An empty patient room at the Children’s Farm Home run by Trillium Family Services in Corvallis on Friday, Oct. 29. The facility currently does not have enough staff to take on more inpatient residents, leaving a building empty. (Amanda Loman/Oregon Capital Chronicle)

EDITOR’S NOTE: This is the third of a four-part series on the problems facing children’s mental health care providers in Oregon. Deputy Editor Lynne Terry interviewed more than a dozen providers, parents and state officials and reviewed state records. For anyone needing immediate help, call the Lines for Life for youth at 877-968-8491 or seek help in a nearby emergency room.

Mental health treatment centers for children have one main problem: finding employees.

They’ve suffered from a chronic workforce shortage for years but the pandemic made it worse, and the impact on children has been profound.

Employees are with the children around the clock, helping them with daily activities. They’re responsible for keeping the children safe, and If a crisis erupts, their job is to diffuse it. 

The facilities also have child and family therapists and other staff. 

Many entry-level jobs in residential care facilities require a bachelor’s degree, while therapists, who devise treatment plans, typically must have a master’s degree. They work under the supervision of a psychiatrist.

The jobs are high stress. Employees who are with the children around-the-clock endure aggression and violence – and the pay is poor.

Employees often don’t get the supervision and training they need to feel supported, said Dr. Ajit Jetmalani, director of child and adolescent psychiatry education at Oregon Health & Science University.

“We saw a massive loss of workforce in the children’s health system,” Jetmalani said. “And what’s happened now is that people are not coming back.”

Fast food often pays more, and the work is easier.

“Panda Express is paying $19 an hour, and we’re paying master’s level clinicians $15 to $17 an hour,” said Chris Bouneff, executive director of the Portland-based National Alliance on Mental Illness Oregon. “There (were) enough altruistic people willing to do the work to kind of hold things together, but that’s been blown up.” 

Trillium Family Services, which runs three residential facilities for children and young adults, plans to raise wages for employees who teach children life skills for managing their emotions. They’re now paid $17 an hour, said Kim Scott, Trillium’s CEO. 

“These people are underpaid,” Kim said. “But if you’re not getting reimbursed correctly, how do you make the math work?”

Fariborz Pakseresht, director of the Department of Human Services, acknowledged their difficulties. His agency and the Oregon Health Authority fund children’s care under a budget set by legislators.

“Right now the labor market is such that it’s very difficult to be able to compete, and these are difficult jobs,” Pakseresht said. “Some of these kids have behavioral issues. Staff can get hurt. It’s much easier to go work at Home Depot.”

Providers now offer financial incentives to attract staff, including hiring bonuses between $1,000 and $5,000, moving expenses and more on-the-job training, according to a recent survey by the Oregon Council for Behavioral Health, a Gladstone-based nonprofit that represents mental health and addiction treatment providers.

DOCUMENT: Oregon Council for Behavioral Health survey

The report showed that it takes providers up to three months to hire for one-third of their positions, six months to fill one-fifth, and nearly one-fifth remain perennially vacant.

“Our observation is that unless you’re getting closer to $20 an hour, it’s very difficult to hire staff,” Pakseresht said.

Even when facilities hire staff, many employees aren’t staying long.

Turnover rates in the industry are high: Scott said they hover between 30% and 40% at Trillium.

The council’s survey found that turnover rates had doubled during the pandemic, with some nonprofits reporting rates over 60%.

“That says to me that people really don’t feel valued,” Scott said.

Operators haven’t had the money to modernize the work environment. In old buildings, floors are often divided into rooms. Employees need open sightlines to see children from afar, Scott said. 

Scott also mentioned another complaint: faded paint and dingy carpeting.

The cash-strapped facilities have had to defer maintenance but that undermines their mission.

“The buildings don’t reflect a therapeutic environment,” Scott said.

Fixing them will require a major investment.

This summer, frustration over staffing peaked. 

In August, the Oregon Council of Behavioral Health issued a statement saying the state’s addiction treatment for youth was in deep trouble. 

“The crisis at hand leaves us with the stark reality that as access collapses, closures of services will exacerbate Oregon’s already poor outcomes,” the letter said.

