Data | Bowen Center for Health Workforce Research and Policy

Mental Health Awareness Week Spotlight: Indiana’s Behavioral Health Workforce

by Guest Author | Oct 8, 2024 | Data, Playbook

As we recognize Mental Health Awareness Week (Oct. 6-12), and World Mental Health Day (Oct. 10), the Bowen Center for Health Workforce Research and Policy would like to highlight our ongoing efforts to analyze and strengthen Indiana’s behavioral health workforce.

Key Findings on Indiana’s Behavioral Health Workforce:

As of 2022, Indiana had 10,503 active BHHS professionals serving Hoosiers, of which 9,449 were included in our reporting sample
These include social workers (61.7%), mental health counselors (28.5%), marriage and family therapists (6.9%), and addiction counselors (2.9%)
The workforce is predominantly female (83.1%), with an average age of 46.3 years
71.6% of BHHS professionals report providing telehealth services
However, all 92 counties in Indiana have federally designated mental health professional shortage areas

Check out all of the data in our in-depth reports and interactive data visualization below:

Spotlight on Recent Initiatives: The Playbook Project

To address workforce challenges, the Bowen Center recently led the development of the Playbook for Enhancing Indiana’s Mental and Behavioral Health Workforce. This comprehensive project brought together stakeholders to identify opportunities for strengthening the pipeline from education to practice for mental health professionals.

The Playbook provides recommendations in four key areas:

Securing the Pipeline: Strategies include growing awareness of mental health careers among youth, addressing training “deserts” in underserved areas, and expanding psychiatry residencies and psychology internships.
Strengthening Clinical Training: Recommendations focus on expanding clinical experiences, elevating the role of professional supervisors, and creating incentives for clinical training.
Aligning Education, Policy, and Practice: The Playbook suggests creating new positions to streamline licensing processes and ensuring evidence-based practices are integrated into education and continuing training.
Assessing School-Based Behavioral Health: Recognizing the critical need for youth mental health services, the Playbook recommends enhanced data collection on school-based behavioral health professionals.

These recommendations provide a roadmap for policymakers, educators, employers, and professionals to strengthen Indiana’s mental health workforce. It is crucial to remember that data and policy choices about mental health care in Indiana have real-life impacts for thousands of Hoosiers in their everyday lives.

Data Visualization on the Hoosier BHHS Workforce:

Celebrating Physician Assistants Week: Spotlight on Indiana’s PA Workforce

by Guest Author | Oct 5, 2024 | Data

Scroll to the bottom to check out a data visualization providing a snapshot of the Physician Assistant workforce in Indiana, based on Bowen Center data

As we celebrate National Physician Assistants Week (October 6-12), we want to recognize the critical role PAs play in our healthcare system and share some key insights from our recent research on Indiana’s PA workforce.

At the Bowen Center, our core mission is to collect comprehensive data on all aspects of the health workforce, transforming it into actionable information products for policymakers and health industry experts.

Our 2022 data on Physician Assistants shows:

There were 2,442 PA license renewals in Indiana in 2022, of which 1,320 were included in our reporting sample
74.7% of Indiana PAs are female, with an average age of 37.8 years
95.5% of PAs report their primary field is in patient care/documentation
46.1% of Indiana PAs reported engaging in telehealth services

We’re also seeing strong projected growth for the PA profession in Indiana:

The Indiana Department of Workforce Development projects a 35% increase in PA jobs from 2020 to 2030
15 Indiana counties are estimated to see PA job growth of 25% or more in this period

However, our research also highlights some workforce distribution challenges, with 20 Indiana counties reporting no PA full-time equivalents.

This Physician Assistants Week, we celebrate the invaluable contributions of PAs while continuing our work to analyze workforce trends and support evidence-based policy making. To all the PAs serving Hoosiers – thank you for your dedication and service!

