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Community Services Boards strain, but persist, under pressure

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Randi B. Hagi
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Rebekah Brubaker and Adam Yoder are with Harrisonburg-Rockingham CSB.

Publicly-funded mental healthcare providers in the area are caught in a perfect storm: they're short-staffed, their workforce is aging, and their community partners also have limits on how many patients they can handle. WMRA's Randi B. Hagi reports.

Kimberly McClanahan, executive director of Valley Community Services Board, summed up the biggest challenge she and other mental healthcare providers are facing in 2022.

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Kimberly McClanahan

KIMBERLY MCCLANAHAN: We don't have the bodies to do all the work that we need to do.

Community Services Boards, or CSBs, are publicly funded, regional agencies that provide services such as therapy, psychiatry, substance abuse treatment, and intellectual and developmental disability support – oftentimes to clients who can't afford to see a private provider. As such, they're on the front lines of their communities' mental and behavioral health issues. And while it seems like every business and organization is short-staffed these days, the CSBs have some very specific challenges in filling their rosters.

MCCLANAHAN: People are not entering behavioral health fields as much as they were, and now that there is more of an option for telehealth, some people are leaving the Community Services Boards or your community mental health centers to go into private practice… because they can stay at home and work from there.

The licensed workforce as a whole is aging out, too. A report published by the Virginia Health Care Foundation earlier this month found that, [quote] "Virginia is fast approaching a provider cliff with 61% of Psychiatrists age 55 or older and 39% of Psych NPs age 60 or older." About a third of all licensed clinical psychologists and social workers and licensed professional counselors in the state are also approaching retirement age.

To add a rock to this hard place, new state-level regulations now require higher levels of credentials for some CSB employees.

ADAM YODER: And that's to the benefit of services offered –

REBEKAH BRUBAKER: Absolutely!

That's Adam Yoder and Rebekah Brubaker, with Harrisonburg-Rockingham CSB.

YODER: At the same time, they're enacted so quickly it's just not possible to keep up with that when you're asking for someone with a license to now supervise staff or to authorize services. Licenses take two to three years to get, along with many hours of residency … and then the other part of COVID is, people have been delaying going to school or going back to school because they don't want to learn online.

Kim Shaw, the executive director of Rockbridge Area CSB, said that being short-staffed has meant that many of their clients have to wait to access services.

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Kim Shaw

KIM SHAW: We have people waiting in the wings. Whereas at one point in time pre-pandemic, we didn't have a wait list, or a very minimal wait list, we now have like a six month wait list for some of our services. And we have fewer resources here in the Rockbridge area than even Harrisonburg-Rockingham or Valley, so we don't even have other providers to refer them out to in some cases.

Even in places where those other providers do exist – such as therapists in private practices – they're mostly at capacity, too. Rebekah Brubaker said that translates into more people showing up at their doors in crisis.

BRUBAKER: What we're hearing is that those folks are not able to secure someone because those therapists are full.

For those who reach a crisis level that requires hospitalization or another form of inpatient care, the CSBs are further handicapped because, as Kimberly McClanahan points out, institutions such as assisted living facilities and Western State Hospital are limiting admissions.

MCCLANAHAN: That, I think, will continue to be a challenge, as far as I can tell, at least for the foreseeable future. Because, again, we work with the most vulnerable in our population … We've had situations where people have been in the emergency room over at Augusta Health for days.

HAGI: Wow.

MCCLANAHAN: For days before they could get in anyplace. And again, this is not unique to Valley.

One silver lining that Valley CSB has found through the pandemic is that more clients are keeping up with their medications now that they can meet with their prescribers remotely.

MCCLANAHAN: And that's probably often because these folks may not have transportation, just can't get here … so it's kind of those medication management appointments that have really been much better attended with the use of telehealth and telephone.

Mental and behavioral healthcare providers see us in and through some of our darkest places – often at the risk of suffering burnout or secondary trauma themselves. While they don't have enough of them, all the administrators I spoke with heaped praise upon their employees.

SHAW: My staff are simply amazing. They go above and beyond every day, and they don't even question it. They do so much with so little.

A proposed bill currently under negotiation in the General Assembly would add more than $160 million toward hiring and retention incentives for CSB employees.

Randi B. Hagi first joined the WMRA team in 2019 as a freelance reporter. Her writing and photography have been featured in The Harrisonburg Citizen, where she previously served as the assistant editor; as well as The Mennonite; Mennonite World Review; and Eastern Mennonite University's Crossroads magazine.