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Last BS, Crable EL, Khazanov GK, Scheinfeld LP, McGinty EE, Purtle J. Impact of U.S. Federal Loan Repayment Programs on the Behavioral Health Workforce: Scoping Review. Psychiatr Serv 2024:appips20230258. [PMID: 38369883 DOI: 10.1176/appi.ps.20230258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE Federal loan repayment programs (LRPs) are one strategy to address the shortage of behavioral health providers. This scoping review aimed to identify and characterize the federal LRPs' impact on the U.S. behavioral health workforce. METHODS A scoping review was conducted in accordance with JBI (formerly known as the Joanna Briggs Institute) methodology for scoping reviews. The authors searched the Ovid MEDLINE, Web of Science, APA PsycInfo, EconLit, PAIS Index, and Embase databases, and gray literature was also reviewed. Two coders screened each article's abstract and full text and extracted study data. Findings were narratively synthesized and conceptually organized. RESULTS The full-text screening identified 17 articles that met eligibility criteria. Of these, eight were peer-reviewed studies, and all but one evaluated the National Health Service Corps (NHSC) LRP. Findings were conceptually organized into five categories: descriptive studies of NHSC behavioral health needs and the NHSC workforce (k=4); providers' perceptions of, and experiences with, the NHSC (k=2); associations between NHSC funding and the number of NHSC behavioral health providers (k=4); NHSC behavioral health workforce productivity and capacity (k=3); and federal LRP recruitment and retention (k=4). CONCLUSIONS The literature on federal LRPs and their impact on the behavioral health workforce is relatively limited. Although federal LRPs are an important and effective tool to address the behavioral health workforce shortage, additional federal policy strategies are needed to attract and retain behavioral health providers and to diversify the behavioral health workforce.
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Affiliation(s)
- Briana S Last
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Erika L Crable
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Gabriela Kattan Khazanov
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Laurel P Scheinfeld
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Emma E McGinty
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
| | - Jonathan Purtle
- Department of Psychology (Last) and Health Sciences Library (Scheinfeld), State University of New York at Stony Brook, Stony Brook, New York; Department of Psychiatry, University of California, San Diego, San Diego (Crable); Center of Excellence for Substance Addiction, Treatment, and Education, Corporal Michael J. Crescenz U.S. Department of Veterans Affairs Medical Center, and Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia (Khazanov); Department of Population Health Sciences, Division of Health Policy and Economics, Weill Cornell Medical College, New York City (McGinty); Department of Public Health Policy and Management, School of Global Public Health, New York University, New York City (Purtle)
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Rowan K, Knudson A, Anderson B, Satorius J, Shah S, Stahl A, Kepley H. Role of the National Health Service Corps in Delivering Substance Use Disorder Treatment in Underserved Communities. Psychiatr Serv 2023:appips20220244. [PMID: 36751906 DOI: 10.1176/appi.ps.20220244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To help address the opioid epidemic, the U.S. Health Resources and Services Administration expanded the National Health Service Corps (NHSC) to include two new loan repayment programs (LRPs)-the Substance Use Disorder LRP and the Rural Community LRP-to supplement the existing standard LRP. In this article, the authors aimed to describe the role of these NHSC programs in addressing workforce shortages and providing substance use disorder treatment, including for opioid use disorder, in underserved areas. METHODS Administrative data on NHSC clinician locations were merged with county-level data to characterize the communities served by NHSC clinicians. Primary data from surveys and key informant interviews with NHSC site administrators (N=9) and clinicians (N=9) were used to describe changes in NHSC clinician service delivery due to the COVID-19 pandemic. RESULTS The NHSC LRP expansion increased the number of clinicians providing behavioral health treatment in underserved areas, especially rural areas. A majority of NHSC sites surveyed have increased their provision of substance use disorder treatment since the COVID-19 pandemic began. CONCLUSIONS This article demonstrates the valuable role of these NHSC programs as resources that policy makers can use to mitigate the challenges of health care workforce shortages and burnout.
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Affiliation(s)
- Kathleen Rowan
- NORC at the University of Chicago, Bethesda (Rowan, Knudson, Anderson, Satorius, Shah); Bureau of Health Workforce, U.S. Health Resources and Services Administration (HRSA), Rockville, Maryland (Stahl, Kepley)
| | - Alana Knudson
- NORC at the University of Chicago, Bethesda (Rowan, Knudson, Anderson, Satorius, Shah); Bureau of Health Workforce, U.S. Health Resources and Services Administration (HRSA), Rockville, Maryland (Stahl, Kepley)
| | - Britta Anderson
- NORC at the University of Chicago, Bethesda (Rowan, Knudson, Anderson, Satorius, Shah); Bureau of Health Workforce, U.S. Health Resources and Services Administration (HRSA), Rockville, Maryland (Stahl, Kepley)
| | - Jennifer Satorius
- NORC at the University of Chicago, Bethesda (Rowan, Knudson, Anderson, Satorius, Shah); Bureau of Health Workforce, U.S. Health Resources and Services Administration (HRSA), Rockville, Maryland (Stahl, Kepley)
| | - Savyasachi Shah
- NORC at the University of Chicago, Bethesda (Rowan, Knudson, Anderson, Satorius, Shah); Bureau of Health Workforce, U.S. Health Resources and Services Administration (HRSA), Rockville, Maryland (Stahl, Kepley)
| | - Anne Stahl
- NORC at the University of Chicago, Bethesda (Rowan, Knudson, Anderson, Satorius, Shah); Bureau of Health Workforce, U.S. Health Resources and Services Administration (HRSA), Rockville, Maryland (Stahl, Kepley)
| | - Hayden Kepley
- NORC at the University of Chicago, Bethesda (Rowan, Knudson, Anderson, Satorius, Shah); Bureau of Health Workforce, U.S. Health Resources and Services Administration (HRSA), Rockville, Maryland (Stahl, Kepley)
