Donate
Independent, objective, nonpartisan research

R 1216SBR

Authors

R 1216SBR

Tagged with:

Publication PDFs

Database

This is the content currently stored in the post and postmeta tables.

View live version

object(Timber\Post)#3742 (44) { ["ImageClass"]=> string(12) "Timber\Image" ["PostClass"]=> string(11) "Timber\Post" ["TermClass"]=> string(11) "Timber\Term" ["object_type"]=> string(4) "post" ["custom"]=> array(5) { ["_wp_attached_file"]=> string(13) "R_1216SBR.pdf" ["wpmf_size"]=> string(6) "473812" ["wpmf_filetype"]=> string(3) "pdf" ["wpmf_order"]=> string(1) "0" ["searchwp_content"]=> string(71595) "DECEMBER 2016 Sarah Bohn, Shannon McConville, and Landon Gibson With research support from Gilbert Placeres Supported with funding from the Sutton Family Fund Career Technical Education in Health An Overview of Student Success at California’s Community Colleges © 2016 Public Policy Institute of California PPIC is a public charity. It does not take or support positions on any ballot measures or on any local, state, or federal legislation, nor does it endorse, support, or oppose any political parties or candidates for public office. Short sections of text, not to exceed three paragraphs, may be quoted without written permission provided that full attribution is given to the source. Research publications reflect the views of the authors and do not necessarily reflect the views of our funders or of the staff, officers, advisory councils, or board of directors of the Public Policy Institute of California. Introduction 5 Health CTE Enrollment at California Community Colleges 7 Health CTE Degrees Create Economic Opportunity 11 Improving Completion Rates 14 Opportunities for Students without High -Value CTE Credentials 21 Conclusion 22 References 24 About the Authors 25 Acknowledgments 25 Technical appendices to this paper are available on the PPIC website. Career technical education (CTE) has received renewed focus from state and national policymakers interested in improving economic outcomes of students and addressing the state’s workforce needs. California’s community colleges are the state’s primary provi der of CTE, also known as vocational education. Career training in health care holds particular promise for students and the state’s economy —health CTE programs attract a large and diverse set of students in California and are linked to growing job opportu nities in health services, a generally well -paying industry for Californians with less than a bachelor’s degree. In this report, we examine outcomes for the 120,000 students who pursued health CTE degrees across California’s community college system over the past decade.  Health CTE students are predominantly female and tend to be slightly older than community college students overall, including those enrolled in other CTE programs. However, nearly 60 percent are identified as academically disadvantaged and 70 percent are economically disadvantaged.  Health CTE credentials afford sizeable returns to students in California, who earn 50 percent more, on average, after they complete their schooling. Returns do not vary across socioeconomic groups but do vary across the type of credential. Associate degrees afford returns about 2 times larger than long -term certificates and about 10 times larger than short term -certificates. However, even within those categorizations, there is variation across programs, with sh ort term certificates in Paramedic programs resulting in much higher returns than for Medical Assistants, for example.  Overall completion rates for health CTE programs are relatively high: more than 70 percent of students who begin a program either obtain a degree or transfer to a four -year college within six years, while only about half of the overall CTE student population obtain a credential within six years. However, success varies substantially across health programs, ranging from 93 percent in dental hygienist programs to 44 percent in emergency medical services.  Although a high share of health students do earn credentials, there are racial and ethnic achievement gaps across health programs. Program choice explains some of the gap, but academic pre paration, financial aid, and course -taking behavior (in particular, full -time attendance and persistence) explain almost all of the observed achievement gap. Policymaker efforts to improve completion rates and reduce achievement gaps could focus on increas ing full-time enrollment and consecutive- term enrollment CONTENTS SUMMARY PPIC.ORG Career Technical Education in Health 4 for students after entering health programs. We find that students who enter health training but do not obtain programs may nonetheless be able to enter the health care industry and experience car eer growth over the long term. But obtaining credentials, particularly in high -reward programs will do the most to improve student and workforce outcomes. PPIC.ORG Career Technical Education in Health 5 Introduction Rising economic inequality in the United States over the past few decades has led to wide-ranging conversations about how to improve economic mobility, especially for disadvantaged groups. Education, the single strongest correlate of economic success, is often regarded as the best way to promote upward mobility. Career technical education (CTE) has garnered particular interest, as perhaps the most proximate tie between postsecondary training and the labor market . Many CTE credentials can be earned over short time horizons, leading to relatively fast wage and labor market gains. S tate and national policymakers have renewed their focus on CTE in recent years. The 2014 Workforce Innovation and Opportunity Act revised federal legislation on large -scale workforce training investment, better engaging community colleges and placing special emphasis on career technical education. In California, in addition to recent voter -approved increases in funding for K –14 education that have benefitted the state’s community college system, policymakers have directed resources to CTE in particular. The state pi loted—and then renewed —the California Career Pathways Trust (CCPT) to invest in CTE pathways. The CCPT has allocated more than $500 million since 2014 to school districts, county offices of education, community college districts, and other partners to support efforts to design and implement well -defined career pathways for CTE programs and support student success. California’s most recent budget also directed an additional $200 million to the Strong Workforce Program, which aims to increase the availability of high-quality, in -demand CTE courses at the community colleges . Career pathways in health -related fields hold particular promise for students and the state economy. California’s health care sector is large and growing ; it provides key services to the s tate’s population as well as employment opportunities to a wide variety of workers. With a growing and aging population, the demand for health workers is projected to continue to grow substantially over the next decade. California’s health workforce is projected to require nearly half a million new workers over the next decade, with more than 40 percent of future health jobs likely to require either postsecondary certificates or associate degrees (McConville, Bohn, and Beck 2014). In addition to satisfying workforce needs, many postsecondary health credentials yield greater labor market returns than other community college –level training (Stevens, Kurlaender, and Grosz 2015; Jepsen, Troske, and Coombs 2014; Dadgar and Wei ss 2015). Furthermore, the need to diversify the health workforce to serve an increasingly diverse senior population provides an additional impetus to ensure that underrepresented minority students and other disadvantaged groups pursue health credentials. C ommunity colleges are well-positioned to address this need , since they serve a high er percentage of underrepresented minority students than other public higher education institutions . F or -profit institutions also provide training in health CTE programs —and they represent the lion’s share of the growth in sub- baccalaureate health degrees over the past decade (McConville et al . 2014). However, i ncreased scrutiny of for -profit colleges due to poor graduation rates, high levels of student debt, and questions about the value of degrees —along with several recent closures of for -profit institutions —has shifted even more attention to the state’s public two -year colleges. While health CTE training has the potential to improve employment and economic outcomes, man y issues and questions need to be addressed. A lthough labor market returns to health CTE awards are sizeable, it is not clear how labor market opportunities vary across health programs or how outcomes differ for students with wide - ranging socioeconomic bac kgrounds. To ensure the efficacy of recent investments —and future reforms —and ultimately to improve economic outcomes through vocational education, it is crucial to identify the student, institution al, and policy choices that lead to optimal outcomes. PPIC.ORG Career Technical Education in Health 6 In this report, we document the pathways to successful completion of health CTE programs in California’s Community College system. We also examine the employment outcomes of students —who complete health CTE degrees as well as those who begin a program but do not finish— to gauge the economic returns for students and the ability of the community college system to train workers for in -demand health jobs. Data Used in This Study To assess the experience of students in health programs in California’s community c olleges, we use longitudinal student data maintained by the Chancellor’s Office. These records contain basic demographic information about the students as well as courses completed or attempted, grades, and credentials received. For most analyses, we use r ecords for students who completed their first health CTE courses between 2000 and 2009. For these students, we also have records on earnings (at the quarter level) between 2000 and2014, if they had jobs covered by the Unemployment Insurance system. See Technical Appendix A for full details. PPIC.ORG Career Technical Education in Health 7 Health CTE Enrollment at California Community Colleges Over the past decade, about 120,000 students entered health CTE program s at California community colleges with the intention of obtaining degrees or credential s. F rom the early 2000s to the end of the decade, about 12,000 students on average each year completed at least eight units in a single health CTE program—a marker used by t he Chancellor’s Office to signal the intent to pursue a CTE credential (Figure 1). 1 Registered nursing, emergency medical services (EMS), and licensed vocational nursing (LVN) had the largest student enrollment , although more than 20 different health programs had at least 1,000 CTE degree- bound students during our study period. Overall, we identified students pursuing CTE degree s across m ore than 40 different health programs. FIGURE 1 Enrollment in health CTE programs has been increasing SOURCE: Author’s calculations from CCCCO data. NOTE: See text box and Technical Appendix A for details on defining CTE degree- bound students. Community colleges offer a range of credentials, from short -term and long -term certificates to associate degrees.2 While the three largest programs account ed for about half of students pursuing health CTE degrees during our study period, other programs —including medical assistant, dental assistant, health IT and administration, respiratory therapy, and technician —had 3,000 to 5,000 students pursuing degrees (Figure 2). 1 We define health CTE -intending students as those who complete at least eight units in a single health program within three years of starting a vocational he alth program (see Text Box). The student counts presented in this section represent individual students. It is possible that a student may have entered a health CTE program more than once over our 10 -year study period, however, for our analysis we only include individual students once reflecting the first instance during ou r sample period that they met the criteria of taking 8 units in a single health program. See Technical Appendix A for more information. 2 Short -term certificates are defined as those that take less than one year to complete and include certificates requiring less than 18 units, both those approved by the Chancellor’s office and local certificates, and certificates requiring between 18 and 29 units. Long- term certificates typically take between one and two years to complete are include certifi cates requiring between 30 and 59 units, and 60 or more units. 0 2000 4000 6000 8000 10000 12000 14000 16000 2000 200120022003200420052006200720082009 Health CTE degree- intending students All Health CTE Students Registered Nursing Emergency Medical Services Licensed Vocational Nursing PPIC.ORG Career Technical Education in Health 8 FIGURE 2 Distribution of health CTE students across programs SOURCE: Author calculations from CCCCO data. NOTE S: Includes all health CTE -in tending students entering programs during the 2000 through 2009 school years. “ M edical assistant ” includes clinical and a dministrative; “technician ” includes psychiatric, pharmacy, cardiovascular, surgical, occupational therapy, o ptical, and radiation therap y. For details on program enrollments by detailed program ca tegories refer to Technical Appendix A . 31% 16% 7% 4% 6% 4% 3% 2% 3% 8% 3% 13% Registered Nursing EMS/Paramedic Licensed Vocational Nursing Dental Assistant Medical Assistant Radiology/Sonography Respiratory Therapy Dental Hygienist Certified Nursing Assistant Technician Health IT and administration All Other Identifying health CTE students California’s community colleges are open -access institutions and generally do not require students to declare, apply for, or be accepted to a particular program of study —there are a few exceptions, such as registered nursing, and current reforms aim to enc ourage students to define their educational goals . Nonetheless, currently it is complicated to identify students who start a particular program but do not finish. We use a strategy similar to that employed by the CCCCO and recent work (Stevens et al. 2015) to identify health CTE students based on their enrollment in certain courses. First, we observe students who completed their first vocational health courses sometime between the 2000 and 2009 school years. If a student subsequently earned at least 8 units in a single health program within three years of completing their first vocational health course, we identity him or her as a “health CTE -intending student”. Health programs are defined by 6 - digit TOP codes. We have tes ted this definition and found that lower cutoffs (6 units or 4 units, for example) or more restrictive cutoffs (achieving 8 units in a shorter time), does not materially impact our results. In addition, 8 4 percent of students who earn a health CTE credenti al meet this 8 unit criterion. It could be that other students would like to pursue health credentials but never enroll in the initial health CTE courses we observe, either because they have not completed prerequisite courses or because the college they wa nt to attend does not have enough capacity in certain programs. While these issues are discussed further in the text, we generally regard them as outside the scope of this report. See Technical Appendix A for full details. PPIC.ORG Career Technical Education in Health 9 Which Students Pursue Health CTE Degrees? Students who pursue degrees in health CTE programs are older and a higher proportion are women , white , and Asian (Figure 3) . About 55 percent of health CTE students were age 25 or older , compared to about 45 percent of all community college students enrolled in credit courses over the same time period. M ore than seven in ten students enrolled in health CTE programs were women, compared to about 55 percent of all community college students and slightly fewer than half of students in other CTE programs . When we exclude students in nursing programs, the share of women and older students declines slightly but these groups remain overrepresented relative to the general student population. FIGURE 3 H ealth CTE students are more likely to be over age 25 and female than other students SOURCES: Author’s analysis of CCCCO MIS data; CCCCO D atamart. NOTE: Distributions of all credit students are calculated based on averages of student counts of term -level data available from D atamart and do not represent unique individual students over the time period. Health CTE and other CTE student characteristics are, however, based on unduplicated student counts and include students identified as CTE -intending in school years 2000 –2009. There are, however, some differences in student characteristics across programs. For example, while women make up more than 80 percent of students in registered nursing, licensed vocational nursing , and certified nursing assistant program s, fewer than 30 percent of students in EMS programs are women. EMS programs also stand out for their racial compo sition; white students are o verrepresented (comprising 60% of EMS students) while African American students are under represented (comprising less than 4%) relative to their shares among all health CTE students ( technical appendix T able A4). So while health CTE students at California’s community college are more diverse than the student population in California’s other public higher education systems, they are somewhat less diverse than in other CTE program s or the community college system as a whole, particularly across certain programs. This suggests that there may be opportunities to improve the diversity of students enrolled in health programs. 