Responding to the Children’s Behavioral Health Crisis
/by Howard Sovronsky
Connecticut Children’s is the state’s only independent children’s hospital focused exclusively on the needs of children. We are also the state’s largest provider of pediatric emergency behavioral health services. I am submitting testimony in support of this proposal and also wish to share some additional insights and recommendations regarding the children’s behavioral health crisis.
New Youth Risk Behavior Survey data coming out of the Centers for Disease Control and Prevention (CDC) shows that an increasing number of youth report experiencing persistent levels of sadness and hopelessness. Especially sobering is that nationwide in 2021, 57 percent of teen girls reported persistent levels of sadness and hopelessness and nearly one in three said they seriously contemplated attempting suicide (source). It is imperative that government leaders work in partnership with schools, families, communities, healthcare and community providers, to seek immediate and sustainable solutions to this crisis.
“nationwide in 2021, 57 percent of teen girls reported persistent levels of sadness and hopelessness and nearly one in three said they seriously contemplated attempting suicide”
State lawmakers took tremendous steps last year to support children’s behavioral health through new investments, programs, and supports. Despite this progress, we know that the pediatric behavioral health system has been under-resourced for many years and more work is needed to ensure that children and families are able to access behavioral health services when and where they need it.
Addressing Workforce Shortages
A significant driver of challenges related to accessing pediatric behavioral healthcare is the behavioral health workforce shortage. To that end, we are supportive of Sec. 1 of SB 2 which would require a full-time employee within the Department of Public Health to assist in the licensure of social workers as well as Sec. 13 of the bill which would lower licensure fees for social workers. We are supportive of any measures to improve the number of licensed social workers entering the field and serving families in need.
Insufficient provider rates which do not match the cost of delivering services are certainly a contributing factor to our state’s workforce and access challenges. When community providers cannot afford to hire new staff or pay a decent wage, it creates a disincentive for people to pursue careers in the mental health field. As much as it is important for the state to invest in new training programs and jobs pipelines, we must also recognize that low reimbursement rates for community service providers diminish the ability to provide desirable salaries and benefits for their employees.
Office of the Behavioral Health Advocate
We are also supportive of Sec. 11 which would establish the Office of the Behavioral Health Advocate within the state’s Department of Insurance. We hope that this appointee will have extensive experience navigating the complex behavioral health system with a keen understanding of the barriers and challenges that many families face in accessing care— particularly families from socially vulnerable communities. Our hope is that this office not only offers public policy recommendations but also serves as a resource to families struggling to access care.
New DSS Employees to Aid in HUSKY Enrollment
At Connecticut Children’s, more than half of our patients who require inpatient care and nearly two-thirds of children who require emergency care, rely on Medicaid. Through its support of the HUSKY program, state leaders are ensuring that all children have access to the health care services they deserve, regardless of their zip code or parents’ income. We are supportive of measures, like those included in Sec. 18 of the bill, to help ensure that all children have access to consistent healthcare coverage, which is especially important given the forthcoming redetermination process following the expiration of the national public health emergency.
“...more than half of our patients who require inpatient care and nearly two-thirds of children who require emergency care, rely on Medicaid.”
School Behavioral Health Training
We also appreciate that this proposal focuses on students. As we know, children spend a large portion of their day in the school setting. Many children who receive behavioral health care in Connecticut Children’s Emergency Department arrive via ambulance straight from their schools.
Oftentimes, these children are not in need of acute, emergency-level care, but their school systems lack the resources and expertise to properly address an emotional episode. Additional resources for schools, like what is proposed in Sec. 18-19, would help school behavioral health providers better respond to students’ needs.
Supporting Behavioral Health Providers in the Community
The state’s behavioral health ecosystem system is built on a foundation of community-level ambulatory services. Now, after years of increasing demand, those of us who make caring for kids our mission seek your partnership to strengthen that foundation. There are access challenges at every level of the pediatric behavioral health system—from free standing community agencies, to in-home services, to outpatient clinics. We encourage state leaders to consider adopting measures which allow these providers to sustain their businesses through reimbursements rates that reflect the cost of care, more innovative payment models, and a robust workforce.
Sustainability
State legislators demonstrated an unprecedented prioritization of children’s behavioral health during the 2022 state legislative session. It is critical that the state help create the infrastructure to ensure last year’s progress is impactful and sustainable. As an example, we were pleased the state approved the use of the Collaborative Care Model, however, the current reimbursement rates make using this model untenable for providers. Our hope is that going forward, investments made in initiatives like pediatric behavioral health urgent care, subacute crisis stabilization, investments in schools, and more, which were largely funded through American Rescue Plan dollars, remain long-term investments.
Howard Sovronsky is Chief Behavioral Health Officer at Connecticut Children’s Medical Center. This testimony, on Senate Bill 2, AN ACT CONCERNING THE MENTAL, PHYSICAL AND EMOTIONAL WELLNESS OF CHILDREN, was provided to the state legislature’s Children’s Committee in the current legislative session. SB2 was subsequently approved by the committee, and is awaiting action by the State Senate.
