WE HAVE DEDICATED our careers to helping children with behavioral health challenges and never has that work seemed more daunting than it is today. The resources to stabilize kids are shrinking and the need for crisis services is soaring. We need an intervention from the Commonwealth, in the form of greater funding that will enable us to raise clinician pay.
We must get our arms around this immense challenge and overcome it. Massachusetts was once the leader in children’s behavioral health services, and we must endeavor to return there.
In-home and community-based services are a critical lifeline for children with complex behavioral health challenges and their families, helping to prevent exacerbation of illness and unnecessary use of hospital emergency departments, the hallways of which are already jammed with kids “boarding” because there are no treatment programs available.
The Association for Behavioral Healthcare’s issue brief, The Kids Are Waiting: The Children’s Behavioral Health Services Crisis and Collapse, reveals a striking decrease in the number of families getting access to home- and community-based services, and a plummeting workforce between 2019 and 2023. Unsurprisingly, the amount of time to get access to care has grown because of the continuing staffing challenges.
Between our two organizations alone – The Home for Little Wanderers in Eastern Mass. and Clinical & Support Options in Western Mass. – nearly 850 children and youth under the age of 21 are waiting for outpatient services, and more than 200 are waiting for in-home services. There are not enough clinicians to meet the growing need.
The staffing crisis is having a dramatic impact on in-home services: According to the issue brief, 1,553 child-serving professionals left their agencies between September 2021 and May 2023, and at least 38 of these specialized programs have permanently closed since 2019 – an average of nearly eight programs a year. That drop is alarming, just as it is unsustainable.
So what is happening to the kids who are waiting? In Western Mass., we have seen a dramatic increase in the utilization of mobile crisis response. Clinical & Support Options provides crisis services in Gardner, Athol, Greenfield, and Northampton. According to internal data comparing 2019 and 2023, the total number of youth under age 21 receiving in-home services fell by 44 percent (988 to 553). Crisis response nearly doubled (from 603 to 1,156).
The crisis response team can provide short-term stabilization services, diverting children from higher-level care and providing linkages to services, but that is where the system currently bogs down: The waitlist for follow-up services means these children are unable to get the level of care they need to maintain stability, and it starts the cycle anew.
In-home services are focused on the entire family unit, because often the needs extend beyond the child. Families are coached on tools to respond to a child’s behavior in a supportive way. When in-home services were implemented in 2008, Massachusetts led the nation in terms of the creativity and variety of services available to families.
At the core of the problem affecting all children’s behavioral health services are salaries. Providers simply are not reimbursed by the state at a high enough rate to offer competitive salaries, and the result is that we lose out to private practice and other settings like schools and hospitals. We are challenged to both recruit and retain skilled and dedicated staff because they have other, less demanding options.
Clinicians who do home-based work are among the most skilled and need to be recognized for the difficult, mobile nature of their job. These professionals should be among the highest paid staff in our system, but are instead often at the bottom of the scale due to lagging reimbursement rates.
We call on the administration and Legislature to prioritize investment in children’s behavioral health services, thereby enabling providers to build a pipeline to strengthen the workforce.
Specifically, we call for immediate and substantial rate increases.
The state recently infused the system with $70 million in emergency rate increases, and while we are grateful for that, it is, frankly, nowhere near enough to recruit and retain the staff we need to meet the moment. Even the way the state prices these services, using salary benchmarks that do not come close to reflecting the market cost for clinician salaries, is simply outdated.
We call for a much more reasonable 75th percentile of the federal Bureau of Labor Statistics benchmark, which comes much closer to our actual labor cost than the state’s antiquated methodology.
Without this assistance, wait times will continue to swell, programs will continue to close, and the system will fail the families who need help the most.
Karin Jeffers is the CEO of Clinical & Support Options in Northampton. Lesli Suggs is the president and CEO of The Home for Little Wanderers in Boston and vice chair of the board of the Association for Behavioral Healthcare.
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