i i 'I 1 4of 1 "lil 0 ' 15 Is IN [@Ill MANI)OWILR K,irgaret Mullins Sl)ero Moutsatsos Eva@I.Liation l@irari@-h Off@i.ce ol- Proi,;run Plannirji!, aiid Evaluation March 5, 1.971 TAB.LL-' OF COiN'aMS PAGf'L . . . . . . . . . . . . . . . . . . . . I i)e.@ign . . . . . . . . . . . . . . . . . . . . . . . . . . Summary of Findings . . . . . . . . . . . . . . . . . . . 2 PART I Orgwilzational Aspects of@Regi.ons Influencing Manpower Development Activities 1. Regional Advisory Group Activities . . . . . . . . . . 5 Stealth Manpower Comittccs . . . . . . . . . . . . . . 8 Core Staff Manpower Focus . . . . . . . . . . . . . . 9 4. C]iP and Other State Agencies or Comissi.ons . . . . . PART II Manpower Activities by Area or @phasis S. i'4anpowor Survey . . . . . . . . . . . . . . . . . . . Legislation . . . . . . . . . . . . . . . . . . . . 13 7. Committee/Consortia . . . . . . . . . . . . . . . . . is 8. Physician Assistants - : . . . . . . . . . . . . . . . .17 i). Ntirse Cl.iiiic:ians/Practiti.oner . . . . . . . . . . . . 18 10. Specific Now Careers . . . . . . . . . . . . . . . 20 11 T@iiii.ing of I,..iy Persontiol/Commiiiiity Health Workers . . . . . . . . . . . . . . . . . . . 22 Curri@u.itun Development . . . . . . . . . . . . . . . . 24 1.@. Recruitniont . . . . . . . . . . . . . . . . . . . . . 25 l@l. Reactivation/Ilefreshcr Coiirscs . . . . . . . . . . . . 26 1 S. Career Mobility . . . . .. . . . . . . .. . . . . . . . 26 PAGE Misccll' . . . . ... . . . 28 PART I I I Rp,gional Models !7i'. Bi-State Regional Medical Program .@29 31, 18@. Alaba= Repional Medical Program. 19.@ Iowa Regional Medical Program 33 TAUM 'Table I Distributi-on of Regional Wdical Program as Relatod to organizational Frmwork Influoncing or Activity. 35 'Table JI Distributim of, Regional Medical Program by or Activity Area or @sis. 36 REGIONAL MEDICAL PROGRAMS C)DRE STAFF ACTIVITIES IN HEALni WER BACKGROUNI) it is currently estimated that approximately one-third of the RMI) funds for operational projects are supporting ovel- 200 iii.iiil)owc-r--r(.!I,itcd ,ictivitics -- iricl(iding 1--raiii.iiig I)rogriinN to improve the Litilizitioi) of cxistini,, hc@iltli in,,iiij)ow(!r,, SLICII as assistants and nurse practiti.ojiqrs. It may he as- simied that a comparable proportion of core funds are support -iii(, manpower-related activities. Iloweve-r, there has been littlO quantitative or anecdotal infomation available to the'RWS to date on the character and extent of these core activities. Given the increasing national emphasis on health iiiajil)owcr problems and the evolving role of R(,@lional Medical Ilrogr;jjiis in these prol)lcnL-,, ii. seemed al)[)-i-opri;it(,@ to (locti- iiic@iit t-lhc current extent of cur-,! ictiviti(.-s iii this circ.,i. I)I:sl(;N '!'lie steady wzts conducted by the Office of 11-rol?,rim Illaririlrig aiid I;v@iluution staff who surveyed I)y telephone each RMP coordinator Liuriii,, ive months. 'i'he questi airc instrumentiused the past f onn was designed to elicit pertinent informtlon which would identify -report concentrates on core staff activities; occasionally ;in operational project is noted as ui otitput'of core staff efforts. -(ir,L, stiff' ;ictiviti.cs with re- I)cct to lic,;iltli i-csl)oiise. by coordinators was Generally very good, in that they "Coined very wi.lling to discuss the subject. lfowever, the nietho- (tology employed left much to I)c'desired in terms of conprehen- slvcness and comparability. Further examination using a stnic- tured format is warranted, given the present emphasis.on health manpower and the beginning of intensive regional activities by core staff as reflected by this survey. SLI.\'h\-L,\RY OF FINDIN(JS 'I'lic level of manpower development activities of RMPs varied from virtually no activity to what appears to be a highly active @ijid integrated program approach in a few regions. 'Me great ma'ority of reg@ons had at least a few man)owc@r activities i which were generally unrelated to program objectives and rather pedestrian. Nearly all, regions expressed concern about manpower development and indicated that there woiild be increasing emphasis on it in the future, but there seemed to be few cases where the cL)orLl illator had a clear strategy in mind. i@licre activity exists, it is manifested Primarily in core staff @ictivity. 'I'his is particularly true with activity which seems to dei)art f roni tradit ional. arl)roaclics. Act iv i t ics by RACS an(! their committees, as reflected by policy, priorities or accom- 1.) I ist-a-,lcnts were rather mini-ma I .@evc,r;i i r-:egioris laid corsidc-red the f)roblcitis ,ilorj$,, with otlier. local agencies, and jointly decided that one or the other would -r the area of manpower develop- ssijjnc major responsibility fo inojit. This was encouraging from the viewpoint of avoiding duplication of effort. I)ata collection on manpower distribution is a common activity. Much of the data collection done by most regions appears not to be used for planning ptirpos(.!s, since little Strategy was - f-,Vi.(lel)cod. It.would seem that this is a rather costly exercise and should be discouraged if it -i.s being done in lieu of planning rather than in support of planning. A fair amount of duplication appears in exploratory planning and operational activity, and there seems to be little awareness of or concern with iwhat other -regions are doing which might be ap- I)licable. It appears that there is no established mechanism f'or exchange of manpower development experience, either among !NP's or wiiojig l@\IP's and other federal I)ro@)rms. 'llic I-ore- @,oing practice is obviously self-limiting ati(,] certainly does Hot enhance the concept of cooperative sharing to reverse the I)roscnt trend of a growing health manpower crisis. It is further noted that present manpower committee structures are all but -ineffective in the area of manpower development. 4 ,%-Iethods for exploiting this expertise deserve a closer look; @lPs are accomplishing virtually nothing by maintaining such. Window-dressing committees. 