Worsening teen mental health continues to be a leading issue in the U.S. The CDC reports that more than 40% of high school students reported feelings of sadness or hopelessness, and about a third experienced poor mental health in 2021.

As a result, there is an uptick in behavioral health utilization. Still, adolescents and their caregivers often face difficulties in accessing behavioral health services due to staffing shortages and the lack of providers.

Behavioral Health Business sat down with Embark Behavioral Health CEO Alex Stavros to discuss the growing needs of the youth population and how the industry will keep up with the demand.

Embark is a youth-focused behavioral health provider that offers day programs, short-term residential care, outpatient behavioral health, and long-term residential care.

Highlights from the conversation are below, edited for length and clarity. Subscribe to BHB Perspectives to be notified when new episodes are released.

We’ve heard about the youth mental health crisis. What are some of the biggest challenges related to the uptick in need?

When you think about this youth mental health crisis and try to address it from the provider’s perspective, there are several barriers.

The first one is really around awareness and stigma. There’s a lack of awareness around youth mental health issues. It’s hard to identify and understand if your child is anxious or nervous, stressed, or if they have an anxiety disorder and need more intensive treatment.

The other issue is around stigma. For children, there’s a double stigma. With mental health, in general, there’s a stigma that exists, unfortunately. Typically, that’s just with the client. But when you have a child, you not only have the stigma that the child may have, but you also have the stigma that the parents carry around.

Then, even if you do know what type of treatments are out there and get around the stigma associated with mental health, it’s tough to find providers. It’s hard to find psychiatrists, psychologists, and therapists who don’t have a waitlist and it’s hard to find one that takes insurance. It’s even harder to go beyond that if you’re looking for an intensive outpatient program, therapeutic day treatment program, or residential treatment program.

How are you addressing some of those challenges at Embark, especially around access to care?

Capacity expansion is really important. We believe that it’s important for any healthcare system if there’s a crisis in society, that you need a continuum of healthcare services so that you can serve the patient at the right time, at the right place, for the right price, and ideally intervene at the lowest level of care possible.

That’s good health care; it’s less costly and less invasive. To do that, first, those programs have to be created. You need a local in that work continuum of care.

We define accessible in two ways. One is geographically accessible, and the next is financial accessibility. From a geographic perspective, it needs to be the right level of care that is local. So it’s not that some lower levels of care are easier to access and near your home. But the higher levels you have to fly to or drive to. It’s about creating more capacity and opening up more of these programs nationwide.

The next is around financial access. We want to move to a place where we can be in-network with payers. We need to ensure that those rates and those contracts allow for the high-quality care that we know deliver the outcomes that all of us desire, want and need.

 What do you see as some of the big trends that payers are really looking for?

Payers are really interested in quick access. They want to know that you have an efficient process that works well to enroll their members and families in need of your care.

Eventually, value-based care is something that we will all move to. Right now, it’s more challenging simply because there isn’t enough experience between payers and providers and, therefore, enough data to understand how to structure those relationships.

There are some more simple forms of value-based care where there may be incentive payments that payers will offer, for example. However, payers spend a lot of time in utilization management, which means ensuring that a client receives the right level of care for the right amount of time.

Payers want to be able to delegate that to the providers as much as possible and trust that the providers are making the right decisions. And so, to get there, that’s where value-based care really comes into play.

You’ve mentioned growth and expansion quite a bit. Is there one strategy Embark looks at when you think about expansion? M&A, de novo, etc..?

Embark has almost always been primarily focused on de novo. And that’s for a few reasons. One of them is around culture. When you start your own program and site, you can hire the team or promote the team from within other sites from scratch. You can nurture that culture more to align with the broader organization.

Having that common culture across an organization as a foundation, just as much as processes and, policies and standards, is important foundationally to allow you to scale and grow while maintaining quality.

Often, what can happen if you make acquisitions is that you can perhaps acquire a different location that is, by definition, going to have a different culture. It’s not necessarily a bad culture, but it’s different. And once you start to bring a lot of different cultures into a broader organization, that original culture becomes more diffuse, and that starts to create some instability foundationally. M&A is a faster way to grow. We’re not focused on fast as the priority; we’re focused on quality as a priority.