Though now fixtures of the healthcare workforce, the physician assistant and nurse practitioner professions started with only a single training program and a handful of graduates.
Katie McLaughlin, PhD, executive director of the Ballmer Institute for Children’s Behavioral Health at the University of Oregon in Portland, told Becker’s she sees a similar opportunity emerging in behavioral health.
Oregon and Nevada passed legislation creating a credential for behavioral health and wellness practitioners, bachelor’s-level behavioral health providers. The Ballmer Institute launched the first U.S. program to train them — a major shift in how the country approaches youth behavioral healthcare workforce development.
“There is a massive shortage of providers, particularly on the youth mental health side and in behavioral health. We simply don’t have enough providers to meet that need,” she said. “Historically, to get this kind of training to deliver mental health services in the U.S., you’ve had to go to graduate school.”
The institute is scaling the program in phases. Its first cohort included 17 students, followed by a second cohort of 15 students, but enrollment is already increasing. Dr. McLaughlin said at least 30 students are expected to enter the program as juniors this fall, with at least 50 students projected the following year as demand grows. The program has the capacity to train up to 150 students annually.
The four-year program follows the 2+2 model similar to a typical bachelor’s program in nursing: two years of general education coursework, and two years of specialized behavioral health training. Providers complete 700 hours of clinical training, with a focus on early identification and prevention-focused behavioral health services in settings where children already are, including schools, pediatric primary care practices and community organizations.
During this time, students work directly with children and families under the supervision of licensed clinicians. The program follows the “see one, do one, teach one” learning model in which students first observe clinicians, and then practice themselves under supervision before ultimately demonstrating the process to someone else.
The role is team-based and requires supervision from a master’s-level or higher licensed provider even after graduation.
With just a bachelor’s degree, providers graduate with hands-on experience proactively identifying behavioral health challenges and delivering brief interventions to prevent challenges from escalating into crises, Dr. McLaughlin said. In many behavioral health training programs, students complete coursework but graduate with limited clinical experience.
This role is distinct from any other behavioral health professions. It’s not intended to replace psychologists, counselors or social workers, but instead to fill prevention and early intervention gaps which require less intensive care.
“We know this sort of return on investment is enormous, not just for the kids, but also their families, and for society more broadly. That this is the best way we can spend our healthcare dollars,” Dr. McLaughlin said. “We’re not typically doing it this way in the U.S. Some places in the world that have a single payer system are, because they’re really incentivized to do prevention.”
Employers in four workforce settings are already showing interest: K-12 schools, pediatric primary care, mental health agencies and community organizations.
In schools, providers can implement behavioral health screenings and work alongside school counselors, psychologists and social workers to expand the reach of services.
Dr. McLaughlin also sees opportunities within integrated behavioral health models and pediatric primary care practices for lower-stakes tasks such as warm handoffs from pediatricians and same-day follow-ups.
“Let’s say you’ve got a social worker embedded in that team. That person tends to be booked like all day with appointments,” she said. “The family comes in and the pediatrician learns something they weren’t expecting to hear about a behavioral health struggle, it’s incredibly effective to have someone right there who could follow up.”
Mental health organizations and youth-serving nonprofits are increasingly interested in hiring trained entry-level workers who can deliver an additional level of support for children receiving therapy, Dr. McLaughlin said.
Accessible undergraduate clinical training and education could also broaden access to behavioral health careers that have traditionally required advanced degrees.
“What we are seeing in our early cohorts of students is a much more diverse group of students than you would traditionally see in behavioral health training programs at the master’s level, or even that you see in the general student body at the University of Oregon,” she said.
Through a diverse workforce, Dr. McLaughlin hopes to better represent the lived experiences of children and their families in need of supportive care.
New healthcare workforce categories can scale nationally, just as physician assistant and nurse practitioner roles have, she said.
Sixty years ago, the professions did not exist, and a shortage of primary care providers persisted in the U.S. In response, both professions began with a single training program: Duke University for physicians assistants and University of Colorado for nurse practitioners.
“They graduated three PAs in the first class and four nurse practitioners in their first class,” she said. “Then you fast forward, and other universities started to pick it up, and it rapidly scaled to where we’ve got more than 200,000 of these providers in each of these professions practicing nationally.”
The Ballmer Institute hopes to achieve the same expansion as a long-term goal for the program.
This summer, the institute will release its curriculum as a free resource for other universities and build technical assistance centers to provide consultation for organizations interested in implementing similar programs.
“The big vision is figuring out how to build a new profession that doesn’t just exist in Oregon and Nevada, but eventually in all states and means the same thing in Massachusetts or Michigan as it does in Oregon,” said Dr. McLaughlin.
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