Covid-19 has brought on a behavioral health tsunami, a crisis in the brewing even before the pandemic. The effects on children’s health and mental health will be long-term. Children who have had Covid may become long haulers with both physical and behavioral health problems lasting years, or a lifetime. The solutions being sought must address both the immediacy of the crisis and the long-term needs. Here are some recommendations:
School social workers: School social workers provide prevention, early identification, crisis intervention, counseling, and working to connect students with needed services. School social workers address drug use, conflict resolution, self-esteem, child neglect and abuse, losses, and the list goes on. These services benefit the student, the student’s family, teachers, and administrators.
The NASW Standards for School Social Work Services call for a ratio of one school social worker for every 250 students. Regretfully, Connecticut schools are not required to have school social workers and, in those schools that do the social worker may split their time between multiple schools. Expansion of school social work services is critically needed.
School Based Health Centers (SBHC): Children today have more stress than ever before that place increasing numbers of children at risk. For many of these children mental health services are not available due to cost, lack of insurance coverage, myths and stigma of mental health services, lack of accessible care in the community, lack of transportation, long wait periods, lack of culturally appropriate services, and parent’s that are struggling with multiple jobs and schedules that leaves no time to bring their children to a mental health program. SBHCs addresses all of these obstacles to care. SBHCs must be expanded throughout the state, from distressed communities to affluent municipalities.
Not all schools have the space necessary for a full SBHC, however the vast majority of schools should be able to accommodate a mental health school-based clinic that consists of a behavioral health clinician within the school. The necessary space consists of a private office and costs are much reduced compared to a full services clinic.
Student Loan Forgiveness and Cost of Education: At one time Connecticut had a student loan forgiveness program through DPH. Loan forgiveness is an excellent way to recruit and retain behavioral health providers to serve in practice fields that have shortages of qualified professionals. Such a program must include clinical social workers given that social workers are the largest group of mental health providers.
Thinking in the longer term, Connecticut must make it more affordable to attain the degree in the first place. A MSW degree can cost upwards of $70,000 in tuition, leaving many qualified individuals unable to enter a program, especially individuals from communities of color. Tuition waivers, tuition reimbursement and scholarships should all be considered.
Compensation: Salaries are another obstacle to attracting and retaining social workers and other behavioral health professionals. This is a pre-pandemic problem that has been made far worse due to Covid-19. Reimbursement rates for providers in independent practice is woefully inadequate and the non-profit sector has been so poorly funded that they struggle to offer competitive salaries. If we expect to have qualified professionals taking on some of the most difficult work in the health care field, in a pandemic and post pandemic, salaries and provider reimbursement rates must significantly increase. This must include increased state funding for community based non-profits salaries. Private health insurers (who get annual rate increases approved by the CT Department of Insurance), must be called to task for stagnant and insufficient reimbursement rates.
Self-Care: Behavioral health providers are in need of self-care. Support services and programs are needed to assure behavioral health providers can continue their stressful work. Students can take off 2 mental health days. How about behavioral health providers being given 2 paid mental health days annually?
Integrated Health Care: It is undisputable that physical health and mental health are intertwined. Now is the time to incentivize and expand integrated health care within pediatric services. Clinical social workers whom are trained in addressing social determinants, can provide assessment, consultation, case management, referral and follow-up services. Utilizing a warm hand-off from physician to social worker creates a fuller care model for children and parents.
Medicaid Provider Status: Providers should be allowed to work at their highest level of Scope of Practice. For social work this means Medicaid giving provider status to Licensed Master Social Workers (LMSW) practicing within an established independent practice. There are many independent practices that are employing LMSWs, however they are not currently Medicaid eligible providers in such settings. This inclusion would increase the availability of qualified clinical social workers to serve the Medicaid population.
Policy makers must engage those professionals who are directly providing children’s mental health services. Social workers, who are essential workers, are ready to be at the solutions table.
Stephen Wanczyk-Karp Executive Director National Association of Social Workers, CT Chapter.