DOCUMENT: Oregon Council of Behavioral Health 

Right before Labor Day, officials at Trillium’s Children’s Farm Home in Corvallis warned the Department of Human Services that they were going to have to release two children to get through the weekend. 

“We had some staff-intensive kids that, if discharged, could help us get through,” said Amy McAdams, vice president of operations at the Children’s Farm Home. “That woke the state up.” 

The facility worked with the department to get five contract registered nurses for a week to ensure they had enough staff and later got more contract staff, McAdams said. 

But managers had to send about half the extra workers home because they were trained to work in long-term care or skilled nursing facilities, not with children with mental health issues. 

“Some have been fantastic but some of them haven’t,” McAdams said. “But they kept us stable at least.”

The state also has used federal funds to pay for contract workers for Trillium’s Parry Center for Children in Portland, Jasper Mountain east of Springfield and Albertina Kerr in Portland, along with Looking Glass in Eugene. Though welcome, providers say that help has not been enough.

In September, nearly 50 Medicaid insurers, children’s advocates and specialists in children’s mental health and addiction signed three different letters about the circumstances, The letters went to state officials, including Gov. Kate Brown and executives at the Oregon Health Authority. 

One letter said that substance abuse was skyrocketing across the board.

“The addiction recovery system workforce is straining to a breaking point with the increase in demand and, ironically, with the infusion of significant resources,” the letter said. “The measures taken in the last legislative session are a step in the right direction, but the slow implementation of resources is causing system failure.”

DOCUMENT: Letter to Gov. Kate Brown from addiction specialists 

In another appeal to the state, Medicaid insurers and others said the millions of dollars allocated for behavioral health during the legislative session were for the long-term transformation of a system which needed immediate help. 

“If we don’t turn our attention to this first, we won’t have a system to transform,” the letter said.

DOCUMENT: Letter from Medicaid insurers and others

The third warning was from children’s behavioral health care specialists, including Doernbecher Children’s hospital, Trillium, the Oregon Family Support Network, the National Alliance on Mental Illness Oregon and Albertina Kerr.

It reiterated complaints of chronic underfunding, a churn of staff and neglected capital investment. 

“We funded programs at levels that created ongoing atmospheres of pending financial ruin,” the letter said. “Long-standing service organizations have burned through reserves.”

DOCUMENT: Warning from children’s behavioral health specialists

At the end of September, Brown heard these complaints in a meeting of her Children’s Cabinet, which includes providers. She ordered the Oregon Health Authority and the Department of Human Services to come up with a plan to meet the crisis in two days.

On Oct. 1, they finalized the plan. 

DOCUMENT: State emergency plan

The proposals included continuing a 10% rate increase through Dec. 31, spending $7 million over the next 20 months to help facilities add staff and giving nearly $4 million to facilities that have had Covid-19 outbreaks. The plan said the health authority was trying to come up with more money for short-term bonuses to help centers retain and hire staff.

The last measure is in the works: The Oregon Health Authority is devoting $15 million of federal funds to help bolster workforces. Facilities have to apply, and the money is for both adult and children’s centers.

Reactions to the proposals have been mixed.“I think the plans that are on the table are solid,” said Carol Dickey, an advocacy and system of care trainer at the Salem-based Oregon Family Support Network.

But Bouneff of the National Alliance on Mental Illness Oregon said the plan submitted by the health authority and Department of Human Services is not enough.

“The state agencies look like they’re doing things because they put together a laundry list with dollar amounts attached,” Bouneff said. “But they aren’t commensurate with the need. That’s the bottom line.”

Pakseresht acknowledged that more needs to be done.

“It did not make enough difference,” he said about $16 million that was allocated in June by the Department of Human Services for staffing. “Absolutely more money is needed.”

NEXT: 

Though some beds are being added for residential mental health and addiction treatment, providers say they need a long-term funding fix to stay afloat.

THE SERIES PART 1: Mental health, addiction care falling short for distressed children

THE SERIES PART 2: ‘Bottlenecked’ mental health system leaves kids untreated

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