As behavioral health needs among individuals with developmental disabilities (DD) become more complex and widespread, the workforce tasked with supporting them is under extraordinary pressure. To ensure quality, continuity, and person-centered care, behavioral health systems must invest in strategic workforce development, retention, and innovation especially in the context of IDD (intellectual and developmental disability) populations. This article outlines key challenges, strategies grounded in evidence, and promising innovations to support behavioral health professionals working in DD contexts.
The Workforce Challenge in DD/Behavioral Health
Elevated Need, Scarce Capacity
Individuals with IDD experience co-occurring mental health and behavioral conditions at far higher rates than the general population. For example, Kalb et al. (2023) notes that roughly 40% of people with IDD have mental health needs, about twice the national average (Kalb, Kramer, Goode, et al., 2023). Yet many outpatient mental health systems lack specialization or flexibility to meet those needs, driving higher reliance on emergency and inpatient services.
Behavioral health provider shortages are pervasive: many areas of the U.S. are designated as “behavioral health workforce shortage areas.” These shortages are acute when considering clinicians with expertise in DD, crisis care, and dual diagnosis.
Turnover, Burnout, and Attrition
Even where clinicians and support staff exist, retention is a critical struggle. In a qualitative study of Oregon’s public behavioral health system, Hallett et al. (2023) interviewed 24 providers, administrators, and policy experts about why staff leave. Key themes emerged: low wages, heavy documentation and administrative burden, weak infrastructure and leadership, limited opportunity for professional growth, and a chronically stressful, under resourced work environment (Hallett, Simeon, Amba, McConnell, & Zhu, 2023).
That study notes that annual turnover in public behavioral health can reach ~30%, resulting in loss of institutional knowledge, continuity disruptions, and high costs of recruiting/training replacements (Hallett et al., 2023).
Inadequate funding, reimbursement constraints, and regulatory burdens compound these issues at system and organizational levels, making it difficult for frontline staff to feel supported or valued.
Unique Barriers in DD Contexts
Staff supporting individuals with DD often receive limited formal training in behavioral health and dual-diagnosis care. Misconceptions about whether standard therapeutic modalities “work” for people with IDD continue to discourage clinicians from entering the field. Common myths include the beliefs that individuals with IDD cannot meaningfully engage in psychotherapy, that they lack the emotional insight needed for treatment, that they cannot generalize skills, or that their behaviors stem solely from the disability rather than from treatable mental health conditions. These assumptions persist despite research demonstrating that evidence-based practices such as CBT, DBT, trauma-informed care, and positive behavior support can be effective when appropriately adapted. As a result, individuals with DD often require clinicians with specialized training in adaptive communication, behavioral interventions, environmental and sensory accommodations, and safety planning competencies many general clinicians have not yet developed.
Because crisis events like behavioral escalation, self-injury, aggression, and elopement are more common in DD settings, staff need enhanced training, support, and resilience measures. Without those, burnout is more likely.
Evidence-Informed and Emerging Strategies
To meet these challenges, behavioral health systems must blend foundational workforce investments with innovative approaches. Below are key strategies, supported by research or promising practice.
Competency-Based Training and Career Ladders
Rather than relying solely on generic behavioral health credentials, developing IDD-specific competency training can ensure staff are equipped with the skills required in this specialized domain. Such training might include modules on positive behavior support, communication with non-speaking individuals, trauma-informed practice, and crisis intervention tailored to DD.
Training also creates career pathways that allow staff (e.g., DSPs) to progress to roles such as behavioral support specialist, clinical coordinator, or supervisor, thereby creating a sustainable trajectory and reducing drift to unrelated jobs.
A good example of a structured modular training is embodied by The College of Direct Support (a national DSP training initiative) which strengthens workforce competency and retention (Boggs Center, n.d.).
Mentorship, Apprenticeship, and Embedded Supervision
Pairing less experienced staff with veteran mentors or supervisors enables hands-on learning and provides emotional support. Apprenticeship models, where staff deliver care under supervision while learning, help build pipelines without compromising service quality.
