Improving Quality of Substance Abuse Treatment By Focusing on the Workforce: Lessons from Massachusetts

Purpose: Building human capital within the addiction treatment workforce is essential to the stability of the profession and the quality of care being delivered. The weak worker pipeline and the lack of long-term stability within the workforce due to a combination of high turnover rates and the high proportion of older clinicians in the field is a significant problem. This study uses data collected from Program Directors and counseling staff in Massachusetts to provide key insights regarding staffing patterns, counselor workload, and counselor perceptions of the work environment.  Massachusetts’ residents seeking addiction treatment had access to universal coverage several years prior to rollout of the ACA. As such, these data provide a window into future program design and staffing issues that may be experienced by programs and providers in other states. This is particularly salient as we consider the push towards higher levels of integration and greater use of evidence based practices.

Methods: Two survey instruments were developed for this study: a counselor-level work environment survey (CS) completed by the counseling staff (n=293) working within participating facilities and a facility-level workforce survey (FWS) completed by the Program Director at each facility (n=48). The CS instrument provides counselor demographics, education, employment history and current employment, current workload, perception of work environment, feelings towards work, income, and overall impressions. The FWS provides facility/agency characteristics, range of services and service delivery information, staffing, and wage and benefits information. Multilevel models were used to detect variation in counselor perceptions of the work environment within- and between-facilities.

Results: Facilities varied by type of ownership, services provided, and staffing. 54% of facilities offered regular or intensive outpatient services, 15% provided opioid treatment only (OTP), and 31% offered both. Among counselors, 76% are female, 84% have a master’s degree, and 19% reported feeling burned out at least once a week. Findings indicate that significant variation in counselor perceptions of the work environment exist both within-facilities and between-facilities. Within-facilities, counselor level of burnout was significantly associated with work environment score, counselor rating of quality care, and counselor job satisfaction. Individual counselor level variables found to be significant in predicting burnout included work environment, time with current employer, and counselor age. Facility level characteristics were also found to impact counselor perceptions of the work environment.  Significant facility level indicators included: a high resignation rate, facility provides OTP treatment only, facility is non-profit, and the percentage of population served receiving group therapy.

Implications: Based on recent legislation, workforce issues within the field of addiction treatment have moved into the spotlight and are relevant for the social work profession. These findings emphasize that exploring burnout and understanding what work environment characteristics make a difference to a counselor’s work life experience is crucial. By focusing on counselors and their workplace, this research creates an opportunity to gain knowledge and insights about the counselors and the challenges they face as they seek to deliver quality care. Findings from this study can inform future workforce development policy in Massachusetts with implications for other states.