'llweiity percent of the coordinators indicated that RPS legislation zuid guidelines are restrict ivo in rcuard to stipends and basic training and therefore inhi.bit manpower development in cr@iti.cal ;iro;ls. Others stated that tlic,lcg'islation neither thwarted nor encourago(I-thcm to become involved in manpower. A number of regions noted problems in developing manpower pro- posais which were subsequently turned down by the National Advisory Council as being inappropriate for support. A strong plea for project brokerage at the federal level was made by several regions who felt that an interagenc "f-umoling" committee for projects .y cotild well make local groups more responsive. Along this same line, several coordinators called for explicit priorities in tlie iii;inpower area from the NA(, and one suggested that a direc- tk)ry be devel ed to, identify which federal agencies fund riiari- OP I)owor development projects. C;cnorally the survey proved to be heartening in that,it un- covered some examples of real, movement in an area not 8pccifi- C.-Ill), mandated by legislation or RW8 policy. It was discourag- ing, however to see how isolated arc tho.ekamples, how little t i,ey a i-c r-(! ],,ite(i to I)rogrwiuii;it i ci s @;cns(.; tiic. confusion I'@elt by many coordiii..ito.rs over I-acl@ of an c-xplic.'Lt policy or guidelines. I']-ic current period may prove to be a critical. turning point for IW. It is essential that Regional Medical Ilrogrwns S(-@rvice develop a coordinated policy with other appropriate federal man- I)ower agencies to jointly explore opportunities and develop strategy to overcome the presefit Health manpower crisis. ORCANIZATIONAI@ OF REGIONS fNFLUL-NCING MANI)OWL-R DI:V]:LOPM.:Nf AM'IVITIES A. RL-GIONAL ADVISORY GROUP ACRIVITIES Approximately one-fcurthof the regions stated that the Regional Advisory Group had adopted formal policy, priori ties, or objectives concerning health manpower development. Niany others said the Regional Advisory (Iroup recognized the i.ssue as being important, but had taken no formal action to (lea.1 with it. 'I'lic. AlAliAMA lzcgiona I Advisory (;rouf) for example, has identified health manpower as a priority area. I)uring the early phase of the program, the RAC, in reviewing a range of health related problems recognized an acute shortage of skilled health personnel in most health care facilities. This was being compounded by a growing number of new health institutions and expand- ing existing facilities, thereby increasing the denian(I for additional health personnel As a rc!;u.it of the RAG declaration, core staff has undertaken a wi.de range of specific activities designed to improve the manpower situation in the region. Activities have ranged from serving as a resource on curricula develop- ment and health manpower legislation, to planning for manpower development in a cooperative relation- ship with official and voluntary community health agencies. The involvement of ARNT staff with the office of Mayor, Model Cities, the Veterans Administrdtion Hospital and two community hospitals in Tuskegee has led to the development of a program to train neighborhood health workers whose prime function will be nutrition consultation to families with identified health needs. In addition, core staff also provided advice and counsel. to Lawson Junior College, a predominantly 131ack institution to develop a $230,000 proposal for a nurse training program. Serving in a role of facilitator, staff arranged for faculty assistance from nearby Jefferson Junior College. Another significant contribution of core staff has been the involvement With the Board of Censors of the Aiabama State @ledical Association in drafting legislation to recognize neu, categories of supportive health workers. OIIIO VALLL7f'S RAG has declared the main "thrust" to be improved health manpower for the delivery of wnl)ulat(.-)ry care. One example of the OVRMP operational activities stcm- Ming from the establishment of zunl)ul.atory care as a priority area has been the development of a coopera- tive home care program involving Clinton County hospital, Somerset City hospital and the County Health Departments in Whitley City, Jamestown and Monticello, Kentucky. The particular focus of this project is on facilitating coordination among the various institutions and health care personnel at the local level to.insurc that th(, quality and wuantity of patient care are adequate. 'f'he program is of s.ignifi6ant importance because it offers a means of expanding the rather limited capacity of the health delivery system through improving efficiency in use of health workers and institutional resources. Among the primary shared resources to be developed are a centralized record and reporting system; a single agency for recruitment and training of health personnel for all affiliated agencies and an areawidc program of continuing education for physicians focusing t-s of home care. 'I'he service area involved various aspcc 8 covers a five county area in extreme South Central Kentucky witil a population of approximately 75,000. 3. In ARKANSAS, as a result of.the RAG's priority setting, RW Is director of education is heavily involved in as- sisting the development of a School of Health Related Professions to be located ,it the LJnivcrsity of Ark@ins.,is Medical C;enter at Little l@)ck. AfNil is playing i iTiajor role in this effort which would I)ri.-ng together the thirteen schools and departments in allied health education at the University under one mbrella. At the present time an ad hoc commttee representative of allied health profes- sionals,of which t@.e director of education is a member is in the process of seeking a dean for this activity. Two other examples of RAC, priority setting are Metropolitan 1).(,.,wliose second 1.)riorl.ty is health manpower foll.owin@,, outpatient care and Now York NLtropo I i tiri whose f 1 rst prior- ity is manpower development through I)roid recruitment wid continuing @cation. B. ill@AEIII iMANTI@,R COM'ITEES Roughly one-fourthof the regions have manpower co@ttcos within their structure. Many more, of course, have co,-mut- toes concerned with continuing education or allied health, but these were not included since tl-ioir primary Focus was itiagc!