The population of children and youth with chronic and complex behavioral and health needs in the U.S. continues to rise, even as the overall child population decreases. States are simultaneously experiencing a reduced health workforce in many areas, including pediatric primary and subspecialty care physicians, nursing, therapists, and direct care professionals. Recent projections indicate the distribution of pediatric subspecialists does not align with need and demand.
The fastest child population growth is projected in the South and West regions of the country, while the supply of subspecialists is expected to grow more rapidly in the Northeast. Estimates indicate the U.S. could experience a 14 percent reduction of pediatric primary care physicians by 2037, while the demand for pediatric physicians is expected to increase. And while child and adolescent psychiatry providers are projected to increase by approximately 14 percent, the anticipated need for these services is expected to increase by 40 percent.
These projections exacerbate existing challenges for the pediatric health care workforce, such as high turnover rates in pediatric nursing and shortages across many pediatric subspecialty areas (e.g., developmental-behavioral pediatrics, genetics, child psychiatry, etc.), pediatric allied health clinicians (e.g., respiratory therapists, radiology technicians, etc.), and support professionals (e.g., care coordinators, direct care professionals, peer supports, etc.).
As states seek to understand the health care workforce shortages affecting children and families, they are actively addressing pediatric primary and subspecialty and other health care workforce challenges through a range of strategies, including the following:
- Engaging in statewide needs assessments and strategic planning initiatives to learn of programmatic strengths, service delivery gaps, community and stakeholder needs, and patient experiences
- Collecting and analyzing workforce data to understand overall capacity and support efforts to expand the provider network
- Investing in training and education initiatives to enhance provider knowledge and expertise to meet population needs
Selected State Laws Passed in 2025 to Address Pediatric Workforce Challenges
- Florida enhanced training and certification requirements for the Home Health Aide for Medically Fragile Children Program and provisions to ensure family caregivers’ earnings will not affect their Medicaid eligibility.
- The Illinois Interagency Children’s Behavioral Health Services Act mandate the state establish and offer a voluntary training on the Behavioral Health Care and Ongoing Navigation (BEACON) portal to hospital social workers, clinicians, and administrative staff, ensuring easier system navigation and improved access to community and residential behavioral health services for children and youth.
- Texas expanded opportunities for hands-on training for medical students interested in pediatric subspecialties through a statewide pediatric subspecialty preceptorship program, to be established and administered by the Texas Higher Education Coordinating Board.
- The Utah Department of Health and Human Services is required to conduct a comprehensive study on barriers to accessing pediatric mental health care, such as wait times to see a therapist and family experiences in accessing care.
Statewide Needs Assessments and Strategic Planning
States frequently engage with core partners, providers, and those they serve to ensure access to high-quality services and supports and conduct robust data analyses to identify what is working well and what opportunities for improvement exist. These comprehensive, statewide, and community needs assessments are a crucial part of strategic planning efforts and provide an invaluable opportunity for states to identify programmatic strengths, service delivery gaps, community and stakeholder needs, and patient experiences.
Arizona’s Division of Developmental Disabilities (AZ-DDD) launched its Strategic Plan 2025-2030 in July 2025, with two targeted workforce priorities commonly shared among states — ensuring an adequate supply of qualified and accessible providers to meet population needs and providing ample training opportunities to support high-quality service delivery. As described in the strategic plan, AZ-DDD supports subcontracted health plans and qualified vendor networks in maintaining a qualified, competent, and adequately staffed workforce through publishing of its Workforce Development Plan and encouraging use of the Provider Workforce Development Toolkit.
Oregon’s biennial Health Care Workforce Assessment provides insights into workforce shortages, diversity gaps, and rural access challenges across ten provider types (e.g., primary care, behavioral health, oral health, nursing, school health, public health, etc.). Key strategies include continued and sustained investment in workforce initiatives and programs and supports for a diverse workforce representative of the community they serve, such as funding for recruitment efforts among Tribal members, residents of rural areas, and those with lived experience among the certified behavioral health workforce.
State Strategies to Address Workforce Capacity
States leverage workforce data to understand overall capacity, identify critical health workforce gaps, and implement strategies to expand provider networks. These data provide important insights into the needs of the workforce, supporting state innovations and investments in strategies to expand and promote the health workforce and support recruitment opportunities, such as leveraging technology platforms and continuing education opportunities.
The Arizona Health Care Cost Containment System (AHCCCS), using funds from the American Rescue Plan Act, contracted with Pipeline AZ (now AZ Pipeline Connects), to develop and implement the AZ Healthcare Careers Hub in 2023. The Hub is a career exploration, planning, skills mapping, and job attainment platform, connecting students and job seekers to information, opportunities, and resources needed to pursue education, training, and employment within Arizona’s physical, behavioral, and long-term health care systems. Today, AZ Pipeline Connects independently operates and maintains the Hub while health care providers, various community groups, high schools, colleges, and universities promote and help expand the use of the platform as a key element of Arizona’s approach to healthcare workforce development.
The Louisiana Department of Health’s Care Coordination Initiative supports medical providers in evaluating services, developing implementation plans, and testing strategies to integrate or improve care coordination services within their clinical practices. The initiative also offers training and support to guide clinics through quality improvement strategies, sustainability planning, and provides opportunities for earning American Board of Pediatrics Maintenance of Certification (MOC-4) credits.
State Strategies to Support the Workforce
States are investing in a range of initiatives to enhance provider knowledge and expertise to meet the unique health and related service needs for families of children and youth with chronic and complex needs. Leveraging partnerships among state agencies and clinical providers, states are offering specialized training programs for health providers and clinical staff to support a stronger understanding of resources, referral and service entry points, community services, and the importance and value of patient and family engagement.
Pennsylvania’s Department of Human Services offers an in-depth, nine-month training program, the Pediatric Capacity Building Institute, which builds administrative and clinical capacity among professionals serving children and youth with chronic and complex needs, with emphasis on behavioral health and developmental disabilities. The program promotes interdisciplinary knowledge, builds system-wide understanding, and facilitates networking across local, regional, and state stakeholders — including families with lived experience — to help drive meaningful system change.
The Oregon Center for Children and Youth with Special Health Needs’ Community Health Worker (CHW) Project offers a self-paced online training to equip CHWs and other related professionals (e.g., care coordinators, home visitors, family navigators) with the knowledge and skills necessary to support families of children and youth with chronic and complex behavioral and health needs. The training focuses on pediatric special health care needs and disabilities, major service systems for Oregon children and youth, family-centered care coordination, and resource navigation.
As states continue implementing strategies to ensure children and youth with chronic and complex needs have access to pediatric primary and specialty services through a qualified workforce, NASHP remains committed to elevating innovations that expand the health care workforce to meet the needs of this population.
Acknowledgments
Many thanks to Karen VanLandeghem for contributing to this resource. NASHP also extends its sincere thanks and appreciation to the state officials and their partners who shared and/or reviewed the examples included.
Support for this work was provided by the Lucile Packard Foundation for Children’s Health. The views presented here are those of the authors and do not reflect those of the Foundation or its staff. The Foundation’s Program for Children and Youth with Special Health Care Needs invests in creating a more efficient and equitable system that ensures high-quality, coordinated, family-centered care to improve health outcomes for children and enhance quality of life for families. Learn more on the Foundation’s website.