0% 10% 20% 30% 40% 50% 60% 70% 80% Over 25 FemaleNon-hispanic white Latino African American Asian and Pacific Islander Percentage of students Health CTE-intending Other CTE-intending All credit students PPIC.ORG Career Technical Education in Health 10 Health CTE programs serve a wide range of economically disadvantaged students. Nearly 40 percent received a Pell Grant at some point in their community college career . 3 And we estimate that 60 percent received a Board of Governors (BOG) fee waiver —which is awarded to low -income students and/or those who receiv e cash assistance through social safety net programs . 4 Furthermore, health CTE appears to attract a relatively sizeable share of students i dentified as CalWORKs recipients. 5 In fact, if we expand the definition of economic disadvantage to include students who received one or more of these type s of aid or were designated as economically disadvantaged for the purposes of receiving Vocational Technical Education Act (VTEA) funds, nearly 70 percent of health CTE students are economically disadvantaged at some p oint in their community college enrollment. 6 Academic Preparation among Health CTE Students Academic preparation plays an important role in boosting program access for disadvantaged students—it also plays a key role in completion, which we examine below. In some respects, students in health programs appear to be better prepared than the overall community college student body , although a large share of students in health CTE programs nonetheless show markers of academic disadvantage. On average, students pursuing health degrees were enrolled in the community college system for about three academic terms in the three years before they entered the health program . About 30 percent had completed at least 30 units. These students may have b een taking preparatory work for health program s and/or had to wait for spaces to open up in their desired program s of study . About 10 percent of students had already earned at least one community college credential before enrolling in a health program , and 20 percent reported earning bachelor ’s or associate degrees before entering a health program. N early 45 percent of health CTE students took at least one biological science course, such as biology or anatomy , in the three years before they began their health CTE program . And although we find little difference i n the number of terms completed across socioeconomic groups of health CTE students, we do find some evidence that more students who are economically dis advantaged attempted and failed common prerequisite courses for health programs such as biology or anatomy compared to those not disadvantaged, which might have affected their choice of health program s. Furthermore, system -wide, students in underrepresent ed groups are less likely to complete certain coursework such as math and science courses, which could prevent them from enter ing some health CTE programs. At the same time, more than three-quarters of s tudents seeking degrees in health CTE programs enrolle d in at least one basic skills or remedial education course and nearly 60 percent had been categorized as academically disadvantaged at some point in their community college history . 7 And the shares of health CTE students with academic and economic disadvantage remain largely the same even when we exclude students in registered 3 While there is no single income guideline for determining Pell Grant eligibility, profiles of students who receive Pell Grant s indicate that they have low family incomes. More than 70 percent of Pell Grant recipients nationwide have an annual family incom e below $30,000 according to the US Department of Education Pell Grant Year End Report, 2013– 14. 4 Other social safety net programs include Supplemental Security Income (SSI), General Assistance, or CalWORKs. Authors calcula tions based on information from CCCCO Datamart, accessed 6/17/16. 5 According to CCCCO, approximately 30,000 CalWORKs students were enrolled in each school year during the period 2006– 07 and 2008–09, which falls in the middle of our study period. Our sample of health CTE students contains nearly 10,000 students who were identified as CalWORKs recipients at some point during their observed enrollment at California community colleges. Although we define our study period based on enrollments between school years 2000 and 2010, we have stude nt information covering the period from 1993 through 2013. For the purposes of identifying economically disadvantaged students, including CalWORKs, GA, SSI, and other poverty -related makers, we use information across the entire time period to define measur es indicating the student ever fell into one of these economically disadvantaged categories. 6 Carl Perkins Vocational Technical Education Act of 2006 provided funding for vocational education. Act was revised and reauth orized in 2012, now the Career Techn ical Education Act (CTEA). 7 Academic disadvantage is defined by the community college system and indicates that a student meets at least one of the following criteria: has been on academic probation or dismissal, had enrolled in remediation courses, or h ad received specialized services to support disadvantaged students. PPIC.ORG Career Technical Education in Health 11 nursing programs , which because of more stringent entrance requirements may be less accessible to disadvantaged students ( see Technical Appendix A ). Overall we find that a div erse group of students are served by health CTE programs , even if there is room for improvement. We now turn to an analysis of the economic returns of these programs. Health CTE Degrees Create Economic Opportunity Many CTE programs, especially health CTE p rograms, are designed to prepare students for specific occupations —and to provide a route to increased earnings. Many health careers offer salaries well above the norm for com munity college credentials. S tudents who receive associate degree s in nursing (AD N) see sizable wage gains after obtaining their degree s, as do students earning other health CTE degrees—such as radiological technicians, dental hygienists, and physician assistants. 8 In fact, according to the Chancellor’s Office, 18 of the top- 25 wage -enhancing degrees are in health. 9 These statistics point to the potential benefits of encouraging students to pursue high- reward health careers. However, there is a lot of variation across programs. Also, large wage gains for some students do not nece ssarily signal gains for all. And, of course, a fair share of students fail to complete a credential or transfer. To assess the success of health CTE programs, it is important to examine employment outcomes in detail. The most important economic outcome for students, of course, is their ear ning capacity . Many factors affect earnings, and not all are related to completing a degree; that is why looking at average student earnings before and after college is not particularly informativ e. In particular, individual characteristics—such as ability or drive—are likely to lead to higher earnings regardless of completing a credential. If high -ability students tend to enter certain programs, looking at how much students in those programs earn before and after obtaining a degree tells you more about the students than the training. The ideal way to measure the economic value of a degree is to compare a student’s earnings trajectory with and without a degree. Of course, such a comparison has to be abstract. But the rich ness of the student information used in this study allows us to approximate it. W e use each student’s earnings trajectory before completing a h ealth credential as a control for all of the characteristics that relat e to the student’s underlying ability. At the same tim e, we compare the earnings trajectory for students who complete a program to those who enter a program but never finish . Both groups of students, in general, have an upward wage trajectory, but the difference between the two tells us how much completing a credential (beyond simply entering a program) increases earnings. Our approach closely follows that of Stevens, Kurlaender, and Grosz (2015), largely replicating their results on our specific sample. See Technical Appendix C for further detail. A number of recent studies use similar methods to measure wage returns for vocational programs in various state contexts ( Stevens et al . 2015 in California , Dadgar and Trimble 2015 in Washington, Jepsen et al. 2014 in Kentucky) . All find that returns increase with length of study and vary substantially by program. This work also consistently finds that health CTE degrees are among the most valuable in terms of increasing employment and 8 This is according to wage information made available by the Community College Chancellor’s Office on their Salary Surfer website, which provides information on median wages for students before and after completing awards in specific programs of study. See http://salarysurfer.cccco.edu/SalarySurfer.aspx; we accessed these statistics 7/5/16, and they pertain to the cohort of students earning an award between 2004– 05 and 2008–09. 9 The othe r top earning certificates are in engineering programs, where, for example, the median student who earns an electrical system s certificate goes from $69,000 before the award to $124,000 afterwards. Note, of course, that the higher earnings before this awar d probably signal a very different student than among the health programs cited. Other top earning engineering awards are similar, with the exception of programs in heavy equipment maintenance. PPIC.ORG Career Technical Education in Health 12 wage outcomes. While these studies examine wage returns to health degrees based on differing award levels — short -term certificates, long -term certificates, and associate degrees— they typically focus on nursing and do not delve into the differences across ot her health programs. And while nursing is the largest single health CTE program, 70 percent of health CTE students in California’s community colleges are enrolled in programs other than registered nursing. On average, h ealth CTE students who obtain credentials increase their earnings 51 percent above both their own earnings before entering CTE training and the wage increase experienced by non -completers (Figure 4 ). The returns are larger for students who earn associate degrees (63%) th an for those who earn long -term certificates ( 39% ). Compared to all health CTE students, those who earn only a short term certificate see a smaller, but positive 6 percent increase in earnings. 10 FIGURE 4 Obtaining a health CTE credential substantially increases earnings SOURCES: Author’s calculations of CCCCO MIS data. NOTES: Chart shows the wage increase an individual experiences after completing a health credential, net of the wage increase the average non- completer earned over the same time frame. Specifically, each bar is the coefficient from a fixed effect regression model of the log quarterly wage on year- quarter, age, enrollment, award completion, and student identifier . The universe includes health -CTE intending students who took a first health CTE course between 2003 and 2009 and either completed a credential or did not (transfer students are omitted), and were between age 18 and 54 at start. For students that earned more than one award during the sample period, we measure the effect of the highest award level o nly. Students are observed (in course taking and wages) from 2000 to 2014, to allow for credential attainment and wage trajectory both before and after. All estimates are statistically significant at the 1% level except for the short term credential return compared to all health CTE -intending students, which is significant at the 5% level . See Technical Appendix C for more details. Although the average wage return of a health credential is large and positive, and generally increases along with program length, some long-term and short -term certificate programs equal or outperform associate degree programs. For example, students who complete paramedic certificates typica lly see wage gains similar to some associate programs (about 56%). The sizeable earnings gain for health CTE programs overall is driven by a 10 We also compare the earnings gain for students who earn he alth awards compared to students who enter similar length programs; the results are similar. See T echnical Appendi x C for these results as well as numerous additional robustness checks. 0% 10% 20% 30% 40% 50% 60% 70% Any credential AssociatesLong term certificate Short term certificate Wage increase of a health CTE degreeholder relative to a non–degree holder PPIC.ORG Career Technical Education in Health 13 handful of programs: registered nursing, radiologic tech, paramedics, respiratory therapy, and dental hygienist. Hi gher wages in these areas are attributable not just to credential attainment but also industry certification. It is true that educational credentials typically prepare student s for certification tests, but we cannot measure the two separately . Other major short -term credential programs have smaller wage return s than those for most longer-term health CTE programs . In fact, except for health IT credentials, we cannot statistically distinguish the returns from zero. 11 FIGURE 5 Earnings gains vary substantially across programs SOURCES: Author’s calculations of CCCCO MIS data. NOTES: Chart shows the wage increase an individual experiences after completing a health credential, net of the wage increase the average non- completer ea rned over the same time frame. Specifically, each bar is the coefficient from a fixed effect regression model of the log quarterly wage on year- quarter, age, enrollment, award completion, and student fixed effects. The universe includes health -CTE intending students who took a first health CTE course between 2003 and 2009 and either completed a credential or did not (transfer students are omitted), and were between the ages of 18 and 54 at the start. For students that earned more than one award during the sample period, we me asure the effect of the highest award level only. Students are observed (in course taking and wages) from 2000 to 2014, to al low for credential attainment and wage trajectory both before and after. All estimates are statistically significant at the 1% leve l unless noted . See Technical Appendix C for more details. *Note : Results are not statistically significantly different from zero. Our estimates control for individual characteristics by measuring the growth in earnings for each student after he or she earns a health credential . It is possible that certain student groups figure more prominently in the overall positive return —just as cer tain programs do. But that does not seem to be the case. We find that wage returns are remarkably similar across a wide range of socioeconomic characteristics. Gender, race and ethnicity, signals of 11 These findings hold even when we attempt to grow the sample in various ways. Using more years of data, we still detect only small, insignificant returns to these short term credentials, with the exception of EMS. We estimate an 8 to 10 percent return in earnings for EMS, sometimes statistically significant, depending on the sample. * * ** * -10% 0% 10% 20% 30% 40% 50% 60% 70% Registered Nursing Radiologic Technology Respiratory Care/Therapy Dental Hygienist Licensed Vocational Nursing Dental Assistant Psychiatric Technician Emergency Medical Services Medical Assisting Certified Nurse AssistantPharmacy Technology Home Health Aide Paramedic Health Information Technology Associates Long term certificate Short term certificate Wage increase of health CTE credential PPIC.ORG Career Technical Education in Health 14 economic disadvantage (such as receiving Pell G rants or participating in CalWORKs), and the region of the state where the credentials were earned do not appear to affect the return to community college health CTE credentials (see Technic al Appendix C for detailed estimates). This suggests that efforts to increase completion of these programs —for average and for historically underrepresented students— are likely to pay off. Nonetheless, the choice of which credential to pursue is clearly a huge factor in how much a student’s economic opportunity might grow as a result of purs uing postsecondary education. As we showed earlier, program choice does vary across socioeconomic characteristics, and it turns out that the choice of program has a significant bearing on whether student s obtain a credential at all. In order to improve outcomes across all student groups, we need to know more about this and other factors in the completion of health programs . Improving Completion Rates Given the dual goal of preparing students for rewarding health careers and meeting the state’s workforce needs, it is crucial to identify factors related to successful outcomes across the health CTE programs throughout the community college system . Registered nursing program s are the largest and most selective—and therefore have high completion rates. But only three in ten health CTE students are in registered nursing programs. Community colleges are being challenged to improve student outcomes, particularly by increasing the number who earn credential s or transfer to four- year colleges ( CCC Student Success Task Force 2012; Metzker and Heiman 2016; Sengupta and Jensen 2006; Shulock, Moore, and Offenstein 2011) . The overall completion rate across C alifornia’s community college system is only 47 percent. Completion across all CTE programs is slightly higher , at 51 percent —probably because CTE programs are more likely to set shorter -term completion goals, such as certificates, than more general programs. 