PT programs (similar to the WWAMIprogram), and 3) offer continuing education training and programs through distance deliveryand summer courses.

One respondent wanted to see an OT and PT program at the University, but wasn’t sure therewas a need for it. Another did not see a need for a speech pathology program.

OtherRespondents listed the following other training needs for school staff: general schoolenvironment issues and associated school paperwork; "adventure counseling" (i.e. ropescourse), and special education laws. One respondent has found that some of the contractedindividuals from private practices are not experienced in these laws.

Respondents want UAA to create a school counseling/psychology program, and to moreactively urge high school students into careers in the health care fields.

Create a school counseling/psychology program [3]Respondents said creating a school psychology and counseling program at UAA would helpalleviate shortages and recruitment difficulties. One respondent said since UAA already hassimilar programs in place, it might not take much work to modify the current programs toaccommodate school counseling and school psychology.

Encourage HS students into health fields [3]Respondents want greater efforts made toward encouraging Alaskan high school students togo into health-related fields. One respondent said students may not in fact realize that schoolsemploy people in health fields. A suggestion was made to provide videos on health careers tostudents and parents on a check out basis.

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OtherIn addition, respondents want to see coursework at UAA that focuses on behavior managementand the special medical needs of children, as well as a program for sign language interpreters.One respondent said all UAA students in health care should take a course in providing servicesin the bush. "There are lots of challenges in working in the 'bush' environment."

School staff members need additional training to help them work with FAS/FAE andautistic children.

FAS/FAE [6]FAS, FAE, and autism are big issues for many school districts. More training in these areaswould help school health care professionals improve services. It would also help professionalsincorporate more FAS/drug related interventions. Respondents also mentioned a need for TBI(traumatic brain injury) training and suicide prevention. One respondent said the schools do notseem to be making much headway with kids who have severe behavioral health problems. "Iwould like to see agencies cooperate more with each other and work together in helpingstudents in the system."

Many schools provide their own staff members with training, particularly in specialeducation (i.e. physical therapy and speech/language pathology).

Schools frequently provide training to staff members who deal with special education topics.Itinerant physical therapists and speech pathologists often give in-service training sessions toteachers and classroom aides on techniques and activities to use with students who are havingdifficulties.

In one case, the school staff goes to DFYS and “the clinic” to get trained, thus keepingthemselves informed about what is happening with youths. One respondent said schoolcounselors work with mental health counselors from Providence Hospital.

In particular, respondents said there is currently a need for training in speech/language andspecial education multiple disabilities.

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Vision Clinics

An increase in technology, a shortage of licensed opticians, and expansion of officeswere the most frequently mentioned trends among vision clinics.

Increased technology [3]Technology has increased in vision clinics, becoming more computerized. Since moremachines are being used, fewer opticians may be hired in the future. One respondent pointedout an increase in Lasik surgery.

Shortage of licensed opticians [2]Although it is fairly easy to hire an optician in Alaska, it is much more difficult to find one that islicensed. Reasons for this shortage is a lack of a program in Alaska and the aging population oflicensed opticians.

Expansion of offices [2]Respondents are seeing an expansion of optical practices. One office reported a plan to put ina lab. In general, bigger offices are replacing “mom and pop” small offices.

OtherOne respondent reported a trend toward more patients being referred by general practitionersto eye doctors. Another said the optical industry has changed significantly (i.e. changes in thematerials being used), requiring the skills of options to also change.

Respondents also offered the following two side comments: 1) People in optical fields tend tostay at one shop for a long time--people do not float around in the profession and 2) mostdoctors on the peninsula are willing to train a person to be an optometric technician.

Respondents want to have a two-year university optician program in Alaska, as well as alicensing program for optometric technicians. Several respondents wantcorrespondence courses for opticians.

Create a two-year optician program [6] and an optometric tech program [1]Creating a two-year optician program in Alaska was listed as a high priority. Currently, there isno licensing program in Alaska, so the only way to become an optician is to apprentice for 3years. Yet, it can be difficult to find an office willing to take people on, and licensed opticiansare only allowed to have two apprentices working under them. Creating an optometric techprogram was also mentioned. However, if UAA decides to develop an optician or optometrictech program, they should work with the State to include licensing into the programs. Licensedindividuals usually have a higher caliber of work, have more experience, and get paid more.

Offer correspondence courses [2] and continuing education courses [1]Two respondents mentioned a need for correspondence courses for opticians that wouldenable them to complete a two-year program. Another respondent wanted to have localcontinuing education courses. The only option is correspondence now.

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OtherIn addition, one respondent said the office staff could use more computer training, particularlyon using the Internet for billing. Another said a coding/billing/collections program would begood. "Current coders/billers in the field are not very experienced."

Five respondents reported various degrees of cross training taking place in visionclinics.

One respondent reported that “limited” cross training is used, two said “some” are cross trained,another said cross training is used between the receptionist and optician, and the fifth reportedthat cross training is used a lot. "Everyone is able to do each other's job."

appendix a - university of alaska anchorage...alaska center for rural health allied health survey...

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