Elizabeth Landsberg, California Department of Healthcare Access and Information and Jessica Pitt, California Labor and Workforce Development Agency: Collaboration to Grow the Behavioral Health Workforce 

Van Ton-Quinlivan

Hello, I’m Van Ton-Quinlivan CEO of Futuro Health, welcoming you to WorkforceRx, an exploration of innovations shaping the future of learning, work, and care.

Today, I’m joined by two guests on the front line of driving big state systems to respond to healthcare workforce shortages and ensuring equity of care. I’m here with Elizabeth Landsberg, director of the California Department of Healthcare Access and Information, otherwise known as HCAI; and I’m also joined by Jessica Pitt with the California Labor and Workforce Development Agency where she is the assistant deputy secretary of Healthcare Workforce. Jessica and I actually first met when I became executive vice chancellor of the California Community Colleges, where she served on the systems advisory body to advise on workforce education programs.

Thank you very much, Elizabeth and Jessica, for joining us today for this important discussion. So, I have a set of questions that can help inform our audience on what the state is doing to meet the growing needs for the mental and behavioral health workforce services required. I’d love to open up with Jessica, followed by Elizabeth. What specific strategies and programs does the state have to address the shortage of mental and behavioral health professionals?

Jessica Pitt

Well, Van, first, thank you so much for having me on your show. It’s great to be here and great to be with you and Elizabeth. So the Labor and Workforce Development Agency and really the state, the Newsom administration more generally, has really recognized mental and behavioral health workforce issues as one of the most important, if not the most important, healthcare workforce challenge facing the state of California right now. We know that the demand for trained mental and behavioral health care workers has grown exponentially and we know that those will continue to grow over time. So it is really imperative that we as a state figure out how to address those needs and we’re doing that in a number of different ways.

First, very significantly, internally within the state, our agencies and departments are coming together in ways they have never come together before to really collaborate and figure out how we can align and leverage resources, expertise, and opportunities across agencies. And that is happening largely under the umbrella of Workforce for a Healthy California, which is an investment of over a billion dollars by the Newsom administration in strengthening the state’s healthcare workforce with a big focus on mental and behavioral health. So really trying to figure out how we can collaborate with our sister agencies and departments is one really important way that we’re trying to go at this.

The other thing is we have a couple of really significant mandates coming from the state. One is the Master Plan for kids’ mental health, and the other one is the Master Plan for career education. We’re really seeing some synergy between these two in terms of elevating this issue as a priority and being very targeted in terms of how we can strategically address our mental and behavioral health issues and really having a roadmap and putting resources behind that roadmap. And so again, a real mandate on the part of the state.

And then just a sort of a couple of things that I’ll mention that we’re really focused on at the labor agency…another big priority of this administration is apprenticeships and what we call ‘earn and learn’ models. We have real opportunities to try to train individuals in a way that they are getting their education and training while they are working and getting paid for that. That’s a much quicker arc towards getting through your education with real retention. So, we’re very excited to be partnering with HCAI around building a certified wellness coach apprenticeship program. Certified wellness coaches are a new occupation that the state is standing up and we want to make sure that that earn and learn opportunity is built in from the start. So, that’s just one initiative. I’m going to pause there and but happy to chime in and say more.

Van Ton-Quinlivan

Well, thank you for that overview, Jessica. Elizabeth, I’d like to invite you to answer the same question regarding strategies and programs, and perhaps you can expound on that in terms of what’s HCAI doing to expand and enhance training opportunities for this workforce as well?

Elizabeth Landsberg

Thanks so much, Van. And I also wanted to start by thanking you for having me. Really appreciate having the opportunity to talk about the state’s commitment and approach to both developing and diversifying California’s behavioral health workforce.

So, Jessica talked about the important collaboration. This is an all hands on deck priority of the administration. We at HCAI and other departments within the Health and Human Services Agency are really pleased to be partnering with the Labor Agency. HCAI’s mission is to expand equitable access to quality, affordable healthcare for all Californians. One of the critical ways that we do that is through making sure we have the workforce and the behavioral health workforce that California needs.

In all of our workforce development programs, we have three goals. One is to increase the racial and linguistic diversity of the health workforce to better reflect California. Another is to support health providers to work in professional shortage areas or medically underserved areas, and then to make sure we’re developing a workforce to serve Medi -Cal members in particular. So we have programs to increase the pipeline — who’s coming in to become a healthcare professional in California — and then programs to support the individuals and support the institutions providing the training programs.

At HCAI, we really start with the data, so we are developing a data -driven strategy. We really want to make sure we’re being evidence -based and to identify the most effective, tested best practices to solve the shortages that we have. HCAI started a research data center a few years ago. If you haven’t, take a look at our data. It shows the geographic maldistribution of California’s health workforce.

