National Center for Health Workforce Analysis

Effects of the Workforce Investment Act of 1998 on Health Workforce Development in the States

November 2004

Submitted in completion of Cooperative Agreement # 4-U79-HP-00011-01 for the Bureau of Health Professions, Health Resources and Services Administration

FINAL REPORT

I. Table of Contents (for on-line viewing only) Printer-friendly report (Adobe/pdf)

II. Executive Summary

III. Why This Report?

IV. What Is WIA?
Origins and Goals
Structure
State and local Workforce Investment Boards (WIBs)
Services at the local level
Services at the state level
Funding Streams
National and state funding allotments
Allocation of funding streams within states
Accountability Measures
Implementation

V. The Health Workforce and WIA
Health Workforce Development Planning
State program highlights: CA, FL, GA, ME, MS, OH, OR,
TX, VT, WA, WV, WI
Programs to Promote Health Care Careers
State program highlights: GA, MS, NJ, OH, PA, SC, TX, WA, WI 41
Health Career Ladder Advancement
State program highlights: CA, FL, GA, MA, TX, WA
Building Health Workforce Educational Capacity
State program highlights: AZ, CO, GA, OR, TX, WA, WI
Health Workforce Retention
State program highlights: CA, MI, TX, WI
Direct Support for Health Careers Education and Training
State program highlights: CA, CO, DE, GA, MS, ND, PA,
SC, TX, VA, WA, WI
One-Stop Center Referrals for Health Workforce Jobs
and Education

VI. WIA Reauthorization

VII. Discussion

VII. Literature Cited

Susan M. Skillman, Joshua Sadow-Hasenberg, L. Gary Hart (Center for Health Workforce Studies, University of Washington) and Tim Henderson (National Conference of State Legislatures)

Address: Center for Health Workforce Studies, 4311 11th Avenue NE, Suite 210, University of Washington, Seattle, Washington 98105 (Phone: (206) 543-3557, FAX: (206) 616-4768, http://www.fammed.washington.edu/chws/)

Acknowledgments: Thanks to the many representatives of state and local workforce investment boards who took the time to respond to our questions. We are also indebted to Alice Porter for her editorial guidance, and Martha Reeves for word processing leadership.

II. Executive Summary

Introduction

The Workforce Investment Act of 1998 (WIA) replaced the Federal Job Training Partnership Act, with the goals of increasing the employment, retention, and earnings of participants in Department of Labor (DOL) employment and training programs, largely by increasing the occupational skills of participants. WIA was designed to streamline services, empower individual participants, provide state and local flexibility, and promote increased accountability in jobs programs.

WIA mandates that states and local areas carry out workforce planning in partnership with business, elected officials, labor, and other key stakeholders through Workforce Investment Boards (WIBs). Every state must be subdivided into workforce development areas, and direct services to clients are delivered through "One-Stop" centers in each of these areas. WIA provides job search assistance, assessment, and training for eligible individuals under three main funding streams: Adult, Dislocated Worker, and Youth. It promotes a "work first" mission for clients, and intensive training resources are provided only if clients do not become employed using other, short-term interventions.

When WIA was implemented beginning in 1999, shortages were emerging among many health workforce professions, and even greater shortages were being projected for the next several decades. DOL named health care as a high-growth industry, containing 10 of the 20 fastest-growing occupations from 2002 through 2012. But most of the health sector jobs that are in high demand require associate- or baccalaureate-level education or other specialized training. Many familiar with the needs of the health care sector wondered how, under these circumstances, WIA resources could relieve its workforce shortages.

This report describes how WIA resources have been used by state and local workforce investment boards to develop the health care workforce. We contacted state and local workforce boards to identify health workforce development activities supported with WIA resources through the DOL. This study also describes characteristics of WIA that can be used to support health workforce development.

Key Findings

As a result of the health workforce sector's high-demand status and states' relative flexibility in implementing WIA, a broad range of WIA-supported health workforce programs were implemented across the country. Health workforce development programs tend to fall into seven general categories: health workforce development planning, programs to promote health care careers, career ladder advancement, educational capacity building, workforce retention, direct training support to individuals, and referral of eligible individuals to health workforce jobs through One-Stop centers.

Health workforce planning: The structure of WIA and its financing features have facilitated assessment and planning efforts for many of the states and their local areas. About 15 percent of WIA funds may be reserved for statewide activities, including planning. Planning functions identified in the report include support for state health personnel shortage committees and task forces, data gathering and dissemination, and the development of grant programs to support activities to reduce shortages. States highlighted in the report: CA, FL, GA, ME, MS, OH, OR, TX, VT, WA, WV, and WI.