12 Recent efforts to improve completion rates culminated in the Student Success Act of 2012, which required changes to enrollment practices, curriculum, and supports that have the potential to help more students complete community college program s across all areas of study . These efforts, along with new initiatives targeted specifically at developing CTE programs, may prove effective in improving completion in health programs. In particular , insufficient course offerings in high -demand program s are especially problematic for CTE programs because courses are more costly to offer (Shulock et al. 2012) . This is why nursing programs at community colleges have long received supplementary funding to ensure adequate course offerings, faculty, and othe r resources needed to meet the state’s nursing workforce needs. Given the importance of degree completion for students, colleges, and the economy, we now turn to a detailed analysis of completi on within health CTE programs. We highlight differences in co mpletion across programs and student groups and measure how student choices might improve the odds of success. Overall Health CTE Completion Is Relatively High Among the sample of students seeking degrees in health CTE programs, 5 9 percent either obtain some type of credential or transfer to a four -year college within three year s and slightly more than half earn a credit award in a health program (Figure 6). When we extend the time window to six years after program entrance, completion rates increase—nearly three -quarters (74%) obtain a certificate or degree and/or transfer to a four -year college and 12 CCCCO Scorecard, accessed 6/17/16. Based on six -year completion for first -time students in 2009– 10. PPIC.ORG Career Technical Education in Health 15 two -thirds (67 %) obtain a health credential. While these completion rates are high compared to other CTE programs, the fact that only half of students complete a health degre e within three years suggest there may be opportunities to shorten the time to degree , particularly when we consider health students have been enrolled for three terms, on average, prior to beginning their health programs. FIGURE 6 Mo st health CTE students get degrees or transfer to four- year schools SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Completion is measured for all health CTE students who entered programs between school years 2000 and 2009 . Both the three -year and six-year completion rates also adjust for colleges not reporting local certificates for certain short -term health programs. See Technical Appendix A for more details. Perhaps not surprisingly, the difference between three- and six-year completion rates is driven almost entirely by more students earning an associate degree or transferring to a four year college . Nearly one -third of students who enter a health CTE program o btain a ssociate degree s in a health field or transfer within three years; that share increases to about half of students when we look out six years. The vast majority of students who do complete programs receive associate degree s. Only about 10 percent of health CTE students earn short -term certificate s ( requiring less than 30 units) as their highest degree and about 13 percent earn a long -term certificate ( which requires more than 30 units) . These rates remain largely the same regardless of the time window for completion. 13 C ompletion Varies across Health Programs Given the sizable variation in economic returns a cross health credentials, we now turn to a more detailed look at completion of health degrees across different programs. Figure 7 presents six-year completion rates of health degrees for the largest health CTE programs. The actual or unadjusted completion rates are simply the percent age of students who begin the health CTE program and earn a certificate or an associate degree in a 13 An unknown share of short -term certificates (6 -18 units) are a warded locally by colleges and are not reported in the CCCCO student -level data. For this reason, short term certificate completion may be understated. We examine programs and colleges that have potentially artificially low completion rates due to non- reporting. Excluding these does not substantively affect overall completion rates, however. See Technical Appendix A and B for more details. 51% 59% 67% 74% 0% 10% 20% 30% 40% 50% 60% 70% 80% Health credential Any credential or transfer Percent of students in health CTE programs 3-year completion 6-year completion PPIC.ORG Career Technical Education in Health 16 health program within six years.14 Registered nursing and dental hygienist students have the highest completion rates —85 and 9 3 percent, respectively —followed by respiratory therapy and radiological technology students. At the other extreme, emergency medical services and health IT programs have completion rates below 50 percent . 15 The composition of students does vary across some health programs in terms of age, gender, ethnicity, as discussed above—and some of these student characteristics are associated with higher or lower completion rates. So to isolate the impact of the choice of health program from the composition of the students enrolled in a program, we hold constant several student characteristics—including age and education level at program entrance, race, ci tizenship, language ability, as well as economic and academic disadvantage. We also account for the colleges that health CTE students attended. The second set of bars in Figure 7 shows that the relatively large differences in completion rates across programs persist even after adjusting for individual demographic and socio economic characteristics and for the college attended. 16 FIGURE 7 Completion rates vary considerably across health programs SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Unadjusted rates are actual 6 -year completion rates for students in our sample of CTE -intending students, according to the program in which they earned the most credits. Adjusted completion rates control for student gender, race/ethnicity , citizenship status , age , education level at program entrance , year of entry, disability status, limited English proficiency, academic disadvantage ( as defined by CCCCO), economic disadvantage , and the college of attendance. The adjusted rates use the following reference gro up: White, female, citizen, high school diploma, academically disadvantaged, non -disabled, and not limited English proficient. Students completing only non - health awards or transferring to four year colleges are excluded from this analysis . See Technical Appendix B for full regression results. 14 We focus on completion of health awards t o examine differences across health CTE programs. The unadjusted and adjusted completion rates presented below do not include students who completed only non -health awards or transferred to a four year college. 15 Once again, even controlling for potentially locally awarded certificates at select colleges does not alter these conclusions . 16 See Technical Appendix B for details on our statistical analysis of completion. Briefly, we estimate linear probability models predicting whether health CTE students complete a health credential within 6 years of entering a program. We control for demographic characteristics and college fi xed effects in this first model. Research on California’s Community Colleges suggests that the college students attend affects the likelihood of degree completion above a nd beyond controlling for individual student factors (Kurlaender, Carrell, and Jackson 2016). 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Percent of students completing health degree Unadjusted Adjusted - Socio-economic Unadjusted Adjusted for socioeconomic differences PPIC.ORG Career Technical Education in Health 17 Although there does not seem to be a direct correlation between studen t socioeconomic characteristics and differential completion ra tes across programs, there may be an indirect link by way of program admission requirements. Community college courses are generally open access, except in special cases where admission requirements are put in place to alloc ate resources effectively and maximize returns on investment in certain programs, particularly those tha t are more expensive to offer. Students need to be prepared for program coursework and have a high likelihood of completing a degree, especially if capacity is limited and many student s seek admission . Registered nursing is a prime example—most if not all colleges have strict admission criteria — su ch as prerequisite courses, minimum GPA, and assessment tests— for these programs. Because there is no comprehensive accounting of entrance re quirements across programs and colleges over time, we cannot systematically assess the impact of program admission criteria on student success. We d id, however, analyze qualitative information on several large health CTE programs from community college course catalogs for the 2012–13 school year. Not surprisingly, programs with the highest completion rates —upwards of 80 percent of students who begin programs for registered nursing, respiratory therapy, and dental hygiene earn degrees —do have more rigor ous admission criteria than programs such as medical assisting and certified nursing assisting . While this makes sense in terms of ensuring that stud ents are prepared for a program’s coursework , these criteria can prevent many students from accessing certain programs. Because underrepresented students are less likely to be prepared for college, they may be less likely to gain access to high- demand and highly rewarded programs, and this in turn may make it harder to close achievement gaps and diversify the health workforce. 17 To assess the role of academic preparation in differential completion rates across programs, we examine how completion of specific pre requisite coursework before entering a health program and course -taking during a health program predict success. Completing a biology, anatomy, or chemistry class in advance increases the odds of finishing a health CTE credential by 4 to 6 percentage points (Figure 8). This correlation persists regardless of whether a student enters a program with strong pre requisite requirements. We also examine student GPA, another indicator of academic preparation. We find that for each 0.5 grade points higher the GPA, student completion rates increase by 6 percentage points. These findings suggest, not surprisingly, that ability and preparation lead to more successful outcomes. While not all students will maintain high GPAs or complete difficult prerequisite coursework, other student course -taking behavior also has the potential to increase successful com pletion of health credentials. We examine a student’s credit accumulation (30+ units) and whether he or she took at least one full -time courseload or enrolled continuously in at least three terms. These markers are treated by the community college system as intermediate mi lestones toward earning a credential. We find that earning 30 or more units (often referred to as an indicator of “momentum ”) prior to health program entry is correlated with higher completion rates. 18 Similarly, once students enter a health program, the faster they accumulate credits, the more likely they are to complete a health credential. For each additional unit per term, completion rates are 2 points higher. Students who attend full time for at least one term are much more likely to complete as well. La st, those who enroll in at least three consecutive f all/spring terms once they enter a health program are substantially more likely —on the order of 15 points —to obtain an award. These students are often referred to as showing “persistence.” These relationships between student course -taking behavior and completion suggest that efforts to improve persistence and momentum could yield sizeable gains. 17 Inde ed the community college system has been assessing the impact of admission criteria and assessment tests on the racial/ethnic composition of students in nursing programs : see, for example, California Community Colleges Chancellor’s Office, Nursing Education Programs (2010) . 18 Because many health programs we evaluate require less than 30 units to complete, we do not measure momentum for students during the program, but rather focus on the prior enrollment period. PPIC.ORG Career Technical Education in Health 18 A student’s ability to attend full time or to quickly accumulate credits toward a degree may very well depend on whether he or she need s to work while attending school . Financial aid programs that serve health CTE stude nts may boost student success. Indeed we find that health CTE students who receive aid during their stud ies are more likely to finish. Specifically, completion rates are 5 points higher for thos e who received some financial aid during their health CTE program compared to those who do not. FIGURE 8 Prerequisite courses, momentum, and financial aid predict successful completion SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Results from a regression model of completion that controls for the socioeconomic factors (age, race, prior education, entry year, language, disability, citizenship status, economic disadvantage and academic disadvantage), college, program, and these variables. All coefficients shown are statistically significant at the 1% level. See Technical Appendix B for full model specification an d results. Given the strong relationships between student preparation and course -taking behavior, we next examine how these factors contribute to differential completion rates across programs. For example, do differences in student GPA or full -time attenda nce across programs explain the variation in completion rates? Figure 9 compares actual completion rates by program to rates that are adjusted for preparation and course-taking behavior. For program s with relatively high completion rates , adjusting for student course-taking or academic achievement does not substantially shift attainment rates. This suggests that most students in these programs are already exhibiting course -taking behavior that is likely to lead to completion. Nonetheless, a small fraction of students in these programs do not obtain degrees . While certain student services like counseling and tutoring might explain some of the remaining non- completion, personal circumstances and choi ces also likely factor in for these students. When we make these adjustments for programs with relatively low completion rates, the likelihood of students completing a health degree increases substantially. This reflects differences in the odds that stud ents attend full time, maintain higher GPAs, persist across terms, and the like. If course -taking patterns across all programs were more similar, completion rates would be much less variable than they actually are. These rates would range from a difference of nearly 50 points (the gap between EMS programs and dental hygiene programs ) to less than 2 0 points. 012345678910 1112131415 Higher GPA (per 0.5 points) Completed biology Completed anatomy Completed chemistry Earned 30+ units prior to program More units per term in program (per 1 unit) Enrolled in health program full-time for at least 1 term Persistence in health program (3 consecutive terms) Received financial aid during health program Difference in completion rate (percentage points) PPIC.ORG Career Technical Education in Health 19 FIGURE 9 D ifference s in completion rates across programs are mitigated once we account for course -taking behavior SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Unadjusted completion rate is the 6 year completion of a health credential for our health CT E student sample; students completing only non- health awards or transferring to four year colleges are excluded. The second set of bars adjust for student characteristics and course -taking before and after entering a health CTE program using regression models. All models include the socioeconomic factors shown in previous chart (age, race, prior education, entry year, language, disability, citiz enship status, economic disadvantage and academic disadvantage). Completion rates are shown for the reference categories as above and achieving academic markers including enrollment in three consecutive primary terms (persistence), full -time enrollment in at least one term, and sample averages for GPA and average number of units per term. See Technical Appendix B for full model specification and results. Examining the Racial Achievement Gap in Health Programs Improving completion among underrepresented minority students is of particular interest, both as an important aspect of increasing degree attainment overall and as a way of diversifying the health workforce so that it better ref lects and serves an increasingly diverse population . While we do find sizable achievement gaps between white and African American —and, to a lesser degree, Latino —students before adjusting for other student characteristics, we are able to explain these gaps once we control for socioeconomic factors, program choice, and course -taking behavior (Figure 10 ). 