From Recommendations to Reality: Building Services Around People with Complex Needs
Shared Wellness welcomes the release of The Link Center’s comprehensive report, Cross-System Strategies to Support Children with Complex Behavioral Health Conditions. The report offers an important national framework for understanding and responding to the needs of children whose developmental, behavioral, physical health, mental health, and trauma-related needs intersect. The Link Center is a Project of National Significance led by NASDDDS in partnership with NASMHPD, NASHIA, and NADD, with federal support from ACL in collaboration with SAMHSA.
Shared Wellness did not contribute to the development of this report, but we strongly support many of its findings and recommendations. We also appreciate the opportunity to be part of the broader dialogue about the next question: How do providers actually make this happen?
The report presents three essential pillars for serving people with complex behavioral health needs: a place that is safe, treatment to heal, and opportunities to grow.
Those principles resonate deeply with our experience.
For providers, the challenge is not simply agreeing with the recommendations. The challenge is translating them into homes, staffing models, training, clinical practices, organizational culture, and everyday interactions.
Seeing Behavior Differently
One of the report’s most important messages is that severe dysregulation should not automatically be viewed as intentional misbehavior. Behavior may reflect trauma, neurological differences, physical discomfort, sensory distress, difficulty communicating, or an overwhelmed nervous system.
That shift in perspective changes practice.
Instead of asking only, How do we stop this behavior?, providers can ask:
What is this person communicating? What happened before this moment? What helps this person feel safe? Is there pain or illness we have not identified? What can we change in the environment? How can we support regulation rather than demand compliance?
The report also highlights diagnostic overshadowing—the risk that symptoms are attributed to intellectual disability or autism without sufficiently investigating co-occurring psychiatric or medical conditions.
For organizations serving people with complex needs, this requires a whole-person approach.
The Provider Has to Be Willing to Change
One of the strongest lessons we have learned at Shared Wellness is simple:
Sometimes the person does not need to change first. The provider does.
People with complex needs frequently expose the limitations of traditional service models. A standard staffing pattern may not work. A home may be overstimulating. A behavioral plan may not fully consider trauma or medical needs. A direct support team may need additional clinical coaching. The routines that work for most people may not work for one individual.
The report recognizes this challenge. It notes that rules, authorization practices, service definitions, reimbursement structures, and documentation requirements can unintentionally interfere with person-centered, trauma-informed care. It calls for service structures that recognize enhanced staffing, specialized training, clinical supports, and the additional resources necessary to serve people with greater complexity.
That is where implementation becomes important.
Providers need enough flexibility to redesign services around people rather than repeatedly trying to fit people into services that were never built for them.
Direct Support Professionals Are Part of the Therapeutic Environment
The report gives significant attention to the importance of caregivers.
It describes consistent, attuned caregivers as central to safety and healing and emphasizes co-regulation—the ability of one person’s calm nervous system to help another person regulate.
It also makes clear that clinical treatment cannot exist only inside an appointment. Daily caregivers, family members, teachers, and clinicians must work together so therapeutic approaches are integrated into daily routines.
This has important implications for the direct support workforce.
At Shared Wellness, we believe DSPs should have the opportunity to up their game—to understand trauma-informed care, co-regulation, evidence-based support approaches, health and wellness, and the reasons behind the strategies they are being asked to use.
DSPs are not simply completing tasks.
They are helping create predictability. They are building relationships. They are noticing subtle changes. They are supporting regulation. They are helping people practice new skills in the real environments where life occurs.
When providers invest in that level of workforce development, ordinary moments can become meaningful opportunities for healing and growth.
A Home Can Be Part of the Intervention
The report also emphasizes the importance of physical environments.
Lighting, sound, sensory conditions, predictable routines, access to calming spaces, nature, and whether a residence truly feels like a home can affect a person’s ability to regulate.
That is an important consideration for residential providers.
A house is not automatically a home simply because it is located in a neighborhood.
The question is whether the environment communicates safety, predictability, dignity, belonging, and choice.
At Shared Wellness, this thinking has influenced our effort to view homes as sanctuaries and to integrate wellness more intentionally into everyday life.
Our orientation is that everything we do is wellness.
That can mean movement, nutrition, meaningful activity, creative expression, mindfulness, time outdoors, sensory supports, relationships, and opportunities for people to understand and regulate their own nervous systems.
The report similarly identifies expressive therapies, mindfulness-based approaches, movement, breathing exercises, grounding strategies, HRV-based techniques, and other approaches that may support self-regulation.
Habilitation Can Be Therapeutic
Another particularly important recommendation in the report is its discussion of habilitation.
The report describes habilitation staff as helping people establish predictable routines, practice self-regulation, build communication and daily living skills, participate in meaningful activity, strengthen relationships, and implement clinical recommendations. It explicitly notes that habilitation can be an integral component of treatment.
This is a significant idea.
For people with developmental disabilities, much of life does not happen in a clinician’s office.
It happens over breakfast.
It happens while preparing for work.
It happens in the grocery store.
It happens during a disagreement with a roommate.
It happens on a walk, during an art activity, while cooking dinner, or while learning how to recover after a difficult day.
Those moments matter.
When staff understand the person, the clinical plan, trauma history, health needs, communication style, and regulation strategies, everyday life can become an environment for learning and recovery.
Building Provider Capacity
The report also makes clear that supporting people with complex needs requires investment in provider capacity.
States are encouraged to build expertise through training, technical assistance, clinical consultation, peer learning, and access to evidence-based approaches.
Pennsylvania is highlighted for several efforts to strengthen this capacity, including Community Capacity Building Institutes, trauma-informed initiatives, START pilots, Project Reassure, Project ECHO, and efforts to develop clinicians prepared to support neurodiverse people who have experienced trauma.
Shared Wellness has benefited from participating in this broader learning environment.
Our experience has reinforced that provider capacity does not happen automatically.
It requires leadership.
It requires clinical expertise.
It requires investment in the frontline workforce.
It requires organizations to look honestly at difficult cases and ask what those experiences are teaching us.
And it requires systems that financially support providers willing to develop this higher level of capacity.
Moving the Conversation Forward
The Link Center report provides an important framework for the field.
The next stage of the conversation must focus on implementation.
How do we build residential programs that truly feel safe?
How do we give DSPs the training and clinical support necessary to work therapeutically?
How do we integrate behavioral health, physical health, nursing, wellness, and habilitation?
How do we prevent people with complex needs from cycling repeatedly through emergency departments, psychiatric hospitals, restrictive placements, and failed service arrangements?
And how do Medicaid systems, regulators, managed care organizations, counties, and providers create funding structures that reward this level of care rather than make it more difficult?
The report recognizes that community providers have a critical role to play and that system structures must support provider development, coordination, and continuous learning.
Shared Wellness is pleased to add our voice to that conversation.
Our experience tells us that people with the most complex needs often teach organizations the most.
They challenge us to become more clinically sophisticated, more flexible, more thoughtful about environments, more supportive of our workforce, and more willing to redesign services when traditional approaches fail.
The recommendations in this report give the field an important direction.
Now the work is figuring out how to make them real.
Read the full report from The Link Center.
Explore the complete series
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