Amid five straight years of record overdose deaths in Illinois, a new state program aims to alleviate a shortage of professionals who work to prevent substance use disorders.
Illinois’ behavioral health counselor workforce “is aging while new entrants are declining,” according to a 2019 report to the General Assembly; 56 percent of certified substance use disorder workers in the state were over the age of 50 at the time. According to the Behavioral Health Workforce Center’s latest data from 2023, 81 of Illinois’ 102 counties have fewer than 13 licensed professional counselors per 60,000 residents, straining those counselors tasked with servicing a large portion of the state.
To alleviate the workforce shortage, the state’s Department of Human Services has partnered with the Illinois Certification Board to offer stipends to lessen the financial burden for those working toward certification in substance use prevention and treatment. The 2019 task force report also found the state’s “already below-national-average” number of behavioral health professionals dropped 23 percent between 2016 to 2018, coinciding with a two-year period in which social services funding was slashed as lawmakers and the governor failed to approve a state budget. While the state’s human service funding has increased in recent years, an analysis from the Chicago-based Center for Tax and Budget Accountability, a nonprofit think tank, found that the current fiscal year marks the first since FY 2000 in which the increase outpaced inflation.
Workforce expansion
The Illinois Certified Alcohol and Drug Counselor Workforce Expansion program launched in May and is currently set to run through June 2024. It offers aid in the form of scholarships, tuition payments, internship stipends, application fees and $1,000 upon hire with a state-licensed provider, following graduation from an ICB accredited training program.
Adriana Trino-Pujals, executive director of the Elgin-based Latino Treatment Center, said the challenge to find, hire and retain workers in behavioral health has remained difficult, mainly due to economic constraints that can push students to consider other career paths. According to Bureau of Labor Statistics data analyzing 2022 payrolls, the median salary for a behavioral health counselor in Illinois is about $48,000.
Some students who start classes to obtain a certification can’t afford to finish, Trino-Pujals said.
“And then you’re going to take that same person and I’m going to tell them that we’re going to pay them 30-grand a year. Well, at that point, I’d rather go work at Walmart,” she said. The new workforce expansion program is a partnership between the ICB – an independent organization that credentials several human services positions in the state – and the IDHS Office of Substance Use Prevention and Recovery.
Chris Boyster, executive director of the ICB, said the workforce expansion program aims “to ensure that there’s absolutely no barriers for completion.”
“Let’s say you want to become a CADC, but that class is taught on Monday nights and Monday nights you don’t have anybody to watch your child. It will cover day care,” Boyster said.
The CADC Workforce Expansion program will also provide internship stipends up to $7,500, providing some reimbursement for work that might otherwise have been unpaid. It can also be used to pay for application and initial certification fees, along with transportation and course costs. Fees associated with enrolling and studying to become a CADC run at least $500, according to the ICB Schedule of Fees.
To qualify for the program’s $1,000 hiring stipend, a student must be in the process of getting credentialed as a CADC and agree to a two-year employment period with a state-licensed facility. Information on how to apply to participate in the program can be found at ilcadcworkforce.org. The workforce expansion program received a $3 million appropriation in the current-year budget. IDHS spokesperson Daisy Contreras said in an email the program’s continuation in future fiscal years is “pending the availability of funds and program performance indicators.”
Contreras said that while it’s too early in the program’s implementation to track significant trends, IDHS saw an “initial increase of approximately 30% in new applications” for the first half fiscal year 2024, which began in July. That followed a dip in the number of CADC applicants coinciding with the COVID-19 pandemic, she said.
Rising toll
During 2021 – the latest year for which comparable data is available – more than 3,000 people died of an opioid-involved overdose in Illinois, while 1,995 in the state were killed by firearms, according to the Illinois Department of Public Health Opioid Data Dashboard and the Centers for Disease Control and Prevention. That same year, 1,611 people in Illinois died of alcohol-induced deaths – more than the number of people killed in traffic accidents, according to KFF, formerly known as The Kaiser Family Foundation.
CADCs offer support and try to assess the needs of individuals who seek treatment.
Jen Andel, who works as overdose prevention manager at Chicago Recovery Alliance, said that in addition to working hundreds of hours in unpaid internships to qualify for her CADC, she had to work multiple jobs to make ends meet. She became certified in 2018 and said her coursework focused heavily on abstinence and relapse prevention.
“Abstinence is the goal,” Andel said. “There was not really any sort of harm reduction education, or what do we do with a client who is continuing to use. How do we help that person identify their own goal, which may not even be abstinence?”
Andel said she left her job in traditional substance use treatment because she saw an opportunity to help more people, and in a more direct way.
Trino-Pujals, who also serves as the ICB’s treasurer, said the program is a step toward keeping more students engaged in the field of substance use treatment and harm reduction.
“We have a horrible shortage,” she said. The lack of CADCs “has hindered us to be able to continue to progress in our field.”
‘Too little, too late’
Trino-Pujals said she was inspired to become an alcohol and drug counselor partly because both of her parents worked in substance use treatment, and she saw her father recover from alcoholism.
“Once I took the test, it not only propelled me professionally, but it also helped me to understand a lot more of the fields, theories and different processes regarding (substance use treatment),” she said.
The ICB expanded its reach in November by naming eight universities, public and private, as accredited training programs, including Loyola University, Southern Illinois University Carbondale and the Chicago School of Professional Psychology. The move will make CADC courses more readily available to college-age students interested in recovery and treatment work.
The program is one of three IDHS initiatives aimed at addressing the shortage of behavioral health workers in the state, with the others being a loan repayment program and another workforce incentive program focusing on certifying people who have lived experience as peer support specialists.
Still, many advocates say the recent state efforts are not nearly enough. Andel, for example, said she fears the hiring stipend is still too low to incentivize people to pursue a certification.
“Two years for $1,000? I’m going to keep it real here, come on,” Andel said.
John Werning, the executive director of Chicago Recovery Alliance – a harm reduction organization founded over three decades ago – said he is skeptical of state investment in an overdose program that isn’t directly aimed at slowing the state’s death toll.
“People who use drugs far outnumber the amount of people who are seeking or treatment or who qualify for a substance use disorder diagnosis,” he said. “We’ve never seen a reduction in the demand for drug use in this country and we’ve only seen overdose rates climb.”
Werning said there remains a need for investment in more social service programs such as overdose prevention sites because a diversity of options expands what people can utilize, hopefully saving more lives.
“It might also be too little, too late,” he said, “we need broad, really tremendous investments in social services across the board, not just treatment modalities.”