The shortage of health care workers is a significant issue that has garnered the attention of state policymakers seeking to bridge the workforce gap and ensure access to vital services. More Americans are reporting mental health issues that would benefit from care. Simultaneously, states have received unprecedented short-term funding from the federal government and are considering the most strategic use of such funds.
While workforce development efforts are underway nationwide, Colorado and Ohio have taken notable strides in expanding their workforce through innovative mechanisms, attracting new workers, and fostering retention. Both states have benefited from strong gubernatorial and legislative leadership in their work to sustain the health care workforce, as well as focusing on coordination and collaboration across state agencies.
Key Takeaways
- Detailed data can help state officials target workforce development efforts to locations and populations who have the greatest needs.
- Workforce strategies can be implemented in multiple areas: regulation, education, paid internship and scholarship opportunities, and burnout. Addressing the workforce shortage requires creative collaboration across multiple agencies, as well as financial investment.
- Formalizing interagency relationship can spur action to address long-term workforce shortages.
Colorado
Colorado has invested in multiple efforts to build and retain its health care workforce. Colorado focuses on workforce pipeline expansion through community colleges and a dedicated AmeriCorps program, and the state coordinates across its agencies through detailed workforce planning.
AmeriCorps in Colorado
Colorado Healthcare Corps, created by the Gov. Jared Polis administration in early 2022 will recruit approximately 150 AmeriCorps members to serve in health care facilities statewide, providing critical support to the state’s health care system. Recruitment will focus on individuals who have certifications, such as certified nursing assistants, qualified medication administration personnel, and medical assistants, as well as those who are interested in earning those certifications. Several health care facilities will be able to provide additional training for participating members.
AmeriCorps members serving with the Colorado Healthcare Corps will receive a living allowance, housing support, and health care and child care benefits. In addition, AmeriCorps members will earn a Segal AmeriCorps Education Award to repay student loans and pay for future education expenses, or if they are over age 55, transfer to a child or grandchild to use.
The Colorado Department of Public Health and Environment and the Colorado Department of Labor and Employment partnered to develop this program, providing funding and workforce development support respectively.
Community Resource Center (CRC), a nonprofit that builds capacity and strengthens communities throughout the state, manages the Colorado Healthcare Corps. CRC develops and manages partnerships with health care facilities; leads AmeriCorps member recruitment, training and placement; and supports members as they transition from the program to the next step in their professional development and careers.
Expanding Access to Health Care Training
In Fall 2022, Colorado officials launched the Care Forward Colorado program, which makes short-term health care training at community and technical college cost-free for aspiring health care professionals. Programs and training opportunities will be available at 19 community and technical colleges across Colorado. Students who enroll in designated health care certificate programs will have tuition, fees, and materials covered as Care Forward Colorado funding allows.
“Colorado’s Next Chapter: Our Roadmap to Moving Forward”
Colorado published “Colorado’s Next Chapter: Our Roadmap to Moving Forward,” a detailed plan for supporting its health care workforce. The work builds on existing efforts and investments, which Colorado has expanded over the past two years. Investments include training for health care professionals and apprenticeship expansion, wage increases for direct care workers, and support for career changers who choose to pursue a health care career. By encompassing a wide range of strategies, the plan tackles workforce challenges at every stage of the pipeline, ensuring a resilient and sustainable health care workforce for the state. To achieve these goals, Colorado is implementing a diverse set of approaches, explored in depth in the plan.
Behavioral Health Workforce
Colorado has taken an assertive approach in partnering across agencies and communities to address its behavioral health workforce shortage. This effort, outlined in their report, “Strengthening the Behavioral Health Workforce in Colorado: An Approach to Community Partnership,” enumerates the multitude of creative partnerships and coordination necessary to address the complex issue of workforce shortages. While the effort focuses on interagency work, the project benefits from substantial financial investment into the workforce.
In 2022, the Colorado General Assembly passed Senate Bill 22-181, allocating $36 million in one-time federal stimulus funds to reinforce the behavioral health workforce that serves people of all ages, including pregnant and parenting people, infants, children, and older adults. The Behavioral Health Administration (BHA) developed a workforce plan that aims to strengthen the career pipeline and publicly fund behavioral health providers, remove barriers for those entering the field, and reduce the administrative burdens that impede entry and retention of workers.
Colorado also includes traditional workforce and labor agencies in its partnerships to build the behavioral health workforce. Aligning work with the Colorado Workforce Development Council and the Colorado Department of Labor and Employment allows for coordinated development of career pathways and apprenticeships in behavioral health care. Additionally, the BHA will coordinate outreach and marketing efforts to promote all professions in the behavioral health field.
Other Colorado behavioral health workforce development projects include:
- Expanding peer support and piloting a behavioral health aide model
- Paid internships and pre-licensure stipends
- Career pipeline development grants
- Behavioral health learning academy
- Behavioral health apprenticeships
- Innovative retention grants and recruitment strategies for behavioral health employers
- Community engagement and promotion of workforce opportunities
Implementation Considerations
Colorado officials cited that involving employers and providers early in workforce development processes sets up better opportunities for success. In the absence of an adequate workforce, providers often develop their own job descriptions and qualifications, which can lead to a patchwork of terminology used to describe essentially the same roles and confusion about services from which providers can be billed to Medicaid.
Officials also noted that involving many different organizations can open previously untapped potential. The BHA has a formalized academic/public health agreement that intentionally follows through some workforce development ideas that Colorado has been working on for years.