Programs to promote health care careers: Providing appropriate and timely information about health care careers to individuals who may become interested in choosing health care employment is critical to developing and maintaining the health workforce and filling the gaps for many occupations. In addition, the health care workforce needs to attract underrepresented minorities to better serve the overall population and to provide all racial and ethnic groups with the economic benefits of employment in the health care sector. This report provides examples of state and local WIB projects to introduce students to health care jobs and of programs to promote health care careers to low-income adults and those seeking a second career. In several states, WIBs have helped to mount media campaigns to inform the general population of the value and rewards of health care careers.
States highlighted in the report: GA, MS, NJ, OH, PA, SC, TX, WA, and WI.

Health career ladder advancement: One strategy for increasing the supply of health care workers is to encourage workers in entry-level positions to gain the training for higher-level health care positions. This approach is efficient because people who have already chosen jobs within the health care field do not need to be oriented to the nature and value of the work. In addition, health care institutions with in-house career ladder advancement programs promote employee loyalty through greater job satisfaction and commitment to the employing organization. One of the most common career advancements that the career ladder programs facilitate and that is described in this report is from licensed practical nurse (LPN, or licensed vocational nurse, LVN, in some states) to registered nurse (RN). Providing training opportunities for certified nursing assistants (CNAs) to become LPNs is another common type of career ladder advancement.
States highlighted in the report: CA, FL, GA, MA, TX and WA.

Building health workforce educational capacity: Qualified applicants to nursing schools are being turned away at institutions across the country, even as the Nation is experiencing an estimated shortage of nearly 140,000 RNs. Similarly, the educational capacity for other health workforce occupations does not produce enough health care workers to meet current demand. To get clients into training for the high-demand health care fields, WIBs explored such innovative approaches as loan repayment programs for faculty training, distance learning programs, provision of site coordinators to expand clinical training capacity, and pooling of WIA tuition resources to provide additional college course sections.
States highlighted in the report: AZ, CO, GA, OR, TX, WA, WI.

Health workforce retention: Many health care jobs are physically and emotionally demanding, which can lead to employee "burnout." Competition among employers for limited numbers of workers also contributes to high turnover. Retaining workers in the health care industry can be challenging, but recruiting and training new employees is a particularly expensive consequence if retention fails. While various strategies are considered effective for employee retention, WIA resources are best suited to retention programs that enhance opportunities for continuing education, certification, training, and career advancement. Providing mentors and preceptors to help employees get through professional hurdles also increases job satisfaction and retention.
States highlighted in the report: CA, MI, TX, and WI.

Direct support for health careers education and training: States also use WIA resources to route individuals directly into health care education and training programs. Some have used WIA funds for health profession-specific tuition. Others have used this resource to develop "Health Careers centers" or to set up training programs to prepare groups of clients for entry-level health care jobs. WIA also supports customized training for employers who are committed to hiring people who complete WIA-supported instruction.
States highlighted in the report: CA, CO, DE, GA, MS, ND, PA, SC, TX, VA, WA, and WI.

One-Stop center referrals for health workforce jobs and education: The linkages of clients to jobs through One-Stop centers are important to health workforce development, but the extent of their application is not easily quantified because WIA performance measures do not document the industry sector in which employment occurs. Because of the large number of health care jobs available compared with other industries, we can nonetheless be certain that One-Stop centers across the Nation have linked many individual job-seeking clients with health care jobs.

WIA's reauthorization by Congress was scheduled for 2003, but because of debate over changes in the program, a continuing resolution has extended the Act since that time. Reauthorization issues being debated are combining the funding streams to provide states with greater spending flexibility, changing WIB membership requirements and functions of local WIBs, tying WIA closer to delivery of Temporary Aid for Needy Families (TANF) services, easing access to training services, and reducing the number and alter the types of performance measures.

Discussion

WIA resources are used across the United States to build the health care workforce, especially for occupations with training requirements of two years or fewer. Use of WIA resources for data collection and planning supports a health workforce planning infrastructure that serves an even larger spectrum of the health workforce. But it is difficult to say how much WIA itself, and not the economic environment, has contributed to the significant emphasis many states and local workforce planning groups have placed on health industry jobs since 1999. Many regions, and several states, have not used WIA resources for specific programs to connect clients with health care jobs; it would require additional study to understand why the health sector was not a priority in those areas.