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of stduents completing health degree Unadjusted Adjusted - Course-taking Unadjusted Adjusted for course- taking patterns PPIC.ORG Career Technical Education in Health 20 FIGURE 10 Achievement gaps across racial/ethnic groups are explained by health program choice and student course-taking SOURCE: Author calculation s using CCCCO MIS data. NOTES: Chart shows difference in completion rates across race/ethnic groups (relative to white students) controlling for various independent variables, as described in text. Each bar plots the coefficient from a regression model ad ding successively more independent variables . See Technical Appendix B for more details. All models also control for college attended . After controlling for socioeconomic factors (age, citizenship status, educational level, and economic disadvantage), the completio n gap between white and African American students is reduced by about 2.5 percentage points and the gap between white and Latino students by nearly 1 point. The fact that students of different racial groups tend to choose programs with varying completion rates also explains a portion of these achievement gaps. Program choice explains more than 3 points of the completion gap between whites and African Americans, and 2 points of the white -Latino gap. Course -taking and achievement seem to account for the remaining completion gaps across racial/ ethnic groups. In fact, the completion gap is elim inated when we adjust for momentum and persistence , full -time enrollment and higher average units per term, and receiving financial aid . These results suggest that efforts to improve completion outcomes for all students, but particularly for underrepresented students , will be most effective if they can enable students to devote more time to their courses of study and performance after they have entered a health program. Such efforts can and do take many forms, from increased financial aid , to more course sections, to advising and other types of student support. I dentifying programs of study and degree goals in order to support completion pathways once a course of study is initiated could prove particularly beneficial. -14-12-10 -8-6-4-2 02African American Asian and Pacific Islander Latino Completion gap compared to White students (percentage points) Course-taking behavior Program choice Socio-economic factors Unadjusted PPIC.ORG Career Technical Education in Health 21 Opportunities for Students without High -Value CTE Credentials Although some programs are more likely to lead to higher wages than others —and there are systematic differences in completion across programs —students who choose a low-return program or fail t o obtain a credential do not necessarily lack economic opportunity. One potential benefit to pursing health CTE training is the chance to move into the health care industry, as an entry point to career ladders that —with additional training or experience —might pay off in the long run. Are students who pursue health CTE training at California’s community colleges able to migrate into the health care industry ? Slightly more than 25 percent of students were employed in the health care industry before they enr olled in a health CTE program. A similar share were employed in either the food services or retail industries. Within the three-year period after enrollment in a health CTE program, about 60 percent of students in our study sample were workin g in the health care industry. While employment in the industry is not necessarily tied directly to specific training (e.g. , hospitals hire janitors and nursing home s employ cooks ), the substantial shift in industry indicates a real change in employment situation regard less of whether students obtained credentials. TABLE 1 Industry of employment for health CTE students, pre - and post -enrollment Industry of employment Pre (3 -yr period before health CTE enrollment) Post (3 -yr period after health CTE enrollment) Health care and social assistance 26.0% 60.7% Hospitals 9.2% 31.7% Ambulatory health services 9.4% 18.9% Nursing and residential care 4.4% 6.9% Accommodation and food service 13.6% 3.7% Food services and drinking places 12.3% 3.1% Retail t rade 18.7% 5.5 % General merchandise stores 4.4% 1.3% Food and beverage stores 3.4% 1.0% Administrative and support services 6.2% 4.2% All other industries 35.5% 25.9% Total 100% 100% SOURCE: Author calculations using CCCCO MIS data. NOTES: The industry analysis is restricted to students who entered a health CTE program in years 2003 through 2009. We create three distinct 3 -year periods for all students entering in these years. The first period includes the 3 years prior to entrance ( Pre -peri od), the second period includes 3 years from the time of program entrance (during) which is not shown in the table, and the third period capt ures the 3 years following the second period (Post). Students may have enrollments during all of these periods and students may not complete a degree within 3 years of program entrance , if ever . Student employment is categorized by the industry in which they earned the highest aggregate wages in each 3 year period. Industry definitions are based on NAICS code at the 2 -digit and 3 -digit levels. Furthermore, students who shifted into the health care industry show more improvement in earnings than those who did not —regardless of whether they completed a program (Table 2). Among all health CTE students, average quarterly earnings in the three year period prior to entering a health training program were $2 ,607, and quarterly earnings increased to $8 ,433 in the three years after the program for an average total earnings increase of $5 ,826. PPIC.ORG Career Technical Education in Health 22 The median increase in earnings was $ 7,063 for CTE students who made this shift, and higher for those who completed a degree ($8, 661) compared to non- completers ($4,435). Even among non-completers who moved into the health care industry, earnings increases were larger ($4,435) compared to other non-completers who did not shift into health care ($2,694). Unlike our previous analysis of wages, these comparisons do not factor in individual factors. TABLE 2 Wage gains are greater for students who shift into the health industry afte r enrolling in a health CTE program Employed in the health industry? (pre/post-enrollment ) Change in q uarterly student wages All employed health CTE students Degree or certificate (3 -year) No degree or certificate Health industry / Health industry $7,969 $9,550 $4,303 Health industry / Non– health industry $4,431 $8,149 $3,261 Non–health industry / Health industry $7,063 $8,661 $4,435 Non-health industry / Non –health industry $2,712 $3,516 $2,694 SOURCE: Author calculations using CCCCO MIS data. NOTES: Only students who entered health CTE programs in school years 2003 through 2009 are included so that all students can be observed for a period of 3 years prior to program enrollment, 3 years during program e nrollment, and 3 years after program enrollment. The sample of health CTE students included in the industry analysis is 78,417 with 52,626 students earning a degree and 25,791 wh o did not earn a degree. Degree completion refers to 3 year completion; studen ts may still be enrolled in the program in both the 3 year pre and post enrollment periods. Industries defined based on 3 digit NAICS code for the industry with the highest aggregate wages during t he 3 year period defined prior to entering the program and the 3 year period after program enrollment. Changes in wages are calculated based on the change in median quarterly wages between the pre and post periods. All dollar amounts are adjusted for inflation. Our analysis shows that pursuing health CTE credentials pays off for students generally but is especially beneficial to those who obtain awards in longer-term programs and those who enroll in certain technical subfields. Nonetheless, even for students who do not complete a program or who obtain a lower-value credential, health CTE programs may afford opportunities to move into the in- demand health care industry. Whether that pays off in the long run depends on subsequent choices —an understudied issue that we plan to explore in future work. Conclusion Health CTE programs at California’s community colleges hold prom ise for students in the state. Many fields— even those outside registered nursing —offer students the opportunity to substanti vely improve their economic standing. T he odds that students will obtain credential s in health programs are often much higher than in other community college programs. However, there is room for improvement —especially given the dual goal of meet ing workforce needs and set ting more students on a path to upward mobility. S tudents who enter health programs are not substantially different from the overall student population— except that they are more likely to be older, female, and not in underrepresented minority groups. L arge shares of both health CTE students and the overall student population are economically or academically disadvantaged. These socioeconomic markers are correlated with completion rates, but their effects are largely explained by academic preparation (in terms of specific coursework ), intermediate milestones that indicate momentum and persistence, and access to financial aid . PPIC.ORG Career Technical Education in Health 23 The largest predictor of program completion is whether students attend full time once they enter a health program or attend consecutive terms. This is particularly true for Latino and African American students, which suggests that current and proposed reforms to encourage student progress are well targeted and may help the state create more diversity in the health workforce. State efforts to cover the full cost of schooling so that students can attend full time could help more students complete high -value health credentials. Considering that students who complete health CTE credentials increase their earnings 51 percent, on averag e, the economic return for policymaker and practitioner efforts to improve completion is quite large. The roughly 3 1,000 health CTE students who started a program during our study period but did not complete or transfer within six years would have earned an additional $10,200 per year (on average) had they obtained credential s. In total, the net additional earnings would have amount ed to nearly $ 320 million per year . 19 In addition to improving the economic standing of individual students , these gains would have had economic value to the state in terms of meeting health workforce needs. It is important to note that these earnings gains are not spread evenly across programs. Lower wage returns for many short -term credential s may call into question the va lue of offering these programs, particularly those that enroll large number s of students . However, the sizable growth in short -term health degrees conferred by for -profit colleges—which tend to cost more than similar programs at community colleges —indicates that there is significant demand for some lower -return programs . Given this demand for training , providing lower-cost opt ions for students wishing to pursue shorter-term degrees could be an important way for community colleges to help more Californians embark on career pathways in the health care industry . In fact, this is the subject of our companion report . Regardless, earning a credential is the first step to increasing earnings and/or moving along a career pathway , and more students could be taking this important step. By combining information on which programs offer better completion rates and increased earnings , students as well as colleges can make more informed choice s. At the same time, there app ear to be many policy levers— some of which we have outlined here —that could improve student outcomes in CTE programs . 19 These calculations are rough estimates based on our calculated 6 -year completion (or transfer) rate, the number of students who begin programs between 2000 -2009, the average wage return for health credentials, and assume $20,000 in median annual earnings prior to obtaining a health credential (estimate based on Sa lary Surfer statistics accessed 10/22/16). PPIC.ORG Career Technical Education in Health 24 REFERENCES Backes, Benjamin, Harry Holzer , and Erin Dunlop Velez. 2014. “Is it worth it? Postsecondary education and labor market outcomes for the disadvantaged.” National Center for Analysis of Longitudinal Data in Education Research, Working Paper 117. California Community Colleges Student Suc cess Task Force. 2012. “Advancing Student Success at the California Community Colleges .” Dadgar, Mina, and Madeline Joy Trimble. 2014. “Labor market returns to sub-baccalaureate credentials: How much does a community college degree or certificate pay?” Educational Evaluation and Policy Analysis. Heckman, James, Robert LaLonde, and Jeffrey Smith. 1999. “The economics a nd econometrics of active labor market programs.” In Handbook of Labor Economics, v. 3 part 1. Orley Ashenfelter and David Card, eds. Amsterdam: Elsevier Science. Jepsen, Christopher, Kenneth Troske, and Paul Coomes. 2014. “The labor-market returns to community college degrees, diplomas, and certificates.” Journal of Labor Economics, v. 32(1). Kurlaender, Michal, Scott Carrell, and Jacob Jackson. 2016. “The Promises and Pitfalls of Measuring Community College Quality .” The Russel Sage Journal of the Socia l Sciences, v. 2(1). Metzker, Brian, and Judy Heiman. 2016. “ California Community Colleges: Second Report on the Student Success Act of 2012.” California Legislative Analyst’s Office. McConville, Shannon, Sarah Bohn, and Laurel Beck. 2014. “ California’s Health Workforce Needs: Training Allied Workers .” Public Policy Institute of California. Sengupta, Ria , and Christopher Jepsen. 2006. “California’s Community College Students.” Public Policy Institute of California. Shulock, Nancy, Colleen Moore, and Jeremy Offenstein. 2011. The Road Less Traveled: Realizing the Potential of Career Technical Education in the California Community Colleges . Institute for Higher Education Leadership and Policy: S hulock, Nancy, Colleen Moore, and Connie Tan. 2012. Workforce Investments: State Strategies to Preserve Higher -Cost Career Education Programs in Community and Technical Colleges. Institute for Higher Education Leadership and Policy. Stevens, Ann Huff, Mich al Kurlaender, and Michel Grosz. 2015. “Career technical education and labor market outcomes: Evidence from California community colleges.” NBER Working Paper 21137. PPIC.ORG Career Technical Education in Health 25 ABOUT THE AUTHOR S Sarah Bohn is a research fellow at the Public Policy Institute of California. A labor economist, her work focuses on how policy affects individual and family economic well-being, with particular attention to low -income and vulnerable populations. Her current work addresses pover ty and inequality in California, the role of safety net policy , and the workforce skills gap . Sarah’s work has been covered by major media outlets including the New York Times, The Economist, and the Washington Post and has been published in a cademic journals including the American Economic Review, Demography, and the Review of Economics and Statistics. She holds a PhD in economics from the University of Maryland, College Park. Shannon McConville is a research associate at the Public Policy Institute of California. Her research interests include health care access, utilization, and outcomes among vulnerable populations. Her current work focuses on examining safety net programs, health wor kforce tr aining needs and capacity, and the effects of the Affordable Care Act in California, including the opportunities for and impa ct of health insurance coverage for the jail population. Before joining PPIC, she was a research training fellow in the Health Serv ices and Policy Analysis doctoral program at the University of California, Berkeley; a senior research associate at the Department of Health Research and Policy at Stanford University; and a project manager at the Lewis Center for Regional Policy Studies a t the University of California, Los Angeles. She holds an MPP degree from the University of California, Los Angeles. Landon Gibson is a former research associate at the Public Policy Institute of California, where he focused on health policy and safety net programs. Before joining PPIC, he was a research assistant at the University of California, Irvine, where he studied the mech anisms of cigarette addiction, and he was a quality assurance data analyst at a community health clinic. He is pursuing his master 's degree in public health at the University of California, Los Angeles, and holds a BS in biological sciences from the University of California, Irvine. ACKNOWLEDG MENTS The authors thank Hans Johnson for guidance and support and the staff of the Research Division of the California Community Colleges Chancellor’s Office for assistance with data . We also greatly appreciate reviews from Lynette Ubois, Olga Rodriguez, Debra Jones, Michal Kurlaender, and Michel Grosz. PUBLIC POLICY INSTITUTE OF CALIFORNIA Board of Directors Mas Masumoto, Chair Author and Farmer Mark Baldassare President and CEO Public Policy Institute of California Ruben Barrales President and CEO GROW Elect María Blanco Executive Director Undocumented Student Legal Services Center University of California Office of the President Louise Henry Bryson Chair Emerita, Board of Trustees J. Paul Getty Trust A. Marisa Chun Partner McDermott Will & Emery LLP Chet Hewitt President and CEO Sierra Health Foundation Phil Isenberg Former Chair Delta Stewardship Council Donna Lucas Chief Executive Officer Lucas Public Affairs Steven A. Merksamer Senior Partner Ni elsen, Merksamer, Parrinello, Gross & Leoni, LLP Gerald L. Parsky Chairman Aurora Capital Group Kim Polese Chairman ClearStreet, Inc. Gaddi H. Vasquez Senior Vice President, Government Affairs Edison International Southern California Edison The Public Policy Institute of California is dedicated to informing and improving public policy in California through independ ent, objective, nonpartisan research. Public Policy Institute of California 500 Washington Street, Suite 600 San Francisco, CA 94111 T: 415.291.4400 F: 415.291.4401 PPIC.ORG PPIC Sacramento Center Senator Office Building 1121 L Street, Suite 801 Sacramento, CA 95814 T: 916.440.1120 F: 916.440.1121" } ["___content":protected]=> string(104) "

R 1216SBR

