Action Urged to Strengthen Behavioral Health Workforce to Aid Children As Anxiety, Depression Grow
/A report and series of recommendations developed by the Child Health and Development Institute (CHDI) and Clifford Beers Community Health Partners calls for a series of state actions and investments to expand the state’s behavioral health workforce, in response to the increased need for behavioral health services, particularly to youth. Rising rates of anxiety and depression among children have exacerbated longstanding strains on the behavioral health system and its workforce, according to the report and highlighted in recent data.
The Policy Brief, “Who Will Do the Work?, suggests ways that the state can “strengthen the children’s behavioral health workforce to meet families’ increasing behavioral health needs.” Key steps include “recruiting, retaining, and diversifying the workforce to fully meet the needs of the state’s children.”
The report, issued this fall, explains that “The children’s behavioral health workforce is being stretched to its limit, and urgent action is needed to strengthen and expand this critical resource for children and families. Prior to the pandemic, it was estimated that 1 in 5 children in the United States met the criteria for a mental health condition each year. The pandemic has resulted in rising rates of anxiety and depression among children, particularly among the most vulnerable families, increasing the need for services and exacerbating longstanding strains on the behavioral health system and its workforce.”
Noting that Connecticut’s legislature has passed legislation that will fund an expansion of services, the authors, Aleece Kelly, MPP and Jason Lang, Ph.D. of CHDI and Alice Forrester, Ph.D. of Clifford Beers, point out that “services, however, cannot be implemented and sustained without a proportional investment in the behavioral health workforce.”
The report cites a number of “significant strengths” in Connecticut’s children’s behavioral health system, but points out that “community-based behavioral health providers face a growing number of challenges,” including overall staff shortage, increasing costs and invigorated competition.
In addition, the organizations point out that the behavioral health workforce in Connecticut is “not reflective of the diversity of the children and families it serves. Among licensed behavioral health professionals, approximately 80% are White, with 6% identifying as Hispanic/Latinx and 15% identifying as Black or African American.11 In contrast, only about 50% of the child population in the state identifies as White Non-Hispanic.”
A series of recommendations included in the Policy Brief aim to “strengthen the children’s behavioral health workforce.” The co-authors urge that the recommendations be integrated into and aligned with existing groups in Connecticut that are working on this issue, including the Governor’s Workforce Alliance, Ready CT, and the Connecticut Recruitment and Retention Learning Collaborative, among others. The recommendations, as outlined in the Policy Brief, call for Connecticut to:
1. Develop a comprehensive children’s behavioral health workforce strategic plan. The state can benefit from an inclusive, efficient, and sustainable approach that improves the workforce's supply, retention, diversity, and career pathways. To identify funding, policy, and practice changes, a comprehensive strategic plan encompassing short and long-term strategies should be developed that is data-driven and informed by multiple stakeholders, including payers, employers, staff, researchers, and families with lived experience.
2. Increase and sustain reimbursement rates. As rates are assessed, the state must increase funding to meet the actual cost of services, including competitive salaries for community-based providers to attract and retain staff and minimally keep pace with inflation. Reimbursement should be based on a quality model of care, including appropriate caseloads, time for administrative and client-management tasks, and professional development. It should be tied to inflation or other indicators to remain competitive and predictable over time. Some increases in reimbursement rates should be tied to performance, such as providing an enhanced rate for delivery of EBTs or for meeting child outcome benchmarks.
3. Diversify the pipeline. Build upon the governor’s initiative to strengthen the pipeline and increase diversity among social work students by extending the pipeline upstream to high school students and broadening it to other behavioral health professions. Financial incentives, such as tuition support, loan repayments, and sign-on and longevity bonuses, should be expanded and prioritized for students and staff who are bilingual or BIPOC. Barriers to degree programs, licensing, and employment should be identified and addressed to facilitate improved diversity throughout the pipeline.
4 Promote opportunities to task-shift and reduce administrative burdens.. The state should collaborate with providers and higher education to update the blueprints of behavioral health career pathways and expand entry-level opportunities. Openings for entry-level staff can be created by developing new professional tracks (such as peer support specialists or community health workers), identifying appropriate and safe roles to task-shift from licensed staff to these professionals, and enacting changes in coverage and reimbursement policies among insurers as needed to support diversification of the workforce. Additionally, the state should work with providers to identify unnecessary and inefficient paperwork requirements and reduce the administrative burden on staff.
5. Increase opportunities for professional development and training. For the workforce to have the time to engage in professional development and training, the state should fund the creation and delivery of training and offer financial support to providers to allow staff time for professional development.