Embedding regular supervision, peer reflection groups, and clinical coaching reduces isolation and helps staff process difficult cases, especially in remote or rural settings.
Tele-Behavioral Health and Hybrid Service Models
Telehealth offers a compelling option to expand both service access and workforce flexibility. A major upcoming trial (within the START model) is comparing tele mental health interventions vs. in-person crisis care for people with IDD in a noninferiority trial (Kalb, Kramer, Goode, et al., 2023). In that design, components such as outreach and consultation are delivered remotely, while assessment and crisis response remain in person (Kalb et al., 2023).
The telehealth adaptation of START has also been studied qualitatively: staff and families identified the importance of rapport building, flexible scheduling, multimodal communication, and hybrid approaches (video + in-person) to maintain trust and engagement.
Telehealth also has workforce advantages: it enables clinicians to work remotely or flexibly, which may improve retention, reduce travel burden, and make roles more attractive in underserved areas.
Technology-Aided Training, Support & Decision Tools
- Simulation, Virtual Reality (VR), and role-play platforms: These can provide staff with experiential practice in crisis de-escalation, behavioral interventions, or communication strategies in a safe environment.
- E-learning / microlearning platforms: Bite sized, asynchronous modules allow staff to learn at their own pace and re-engage for refreshers.
- Clinical decision-support tools / AI aids: Systems that assist with behavioral assessment scoring, documentation prompts, risk flagging, or tailored intervention recommendations can reduce the administrative burden and cognitive load.
- Assistive robotics / social robots: In some pilots, socially assistive robots (SARs) are being explored to support prompting, engagement, or reminders augmenting but not replacing human staff (The Role of Healthcare Financing and Delivery Systems to Advance Health Equity, 2024).
While the evidence base is still emerging, digital health tools (especially telehealth) are the most well studied in IDD contexts (The Role of Healthcare Financing and Delivery Systems to Advance Health Equity, 2024).
Co-Design, Inclusion, and Lived Experience
A sustainable workforce ecosystem should include people with DD as staff, peer mentors, trainers, or advisors. Their lived experience fosters cultural competence, authenticity, and deeper empathy.
Training curricula and service redesign should employ co design methods, involving DSPs, clinicians, self-advocates, families, and administrators in developing content and systems.
The START telehealth trial integrates stakeholder engagement: its leadership includes individuals with lived disability experience, and its engagement team includes people with IDD, caregivers, and providers (Kalb et al., 2023).
Policy, Financing, and Incentive Factors
Even the most proficient workforce model requires sustainable funding and supportive policy.
Key components include:
- Loan forgiveness, tuition assistance, stipends for clinicians who commit to serving in DD/behavioral health settings
- Reimbursement reform to pay for telehealth, care coordination, supervision time, and non–face-to-face tasks
- Workforce stabilization funds or grants to support recruitment, training, and retention, especially in underfunded systems
- Alternative licensure pathways / reciprocity to reduce barriers for providers moving across states
- Data & workforce analytics systems that monitor vacancy rates, turnover drivers, workforce demographics, and link them to outcomes
Some of these funding needs and policy changes are already being piloted or implemented in some states in response to behavioral health workforce crises (Hallett et al., 2023).
Vision Forward and Recommendations
A sustainable and effective behavioral health workforce for DD populations would encompass:
- Clear, competency-based career paths from DSP to behavioral specialist to clinical roles
- Integrated telehealth-enabled teams to extend reach without sacrificing quality
- Ongoing mentoring, supervision, and reflective support built into roles
- Staff empowered by decision support tools to reduce administrative burden
- Engagement of people with DD in workforce roles and system design
- Policy and funding mechanisms that sustain workforce investment
To realize this vision, leaders in agencies, academia, and government must collaborate. Pilots and demonstration projects can test hybrid models, apprenticeship systems, telehealth innovations, and co-design training. Simultaneously, data systems must track workforce metrics and their relation to quality and access outcomes.