" ["_permalink":protected]=> string(145) "https://www.ppic.org/publication/career-technical-education-in-health-an-overview-of-student-success-at-californias-community-colleges/r_1216sbr/" ["_next":protected]=> array(0) { } ["_prev":protected]=> array(0) { } ["_css_class":protected]=> NULL ["id"]=> int(9032) ["ID"]=> int(9032) ["post_author"]=> string(1) "1" ["post_content"]=> string(0) "" ["post_date"]=> string(19) "2017-05-20 02:43:12" ["post_excerpt"]=> string(0) "" ["post_parent"]=> int(4593) ["post_status"]=> string(7) "inherit" ["post_title"]=> string(9) "R 1216SBR" ["post_type"]=> string(10) "attachment" ["slug"]=> string(9) "r_1216sbr" ["__type":protected]=> NULL ["_wp_attached_file"]=> string(13) "R_1216SBR.pdf" ["wpmf_size"]=> string(6) "473812" ["wpmf_filetype"]=> string(3) "pdf" ["wpmf_order"]=> string(1) "0" ["searchwp_content"]=> string(71595) "DECEMBER 2016 Sarah Bohn, Shannon McConville, and Landon Gibson With research support from Gilbert Placeres Supported with funding from the Sutton Family Fund Career Technical Education in Health An Overview of Student Success at California’s Community Colleges © 2016 Public Policy Institute of California PPIC is a public charity. It does not take or support positions on any ballot measures or on any local, state, or federal legislation, nor does it endorse, support, or oppose any political parties or candidates for public office. Short sections of text, not to exceed three paragraphs, may be quoted without written permission provided that full attribution is given to the source. Research publications reflect the views of the authors and do not necessarily reflect the views of our funders or of the staff, officers, advisory councils, or board of directors of the Public Policy Institute of California. Introduction 5 Health CTE Enrollment at California Community Colleges 7 Health CTE Degrees Create Economic Opportunity 11 Improving Completion Rates 14 Opportunities for Students without High -Value CTE Credentials 21 Conclusion 22 References 24 About the Authors 25 Acknowledgments 25 Technical appendices to this paper are available on the PPIC website. Career technical education (CTE) has received renewed focus from state and national policymakers interested in improving economic outcomes of students and addressing the state’s workforce needs. California’s community colleges are the state’s primary provi der of CTE, also known as vocational education. Career training in health care holds particular promise for students and the state’s economy —health CTE programs attract a large and diverse set of students in California and are linked to growing job opportu nities in health services, a generally well -paying industry for Californians with less than a bachelor’s degree. In this report, we examine outcomes for the 120,000 students who pursued health CTE degrees across California’s community college system over the past decade.  Health CTE students are predominantly female and tend to be slightly older than community college students overall, including those enrolled in other CTE programs. However, nearly 60 percent are identified as academically disadvantaged and 70 percent are economically disadvantaged.  Health CTE credentials afford sizeable returns to students in California, who earn 50 percent more, on average, after they complete their schooling. Returns do not vary across socioeconomic groups but do vary across the type of credential. Associate degrees afford returns about 2 times larger than long -term certificates and about 10 times larger than short term -certificates. However, even within those categorizations, there is variation across programs, with sh ort term certificates in Paramedic programs resulting in much higher returns than for Medical Assistants, for example.  Overall completion rates for health CTE programs are relatively high: more than 70 percent of students who begin a program either obtain a degree or transfer to a four -year college within six years, while only about half of the overall CTE student population obtain a credential within six years. However, success varies substantially across health programs, ranging from 93 percent in dental hygienist programs to 44 percent in emergency medical services.  Although a high share of health students do earn credentials, there are racial and ethnic achievement gaps across health programs. Program choice explains some of the gap, but academic pre paration, financial aid, and course -taking behavior (in particular, full -time attendance and persistence) explain almost all of the observed achievement gap. Policymaker efforts to improve completion rates and reduce achievement gaps could focus on increas ing full-time enrollment and consecutive- term enrollment CONTENTS SUMMARY PPIC.ORG Career Technical Education in Health 4 for students after entering health programs. We find that students who enter health training but do not obtain programs may nonetheless be able to enter the health care industry and experience car eer growth over the long term. But obtaining credentials, particularly in high -reward programs will do the most to improve student and workforce outcomes. PPIC.ORG Career Technical Education in Health 5 Introduction Rising economic inequality in the United States over the past few decades has led to wide-ranging conversations about how to improve economic mobility, especially for disadvantaged groups. Education, the single strongest correlate of economic success, is often regarded as the best way to promote upward mobility. Career technical education (CTE) has garnered particular interest, as perhaps the most proximate tie between postsecondary training and the labor market . Many CTE credentials can be earned over short time horizons, leading to relatively fast wage and labor market gains. S tate and national policymakers have renewed their focus on CTE in recent years. The 2014 Workforce Innovation and Opportunity Act revised federal legislation on large -scale workforce training investment, better engaging community colleges and placing special emphasis on career technical education. In California, in addition to recent voter -approved increases in funding for K –14 education that have benefitted the state’s community college system, policymakers have directed resources to CTE in particular. The state pi loted—and then renewed —the California Career Pathways Trust (CCPT) to invest in CTE pathways. The CCPT has allocated more than $500 million since 2014 to school districts, county offices of education, community college districts, and other partners to support efforts to design and implement well -defined career pathways for CTE programs and support student success. California’s most recent budget also directed an additional $200 million to the Strong Workforce Program, which aims to increase the availability of high-quality, in -demand CTE courses at the community colleges . Career pathways in health -related fields hold particular promise for students and the state economy. California’s health care sector is large and growing ; it provides key services to the s tate’s population as well as employment opportunities to a wide variety of workers. With a growing and aging population, the demand for health workers is projected to continue to grow substantially over the next decade. California’s health workforce is projected to require nearly half a million new workers over the next decade, with more than 40 percent of future health jobs likely to require either postsecondary certificates or associate degrees (McConville, Bohn, and Beck 2014). In addition to satisfying workforce needs, many postsecondary health credentials yield greater labor market returns than other community college –level training (Stevens, Kurlaender, and Grosz 2015; Jepsen, Troske, and Coombs 2014; Dadgar and Wei ss 2015). Furthermore, the need to diversify the health workforce to serve an increasingly diverse senior population provides an additional impetus to ensure that underrepresented minority students and other disadvantaged groups pursue health credentials. C ommunity colleges are well-positioned to address this need , since they serve a high er percentage of underrepresented minority students than other public higher education institutions . F or -profit institutions also provide training in health CTE programs —and they represent the lion’s share of the growth in sub- baccalaureate health degrees over the past decade (McConville et al . 2014). However, i ncreased scrutiny of for -profit colleges due to poor graduation rates, high levels of student debt, and questions about the value of degrees —along with several recent closures of for -profit institutions —has shifted even more attention to the state’s public two -year colleges. While health CTE training has the potential to improve employment and economic outcomes, man y issues and questions need to be addressed. A lthough labor market returns to health CTE awards are sizeable, it is not clear how labor market opportunities vary across health programs or how outcomes differ for students with wide - ranging socioeconomic bac kgrounds. To ensure the efficacy of recent investments —and future reforms —and ultimately to improve economic outcomes through vocational education, it is crucial to identify the student, institution al, and policy choices that lead to optimal outcomes. PPIC.ORG Career Technical Education in Health 6 In this report, we document the pathways to successful completion of health CTE programs in California’s Community College system. We also examine the employment outcomes of students —who complete health CTE degrees as well as those who begin a program but do not finish— to gauge the economic returns for students and the ability of the community college system to train workers for in -demand health jobs. Data Used in This Study To assess the experience of students in health programs in California’s community c olleges, we use longitudinal student data maintained by the Chancellor’s Office. These records contain basic demographic information about the students as well as courses completed or attempted, grades, and credentials received. For most analyses, we use r ecords for students who completed their first health CTE courses between 2000 and 2009. For these students, we also have records on earnings (at the quarter level) between 2000 and2014, if they had jobs covered by the Unemployment Insurance system. See Technical Appendix A for full details. PPIC.ORG Career Technical Education in Health 7 Health CTE Enrollment at California Community Colleges Over the past decade, about 120,000 students entered health CTE program s at California community colleges with the intention of obtaining degrees or credential s. F rom the early 2000s to the end of the decade, about 12,000 students on average each year completed at least eight units in a single health CTE program—a marker used by t he Chancellor’s Office to signal the intent to pursue a CTE credential (Figure 1). 1 Registered nursing, emergency medical services (EMS), and licensed vocational nursing (LVN) had the largest student enrollment , although more than 20 different health programs had at least 1,000 CTE degree- bound students during our study period. Overall, we identified students pursuing CTE degree s across m ore than 40 different health programs. FIGURE 1 Enrollment in health CTE programs has been increasing SOURCE: Author’s calculations from CCCCO data. NOTE: See text box and Technical Appendix A for details on defining CTE degree- bound students. Community colleges offer a range of credentials, from short -term and long -term certificates to associate degrees.2 While the three largest programs account ed for about half of students pursuing health CTE degrees during our study period, other programs —including medical assistant, dental assistant, health IT and administration, respiratory therapy, and technician —had 3,000 to 5,000 students pursuing degrees (Figure 2). 1 We define health CTE -intending students as those who complete at least eight units in a single health program within three years of starting a vocational he alth program (see Text Box). The student counts presented in this section represent individual students. It is possible that a student may have entered a health CTE program more than once over our 10 -year study period, however, for our analysis we only include individual students once reflecting the first instance during ou r sample period that they met the criteria of taking 8 units in a single health program. See Technical Appendix A for more information. 2 Short -term certificates are defined as those that take less than one year to complete and include certificates requiring less than 18 units, both those approved by the Chancellor’s office and local certificates, and certificates requiring between 18 and 29 units. Long- term certificates typically take between one and two years to complete are include certifi cates requiring between 30 and 59 units, and 60 or more units. 0 2000 4000 6000 8000 10000 12000 14000 16000 2000 200120022003200420052006200720082009 Health CTE degree- intending students All Health CTE Students Registered Nursing Emergency Medical Services Licensed Vocational Nursing PPIC.ORG Career Technical Education in Health 8 FIGURE 2 Distribution of health CTE students across programs SOURCE: Author calculations from CCCCO data. NOTE S: Includes all health CTE -in tending students entering programs during the 2000 through 2009 school years. “ M edical assistant ” includes clinical and a dministrative; “technician ” includes psychiatric, pharmacy, cardiovascular, surgical, occupational therapy, o ptical, and radiation therap y. For details on program enrollments by detailed program ca tegories refer to Technical Appendix A . 31% 16% 7% 4% 6% 4% 3% 2% 3% 8% 3% 13% Registered Nursing EMS/Paramedic Licensed Vocational Nursing Dental Assistant Medical Assistant Radiology/Sonography Respiratory Therapy Dental Hygienist Certified Nursing Assistant Technician Health IT and administration All Other Identifying health CTE students California’s community colleges are open -access institutions and generally do not require students to declare, apply for, or be accepted to a particular program of study —there are a few exceptions, such as registered nursing, and current reforms aim to enc ourage students to define their educational goals . Nonetheless, currently it is complicated to identify students who start a particular program but do not finish. We use a strategy similar to that employed by the CCCCO and recent work (Stevens et al. 2015) to identify health CTE students based on their enrollment in certain courses. First, we observe students who completed their first vocational health courses sometime between the 2000 and 2009 school years. If a student subsequently earned at least 8 units in a single health program within three years of completing their first vocational health course, we identity him or her as a “health CTE -intending student”. Health programs are defined by 6 - digit TOP codes. We have tes ted this definition and found that lower cutoffs (6 units or 4 units, for example) or more restrictive cutoffs (achieving 8 units in a shorter time), does not materially impact our results. In addition, 8 4 percent of students who earn a health CTE credenti al meet this 8 unit criterion. It could be that other students would like to pursue health credentials but never enroll in the initial health CTE courses we observe, either because they have not completed prerequisite courses or because the college they wa nt to attend does not have enough capacity in certain programs. While these issues are discussed further in the text, we generally regard them as outside the scope of this report. See Technical Appendix A for full details. PPIC.ORG Career Technical Education in Health 9 Which Students Pursue Health CTE Degrees? Students who pursue degrees in health CTE programs are older and a higher proportion are women , white , and Asian (Figure 3) . About 55 percent of health CTE students were age 25 or older , compared to about 45 percent of all community college students enrolled in credit courses over the same time period. M ore than seven in ten students enrolled in health CTE programs were women, compared to about 55 percent of all community college students and slightly fewer than half of students in other CTE programs . When we exclude students in nursing programs, the share of women and older students declines slightly but these groups remain overrepresented relative to the general student population. FIGURE 3 H ealth CTE students are more likely to be over age 25 and female than other students SOURCES: Author’s analysis of CCCCO MIS data; CCCCO D atamart. NOTE: Distributions of all credit students are calculated based on averages of student counts of term -level data available from D atamart and do not represent unique individual students over the time period. Health CTE and other CTE student characteristics are, however, based on unduplicated student counts and include students identified as CTE -intending in school years 2000 –2009. There are, however, some differences in student characteristics across programs. For example, while women make up more than 80 percent of students in registered nursing, licensed vocational nursing , and certified nursing assistant program s, fewer than 30 percent of students in EMS programs are women. EMS programs also stand out for their racial compo sition; white students are o verrepresented (comprising 60% of EMS students) while African American students are under represented (comprising less than 4%) relative to their shares among all health CTE students ( technical appendix T able A4). So while health CTE students at California’s community college are more diverse than the student population in California’s other public higher education systems, they are somewhat less diverse than in other CTE program s or the community college system as a whole, particularly across certain programs. This suggests that there may be opportunities to improve the diversity of students enrolled in health programs. 0% 10% 20% 30% 40% 50% 60% 70% 80% Over 25 FemaleNon-hispanic white Latino African American Asian and Pacific Islander Percentage of students Health CTE-intending Other CTE-intending All credit students PPIC.ORG Career Technical Education in Health 10 Health CTE programs serve a wide range of economically disadvantaged students. Nearly 40 percent received a Pell Grant at some point in their community college career . 