We can see where do we have psychiatrists, where do we have social workers? We can see the race, ethnicity, and the languages spoken by the workforce and to see that we don’t have the diversity that we need. We’re really now taking this to the next level, and we’re building a supply and demand modeling tool that looks at role -specific data by region. That could be county, sub -county level to identify the specific shortages.

So for example, we can tell there is a shortage of non -prescribing behavioral health clinicians, folks like the licensed marriage family therapists, psychologists in the San Joaquin Valley. Once we’ve identified that shortage, we can also look to see the causes. We see that there’s not enough educational capacity, there’s not enough clinical supervision, students need more support and then we can really customize our interventions to address that problem. We also can see the race, ethnicity, and language data, like I said. So we see that in most behavioral health professions, we don’t have enough Latina professionals. They’re underrepresented, and so that’s an important area to focus on. So we’re really using that data to prioritize our efforts geographically and by role to address the largest shortage areas.

In terms of HCAI strategies, we’ve long had scholarship and loan repayment programs. It’s been wonderful to learn from the labor agency more about apprenticeship and earn and learn approaches. We have our pipeline programs. And we also think it’s really important to integrate behavioral health into primary care.

As Jessica noted, we have created at HCAI a new profession, the wellness coaches, and that’s part of the Children and Youth Behavioral Health Initiative, part of the master plan to provide behavioral health that kids need. So this new wellness profession is, we hope, going to really increase capacity to support the behavioral health needs of kids and respond to the behavioral health crisis. So, we’re starting with the data, we have clear goals, we have this exciting new profession.

In using that data, I’ll just talk a little bit about some of the strategies we’re looking at implementing. So with the voters passing Proposition 1 and with the Newsom administration implementing the behavioral health transformation, HCAI is set to receive very significant funding for behavioral health workforce. Over the next few years, we’re going to have very significant funding to address this workforce shortage.

One thing we need to start with is educational capacity. We know we don’t have the training slots and the education slots that we need to train all the behavioral health professionals that we need. So we are focusing on increasing that educational capacity, particularly in shortage areas, to increase educational slots, address faculty shortages, and also clinical supervision.

In terms of clinical supervision, we see that’s consistently cited as a barrier for training folks that we need at the associate level, at the master’s level. You can’t get licensure without the supervision, so we need to do more to fund and support that increased clinical supervision, particularly in rural and in shortage areas. We also know that we can’t train the folks that we need without the faculty. We’ve also consistently heard that faculty shortages are a driver of insufficient training capacity, so we’re looking to see what we can do to support pay and incentives for faculty and staff recruitment so that we can improve this bottleneck.

Then the students themselves need support. We know that there is a racial wealth gap and that it’s really important to provide loan repayment, scholarships, stipends to support students to come in to the behavioral health professions. It’s particularly daunting for some of the more expensive and lengthy training programs such as psychiatry, but even getting your masters can be really daunting to folks. So making sure that we’re providing opportunities both for initial training programs and upskilling.

So again, providing those loan repayment and scholarships, which do come with a service obligation to serve in the public system and shortage areas. Those interventions are really known to improve equity. We know it’s really important to recruit and retain behavioral health professionals in targeted settings. The last thing we want to do is bring folks in and have them leave, so we’re seeing that retention is a significant problem for behavioral health professionals. People are leaving because of burnout, because of pay. So again, loan repayment and service obligations can keep folks in their roles along with providing financial incentives to stay long -term. Those are important equity strategies.

The last thing I just want to lift up is how important it is to really integrate behavioral health into primary care. We know that primary care providers play a really key role in identifying and treating the mild to moderate behavioral health issues. A lot of people come to their nurse practitioner, their primary care provider, who can identify that they have depression and start their treatment. So we’re working to support making sure that primary care teams are trained on how to treat behavioral health conditions, again, especially in underserved areas. So we’ve invested in these training programs and plan to increase those investments.

Van Ton-Quinlivan

Well, thank you very much for the super comprehensive answer to that question. Clearly, there’s a lot being done by the state. A follow on question for you is — as we have listeners in the audience who may be interested in tapping into a number of the programs that you’ve mentioned — is there some place where they can learn more about any of the programming that you’ve laid out?

Elizabeth Landsberg

Absolutely, Van. We really hope folks will go to our website, HCAI.california.gov. and go to our workforce section and please sign up to get our emails about our programs. We do always have a webinar explaining our loan repayment and scholarship programs that are available. So whether you’re an individual who may want to be a wellness coach, we have scholarships available, whether you think you want to become a licensed clinical social worker…we have a lot of different programs constantly opening different cycles and we anticipate that that will increase in the coming years with the passage of Prop 1 in the Behavioral Health Services Act.

Van Ton-Quinlivan

So Jessica, I know you mentioned apprenticeship as a program that has a lot of excitement. You also have a number of other programs that can support underserved and rural areas especially to invite participation in the healthcare workforce, right?

