Last year, Badlands Human Service Center in Dickinson had the highest turnover rate in the state. With Badlands being understaffed, the North Dakota Department of Human Services is creating ways to entice workers into filling the nine positions it has vacant.

Bradley Brown, regional director for Badlands, thinks the majority of the turnover came from retirements and relocation, as Badlands had the lowest rate in the state only three years ago.

"Over the last two years, we've offered a voluntary separation program called VSIP - Voluntary Separation Incentive Program," he said. "What that allows people to do is if they're close to retirement or wanting to retire, they were giving them several options to where they could kind of take a buy-out early. Several staff took advantage of that, so we may have had some staff retire a little bit earlier than we had planned on them retiring."

The problem

One of the reasons why Badlands may have a harder time finding people than the human service centers in the eastern part of the state, Brown said, is due to a lack of feeder schools.

"Grand Forks, Fargo, they have several universities out that way that have graduate-level programs. You have students who are graduating every year looking for internships, looking for employment. We get some of those out at Dickinson, but you don't have a large selection," he said.

He said he thinks the number of people here contributes as well.

"Census and population being less, you're going to have less people in the behavioral health field in general. A lot of them are already working (elsewhere)," he said.

However, Dickinson and North Dakota in general are far from the only places in the nation facing a workforce shortage in behavioral health. A study by the Health Resources and Services Administration showed shortages throughout the Midwest and South in 2016 and predicted an exacerbation of the problem by 2030 in both areas.

Brown said he believes several factors contribute to the shortage.

"It's not the most attractive field for several reasons, one of them being the reimbursement and number two, maybe you work with some very difficult clientele, depending on where you're going to be working at," he said.

Education can also be a barrier, he said, with some positions requiring at least a master's degree or higher - and the preparation doesn't stop there.

"There's going to be some time and effort into getting your education and obtaining the license that you want. If your final goal is to be a licensed, independent clinical social worker, that's going to take you a number of years beyond your education, beyond your master's degree; you're going to look at another three years of supervision," he said, for example.

The solution

The Department of Human Services is doing several things to bring workers to western North Dakota.

The Human Resources Department offers employees in western North Dakota, including Badlands, $200 extra a month as "economic enhancement," Brown said.

"Each employee gets an extra $200 a month if they take a position out in Badlands Human Service Center," he said. "... It's supposed to help with the cost of living differences out there. I know it's not much, but it's $200 more than people are getting in West Central and Bismarck."

It is advertising across the state for telehealth positions.

"The stipulation is you work for Badlands Human Service Center, but you can live in Bismarck or you can live in Fargo," Brown said. "It's just that you would be an employee of Badlands. You would work at the other human service center, but you would be doing strictly telehealth to (Badlands)."

They've started advertising positions on Facebook and LinkedIn, as well as in the surrounding states. Should those people decide to take the position, DHS will offer to reimburse them for moving expenses.

In the meantime, Badlands is changing its programming somewhat to accommodate the shortage and to provide best practices.

"We're doing a lot more mental health groups," Brown told the advisory team. "That way you can serve more people in these groups than you can individually, because we have such a limited supply of human resources ... when it comes to staff."

They are also providing team-based care, so an individual will be assigned to more than one professional to address their various needs. If one member of their team is absent, they can still receive care.

When they don't have a staff member available, they borrow workers from nearby human service centers.