Does Utah’s ‘relatively lax supervision’ of mental health care trainees pose risks for patients?
Compounding the challenge of Utah’s shortage of behavioral health care providers is a higher-than-average percentage of professionals who are “repeat offenders” when it comes to medical malpractice payments and other adverse actions, according to a federal data bank that tracks such incidents.
The National Practitioner Data Bank, a web-based repository of reports on medical malpractice payments and adverse actions related to health care practitioners, reveals Utah’s rate of repeat offenders was 44%, compared to the national median of 25%.
From 2010-2022, there were 360 unique practitioners in Utah with a report in the National Practitioner Data Bank. Among them, 159 had at least two data bank reports.
Findings in the data bank could include revocation of a professional license, an industry association terminating a practitioner’s membership, or the Centers for Medicare and Medicaid Services revoking a practitioner’s ability to be reimbursed for services, said Jeff Shumway, director of the Utah Department of Commerce’s Office of Professional Licensure.
“That all counts as a safety incident,” which in some instances includes “a boundary violation between a therapist and a client like sexual misconduct,” Shumway explained.
Shumway, presenting recently to the Utah Legislature’s Health and Human Services Interim Committee, shared one slide titled “Utah has a safety problem.”
“So when we started looking at safety, we were somewhat surprised,” Shumway said.
According to the presentation, “Utah ranks far above the median number of (data bank) reports per behavioral health licensee (annually) in the United States at 12th of 51 states.”
Shumway noted that included in that, “we tend to have more repeat offenders.”
Substantiated claims are far more common among Utah practitioners early in their careers — those licensed zero to five years — and those who work in small settings, either as sole practitioners or in settings up to 19 employees, according to the state Division of Professional Licensing.
“So you can think of this as the archetypal safety issue is someone who’s recently licensed in private practice working in isolation. But we think some of what’s going on in safety is we have relatively lax supervision, both in law and rule and by practice in the state of Utah. We think we also have a lot of folks early career who are going straight into private practice, which has its own dynamic. That has to do with insurance and other things,” Shumway said.
With respect to supervision, licensing officials propose revising requirements to “get rid of general experience hours requirements, which are less related to safety, and bump up the direct client hours where we can actually see if you’re safe with clients. The point is reduce the overall hours, but crank up those that are more related to safety and make them higher quality,” Shumway said.
To improve quality, “we define in rule what supervision means. Right now, part of what we’re hearing is, people will have sign-off on supervision without actually receiving anything because there’s no actual definition of what supervision is. We want to set a minimum standard for what supervision is, require a minimum level of training to become a supervisor, and require some level of direct observation of the supervisee,” he said.
Such changes would require changes in administrative rule and statute, the latter requiring approval of the Utah Legislature.
Related
Safety concerns further complicate access to behavioral health care, with the numbers of patients with unmet needs in Utah ranging from 210,000 to 515,000 individuals, according to the report to lawmakers.
Some 530,000 Utahns are receiving behavioral health care, but it is difficult to obtain. “Even among those children in Utah who do access care, 40% of parents report that it is difficult or impossible to obtain this care for their children,” according to the report.
Access to behavioral health services in rural communities is also problematic, he said.
The lack of access has personal and economic consequences.
According to the report, 15,000 to 23,000 adults in Utah, those age 18 and up, will suffer from suicidal ideation in any given year because unmet needs for behavioral health care. Some 7,000 to 10,000 more youth ages 11-17 will likewise suffer from suicidal ideation because of unmet needs.
The report states that unaddressed behavioral health issues lead to two to 10 times increases in health care and criminal justice spending as well as decreased economic productivity.
Shumway said Utah also appears to have an “educational misalignment” as it relates to behavioral health.
The physical health care workforce is skewed toward people with bachelor’s degrees or less.
“If you look at behavioral health, it’s exactly inverted so you have a tremendous number of people with a master’s and up and relatively few extenders,” he said.
Meanwhile, students are earning degrees from Utah’s colleges and universities that don’t lead to a license to work in behavioral health, such as 6,000 psychology degrees awarded by state supported institutions in the five-year period between 2017 and 2022.
“I think many of them would say they thought they were going to become a therapist by going into psychology as an undergrad, right? And yet, that’s not what the training is. That seems to be a miss,” he said.
According to Talent Ready Utah, the No. 1 industry that psychology undergraduate degree graduates go into is retail, Shumway said.
“So we think there’s a disconnect there. We think we could probably do a better job opening this pathway educationally in licensure and to the workforce,” he said.
The report recommends creating a clinical psychology track for undergraduates as well as a one-year certificate program to train behavioral health technicians.