By actively involving stakeholders and fostering collaboration, Colorado strives to overcome challenges and create a more unified and streamlined behavioral health workforce. Through shared efforts and a commitment to ongoing improvement, the state is paving the way for a more cohesive and effective approach to addressing the behavioral health needs of its population.
Related Blogs: State Strategies to Address Workforce Challenges
Ohio
Ohio has years-long efforts to invest in its behavioral health workforce. Notably, the state focuses on analyzing county-level data to determine precisely where the greatest behavioral health workforce needs are, in addition to supporting the recruitment, training, and retention of workers.
Workforce Investments
In 2023, the Ohio General Assembly used American Recovery and Prevention Act funds to grow its behavioral health workforce. The investment of $85 million of federal funds gives the state an opportunity to make education more attainable and affordable for students aspiring to join the behavioral health workforce. These investments include:
- Enhancing paid internship and scholarship opportunities for students earning behavioral health certifications and degrees at Ohio’s two- and four-year colleges and universities and other educational career development settings
- Removing financial barriers from obtaining licenses, certifications, and exams necessary for employment in these careers
- Financially supporting providers in their ability to supervise and offer internships and work experiences
- Establishing a technical assistance center to help students navigate the federal and state funding opportunities available to them
Behavioral Health Workforce Supply and Demand
Ohio has demonstrated a proactive approach to addressing workforce shortages in the behavioral health sector by investing in comprehensive data collection to gain a nuanced understanding of the state’s workforce needs. Instead of relying solely on national and state-level data, Ohio has taken a more granular approach to analyze behavioral health demand and workforce supply. A study completed in 2021 by the Ohio Department of Mental Health and Addiction Services (OhioMHAS), the Governor’s Office of Workforce Transformation, the InnovateOhio platform team, and Deloitte found that the demand for behavioral health care services in Ohio increased 353 percent from 2013 to 2019, while the behavioral health workforce only grew by 174 percent.
For this analysis, several state agencies provided detailed granular data to create a focused workforce analysis. Ohio-specific claims data from Medicaid and the mental health and addiction services were aggregated to create a demand analysis, and demand was segmented across counties, practitioners, ages, facilities, and service types. State-specific licensing, education, and demographic data enabled detailed practitioner supply analysis. The state also convened focus groups and individual interviews and conducted a survey to supplement the data gathered with qualitative, on-the-ground perspectives.
Armed with this comprehensive analysis, Ohio was able to forecast demand and supply for behavioral health services across the state for each county and practitioner. With these data, the state is able to pinpoint key areas where variance is growing or shrinking, giving state officials direction to focus their workforce recruitment efforts.
Provider Incentives
These investments build on earlier work in Ohio. In 2020, OhioMHAS took action to strengthen and enhance the state’s behavioral health care workforce through $3 million in grants to OhioMHAS-certified community behavioral health centers (CBHCs). The funds support CBHC-led recruitment and retention efforts and incentivize existing professionals to attain a higher level of professional certification. In a follow-up investment, OhioMHAS spent $5 million federal CARES Act funds to retain the community provider workforce by providing 115 OhioMHAS-certified CBHCs with up to $50,000 in one-time retention incentives for their frontline staff. The CBHCs were able to use the funding to pay retention bonuses to medical, administrative, credentialed (including prevention specialists), peer recovery supporters, and non-credentialed (qualified mental health specialists and care management specialists) staff.
Partnering with Higher Education
At Ohio’s two- and four-year colleges and universities, Ohio launched the Ohio Great Minds Fellowship in May 2023, which will be available to students who are within two years of graduating with degrees or certificates in social work, marriage and family therapy, mental health counseling, psychiatric/mental health nursing, and substance abuse/addiction counseling.
Through participating colleges and universities, Great Minds Fellows will be eligible for up to $10,000 during the undergraduate and graduate studies for scholarship opportunities to assist with the costs of obtaining these undergraduate and graduate level degrees or certificates, paid internships in CBHCs at the undergraduate and graduate level, required license and certification preparation and exams, and other necessary costs related to the degree or certificate.
Cross-Sector Collaboration
In Ohio, gubernatorial leadership has maximized ongoing efforts in the behavioral health workforce. Governor Mike DeWine has prioritized building Ohio’s “Wellness Workforce” to adequately meet the needs of the state’s population. The Ohio departments of Mental Health and Addiction Services, Medicaid, and Higher Education are intentionally focused on increasing career awareness, supporting recruitment, incentivizing retention, and supporting contemporary practice, and state officials are pursuing partnerships with Ohio’s provider, education, and business communities to further develop workforce pipelines and career pathways.
A notable example of Ohio’s collaborative approach is the Behavioral Health Workforce Council, which brings together a cross-section of agencies, providers, employers, and chambers of commerce. This council serves as a platform for fostering connections and encouraging providers to see themselves not only as health care professionals but also as employers. The state’s comprehensive and inclusive approach, spearheaded by executive leadership, demonstrates the importance of engaging diverse stakeholders and fostering partnerships to drive workforce development strategies.
Acknowledgements
The authors would like to thank Commissioner Lori Criss and Zandia Lawson with Ohio Mental Health and Addiction Services, Wendy Simmerman with the Colorado Behavioral Health Administration, and Michele Shimomura with Colorado Local Public Health and Environmental Resources for their contributions to this publication. This work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award under the National Organizations of State and Local Officials (NOSLO) cooperative agreement totaling $836,859. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. government. For more information, please visit www.HRSA.gov.
