Strengthening the Behavioral Health Workforce for Children, Youth, and Families: A Strategic Plan for Connecticut

These excerpts are from the Executive Summary of a report issued this month by the Child Health and Development Institute.

Like nearly every other state in the country, Connecticut is facing two urgent challenges that are resulting in long waitlists and delays in care:

• Increasing behavioral health needs among the state’s children

• A workforce shortage among those who serve children with behavioral health needs

When we strengthen the behavioral health workforce, children and communities in Connecticut are stronger. This Plan identifies best practices and innovative solutions from across the nation that will help Connecticut address both immediate and long-term needs of the pipeline, recruitment, retention, diversity, and competencies of the workforce.

It also reviews the conditions contributing to the current workforce challenges and the support systems that behavioral health workers need to do their jobs well. When we truly support those who are working hard to serve our youngest citizens with behavioral health needs, we provide our children with a high-quality foundation of health and well-being upon which to grow.

Key Findings from the Plan: A Solid Foundation Has Been Severely Strained

Connecticut’s system of care for children has many strengths on which to build, including a robust continuum of services, a specific focus on the child and youth population, a dedicated network of providers, and comparatively good access to evidence-based practices. However, for years reimbursement rates and grant funding have failed to keep pace with inflation and the true costs of delivering effective care. In addition, the COVID-19 pandemic has increased needs and changed care delivery, severely straining the workforce.

The Plan Identified the Following Workforce Challenges:

• Rising acuity (i.e., severity of behavioral health symptoms) and staffing shortages are creating a cycle of workforce burnout and delays in care.

• Insurance reimbursement rates do not cover the true costs of delivering high-quality services, have not kept pace with inflation, do not reflect staff education and skill level, and are restricting the ability to offer compensation that attracts and retains qualified staff to the field.

• Telehealth has presented the workforce with more flexibility in private practice, pulling clinicians away from settings where more underserved children are treated, potentially widening disparities in care.

• There is an ongoing lack of parity between mental and physical health insurance in spite of existing laws.

• Behavioral health workforce demographics are less diverse than the population served, and there are systemic barriers to entering the workforce.

• Some members of the workforce lack the training and competencies needed to serve specific populations.

• There are gaps in Connecticut’s workforce data that limit our ability to understand service and staffing needs and quality

Connecticut is Resourceful and Can Apply Best Practice Solutions to Address Our State’s Workforce Challenges

While there are many factors straining the children’s behavioral health workforce, the Plan provides guidance on what supports are needed, why they are important, and how they work so that our state’s decision-makers can implement them. A review of Connecticut’s prior and current efforts specific to the workforce found that Connecticut’s relatively strong and nationally recognized infrastructure of behavioral health services for children offers a solid foundation to build upon. The Plan also identifies several best practices and innovative approaches for improving the workforce that are being used by other states and national organizations with success. States such as Oregon, Nebraska, and Massachusetts, have made significant investments in the behavioral health workforce and are finding that these solutions are working.

Growing and strengthening the children’s behavioral health workforce requires a coordinated effort and sustained long-term commitment from policymakers, payers, educators, and behavioral health administrators. The result is a stronger and healthier future for our state.

Recommendations

The following recommendations provide Connecticut with a blueprint for supporting a strong, diverse, and competent workforce to meet the behavioral health needs of children, youth, and families.

1.        Increase reimbursement rates for children’s behavioral health services to cover actual costs of high-quality care and establish a transparent and systematic rate-setting process.

2.        Make immediate and significant investments in behavioral health workforce recruitment and retention.

3.        Develop a children’s behavioral health workforce center that can track and respond to trends in supply and demand and sustain workforce development efforts.

4.        Grow and diversify the children’s behavioral health workforce pipeline.

5.        Increase behavioral health training across the child-serving workforce.

6.        Remove administrative barriers to workforce entry and retention.

7.        Expand the youth and family peer support workforce.

8.        Expand the role and capacity of community-based organizations in prevention and early intervention.

The complete 27-page report can be viewed here.  It was produced in November 2023 by CHDI in collaboration with the Connecticut Children’s Behavioral Health Plan Implementation Advisory Board with funding from the Connecticut State Department of Children and Families.  Authors are Aleece Kelly, MPP, Child Health and Development Institute; Michael Hoge, PhD, Yale School of Medicine; The Annapolis Coalition on the Behavioral Health Workforce; and, Jason Lang, PhD, Child Health and Development Institute.