Friday’s testimony on a 100-page bill aimed at addressing children’s mental health focused on two major and intertwined problems — a lack of available mental health workers and low or non-existent reimbursement from insurance companies for mental health services.
During the Committee on Children public hearing, Frank Fortunati, Vice Chief of Psychiatry at Yale New Haven Hospital, said that in the last year the lack of insurance reimbursement pushed five of the hospital’s experienced licensed social workers to leave for jobs at schools.
“We need to retain folks who we’ve taken years to train and have become quite good,” said Fortunati.
He said he believed the social workers were burned out and that working at schools offered better pay and summers off.
Ron Adelman, president of the Connecticut State Medical Society, said that Connecticut ranked 47th out of 50 states in its ability to keep physicians who trained in-state.
Adelman said that he believed loan forgiveness could help incentivize these workers to stay. The current bill asks the Department of Public Health to offer grants to employers who hire child psychiatrists and to help develop a loan forgiveness program for therapists, physicians, psychologists, professional counselors, clinical social workers and behavior analysts who work in an area where there is a shortage of mental health professionals for children.
The bill, developed by a bipartisan group of legislators, also creates other grant opportunities, including a grant program for school districts who want to hire school psychologists, social workers, trauma and behavioral specialists and school counselors. Another grant program would waive the licensing fees for social workers who come from diverse backgrounds.
State Rep. Liz Linehan, D-Cheshire, co-chair of the Committee on Children, said that recruiting diverse mental health workers was critical for making sure that everyone in the state was getting the services they need.
“We’re not just talking about [non-English speaking] social workers and clinicians. There’s also a shortage of LGBTQ clinicians, and LGBTQ youth are four times more likely to have a plan for suicide than their cisgender or straght counterparts,” sad Linehan. “We need to make sure that we are looking at diversity through more than just a language or race lens. We have to look at true diversity in our clinicians to be able to help our children.”
Diane Michaelsen, Director of Field Education and M.S.W. Admissions at Southern Connecticut State University, said there was a definite need for a more diverse cohort of social workers in the state.
“In Southern Connecticut State University, we’ve worked really hard to appeal to people of color and people of minority populations, because those are the folks that are needing our help as well,” she said. “And so we talk a lot about, you know, help is better received when the person who needs help looks like you.”
The need for more social workers
Stephen Wanczyk-Karp, executive director for the National Association of Social Workers Connecticut Chapter, said that rather than creating a grant program, he believed the legislature should waive the licensing fees for all social workers, which he said were some of the most expensive in the nation. Connecticut requires a yearly $195 licensing renewal fee, plus a first-time fee of either $220 for master’s social workers or $315 for clinical social workers.
“The fee is outrageously high,” he said. “In their first year, [social workers] are paying two to four hundred dollars, typically more than any other state.”
Wanczyk-Karp and Michaelsen said they both disagree with a provision in the bill allowing English Language Learners who fail the national licensure exam to practice as long as they are supervised by a licensed social worker and promise to take the exam again in six months.
Linehan said this stipulation was included in the bill because of the high demand for non-English speakers to provide services to youth in intensive outpatient programs.
“That test is only administered in English. So what we see happening is that they failed the test because English is their second language, and then they are unable to stay on as employees for these [intensive outpatient] programs,” said Linehan.
But Michaelsen and Wanczyk-Karp said they were concerned about allowing anyone to practice without a license.
“We’re not in favor of waiver of licensure for any period of time,” said Wanczyk-Karp. “We think that that’s the purpose of licensing — to make sure that people are qualified to practice. And that it also protects the public.”
Wanczyk-Karp’s organization partners with Social Work Examination Services, which provides test prep for the national social work exam.
According to the Association of Boards of Social Work, the national organization that administers the exam, the pass rate for the exam is about 75 percent for both clinical social workers and those with a masters in social work.
Wanczyk-Karp suggested a different model would extend the length of the temporary license from the current 120 days to 180 days.