(! to I)c-otlicr than iii,,.inpower d c f I r;@ (i fr, this study. Several regions noted that manpower co=iittec-s have been dissolved because members felt the issue 'could he handled better through categorical disease or continuing education committees. The impression left by coordinators was that manpower com- mittees, where they exist, were generally ineffective in influencing Regional Medical Progrwns'd-ircction in manpower program p anning. C. CORIE STAF@F MANPOWER-FOCUS Approximately one- @ of the regions indicated that their core staff included a person whose primary respo risibility was health manpower. General continuing education special- ists are not included in this number. 1. OIIIO STATE-,for example, has designated a staff person "to assist with further development and improvement of the present health manpower and health careers programs by creating a Coordinating,, mechanism designed to increase the supply of health manpower anu' achieve effective utilization of existing resources." Activi_- ties have ranged from consultation services for the organization of local groups and assistance to existing gro(il)s concerned with health ciir,cer.@ ni,,itil)owcr- to tho.ostablis@nt of the OS-R4P as 'the infoi7.a+uio,-.. center for health c@iT@cors and health manpower @@ii the l@ I)iroctor of the OS-RMP ficalth Minpowcr -rv' -ri developing cuol)cra- ices has I)ccn iristrum(,ntal i ti.ve arrangements witii the Ohio Off'icc of Comprehensive Health Planning ("A" agency) to determine the best methods of increasing the supply and effective utili- zation of health manpower ? WFSTFAN- PENNSYLVANIA RNT's manpower designee has inia- ti-ated a training project for -nursing home personnel to improve the quality of nursi.ng and administrative services. An intensive 8-month course, planned ;iri(i iiiil)lcmeiitocl with tli(@ support of' spcci@il.ists i.n hospital management and nursing (,,dticatioii, trained 137 nurses and administrators. Nursing practices i.n the participating homes have been significantly improved as have the social services provided by the homes. Various administrative procedures have been improved through the development of suc h practices as prospec- tivo budgeting lji(J personnel mariigefii(,,jit. fill' A\'I) O'llil:IZ STNI'E ACI-"N(,Il@S OR C)D,%NISSIONS 'I'wolvc i-cgions indicated that @i core staff member sat on the State (1-11) agency or comparable manpower commission. (Other examples arc cited in legislation section and other pdrtj of study.) 1. [-or example, ARKANSAS RMP core staff have been with the Arkansas Medi.cal Society a,-id the (J,,P st@.it@- agency to assess the current health manpower situation and to plan a course of action necessary to provide better health care in the State. This is an ongoing activity. 2. In CONNE-CTICUF, a part-time core staff member works with the State Board of Education, charting a compre- hensive design for both physician and allied health manpower. 3. In GREATER DEIAWARE- VALLEY, an institutionally affiliated core member was appointed by the Governor -Lc) the State health manpower commission. ii. NtkNpol@ll.:R AC'TlVlTIL-S BY AREA OR @iLkc;is* A. @.\IAN'POWL-R SLJRVEYS Most of the manpower surveys mentioned by coordinators were concerned with distribution of physicians and allied health personnel and most included data on only one or two other professional categories of personnel. Several exceptions should be noted: PUERTI@ RICO's distribution study included Llata on 51 categories of personnel; WE-STERN NEW YORK's included 22 categories. Only two regions (NOKFHWL-'Sl' OI]IO @\11) W)RIIILANI)S) Vindicate(] that- distribution data i.s coinpu- terize(i ,ind -is updated f)cr,i.odica.ily, see 12 The KKNSAS has facilitated'the implementation cf of a health manpower inventory shared with the Kansas Comprehensive Health Planning Agency and the Kansas Health Careers Council. Activities to date include the collection of data portaining to professional and he,ilth-rol.ated personnel of the State and stirv("Yj.ng the educational pi-ogruns of the institutions, of higher learning to determine how future programs may improve the pool of health manpower. Three regions have studied physician and nursing activities to determine time spent on non-medical matters. For example, in ALABAMA a task analysis of nursing services at Huntsville Hospital, covering RN's, LPNS, aides, ward secretaries and attendants in nine categories of activities was conducted. Ilosults of the stli(ly prompted @i restructuring of nursing service it the hospital and the iM) fools that findings can be generalized to other health institutions in the State and perhaps other parts of the country. I-,O,Llr regions reported compiling (and scvQral. publ,@shed) data on educational programs -for health personnel in the region- '.N'ote: Several rather serious questions are raised by what coordina- tors did not report: .There was little, if any, mention of utilizatior. rf existing data on manpower distribution of utilization. Among t'i'lose who had conducted surveys, there were notably few comments on either why the data was col- iccted or how it has been used. Two regions noted physician mobility studies; two oth(,rs studied the distribution of physicians as part of layer patient flow pattern studies. For example, the WESTERN NEW YORK IW in a coopera- tive venture with the Department of Preventive Medicine, School of Medicine at Buffalo, conducted a survey to determine the current resources an(] distribution of physicians including 21 allied health categories A particular focus of the study was to identify areas of present manpower needs due to maldistribution or in- adequate supply and to obtain baseline information which could be related to manpower requirctrients of- future projects. B. LEGISLATION Ten regions described core staff activity In the area of legislation influencing manpower development. In most cases, efforts were related to loosening of legislative ]),carriers to use of now li(@;ilth personnel @irid recognition or L,Crt il'iczjtion of new c,,ilc!),,oric,,s of m,,inl@)owcr. .14 ln'MIN-iN].