WIA has been a catalyst for helping to alleviate health care workforce shortages with pooled resources — mobilizing additional resources from both public and private sources. The WIA mandate for business partnership helped provide new opportunities for involvement of the health care industry in workforce planning. It also increased awareness of the health care industry's high-demand, high-growth status. But the health care industry would likely have been represented at many WIA planning tables without its mandated involvement. The health workforce shortage "crisis" had already brought many in the industry together to seek solutions.

Reauthorization may affect how WIA relates to the health care industry. If clients can be routed quickly to training programs, and if new performance measures are designed to support WIBs that encourage clients to receive training, more WIBs may take on health workforce development activities. Health industry participation in state and local WIBs, whether encouraged by WIA requirements or by activism within the industry, will continue to promote awareness of the health care sector's needs.

While this report has documented the process of health care workforce development with WIA resources, little information is available on the outcomes of these WIA-funded programs. Research and evaluations are needed to identify which programs are successful in increasing the supply of needed health care workers and connecting them with stable jobs that provide living wages.

WIA is not the sole vehicle for meeting our health workforce needs. Nonetheless, it provides a multi-billion dollar infrastructure that can help the Nation's health care industry fill major gaps in many entry-level, allied health and nursing jobs. Health care business, educators, policy makers and workers benefit from understanding how WIA relates to their needs and how changes will affect them in the future.

III. Why This Report?

The Workforce Investment Act of 1998 (WIA) was one of several efforts at "devolution" of Federal programs to provide greater state control of Federal resources. It represented the first major job training reform in more than 15 years—replacing the Job Training Partnership Act (JTPA). The legislation's goal was to increase the employment, retention, and earnings of participants in Department of Labor (DOL) employment and training programs, largely by increasing the occupational skills of participants. Among the DOL's stated principles for WIA were streamlining services, empowering individual participants, providing state and local flexibility, and promoting increased accountability. WIA reauthorized the DOL's Adult Education and Literacy programs, amended the Wagner-Peyser Act (the Federal-state partnership for providing unemployment insurance), and provided for linkages to other Federal labor programs. States were to have fully transitioned to the new WIA program by July 2000.

As WIA was being implemented, health care employers were experiencing major shortages of registered nurses (RNs) and other health professionals in all types of health care settings, including hospitals, long-term care, and ambulatory care facilities. At the same time, jobs in manufacturing and technology—business sectors whose employees were most often recruited and trained through JTPA programs—were in decline. WIA mandates that states carry out workforce planning with the involvement of business, elected officials, labor, and other key stakeholders. Having high demand for employees, health sector businesses were frequently at the WIA table to encourage that resources be spent to expand their pool of potential employees.

Responding to persistent need, programs to reduce health workforce shortages have been growing in number and intensity across the states during the past decade. These programs have occurred through sponsorship of state and local governments and professional organizations such as state hospital associations and nursing associations. For many who had been working in health workforce education, planning, policy, and research, WIA represented a new player on the scene. Those not familiar with the DOL's programs — in particular, with WIA — had questions about the law, the department's goals, and how these resources would be used. Specific questions about WIA's impact on the health care workforce included whether health care would surface as a priority for WIA funding among all states, which types of health workforce development programs would be implemented, how many professions would be involved, and whether the program would generate health workforce development models for others to follow.

The purpose of this report is to describe the extent to which WIA resources have been used by state and local workforce investment boards to develop the health care workforce. It provides examples of specific local and statewide health workforce development programs from the first years after WIA implementation, and it describes key features of WIA that lend themselves to health workforce development. This report should interest states and local jurisdictions that want to develop similar programs, Federal agencies that want to know how this program is being implemented in the health sector, and health workforce policy makers seeking new programs and resources for health workforce development.

IV. What Is WIA?

Following is a general overview of the WIA: its origin and goals, structure, funding streams, accountability measures, and implementation status. Health care is only one of several industry sectors for which WIA links clients with jobs. WIA is a complex law, with many rules, formulas, and exceptions. Basic knowledge of the law and how it has been implemented is necessary to understand how the health care industry can be served by WIA, as well as barriers to using WIA resources for health workforce development.

