Behavioral Health Workforce Distribution in Socially Disadvantaged Communities.

This study sought to understand the geographic distribution of three behavioral health clinician (BHC) types in disadvantaged communities in the U.S. across a standardized index of area disadvantage. CMS National Plan and Provider Enumeration System's data were used to identify BHC practice addresses. Addresses were geocoded and mapped to census block groups across Area Disadvantage Index (ADI) scores. Differences in the proportion of BHCs per 100k people in a block group by ADI, clinician type, and rurality were compared. Zero-inflated negative binomial models assessed associations between ADI score with any amount, and expected count, of BHC type in a block group. The sample included 836,780 BHCs (51.5% counselors, 34.5% social workers, 14.0% psychologists). Results indicated there were fewer BHCs in areas of high disadvantage with 351 BHCs in the lowest need versus 267 BHCs in highest need areas, per 100k people. BHC type was differently associated with the rate of clinicians per 100k by ADI and block groups that were both rural and high ADI had the least BHCs located. Findings suggest the maldistribution of BHCs by ADI underscores how some BHCs may be better positioned to meet the needs of vulnerable communities. Increasing access to behavioral health care requires a workforce equitably positioned in high-need areas. Reforms to payment and practice regulations may support BHCs to deliver services in socially disadvantaged neighborhoods.