@S(YfA, the Northlands @T a,-id the State (-','iP alone. have established a study group to review c-atren.t proF@sec' legislation to loosen legal barriers for utilization of medical assistants, i.e.., physician assistants in the -region. In the current session of the State Lcg,,is'lature, the State Medical Society has Introduced a bill which would recognize the practice of these new health workers under direct supervision of practicing physicians. 'Fhc bill also calls for the certification of these assistants to be placed under the State Board of'.14edical I-;xaniners. In this connection, Northlands RMP and GiP have recori,- mended that registration be set up apart from the medical examining board an(', instead be placed under the aegis of a proposed new state board, flealtli Manpowcr Coordi- nating Commission. '[he proposed ('.Iommission would include public accountability which is presently absent in other comparable Commi.ssi.ons or lioards. 2. In (Al,[T.'ORNIA Area IV, a district coordinator succeeded in getting legislation passed for the training (-if fire- men in coronary care techniques which will allow them to be utilized as ambulance personnel. In IIAWATI, INP ui(i (:IIP @iy,-(,, wor-kitip, 'ointly to change liceii.,;ure I.,iws health [)i-oCessioiiiiis tr,,iillecl ()tit-of- Stite. 4. BI-STATE succeeded in obtaining a waiver from the Council on Higher Education to allow non-high school graduates to enter junior colleges for training as ai.do-level neighborhood health workers. C. COMMITTEES/CONSORTIA There is certainly an abundance of task about manpower develop.- ment in the regions. 'there were six regions where RW seems to have stimulated regioriwide, high level committees which have great potential for influencing manpower development and utilization. 1. Bi-State core staff facilitated formation of, provides staff support for, and chairs a permanent committee of representatives with planning level responsibility from all allied health education institutions in the greater St. Louis Metropolitan irc;i. 'fhis committee acts in in advisory capacity to effect coordinated centralized planning and implementation of manpower development. 2. CONNECTICLJT has stimulated a State Coordinating Council for manpower, a coalition of the State Medical Society, hospital Association, Committee on 1-figher Education, Blue Cross and several voluntary health agencies. It will function as a sort of "super health careers council," to deal with the questions of manpower needs, recr-@it- mont placement and function. The committee is chaire,@' by the Secretary of State. Also, in Connecticut, each health service area has developed a working consortia of hospitals and local high, technical and vocational education schools for the training of allied health personnel ;iti(i,inore generally, to cric()Liragc hospitals to function as change agents. 3. ll,l,!NOIS has formed an Inter-agoncy Task Force on I-,duca- tioii and Manpower, with representatives from ClfPState Education Commission, the Governor's office, Health Careers Council, and the nursing and dental association. 4. ROGIESI'I:R is f-ormi.iig a consortia of colleges in the region for healtli c:jrc training. .@i. SIJ,13QUI.,"fiMNA VAJ,Ll-,-Y Is pizinn-ii),g ,i c(.)rij -crencc! of III pertinent agencies, organizations ;,ind hospitals iii the region to devclol) health miripower priorities and dociLlc who will do what. The f-'OCLI,'i W@ill @@)c on"pfiysician expanders. 6 . 'I'he OlilO STATE RMP converted a meeting of other Ohio l@MPs and 65 other organizations ay)(] groups interests he fic@zilth c;ircors ii)(I health ii,,.@itipowcr to i p(,rmiri(,tit, !;I.it(.'WILIC, COOI'(Iill,'@ll ilig lg('IICY f'ot- li(!.iltfl cjt-ccrs f)jzljlliijig, 1 7 improvement, education and promoti(,ri. An ad hoc com- mittee of ten members, nominated by the group, will form the working committee, with the @ providing coordinative and staff functions. D. PfiYSICIAN'S ASSISTANTS Nearly all coordinators expressed interest in physician assistants (NEDEX, MEDII-IC) and had given it prime considera- tion. Outlined below are activities which reflect RMP discussion and/or action. 1. BI-STATE, HAWAII and KANSAS regions are surveying need for, desire for, and feasibility of utilizing physician assistants. 2. The BI-STATE PM in an effort to decide on an approach to broaden the scope and practice of doctors to enhance the delivery of health care,is cooperating with the American Medical Association to examine attitudes of physicians toward utilization of I)hysi,cian assistants. It is expected that this study will yield information which will enable the invcstigatoi-,to more clearly ]identify factors which can serve as a basis to effect changes in the provision of health care where the need is ever increasing. One major benefit of the study has been the development of a cooperative relationship with the American MeLlical Association. I'hii-tecii rcgi@ons have physici.ziii assistant projects in cievelof,- mont or in operation. Most wi.11 utiiizc the assistants in rural areas, though several are designed for implementation in urban areas having few physicians. NORTH CAROLINA.,for example, has assisted Bo . i@.Gray to develop a program to produce well-trained and educated health assistants at t he intermediate profes,,iional level who, by worki.tii,, with a physician, can supplement his services and th(@rol)y increase his productivity. I'he physician assistants program is designed especially for ex medical corpsman or persons wit], two or more years of college Three regions have helped other institutions develop curri- culum for physician assistants. For example: CALIFORNIA RMP core staff has been actively involved in curriculum development for a physician assistant program with Nortliorr) California Junior College and Drew Medical School. NLlItSi: CI,INICIAN/PRACTITIONER Additional training given nurses to quality them as nurse practitioners was noted by nine regions as receiving atten- tion. It is interesting that actual implementation of programs in this area seems to have been accomplished with greater ease than with physicians assistants. With a few 19 exceptions, nurses arc bc,irig trained to work,in pediatrics-. Scvcril ex@,aiil)lcs of acti-vity irc described below. 