Shortage of counselors, social workers affecting behavioral health services

NEW PHILADELPHIA — Agencies that provide counseling and support to people with behavioral health needs are having a hard time filling staff vacancies at the same time that the need for their services is increasing.

It can take three to four months to fill a staff opening, according to Pam Trimmer, executive director of the local office of OhioGuidestone. 

"Candidate applications have decreased by 80 percent year over year," she said. "In the past, we've relied heavily on our college recruitment efforts. Those included in-person career fairs, meeting student groups for career questions and speaking directly to students in the classroom."

But as the COVID-19 pandemic restricted in-person contact, student engagement and recruitment went remote. 

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"We're seeing little to no student engagement," Trimmer said. 

The New Philadelphia office of OhioGuidestone has eight staff openings for both licensed and unlicensed workers, "which is probably the largest number that we've had open at any given time in years," she said. "We're not getting applicants. Some of these positions have been posted for nine to 12 months. It's disturbing to say the least.

"At this point in time we have the highest need for services and the largest volume of clients calling, and do not have the human infrastructure to meet the need," Trimmer said.

She is seeing more need due to increased stress, depression, anxiety, grief, loss, isolation and substance abuse.

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"Our counselors have caseloads up to 80 clients each when they should have about 50," Trimmer said. "Our goal would be to get a client in the office within five to seven days of calling for support and right now it's about two weeks. Follow-up appointments are also impacted. We would prefer to see people weekly to solidify gains in counseling. However, it is difficult to meet this timeframe due to high caseloads of the counselors."

Trimmer said OhioGuidestone copes with the staff shortage by prioritizing patients who have been recently discharged from a hospital, high-risk substance users and people thinking about suicide.

"We do keep a close watch on progress. We use standardized outcome measures to know whether someone's getting better, getting worse," she said. Counseling frequency can be increased with those who need more help. 

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Case managers can be assigned to check patients between counseling sessions, Trimmer said. They can help with transportation, food, clothing and other needs that can cause anxiety, stress and worsen conditions.

The New Philadelphia OhioGuidestone office is seeking counselors with a master's degree and social workers with a bachelor's degree. Both must be licensed in Ohio. Other openings are available for jobs that do not require licensing, such as an advocate for the domestic violence shelter, a position at the sober living home for men and a drug-abuse prevention educator.

The office is part of an agency that has 164 openings and roughly 1,400 employees in 21 counties across the northeast, central and northwest areas of Ohio, according to Steven Asimou, senior communications specialist for OhioGuidestone, which is based in the Cleveland suburb of Berea.

"There is a shortage of behavioral health staff not only in the area but in the state and in the country," said Natalie Bollon, executive director, of the Alcohol, Drug Addiction and Mental Health Services Board of Tuscarawas and Carroll Counties. "The way that this impacts our communities, especially our rural communities ... is that we have longer length time to get counseling sessions. There is a longer wait time between your sessions because the counselors are seeing many individuals."

Trimmer said COVID has compounded a behavioral healthcare labor shortage that has been an issue for three to five years. She attributes the worker shortage in behavioral health to a "perfect storm" caused by multiple factors: 

• Fewer people entering the field as more go into science, technology, engineering and medicine.

• Fewer graduates passing licensing exams.

• People not wanting to change jobs due to COVID.

• Federal economic stimulus checks and extra unemployment compensation keeping people at home.

• Workers leaving certain jobs due to COVID and choosing not to return to the field.

• Some people learning to live on less money.

Bollon also sees some trained behavioral health care providers going to work for managed care organizations or staffing services at locations other than counseling offices.

Trimmer sees Tuscarawas County having difficulty attracting educated, licensed behavioral health workers to a rural area.

"We are not super close to a university pumping out master's-level people," she said. 

Malone University in Canton and Walsh University in North Canton are the two closest institutions educating counselors and social workers. 

"If they're not from this area, they usually don't want to come work in this area," Trimmer said.

Walsh University has seen a decline in the last five years for students enrolling in master's degree program in counseling, said Teresa Fox, spokeswoman for the school. In the 2016-17 academic year, Walsh had 139 students in the program. Enrollment hit 155 in 2017-18 of 155 students, but fell to 108 in 2020-21.  

Research and talking with students revealed the reason for the drop-off.

"The majority of students were working full-time, and so they couldn't afford to quit their jobs to pursue a degree in counseling, their master's in counseling," Fox said. "They needed to have their job in order to pay for the degree. Even though we had evening and weekend classes, it was still pretty cumbersome for them. A lot of them have families. Some of them are single parents."

In response, Walsh launched an online master's counseling program in the spring to accommodate working adults.

"Since we did that, the number of folks interested in that program has been phenomenal," Fox said.  "We are forecasting that that's probably going to bounce right back up and probably exceed our forecast."

Bollon is among those working to establish a bachelor's degree program at Kent State University at Tuscarawas to help alleviate the local shortage in behavioral health staff. 

"We have been working on this since 2018 with Ohio Means Jobs and our local Kent State campus," she said. "There are logistics and processes that universities have to go through to get programs accredited and certified. So that took a little while."

The goal is to educate local people who will want to stay in their community to work in behavioral health.

"We see our young individuals leave the county for school and oftentimes not come back," Bollon said. "So, how do we build it locally so that hopefully they'll stay locally? The good news, the program is really close to being up and running. The bad news is our first graduating class still won't graduate for four years after the program starts."