Children’s Behavioral Health Workforce is Stretched Too Thin
/By Aleece Kelly, MPP, Jason Lang, Ph.D. and Alice Forrester
Who Will Do the Work? Strengthening the Children’s Behavioral Health Workforce to Meet Families’ Increasing Behavioral Health Needs, is a Policy Brief that explores Connecticut’s behavioral health workforce crisis and presents recommendations for recruiting, retaining, and diversifying the workforce to fully meet the needs of the state’s children. This is an excerpt from the Policy Brief.
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.
State and national leaders, in response to demand from families, advocates, and providers, have acknowledged the children’s behavioral health crisis. In Connecticut, recently passed legislation will fund an expansion of services, such as additional inpatient beds, new acute and sub-acute levels of care, and extended hours for Mobile Crisis services. This investment in direct care is critical to closing the gap between needs and available services, especially among the state’s most vulnerable children. Services, however, cannot be implemented and sustained without a proportional investment in the behavioral health workforce.
The following recommendations will strengthen the children’s behavioral health workforce. These recommendations should 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.
Specifically, Connecticut should:
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.
The full Policy Brief, issued on September 22, 2022 by the Child Health and Development Institute and Clifford Beers Community Health Partners, was written by Aleece Kelly, MPP and Jason Lang, Ph.D. of CHDI and Alice Forrester, Ph.D. of Clifford Beers. The introduction and recommendations are presented here. The full policy brief is available here. It explores Connecticut’s behavioral health workforce crisis and presents recommendations for recruiting, retaining, and diversifying the workforce to fully meet the needs of the state’s children.
