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The COVID pandemic created a dilemma for providers of behavioral health services in Montana (and across the US): the need for behavioral health services sharply increased, while at the same time it became difficult for providers to fill key positions. Demand was high, turnover was rampant, and the combination was grim. A 2021 survey by the Behavioral Health Alliance of Montana found that group homes and acute care facilities were especially hard hit. Due to workforce shortages, Montana’s available behavioral health inpatient beds decreased by 25%, and almost 20 group homes shut their doors.
“A strong behavioral health workforce is essential, but retaining that workforce has become increasingly difficult.”
— Meghan Peel, Acting Administrator DPHHS BHDD
Montana DPHHS’ Behavioral Health and Disabilities Division (BHDD) knew this problem wasn’t going away anytime soon. BHDD partnered with the Center for Children, Families and Workforce Development (the Center) to help Montana’s behavioral health providers reverse the trend. “A strong behavioral health workforce is essential, but retaining that workforce has become increasingly difficult,” says Meghan Peel, Acting Administrator DPHHS BHDD. “Partnering with the Center to work directly with providers is one way we are investing in strengthening this critical workforce.”
Homegrown Strategies
As Center staff talked to behavioral health providers, it quickly became apparent that they all faced somewhat different challenges. What providers had in common was a sense of defeat and overwhelm. Clearly, the Center needed to design a training that brought leaders together to support each other as they explored strategies to address their own individual needs and challenges. Center staff and consultant Will Tedrow put their heads together to develop a relevant and effective training.
In 2023, the Center launched a pilot project of the Behavioral Health Recruitment and Retention Strategies (BHRR). Leaders representing 11 behavioral health providers from six agencies came together with Tedrow and Center staff. Their goal was to create strategies to support and grow the workforce for the long-term, from the bottom to the top of their organizations. Most public concern about the behavioral health workforce had been directed at licensed professionals, especially psychiatrists and counselors. However, “direct care workers deserve the bulk of our attention,” says Tedrow. “They are the core of the impact created by this industry.” Licensed professionals provide essential guidance and leadership in treatment planning, but direct care workers provide the day-to-day, moment-to-moment-to-moment support that makes up the bulk of treatment. They execute treatment plans, witness their effectiveness, and make real-time decisions in delivering treatment services.
The first BHRR learning collaborative met six times over 18 weeks. Group sessions with providers examined the role of compensation, benefits, burnout, and targeted recruitment and retention efforts within their organizations. Between sessions, each organization worked on their own recruitment and retention plan. Participants also received three months of individualized leadership coaching centered on “change management”—developing and implementing strategies to help organizations adapt to new and emerging situations.
The learning collaborative’s overall goal was to harness providers’ strengths and to support them in building plans that reflect their individual agencies. At the same time, the Center introduced providers to evidence-based practices that research shows are effective for behavioral health and developmental disability services. “That’s how the Center, the providers, and the state approach the issue,” says Tedrow. “We want to take actions that are going to work.”
“What people are asking for from their organizations is different than what has worked in the past.”
— Will Tedrow, Consultant
Tedrow reports that participants embraced the process. He cites two key findings:
- Leaders felt a deep appreciation for working in a group. “Trying to solve these workforce challenges can be isolating for leaders. It’s easy to feel hopeless like these problems can’t be fixed, which can even create a sense of shame…We needed to rethink how we approach these workforce issues. Leaders need a community where they can really rumble with this stuff.”
- The needs of the workforce have changed. “What people are asking for from their organizations is different than what has worked in the past. People want to feel like they are making an impact in their communities, and they want to be able to do it in a way that doesn’t leave them feeling depleted. They are calling on us to create environments where people can thrive.”
“As this community engages with their challenges, we saw each of them create an individualized approach that was a direct outgrowth of their organization’s culture,” says Tedrow. He listed a few notable accomplishments: one organization changed their compensation philosophy based on what they learned; another tackled leadership development; a third created a new position to focus solely on staff burnout; and a sole proprietor established a succession plan to mentor a family member through the process of becoming an addiction counselor.
“It was supportive to hear other teams’ experiences and know that we are not alone in our challenges."
— Collaborative Participant
Participants agree that the process had strong impacts. One participating leader said that attending BHRR changed their planning significantly, becoming more focused and detailed on current challenges. Another leader reported, “It was supportive to hear other teams’ experiences and know that we are not alone in our challenges. The relationships help expand ideas I may have not thought of on my own.”
The Learning Continues
The Center launched a second learning collaborative in May 2024, with 11 participants from six organizations currently moving through the process. A third cohort kicks off in July.
The Center is proud and humbled to be part of this critical work. “The next generation of leaders is taking shape right now. They will determine what the workforce and the industry will look like over the coming 15 to 20 years,” Tedrow says. “It is incredibly rewarding to help them lay the groundwork for Montana’s future behavioral health workforce.”
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