If you’re part of the IDD workforce within these systems, you can campaign within your organization for launching a small-scale mentorship program or telehealth adaptation, and commit to co-designing training, programs, and service improvements with staff and individuals with DD. If you’re a clinician or DSP, you can advocate for protected supervision time, access to training, and meaningful roles in innovation.
The opportunity is urgent and profound: with the right investments, we can build a behavioral health workforce that is not only resilient, but capable of providing equitable, effective, and person-centered care for people with developmental disabilities.
Conclusion
The behavioral health workforce supporting individuals with developmental disabilities is at a pivotal moment. States across the country are facing deep shortages but also possess robust infrastructure and the opportunity to implement forward-looking strategies that strengthen training, improve retention, modernize care models, and prioritize lived experience. With alignment across policy, funding, and practice, states can build a workforce that is resilient, skilled, and capable of delivering equitable, person-centered care for decades to come.
Mark Schwartz is a veteran workforce development and IDD programs leader with more than 30 years of experience advancing training excellence, staff development, and clinical practice standards and quality of care across behavioral health, intellectual and developmental disabilities (IDD), and human services organizations. He started his career working with teenagers with developmental disabilities 32 years ago and these early experiences shaped his career trajectory.
As VP of Workforce Development at ICL, Mark oversees a comprehensive training infrastructure that supports more than 1,500 employees across clinical and non-clinical roles. He leads a dedicated team responsible for designing and delivering evidence-based, trauma-informed, and person-centered training programs. Mark brings a deep commitment to ethical practice, human rights, and ensuring staff are equipped to provide safe, compassionate, person-centered care.
Prior to his current role, Mark provided training that supported adults and children with developmental disabilities. In these roles, he worked to strengthen agency-wide training systems, advanced best-practice implementation, and supported staff across behavioral health and IDD programs.
Mark holds a master’s degree in Disability Studies from the CUNY School of Professional Studies, where he also served as an adjunct professor, and a bachelor’s degree in English from the University of Connecticut.
Richard Anemone, MPS, LMHC, holds a master’s degree in psychology and is a licensed mental health counselor in New York State. He owns Behavioral Mental Health Counseling PLLC, a private practice specializing in gambling addiction, anger management, intellectual developmental disabilities, and psychiatric disorders. He is also Senior Vice President of the IDD division at ICL, which provides comprehensive housing, healthcare, and recovery services to New Yorkers with behavioral health challenges. He can be reached at Richard.Anemone@BMHC-NY.com.
References
Boggs Center on Developmental Disabilities. (n.d.). College of Direct Support. boggscenter.rwjms.rutgers.edu
Hallett, E., Simeon, E., Amba, V., McConnell, K., & Zhu, J. (2023). Factors influencing turnover and attrition in the public behavioral health workforce: A qualitative study. Psychiatric Services. Advance online publication. https://doi.org/10.1176/appi.ps.20220516
Kalb, L. G., Kramer, J. M., Goode, T. D., Black, S. J., Klick, S., Caoili, A., … Beasley, J. B. (2023). Evaluation of telemental health services for people with intellectual and developmental disabilities: Protocol for a randomized non-inferiority trial. BMC Health Services Research, 23, 795. doi.org/10.1186/s12913-023-09663-6
Kramer, J. M., Beasley, J., Caoili, A., Kalb, L., Urquilla, M. P., Klein, A., … Tessler, R. (2025). Optimizing telehealth delivery for people with intellectual and developmental disabilities and mental health service experiences. Journal of Mental Health Research in Intellectual Disability. (In press).
The Arc New York. (2024). Workforce crisis information sheet. thearcny.org
The Role of Healthcare Financing and Delivery Systems to Advance Health Equity for People with Intellectual and Developmental Disabilities. (2024). American Association on Intellectual and Developmental Disabilities. www.aaidd.org