Origins and Goals

The aim of WIA was to overhaul and consolidate the fragmented system of U.S. workforce development programs in place prior to 1998. WIA was designed to provide job search assistance, assessment, and training for eligible individuals under three main funding streams: 1) Adult, 2) Dislocated Worker, and 3) Youth. The WIA required that specific employment-related services be administered through a "one-stop system" whose clients are both potential employees and employers.

The new "Workforce Investment System" was designed with the principles of streamlining services, empowering individuals, providing universal access, increasing accountability, providing new roles for local workforce boards, encouraging state and local flexibility, and improving systems to support youth (U.S. Department of Labor, 2003c). WIA replaced the JTPA, which had been the main vehicle for DOL employment programs since 1982. WIA brought together 17 Federal programs previously operating autonomously out of four different agencies. A primary change that WIA made to the JTPA was to mandate state and local Workforce Investment Boards (WIBs) and their core membership and functions. WIA requires each state to support a state-level WIB and be divided into local workforce development areas, each served by a local WIB. These WIBs guide all employment programs, as prescribed by WIA, in their region.

Signed into law on August 7, 1998, the Workforce Investment Act of 1998 has five components:

• Title I — Workforce investment systems
• Title II — Adult education and literacy
• Title III — Workforce investment-related activities
• Title IV — Rehabilitation Act amendments of 1998
• Title V — General provisions

Title I contains most of the details of the new workforce investment system. It describes the roles and functions of its components, how funds are allocated, how accountability is measured, how the programs are evaluated, and what special programs and technical assistance will be provided under the Act. Title II and Title IV reauthorize the Adult Education and Literacy and the Rehabilitation Act programs. Title III authorizes and links other related programs to WIA programs. Title V requires DOL to award "incentive grants" to each state that exceeds the state-adjusted levels of performance for each of the three WIA programs: workforce investment, adult education, and vocational education (states must submit applications for these incentive grants).

Structure

While not as "devolved" as block grants, WIA gives states and local areas more control over workforce development programs than existed prior to 1998. The law includes both mandatory and voluntary elements, and states have the opportunity to grandfather some existing programs if they are consistent with WIA's goals. As a result, the WIA programs vary among the states, although there are some core elements that are common to all WIA programs.

State and Local Workforce Investment Boards (WIBs)

Planning and oversight of state and local WIA programs take place through WIBs; one at the state level and one at each of the local workforce development areas required under the law. The mandated membership of the WIBs is intended to increase the likelihood of serving the two main customers of the new Workforce Investment System: local businesses and individuals seeking employment. Business, labor, and community organizations must be represented on state and local WIBs (see Table 1). WIA allows for some grandfathering of existing workforce boards and committees to become WIBs.

Table 1
Required Members for State and Local Workforce Investment Boards (WIBs)

Source: U.S. Department of Labor, 2003b.

The law permits great diversity in the structure of a local WIB. While some WIBs are both policy makers and service deliverers, many local WIBs work in partnership with a state agency or non-profit organization that actually delivers services to job seekers and employers.

Services at the local level

Under WIA, states must assign all their area into local workforce development areas. While most states have many local workforce development areas (New York has 33, Michigan has 25, and California has 50), some have only one or very few (North Dakota and New Hampshire have one, and Alaska has two). Regardless of the number in the state, each workforce development area operates with some common features, as described below.

One-Stop delivery system: WIA mandates that local programs be delivered through a One-Stop delivery system within each workforce development area. While workforce development areas have flexibility in designing their One-Stop systems, the One-Stop centers must have a physical presence in the local area and must have specified contractual relations with the local WIB. One-Stop centers may be operated by postsecondary educational institutions, local employment service offices, community-based organizations, for-profit entities, or government agencies. The One-Stop centers are responsible for providing services for Dislocated Workers and Adult programs.

One-Stop centers operate under a "work first" mission. Eligible clients are to be connected with resources to help them obtain jobs or promotions to higher-paying positions as quickly as possible. On-the-job training receives priority, as does short-term programs for upgrading skills, adult education and literacy programs, and customized training for an employer who is committed to hiring people who complete the WIA-supported training program.

