The event, which Scott said was the first of its kind, brought more than 150 people into the same room to hear from panelists and brainstorm ways Vermont can train more people to provide treatment and make licensure easier for those already trained.
Scott estimated that 10 percent of Vermont’s population misuses or is dependent on alcohol or drugs. He said the number of people in treatment has gone from 4,000 in 2014 to 6,000 this year, but there are still long waiting lists for treatment.
Additionally, the Vermont Department of Health says final numbers show that 106 people fatally overdosed on opioids — including prescription drugs, heroin and fentanyl — in 2016. The represents a 74 percent jump over 2014 and a 41 percent jump over 2015.“We lack the number of qualified professionals we need today to treat Vermonters with substance use disorder,” Scott said, using the clinical term for what is commonly called substance abuse. “And there are several reasons for this, one being the cost of education, as well as the lack of educational opportunities in Vermont.”
“Many colleges or universities don’t offer the essential coursework to train aspiring clinicians in those specific areas,” he said. “So, in addition to the student debt load they already carry, they must also complete additional educational requirements at a greater cost to themselves as well as their agencies.”
“Second is the lack of clearly understood information on preventions and licensing rules,” he said. “The rules and educational requirements for professionals are complicated. Worse, they are not aligned with training opportunities. This creates barriers that were never intended.”
“Third,” he said, “the stigma related to and referred to in mental health and substance use disorders combined with all the barriers I just laid out may be why our counselors feel so undervalued. Taking action on this health care crisis means we can make progress.”
Barbara Cimaglio, the deputy commissioner of the Vermont Department of Health, said the state has not set a number for how many professionals it needs to meet demand. She said that has been hard to do because opioid addiction has “mushroomed” so quickly.
“It’s not a situation that’s static, so we’ve been ramping up for years and are trying to figure out where the break-even point is,” Cimaglio said. “We haven’t hit that point yet, and it’s changing so quickly that you can’t really use a static model. That’s part of the problem.”There are currently 11 professions that treat substance use disorder, according to Colin Benjamin, the director of Vermont’s Office of Professional Regulation. The education requirements for those professions range from a bachelor’s degree and additional training to a doctorate.
Two undergraduate students in Rutland County who spoke at the event said they did not find out until recently that they would likely need master’s degrees for what they hope to do. They both said one of the best degrees for them would be a master’s in social work, or MSW, but that options are limited in Vermont.
“Castleton doesn’t have a master’s degree in our field,” said Victoria Pollard, who is getting a bachelor’s in social work at Castleton University. She is one of just two students in her program. “The master’s degrees they have are in education and theater arts, or something like that, which is really shocking.”
“I moved my life down to Castleton and into Rutland, and now I’m forced to look outside of Vermont for grad programs,” Pollard said. “My roots are in Vermont, and I don’t want to leave those, but there are no educational opportunities here unless I want to do an online program.”
The University of Vermont in Burlington does offer a master’s in social work. But Pollard said, based on the experience of her peers, the program does not often accept students from Vermont.
Jessica Griffin, an undergraduate student studying substance abuse counseling at the College of St. Joseph in Rutland, said her school offers several master’s degrees related to substance abuse and counseling. But she said those degrees would allow her to practice only within narrow fields.
Additionally, Griffin said she has children and a family and cannot travel long distances to study at a school in another region. She said she is looking at online programs from schools in other states to get a master’s in social work. One of those is at the University of New Hampshire.
“I know that I need a master’s degree regardless in order to do anything in this field, but substance abuse counseling or counseling in general … you’re so pigeonholed into what you can do,” Griffin said. “I’m leaning to the social work aspect just because I’m unlimited to what I can do.”
“You can’t touch the whole person (as a licensed alcohol and drug counselor),” Griffin said. “You can’t touch the depression, unless you get a dual license. I honestly didn’t learn this until a few months ago, and I’m getting ready to graduate.”Jason Goguen is the regional director of operations for BAART Behavioral Health Services, which has treatment centers in Berlin, St. Johnsbury and Newport and has been working to open a facility in St. Albans.
Goguen said the industry should not place so much value on master’s degrees. He said when he first started recruiting for positions, “we weren’t getting a plethora of applications from master’s degree programs, so we lowered it. We brought it down to bachelor’s degree.”
Goguen held up a pad of paper that was handed out at the conference. “This piece of paper, which could be my diploma from any such college, is a piece of paper,” he said. “It doesn’t create life experiences. It doesn’t create common sense. And it doesn’t create skill with people.”
“I’ve had several interviews over the past three years where I’ve leaned toward the candidate with the bachelor’s degree,” Goguen said. “(Because) what’s the best thing a counselor can do or a therapist can do? Listen. Listen. Listen. Listen.”
Ginger Cloud, a project manager at Central Vermont Medical Center in Berlin, said the field should not be “trying to minimize people’s education” because people with substance use disorder are “very complex patients that deserve a lot of thoughtful care.”
She said practitioners often need master’s degrees.
Melinda Lussier, who works for Turning Point in St. Albans, said she is in recovery from alcohol, heroin and opioids. She said that experience has helped her learn how to best help people in recovery, but she had to start her education and training from the ground up.
“I had no history working in the field, and yet I definitely had a master’s degree in opiate addiction, working firsthand,” Lussier said of her path to becoming a counselor.
Jolinda LaClair, the governor’s drug prevention policy director, said she encouraged participants at the event to “raise critical questions, ideas and strategies for action” on workforce issues in substance use disorder.
LaClair then encouraged them to join working groups, which will meet for four months, starting in two weeks, and then propose solutions.
LaClair said the Governor’s Opiate Coordination Council will start meeting in May. Scott created the group with an executive order to promote interdisciplinary coordination on substance use disorder.
Update: After this story was published, Susan Comerford, MSW program coordinator for the UVM Department of Social Work, requested that VTDigger note that enrollment statistics from 2000-2017 show that 78 percent of students in the MSW program were in-state students. Only 22 percent of students in the program over the last 17 years were from out of state, she said.