A challenged workforce needs mentors

We are all too familiar with the haunting statistics on addiction and treatment. Research shows high relapse rates for specific drugs, particularly opioids; the deleterious effects of substance use on physical and emotional well-being; the range of consequences suffered by families and other loved ones; and the chasm that exists between those who need treatment and those who receive it. Yet we allow our hope, our passion and our belief in the possibility of recovery to strengthen our resilience and solidify our commitment to the treatment field.

We have seen, heard and, in some cases, lived success stories in the battle, and we know that as providers we make a difference in the lives of those we serve. But is there a way to do what we do better—that is, with greater skill and efficiency, and more effective outcomes?

The addiction treatment workforce

In its 2006 report to Congress, the Substance Abuse and Mental Health Services Administration (SAMHSA) stated that the addiction treatment field is facing a workforce crisis. The federal agency responded by elevating workforce development to a program priority.¹

The report acknowledged key issues facing the field, including but not limited to the changing profile of those needing services (e.g., an increase in the number of injecting drug users and in the abuse of prescription medications); a movement toward recovery management and a chronic care approach; and use of performance and patient outcome measures.

Success of treatment provision, however, depends largely on human resources, and at the root of many of the issues facing the treatment field is an insufficient workforce. The field has experienced worker shortages, high turnover rates, and a lack of professional development opportunities.

In light of impending healthcare changes, SAMHSA issued a new report in January 2013.² This report further highlighted the necessity for developing a high-quality workforce, stating, “Workforce issues, which have been a concern for decades, have taken on a greater sense of urgency with the passage of recent parity and health reform legislation.”

Some initial goals for improving workforce sufficiency include recruiting a younger workforce diverse in personal and educational backgrounds, and retaining existing staff by providing training, certification and career trajectory opportunities. Having clearly delineated career paths based on what provider organizations offer and the interests and skills of prospective employees could work toward reducing turnover, and employing new marketing strategies to improve student recruitment from educational institutions would meet the goal of attracting new employees seeking to build careers in addiction prevention, treatment, research and education.

In this effort to strengthen and grow the workforce, it seems that the need for mentors is reaching crucial levels. With many aging workers approaching retirement, new staff not only will inherit existing issues, but also will work within the new opportunities and constraints that lie ahead as we usher in the era of healthcare reform.

Clinical supervision vs. mentoring

The terms “supervisor,” “coach” and “mentor”are used interchangeably, but as we discuss the importance of advancing the addictions workforce, the remainder of this article will focus on clinical supervisors and mentors.

Multiple definitions of the function of clinical supervisors exist. For our purposes, we will describe the role of the clinical supervisor as one who works on skill development while maintaining quality-of-care standards with the supervisee; one who protects patient welfare by ensuring that care is delivered by supervisees according to ethical and legal guidelines; and one who assesses the strengths and training needs of supervisees in an ongoing and supportive manner.

According to SAMHSA’s Treatment Improvement Protocol (TIP) 52, the clinical supervisor, the liaison between administrative and clinical staff, makes certain that patients/clients are competently served.³ Safe and competent practice facilitates recovery.

How does this role differ from that of mentor? Both clinical supervisors and mentors act as coaches. But whereas clinical supervisors encourage and support high-quality service delivery, mentors provide career guidance for their mentees. The feedback that they provide focuses on performance beyond routine job duties and the task at hand.

Clinical supervisors and mentors role model correct behavior, but mentors model and advise on professional behaviors that translate across departments and beyond the walls of the provider organization. Finally, they connect mentees to resources, including people and financial resources that may be beyond the scope of access for clinical supervisors.

The mentor-mentee relationship may be difficult to cultivate, since it often requires a shared, congruent and hopefully well-explained view of the relationship’s expectations. A brief synthesis of research on mentors and mentees finds that the mentor should embody the organization’s mission, vision and values, which is important to the role modeling aspect of the relationship. Given the workforce crisis, a mentor should be someone with significant clinical experience (i.e., five to seven years), so that the mentee can see concrete examples of the mission, vision and values in action, as well as an understanding of the prominence of patient care in the business of addiction treatment.

Related to this, mentors also should understand other aspects of business such as operations, marketing and finance, so that they can provide examples of how these affect patient care. Finally, it is recommended that mentors possess demonstrated leadership ability, where they can inspire pioneering attitudes, reduce fear and other barriers to creativity, and promote professional growth within our field.

Good mentors are made, not born, and oftentimes they are fashioned by those who have mentored them. Exposing mentors’ talents and fostering an environment where those talents are shared willingly with mentees will likely address the recruitment and retention issues highlighted in the SAMHSA reports.

Mentoring Millennials

Mentoring is a vital task for staff development, but today we see the extreme value of the mentor-mentee relationship when working with the “Millennial” generation, also known as Generation Y or Trophy Kids.

Millennials’ entry into the workforce has implications for human resource personnel, managers, leaders, and the Millennials themselves. The business and psychology literatures present a breadth of studies and commentary on the differences (and some noted in this section may be generalities) between the Millennials and their predecessors, Generation X and the Baby Boomers.