Read our full PA workforce reports to learn more. And scroll down to check out a data visualization snapshot of Indiana’s Physician Assistant workforce, based on the data available in the three reports below:

Rural Health in Indiana: Challenges and Strategies

by Guest Author | Aug 15, 2024 | Data, Events, Presentations

Bowen Assistant Director of Data and Research Sierra Vaughn

Bowen’s Assistant Director of Data and Research Sierra Vaughn gave a presentation on rural health care in Indiana to the Indiana Rural Health Association on August 1.

Mirroring national trends, rural health care in Indiana faces significant challenges. The state has seen hospital closures, with 52 rural hospitals remaining as of 2024, and 25% of open hospitals experiencing service reductions. Workforce shortages are acute, particularly in mental health, where rural areas have two-thirds fewer behavioral health professionals than urban areas. Additionally, 35 Indiana counties lack a birthing hospital, impacting maternal care access. These issues are compounded by broader rural health disparities, including slower life expectancy increases and higher mortality rates for conditions like heart disease and cancer compared to urban areas.

Read more about the challenges faced by rural hospitals in Indiana and nationwide as well as potential solutions in Vaughn’s presentation here:

Policymakers Tapping into the Power of Indiana’s Health Workforce Data

by Becky Boustani | Jun 7, 2023 | Data, Policy, Topics of Interest

The Bowen Center believes in the power of data to support informed policy.

Workforce data provides valuable insights regarding trends in and dynamics of supply, pinpoints where shortages exist and informs emerging workforce models which aim to fill gaps. The Bowen Center supports Indiana’s efforts to collect data on licensed healthcare occupations. When health professionals renew their Indiana license, they provide supplemental information through a series of questions structured to capture data needed to inform state policy, such as: where they practice, how many hours they work, demographics, and their plans for the future. Our team partners with the state to transform these data into reports and briefs that (we hope) promote a better understanding of Indiana’s health workforce, the strengths, challenges, and where opportunities exist to fill gaps.

Recently, we were approached to provide data insights on the contraceptive care workforce – where Indiana had potential contraceptive care providers, and where there were gaps. These data were used to inform 2023 House Enrolled Act 1568. This bill expanded the role of trained pharmacists by allowing them to prescribe hormonal contraceptives to adult women, a service that was previously held by traditional prescribers – generally physicians, advanced practice registered nurses, and physician assistants. Lawmakers wanted to understand the potential impact on access to contraceptive care if pharmacists were granted the ability to contribute as prescribers.

Read the Brief Here

Leveraging workforce data, the Bowen Center generated a policy brief and map that examined the distribution of primary care and maternity care practitioners and pharmacists across Indiana. The map revealed that pharmacists were spread out more widely across the state than primary care and maternity care practitioners, with at least one pharmacist practicing in every one of Indiana’s 92 counties, including within counties that are underserved by traditional contraceptive prescribers. Supporters of the legislation used this map during debate in the statehouse, and backed by evidence, HB 1568 successfully passed through the legislature and was signed into law by the governor. More information about the methodology and findings from this research request can be found in our accompanying brief.

What makes Effective Data?

In fulfilling this data request, we realized this exercise might provide us an opportunity to share our thoughts on the “values” that a dataset might hold in order to be used most effectively to support informed policy.

1. Timeliness and Accuracy.

It is crucial to use the most up-to-date information to have a current understanding of labor market conditions. Outdated or inaccurate data can lead to decisions based on flawed information.

The supplemental data used for the Bowen Center’s primary care, maternity care, and pharmacist map were collected within the last two to three years, ensuring its relevancy. Physician and APRN data came from the 2021 license renewal cycle, while pharmacist data was sourced from the 2020 report. To identify primary care shortage areas and maternity care capacity, a trusted federal source, the Health Resources & Services Administration, was utilized.

2. Relevance.

Workforce data analysis should align with the strategic goals and priorities of the inquiry and should provide actionable insights that can help improve stakeholder understanding without the addition of extraneous data points. This means that the data should be sufficient to provide an understanding of the workforce’s capacity and capabilities with the minimum amount of information needed to answer the research question.

