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Providers, state officials warn of workforce crunch and long waits for early-childhood behavioral care
Summary
Panelists and state officials told the council workforce shortages and pandemic attrition have left clinics with long waitlists for PCIT and OT-behavioral co-treatment; Oregon is working to train more clinicians and explore incentives to retain them.
Panelists from treatment programs and state agencies warned the Early Learning Council that demand for specialized infant/early-childhood clinicians far outstrips supply, producing multi-month waitlists for evidence-based interventions.
Kristen Eby of Treehouse Therapies told the council her clinics have "about 500 children on our wait list" for occupational therapy and behavioral referrals and that 77% of those referrals are for children aged 5 to 10. She said her nonprofit clinic takes OHP and commercial payers and that "over 60%" of its caseload is OHP. Alejandra, a regional PCIT trainer, said PCIT has a strong evidence base and broad demand: some clinics report PCIT waitlists of eight to 12 months, and training to certification can take 12—18 months or longer.
State officials acknowledged the problem and described a mix of short- and long-term responses: making PCIT and other models available in multiple modalities (including teacher- or paraprofessional-delivered models), funding training and consultation, funding rooms and lost-billing time for clinicians during training, and considering wage or reimbursement differentials to retain clinicians. "We pay the provider for lost billing time for their therapist to go to those trainings," a DELC official said, and ARIMHA recommended partnering with licensing boards to recognize infant/early-childhood consultation hours toward licensure.
Speakers urged multiple strategies simultaneously: invest in versatile prevention models that don't always require a master's-level clinician; expand training-of-trainers; use apprenticeship and pre-apprenticeship pathways; and collect better regional data so advocacy and funding can be targeted where the workforce gaps are largest.
The council heard specific local descriptions of burnout and attrition: PCIT-certified clinicians decreased in one team from 16 to 5, and state program leads said many clinicians left during the pandemic. Council members and agency directors discussed incentives for retention and the need for federal and state funding streams to support scale-up of evidence-based programs.
