Oregon Health Authority auditors found the agency needs better tools to track and demonstrate the results of its behavioral health workforce grants. (Getty Images)
Starting in 2021, Oregon lawmakers gave tens of millions of dollars in funding to the Oregon Health Authority to bolster the behavioral health workforce, encourage people to enter the field and reach marginalized communities and rural pockets of the state where mental health care is scarce.
The money, $80 million by 2022, was supposed to help the state grow a diverse behavioral health workforce to meet the needs of a state that struggles to provide care to all who need it. That push came amid a recognition that Oregon’s behavioral health care system is difficult to access, with the state consistently ranking low in national reports.
Yet after state lawmakers stepped up with more money, the Oregon Health Authority stumbled.
It’s unclear how much progress the funding brought. The agency cannot show the effectiveness of its programs because it did not design performance metrics to show their impact, the agency’s auditors concluded in an internal report. This has restricted the agency’s ability to demonstrate the long-term benefits to lawmakers or communities.
Another major problem: a lack of planning.
“Without an effective plan, OHA could not properly engage intended communities across Oregon to provide necessary retention and recruitment efforts to develop and grow the behavioral health pipeline,” auditors wrote in the January report, obtained by the Capital Chronicle through a public records request.
The agency has already started to make improvements and changes to guide its work in response to the audit, said Tim Heider, a spokesman for the Oregon Health Authority.
“Since the audit, OHA has increased participation from organizations that serve diverse and rural communities by offering simpler grant processes and more straightforward guidance on expectations of the workforce programs,” Heider said in an email.
Problems outlined
The authority’s shortcomings included insufficient outreach to rural and other underserved communities and inconsistent requirements for grant recipients to provide race, ethnicity and other demographic requirements.
This means the authority cannot show how effective the programs were in recruiting and retaining behavioral health providers who are people of color, tribal members or residents in rural regions, auditors concluded.
“OHA is not able to show the effectiveness of incentive programs, due to a lack of performance metrics and outcome measurements,” auditors wrote.
Separately, auditors found “severe delays” in award distribution in some cases. For five agreements, the authority took longer than five months to finalize contracts after receiving submissions from community mental health providers.
That finding mirrors other complaints behavioral health providers have made about the agency’s sluggishness to respond in other areas, too. Behavioral health providers say the authority has taken months to award money for residential treatment projects, including a much-needed youth facility.
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Health authority employees interviewed by auditors outlined a variety of concerns and reasons for the poor execution, including staff turnover, pressure to get funding out to providers and communication breakdowns, records show.
One authority employee said the agency’s contracting office has been a “pain point,” comparing the situation to a “messy room” they are trying to clean up.
Another employee, whose name is redacted like the others, backed up that account, saying that contracts were supposed to be done in December 2022 and were still unfinished in April 2023.
That employee said the contracting department is understaffed, adding “we get (the) short end of stick.”
Another employee said the objective and timeline for the project was unclear and as the workloads increased, upper managers struggled to communicate expectations.
An analyst with the authority said the data and reporting requirements need to be better.
“It’s not sufficient and we aren’t prepared to answer questions about how the program has helped Oregonians,” the analyst told auditors.
While the outcomes are fuzzy, auditors also acknowledged the money went out widely: It has covered more than 40 clinical supervision grants, helped pay student loans for more than 250 people, provided 20 grants to organizations for bonuses and housing. Nearly 60 peer support organizations, which connect clients to peers with similar experiences, also have received grants.
Kimberly Lindsay, director of Community Counseling Solutions, a behavioral health nonprofit that received funds, said the health authority tried to distribute money as fast as it could.
“I do think time was of the essence in getting those funds out as soon as possible,” Lindsay said.
A provider’s perspective
In rural Oregon, the needs for behavioral health workers remain strong. And the workforce incentive funding, where available, has helped retain staff.
Community Counseling Solutions, which has 450 workers spread across Morrow, Grant, Gilliam, Wheeler and Umatilla counties, received about $1.1 million in behavioral health workforce funds, Lindsay said.
“It was very helpful,” Lindsay said. “We used the bulk of ours for retention payments.”
The organization offers community mental health services, residential programs and operates the Oregon Warmline , a toll-free service for people to call for counseling about their challenges, which could include mental health, homelessness or addiction issues.
The health authority funding helped the nonprofit retain staff with about $2,500 in incentives per employee, Lindsay said.
Yet people in rural areas who need to access services face different challenges compared to urban areas. For example, people in some regions need to travel outside their community to see a clinician and have no public transportation.
“If you’re low-income, you might not have a vehicle that’s able to drive you long distances,” Lindsay said. “I think the rural areas of the state are impacted a little bit more. That’s not to say that there’s not struggles in downtown Portland.”
The work ahead
The audit makes recommendations that include: establishing measurements to show the effectiveness of the programs, improving data collection on the workforce and developing an effective outreach strategy statewide, including in rural areas, to increase participation in state incentives.
Auditors also recommended consistent requirements for grant recipients to show their results.
Health authority officials agreed with the recommendations and said they are pursuing plans to make improvements.
Heider, the authority spokesperson, said the agency has created surveys for grant recipients and is tracking the state’s behavioral health workforce capacity.
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To reach more providers serving diverse and rural communities, the state offers live webinars about programs that are posted online along with documents answering frequently asked questions, Heider said. The state also started a simplified online application process to make programs more accessible.
The authority is participating in the National Governors Association Policy Academy, which gives the agency opportunities to collaborate with other states to identify successful ways to collect data and track outcomes, Heider said.
“As of this time, all of the recommendations are in full swing and on time,” Heider said.
On a related front, the Oregon Health Authority has identified increasing the behavioral health workforce as a goal for its strategic plan to reduce health inequities by 2030.
The plan, released last week, says that increase will be tracked, but doesn’t give a numeric target. Oregon Health Authority Director Sejal Hathi has said detailed metrics for the plan will be tracked internally.
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