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Behavioral Health Workforce in Appalachia

By Patrick Caniglia, Policy and Research Fellow, Appalachian Children Coalition The Issue

After years of hard work, a long-awaited need for Appalachian Ohio finally appeared to be filled. A former residential unit for adults with developmental disabilities located in Gallipolis, the county seat of Gallia County, had just finished its renovations. Over several months, the residential unit was transformed into a cutting-edge crisis stabilization center for youth. In July 2022, a ribbon-cutting ceremony celebrated the timely opening of the facility. Over one year later, however, it has yet to welcome any kids through its doors.

Spearheaded by Hopewell Health Centers’ Clinical Officer David Schenkleberg and Robin Harris, executive director of the Galia/Jackson/Meigs Alcohol, Drug Addiction, and Mental Health (ADAMH) Board, the crisis stabilization center addresses one of the most important needs in the region. Without a place designated to treat, de-escalate, and teach youth to learn the skills they need to help cope and prevent future crisis scenarios from arising, medical hospitals will be left to face behavioral health crises without adequate equipment or training.

“Hospitals only help for maybe two, three days,” Harris said. “After the kids are discharged, nothing changes for them.”

The story of this open but empty crisis stabilization center disproves the Field of Dreams philosophy, “If you build it, they will come.” Gallia County’s beautifully constructed but unopen crisis stabilization center is a snapshot of the greatest barrier to Appalachian Ohio’s at-risk youth: a lack of behavioral health workers.

The Behavioral Health Workforce in Appalachian Ohio

Why, after years of tireless efforts from regional leaders such as Robin Harris and David Schenkelberg, is there still such a need for behavioral health workers across the state, and specifically, within the Appalachian region? The answer cuts far deeper than one may think.

For starters, the demand for behavioral health workers is at an all-time high. Rates of youth crisis cases have risen significantly while workforce numbers have struggled to catch up. Nearly 50 percent of the Appalachian region’s adolescents meet diagnostic criteria for a mental illness and fewer than half receive treatment. Nationally, between March and October of 2020, emergency department visits for youth with mental health conditions rose 24 percent for children ages 5-11 and 31 percent for adolescents ages 12-17. The same study also indicates that suicide attempts among girls ages 12-17 saw a 50.6 percent increase in February-March 2021 versus February-March 2019. Children in rural areas disproportionately contributed to these rising statistics, as rural youth are more likely to visit the emergency department for cases of self-harm.

As the demand increases for behavioral health workers, barriers prevent the supply of workers from keeping up. These roadblocks for progress include, but are not limited to:

  • Low agency reimbursement rates for behavioral health services, leading to low pay for service providers.

  • Lengthy educational tracks for full behavioral health professional licensure.

  • High burnout rates due to compassion fatigue and high caseloads. Each year, between 30 percent and 60 percent of therapists leave their profession.

  • Lack of child care access for behavioral health professionals and clientele alike.

  • Stigma of working with at-risk populations.

These factors all combine to become concentrated within the Appalachian Ohio region. In the United States, there are about 497 individuals per each behavioral health professional. In Ohio, the ratio is 645:1, respectively. In Appalachian Ohio, the gap widens even further at 1,010:1. This disparity results in youth being left without critical care.

Behavioral Health Workforce Solutions

Solving the behavioral health workforce issue within Appalachian Ohio will take multiple initiatives, such as addressing workforce recruitment, retention, and child care.

Robin Harris, of the Galia-Jackson-Meigs ADAMH Board, believes that more expansive outreach is one component needed to better fill the labor demand.

“We need to get creative with recruiting,” she stated enthusiastically.

Harris feels that the key to filling direct care positions in the region begins with looking into a crop of untapped, nontraditional workers. She specifically noted individuals from faith communities and individuals in recovery from substance use as some of her best and most motivated direct care employees from her time running a crisis stabilization unit herself. Outreach to those communities can connect these critical roles with prospective employees dedicated to the work and/or looking for a change in career trajectory.

Other solutions target traditional populations through innovative approaches. For example, the Appalachian Children Coalition’s (ACC) Workforce Hub recently launched a high school internship program working to provide young students with the opportunity to experience the behavioral health workforce environment for the first time. These paid internships can help break the stigma of working in behavioral health by giving students a glimpse into the many, diverse responsibilities of social workers, counselors, case managers, administrators, nonprofit leaders, and more. The ACC also provides personalized coaching services for both young people and displaced workers interested in exploring careers in behavioral health.

Another innovative recruitment and retention strategy in behavioral health is streamlining licensure requirements to enhance access to training and licensure opportunities. To become a licensed independent social worker in Ohio, one must graduate from a four-year undergraduate program, obtain a Master of Social Work degree from an accredited university, and log 3,000 hours of post-graduate supervised practice. This track typically takes at least eight years to complete. Through streamlining licensure processes, more individuals will have access to pursuing careers in behavioral health. This approach may also help incentivize displaced workers and midlife career changers already interested in pursuing a career in behavioral health to take action. Otherwise, the process to achieve licensure may be too expensive and time-consuming for many to tackle.

Lastly, child care access is hurting workforce development in the region. If individuals cannot access child care, or if it costs more than they can afford, then they cannot work outside of the home. Appalachian Ohio is riddled with child care deserts, meaning that there is a significant lack of access to child care facilities in comparison to more affluent, urban areas. Organizations such as the Corporation for Ohio Appalachian Development (COAD) and Groundwork Ohio are working to reduce this disparity at the regional and state levels, respectively. Increasing access to child care not only assists low-earning behavioral health workers, but it helps their clients, as well. Addressing workforce issues from both the workers’ and clients’ sides will lead to stronger Appalachian communities.

Uplifting Our Appalachian Youth

As we ended our conversation, ADAMH Board Director Robin Harris retained a sense of optimism despite the great obstacles at hand.

“We are close,” Harris said. “We need to ensure the kids would get medical care. The biggest hurdle is direct care staff.”

Through leveraging unique outreach strategies and being a part of greater collaboration throughout the region, Harris is confident that Gallipolis’ crisis stabilization center will begin operating within the calendar year.

Bolstering the behavioral health workforce is a critical response to ensure that Appalachian Ohio children get the care they need to survive and thrive. Through collaboration and creativity, Appalachian youth can finally receive greater access to the treatment that will help improve their outcomes. The results will be well worth the wait.

About the Appalachian Children Coalition

The Appalachian Children Coalition is an alliance of behavioral health, education, and social service professionals from the Appalachian region seeking public and private solutions to our region’s most acute needs. Every child deserves equal access to support services to help them grow into happy, productive adults.

To contact the Appalachian Children Coalition, please email With questions or comments regarding this blog post, you can reach out to Patrick Caniglia at

We look forward to hearing from and working alongside you.


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