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“During the spring 2018 legislative session, a bipartisan group of 10 legislators sponsored aresolution, HR 711, which declared that Illinois is suffering from a Behavioral Healthcare WorkforceEmergency. House lawmakers are correct and the emergency has escalated to a crisis. In fact,the statistics are blinking red.” - Behavioral Health Workforce Education Center Task Force ReportBehavioral HealthWorkforceEducation CenterTask Force Reportto the Illinois GeneralAssemblyA Report on the Illinois Behavioral HealthWorkforce Crisis andRecommended Solutions to Grow,Recruit & Retain a Qualified, Modern,Diverse, and Evolving Behavioral HealthWorkforce: Response to House Bill 5111(PA 100-0767)December 27, 2019

Task Force MembersChairman: Marvin Lindsey, MSW, CADCChief Executive OfficerCommunity Behavioral Healthcare Association of IllinoisSukhveer Bains, MDAssistant Professor of Clinical EmergencyMedicine and Internal MedicineUniversity of Illinois at Chicago Hospital &Health Sciences System (UI Health)Sonya Leathers, PhDProfessorUniversity of Illinois at Chicago, Jane AddamsCollege of Social WorkCourtney Boddie, PhDDirector of Counseling ServicesSouthern Illinois University at EdwardsvilleJanet Liechty, PhD, MSW, LCSWAssociate ProfessorUniversity of Illinois at Urbana-Champaign,School of Social WorkStephen Brown, MSW, LCSWDirector of Preventive Emergency MedicineUniversity of Illinois at Chicago Hospital &Health Sciences System (UI Health)Ann McCaughan, PhDAssociate Professor & Department ChairDepartment of Human Development CounselingUniversity of Illinois at SpringfieldBlanca Campos, MPAVice President of Public Policy and GovernmentAffairsCommunity Behavioral Health Association ofIllinoisRobin Mermelstein, PhD,Distinguished Professor of PsychologyUniversity of Illinois at ChicagoDirectorInstitute for Health Research and Policy,University of Illinois at ChicagoHolly Cormier, PhDDirector of the Clinical CenterSouthern Illinois University at CarbondaleColleen Cicchetti, PhDExecutive DirectorCenter for Childhood Resilience,Pritzker Department of Psychiatry andBehavioral Health, Ann & Robert H. LurieChildren’s Hospital of ChicagoAssociate ProfessorNorthwestern University Feinberg School ofMedicineDiana Knaebe, MSWDirectorIllinois Department of Human Services, Divisionof Mental HealthJaimee Ray, BSSenior Associate DirectorIllinois Board of Higher EducationTerry Vanden Hoek, MD, FACEPProfessor and HeadDepartment of Emergency MedicineUniversity of Illinois at Chicago College ofMedicineKari Wolf, MDAssociate Professor and Chair,Department of PsychiatrySouthern Illinois University School of Medicine

Stakeholder ContributorsSherie ArriazolaAssociate Vice President ofBehavioral Health ServicesSafer FoundationRegina CriderDirectorYouth & Family Peer SupportAllianceLia DanielsManager of Health Policyand FinanceIllinois Health and HospitalAssociationErin E. Emery-Tiburcio,Ph.D., ABPPAssociate ProfessorRush University Departmentof Behavioral SciencesGeriatric and RehabilitationPsychologyMelissa Fischer, PhDVice President of Curriculum,Research, and AccountabilityGolden AppleStephanie Frank, LCSWDeputy Director of Planning,Performance Assessment andFederal ProjectsDHS/SUPR – Division ofSubstance Use Preventionand RecoveryNeha GillExecutive DirectorApna Ghar, Inc.Angie HamptonChief Executive OfficerEgyptian Health DepartmentJessica HayesExecutive DirectorIllinois Certification BoardSara HoweChief Executive OfficerIllinois Association forBehavioral HealthJim KaitschukExecutive DirectorIllinois Sheriffs’ AssociationHoward Liu, M.D., M.B.A.Chair and Associate ProfessorUniversity of NebraskaMedical Center, College ofMedicine, Department ofPsychiatryFormer Co-Director,Behavioral Health EducationCenter of Nebraska (BHECN)Brent Khan, Ed.D.Co-DirectorBehavioral Health EducationCenter of Nebraska (BHECN)Martin MacDowell, DrPH,MBA, MS and ACHE FacultyAssociateResearch Professor andAssociate DirectorRural Health ProfessionsProgram, University of Illinoisat Rockford – Colleges ofMedicine and PharmacyHeather O'DonnellSenior VP, Public Policy andAdvocacyThresholdsSusan M. Scherer, M.D.Pediatric and GeneralPsychiatryMeryl SosaExecutive DirectorIllinois Psychiatric SocietySeth Seabury, PhDDirectorUSC Keck-Schaeffer Initiativefor Population Health PolicyLinda Xóchitl TortoleroPresident and CEOMujeres Latinas en AcciónAmanda M. Walsh, JD, LLM,MSWDirectorIllinois Children’s MentalHealth Partnership

Report AuthorSharon Post, BAPaterson Healthcare Writing & Research LLCReport UnderwriterOPTUM Health