Jessica Pitt

Sure, the main program I want to talk about is the High Road Training Partnership — that we often refer to as the HRTP program — that’s administered by the California Workforce Development Board. Under the auspices of Workforce for a Healthy California initiative, we have had $135 million that is dedicated to healthcare workforce. In this coming year, we will be able to fund $30 million and will be releasing a solicitation for applications this fall. This is a program that will particularly focus on allied health professions, and so those are the mental and behavioral health professions that we sometimes refer to as paraprofessional positions. They don’t typically require a license. They may require a certification, like a wellness coach, for instance.

The types of mental and behavioral health roles that fall into that category that we often talk about are substance use disorder counselors, peer support specialists, certified wellness coaches, and community health workers with a mental health focus. That funding stream will become available this fall and really be able to support training into some of those roles and building pipelines into those roles and career pathways for people to advance to higher levels of education and licensure. We are very much focusing on individuals who have come with lived experience. I want to note that the HRTPs will both support new people coming into these healthcare roles as well as advancement for what we call incumbent workers, people who are already in a healthcare role but want to move up in their careers.

Van Ton-Quinlivan

So would you mind sharing the website or how would our audience members find out about the HRTP program?

Jessica Pitt

So the website is www.cwdb.ca.gov.

Van Ton-Quinlivan

Wonderful. So Elizabeth, do you have any call outs for the audience in terms of being of help to HCAI in inviting participation into the workforce?

Elizabeth Landsberg

Yeah, we’re always wanting to engage with stakeholders. So a couple of things: Van is the chair of the California Health Education Workforce Training Council. This is the statewide body that was created in 2021 to really look at the statewide strategic needs of California’s healthcare workforce. We look at primary care, but we’re definitely focused on behavioral health. So if you’re a stakeholder that’s interested, I really encourage you to attend the behavioral health Workforce Training Council meetings. Those are public meetings anyone can attend. You can look at our slides. We are presenting on the supply and demand modeling tool that we’re developing. So we want our information to be actionable, and we really encourage people to help us get out the word about the programs.

We want the community to know about our scholarship and loan repayment programs. We want the public educational institutions to know about the programs that we’re doing. So we’re really happy that we have representatives at the community colleges, the CSUs, and the University of California on our Workforce Council. There are really great, important partnerships there. We know that those partners are critical in achieving our goal of developing and diversifying the healthcare workforce.

Van Ton-Quinlivan

We’ve talked about workforce development training programs and the resources being made available by the state in support of diversifying and growing this workforce. Elizabeth, you previously mentioned the integration of mental and behavioral health services into primary care and other healthcare settings. I was wondering if you could just take a moment to deep dive on that. What are some initiatives being implemented that touch on that level of integration?

Elizabeth Landsberg

Yeah, thanks so much, Van. I think this is critical. One of the key programs that HCAI supports is the train new trainers program for primary care physicians. This is a yearlong clinical education program for folks to get advanced training in primary care psychiatry. Trainees learn how to complete an evidence-based psychiatric interview in the primary care medical setting, how to effectively diagnose and treat commonly encountered psychiatric conditions like anxiety or substance abuse, and how to teach these principles to their primary care colleagues. So that’s the train new trainers part of it.

This is a program run by the University of California at Irvine. We just think that it’s key to know that primary care providers are identifying depression and substance use disorder with young people and with adults. They really are that first line of identification and treatment. So, we are looking to see how to scale up programs like that and make sure that primary care providers — who we are asking to do so much — have the tools that they need to address behavioral health issues.

Jessica Pitt

Can I maybe add to that, Van?

Van Ton-Quinlivan

Please.

Jessica Pitt

I think we are seeing a movement within healthcare towards more care teams and recognizing that those teams include not just physicians and nurses, but medical assistants and community health workers and some of the other paraprofessional roles that I mentioned. We have a real opportunity in California right now with our Medi -Cal transformation, which has made some of these roles reimbursable, that will really provide ways to actually pay and sustain these roles.

I think we’re really seeing more of an integration of some of these roles into care teams and many times those are people who can relate to patients, particularly those patients who come from different language or ethnic backgrounds. They are also often closer to the community and in the community, so they often increase access into the healthcare setting.

Van Ton-Quinlivan

I know I can speak on behalf of our audience that it is so wonderful that we have such smart, thoughtful leaders at the helm of our major public agencies. And thank you for being systems thinkers as well.

Thank you very much, Elizabeth and thank you very much, Jessica, for being with us today and giving us insights into what is happening at the state to address the healthcare workforce needed in the state of California.

Elizabeth Landsberg

Thanks for having us, Van.

Jessica Pitt

Yes, thank you so much. It was a pleasure.

Van Ton-Quinlivan

I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future -focused workforce in America.