We need to meet the needs of children’s behavioral health
There is a lot of attention on children’s behavioral health this year, and for good reason.
We are in a children’s behavioral health crisis, and we have been for many years. The pandemic intensified the crisis and broadened awareness beyond those of us in the children’s behavioral health field. This, in turn, sparked more federal and state investment in children’s behavioral health than we have seen in decades.
The last major investment in children’s behavioral health also was borne from tragedy. Ten years ago the horrific shootings in Newtown sounded alarms nationally about gaps in behavioral health care and led to calls for better screening and services for youth.
In Connecticut, the primary behavioral health response to Newtown was Public Act 13-178, which called for a comprehensive children’s behavioral health plan for the state. I was honored to play a lead role in developing that plan, which included extensive input from families, community members, researchers and providers. It reflected a collective vision for the children’s behavioral health system, and it has guided our state’s planning for the past eight years.
Yet, despite many improvements, we are not where we need to be. Ten years after Newtown and eight years after the plan was accepted by the legislature, we still have a crisis.
It’s not that we haven’t made progress or that the direction we are moving in is wrong. For instance, Connecticut is the envy of many states for its community-based nonprofit provider network, availability of evidence-based treatments, strong youth mobile crisis program, care coordination services and trauma-focused interventions. The foundation is strong and we don’t have to reinvent the wheel.
Nevertheless, additional investments and improvements are needed. The pandemic widened cracks in the children’s behavioral health system and diminished its capacity to meet families’ needs. Our most disadvantaged and historically underserved youth continue to experience disparities in service access and outcomes in many parts of the system.
Record numbers of youth are experiencing behavioral health concerns, and at the same time clinicians are leaving the field, citing low wages and burnout. No other sector of the health care delivery system has so many providers that do not accept insurance due to low reimbursement rates and ask families to “self-pay.”
In Connecticut, the cost to nonprofit community providers for delivering behavioral health care too often exceeds what they are reimbursed for those services. Many times they close financial gaps and remain solvent through galas, golf tournaments and other fundraising activities.
To fix this system we need to fund children’s behavioral health at equivalent levels to physical health and in a way that matches the true cost of providing high-quality care. We need to ensure sustained and strategic investments that are not driven by tragedy but by data on youth and family needs.
Each year legislators and policymakers can be overwhelmed by hundreds of ideas to fix the children’s behavioral health system. In the coming years,sustained investments in three categories will have the most impact: streamlined governance and decision-making, a larger and more diverse workforce, and service expansions that meet the needs of all children.
First, Connecticut has a growing number of committees, councils and task forces working to address children’s behavioral health, often for specific parts of the system. It’s time to intentionally streamline and integrate state-level decision-making.
We will accelerate progress when all child-serving systems work together to ensure that resource allocation decisions are informed by data, guided by the same playbook and implemented consistently across all child-serving systems.
Second, we need substantial investment of new funding to expand and diversify the behavioral health workforce. Increasing reimbursement rates and grant funds will allow providers to increase clinician compensation and make it more appealing to enter and remain in the behavioral health field. We should also begin reimbursing for services provided by certified peer specialists, as other states have done.
Third, we need service expansion in areas that align with the needs of youth and families. Although nearly all services could benefit from additional resources, we should prioritize efforts to expand prevention, early intervention and treatments with the strongest evidence for effectiveness.
These strategies have the best chance to improve outcomes and achieve long-term cost savings.
With focused attention on each of these three areas, I remain optimistic that Connecticut can end this crisis and set an example for other states to follow.