1. MAINJ: last ycar@spdnsored as a feasibility @tudy the training of six RNs in an 18 week pediatric nurse prac- titioncys course. 'I'l-icy were granted certificates by the University of Maine and are currently at work in private physicians or in home health agencies. Licen- sure has not been a problem. Six more are currently in training. 2. In CALIFORNIA Area IV an informal @,roup of pediatricians and pediatric nurses were concerned with developing a curriculum for training nurses to practice in pediatrics care settings such as OPD'S, Kaiser plan centers and ficad Start, but were unsuccessful in negotiating with the School of Nursing in the establishment of such a course. An RNT core staff member who also sits on the pertinent school of nursing committee was able to convene the two groups and convince the school to take action i.n expanding the nurses role. At this time, the curri- CLIIIIM is in final stages of development and the course will begin this spring. 3. TRI-STKi7E RMP lias assisted the development of a geriatric nurse practitioner program involving Cambridge @lospital (@i municipal hospital) and the Heston University School 20 of Nursing, the Cofrurionwealth Fund and the (,ity (@f C;unbridge. The program will teach nurses tr) takc- over much of the care of older persons, particularly in nurs- Ing homes and in extended care facilities. Nl,"w Seventeen regions noted 26 discrete activities relating to development of specific new career c@itoi4orics. Many of these are clos'e'ly related to the concept of physician assistants, but were separated because the scope of work is narrower than those categorized as physician assistants. Most of the now career activities are manifested in operational projects or proposals. Five regions, WESTERN NL-W YORK, GWR(;IA, METROPOLI'IAN 1). C., MISSISSIPPI,@and SUSQUEIIANNA VALLEY, have implemented train- Ing activities for pulmonary technicians, mostly inhalation therapists. For cxwnple, WESTERN,NLW YORK IMI,in cooperation with a local community college and.three area hospitals,has developed a program for the training of inhalation therapists in the region. Thedidacticportion of the training takes place at the college with the clinical experience shared by the participating hospitals. 'I'hi.-i-ty students have I)ccn accepted for, the two y(,@.ir prograin from within the region. I,oll.owi.ng the initial finding of the project by WNYK@, t'ric tota-i --'Iria.-icial. support will be supplied by the college. The regions of COLORADO-INIYOMING, OFIIO VALLL-Y, WASHINGTO@N,- ALASKA, and SUSQUEHANNA VALLEY have focused on training of radiation/ixclear medicine technicians. For example in the COLK)RADO-WYOMING region there has been a concerted effort by the RMP to reduce the acute short- age of well-traincd radiation therapy and nuclear medicine technologists through trainini,, est@jf)I:I.she(I in cori't;ncti()ri with the Denver Conuiiiinity College iiii(I nine @@tir-roi)ndir;,,; hospitals. It is expected that at leist seventy @;tudents 'II be graduated from the program in the immediate w.L future and be eligible for examination and certification in radiation therapy or nuclear medicine technology by the American Registry of Radiologic Technol.ogies. The SOlMi CAROLIIQA and NIW MEXICO RMPs.have developed proje(.:ts concerned with the training of emergency mod.i.cal personnel. In an effort to meet the needs of c.,tr(IIOPLI.Imonary resuscitation tnii.niiig for a].] levels of health r)(-:rsoij- n(-I, the SOUfli C:M@Ol,f'NA f@ has provided assistance for over 300 courses @icr(.)ss the Stiitc. Approxi.i[i;ltcly 300 physicians, 4800 nurses and over 3000 all.iod health workers such as ambulance and rescue s(luad personnel have received training to date. A cooperaive arrange- niont among the South Carolina IM, @)uth Carolina Heart Association and riLmicrous other ficalti-i related agencies an(] institutions has proved to I)c @j major strength ol' the program. ARKANSAS and MISSISSIPPI focused on training equipment/ instrumentation technicians. METROPOLI'FAN D. C. and WASHINGTON have developed training projects for cardio-pulmona@, technicians. The remaining activities ;ire a mixed bag, of training projects, itICILIdi.ng that for orthof)(.!(Iic assistants, i now type of dental technician, electronic s(@rooni.ng tochniclarLi) hospital unit managers, mammograp tccf-uiici.ans, c)l)izt almolog,,yassi.stants, urologic assistants, dialysis technologists, and enterostomal therapists. G. 'I'RAINIING OF 1,AY PERSONINEL/CO@ITY @IEAJ,'ITf WORKI.P.S ']hi-rtocii coordinators reported activities rel.ated to the train- ijig aiiLl/or utilization of 'l.ay persons as community health wor@ers or home health ai(les. Most of t.he persons arc drawn 1'rom among the disadvantaged and mzuiy of' these activities Were ill cooperation with 01-lo or Model C.It.ics programs. Illustrative of this iiid of activities fire the following few CX'WTI es. @13 - A multiphasic screening program de@,eloped 'D), the INDIAM W @ shown that relatively uneducated, indigenous persons from the poverty area can be ef- fcctively trained to conduct the t(@.,;tirig accurately. l'o date, 35 technicians, many of wiiom did not have a high school education, have been trained. The project also has shown that it can (ictect diseases. Sampling of screenecs indicate that approximately 50% of these patients had a significant test abnormal- ity of which they had no previous knowledge. The multiphasic screening programs have been moved recently into neighborhood health centbrs,which has resulted in an excellent follow-up on screened patients. 2. 'nic COLORADO-WYOMIN(, IM is working with the Migrant Council of Colorado to recruit and train migrants in Colorado as home health ai.des who wi-11. be knowledgeable about health services available, sanitation, nutrition, and record keeping for the migrant population. -r, ,is follow-up to a A Wisconsin RMP core Staff membe Milwaukee inner city student health project had develop- ed a proposalfor submission.to 0.1@.O. to train community health workers. 