Current Statistics

Up to 40% of children in the United States have a mental health or behavioral disorder, and the prevalence of these disorders is even higher in vulnerable populations (Hudson, 2016). In Tennessee, one in 5 children have a mental health disorder and one in 20 teens has a substance abuse disorder, and a large percentage of children and adolescents with behavioral health challenges do not receive care. For example, approximately 60% of Tennessee residents who need mental health services do not receive treatment (TAMHO). These numbers were all noted pre-COVID-19. Current statistics found in a recent research study where 359 children and 3254 adolescents (aged 7 to18 years) completed an online questionnaire survey during the spread of COVID-19 in the country (Duan et al, 2020). Results showed 22.3% of youth had scores indicative of clinical depressive symptoms, which is higher than the 13.2% estimated prevalence of youth depression (Duan et al, 2020). Anxiety symptom levels were also higher after COVID-19 than previously reported (Duan et al, 2020). During such an increase in need, there are still a number of barriers that prevent families from accessing needed services. Common barriers to treatment which include stigma, lack of insurance, and limited availability of providers (Whal, 2012; Corrigan, 1998). As often seen, the need in the community outweighs the available services.

There are not enough mental health practitioners in Tennessee to serve all of the needs within the public education system. Schools typically use a national Basic Education Program (BEP) model in determining ratios for supports in schools. The national BEP standard for School Social Worker is 1:2500; however, over time states and districts have come to understand that this is not a feasible ratio. The state of TN currently has a 1:2000 ratio but are advocating for changes. The state department of Education in TN has been reviewing this for some time, and based on their assessments, they are proposing that a 1:250 ratio be used based on feedback from Tennessee Association of School Social Workers; The National Association of Social Work, Standards for practice developed by national organizations such as The American Council on School Social Work (ACSSW), and the School Social Work Association of American (SSWAA). These suggestions were made after data was gathered in 2016-2017 that yielded 59 out of 136 school districts (43%) had no school social worker, and only 28 districts of those 59 (29.9%) had the adequate staff to meet the standard and current ratio of 1:2000.

Additionally, there is a national mental health shortage also which makes accessing evidence-based and supportive services even more difficult. For example, in rural states such as Tennessee, most mental health providers are clustered in major urban areas, making it necessary for rural residents in need of those services to travel long distances for care, incurring transportation and childcare costs and days lost from work. It’s not just rural areas that struggle to access effective, evidence-based mental health services. Both rural and urban underserved areas often have a difficult time attracting and accessing licensed and credentialed clinicians. There is a health care shortage in the United States, and this includes a shortage of trained and licensed mental health professionals and other medical professionals who can serve the mental health needs of children and youth. Many parts of our state have been designated a Health Professional Shortage area by the U.S. Department of Health and Human Services due to having a partial low-income population (Tennessee Department of Health, 2017). Finally, many counties across Tennessee are designated as Medically Underserved Areas (MAUs) or Federal Primary Care Shortage Areas for Mental Health (Tennessee Department of Health, 2017). This healthcare shortage impacts the ability for clients and mental health consumers to find clinicians near their homes.

As rates of reported mental health conditions are on the rise, and there is a serious known mental health workforce shortage there is a need for innovative approaches to service the community needs. The aforementioned reported shortage of mental health and trained clinicians indicates that there is only 1 mental health profession for every 1,000 clients (MHA, 2016). Now that we have identified that there is a large societal need for mental health services, but not enough mental health professionals to serve the need, one can see that a University-community partnership that utilizes a technology-based support can be beneficial in providing needed services, and moreover essential to serving the needs of the state’s child and youth populations at this time.

The SMART Center is a piece to this state-wide puzzle of service delivery options and programs. Through our direct treatment programming, to our community-based outreach and training, we are hoping to develop strong programs across the state to meet the behavioral and social emotional needs of children and youth.