Having grown up with technology, the Millennials are extremely tech-savvy, and their knowledge of technology can serve them well in the workplace. Some psychologists believe that their involvement with computer games and gaming systems increases critical thinking and problem-solving ability, and their experience with the Internet allows them to tap into web-based resources quickly and to execute tasks efficiently. They maintain connections via social media and have a well-developed understanding of social networks. This new generation is intellectually curious and tolerant of differences among people. They appreciate diversity by way of race/ethnicity, sexual orientation and disability.

Although employers recognize these attributes as strengths, some also note ways in which these qualities might impede Millennials’ professional growth, particularly for those who are new to the workforce. For example, Millennials’ heavy reliance on technology has been linked to their inability to work within team-based settings. The singularity of using laptop computers, tablets and smartphones may reduce the social skills and strategic thinking needed to achieve collaborative forces that evolve from committees and work groups.

Millennials’ constant connection to their phones can contribute to disruptions, breaks in concentration, and ultimately a loss of productivity. Further, social media immersion presents new risks to organizations, such as confidentiality breaches and the blurring of professional boundaries.

In addition, Millennials often have unrealistically high expectations that they should be socializing among senior executives and that they should be promoted before they have achieved the adequate accomplishments, experiences, tenure, or education required for promotion.

These limitations, however, pave the way for a fruitful mentor-mentee relationship. In a recent Harvard Business Review article, Meister and Willyerd present three types of mentoring for Millennials, two of which can be applied in treatment settings.⁴

Group mentoring via online platforms can be self-organized or structured by senior leaders. This virtual mentoring can consist of one or more mentors interacting with multiple mentees, offering a valuable option for providers that have several treatment sites. One or more mentors join group discussions weekly while mentees connect with peers across geographically (and in some cases programmatically) diverse treatment sites.

Mentors may lead discussions of issues facing the organization or larger policy-level issues, and allow the mentees to respond in a socially supportive way. Discussion boards, if available, can sustain an ongoing conversation among mentees until the next formal online meeting. When constructed carefully, these learning circles can influence collaboration and the development of critical thinking.

Although the above example supports the use of technology in the mentor-mentee relationship, this type of mentoring can succeed without it. For example, meetings can be held in-person or by telephone while achieving the goals of reaching multiple mentees and creating opportunities for shared support among them. Group projects that include team-based problem solving may naturally evolve from these settings.

Reverse mentoring helps Millennial mentees hone their skills in instruction and role modeling. Integrating technology into the mentoring relationship meets mentees in their familiar mode of communication and gives the less technology-centric mentor an area for possible skill advancement. Meister and Willyerd suggest that mentees matched with senior executive mentors can show them how to use social media to connect with customers.⁴

In the treatment provider arena, the mentor can share with the mentee how providers convey respect to patients/clients by upholding confidentiality and protecting their right to privacy (e.g., 42 CFR Part 2; HIPAA). Social media, when used inappropriately or irresponsibly, can cause harm to patients through intentionally or unintentionally violating their privacy. In this example of reverse mentoring, mentors learn the advantages of modern-day business tools, while mentees become educated in professional behavior, core values, organizational culture and risk mitigation.

Conclusion

Creating and sustaining mentor-mentee relationships offers one method of investing in the future of alcohol and drug treatment. Providing new employees with skilled mentors will help them gain the skills required to deliver high-quality care and improved outcomes, while building long-term career paths.

When providers devote the time and energy to infrastructure development wherein mentees can flourish, our strengthened workforce will provide expert care. That in turn will improve lives by reducing the long-term consequences for individuals with addiction.

Cara M. Renzelli, PhD, is Vice President of Research and Clinical Training at Gateway Rehabilitation Center in western Pennsylvania. She leads the Kenneth S. Ramsey, PhD, Research and Training Institute at Gateway. Her areas of interest include workforce advancement, the integration and sustainability of new treatment practices, and organizational change. Her e-mail address is Cara.Renzelli@gatewayrehab.org.

References

1. Substance Abuse and Mental Health Services Administration.  Report to Congress: Addictions Treatment Workforce Development; 2006. Retrieved from https://partnersforrecovery.samhsa.gov/docs/Report_to_Congress/pdf.

2. Substance Abuse and Mental Health Services Administration. Report to Congress on the Nation’s Substance Abuse and Mental Health Workforce Issues; 2013. Retrieved from https://store.samhsa.gov/shin/content/PEP13-RTC-BHWORK/PEP13-RTC-BHWORK.pdf.

3. Center for Substance Abuse Treatment. Clinical Supervision and Professional Development of the Substance Abuse Counselor; Treatment Improvement Protocol (TIP) Series No. 52. Rockville, Md.: Substance Abuse and Mental Health Services Administration; 2009. Retrieved from www.ncbi.nlm.nih.gov/books/NBK64845.

4. Meister JC, Willyerd K. Mentoring Millennials. Harv Bus Rev 2010 May;88:68-72.