3 And we estimate that 60 percent received a Board of Governors (BOG) fee waiver —which is awarded to low -income students and/or those who receiv e cash assistance through social safety net programs . 4 Furthermore, health CTE appears to attract a relatively sizeable share of students i dentified as CalWORKs recipients. 5 In fact, if we expand the definition of economic disadvantage to include students who received one or more of these type s of aid or were designated as economically disadvantaged for the purposes of receiving Vocational Technical Education Act (VTEA) funds, nearly 70 percent of health CTE students are economically disadvantaged at some p oint in their community college enrollment. 6 Academic Preparation among Health CTE Students Academic preparation plays an important role in boosting program access for disadvantaged students—it also plays a key role in completion, which we examine below. In some respects, students in health programs appear to be better prepared than the overall community college student body , although a large share of students in health CTE programs nonetheless show markers of academic disadvantage. On average, students pursuing health degrees were enrolled in the community college system for about three academic terms in the three years before they entered the health program . About 30 percent had completed at least 30 units. These students may have b een taking preparatory work for health program s and/or had to wait for spaces to open up in their desired program s of study . About 10 percent of students had already earned at least one community college credential before enrolling in a health program , and 20 percent reported earning bachelor ’s or associate degrees before entering a health program. N early 45 percent of health CTE students took at least one biological science course, such as biology or anatomy , in the three years before they began their health CTE program . And although we find little difference i n the number of terms completed across socioeconomic groups of health CTE students, we do find some evidence that more students who are economically dis advantaged attempted and failed common prerequisite courses for health programs such as biology or anatomy compared to those not disadvantaged, which might have affected their choice of health program s. Furthermore, system -wide, students in underrepresent ed groups are less likely to complete certain coursework such as math and science courses, which could prevent them from enter ing some health CTE programs. At the same time, more than three-quarters of s tudents seeking degrees in health CTE programs enrolle d in at least one basic skills or remedial education course and nearly 60 percent had been categorized as academically disadvantaged at some point in their community college history . 7 And the shares of health CTE students with academic and economic disadvantage remain largely the same even when we exclude students in registered 3 While there is no single income guideline for determining Pell Grant eligibility, profiles of students who receive Pell Grant s indicate that they have low family incomes. More than 70 percent of Pell Grant recipients nationwide have an annual family incom e below $30,000 according to the US Department of Education Pell Grant Year End Report, 2013– 14. 4 Other social safety net programs include Supplemental Security Income (SSI), General Assistance, or CalWORKs. Authors calcula tions based on information from CCCCO Datamart, accessed 6/17/16. 5 According to CCCCO, approximately 30,000 CalWORKs students were enrolled in each school year during the period 2006– 07 and 2008–09, which falls in the middle of our study period. Our sample of health CTE students contains nearly 10,000 students who were identified as CalWORKs recipients at some point during their observed enrollment at California community colleges. Although we define our study period based on enrollments between school years 2000 and 2010, we have stude nt information covering the period from 1993 through 2013. For the purposes of identifying economically disadvantaged students, including CalWORKs, GA, SSI, and other poverty -related makers, we use information across the entire time period to define measur es indicating the student ever fell into one of these economically disadvantaged categories. 6 Carl Perkins Vocational Technical Education Act of 2006 provided funding for vocational education. Act was revised and reauth orized in 2012, now the Career Techn ical Education Act (CTEA). 7 Academic disadvantage is defined by the community college system and indicates that a student meets at least one of the following criteria: has been on academic probation or dismissal, had enrolled in remediation courses, or h ad received specialized services to support disadvantaged students. PPIC.ORG Career Technical Education in Health 11 nursing programs , which because of more stringent entrance requirements may be less accessible to disadvantaged students ( see Technical Appendix A ). Overall we find that a div erse group of students are served by health CTE programs , even if there is room for improvement. We now turn to an analysis of the economic returns of these programs. Health CTE Degrees Create Economic Opportunity Many CTE programs, especially health CTE p rograms, are designed to prepare students for specific occupations —and to provide a route to increased earnings. Many health careers offer salaries well above the norm for com munity college credentials. S tudents who receive associate degree s in nursing (AD N) see sizable wage gains after obtaining their degree s, as do students earning other health CTE degrees—such as radiological technicians, dental hygienists, and physician assistants. 8 In fact, according to the Chancellor’s Office, 18 of the top- 25 wage -enhancing degrees are in health. 9 These statistics point to the potential benefits of encouraging students to pursue high- reward health careers. However, there is a lot of variation across programs. Also, large wage gains for some students do not nece ssarily signal gains for all. And, of course, a fair share of students fail to complete a credential or transfer. To assess the success of health CTE programs, it is important to examine employment outcomes in detail. The most important economic outcome for students, of course, is their ear ning capacity . Many factors affect earnings, and not all are related to completing a degree; that is why looking at average student earnings before and after college is not particularly informativ e. In particular, individual characteristics—such as ability or drive—are likely to lead to higher earnings regardless of completing a credential. If high -ability students tend to enter certain programs, looking at how much students in those programs earn before and after obtaining a degree tells you more about the students than the training. The ideal way to measure the economic value of a degree is to compare a student’s earnings trajectory with and without a degree. Of course, such a comparison has to be abstract. But the rich ness of the student information used in this study allows us to approximate it. W e use each student’s earnings trajectory before completing a h ealth credential as a control for all of the characteristics that relat e to the student’s underlying ability. At the same tim e, we compare the earnings trajectory for students who complete a program to those who enter a program but never finish . Both groups of students, in general, have an upward wage trajectory, but the difference between the two tells us how much completing a credential (beyond simply entering a program) increases earnings. Our approach closely follows that of Stevens, Kurlaender, and Grosz (2015), largely replicating their results on our specific sample. See Technical Appendix C for further detail. A number of recent studies use similar methods to measure wage returns for vocational programs in various state contexts ( Stevens et al . 2015 in California , Dadgar and Trimble 2015 in Washington, Jepsen et al. 2014 in Kentucky) . All find that returns increase with length of study and vary substantially by program. This work also consistently finds that health CTE degrees are among the most valuable in terms of increasing employment and 8 This is according to wage information made available by the Community College Chancellor’s Office on their Salary Surfer website, which provides information on median wages for students before and after completing awards in specific programs of study. See http://salarysurfer.cccco.edu/SalarySurfer.aspx; we accessed these statistics 7/5/16, and they pertain to the cohort of students earning an award between 2004– 05 and 2008–09. 9 The othe r top earning certificates are in engineering programs, where, for example, the median student who earns an electrical system s certificate goes from $69,000 before the award to $124,000 afterwards. Note, of course, that the higher earnings before this awar d probably signal a very different student than among the health programs cited. Other top earning engineering awards are similar, with the exception of programs in heavy equipment maintenance. PPIC.ORG Career Technical Education in Health 12 wage outcomes. While these studies examine wage returns to health degrees based on differing award levels — short -term certificates, long -term certificates, and associate degrees— they typically focus on nursing and do not delve into the differences across ot her health programs. And while nursing is the largest single health CTE program, 70 percent of health CTE students in California’s community colleges are enrolled in programs other than registered nursing. On average, h ealth CTE students who obtain credentials increase their earnings 51 percent above both their own earnings before entering CTE training and the wage increase experienced by non -completers (Figure 4 ). The returns are larger for students who earn associate degrees (63%) th an for those who earn long -term certificates ( 39% ). Compared to all health CTE students, those who earn only a short term certificate see a smaller, but positive 6 percent increase in earnings. 10 FIGURE 4 Obtaining a health CTE credential substantially increases earnings SOURCES: Author’s calculations of CCCCO MIS data. NOTES: Chart shows the wage increase an individual experiences after completing a health credential, net of the wage increase the average non- completer earned over the same time frame. Specifically, each bar is the coefficient from a fixed effect regression model of the log quarterly wage on year- quarter, age, enrollment, award completion, and student identifier . The universe includes health -CTE intending students who took a first health CTE course between 2003 and 2009 and either completed a credential or did not (transfer students are omitted), and were between age 18 and 54 at start. For students that earned more than one award during the sample period, we measure the effect of the highest award level o nly. Students are observed (in course taking and wages) from 2000 to 2014, to allow for credential attainment and wage trajectory both before and after. All estimates are statistically significant at the 1% level except for the short term credential return compared to all health CTE -intending students, which is significant at the 5% level . See Technical Appendix C for more details. Although the average wage return of a health credential is large and positive, and generally increases along with program length, some long-term and short -term certificate programs equal or outperform associate degree programs. For example, students who complete paramedic certificates typica lly see wage gains similar to some associate programs (about 56%). The sizeable earnings gain for health CTE programs overall is driven by a 10 We also compare the earnings gain for students who earn he alth awards compared to students who enter similar length programs; the results are similar. See T echnical Appendi x C for these results as well as numerous additional robustness checks. 0% 10% 20% 30% 40% 50% 60% 70% Any credential AssociatesLong term certificate Short term certificate Wage increase of a health CTE degreeholder relative to a non–degree holder PPIC.ORG Career Technical Education in Health 13 handful of programs: registered nursing, radiologic tech, paramedics, respiratory therapy, and dental hygienist. Hi gher wages in these areas are attributable not just to credential attainment but also industry certification. It is true that educational credentials typically prepare student s for certification tests, but we cannot measure the two separately . Other major short -term credential programs have smaller wage return s than those for most longer-term health CTE programs . In fact, except for health IT credentials, we cannot statistically distinguish the returns from zero. 11 FIGURE 5 Earnings gains vary substantially across programs SOURCES: Author’s calculations of CCCCO MIS data. NOTES: Chart shows the wage increase an individual experiences after completing a health credential, net of the wage increase the average non- completer ea rned over the same time frame. Specifically, each bar is the coefficient from a fixed effect regression model of the log quarterly wage on year- quarter, age, enrollment, award completion, and student fixed effects. The universe includes health -CTE intending students who took a first health CTE course between 2003 and 2009 and either completed a credential or did not (transfer students are omitted), and were between the ages of 18 and 54 at the start. For students that earned more than one award during the sample period, we me asure the effect of the highest award level only. Students are observed (in course taking and wages) from 2000 to 2014, to al low for credential attainment and wage trajectory both before and after. All estimates are statistically significant at the 1% leve l unless noted . See Technical Appendix C for more details. *Note : Results are not statistically significantly different from zero. Our estimates control for individual characteristics by measuring the growth in earnings for each student after he or she earns a health credential . It is possible that certain student groups figure more prominently in the overall positive return —just as cer tain programs do. But that does not seem to be the case. We find that wage returns are remarkably similar across a wide range of socioeconomic characteristics. Gender, race and ethnicity, signals of 11 These findings hold even when we attempt to grow the sample in various ways. Using more years of data, we still detect only small, insignificant returns to these short term credentials, with the exception of EMS. We estimate an 8 to 10 percent return in earnings for EMS, sometimes statistically significant, depending on the sample. * * ** * -10% 0% 10% 20% 30% 40% 50% 60% 70% Registered Nursing Radiologic Technology Respiratory Care/Therapy Dental Hygienist Licensed Vocational Nursing Dental Assistant Psychiatric Technician Emergency Medical Services Medical Assisting Certified Nurse AssistantPharmacy Technology Home Health Aide Paramedic Health Information Technology Associates Long term certificate Short term certificate Wage increase of health CTE credential PPIC.ORG Career Technical Education in Health 14 economic disadvantage (such as receiving Pell G rants or participating in CalWORKs), and the region of the state where the credentials were earned do not appear to affect the return to community college health CTE credentials (see Technic al Appendix C for detailed estimates). This suggests that efforts to increase completion of these programs —for average and for historically underrepresented students— are likely to pay off. Nonetheless, the choice of which credential to pursue is clearly a huge factor in how much a student’s economic opportunity might grow as a result of purs uing postsecondary education. As we showed earlier, program choice does vary across socioeconomic characteristics, and it turns out that the choice of program has a significant bearing on whether student s obtain a credential at all. In order to improve outcomes across all student groups, we need to know more about this and other factors in the completion of health programs . Improving Completion Rates Given the dual goal of preparing students for rewarding health careers and meeting the state’s workforce needs, it is crucial to identify factors related to successful outcomes across the health CTE programs throughout the community college system . Registered nursing program s are the largest and most selective—and therefore have high completion rates. But only three in ten health CTE students are in registered nursing programs. Community colleges are being challenged to improve student outcomes, particularly by increasing the number who earn credential s or transfer to four- year colleges ( CCC Student Success Task Force 2012; Metzker and Heiman 2016; Sengupta and Jensen 2006; Shulock, Moore, and Offenstein 2011) . The overall completion rate across C alifornia’s community college system is only 47 percent. Completion across all CTE programs is slightly higher , at 51 percent —probably because CTE programs are more likely to set shorter -term completion goals, such as certificates, than more general programs. 