Confronting the Challenges of Youth Increasingly in Need of Behavioral Health Care
/The average number of youth served by Connecticut’s 22 outpatient psychiatric clinics for children has increased 20% in the last two years. Each provider served an average of 1,250 youth in fiscal year 2023, compared to 2019’s average of 1,034.
Connecticut, like much of the country, is grappling with a post-pandemic surge in youth seeking mental health services, coinciding with a serious shortage in the clinical workforce. Many of these young people will receive treatment at one of the state’s 22 outpatient psychiatric clinics for children (OPCCs).
After the staffing upheaval of the pandemic, newer clinicians - and their supervisors - need more support to navigate a children's behavioral health system under strain, explain Child Health and Development Institute (CHDI) Senior Associate Katie Newkirk, Ph.D., and Associate VP of Quality Improvement Kellie Randall, Ph.D., in a recent blog post, part of a CHDI series on the state's behavioral health workforce challenges. They highlight why the current situation is a recipe for burnout and share suggested solutions for Connecticut to respond.
Even before the pandemic, they point out, “adjusting to this growing demand would have been challenging. But new clinicians who trained during the pandemic are entering the field with less face-to-face experience than their earlier counterparts, due to necessary shifts to remote field placements and, for many, substituting simulations for field hours.”
“Prior to COVID, we had a steady group of clinicians who had been with us for a long time. But after COVID, a lot of our more seasoned clinicians [went] into private practice,” says Melissa Jacob, LCSW, Director of Child Outpatient Services and Care Coordination at Bridges Healthcare, a Milford-based OPCC.
Erica Mott, LPC, Director of Outpatient Services at Manchester’s Community Child Guidance Clinic, had a similar experience. “Between 2021 and 2022, I lost eighty percent of my experienced staff,” she says. “I’m fully staffed again now, but it’s mostly with people who have graduated within the last two years.”
According to CHDI’s annual survey of staff from the 22 OPCC providers across Connecticut, the share of OPCC clinicians with two or fewer years of experience increased from 25% in 2019 to over a third in 2022 and 2023, the blog post indicates.
Additionally, they note, OPCC leaders reported more difficulty with recruitment, turnover, and “the dilemma of whether to assign an influx of more challenging cases to inexperienced staff who may not have the appropriate training or add to the already full plates of their experienced clinicians.”
The combination of higher caseloads, increased demand and acuity, insufficient pay, and a “greener” workforce is a recipe for burnout for clinicians at all experience levels,” Newkirk and Randall suggest, adding that “according to our OPCC surveys, 36% of clinicians reported burnout in 2023 compared to 26% in 2019.”
“Some of [our younger clinicians] are coming out of grad school with $200,000 in student loans,” says Jacob. “Several of my youngest clinicians have three jobs, and they’re tired… The burnout rate is high for our younger clinicians. They can’t afford to just come in and do the job and go home. We do a lot of work on self-care. But when the system is this broken, you can self-care all you want - it’s not enough.”
The results of the current situation resonate not only among the relatively inexperienced, but their supervisors as well. “Unsurprisingly,” Newkirk and Randall explain, “the OPCC supervisors we surveyed are showing an even more dramatic increase in burnout, with 2023 supervisor burnout rates increasing more than 50% compared to 2019. Experienced clinicians having to take on more intensive cases also means they aren’t available for new clients, contributing to the longer delays and waitlists many families across the state are facing.”
They urge Connecticut to “craft a new recipe that supports the entire behavioral health workforce and the families they serve.” By implementing a three-point strategy:
1. Increase Training and Professional Development in Key Areas
2. Create a Behavioral Health Workforce Center to Provide Centralized Training & Workforce Support
3. Invest More Funding in the Behavioral Health Workforce
Details of the proposal can be seen here - https://www.chdi.org/news/blog/blog-helping-new-clinicians-navigate/ - and include establishment of a statewide Children’s Behavioral Health Workforce Center, include additional staff training, and higher reimbursement rates and increased state funding that will cover the true cost of providing high-quality care.
“To support our behavioral health workforce and ensure that all Connecticut youth and families can access high-quality care, now it’s time to start,” Randall and Newkirk conclude.
