There is widespread recognition of the challenges in recruiting and retaining behavioral health professionals. For context, these challenges are not new; they exist across the nation, they were evident before the COVID-19 pandemic, and they were exacerbated by the pandemic. As states work to identify and address the behavioral health workforce, there’s an opportunity to create new opportunities, address disparate standards, and create more clearly defined career tracks.

Pathways to Resilience hosted a conversation about building capacity in the behavioral health workforce with Libby Abbott, Deputy Director, California Department of Health Care Access and Information; Hannah Maxey, PhD, Director, the Bowen Center for Health Workforce Research and Policy; and Jeff Shumway, Director, Utah Department of Commerce, Office of Professional Licensure Review. We discussed misalignments among higher education, training, credentialing, the workforce, and wages, and how thoughtful and thorough data collection can serve as a foundation to inform solutions.

Identify efficient strategies for collecting and analyzing standardized information about the health care workforce

  • Pursue the federal process to be designated as a Health Workforce Shortage Area (HPSA/mHPSA)
  • Ensure that workforce data is high-quality and robust
    • Maxey stressed that states must know more than the number of people who hold licenses; they must know who is actually practicing, the communities where they practice, the type of services they provide, and the populations they serve.
    • Additionally, Maxey underscored the necessity of clear definitions when collecting data to ensure accuracy of information.
  • Consider resources from the Healthcare Regulatory Research Institute (HRRI) Roadmap for Enhancing State Health Workforce Data; the National Governors Association State Health Workforce and Informing Health Care Workforce Policy by Leveraging Data toolkits
  • Employ supply-and-demand modeling and evidence-based decision-making to make proactive projections about the workplace
    • Abbott underscored that her office is considering demographics, population growth, service delivery changes and education pathways to map what the workforce should look like in the years ahead and help determine whether present-day interventions should lean toward training or development.

Address issues related to licensure, liability, protection, and scope of practice policies

  • Assess licensure questions, considering what questions may need to be added, and which questions should be limited or eliminated
  • Position clinicians to work at the top of their license and optimize their scope of practice
    • Shumway is an ardent proponent for finding ways to better utilize professionals such as case managers, crisis managers, peer support specialists, community health workers, etc.
  • Investigate and evaluate workforce incentives
    • Are they aligned and appropriate for workforce development?
    • Are the allocated resources being maximized?
    • Are there better options?
  • Support health care workers by addressing the challenges of the profession and allowing them to access support without fear or consequence
    • The “State Strategies to Support the Future of the Primary Care Physician and Nursing Workforce” cites promoting provider wellness and wellbeing, guarding against burnout and ensuring safe working environments and conditions as areas to address
    • To mitigate turnover and burnout, Maxey asserted that residents and workers (especially those who work in community-based settings) should receive behavioral health care from the first day their work commences. Shumway built on this point, noting that, given the difficulty and emotional toll of behavioral health occupations, quality and consistent supervision “is about more than safety and gaining skills, it’s really a workforce retention tool.”
  • Establish trauma-responsive workplaces and institute trauma-responsive culture within organizations

Pursue new training and career pathways for behavioral health professionals, and provide support throughout their career lifespans

  • Explore and establish new categories and designations that can scaffold pipelines, respond to emerging and projected trends, and broaden access to the profession
  • Pursue cross-sector and inter-sector insights and examples that can defray training and education costs for potential providers (ex. paid internships, apprenticeships, letting part-time workers access or retain benefits, etc.)
    • Make sure that graduates aren’t paying for their own supervision
    • Consult bodies such as The National AHEC (Area Health Education Centers) Organization and The National Conference of State Legislatures Scope of Practice Landscape
    • Abbott shared that California is tapping into the expertise of its labor and workforce development agency to collaborate and look at creating paid and supported transitions into the field.
    • “States can have a role in looking at workforce and training investments, but employers also need to be a very big part of the solution; they should see their contributions and resource allocations as part of a larger workforce development strategy,” Maxey said
  • Consider new pathways that can circumvent potential barriers and biases
    • In its 2023 Periodic Review, Utah puts forth a path that would allow potential providers who have attempted the licensing exam to do additional clinical hours in lieu of retesting. “Research shows a strong correlation between doing supervised clinical hours and building skills related to patient outcomes and patient safety. We couldn’t find any studies that showed changes in skills, behaviors, and patient outcomes related to the national exam, it shows almost no connection, which I think is largely because the exam is duplicating what the master’s does in terms of abstract knowledge,” Shumway said
  • Establish trauma-responsive workplaces and institute trauma-responsive culture within organizations

*One month after this Learning Network Session, Utah passed S.B. 26, the Behavioral Health Licensing Amendments bill, which introduces new certifications for entry-level workers, allows entry-level workers with related degrees to pursue a BH Coach license, and creates an alternate pathway for mental health therapists to become fully licensed with additional clinical supervision and recommendations in lieu of passing a national exam.

Watch the full Pathways Learning Network session below or on our event page. Pathways to Resilience will continue to amplify strategies for promoting healing and resilience and share resources for those seeking to implement similar approaches.