12 Recent efforts to improve completion rates culminated in the Student Success Act of 2012, which required changes to enrollment practices, curriculum, and supports that have the potential to help more students complete community college program s across all areas of study . These efforts, along with new initiatives targeted specifically at developing CTE programs, may prove effective in improving completion in health programs. In particular , insufficient course offerings in high -demand program s are especially problematic for CTE programs because courses are more costly to offer (Shulock et al. 2012) . This is why nursing programs at community colleges have long received supplementary funding to ensure adequate course offerings, faculty, and othe r resources needed to meet the state’s nursing workforce needs. Given the importance of degree completion for students, colleges, and the economy, we now turn to a detailed analysis of completi on within health CTE programs. We highlight differences in co mpletion across programs and student groups and measure how student choices might improve the odds of success. Overall Health CTE Completion Is Relatively High Among the sample of students seeking degrees in health CTE programs, 5 9 percent either obtain some type of credential or transfer to a four -year college within three year s and slightly more than half earn a credit award in a health program (Figure 6). When we extend the time window to six years after program entrance, completion rates increase—nearly three -quarters (74%) obtain a certificate or degree and/or transfer to a four -year college and 12 CCCCO Scorecard, accessed 6/17/16. Based on six -year completion for first -time students in 2009– 10. PPIC.ORG Career Technical Education in Health 15 two -thirds (67 %) obtain a health credential. While these completion rates are high compared to other CTE programs, the fact that only half of students complete a health degre e within three years suggest there may be opportunities to shorten the time to degree , particularly when we consider health students have been enrolled for three terms, on average, prior to beginning their health programs. FIGURE 6 Mo st health CTE students get degrees or transfer to four- year schools SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Completion is measured for all health CTE students who entered programs between school years 2000 and 2009 . Both the three -year and six-year completion rates also adjust for colleges not reporting local certificates for certain short -term health programs. See Technical Appendix A for more details. Perhaps not surprisingly, the difference between three- and six-year completion rates is driven almost entirely by more students earning an associate degree or transferring to a four year college . Nearly one -third of students who enter a health CTE program o btain a ssociate degree s in a health field or transfer within three years; that share increases to about half of students when we look out six years. The vast majority of students who do complete programs receive associate degree s. Only about 10 percent of health CTE students earn short -term certificate s ( requiring less than 30 units) as their highest degree and about 13 percent earn a long -term certificate ( which requires more than 30 units) . These rates remain largely the same regardless of the time window for completion. 13 C ompletion Varies across Health Programs Given the sizable variation in economic returns a cross health credentials, we now turn to a more detailed look at completion of health degrees across different programs. Figure 7 presents six-year completion rates of health degrees for the largest health CTE programs. The actual or unadjusted completion rates are simply the percent age of students who begin the health CTE program and earn a certificate or an associate degree in a 13 An unknown share of short -term certificates (6 -18 units) are a warded locally by colleges and are not reported in the CCCCO student -level data. For this reason, short term certificate completion may be understated. We examine programs and colleges that have potentially artificially low completion rates due to non- reporting. Excluding these does not substantively affect overall completion rates, however. See Technical Appendix A and B for more details. 51% 59% 67% 74% 0% 10% 20% 30% 40% 50% 60% 70% 80% Health credential Any credential or transfer Percent of students in health CTE programs 3-year completion 6-year completion PPIC.ORG Career Technical Education in Health 16 health program within six years.14 Registered nursing and dental hygienist students have the highest completion rates —85 and 9 3 percent, respectively —followed by respiratory therapy and radiological technology students. At the other extreme, emergency medical services and health IT programs have completion rates below 50 percent . 15 The composition of students does vary across some health programs in terms of age, gender, ethnicity, as discussed above—and some of these student characteristics are associated with higher or lower completion rates. So to isolate the impact of the choice of health program from the composition of the students enrolled in a program, we hold constant several student characteristics—including age and education level at program entrance, race, ci tizenship, language ability, as well as economic and academic disadvantage. We also account for the colleges that health CTE students attended. The second set of bars in Figure 7 shows that the relatively large differences in completion rates across programs persist even after adjusting for individual demographic and socio economic characteristics and for the college attended. 16 FIGURE 7 Completion rates vary considerably across health programs SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Unadjusted rates are actual 6 -year completion rates for students in our sample of CTE -intending students, according to the program in which they earned the most credits. Adjusted completion rates control for student gender, race/ethnicity , citizenship status , age , education level at program entrance , year of entry, disability status, limited English proficiency, academic disadvantage ( as defined by CCCCO), economic disadvantage , and the college of attendance. The adjusted rates use the following reference gro up: White, female, citizen, high school diploma, academically disadvantaged, non -disabled, and not limited English proficient. Students completing only non - health awards or transferring to four year colleges are excluded from this analysis . See Technical Appendix B for full regression results. 14 We focus on completion of health awards t o examine differences across health CTE programs. The unadjusted and adjusted completion rates presented below do not include students who completed only non -health awards or transferred to a four year college. 15 Once again, even controlling for potentially locally awarded certificates at select colleges does not alter these conclusions . 16 See Technical Appendix B for details on our statistical analysis of completion. Briefly, we estimate linear probability models predicting whether health CTE students complete a health credential within 6 years of entering a program. We control for demographic characteristics and college fi xed effects in this first model. Research on California’s Community Colleges suggests that the college students attend affects the likelihood of degree completion above a nd beyond controlling for individual student factors (Kurlaender, Carrell, and Jackson 2016). 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Percent of students completing health degree Unadjusted Adjusted - Socio-economic Unadjusted Adjusted for socioeconomic differences PPIC.ORG Career Technical Education in Health 17 Although there does not seem to be a direct correlation between studen t socioeconomic characteristics and differential completion ra tes across programs, there may be an indirect link by way of program admission requirements. Community college courses are generally open access, except in special cases where admission requirements are put in place to alloc ate resources effectively and maximize returns on investment in certain programs, particularly those tha t are more expensive to offer. Students need to be prepared for program coursework and have a high likelihood of completing a degree, especially if capacity is limited and many student s seek admission . Registered nursing is a prime example—most if not all colleges have strict admission criteria — su ch as prerequisite courses, minimum GPA, and assessment tests— for these programs. Because there is no comprehensive accounting of entrance re quirements across programs and colleges over time, we cannot systematically assess the impact of program admission criteria on student success. We d id, however, analyze qualitative information on several large health CTE programs from community college course catalogs for the 2012–13 school year. Not surprisingly, programs with the highest completion rates —upwards of 80 percent of students who begin programs for registered nursing, respiratory therapy, and dental hygiene earn degrees —do have more rigor ous admission criteria than programs such as medical assisting and certified nursing assisting . While this makes sense in terms of ensuring that stud ents are prepared for a program’s coursework , these criteria can prevent many students from accessing certain programs. Because underrepresented students are less likely to be prepared for college, they may be less likely to gain access to high- demand and highly rewarded programs, and this in turn may make it harder to close achievement gaps and diversify the health workforce. 17 To assess the role of academic preparation in differential completion rates across programs, we examine how completion of specific pre requisite coursework before entering a health program and course -taking during a health program predict success. Completing a biology, anatomy, or chemistry class in advance increases the odds of finishing a health CTE credential by 4 to 6 percentage points (Figure 8). This correlation persists regardless of whether a student enters a program with strong pre requisite requirements. We also examine student GPA, another indicator of academic preparation. We find that for each 0.5 grade points higher the GPA, student completion rates increase by 6 percentage points. These findings suggest, not surprisingly, that ability and preparation lead to more successful outcomes. While not all students will maintain high GPAs or complete difficult prerequisite coursework, other student course -taking behavior also has the potential to increase successful com pletion of health credentials. We examine a student’s credit accumulation (30+ units) and whether he or she took at least one full -time courseload or enrolled continuously in at least three terms. These markers are treated by the community college system as intermediate mi lestones toward earning a credential. We find that earning 30 or more units (often referred to as an indicator of “momentum ”) prior to health program entry is correlated with higher completion rates. 18 Similarly, once students enter a health program, the faster they accumulate credits, the more likely they are to complete a health credential. For each additional unit per term, completion rates are 2 points higher. Students who attend full time for at least one term are much more likely to complete as well. La st, those who enroll in at least three consecutive f all/spring terms once they enter a health program are substantially more likely —on the order of 15 points —to obtain an award. These students are often referred to as showing “persistence.” These relationships between student course -taking behavior and completion suggest that efforts to improve persistence and momentum could yield sizeable gains. 17 Inde ed the community college system has been assessing the impact of admission criteria and assessment tests on the racial/ethnic composition of students in nursing programs : see, for example, California Community Colleges Chancellor’s Office, Nursing Education Programs (2010) . 18 Because many health programs we evaluate require less than 30 units to complete, we do not measure momentum for students during the program, but rather focus on the prior enrollment period. PPIC.ORG Career Technical Education in Health 18 A student’s ability to attend full time or to quickly accumulate credits toward a degree may very well depend on whether he or she need s to work while attending school . Financial aid programs that serve health CTE stude nts may boost student success. Indeed we find that health CTE students who receive aid during their stud ies are more likely to finish. Specifically, completion rates are 5 points higher for thos e who received some financial aid during their health CTE program compared to those who do not. FIGURE 8 Prerequisite courses, momentum, and financial aid predict successful completion SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Results from a regression model of completion that controls for the socioeconomic factors (age, race, prior education, entry year, language, disability, citizenship status, economic disadvantage and academic disadvantage), college, program, and these variables. All coefficients shown are statistically significant at the 1% level. See Technical Appendix B for full model specification an d results. Given the strong relationships between student preparation and course -taking behavior, we next examine how these factors contribute to differential completion rates across programs. For example, do differences in student GPA or full -time attenda nce across programs explain the variation in completion rates? Figure 9 compares actual completion rates by program to rates that are adjusted for preparation and course-taking behavior. For program s with relatively high completion rates , adjusting for student course-taking or academic achievement does not substantially shift attainment rates. This suggests that most students in these programs are already exhibiting course -taking behavior that is likely to lead to completion. Nonetheless, a small fraction of students in these programs do not obtain degrees . While certain student services like counseling and tutoring might explain some of the remaining non- completion, personal circumstances and choi ces also likely factor in for these students. When we make these adjustments for programs with relatively low completion rates, the likelihood of students completing a health degree increases substantially. This reflects differences in the odds that stud ents attend full time, maintain higher GPAs, persist across terms, and the like. If course -taking patterns across all programs were more similar, completion rates would be much less variable than they actually are. These rates would range from a difference of nearly 50 points (the gap between EMS programs and dental hygiene programs ) to less than 2 0 points. 012345678910 1112131415 Higher GPA (per 0.5 points) Completed biology Completed anatomy Completed chemistry Earned 30+ units prior to program More units per term in program (per 1 unit) Enrolled in health program full-time for at least 1 term Persistence in health program (3 consecutive terms) Received financial aid during health program Difference in completion rate (percentage points) PPIC.ORG Career Technical Education in Health 19 FIGURE 9 D ifference s in completion rates across programs are mitigated once we account for course -taking behavior SOURCE: Author’s calculations of CCCCO MIS data. NOTE: Unadjusted completion rate is the 6 year completion of a health credential for our health CT E student sample; students completing only non- health awards or transferring to four year colleges are excluded. The second set of bars adjust for student characteristics and course -taking before and after entering a health CTE program using regression models. All models include the socioeconomic factors shown in previous chart (age, race, prior education, entry year, language, disability, citiz enship status, economic disadvantage and academic disadvantage). Completion rates are shown for the reference categories as above and achieving academic markers including enrollment in three consecutive primary terms (persistence), full -time enrollment in at least one term, and sample averages for GPA and average number of units per term. See Technical Appendix B for full model specification and results. Examining the Racial Achievement Gap in Health Programs Improving completion among underrepresented minority students is of particular interest, both as an important aspect of increasing degree attainment overall and as a way of diversifying the health workforce so that it better ref lects and serves an increasingly diverse population . While we do find sizable achievement gaps between white and African American —and, to a lesser degree, Latino —students before adjusting for other student characteristics, we are able to explain these gaps once we control for socioeconomic factors, program choice, and course -taking behavior (Figure 10 ). 