Behavioral Health Workforce
As Washington moves forward to achieve integration of its statewide physical and behavioral healthcare systems, demand for a qualified behavioral health workforce continues to grow. While the state has many highly competent and committed professionals working hard to deliver behavioral health services, barriers to educational attainment, professional recruitment, and long-term retention may prove detrimental to the state’s ability to provide sufficient behavioral healthcare – defined as mental health and substance use disorder treatment – to its residents.
Work in 2022
Board staff partnered with Halcyon Northwest, a research contractor, to assess the status and relevance of prior recommendations made as part of the board’s Behavioral Health Workforce Assessments done in 2016-17, 2019-20, and 2021. The team conducted key informant interviews to assess the status of each recommendation. These findings informed six planned workforce meetings in August 2022. Stakeholders had an opportunity to attend sessions covering topics such as professional licensure, reimbursement, and supervision to give their feedback and prioritization.
This work was combined with two other research efforts done as part of a separate legislative proviso by the UW Center for Health Workforce Studies (UW CHWS) and Washington STEM to create a more complete picture for policymakers.
2022 Behavioral Health Workforce Assessment Recommendations
Addressing educational debt
Recommendation 1: As a short-term strategy, the Legislature should appropriate additional funds to support behavioral health loan repayment awards via the Washington Health Corps to address immediate retention challenges within a variety of behavioral health settings.
Recommendation 2: The Washington Student Achievement Council (WSAC) should work with its planning committee, participating sites, potential applicants, and awarded providers to ensure clear understanding that behavioral health loan repayment participants’ hours worked in community settings, such as crisis response services, homeless shelters, supportive housing, street outreach, and families’ homes, may count towards the required service obligation hours.
Recommendation 3: As part of supporting the investments made in loan repayment programs in Washington, the Legislature should appropriate funds to support administration of the Washington Health Corps and require an evaluation of program outcomes.
Recommendation 4: As a middle- and long-term strategy, policymakers should require eligible behavioral health employers to provide Public Service Loan Forgiveness educational materials and information about the Office of the Student Loan Advocate at WSAC when hiring a new employee, annually, and at the time of separation. Within already appropriated resources, the Office of the Student Loan Advocate should conduct outreach to eligible behavioral health employers and assess if additional staff support is needed to serve demand.
Recommendation 5: As a middle- and long-term strategy, if the currently operating, privately funded, conditional grant program demonstrates successful outcomes in educating and retaining a diverse master’s-level workforce for community behavioral health settings, the Legislature should provide funding to continue the program beginning in the 2025-26 biennial budget.
Addressing behavioral health workforce wages
Recommendation 6: In addition to increasing Medicaid behavioral health rates as a way to increase wages for behavioral health workers, Washington should also provide continuation funding for planning and development of Certified Community Behavioral Health Clinics. Build on foundational work from FY 2022 to develop a sustainable, prospective payment system for comprehensive community behavioral health services by refining the CCBHC model, pursuing federal demonstration state status, conducting related actuarial analysis, obtaining continued technical assistance from the National Council for Mental Wellbeing, and proposing a pathway for statewide implementation of CCBHCs.
2016-2021 Behavioral Health Workforce Assessments
The Workforce Board has led efforts to address behavioral health workforce barriers since 2016. Governor Inslee tasked the agency with assessing workforce needs across behavioral health disciplines and charged them with creating an action plan to address these needs. This multi-year stakeholder engagement process culminated in the development of the 2016-2017 Behavioral Health Workforce Assessment, which profiled key professions within behavioral health, identified many of the barriers facing those professionals, and provided recommendations to address said barriers.
In 2019, the Washington State Legislature directed the formation of a workgroup to continue work on select barriers identified in the 2016-2017 Assessment, again led by the Workforce Board. This effort, which involved more than 250 stakeholders from across the state and the spectrum of the behavioral health workforce, resulted in the publication of the 2019-2020 Behavioral Health Workforce Report & Recommendations. This report included policy recommendations to address specific barriers to education, training, and retaining qualified behavioral health professionals. The 2016-17 and 2019-20 Assessments were done in partnership with UW CHWS.
Following the 2020 assessment, the 2021 Washington State Legislature formalized the stakeholder workgroup that had informed previous iterations of policy and practice recommendations as the Behavioral Health Workforce Advisory Committee (BHWAC). The BHWAC is charged with assessing the progress of recommendations from the Workforce Board’s previous assessments and updating policy recommendations. The 2021 state operating budget also funded a research collaboration between the Workforce Board and Washington STEM. This partnership will develop an analysis of the talent development pipeline for behavioral health workers, along with a projection for employer demand, which will inform the recommendations for the BHWAC’s full report in December 2022.
A preliminary BHWAC report, including updates to policy recommendations aimed at addressing barriers to recruitment and retention of well-qualified behavioral health professionals was completed in 2021.