Table of ContentsExecutive Summary1Introduction6Behavioral Health Workforce DataIllinois State DataNational DataNext Steps for Behavioral Health Workforce Data CollectionBehavioral Health Workforce Shortages—Evidence and Paths ForwardUnmet Need for Behavioral Health ServicesBehavioral Health Workforce SupplyLessons from Behavioral Health EmployersReplicable Models to Address Behavioral Health Workforce ShortagesSupport for Use of Evidence-Based PracticesIllinois Strengths and Assets for Evidence-based PracticesModel Program for Training in Evidence-based Practices: The North CarolinaChild Treatment ProgramTraining the Future Behavioral Health Workforce in Evidence-based PracticesNext Steps and Recommendations for a Workforce ix A1: Task Force Enabling LegislationAppendix A2: HB 5111 as Introduced, with Concepts for Study by the Task ForceAppendix B: Table of HB 5111 Concepts and Findings of the Task ForceAppendix C: Select Licensure Data from the Illinois Department of Financial andProfessional RegulationAppendix D: Map of Certification-holders by RegionAppendix E: Stakeholder FeedbackAppendix F1: Behavioral Health Education Center of Nebraska BudgetAppendix F2: Comparison Population and Workforce Needs of Nebraska and Illinois535559626571727879

EXECUTIVE SUMMARYWe have had no applicants for clinical positions who have possessed a master's degree orlicense since 2018. In 2019 we have only been able to hire individuals with bachelor’s degreesand no experience or minimal experience to fill clinical positions. Georgianne Broughton,Executive Director, Community Resource CenterSince the budget impasse we have seen turnover numbers or vacancies that we are unable to fillat records rates. Some behavioral healthcare positions have a 60% turnover and some positionshave been vacant for over 1 year. Sherrie L. Crabb, MS, QMH, Chief Executive Officer, FamilyCounseling Center, IncWe currently have over 50 full and part-time clinical positions open with very few applicantscausing waitlists in many of our programs. Joan Hartman, Vice President of Strategy &Innovation, Chestnut Health SystemsWithout workforce development initiatives, access to treatment will remain elusive for millionsbecause there are simply not enough workers. Heather O’Donnell, Vice President of PublicPolicy and Advocacy, ThresholdsThe quotes listed above are from community behavioral health providers and stakeholdersacross the state of Illinois. Behavioral health workforce shortages, which have been a majorconcern in Illinois for decades, have gained a greater sense of urgency as demand forbehavioral health services grows. The Illinois behavioral health workforce situation is at a crisisstate and the lack of a behavioral health strategy is exacerbating the problem.During the spring 2018 legislative session, a bipartisan group of 10 legislators, led byRepresentatives Lou Lang and Tom Demmer, sponsored a resolution, HR 711, which declaredthat Illinois is suffering from a Behavioral Healthcare Workforce Emergency. The resolutiondeclaring a workforce emergency was unanimously adopted by House lawmakers. Houselawmakers are correct, and the emergency has escalated to a crisis. In fact, the statistics areblinking red.That legislation was followed by SB 1165 (Public Act 101-0202) which received unanimoussupport in both chambers and was signed into law by Governor Pritzker on August 2, 2019. Thelaw called for the creation of a Behavioral Health Workforce Education Center Task Force (TaskForce). The law mandated the Task Force: to study the concepts presented in House Bill 5111, as introduced, of the 100th GeneralAssembly,1

to gather data, receive stakeholder input, to consider the fiscal means by which the General Assembly might most effectively fundimplementation of the concepts presented in House Bill 5111, and to submit its findings and recommendations to the Illinois General Assembly on orbefore December 31, 2019.From November 16, 2018 to December 12, 2019, the Task Force held monthly video conferenceand teleconference calls to receive input from stakeholders, examine data collected and discussstrategies and recommendations which this report will cover in the following pages. Appendix Ecompiles the written stakeholder feedback that was shared with the Task Force.Mental Health America ranks Illinois 29thth in the country in mental health workforceavailability based on its 480-to-1 ratio of population to mental health professionals, and theKaiser Family Foundation estimates that only 23.3% of Illinoisans’ mental health needs can bemet with its current workforce. Long wait times for appointments with psychiatrists—4 to 6months in some cases— high turnover, and unfilled vacancies for social workers and otherbehavioral health professionals have eroded the gains in insurance coverage for mental illnessand substance use disorder (SUD) under the Affordable Care Act (ACA) and parity laws. Illinoisfaces a statewide crisis in behavioral health access due to its inadequate workforce capacity.Fueled by the growing opioid epidemic, drug overdoses have now become the leading cause ofdeath nationwide for people under the age of 50. According to the Illinois Department of PublicHealth, opioid overdoses have killed nearly 11,000 people in Illinois since 2008. Just last year,nearly 2,000 people died of overdoses—almost twice the number of fatal car accidents. Beyondthese deaths are thousands of emergency department visits, hospital stays, as well as the painsuffered by individuals, families, and communities. The Department also notes that the opioidepidemic is the most significant public health and public safety crisis facing Illinois.Shortages are especially acute in rural areas and among low-income and under-insuredindividuals and families. 30.3% of Illinois’ rural hospitals are in designated primary careshortage areas and 93.7% are in designated mental health shortage areas. Nationally, 40% ofpsychiatrists work in cash-only practices, limiting access for those who cannot afford high outof-pocket costs. Community mental health centers have long argued that low Medicaidreimbursement rates limit capacity and do not allow for expanding access to services or coverthe costs of recruiting and retaining teams for evidence-based behavioral health practices likeAssertive Community Treatment.Insufficient numbers of behavioral health professionals, the absence of an action plan onbehavioral health workforce development, inadequate training in evidence-based practices,2