In the case of the policy relevant inquiry related to contraception prescribing, the quick turnaround map was created to gain a better understanding of the issue. The map included only relevant data, designed to be easily comprehensible “at a glance.” Each data element in the map contributed to answering the central question: Might access to contraceptives be impacted if pharmacists were permitted contraceptive prescribing privileges?

3. Comprehensiveness.

To maximize the utilization of data, it is ideal to have a complete picture of the workforce that addresses the initial query. It’s important to consider all the necessary information that contributes to an accurate understanding of workforce distribution.

Indiana’s practice of collecting supplemental data during the licensure renewal process provides essential workforce information that would not be gleaned from the license renewal data alone. Without this additional data, Indiana would be unable to identify such elements as practice location, FTE and practitioner specialty, severely hampering a comprehensive understanding of the workforce in Indiana. From this valuable supplemental data, we were able to incorporate both primary care and maternity care capacity as separate mapped elements since both groups can prescribe hormonal contraceptives. By including all significant workforces, we assure that the take-away is a comprehensive depiction of the current state of relevant healthcare in Indiana.

4. Balance of Granularity and Aggregation

Data should strike a balance between being detailed enough to capture the nuances of the workforce landscape and providing an overview of the bigger picture.

The policy map achieved this balance by using both granular and aggregate data in a user-friendly format. Indiana Primary Care Health Professional Shortage Areas and Maternity Care Practitioner capacity were aggregated across counties using two different visual tools, while pharmacist data was presented more granularly with individual pinpoints for each practice location. This allowed for a quick understanding of workforce capacity in specific areas without losing sight of the broader workforce gaps.

Research and data analysis are vital components of the policy and legislative process. Data analysis that is carefully considered and displayed in a user-friendly way can play an important supporting role in policymaking by providing actionable, evidence-based insights. The successful passage of House Enrolled Act 1568-2023 in Indiana demonstrates that data-driven approaches can help policymakers make informed decisions that can positively impact the health and well-being of people in the state. Ultimately, it contributes to the delivery of comprehensive, high-quality healthcare. At the Bowen Center, we are honored to be able to provide data that empowers Indiana policymakers.

Through My Eyes: Work Experience in Diversity

by Chelsea Sparks | May 24, 2023 | Data, Policy, Topics of Interest

Often, I have heard that you learn more by way of experience than from school. I found this to be true as during the past year and a half that I have worked with the Bowen Center. I have learned valuable information that has made me a well-rounded public health professional and have gained an abundance of skills. The Bowen Center has taught me about the importance of access to care, diversity in our health workforce, and expanding care through policy implications such as health workforce training programs, loan repayment programs, and other means to retaining our health workforce.

Diversity in the health workforce is important for creating a thriving and successful work environment and work culture for all health professions. Moreover, diversity in the health workforce is crucial for both better access to care and higher quality of care for underserved communities (Walker, et al, 2012).[1] Recruitment of a diverse staff can lead to the removal of barriers to health-care access in these underserved communities. A workforce that is diverse in race, ethnicity, sex, and age can lead to delivering the best possible care to diverse patient populations (Stanford, 2020).[2] Higher quality of care in these areas then leads to increased patient satisfaction, which can also improve the overall health outcomes of Indiana (Gomez, 2019) (Harker, 2020)[3], [4]. Considering this impact, it is no wonder that recruiting and retaining a diverse health workforce has become a top priority at the state and federal levels.

I participated in an examination of diversity in Indiana’s health workforce, and the first examination used historical data specific to Indiana physicians gathered during license renewal. This data shows much growth in diversity among physicians over the last 25 years. In 1997, less than 20% of physicians identified as non-white. In 2021, nearly one-third of fell into this group. Likewise, gender diversity has also increased, with women making up 18% in Indiana physicians 1997 and 32% in 2021.

More than looking at the numbers, I also examined the multitude of programs and initiatives which address workforce diversity and aim to support early recruitment of health professionals from underrepresented communities. Elements of these programs and initiatives may include incentive programs, such as scholarships and loan repayment options. It is essential to understand how important programs like these are and their roles in increasing the amount of diversity in the health workforce in Indiana.