One-Stop centers use WIA resources to provide job seekers first with "core," then "intensive" services, and if the client's needs are not met, the resources can be used for "training" activities (see Figure 1). One-Stop centers have limited discretion to provide customized services to clients. WIA funds may be used to pay for tuition and books, as well as to support services such as child care and transportation. "Core activities" include determining WIA eligibility, job search and placement assistance, career counseling, assistance in establishing eligibility for welfare-to-work and financial aid, provision of information on filing unemployment insurance claims, and providing various employment statistics. One-Stop centers can use "intensive services" for unemployed job-seekers who are unable to obtain employment through core services and for employed persons unable to be self-sufficient in their current jobs and who need services to keep their jobs or obtain new ones. Intensive services can be provided directly by the One-Stop centers or can be contracted to other entities. These intensive services include more comprehensive skill and needs assessments, group and individual counseling, career planning, and case management. WIA intended "training" services to be used if clients were not adequately served through core and intensive services and if clients were determined, through "core" and "intensive" assessments, to need additional training. Training is to be provided through Individual Training Accounts (ITAs) and only for occupations with demonstrated demand. ITAs act as vouchers that can be used to obtain services from WIA-eligible training providers. The ITAs are intended to promote customer choice—allowing recipients to purchase the training services (within some program constraints) that best meet their needs. This approach is a departure from the pre-WIA system of delivering training services, where program participants were often routed into specific program-funded training programs.

Figure 1
Progression of WIA Client Services Delivered by One-Stop Centers [D]

Figure 1 description: The first level of WIA client services to be provided by One-Stop Centers are "core" services including activities such as determining eligibility; outreach, intake and orientation; assistance with job search and placement; initial skills assessments; career counseling; compiling employment statistics; providing information on filing unemployment insurance claims; and providing assistance with accessing Welfare-to-Work and financial aid. After providing core services, One-Stop Centers may progress to "intensive" services, which include comprehensive skills and training needs assessment; group and individual counseling; development of individual employment plan and career counseling; and case management. After core and intensive services are offered, the One-Stop Center may provide "training" services. Training includes services such as occupational skills training; on-the-job training; upgrading skills; adult education and literacy training; entrepreneurial training; and customized training for employers who have committed to hiring.

One-Stop centers administer more than WIA programs. As shown in Table 2, job seekers and industry can access other DOL programs at One-Stop centers, as well as programs administered by the Federal Department of Education, Department of Health and Human Services, and Department of Housing and Urban Development. States may route other services, such as Temporary Assistance for Needy Families Program (TANF), through the One-Stop system. TANF is the Federal block grant program that provides states with funding for providing welfare services, replacing the Aid to Families with Dependent Children program, through the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. In 2001, 28 states had formal agreements that linked TANF to their WIA One-Stop systems (U.S. General Accounting Office, 2002b).

Eligibility: WIA Youth programs target low-income youth between the ages of 14 and 21 who need basic literacy skills or otherwise need assistance to complete their education or to find a job. Adults can use core services with no eligibility requirements. Priority for intensive services under WIA Adult programs is given to persons receiving public assistance or determined to be "low-income." Dislocated worker programs serve unemployed individuals and displaced homemakers, but they exclude long-term unemployed. The programs include provisions to encourage assistance to economically disadvantaged adults (determined through Census income data for geographic areas). Young adults ages 18-24 can obtain WIA resources through the Adult WIA programs, and when they use those programs, they do not have to meet the regular adult income requirements.

All individuals are eligible for "core" services from One-Stop centers. Local WIBs determine income eligibility criteria for adults who make use of the "intensive" One-Stop center services. The WIA requires that priority for adult "training" services go to welfare recipients and other low-income individuals. If resources are not limited, the "intensive" and "training" services can be made available to other clients. Dislocated worker funds must be used exclusively for services for persons who have been laid off or who have been notified that they will be laid off.

Postsecondary educational institutions and apprenticeship programs meeting basic criteria are automatically eligible to be WIA training providers. Each state's governor sets criteria for determining the eligibility of other training providers. All providers must meet minimum levels of performance and have their eligibility renewed at regular intervals.

Local planning and oversight: Local WIBs plan and oversee the WIA programs for their workforce development areas, with local elected officials' involvement. Among the mandates for local WIBs are that they develop local plans (subject to approval by the governor), designate One-Stop center operators and eligible training providers, and negotiate performance measures, which WIA requires. Some local WIBs have established additional workforce subpanels (e.g., "WIBlets" in Illinois and Health Skills Panels in Washington) to take on specific local workforce planning tasks. While membership of local WIBs is mandated by WIA, these sub-WIB planning panels have more freedom in selecting members and can address more targeted goals by selecting members with backgrounds more suited to specific industry or skills-related planning tasks.