24 4 In NOR'DI CAROLINA a filack hospital-was-about to closc- and their proposal to OEO for a neighborhood health contcrwas turned down. The North Carolina RMP staff helped rewrite the proposal, including,training.of community persons as home health aides, and as a result the project received one million dollars in OEO funding. S. The NT-,W JERSEY RV developed ;-t sc-reon.@ng project iT-t the YiDdel Cities area involving training of ghetto residents to refer people for screening and to consti- tuto a follow-up team to ensure that persons with positive findings Would receive re examination and if necessary treatment. H. CLJRRICULUM DEVEIOPWM Thirteen coordinators reported core activity in curriculum development, much of it directed at aiding junior colleges in establishing health training programs facilitating the tie-in of junior colleges and hospitals. 1. For example, in SOU'I'll DAKOTA, a core staff member who is supported in part by (IIP is working with small col- leges in the State to plan core curriculum in the health fields. .2. In HAWAII, a core staff member has developed and sub- mitted to NIH a proposal for allied health core ctirri- cLilLun at five community colleges under the University 25 @l w@i" @tu(iont-@(i,would of t/ area during the clinical i)hasc of ti t @j i rt@,. in AL"AMA, The Regional 1'echh.ical Institute ill Iii-rmingham provides the clinical Si'tUatiOrl.fOr junior college health students IW Etind.@ a cooperative net- work of seventeen rural 'unior college deans who use the Institute. Much of the operation is directed at encourag- ing the health workers to remain in rural areas. Other core activities In curriculum devclol)rncnt vary widely@ ranging from development of curriculum for- comprehensive iori of health iio,ilth planning for a major university to cvaiii.,it' graduates' performance to determine curriculum revision. It is interesting that in only one instance did a coordinator note that a committee of the RAG and core were working together. Seventeen coordinators noted recruitment to health c@irc(,,rs ;is i program activity. l@ough.ly half' of ,.ictiviti(,s ivore Ill the form of support to licil.t@l little Oiitliusiasm was exT)rcs.,;(,d al)out t"ic@ir overall (@l@fc:c-L@vc.- iless. Nine reg@ioris were makin@y specific efforts to recruit members of minority groups and disadvantaged or unemployed persons. @b For example, in ALBKNY the @ working State university of New YorR ;it Al@,@ir)y ha(! led the admission of approximately 600 clis,,Advaritaged sttideiiti; this past academic year. Core staff together with personnel from the university and niedicaL college will .provide intense counseling to insure continuation or maintenance of the students. Their involvement with the University's open-door policy has resulted in the RN) taking a new look at the area of recruitment for the allied health professions. Staff are presently develop- ing a registry of health related education and training programs in the regions to be distributed to counselors and other persons concerned with counseling and r(,c-niit- 'R C Six regions noted core @iii(i project activity directed toward reactivating jitirses by providing refresher coLirscs; otic. w(.is similarly planning training foi, Lli.eti.ci.@in,;. K. i-',Ievcji regions are involved in activities related tcj (](@vc-lop- ilig literal or vertical mobility for health workers, with emphasis on those in nursing services. In somc c@ises 27 efforts are directed at expanding the role of aides a,-.d LPNS; in others, at more formal mechanisms such as cur-ri@!.un,, changes and equivalency testing. 1. 'In CALIFORNIA Area IV, core staff has helped UCIA develop career mobility into its Curriculum, which allows students completing necessary requirements to qiiilify is hospital aides nursing horTic @i-idcs, home health aides, etc. 2. The NEW YORK Mctro RMP is working with the Urban Coali- tion in an attempt to get the labor unions to develop both lateral and vertical career ladders for their members and facilitating discussion between unions and other agencies concerning training to implement the' above. These activities,focus on LPNS, RNs and X-ray technicians 3. The Nl-,W J@SFY IW iii plinnirig training for "faf-@iily health" personnel, a new allied health field, has proposed a strate which provides i "lattice mobility" gy for these workers. I'he RMP has ])con @3Licccssful in eliciting cooperation from area hospital a(ininistra- toys to provide "release time" for the individual to attend courses of study at a nearby university or 28 - ty collcgc!. Education coupl(-,d w' CoTnmtln ith work (,X- p@@riencc will provide a basis from which tire individual can move vertically or horizontally wi.thin the frame- work of the employing health facility. MISCII,'LLAN'EOUS A broad range of rather interesting, if unrelated, activities exist, which is best illustrated by several examples. 1. MISSOURI uses a ficart Association "(Ictai.1 irian" to call on MDs outside the metropolitan areas to provide informa- tion about, and enlist involvement in, the primary and secondary rheumatic heart disease prevention programs of the State Division of Flealt@i. 2. WESTERN NEW YORK provides English language lessons to foreign medical graduates in the area. 3. The ALABAMA coordinator is working with the vice prcsi" dents and deans of the University of Alabama in '1'usca- loosa on the plamijig of a two year medical school. 4. The MAIN-E RMP has provided major planning and stirriiila- tion for a new medical school to train four-year graduates to practice family medicine. The plan, which would use existing facilities, available expertise and TV has gained support from key officials and @'Instittitioris both within ;ii(I the Stite. 