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This spring, we released the Pathways Action Map to help advance a shared vision where all North Carolina children are reading on grade-level by the end of third grade and have the greatest opportunity for success. The first edition of the Map focused on initiatives working to ensure NC’s social-emotional health system is accessible and high-quality. Learn more about Pathways’ recommendation to expand the NC Child Treatment Program, and other actions to build a well-trained and adequate workforce of infant and early childhood mental health clinicians.
In North Carolina, there is a growing need for mental health clinicians who are trained to provide evidence-based treatment for young children and their families. The North Carolina Child Treatment Program (NC CTP) is leading efforts to fill this gap.
Founded in 2006, NC CTP serves children, adolescents, and families that are coping with serious psychological trauma and other behavioral-emotional challenges. The program specializes in evidence-based practice training and coaching for mental health providers across the state, including those serving infants and young children.
It is one of the only programs in North Carolina—and the country—providing this type of specialized training and support.
We talked with NC CTP team members, Mellicent Blythe, Implementation Specialist; Maria Ruatto, Strategy and Operations Manager; and Beverly Glienke, Training Director, to discuss their services for families and providers, and how to best support the program’s expansion to reach more children.
Specialized Mental Health Treatment and Training
NC CTP’s in-house clinical expertise, and long-term relationships with mental health providers and communities, sets them apart from other treatment and training programs. Their strong experience and relationships allow them to stay connected with what’s happening at the state and national level.
“It was not, at first, a traditional training program. It came out of deep clinical experience, which I think is really significant. We work with nationally endorsed trainers in each of the models, so that allows us to keep up with ongoing research in each of the treatment areas,” said Blythe.
The program is also unique in its commitment to working with agency leaders to “sustain evidence-based treatment so they can continue to provide them, even after clinicians have completed their training year,” said Ruatto. This continuity helps to ensure services are maintained and remain high-quality. Additionally, NC CTP can learn from trained clinicians in local communities, and see what’s working for families on the ground level.
Expanding Therapy Services for Infants and Young Children
NC CTP provides training on therapies for children and youth of all ages, including several evidence-based treatment (EBT) models designed specifically for young children, birth to age eight, and their families (e.g., Parent-Child Interaction Therapy, Trauma-Focused Cognitive-Behavioral Therapy). These EBTs are appropriate for children who have experienced traumatic events, mental health issues, or behavioral problems.
While these treatments would benefit many children, they are not currently accessible to all families across the state. NC CTP is working to expand therapy services to reach more children.
“Our Child-Parent Psychotherapy Program, which works with children ages birth to five, has really expanded. We’re continuing to work with CDSAs [Children’s Developmental Service Agencies] and CAC [Children’s Advocacy Centers of NC] building relationships with and recruiting infant and toddler mental health clinicians,” said Glienke.
Recently, the program has focused on expanding access to Problematic Sexual Behavior-Cognitive Behavioral Therapy across the state. Benefits of this treatment include reduced engagement in problematic sexual behaviors; improved emotional difficulties and trauma symptoms; and decreased costs and disruption related to out-of-home placement.1
Challenges to Recruiting and Retaining Infant and Toddler Clinicians
A major barrier to providing young children and families with access to high-quality mental health treatment in North Carolina is recruiting and retaining clinicians who are trained to provide these therapies.
“We’re in a real retention crisis right now,” agreed the NC CTP team.
Caseload burnout and secondary stress make it harder to recruit mental health clinicians and keep them on board. In addition, NC CTP leaders said that scarce funds and the use of enhanced pay rates, versus cost-based rates, by health insurance providers make it difficult to provide services and keep caseloads manageable.
“The fact is, the Medicaid based rates for mental health do not cover the cost of evidence-based treatment because of planning, supervision, and quality assurance,” said Blythe. These areas are necessary to providing effective treatment and retaining clinicians, but are not sufficiently covered in payment for services.
This is even more relevant in rural communities reliant on Medicaid for mental healthcare support. Blythe stated, “We actively look at where we need more clinicians and do specific outreach to those areas. In rural areas, there are few clinicians that serve the Medicaid populations, which makes it harder to serve those areas.”
Stakeholders agree that moving toward evidence-based treatments is the right move, but the rates they are currently paying providers makes it difficult for them to keep their doors open.
“’It’s a vicious cycle where you need more hours to cover costs, but it could also make it harder for overworked clinicians to ensure quality services,” added Glienke.
Building a Pipeline of Health Providers of Color
Increasing the number of mental health providers of color is particularly important in order to effectively serve North Carolina’s diverse communities.
Similar to other healthcare fields, providers of color are significantly underrepresented in mental health professions. Families may prefer a provider who they can identify with, has a similar background, or understands their culture.
NC CTP has begun collecting demographic information on trainees so that they can have a better understanding of the populations being served and trained. With this data, they are identifying areas in need of more outreach and support.
The program also continuously strives to address the impact of systemic racism on children and families, by incorporating race-based traumatic stress principles throughout the clinical training and consultation platform. This is also prioritized in some student preparation programs, like the UNC School of Social Work, with support from the National Child Traumatic Stress Network.
“We work with model developers and the national trainer network, so each EBT integrates training with a racial equity lens on both the national and state level, whether it be in training or consultation,” said Ruatto.
Expanding the NC Child Treatment Program
To better meet North Carolina children’s mental health needs, early childhood stakeholders say the NC CTP should be expanded to reach to more providers, families, and communities. The Pathways to Grade-Level Reading Action Framework and EarlyWell Initiative both include this in their policy and practice recommendations for the state.
When asked what would best support the program’s expansion, NC CTP leaders emphasized the need for improved reimbursement, funding, and infrastructure.
“Right now, the biggest constraint is the demand and rates issue,” said Ruatto. Demand for mental health services is high across the state. NC CTP leaders agreed if health insurance providers implemented a cost-based reimbursement rate, it would help to cover the true cost of delivering evidence-based treatment to children and families who need it.
Funding for specific initiatives would also benefit expansion. The program is currently considering partnering with organizations around funding for workforce development in order to increase its capacity to train more clinicians.
“We need to have the in-state, lasting infrastructure to continue to train clinicians,” said Blythe. “We really want to have that ongoing relationship and connection, which does come down to funding for our team and its infrastructure.”
Prioritizing A Strong Mental Health Workforce for Young Children
When young children have positive early life experiences and other needed mental health supports, they are set up for life-long well-being and success. Building a well-trained and adequate workforce of infant and early childhood mental health clinicians, with a focus on increasing the number of providers of color, is a key strategy for ensuring this is possible for all North Carolina children. Read more in our recent blog.
Explore the Pathways Action Map to learn more about prioritized actions to ensure North Carolina’s social-emotional health system is accessible and high-quality, and initiatives working to impact them. Find a summary of NC CTP’s work on the Map, highlighting how they are using a racial equity lens, incorporating community voices, and some areas for next steps.
Visit the NC Child Treatment Program online to learn more about their training opportunities, support for EBT implementation, and a roster of trained providers in your area.