The bill also creates a “reciprocity agreement” that would make it possible for social workers who are licensed in neighboring states like New York, New Jersey and Massachusetts to work in Connecticut. Wanczyk-Karp said his organization was in full support of this measure.
Howard Sovronsky, Chief Behavioral Health Officer at Connecticut Children’s Medical Center, said that the state needed to begin working on the creation of a pipeline into the mental health professions, beginning in high school. He also emphasized the need to train pediatricians in behavioral health so that they can screen and support children with behavioral as well as physical health conditions.
“Many of them don’t feel that they have the equipment and the training and the skills needed, so it’s incumbent upon us now … to be able to deliver that support,” said Sovronsky.
A lack of beds
Physicians who testified at the public hearing also urged legislators to further fund existing programs, like intensive inpatient units for children in crisis.
The lack of bed capacity in intensive care institutions was cited repeatedly as a problem.
Fortunati said that last year, children spent 900 extra days in Yale-New Haven Health’s psychiatric units simply because there was no capacity to move them to a lower level of care — preventing the intake of new patients. Fortunati estimated that about 30 additional psychiatric beds were needed for children and adolescents across the state.
Vannessa Dorantes, Commissioner of the Department of Children and Families, said the department was piloting urban crisis centers that would provide alternatives to sending children to the emergency room. The department is already in the process of developing one, she said, and the governor’s budget provides funds for three more.
Deidre Gifford, Commissioner of the Department of Social Services, said the department saw a greater need for beds in Hartford, where expansions were taking place.
Several legislators also addressed concerns about the geographic distribution of beds, and of mental health care in general, throughout the state. Sen. Heather Somers, R-Groton, said that people in her district often had to seek placements in mental health inpatient centers outside of Connecticut because there were no services available in the state.
“Many of the people in my district … have really suffered in the fact that there is no access to healthcare for mental health issues in [children’s hospitals], and therefore the child ends up in the emergency room, which we could avoid if we had some access to healthcare,” said Somers. “In Eastern Connecticut … it is an absolute desert.”
The bill also includes several sections concerning insurance reimbursement, another key focus of many doctors who testified at the hearing.
Legislators proposed a study to scrutinize the rates at which insurance companies are reimbursing providers, to see if private insurers and HUSKY reimburse at the same levels, and to find ways to encourage more providers to accept HUSKY. The bill will also extend reimbursements for telehealth through 2024.
Aldeman urged legislators to go even further and to permanently extend telehealth. He also asked them to change certain laws in order to increase the number of providers who would be covered by insurance.
State Rep. Jonathan Steinberg, D-Westport, agreed.
“We need more high level psychiatrists to be willing to take something beyond private insurance if we’re going to address this problem. Way too many of them only accept effectively cash on the barrelhead,” he said.
The bill would also require the Department of Children and Families to offer grants to families for drugs and treatments that have not been approved by the Food and Drug Administration, or for intensive treatments that are not covered under Medicaid, but have been prescribed to treat a mental health condition.
State Rep. William Petit, R-Plainville, who is also a physician, told CT Examiner that sometimes doctors will prescribe drugs that have been approved by the FDA for adults but not for children although they have been found effective for both, for example Zyprexa for bipolar disorder or Clozapine for schizophrenia.
But Gifford said she had some concerns about the program — mainly who would decide what should or should not be covered, and whether it could encourage other insurance providers not to cover these treatments if they knew there was a state program available.
The bill also requires HUSKY to reimburse mental health providers with a master’s degree in social work, further expanding the available pool of providers. Currently, it will only reimburse those who are licensed clinical social workers. It also requires insurers to cover “intensive” and “evidence-based” mental health services for adolescents and children.
Victoria Veltri, executive director at the Office of Healthcare Strategy, also pointed out that there was nothing in the proposed bill as written that penalizes providers who fail to take in-network insurance or HUSKY.
Linehan told CT Examiner that she doesn’t yet know what the bill will cost overall, but she said that she expected that the programs would be funded by a combination of state budget funds and money from federal coronavirus relief funds.