29' III. RL@"GION@AL, @'vK)I)L-LS After looking at manpower activities by category of activity, it may be helpful to review the approaches used by selected regions which seem to have substantial activity in their region. The descriptors are not i.ntendedito be comprehensive, but rather to illustrate varying approaches. A. (,ONVFNOR OF FORMAL COMMII'I'I-.'ES OF KL-Y IN'I'L:PJ-ST ii. FACII,I'I-IVI'OR/STIMULATOIZ 'IIIROUGII INFORMAI, CORI:: CONSULTATION (ALA13AMA) (I. PROJECT ORIENTATION (IOWA) A. BI-STATE A main thrust of the Bi-State cote staff, in accordance with the Regional Advisory Group priority on manpower, has been as a convenor of a formal committee of key interests. With Bi-State W staff support, a permanent Inter-Institu- tional Commi- ttoo on Allied Health Programs, representing all interested educational institutions in metropolitan St. Louis, has been established. It was organized to cxchani.,,c iriforma- tion, coordinate activities, and develop a variety of exchange programs. It has capability to respond to community needs and provide direct coordination among ail educational com- ponents from junior colleges to the medical schools. 30 According to the coordinator, "fomation of this'committee represents a major triumph in cooperation, bringing together in a common effort institutions which in the past have pre@ ferred to operate independently." While initiative for this new spirit of cooperation cannot all be attributed to Bi-State RMP, there can be no question that if Bi-Statc RKP had not been in existence to lend encouragement and set examples, this committee would not be a reality at this time. The committee, in addition to the RW's coordinator and associate director for allied health manpower, consists of representatives from.educational institutions in,the greater metropolitan St. Louis area who positions in the area of health planning. The RMP-coTe staff performs the following functions for the committee: Development and maintenance of continuing survey information on health manpower needs in the region. Development and maintenance of a current registry on allied health education programs. Information on standards and requirement for approval of allied health manpower programs and data on funding services CIVliliblc. 31 'llic readiness of key institutional personnel coupled with Bi-State's ability to act as a convening and support re- source, has led to a strong cooperative effort for plan- ning and implementing central coordination, recruiting, and allocation of clinical facilities with existing and proposed training programs. B. Al AJIAMA Efforts by the Alabama RMP core staff to improve the health manpower situation there appears to take the form of informal consultation provided to other agencies and institutions. This is perhaps best illustrated by enumerating the acti- vities in brief form. The coordinator, Associate Dean for Comunity Health Services at the Medical School has played an active role in the planning and implementation of a new division of family practice. Because of above role, coordinator has aided the State Association of (;cricral Practice in planning a physician's assistant proilram. RMP core staff developed the program and curriculum for medical assistant training at John C. Calhoun Junior College (Medical Assistant is somewhat more clerical than physician's assistant, with training'@ -in accounting and the like.) 32 The RMP coordinator has helped the Board of Censors of the Stdte Medical Association draft legislation that would recognize now paramedical fields. The cootdihator-is working with the heads of the Nbdol City, Veterans Administration, 2 hospitals, the mayor, several key dieticians, and the Alabama Nutrition Council on a plan to train neighborhood health workers whose primary focus will be nutrition. A core staff member helped Hines Junior College develop equivalency testing for LPNs wishing to enter the associate degree nursing program., RNT core staff has helped five hospitals in Montgom,,-r/ set up a coordinated residency/intem program outide of the medical school setting. Core staff helped l,awson Junior College wri.te a pro- posal for submission to the Division of Mirs.i.ng ind facilitated faculty arrangements ind assistance from a nearby junior college. The coordinator is working with the vice president ind dean of the Univbrsity of Alabama in Tuscaloosa on plans for a two-year medical school whi-ch has been recommended. 33 C. I OWA The Iowa RMP is one of several regions whose interest in rti@inpower development is manifested I)rimiri.ly in operational projects. Projects in lowi illustrate two distinct approaches to manpower development; projects that (leal exclusively with innovative training or utilization of health workers and others which build manpower development into projects of somewhat broader scope. Illustrative of a pro4ect focusing exclusively on i manpower development through use of a new teaching technique is Iowa's program to teach cardiac ausculta- tion and cardiovascular examination in children, utilizing now electronic aidsi to assist physicians not fainilai- with the equipment. lbo project titled, "I)iaifnosis and Follow-up Care of Children With Heart Disease" has two foci. I'hc first is described by project title. The second, and that which probably has the greatest potential for impact on the health care,systcm is designed to alleviate the critical manpower shortage by train- ing RNs and LPNs to provide initial, general, and follow-up medical interrogation, limited examination, and counsel for children irid thei.r I'wnil.ics. Train- ing will prepare the nurses :for expanded roles in )4 private practitioners' offices and areas with ii, .ade-qi.iate health services. Preliminary evaluation showed the training to result in clinical judgement as good as physicians making the same judgements. The Iowa RMP Multipliasic lioaltli Screening Project in- cIludes a q onent to train and utilize disadvantaged OMP residents of the Model City area to help operate the project and encourage residents to take part in the screening program. The project helps to alleviate the critica'L physician manpower shortage by using lesser- trained professionals to conduct the screening. 