Services at the state level

State WIBs are responsible for statewide workforce investment activities. They must develop five-year plans for state WIA activities, subject to approval by the Secretary of Labor. They develop and/or advise the governor on systems for statewide workforce investment and employment statistics, and they assist the governor in monitoring the statewide system. Statewide efforts that can be carried out by the state WIB include disseminating lists of eligible training providers, conducting evaluations, providing incentive grants to local workforce development areas, providing technical assistance to local areas with poor performance records, and supporting One-Stop centers and management information systems. States may also use WIA funds for activities such as incumbent worker programs (to assist employed workers to gain skills required for higher paying jobs), special programs in high-poverty areas, capacity building, and research. Required and allowable statewide activities are listed in Table 3, below. WIA is structured to provide states with set-asides from each funding stream for statewide activities (see Funding streams, below). In general, states may use up to 15 percent of funds from each funding stream for statewide activities.

Source: U.S. Department of Labor, 2003c.

Funding Streams

The WIA designates three major funding streams: Youth, Adult, and Dislocated Worker funds. The three WIA programs, housed in the DOL Education and Training Administration (ETA), have provided from $3 billion to $4 billion in workforce development funds each year since 2000 (see Table 4).

Sources: U.S. Department of Labor, 2003a; U.S. General Accounting Office, 2002c.

National and state funding allotments: The Secretary of Labor withholds 20 percent of Dislocated Worker funds for national programs such as National Emergency grants, technical assistance, and demonstrations. State WIA allotments are calculated annually based on formulas defined in the Act. State formula variables include the annual average number of unemployed, the annual average number of excess unemployed, the annual average number of long-term unemployed, and the number of economically disadvantaged youth within the state. Because of the variability of these factors, and because of changes from year-to-year in the Federal WIA budget, state WIA resources vary by state, and they can change significantly from one year to the next, as shown in Figure 2.

Figure 2
Examples of State WIA Allocations (Combined Youth, Adult and Dislocated Worker Funds Program Years 2000-03) [D]


Data compiled from: Federal Register, 2003; U.S. Department of Labor, 2001a.

Allocation of funding streams within states: For the most part, WIA distributes funds within states by formulas detailed in the Act. There are various exceptions, such as minimum allocations for some small states and hold-harmless assurances that ensure, for some allocations, that states receive no less than they received in a specified prior year. The Youth and Adult streams require that 85 percent of funds be spent on local programs. The Dislocated Worker stream requires that 60 percent of funds be spent on local programs, while 25 percent is earmarked for emergency state use, e.g., for rapid response if large numbers of workers lose their jobs because of major industry changes. The remaining 15 percent of each of the three funding streams are for discretionary use by the states, allowing state WIBs to create statewide strategies for workforce development, invest more heavily in particular funding areas, or any of the other activities listed in Table 3 (with administration activities limited to no more than 5% of funding).

Accountability Measures

WIA mandates program performance measures and evaluation. Several descriptive evaluations of WIA implementation have been published or are underway (Barnow and King, 2003; D'Amico et al., 2001; U.S. Department of Labor, 2001b; U.S. General Accounting Office, 2003b). The results of DOL-funded evaluations have described the speed at which states have implemented WIA, different structural approaches, effects of different political environments, implementation problems, and other comparative features, but there has been little description of the business sectors for which WIA has provided employees. This omission is not surprising, as the mandated WIA performance measures look only at numbers of persons employed (or, for youth, completing education programs), earnings, and satisfaction (see Table 5). The Act includes financial incentives for high performance on these measures and financial sanctions for poor performance (although these sanctions have not been implemented—see next section). WIA outlines a parallel incentive process for setting local performance levels between state and local WIBs. The DOL published results based on WIA performance measures in June 2003 (U.S. Department of Labor 2003c).

Sources: U.S. Department of Labor, 2000; U.S. General Accounting Office, 2003c.
* Of those who did not have a job when they registered for WIA, the percentage of adults who got a job by the end of the first quarter after exit. This measure excludes participants who are employed at the time of registration.
** Of those who had a job in the first quarter after exit, the percentage of adults who have a job in the third quarter after exit.
*** Of those who had a job in the first quarter after exit, the postprogram earning increases as compared with pre-program earnings.
**** Of those who received WIA training services, the percentage who were employed in the first quarter after exit and received a credential by the end of the third quarter after exit.

