Partnerships between states and community colleges and high school career and technical education (CTE) programs can be a valuable strategy to build and sustain the behavioral health workforce. These education programs are uniquely positioned for scalable workforce pipelines, as they offer accessible, affordable entry points in the workforce, quick outcomes with rapid training and deployment, and opportunities for a career ladder.
State officials can look to Colorado for an example of an efficient, scalable approach to collaborating with community colleges and CTE programs. These educational pathways can meet the needs of future behavioral health professionals and support their long-term career growth in the field.
Colorado’s Model: Designing a Stackable Credential Pathway
To meet the growing need for mental health providers, the State of Colorado has developed and implemented a behavioral health stackable credential career pathway. It was designed in an 18-month collaboration led by Colorado’s Behavioral Health Administration in partnership with eight community colleges and other partners. The goal was to create a role to meet one of providers’ immediate needs: a professional specifically focused on intake. Under supervision, qualified behavioral health assistants may also deliver elements of wellness promotion, education, community needs assessment, screening, referral, crisis management, case management, orientation to services, and individual/group interventions.
Stackable microcredentials are targeted, competency-based learning modules that allow learners to gain specific skills and knowledge in a particular area. These microcredentials can be combined, or “stacked,” to build toward broader qualifications, such as professional certifications or academic degrees. They are designed to be flexible, enabling learners to progress at their own pace.
The Qualified Behavioral Health Assistant (QBHA) training program is designed to equip individuals with the foundational knowledge and skills necessary to become effective entry-level behavioral health care practitioners and equips participants to be included in Medicaid-reimbursable care teams. The training covers essential competencies such as understanding behavioral health and health care systems, trauma-informed care, cultural competency, crisis intervention, wellness, therapeutic communication skills, case management, documentation, empathy, and maintaining healthy boundaries. People with the QBHA credential can then apply this training to further career opportunities that include behavioral health assistant II, addiction recovery assistant, patient navigator, associate of applied science degree, and bachelor of applied science degree.
Recognizing concerns about potential overlapping scopes of practice, the Colorado Behavioral Health Administration and the Department of Health Care Policy and Finance, which administer the state’s Medicaid program, collaborated with providers to develop a position that was not duplicative of current behavioral health professionals, met providers’ staffing needs, and could be a part of Medicaid billable teams. The QBHAs can bill as a part of treatment teams that provide a wide variety of behavioral health services. To ensure accountability, the program has established a system for addressing the licensing and grievances for paraprofessional roles. Additionally, the Behavioral Health Administrative Services Organization oversees grievances at both the clinical and organizational levels.
Lowering Barriers: Bootcamp and Scholarships
To make the pathway accessible, state officials, in partnership with community colleges, created a bootcamp that allows participants to complete the program in 10 weeks. The bootcamp is free for those who meet work history requirements: at least one year of experience in mental health, behavioral health, or substance use disorder settings in a front-line capacity; or current pursuit of a secondary or postsecondary CTE teaching credential. Participants can earn up to 10 credit hours toward a degree or continuing education. Senate Bill 22-181 provided $1.3 million in scholarships, covering costs for more than 500 students.
To support the development of instructors and contribute to the growth of the behavioral health workforce, Colorado offers financial assistance for teachers who wish to become qualified to teach the QBHA curriculum at the high school level. The Colorado Community College System offers scholarships to help teachers upskill into this new role. The scholarships can be used to cover expenses such as tuition, fees, child care, and transportation.
Options for High School Students
Colorado also developed an access point to behavioral health training in high school settings. The Pathways in Technology Early College High School (P-TECH) behavioral health program includes the stackable QBHA credential, but it also gives high school students the opportunity to pursue paid work-based learning experiences. The program is intended to remove financial barriers to students and allows them to earn both a high school diploma and an associate degree in behavioral health from a community college — valued at nearly $18,000 — at no cost to the student or their family.
Aligning Funding and Partnerships
These initiatives were initially funded with $35 million under Senate Bill 22-181 with American Rescue Plan Act funds. However, knowing that these funds were a one-time opportunity, Colorado focused on developing sustainable funding sources. In the case of the P-TECH program, after Colorado’s initial investment in the start-up costs for training teachers and acquiring accreditation, ongoing costs for training students will come from state education funding and federal Department of Labor-administered Workforce Innovation and Opportunity Act funds.
Strategic partnerships with community colleges and provider agencies have been crucial to the program’s success. For example, the Metropolitan State University works with rural regions and communities to provide support to all behavioral health students, from high school to post-doctoral levels. The Colorado Provider Association also recruits participants who will host P-TECH students in their work-based learning.
Colorado’s behavioral health stackable credential pathway is a promising initiative that addresses the urgent need for mental health providers. By creating a sustainable and skilled workforce, the program aims to improve access to mental health services and reduce wait times for clients. With continued support, this initiative has the potential to make a significant impact on the state’s mental health landscape.
Other states exploring paraprofessional pathways or stackable credentials can look to Colorado’s model for aligning workforce, education, and financing strategies to create scalable pipelines as part of efforts to address behavioral health workforce needs.
Acknowledgments
The author thanks Lisa Batter Weinberg and Mary McMahon for their contributions. This publication was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U2MOA39467 the National Organizations of State and Local Officials co-operative agreement. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by, HRSA, HHS, or the U.S. government.