35. TABLE I DISTRIBLrrIO4N OF RE-GIOXU N@-")I(:AL PROGRA.MS AS RELATED TO - ORGANIZATIOINAL F RK INFLUENCING MANIIOIQER kCrIVITY SUMMARY OF DATA -ion IV clarat of Estallished @ RMP Sta f Niember Core Staff Invo - Health @lanpower Health Manpower Desigruited for With CHP or State As aPriority - Cmmittee The Area of Commissions for Formal RAG Po@ Health Manpower, Health Manpower Alabama . . . . . . . . . . . . . . . . . . . . . Albany . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . Arizona . . . . . . . . . . . . . . . . . . . . X x Arkansas . . . . . . . . . . . . . . : Bi-State . . . . . . . . . . . . . . x x x . . . California .. . . . . . . . . . . . . . x . . . . . . . . . . . . . Central New York . . . ... ... . . . . x Colorado-Wyoming . . ... . . . . . . . . . . . . . . . . . x . . . Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . x . . . . . Florida . . . . . . . . . . . . . . x Georgia . . . . . . . . : : x x Greater Del. Valley. x . . . . . . . . . . . . . . . . . . . . . . Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . Illinois . . . . . . x . . . . . . . . ... . . . Indiana . . . . . . . . Intermountain . . . . . x x Iowa . . . . . . . . . . . . . . . . . . . . . . . . . . . x . . . . . . . . . . . . . Kansas . . . . . . . . . . . . . . . . . . . . . . . . . . . Izuisiana . . . . . . . . . . . . . . . . . . x x . . . . . . . . x Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. Maryland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Memphis . . . . . . . . . . . . . . . . . . . x x . . . . . . . . . . . . . Metro. Wash.,D.C .. . . . . . . . . .: . : : . . . ... . . . . . . . x x Michigan . . . . . . . ... . . . . . Mississippi . . . . . . . . . . . . . . . . . . . . . . . . : x x Missouri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Muntain States . . . . . . . . . . .1. . . . . . . . . . . . . . . . . . . Nassau-Suffolk . . . . . . . . . . . . . . x x . . . . . . . . Nebraska-S. Dakota . . . . . . . . . . . . x New Jersey . . . . . . . . . . . . . . . . . . . . . . . . ,New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . New York tktro .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . x North Carolina . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . North Dakota . . . . . . . . , , : : : : : , : ::: : : : : , : - : : , , , x ,Northeast Ohio . . . . . . .x . . North New England . . . . . . . . .. . . . . . . . . . . : . : : . x Nc)rthlands . . . . . . . . . . . . . . . . . . . . . . . . Northwest Ohio . . . . . . . . . . . . . . . . . Ohio State . . . . . . x Ohio Valley . . . . . . x . . . . . . . . . . . . . . . . . . . . . . Oklahoma . . . . . . . . x . . . . . . . . . . . . . . . . . . . . . . . . Oregon . . . . . . . . . . .X . . . . . . . . . . . . . . . x . ... . . . . . . . . . Puerto Rico . . . . . . . . . . . . . . . . . . . . Rochester . . . . . . . x -olina x South Cai - - - - : : : : : x :. . . . . . . . . ... Susquehanna Valley . . . . .x . . . . . . . . . . . . . . . . . . . . . . . Tennessee Mid-South . . . . .x . . . . . . . x x . . . . . . . . . Texas . . . . . . . . . . . . x x . . . . . . . . . . Tri-State. x x . . . Virginia . . . . . . . . . .x . . . . . . . . . . . . . Washington-Alaska . . . . . . . . . . . . . . . . . . . . . . West Virginia . . . . . . . .9 . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . Western New York . . . . . . . . . . . . . . x :-' ' ' ' x . . . . . . . . . . . . ,West. Pennsylvania . . . . . . . . . . . . . . . . . . . . . . . . . Wisconsin . . . . . . . . . . . . . . . . . . . . . . . . . . x . . . . . . . . . . . . TOTAI, 12 13 17 12 TABLE I I 36 DISTRIBWION OF RL-GIONAL KI)ICAL BY ACTIVITY OR IS L4 ;n In 0 4. Li r4 0 C@, 'In Iz 0 9 co co 4i u u > ,A 'A 'Au tw BC D E P G H IJJ L x x x x x x x x Alabama . . . . . . . . . . . . X A,Ibany . . . . . . . . . . . . . x x x x x . . . Arizona . . . . . . . . . . . . . . . . . . . Arkansas . . . . . . . ... . . . . . . X x x x Bi-State . . . . . . . . . . . . . . .xx x x x x x x X x California . . . . . tentral New York . . . x . . . x GDlora&-Wyoming . . . . . . . . X x x x x Connecticut . . . . - x x Florida . . . . . . . x x x Georgia . . . . . . . . . . . x x x x x Greater Delaware Valley . . . . . . . x x x x x x Hawaii: . . . . . . . . . . . . x . . . . . . . . Illinois . . . . . . . . . . . . ..x x . . . . . . Indiana . . . . . . . . . . . . . . . . . . x x rntermotmtain . . . . . . ; . . . . . . . . x x x . . . Iowa. . . . . . . . . x x Kawas .. ... . . . . . . . x x x x x x x IDuisiarLa . . . . . . ?Uine . . . . . . . .:: . : : x x x x Maryland . . . . . . . . . . . . x x WWhis . . . . . . . . . . . . . . . . . . x Metropolitan Washington, D.C . . . . . . . . x x :: : .. . Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mississippi . . . . . . . . . . . . . . . . . . x Missouri . . . . . . . . . . . . . . . . . . x x Mmmtain States . . . . . . . . . . . x x x x x x x . . . Nassau-Suffolk . . . . . . . . . X Ncbraska-South Dakota . . . . . . . . . . . . x x x x x . . . New Jersey . . . . . . . . . . .It'. :... - . .. , New Ymico . . . . . . x x x .. . New York Metropolitan x ::: .. x x . . . North Carolina . . . . . . . . . . . . . . . x x x x North Dakota . . . . . . . . . . . . . . . . x x x . . . . . . . Northeast Ohio . . . . . . . . . . . . . . Northern New Enland . . ... . . x Northiands . . . . . . x x x x x x . . . . . Northwest Ohio . . . x Ohio State . . . . . x Ohio Valley . . . . . . . . . . x x X Oklahow . . . . . . . . . . . . . . . . x x . . . . . . . Oregon . . . . . . . :X: Nerto Rico . . . . Roaester . . . . . . . . . . . 0 South Carolina - - :. . . . . . . x x x x x . . . 00- Susquehanna Valley . . . . . . . . . .x x x . . . . . . . . . . . . Tennessee Mid-South . ... . . . . . . . . . . . . . Texas . . . . . . . . . . . . . . . . . . . . . . . x x Tri-State . . . . . . . . . . . Virginia . . . . . . . . . . . . x Washington-Alaska . . . . . . . . . .x x x West Virginia . . . . . . . x x Western New York x x x x x x x Western Pennsylvania x x WiscoTLsin . . . . . x x California Area IV- x X X . . . . . . Total 17 10 16 20-L 9 i17i 13 -L