Imagine a child arriving home from elementary school to find an unresponsive parent stretched out on the couch – a needle sticking from the parent's arm. Imagine a baby crying in the crib for hours because the parent has died of an overdose. Imagine a child living in a home where a dozen people are in and out daily – all buying and using opioids together. These nightmare situations are happening throughout northeast Indiana.
An addict is a person who is ill with a disease. Living with the disease causes chaos at home. The highs and lows of drug usage create an environment where the family at home is ignored at best, abused at worst. Addicts spend all the household's money to feed their habit, leaving the family no money for food or rent.
The spouse of the addict lives on a roller coaster of pain. The roller coaster traumatizes children, resulting in lifelong physical and mental health problems if not treated. The entire family needs treatment.
According to Cathy Graham, CEO of Indiana Association of Resources and Child Advocacy, “...The 12,000 children and families that IARCA agencies collectively serve have experienced multiple Adverse Childhood Experiences (ACEs) that, if left untreated, can lead to further mental illness and family breakdown.” Living in a home with a drug addict is a leading adverse experience. Therapists alleviate the problems if there is a therapist available.
Recently, The Journal Gazette highlighted the need for more social workers. Demand for social workers and therapists soared over two years ago. The rampant opioid epidemic in northeast Indiana has those in the trenches stretched to the limit. Waiting lists for services for families have grown. Hiring therapists is difficult. Providers are desperately recruiting therapists throughout the state and country.
The shortage of professional therapists comes from several factors, including licensing requirements.
Prospective therapists often borrow money for graduate studies. They work full-time jobs in human services to attend a university in Indiana with an accredited counseling, marriage and family therapist or social work program. They graduate in debt, but are trained and eager to get to work as a therapist.
They start work, but there is no guarantee they can get the initial license needed to work under a licensed therapist as required to become a full therapist themselves. Discouraged, they sometimes leave the field or the state. This is all too often the reality in Indiana.
There are several licenses to become a therapist in Indiana, depending on the graduate degree you obtained. Each has different requirements. All require a preliminary license, plus post-graduate supervised hours that take several years to complete.
The licensing is controlled by Indiana Professional Licensing Agency's Behavioral Health and Human Services Licensing Board.
Requirements are necessary to assure we have qualified therapists in the field. According to Randy Rider, CEO of Crossroads Children and Family Services, “Professional licensing boards have a responsibility to maintain high standards for their professional disciplines, but also to credential a workforce sufficient to meet the growing needs of persons requiring care.”
No one argues with the need for high standards. The key is a “workforce sufficient to meet the growing needs.”
Conversations with IARCA's Graham and with several providers offering therapy services in northeast Indiana confirm there are major obstacles in the licensing process. Here are a few of the critical issues:
• License applications get lost. Required information is sent to the board, then more information is requested. Accredited graduate school courses are not accepted, so a syllabus must be sent for review to determine whether the course covers the subject matter needed. Months can go by before an applicant is told the status of their application.
• Candidates call to track their applications and are placed on hold for long periods of time. Other times, no one answers the phone at the licensing agency.
• Individuals who have already incurred debt and long hours of study from accredited graduate programs are told that they must go back to school at their own expense and take additional courses to become licensed, even though all programs require hours of internship work while in school. The agency will rule the accredited graduate program did not have sufficient hours. This is particularly true of those who graduated from a Council for Accreditation of Counseling and Related Educational Programs-accredited graduate school of mental health counseling. The statute and requirements in Indiana do not match CACREP accreditation standards.
Sadly, some mental health counseling graduates say they wished they had never gone back to school to be a mental health counselor. Others leave Indiana for states that accept the college accreditation standards. Any way you look at it, Indiana's families lose.
As the shortage of therapists increased, providers of mental health service recruited counselors from surrounding states, only to find out that the licensed therapist from out of state was not always granted reciprocity.
Much of the work of the licensing process appears to be conducted by a volunteer board whose members have full-time jobs. A candidate's application may come up for review and the board runs out of time at its monthly meeting. The applicant waits.
As the demand for licensed therapists began increasing in 2014, a backlog of licensing applications developed.
Some relief has occurred. The Indiana General Assembly passed a law that went into effect July 1, smoothing the way for a licensed therapist from another state to be granted a reciprocal license in Indiana. Providers report those graduating from accredited social work schools with a master's degree in social work can have their applications processed quickly because the statute and the licensing board accept the accreditation standards.
But providers attempting to hire a workforce large enough to meet the needs of the victims of the opioid epidemic say the system is still flawed.
Dee Szyndrowski, CEO of SCAN, said state leaders, agencies and advocacy groups must collaborate to ensure we are licensing clinicians in a timely manner – “streamlining the process, from education to internships to licensing to stop the shortage.”
Laura Hoffman, clinical director for Lutheran Social Services of Indiana, says, “We recognize that policy changes have placed increasing demands on the licensing board, and we are willing to be a part of a solution-building process to expedite the license application.”
Therapists do a job few want to do. They are called to make life-or-death decisions in determining whether the addict, the children and others in the home are safe. Frequently, therapists visit homes where drugs and drug paraphernalia are found. They are truly the Mother Teresas of this decade. It is essential for them to be highly qualified and licensed. But the system to process that license should not be a burden to these fine professionals.
A system overhaul of licensing in Indiana is crucial in solving the shortage. Indiana has the money and capability to create a tech-savvy, adequately staffed system of licensing for therapists. Coordinating statutes to match graduate school accreditation would assure efficiency without sacrificing quality.
Everyone says they want to solve the addiction problem. How long can we wait for these licensing issues to be fixed? More importantly, how long can these children and families survive while we fix the system to assure they have help?
Rachel Tobin-Smith, the former CEO of SCAN, is executive and career coach for Organization Advisor.