Staffing Patterns in Rural Community Support Programs

Rural mental health programs are thought to have difficulty recruiting and retaining qualified staff and to have excessively large caseloads per staff member. The authors surveyed 12 community support programs in small cities and rural areas of Wisconsin to determine staff size and characteristics, staff-to-client ratios, and the relative use of paraprofessional staff and professional staff excluding psychiatrists. Results: The programs surveyed had an average of 5.6 full-time-equivalent caregiving staff and an average caregiver-to-client ratio of 1 to 13. Caregiving staff were predominantly female, had been in the mental health field a mean of 8.8 years, and received an average salary of $20,732. Although program directors indicated that about one-fifth of staff left in the previous year, they reported little difficulty recruiting staff Thirty-eight percent of all caregivers were paraprofessionals; in several programs, more than half the caregivers were paraprofessionals. Use of paraprofessionals is more common in rural programs; thus caregivers in those programs are likely to have lower levels of salary and experience. Conclusions: The community support programs in the sample employed experienced caregivers and had staff-to-client ratios that were close to the ratio recommended for such programs by Wisconsin legislation. The survey findings suggest that claims of acute staffing problems in rural community support programs need to be examined more closely, with attention to the relationship between staff characteristics and client outcomes.