Chelsea Sparks

Graduate Research Assistant

I utilized this experience in my graduate work by creating a pilot program for one of my master’s degree courses with guidance from the Bowen Center. This program was named “Better Together in the Physician Workforce” and aimed to promote culturally inclusive, and diversity driven workplace environments, starting with 3 program implementation locations. This program promotes change in diversity at these three locations through increased educational opportunities on the importance of workplace diversity, increased culturally sensitive materials, and opportunities for scholarship. The intended outcome of this program is that physicians working in these implementation locations will feel a better sense of belonging in their work environment, workplace culture will harbor diversity and inclusion overall, and physicians could further their education from funding opportunities such as scholarships or grants. It is important to me that I have contributed in some way to achieving health equity and the better representation of underrepresented minority group members and I feel as though I have done just that by building this program. This program has not been implemented; however, it is important to me that the entire program structure be built in hopes of one day launching a similar program and increasing diversity rates among the health workforce.

From this position, I now have several useful skills and even publications that I possess and can take with me to my future career. I currently have been working on a diversity report series that encompasses 11 different health professions for about a year now. This report series provides longitudinal trends in health workforce diversity in hopes of informing existing programs which aim to diversify the health workforce. I understand that I have contributed not only to public health, but also population health. Throughout this working experience I have been able to learn about higher level concepts regarding healthcare and how these concepts are tied to specific policies and impact public health overall. Not only did this graduate employment opportunity allow me to build public health skills, but it also gave me a deeper understanding of how the health workforce and other issues impact health equity. I now understand what racial concordance means and how healthcare workers reflect the populations that they serve

My colleagues at the Bowen Center have not only been the best mentors but have also given some of the best guidance and life advice to help me on my way. The Bowen Center also provides a space where I have maintained close relationships with my mentors and other coworkers. I understand that the next individual welcomed to the team as a graduate research assistant will gain a large amount of knowledge and plentiful experiences. I am thankful for this opportunity and am excited for the future.

If you would have asked me if I would have thought that at the start of my college career I would be in school for 7 years, I would have laughed. So, as for me, I am not sure what my future holds, but I am sure that I am prepared for my next adventure as this team has helped me prepare a foundation for the career that I will pursue.

References

[1] Walker, K. O., Moreno, G., & Grumbach, K. (2012). The Association Among Specialty, Race, Ethnicity, and Practice Location Among California Physicians in Diverse Specialties. Journal of the National Medical Association, 104(1-2), 46–52. https://doi.org/10.1016/s0027-9684(15)30126-7

[2] Stanford FC. The Importance of Diversity and Inclusion in the Healthcare Workforce. J Natl Med Assoc. 2020 Jun;112(3):247-249. doi: 10.1016/j.jnma.2020.03.014. Epub 2020 Apr 23. PMID: 32336480; PMCID: PMC7387183.

[3] Harker, L. (2020, January 15). Unlocking the Benefits of an Inclusive Health Workforce. Georgia Budget and Policy Institute. Retrieved November 14, 2022, from https://gbpi.org/unlocking-benefits-diverse-health-workforce/

[4] Gomez LE, Bernet P. Diversity Improves Performance and Outcomes. J Natl Med Assoc. 2019 Aug;111(4):383-392. doi: 10.1016/j.jnma.2019.01.006. Epub 2019 Feb 11. PMID: 30765101.

Through My Eyes: Black Maternal Health

by Guest Author | Apr 6, 2023 | Data, Policy, Topics of Interest

Black maternal health has been a professional passion of mine since completing an internship focused on data informed policy solutions to Black maternal health issues while in graduate school. As a Black woman, it has also been a personal passion. When I became a mother in August of 2022, this issue only became dearer to my heart. I wanted to keep myself safe during pregnancy, labor, and postpartum and I want to find solutions that will keep my daughter safe once it’s time for her to become a mother.

