Private practitioners cast aside as funding for struggling families favors large agencies

The federal Family First Prevention and Services Act, signed into law in February 2018, is the driving force behind much of the programming available to help struggling families.

The primary focus of Family First is prevention. Federal dollars provide states the resources needed to prevent children from entering the child welfare system through programs identified in the Family First clearinghouse.

The clearinghouse rates treatment methods from “well-supported” to “does not currently meet criteria.” To access funding, agencies must use services that at least meet the “promising practice” minimum standard; develop a prevention plan that details programs and services being offered; and ensure that the program is trauma-informed and evidence-based.

For mental health professionals in private practice, the process of becoming certified in many of the evidence-based modalities has been met with a roadblock. Treatments rated well-supported, supported, or promising quite often do not allow individuals in private practice settings to become certified. What’s more, many of the evidence-based programs identified by the Title IV-E Prevention Services Clearinghouse mirror the services already being provided by individuals in private practice.

This group of individuals has chosen to work for themselves for a myriad of reasons. In doing so, they offer mental health support without additional drain on precious resources. Research shows one in five adults lives with a mental illness that is exacerbated by financial strain and other environmental stressors. For families experiencing challenges like limited resources and difficulty accessing services, private practitioners have been a godsend.

Many professionals expand their roles to include building support systems around their clients. This network of natural resources helps to strengthen the impact of their efforts with the family. Some state policies prevent private practitioners from billing services outside of therapy, regardless of their training or certifications. Clearly these professionals have the knowledge and skills to respond to the needs of those with mental health issues. Yet, they are excluded from Family First funding until they can become connected to a larger entity and then certified in skills and treatment methods they have already been practicing. Few, if any, of the programs are willing to make exceptions.

The implication for families is a limited pool of therapists capable of responding to their needs, including critical support like early morning, evening and weekend appointments. It also means limited opportunity for families to be served by someone willing to understand what healthy functioning is to them, rather than applying a blanket solution to complex issues.

Research indicates these nonconforming, non-isomorphic providers are more likely to be successful engaging in evidence-based practices than their counterparts. Yet they face systemic alienation from federal and private funding opportunities. Additionally, these providers struggle because of insufficient funding in the form of lower rates and a lack of reimbursement for missed appointments. Current policies on multiple levels disregard these funding challenges while continuing to expect high-quality mental health services.

The federal government is poised to provide state funding specific to grassroots, “community-led initiatives intended to prevent and heal mental health problems caused by toxic stresses, emergencies, and disasters.” HR 3073 has been endorsed by more than 140 national, state, and local health organizations. However, few of these organizations have addressed how this funding is distributed within local communities. The Substance Abuse and Mental Health Services Administration has questioned the discrepancy between funding and outcomes by seeking reports evaluating performance measures.

Years of funneling federal, state, and local grants to large agencies has not made a significant impact on a growing population with unaddressed mental health concerns. More of the same legacy grant funding can only result in … well, more of the same results: a diminishing pool of qualified professionals to address mental health needs.

Funding opportunities must consider the value found in nontraditional providers whose primary focus is meeting the hurting at the point of their need. Private practitioners, like many larger agencies, strive to restore functioning and a sense of autonomy to the members of their community. Their success should not have to come at the loss of their autonomy and livelihood.