Implementation

Some state and local WIBs have used the implementation of WIA as an opportunity to substantially restructure their workforce development networks, while others have limited their changes to those mandated and have only cautiously exercised the options for new directions allowable under WIA (O'Shea and King, 2001). In a related way, the extent to which workforce development activities are led by the state WIB versus local WIBs also varies by state. At one end of the spectrum is Utah, which has only one WIB, and most workforce development activities are orchestrated through the State Department of Workforce Services. Florida and Texas also have strong state roles, backed by state legislation, but they still have active local WIBs. Others such as Maryland, Michigan, Missouri, and Oregon have very strong local WIBs with wide discretion in policy formulation and decision making (Barnow and King, 2003).

WIA performance measures have generated considerable discussion and controversy. The measures differ from those required under JTPA, and some participants complained that the new measures were quite onerous. While community colleges are major training providers for WIA programs, many perceived performance measurement as an unfunded mandate and limited their participation—slowing WIA implementation in some states (Dervarics, 2001; Shaw and Rab 2003). States' compliance with performance measurement was hampered because the WIA specifications were not released until the first year of implementation was underway. These problems were described by the General Accounting Office (GAO) in 2002 (U.S. General Accounting Office, 2002a) along with problems such as a lack of comparable data across states, sentiment that the measures lacked methods to factor-in local economic conditions, and a lack of measures to assess the performance of the One-Stop system as a whole (U.S. General Accounting Office, 2002a). Some states and local regions may have adopted a "creaming" approach to program enrollment: targeting individuals for enrollment who were more likely to score favorably on performance measures (Barnow and King, 2003; U.S. General Accounting Office 2003a). As a result of these controversies, states performing well on the performance measures have remained eligible for WIA performance incentive grants, but the DOL postponed financial sanctions for not meeting minimum performance. Much discussion has addressed ways to improve WIA performance measures, and as a result, the Bush Administration and the House and Senate have included modifications in their WIA reauthorization proposals (see WIA Reauthorization section).

Other important implementation factors have been the level of WIA's contribution to the overall pool of workforce funding for a state, as well as limits to the amount of resources an individual client can receive. WIA funding makes up variable amounts of states' total workforce development streams: other Federal, state, and local funds combine with WIA to create the total resource pool. WIA's contribution can be a very small portion, as in Texas where WIA makes up only 16 percent of the state's Workforce Commission's budget and in Utah, where WIA provides only three percent of Utah's Department of Workforce Development budget. The fact that state workforce development is supported, and complicated, by multiple funding sources drove WIA's emphasis on One-Stop centers and attempts to merge some funding streams. Some states have succeeded more than others on creating relatively seamless systems that help connect clients to resources, patching together resources for which the client is eligible from the various Federal and state workforce programs. Success has been related to the strength of state leadership to support seamless programs, being able to manage the variability of funding among employment programs, and applying creativity to overcome the barriers of program compartmentalization (examples include meeting the individual administrative requirements of programs such as TANF, Employment Security, and Food Stamp Employment and Training — all programs that are important employment resources) (Barnow and King, 2003). For industries such as health care, in which many jobs require college education at two-year, four-year, or higher levels, WIA resources alone usually cannot carry a client through to attainment of a higher paying job.

WIA is described and implementation is detailed in the reports listed in Table 6, as well as in the references cited in this report.

V. The Health Workforce and WIA

WIA was designed to give states and sub-state regions considerable latitude to build systems of workforce development that meet the needs of local business while giving job seekers choice among job and training opportunities. The Federally imposed structure includes many mandatory elements that give the workforce programs some common features and constraints, but it also encourages flexibility in some aspects of the program so that states and local areas can respond to workforce needs and development resources in their areas. As a result, there has been great variability in the extent and types of WIA-supported workforce development activities across the United States since the Act was implemented.

States' political and economic environments, how they had previously managed their JTPA programs, and their level of business involvement in workforce planning have all been significant factors in how fast and in what form WIA was implemented. In general, business involvement in WIA has not been as great as hoped, but business has more often been active at the planning table when specific industries' workforces were targeted for development (Barnow and King, 2003; D'Amico et al., 2001; National Governors' Association, 2002). Industry-specific, or "sectoral" strategies have strengthened relationships between the One-Stop centers and the business community as they work together to solve specific industry problems (John J. Heldrich Center for Workforce Development, 2002). In the late 1990s and early 2000s, the health care sector has faced shortages of many different professionals, and these have brought that industry's representatives to many WIA planning tables across the Nation. The Nationwide shortage of RNs, the largest single profession in the health workforce, was the impetus for many health sector leaders to get involved in statewide and local workforce forums. In many state and local health workforce development programs, the health sector business partnerships filled the gaps where Federal resources were limited or could not be used.