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Pathman DE, Sewell RG, Rauner T, Overbeck M, Fannell J, Resendes J. Outcomes of States' Loan Repayment and Forgiveness Programs From the Perspective of Safety Net Practice Administrators. J Am Board Fam Med 2022; 35:1015-25. [PMID: 36113997 DOI: 10.3122/jabfm.2022.AP.220092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 03/21/2023] Open
Abstract
Nearly every state offers loan repayment (LRP) and some offer loan forgiveness to clinicians who commit to work in safety net practices. The effectiveness of these programs from the perspective of safety net practices is largely unknown. OBJECTIVES: To assess safety net practice administrators' assessments of key outcomes for the 3 principal types of state service programs: LRPs funded by states, LRPs funded jointly by states and National Health Service Corps, and loan forgiveness programs. SUBJECTS: Administrators of safety net sites where primary care, behavioral health and dental health clinicians began serving in 26 state service programs in 14 states from 2011 to 2018. Survey responses were received from 455 administrators reporting on 754 of 1380 clinicians (54.6%). OUTCOME MEASURES: Administrators' ratings of their sites' difficulty recruiting clinicians; relative ease, quickness and cost of recruiting the participating (index) clinician with the service program; program expected effects on participants' retention; participants' job performance. RESULTS: Most administrators (66.1%) reported that recruiting clinicians of the index clinician's discipline is generally difficult but made easier (81.7%) and quicker (65.4%) with the service program, but only sometimes less expensive (34.8%). 78.8% of administrators anticipate that the clinicians will remain longer because of program participation. Participants are perceived to practice good quality care (96.9%) and be positive contributors (92.4%). Administrators' assessments are generally similar for the 3 types of programs. CONCLUSIONS: Administrators of safety net practices generally perceive states' loan repayment and loan forgiveness programs succeed in helping them recruit and retain good clinicians.
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Pathman DE, Sonis J, Harrison JN, Sewell RG, Fannell J, Overbeck M, Konrad TR. Experiences of Safety-Net Practice Clinicians Participating in the National Health Service Corps During the COVID-19 Pandemic. Public Health Rep 2022; 137:149-162. [PMID: 34694922 PMCID: PMC8721684 DOI: 10.1177/00333549211054083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The impact of the COVID-19 pandemic has been particularly harsh for low-income and racial and ethnic minority communities. It is not known how the pandemic has affected clinicians who provide care to these communities through safety-net practices, including clinicians participating in the National Health Service Corps (NHSC). METHODS In late 2020, we surveyed clinicians who were serving in the NHSC as of July 1, 2020, in 20 states. Clinicians reported on work and job changes and their current well-being, among other measures. Analyses adjusted for differences in subgroup response rates and clustering of clinicians within practices. RESULTS Of 4263 surveyed clinicians, 1890 (44.3%) responded. Work for most NHSC clinicians was affected by the pandemic, including 64.5% whose office visit numbers fell by half and 62.5% for whom most visits occurred virtually. Fewer experienced changes in their jobs; for example, only 14.9% had been furloughed. Three-quarters (76.6%) of these NHSC clinicians scored in at-risk levels for their well-being. Compared with primary care and behavioral health clinicians, dental clinicians much more often had been furloughed and had their practices close temporarily. CONCLUSIONS The pandemic has disrupted the work, jobs, and mental health of NHSC clinicians in ways similar to its reported effects on outpatient clinicians generally. Because clinicians' mental health worsens after a pandemic, which leads to patient disengagement and job turnover, national programs and policies should help safety-net practices build cultures that support and give greater priority to clinicians' work, job, and mental health needs now and before the next pandemic.
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Affiliation(s)
- Donald E. Pathman
- Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey Sonis
- Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Robert G. Sewell
- Office of Healthcare Access, Section on Rural and Community Health Systems, Division of Public Health, Alaska Department of Health and Social Services, Anchorage, AK, USA
| | - Jackie Fannell
- Provider Retention and Information System Management Collaborative, National Rural Recruitment and Retention Network (3RNET), Jefferson City, MO, USA
| | - Marc Overbeck
- Oregon Primary Care Office, Oregon Health Authority, Portland, OR, USA
| | - Thomas R. Konrad
- Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Health Workforce Analytics, Chapel Hill, NC, USA
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Yun J, Zerden LDS, Cuddeback G, Konrad T, Pathman DE. Overall Work and Practice Satisfaction of Licensed Clinical Social Workers in the National Health Service Corps Loan Repayment Program. Health Soc Work 2021; 46:9-21. [PMID: 33954777 DOI: 10.1093/hsw/hlaa033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/19/2019] [Accepted: 10/06/2019] [Indexed: 06/12/2023]
Abstract
Little is known about the job satisfaction of licensed clinical social workers (LCSWs) participating in the National Health Service Corps (NHSC) federal Loan Repayment Program (LRP). Employee satisfaction in organizations is important for organizational well-being and to decrease turnover. A satisfied NHSC LCSW workforce is also important given the array of services it provides, especially in rural and underserved areas. This study examined the work satisfaction of 386 LCSWs participating in the NHSC LRP in 21 states. Rural upbringing, being older than 40 years, and a higher salary were significantly associated with overall work and practice satisfaction. In addition, satisfaction with administration, staff and the practices' linkages to other health providers, the mission of the practice, and connection with patients were strongly associated with overall work and practice satisfaction. To our knowledge, this is the first study to examine the work and practice satisfaction of LCSWs participating in the NHSC LRP, and our findings have the potential to inform the NHSC's strategies in managing and retaining LCSWs.
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