Black Maternal Health Week was first implemented by President Biden in 2021 (1). This week is focused on bring awareness to the pregnancy-associated health issues experienced by Black women in the United States. Maternal mortality, or pregnancy-related deaths, refer to any death during pregnancy or within the first year after birth that is caused by or exacerbated by pregnancy (2). National trends in the U.S. show that Black women have a maternal mortality rate 2.9 times higher than the maternal mortality rates for white or Hispanic women and, alarmingly, rates have increased since 2019 (3). In 2020, Indiana had the third highest maternal mortality rate in the entire country. Black Hoosier women had maternal mortality rates almost twice as high as white Hoosier women and almost three times as high as Hispanic Hoosier women (2). As a response, the Indiana state legislature passed SB 142 in 2018 (4) which established the maternal mortality review committee (MMRC). This committee is responsible for investigating the deaths of pregnant women or women up to 1 year postpartum, which are required to be reported by all health care providers in Indiana. Indiana cares about Black Maternal Health and has implemented state policies to improve it. The theme for Black Maternal Health Week this year is “Our Bodies Belong to Us: Restoring Black Autonomy and Joy”, and it is true – Black mothers can take control of their birthing experience.

Lessons Learned

I’ve learned some things through my journey to motherhood that I’d like to share.

1. Know Your Options. There are many different maternity care providers in Indiana, from traditional OB-GYNs to Advanced Practice Registered Nurses or Certified Nurse Midwives. Along with different providers, there are a variety of settings within which maternity care can be provided such as hospitals, birth centers and even within your own home. Don’t be afraid to shop around to find a provider that aligns with your values and your desires for your birth.

The Bowen Center has published a detailed Maternity Care Workforce Assessment, which can be found here, and an accompanying brief, here. This resource details characteristics of all physicians or Advanced Practice Registered Nurses who report providing maternity care services. I personally chose to deliver in a hospital setting with a Certified Nurse Midwife. I also chose to have a doula as research seems to indicate the presence of a doula can reduce risk of maternal mortality and adverse birth outcomes (5,6).

2. Be persistent. Diversity in medical providers can reduce risk of maternal mortality which led me to personally prioritize finding a provider that was from a racial minority group that is underrepresented in medicine (2,7). The Bowen Center has recently published a series of reports and briefs detailing diversity in a variety of healthcare professions. You can currently find the methodology here and the report on physicians here. Reports for registered nurses, pharmacists, dentists and other healthcare professionals are forthcoming.

In my own experience, I found it difficult to find a provider who accepted my insurance, was from a minority group and could see me without a long wait. I even switched my provider when I was 8 months pregnant because I felt I wasn’t in alignment with my first one. Be persistent, and don’t be afraid of uncomfortable conversations. The payoff of having a maternity care provider who aligns with your values is worth the effort required for your best experience during pregnancy and childbirth.

3. Prepare for postpartum. I spent a lot of time preparing for birth and preparing for bringing my sweet baby home, but not a lot of time preparing for my postpartum experience. The postpartum experience can be very difficult as you physically heal from giving birth, deal with sleeping less than before, adjust to your new role as a mother AND learn to care for a baby! It’s imperative that mothers have access to resources to deal with these changes. In 2022, Indiana passed HB 1140 which extended pregnancy Medicaid coverage to 1 year past birth to help ensure access to healthcare services during this sensitive time (8). Each legislative session, the Bowen Center posts bi-weekly updates on the progress of bills, like HB 1140, that are related to health or the health workforce. Whether it’s a health care provider to check on you physically or mentally, or a postpartum doula to help with laundry and the dishes, don’t be afraid to ask for help. There are options available for you.

Becoming a mother has been the most joyful and fulfilling experience of my life and getting to watch my beautiful baby girl learn and grow is the best part of my life. Every mother deserves to experience that. I am very thankful to work on projects that highlight opportunities to enhance health workforce diversity. In fact, I am honored to have the opportunity to speak on this topic at my first national conference in Washington D. C. in May. I hope that the health workforce research I am involved in will improve Black maternal health enough that my daughter will not face the challenges that I faced when searching for a Black maternity care provider who shared my same vision for my birth.