Whether they are called “behavioral health technicians” or “residential technicians,” what they do is far from technical. They are the people who spend the most time with patients in residential rehabilitation programs. And they’re hard to find, according to Peter Thomas, membership manager of the National Association of Addiction Treatment Providers (NAATP).

Thomas, who joined NAATP last month, was previously executive director of Chapter 5, based in Prescott, Arizona. With the caveat that most of his experience is from his work in Arizona, Thomas said that techs are important because they “have the most face time with patients.” They don’t need a degree, but it’s important that they have training, especially around boundaries and de-escalation, he said.

“The biggest challenge is the ability to find really qualified people, especially for the more entry-level positions like techs,” he said. “Few people want to do this work.”

And unfortunately, there is little research about this role in treatment programs, said Thomas. “Anecdotally, the techs do work that is more dialogue-based,” he said. Patients may feel more open to talking to techs than they do with licensed clinicians.

Programs would like to have more highly trained personnel as techs, but it’s hard to attract them to these low-level jobs, said Thomas. And even if they start as techs, the real goal for most is to move up to a clinical position. “People who invest the time to go to school and be credentialed want to be in the hierarchy and become a clinician, not just stay as a tech,” he said.

It’s up to each individual facility to bring in good training for their techs, especially around boundaries — making sure that techs don’t share too much of their own personal information, for example. “Many of the people who take roles as a residential tech are doing it as one of their first jobs out of treatment,” said Thomas. “That brings a lot of value to the patients, but it can also bring in some less healthy dynamics.” In Arizona, there was a four-day, 40-hour training for techs that covered much of the basics, drawing on research into best practices in counseling, he said.

In many residential rehabs, tech staff are trained to “observe and report,” said Thomas. “They have good systems in place, so techs don’t have to address a crisis by themselves,” he said. “For uncredentialed staff, this is a good approach — they should not have to deal with intense situations.”

Medical staff

Despite the importance of techs, there also needs to be a strong medical presence in residential rehabs, said Thomas. “There absolutely needs to be a psychiatrist who sees patients in a residential facility,” said Thomas, adding, “I’ve also seen good results with psychiatric nurse practitioners.”

The main driver for more medical staff is the greater awareness of addiction as a disease, said Thomas. “There has been pressure put on the field from regulators and insurance companies to have good medical staff in-house, to get good nursing assessments regularly,” he said. “We need to be aware of cutting corners. Why would we choose to go with a less credentialed medical professional when what we need is more in-house medical staff?” Ideally, there would be a medical doctor and a psychiatrist on staff, and a registered nurse in the program all day, he said.

There also needs to be more standardization, even if at a state level, said Thomas. For example, in Arizona, rehabs need to have a medical director, but this person does not need to be on staff. “We need to be doing best practices,” said Thomas.

Retention

But no matter how credentialed the medical staff, the techs are still needed. The key is keeping them there — and training them is the best way to do that, said Thomas. “Training is the biggest piece in increasing staff retention,” he said. “Well-trained staff are less likely to be burned out and they know where to go and get resources if they need further help.”

Community colleges may have tracks that can help residential technicians move up a career ladder — one in Arizona is hosting a training for techs, said Thomas. This is a win-win, for the tech and for the treatment program. “It’s a way to get newly sober people back to school,” he said.

If tech staff don’t have good boundary training and good self-care tools, there will be high turnover, said Thomas. And programs could work with techs to get them to move up, he said. That is not currently happening, except for the case of the tech who happens to shine in that role and gets to be “tech manager.” When they really want to be more involved in treatment, that’s not ideal. Career ladders are needed, but counselor certification requires education and hundreds of hours of supervision. It's a challenge that states, hard-pressed for a treatment workforce, need to address.