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.