CHILDREN’S MENTAL HEALTH
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WORKFORCE IN MASSACHUSETTS:
Defining Workforce Capacity in a
Complex Healthcare System
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Academy Health Annual Research Meeting
June 27, 2010
DMA
Health
Strategies
Massachusetts in a National Context:
S
Supply
l and
dD
Demand
d
 MA h
has h
higher
h rates off psychiatrists
h
and
d sociall workers
k
than
h
any other state
 MA is in the top three states for rates of psychologists per
resident
― However, rates of child providers are not available nationally or in
Massachusetts
 Massachusetts has high rates of outpatient mental health
service utilization compared to the nation
― Nationally, 7% to 8% of children ages 13 to 18 enrolled in commercial
plans accessed mental health services compared to almost 14% in
Massachusetts
― Nationally, 12% of children ages 13 to 18 enrolled in Medicaid plans
accessed mental health services compared to 17% in Massachusetts
DMA
Health
Strategies
1
Blue Cross Blue Shield
off Massachusetts
M
h tt F
Foundation
d ti
 Purpose of the Project
― Develop an estimate of need for children’s mental health
services in Massachusetts
― Assess the capacity for child and family mental health service
delivery among licensed providers
― Identify variation in capacity to meet the mental health needs
of children and families
― Document challenges to meeting current demand for services
DMA
Health
Strategies
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M th d l
Methodology
The study involved three components:



Targeted
T
t d lit
literature
t
review
i
Mail and web survey of licensed mental health
professionals in Massachusetts
Key informant and stakeholder interviews
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Health
Strategies
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Survey Methodology:
S
Survey
Design
D i & SSampling
li A
Approach
h
 One
O survey ttailored
il d tto prescribing
ibi providers
id
― Psychiatrists and Clinical Nurse Specialists
― sampled the universe of providers
 One survey tailored to non-prescribers
― Psychologists, Mental Health Counselors, Marriage and Family
Th
Therapists,
i
and
d SSocial
i lW
Workers
k
― used a random sample of providers, adjusted by provider
presence in six regions
Provider Type
Prescriber
Non-prescriber
Total
DMA
Health
Strategies
Surveys
Returned
521
1461
1982
Response
Rate
16%
21%
19%
4
C it i ffor Child P
Criteria
Provider
id
 Of the 1,982
1 982 survey respondents
respondents, 735 (37%) serve a
case load of at least 10% children and adolescents
(ages 0
0-21),
21), which was the threshold for “child
child
provider” used for the study
 466 ((63%)) of the 735 child p
providers have caseloads
>50% of children and adolescents
DMA
Health
Strategies
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Child Provider
P id SSample
l (N
(N=735)
735)
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Health
Strategies
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Supply: Demographics of Child Provider
R
Respondents
d t
Combined, prescribers and non-prescribers are:
 72% female
 45% over the age of 55
 94% white
 95% serve E
English
li h speaking
ki caseloads
l d
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Health
Strategies
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Demand: Racial and Linguistic
Ch
Characteristics
t i ti off MA Child
Children
 St
Statewide,
t id 25% off children
hild
are non-white
hit
― Boston region: 50% of children are Black or Hispanic
― Northeast and Western Mass.:
Mass : 17% and 18% Hispanic
 Linguistic diversity (2008-09 school year):
― 14% of children (135
(135,685)
685) enrolled in schools did
not speak English as their first language
,
) enrolled in schools have
― 6% of children ((53,289)
limited English proficiency
DMA
Health
Strategies
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Workforce Capacity:
P id
Providers
R
Reportt A
Availability
il bilit
While providers report openings,
openings availability varies by
geography and provider type
P
Prescriber
ib
Open Slots
Non-prescriber
N
ib
LICSW/
Psychologist LMFT/LMHC
Psychiatrist
CNS
Full, I maintain a waitlist
56%
33%
36%
20%
32%
1 to 2 slots open
25%
33%
43%
42%
39%
3 to 5 slots open
Can almost always accept
new clients
7%
20%
11%
16%
13%
12%
13%
10%
22%
16%
100%
100%
100%
100%
100%
Total
DMA
Health
Strategies
Total
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Workforce Dynamics: How Providers Report
S
Spending
di Ti
Time
On average, providers spend 24
hours per week on direct care
 98% of respondents report evening and weekend hours
DMA
Health
Strategies
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Workforce Dynamics: Private Practice
P id
Providers
Insurance
I
P
Participation
ti i ti
DMA
Health
Strategies
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Workforce Dynamics:
Di i
Disincentives
ti
to
t Panel
P
lP
Participation
ti i ti
Disincentives to panel participation, identified by at least
20% of child providers:
 Administrative
Ad i i t ti b
burden
d
 Lack of compensation for necessary collateral work
 Low
L
rates
t off paymentt
DMA
Health
Strategies
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W kf
Workforce
Dynamics:
D
i
F
Future
t
Pl
Plans
 More than half (54%) of children’s
children s mental health providers plan to
leave the state or leave direct care in the next five years
Percentage of respondents who plan to leave the state or leave direct care in the next five years
Prescriber
Non prescriber
Non-prescriber
Total
T
t l
Plans For Next Five
LICSW/
Years by Age Group
Psychiatrist
CNS
Psychologist LMFT/LMHC
LCSW
Age: Less than 35
50%
0%
67%
46%
37%
43%
Age: 35 to 54
54%
41%
50%
52%
54%
51%
Age: 55-65
50%
44%
64%
62%
67%
60%
Age: Over 65
74%
40%
70%
57%
50%
64%
Total: All Ages
56%
39%
58%
54%
44%
54%
Source: Provider Survey - respondents with a caseload of at least 10 % children; N=705
 Workforce replacement rates (new licenses) fall far short of the
anticipated
i i
d loss
l
off providers
id
― Rates of entry over 5 years are roughly one half the rates of planned
departure
DMA
Health
Strategies
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Workforce Dynamics:
P id Satisfaction
Provider
S ti f ti
Strategies for improving child provider
satisfaction include:
― Financial support for collateral work (57%)
• Child providers spend between 7% and 12% of their time
on unreimbursed collateral
collateral, more than adult providers
• Time spent on unreimbursed collateral increases with the
proportion of children and adolescents on providers’
caseloads
― Higher pay (55%)
― Decrease in administrative demands (30%)
― Receiving relevant training and supervision (17%)
DMA
Health
Strategies
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Workforce Dynamics:
I
Incentives
ti
tto W
Work
k with
ith Child
Children
Strategies to increase likelihood that providers
work with children:
― Nothing (don’t wish to treat children) (67%)
― Receiving relevant training and supervision (19%)
― Financial support for collateral work (16%)
― Reduction of risk/liability (9%)
― Higher pay (7%)
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Health
Strategies
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Recommendations
R
d ti
and
d IIssues
for Consideration
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Health
Strategies
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I
Improve
IInformation
f
ti
 Track
T k and
d monitor
it mental
t lh
health
lth workforce
kf
― collect data on race, ethnicity, language, and geographic
service area as p
part of licensure
― develop approaches to track mental health access, capacity,
and demand routinely across the state
― develop coordinated strategies to address identified
workforce issues
 Create a single referral source to aid families in
fi di a good
finding
d match
t h ffor th
their
i needs
d
― Include information on all payers
DMA
Health
Strategies
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Add
Address
providers’
id ’ concerns
 Encourage greater participation by prescribers in
commercial and public health plans
― Work collaboratively with payers and professionals on crosscutting strategies
― Refine
R fi paymentt rates/models
t / d l
― Reduce administrative burden
 Compensate providers for care coordination inherent
in children’s mental health care
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Health
Strategies
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E
Expand
d and
d IImprove T
Training
i i
 Training students to treat ethnically and linguistically
diverse children and their families
 Expand existing loan forgiveness programs to enable a
more diverse group to become licensed
 Prepare
P
clinical
li i l nurse specialists
i li t tto serve children
hild
 Strengthen the internship system financially and
programmatically
― Allow billing for well-supervised interns in approved programs
 Prepare students to provide evidence-based services
DMA
Health
Strategies
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Acknowledgements And Contact
I f
Information
ti
Project
P
j
Sponsor
S
Blue Cross Blue Shield of Massachusetts Foundation
Marcia Ravetch and Shanna Shulman.
Full Report
Accessing Children’s Mental Health Services in Massachusetts:
Workforce Capacity Assessment
http://bluecrossfoundation.org/~/media/Files/Publications/Policy%20Pu
blications/091029CBHReportForWeb.pdf
Coauthors
Karen Linkins and Jessica Boehn
Boehn, The Lewin Foundation
Richard H. Dougherty, DMA Health Strategies
Wendy Holt: wendyh@dmahealth.com
DMA
Health
Strategies
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Th k you.
Thank
Questions?
DMA
Health
Strategies
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