The health care sector includes many types of facilities, some of which are for-profit businesses and others, not-for-profit community services. These facilities include hospitals, medical clinics, long-term care facilities, dentists' offices, laboratories, pharmacies, and public health agencies. Health care facilities employ a large array of occupations, requiring various training routes. Medical care is generally provided in hospitals and medical clinics that employ some professions that require long training paths—e.g., physicians, physician assistants, and advanced registered nurse practitioners (ARNPs)—as well as staff who can be trained on-the-job or in short training courses, such as certified nursing assistants and pharmacy technicians. In-between are many medical professionals who can be trained in two through four years, including RNs, radiographer/radiology technologists, and medical/clinical laboratory technologists. In long-term care facilities, RNs, licensed practical nurses (LPNs, also called licensed vocational nurses or LVNs in some states), and certified nursing assistants (CNAs) make up the majority of employees. Their training ranges from on-the-job (CNAs), to specialized training programs and associate degree programs (LPNs and RNs), to baccalaureate degree programs and higher (RNs and ARNPs).

Most oral health care services are delivered by dentists, dental hygienists, and dental assistants in private dental offices. Dentist training is at the graduate (post-bachelor's) level. Initial training for dental hygienists is at the associate degree or bachelor's degree level, while most dental assistants are trained on-the-job. Public health services rely heavily on RNs to carry out their functions, but among clinically trained professionals, the field also uses physicians, dentists, dental hygienists, and LPNs. Most health care disciplines rely on the services of pharmacists (now trained through post-graduate programs), laboratory personnel (several training routes), and many administrative professions.

Because of its "work first" emphasis, WIA has been blamed for reducing the flow of workforce training funding to community colleges, in contrast to the JTPA era (Shaw and Rab, 2003). WIA performance measures favor interventions that rapidly route clients to jobs rather than to more time-consuming training and education. But few of the health sector jobs that are in high demand can be obtained without associate or baccalaureate level education or other specialized training. This was less the case for the high-demand jobs in the manufacturing and high technology sectors during the JTPA era. Manufacturing and high tech sectors were in decline in many states at the time WIA was implemented, and they were losing their high-demand status. Many local and state WIBs and One Stop centers recognized that health care was gaining prominence as a high-demand industry and that, in spite of WIA's work first ethic, they needed to find ways to route clients into the specialized training required for health care jobs. WIA has many requirements, but the law provides considerable flexibility for program implementation. Many states and local WIBs saw health sector jobs going unfilled and side-stepped the work-first policy by finding ways to use WIA resources (often combined with other public and private job training resources) for needed training, very often in two-year and even four-year and higher education programs.

Worker retention was also recognized as a problem in the health care sector, especially for entry-level jobs. In this area, WIA's work-first emphasis was well suited to the industry. Incumbent worker training programs, which move entry level workers up a health care career ladder, have been developed in many states. These programs identify individuals who have already chosen a job in health care and provide skill-enhancement and training to advance their health careers.

As a result of the health workforce sector's high-demand status and states' relative flexibility in implementing WIA, a broad range of WIA-supported health workforce programs were implemented across the country. Health workforce development programs tend to fall into seven general categories: health workforce development planning, programs to promote health care careers, career ladder advancement, educational capacity building, workforce retention, direct training support to individuals, and referral of eligible individuals to health workforce jobs through One-Stop centers.

Table 7 summarizes, to the extent we were able to ascertain, the types of health workforce development activities developed by state and local WIBs since WIA started to be implemented. This wide range of programs is further described in subsequent sections of this report. Because it is possible for local WIBs to operate somewhat autonomously, a complete census of WIB workforce development programs would require contacting all the state and local WIBs across the United States—work that requires more resources than this project had available. From Fall 2002 through the end of 2003 we conducted internet searches for health workforce development activities by WIBs in all states and U.S.-associated jurisdictions. During that time we also made phone and e-mail contact with most state WIB offices and obtained further contact information and details on any health sector workforce development efforts in that state. Many states verified that, at the time of our contact, they were unaware of any specific health workforce development activities using WIA funding. It is significant to note that the states vary considerably regarding their use of WIA resources for health care workforce development.

The specific health professions that states have used WIA funds to develop are summarized in Table 8. Table 9 provides a summary of the level of education that these state programs use in their health workforce training efforts.