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percent of stduents completing health degree Unadjusted Adjusted - Course-taking Unadjusted Adjusted for course- taking patterns PPIC.ORG Career Technical Education in Health 20 FIGURE 10 Achievement gaps across racial/ethnic groups are explained by health program choice and student course-taking SOURCE: Author calculation s using CCCCO MIS data. NOTES: Chart shows difference in completion rates across race/ethnic groups (relative to white students) controlling for various independent variables, as described in text. Each bar plots the coefficient from a regression model ad ding successively more independent variables . See Technical Appendix B for more details. All models also control for college attended . After controlling for socioeconomic factors (age, citizenship status, educational level, and economic disadvantage), the completio n gap between white and African American students is reduced by about 2.5 percentage points and the gap between white and Latino students by nearly 1 point. The fact that students of different racial groups tend to choose programs with varying completion rates also explains a portion of these achievement gaps. Program choice explains more than 3 points of the completion gap between whites and African Americans, and 2 points of the white -Latino gap. Course -taking and achievement seem to account for the remaining completion gaps across racial/ ethnic groups. In fact, the completion gap is elim inated when we adjust for momentum and persistence , full -time enrollment and higher average units per term, and receiving financial aid . These results suggest that efforts to improve completion outcomes for all students, but particularly for underrepresented students , will be most effective if they can enable students to devote more time to their courses of study and performance after they have entered a health program. Such efforts can and do take many forms, from increased financial aid , to more course sections, to advising and other types of student support. I dentifying programs of study and degree goals in order to support completion pathways once a course of study is initiated could prove particularly beneficial. -14-12-10 -8-6-4-2 02African American Asian and Pacific Islander Latino Completion gap compared to White students (percentage points) Course-taking behavior Program choice Socio-economic factors Unadjusted PPIC.ORG Career Technical Education in Health 21 Opportunities for Students without High -Value CTE Credentials Although some programs are more likely to lead to higher wages than others —and there are systematic differences in completion across programs —students who choose a low-return program or fail t o obtain a credential do not necessarily lack economic opportunity. One potential benefit to pursing health CTE training is the chance to move into the health care industry, as an entry point to career ladders that —with additional training or experience —might pay off in the long run. Are students who pursue health CTE training at California’s community colleges able to migrate into the health care industry ? Slightly more than 25 percent of students were employed in the health care industry before they enr olled in a health CTE program. A similar share were employed in either the food services or retail industries. Within the three-year period after enrollment in a health CTE program, about 60 percent of students in our study sample were workin g in the health care industry. While employment in the industry is not necessarily tied directly to specific training (e.g. , hospitals hire janitors and nursing home s employ cooks ), the substantial shift in industry indicates a real change in employment situation regard less of whether students obtained credentials. TABLE 1 Industry of employment for health CTE students, pre - and post -enrollment Industry of employment Pre (3 -yr period before health CTE enrollment) Post (3 -yr period after health CTE enrollment) Health care and social assistance 26.0% 60.7% Hospitals 9.2% 31.7% Ambulatory health services 9.4% 18.9% Nursing and residential care 4.4% 6.9% Accommodation and food service 13.6% 3.7% Food services and drinking places 12.3% 3.1% Retail t rade 18.7% 5.5 % General merchandise stores 4.4% 1.3% Food and beverage stores 3.4% 1.0% Administrative and support services 6.2% 4.2% All other industries 35.5% 25.9% Total 100% 100% SOURCE: Author calculations using CCCCO MIS data. NOTES: The industry analysis is restricted to students who entered a health CTE program in years 2003 through 2009. We create three distinct 3 -year periods for all students entering in these years. The first period includes the 3 years prior to entrance ( Pre -peri od), the second period includes 3 years from the time of program entrance (during) which is not shown in the table, and the third period capt ures the 3 years following the second period (Post). Students may have enrollments during all of these periods and students may not complete a degree within 3 years of program entrance , if ever . Student employment is categorized by the industry in which they earned the highest aggregate wages in each 3 year period. Industry definitions are based on NAICS code at the 2 -digit and 3 -digit levels. Furthermore, students who shifted into the health care industry show more improvement in earnings than those who did not —regardless of whether they completed a program (Table 2). Among all health CTE students, average quarterly earnings in the three year period prior to entering a health training program were $2 ,607, and quarterly earnings increased to $8 ,433 in the three years after the program for an average total earnings increase of $5 ,826. PPIC.ORG Career Technical Education in Health 22 The median increase in earnings was $ 7,063 for CTE students who made this shift, and higher for those who completed a degree ($8, 661) compared to non- completers ($4,435). Even among non-completers who moved into the health care industry, earnings increases were larger ($4,435) compared to other non-completers who did not shift into health care ($2,694). Unlike our previous analysis of wages, these comparisons do not factor in individual factors. TABLE 2 Wage gains are greater for students who shift into the health industry afte r enrolling in a health CTE program Employed in the health industry? (pre/post-enrollment ) Change in q uarterly student wages All employed health CTE students Degree or certificate (3 -year) No degree or certificate Health industry / Health industry $7,969 $9,550 $4,303 Health industry / Non– health industry $4,431 $8,149 $3,261 Non–health industry / Health industry $7,063 $8,661 $4,435 Non-health industry / Non –health industry $2,712 $3,516 $2,694 SOURCE: Author calculations using CCCCO MIS data. NOTES: Only students who entered health CTE programs in school years 2003 through 2009 are included so that all students can be observed for a period of 3 years prior to program enrollment, 3 years during program e nrollment, and 3 years after program enrollment. The sample of health CTE students included in the industry analysis is 78,417 with 52,626 students earning a degree and 25,791 wh o did not earn a degree. Degree completion refers to 3 year completion; studen ts may still be enrolled in the program in both the 3 year pre and post enrollment periods. Industries defined based on 3 digit NAICS code for the industry with the highest aggregate wages during t he 3 year period defined prior to entering the program and the 3 year period after program enrollment. Changes in wages are calculated based on the change in median quarterly wages between the pre and post periods. All dollar amounts are adjusted for inflation. Our analysis shows that pursuing health CTE credentials pays off for students generally but is especially beneficial to those who obtain awards in longer-term programs and those who enroll in certain technical subfields. Nonetheless, even for students who do not complete a program or who obtain a lower-value credential, health CTE programs may afford opportunities to move into the in- demand health care industry. Whether that pays off in the long run depends on subsequent choices —an understudied issue that we plan to explore in future work. Conclusion Health CTE programs at California’s community colleges hold prom ise for students in the state. Many fields— even those outside registered nursing —offer students the opportunity to substanti vely improve their economic standing. T he odds that students will obtain credential s in health programs are often much higher than in other community college programs. However, there is room for improvement —especially given the dual goal of meet ing workforce needs and set ting more students on a path to upward mobility. S tudents who enter health programs are not substantially different from the overall student population— except that they are more likely to be older, female, and not in underrepresented minority groups. L arge shares of both health CTE students and the overall student population are economically or academically disadvantaged. These socioeconomic markers are correlated with completion rates, but their effects are largely explained by academic preparation (in terms of specific coursework ), intermediate milestones that indicate momentum and persistence, and access to financial aid . PPIC.ORG Career Technical Education in Health 23 The largest predictor of program completion is whether students attend full time once they enter a health program or attend consecutive terms. This is particularly true for Latino and African American students, which suggests that current and proposed reforms to encourage student progress are well targeted and may help the state create more diversity in the health workforce. State efforts to cover the full cost of schooling so that students can attend full time could help more students complete high -value health credentials. Considering that students who complete health CTE credentials increase their earnings 51 percent, on averag e, the economic return for policymaker and practitioner efforts to improve completion is quite large. The roughly 3 1,000 health CTE students who started a program during our study period but did not complete or transfer within six years would have earned an additional $10,200 per year (on average) had they obtained credential s. In total, the net additional earnings would have amount ed to nearly $ 320 million per year . 19 In addition to improving the economic standing of individual students , these gains would have had economic value to the state in terms of meeting health workforce needs. It is important to note that these earnings gains are not spread evenly across programs. Lower wage returns for many short -term credential s may call into question the va lue of offering these programs, particularly those that enroll large number s of students . However, the sizable growth in short -term health degrees conferred by for -profit colleges—which tend to cost more than similar programs at community colleges —indicates that there is significant demand for some lower -return programs . Given this demand for training , providing lower-cost opt ions for students wishing to pursue shorter-term degrees could be an important way for community colleges to help more Californians embark on career pathways in the health care industry . In fact, this is the subject of our companion report . Regardless, earning a credential is the first step to increasing earnings and/or moving along a career pathway , and more students could be taking this important step. By combining information on which programs offer better completion rates and increased earnings , students as well as colleges can make more informed choice s. At the same time, there app ear to be many policy levers— some of which we have outlined here —that could improve student outcomes in CTE programs . 19 These calculations are rough estimates based on our calculated 6 -year completion (or transfer) rate, the number of students who begin programs between 2000 -2009, the average wage return for health credentials, and assume $20,000 in median annual earnings prior to obtaining a health credential (estimate based on Sa lary Surfer statistics accessed 10/22/16). PPIC.ORG Career Technical Education in Health 24 REFERENCES Backes, Benjamin, Harry Holzer , and Erin Dunlop Velez. 2014. “Is it worth it? Postsecondary education and labor market outcomes for the disadvantaged.” National Center for Analysis of Longitudinal Data in Education Research, Working Paper 117. California Community Colleges Student Suc cess Task Force. 2012. “Advancing Student Success at the California Community Colleges .” Dadgar, Mina, and Madeline Joy Trimble. 2014. “Labor market returns to sub-baccalaureate credentials: How much does a community college degree or certificate pay?” Educational Evaluation and Policy Analysis. Heckman, James, Robert LaLonde, and Jeffrey Smith. 1999. “The economics a nd econometrics of active labor market programs.” In Handbook of Labor Economics, v. 3 part 1. Orley Ashenfelter and David Card, eds. Amsterdam: Elsevier Science. Jepsen, Christopher, Kenneth Troske, and Paul Coomes. 2014. “The labor-market returns to community college degrees, diplomas, and certificates.” Journal of Labor Economics, v. 32(1). Kurlaender, Michal, Scott Carrell, and Jacob Jackson. 2016. “The Promises and Pitfalls of Measuring Community College Quality .” The Russel Sage Journal of the Socia l Sciences, v. 2(1). Metzker, Brian, and Judy Heiman. 2016. “ California Community Colleges: Second Report on the Student Success Act of 2012.” California Legislative Analyst’s Office. McConville, Shannon, Sarah Bohn, and Laurel Beck. 2014. “ California’s Health Workforce Needs: Training Allied Workers .” Public Policy Institute of California. Sengupta, Ria , and Christopher Jepsen. 2006. “California’s Community College Students.” Public Policy Institute of California. Shulock, Nancy, Colleen Moore, and Jeremy Offenstein. 2011. The Road Less Traveled: Realizing the Potential of Career Technical Education in the California Community Colleges . Institute for Higher Education Leadership and Policy: S hulock, Nancy, Colleen Moore, and Connie Tan. 2012. Workforce Investments: State Strategies to Preserve Higher -Cost Career Education Programs in Community and Technical Colleges. Institute for Higher Education Leadership and Policy. Stevens, Ann Huff, Mich al Kurlaender, and Michel Grosz. 2015. “Career technical education and labor market outcomes: Evidence from California community colleges.” NBER Working Paper 21137. PPIC.ORG Career Technical Education in Health 25 ABOUT THE AUTHOR S Sarah Bohn is a research fellow at the Public Policy Institute of California. A labor economist, her work focuses on how policy affects individual and family economic well-being, with particular attention to low -income and vulnerable populations. Her current work addresses pover ty and inequality in California, the role of safety net policy , and the workforce skills gap . Sarah’s work has been covered by major media outlets including the New York Times, The Economist, and the Washington Post and has been published in a cademic journals including the American Economic Review, Demography, and the Review of Economics and Statistics. She holds a PhD in economics from the University of Maryland, College Park. Shannon McConville is a research associate at the Public Policy Institute of California. Her research interests include health care access, utilization, and outcomes among vulnerable populations. Her current work focuses on examining safety net programs, health wor kforce tr aining needs and capacity, and the effects of the Affordable Care Act in California, including the opportunities for and impa ct of health insurance coverage for the jail population. Before joining PPIC, she was a research training fellow in the Health Serv ices and Policy Analysis doctoral program at the University of California, Berkeley; a senior research associate at the Department of Health Research and Policy at Stanford University; and a project manager at the Lewis Center for Regional Policy Studies a t the University of California, Los Angeles. She holds an MPP degree from the University of California, Los Angeles. Landon Gibson is a former research associate at the Public Policy Institute of California, where he focused on health policy and safety net programs. Before joining PPIC, he was a research assistant at the University of California, Irvine, where he studied the mech anisms of cigarette addiction, and he was a quality assurance data analyst at a community health clinic. He is pursuing his master 's degree in public health at the University of California, Los Angeles, and holds a BS in biological sciences from the University of California, Irvine. ACKNOWLEDG MENTS The authors thank Hans Johnson for guidance and support and the staff of the Research Division of the California Community Colleges Chancellor’s Office for assistance with data . We also greatly appreciate reviews from Lynette Ubois, Olga Rodriguez, Debra Jones, Michal Kurlaender, and Michel Grosz. PUBLIC POLICY INSTITUTE OF CALIFORNIA Board of Directors Mas Masumoto, Chair Author and Farmer Mark Baldassare President and CEO Public Policy Institute of California Ruben Barrales President and CEO GROW Elect María Blanco Executive Director Undocumented Student Legal Services Center University of California Office of the President Louise Henry Bryson Chair Emerita, Board of Trustees J. Paul Getty Trust A. Marisa Chun Partner McDermott Will & Emery LLP Chet Hewitt President and CEO Sierra Health Foundation Phil Isenberg Former Chair Delta Stewardship Council Donna Lucas Chief Executive Officer Lucas Public Affairs Steven A. Merksamer Senior Partner Ni elsen, Merksamer, Parrinello, Gross & Leoni, LLP Gerald L. Parsky Chairman Aurora Capital Group Kim Polese Chairman ClearStreet, Inc. Gaddi H. Vasquez Senior Vice President, Government Affairs Edison International Southern California Edison The Public Policy Institute of California is dedicated to informing and improving public policy in California through independ ent, objective, nonpartisan research. Public Policy Institute of California 500 Washington Street, Suite 600 San Francisco, CA 94111 T: 415.291.4400 F: 415.291.4401 PPIC.ORG PPIC Sacramento Center Senator Office Building 1121 L Street, Suite 801 Sacramento, CA 95814 T: 916.440.1120 F: 916.440.1121" ["post_date_gmt"]=> string(19) "2017-05-20 09:43:12" ["comment_status"]=> string(4) "open" ["ping_status"]=> string(6) "closed" ["post_password"]=> string(0) "" ["post_name"]=> string(9) "r_1216sbr" ["to_ping"]=> string(0) "" ["pinged"]=> string(0) "" ["post_modified"]=> string(19) "2017-05-20 02:43:12" ["post_modified_gmt"]=> string(19) "2017-05-20 09:43:12" ["post_content_filtered"]=> string(0) "" ["guid"]=> string(51) "http://148.62.4.17/wp-content/uploads/R_1216SBR.pdf" ["menu_order"]=> int(0) ["post_mime_type"]=> string(15) "application/pdf" ["comment_count"]=> string(1) "0" ["filter"]=> string(3) "raw" ["status"]=> string(7) "inherit" ["attachment_authors"]=> bool(false) }