A growing shortage of behavioral health workers persists across the country, posing a significant obstacle for states working to address the opioid crisis and other substance use disorders (SUDs). The National Academy for State Health Policy (NASHP) has recently completed a 50-state scan to identify the full range of strategies states are using to expand this critical workforce. The data results and findings are scheduled to be published by NASHP on Aug. 27, 2019.
The reasons behind the behavioral health workforce shortage are varied and include too few people entering the profession, an aging workforce, overall lack of resources for behavioral health services, and comparatively low salaries. States are deploying a number of strategies to address these challenges, including using non-licensed professionals to delivery an array of behavioral health services within state Medicaid programs.
As states increasingly turn to these non-licensed staff to provide services to individuals with SUD (and other complex, co-morbid conditions) policymakers are grappling with how to structure reimbursement, training requirements, supervision, and other components of this care, both to support and retain this workforce and to ensure high-quality treatment.
NASHP’s comprehensive 50-state scan examines how state Medicaid programs are supporting non-licensed staff to deliver a range of SUD services, including peer supports, counseling, and rehabilitative care. NASHP reviewed relevant Medicaid policies and guidance, and analyzed information detailing how:
- States are paying for these services;
- Where the services can be delivered; and
- What education, training, and supervision are required for non-licensed staff.
Non-licensed staff are an important resource for state behavioral health/SUD systems of care, and most state Medicaid programs across the country allow for at least one type of service to be delivered by non-licensed, non-Master’s-level staff.
States use a range of titles to describe non-licensed staff. This workforce generally falls into the three broad categories — peers, non-licensed counselors, and other qualified staff – who typically provide rehabilitative supports.
Training, educational requirements, and supervision for non-licensed staff are also highly variable, and include both national certification programs and state-specific training and standards. This enormous variability across states underscores the need for additional resources for states interested in learning how these staff can utilized to support best practices in SUD treatment and recovery.
In related work, NASHP in partnership with the National Governor’s Association and the National Council of State Legislators recently convened the Improving Capacity for Health Care Service Delivery Summit in Indianapolis to discuss states’ major workforce challenges and potential strategies to address them.
Many of the challenges discussed across the SUD, oral health, maternal child health, and general workforce sectors reflected themes . As needs continue to outstrip workforce supply, states are exploring how to increase access to care using non-licensed staff, while maintaining quality and providing a career ladder for this critical segment of the workforce.