Opinion | How to Address the Child Therapist Shortage

My stomach clenched as I answered the phone in my therapy office. On the line was the last concerned and angry parent hoping to set up a psychotherapy appointment with me for their child or teen. I’m one of the few child and adolescent therapists in my area, and I was dreading telling this mom that my schedule was full. I listened to her, made a few recommendations, and suggested some self-help or online resources the family could use while they wait to get into therapy with someone else.

“But it’s urgent,” said the mother. Of course she’s right. Some parents try to keep me on the phone hoping that I will hear their desperation and agree to make an appointment for their child. And every once in a while I break my promise not to overbook. I know how needed my services are. But now that school has started and the children’s availability for therapy is being restricted, I can’t anymore.

There is a nationwide shortage of mental health professionals, but it is particularly acute for children and adolescents. The US Department of Health and Human Services estimates that by 2025 the nation will have 10,000 fewer mental health professionals than it needs. Even before 2020, many children and young people with behavioral problems were not receiving any benefits. Reasons included a lack of financial resources, the stigma of mental health issues, and of course, the lack of therapists trained to work with children.

High-quality training courses in child and youth therapy are difficult to find. Most therapists in the United States, like me, are clinical social workers. We spend two years in graduate school and only part of our studies is spent developing counseling and clinical practice skills. Further training in child and youth therapy often takes the form of internships (similar to internships), extra-occupational training and costly postgraduate courses. Clinical and school psychologists have opportunities for more focused and intensive training when working with children, but these professions require longer doctoral training.

But there are other key reasons why therapists shy away from working with children, when this population is so clearly in need.

Child therapy is not always intuitive to therapists used to traditional talk therapy, and talking alone does not always work with children and adolescents. Instead, child therapists use games, activities and exercises, role-plays, and other tools to communicate with young clients. This requires creativity, time-consuming preparation work and a sufficiently spacious therapy office equipped with toys, games, painting materials and books. These all come with price tags—both in energy and money—for therapists.

Discussions with parents, clerks and school staff outside of the therapy session are also time-consuming. These so-called collateral contacts are not reimbursed by most insurance companies, but are crucial for good treatment. Like all clients, children tell their stories from their unique perspective and there is a need to get a bigger picture of the adults in their lives.

But there is only a limited number of free hours in a week. Young children have a small window between school, dinner and bed, and therapy can compete with sports, arts, tutoring, religion classes and more. This means that child and youth therapists frequently work late afternoons, evenings and often weekends to also fill a part-time schedule with young clients.

Child and adolescent therapists who work for psychiatric institutions or hospitals usually have enormous case numbers. Many are paid little. Social workers and other mental health workers typically take low-paying jobs to gain the supervised experience necessary for state clinical licensing. Even if we are approved to practice unsupervised, our income is unlikely to help us reduce the student loan debt we incur while we graduate. According to the Bureau of Labor Statistics, the median salary for social workers in the United States in 2021 was $50,390. The median income for psychologists was much higher, but they have longer and more rigorous educational requirements.

There are ways to reduce the child and youth therapist shortage by making work more sustainable for new and experienced therapists. State and federal governments can increase funding for mental health facilities to allow child therapists to earn a decent wage. National legislation may require insurance companies to reimburse child therapists for accompanying contacts that take so much time and energy.

The United States can also follow England’s lead and build something like Children and Young People’s Improving Access to Psychological Therapies (CYP-IAPT), a program to improve and expand the workforce with a focus on child and adolescent mental health. In its first five years, it has trained 1,000 “Therapists in Evidence-Based Psychological Therapies,” greatly improving its workforce. Although researchers have identified some administrative issues with CYP-IAPT, such as B. hasty introductions and lack of guidance for workers, we can learn from his mistakes and do better. Here in the United States, the Health Resources and Services Administration has initiated a smaller initiative called the Behavioral Health Workforce Education and Training Program that aims to train more behavioral health professionals who can reach underserved communities. This investment is promising.

Parents with children who are on therapy waiting lists have a few options. Digital mental health platforms provide access to game-based interventions that represent promising therapy alternatives for young people with problems such as anxiety or poor impulse control. While researchers are still studying the effectiveness of online interventions, they could serve as a stopgap measure. But children and young people with more severe mental health problems benefit most from treatment by well-trained and experienced professionals.

If we believe that children are our most valuable resource and that there is a crisis in child mental health care, we should invest in those who care for our children.

Rebecca Bonanno is a Licensed Clinical Social Worker and former Associate Professor of Human Services at SUNY Empire State College.

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