Blueprint for a National Prevention Infrastructure for Mental, Emotional, and Behavioral Disorders (2025) / Chapter Skim
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3 Workforce, Training, and Technical Assistance
3 Workforce, Training, and Technical Assistance
Pages 79-112
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and MH treatment. Most primary prevention activities take place outside of clinical settings, and the prevention workforce typically relies on a different set of skills than the behavioral health (BH)
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. Prevention workers include a variety of generally non-licensed workers, such as community health workers, aides, and peer workers.
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Pay and Other Workforce Issues Some categories of prevention workers, like others in BH, are underpaid, may lack labor protections, and do not receive adequate training or pathways to advance their careers. Community health workers and similar 1 Including adult psychiatrists, addiction counselors, child and adolescent psychiatrists, "child, family, and school social workers," health care "social workers, marriage and family therapists, mental health and substance abuse social workers, mental health counselors, psychiatric aides, psychiatric nurse practitioners, psychiatric physician assistants, psychiatric technicians, psychologists, and school counselors" (HRSA and SAMHSA, 2016)
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. PREVENTION WORKFORCE NEEDS The prevention infrastructure needs three kinds of workers to move evidence-based prevention interventions for MEB disorders into routine practice.
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Improving Access to Psychological Therapies, now Talking Therapies for Anxiety and Depression, is largely a treatment program, but some of its dimensions of it hold lessons for implementing a broad based prevention infrastructure. In 2007, 5 percent of people in the U.K.
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Trainers may be associated with academic institutions, Prevention Technology Transfer Centers (PTTCs) , other organizations that provide training and technical assistance, such as Centers for Disease Control and Prevention (CDC)
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In their present roles, they may be titled BH support specialists, community health workers, peer counselors, family support specialists, etc. Two types of non-clinician BH workers in the federal government who deliver some preventive interventions are the BH technicians3 in the Defense Health Agency and peer specialists in the Veterans Health Administration (Kanzler et al., 2024)
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Prevention specialists or coordinators who support communities in selecting interventions require the knowledge and skills to convene community leaders and members, assess community needs, identify strategies to address the needs by building on community culture and strengths (e.g., social validity, acceptability, appropriateness) , and undertake ongoing BOX 3-2 Training Frontline Workers from Other Sectors: Sample Strategies Rhode Island's 11 Health Equity Zones implement a variety of locally developed solutions for public health issues and include several sites providing prevention programming, ranging from cigarette and vaping bans to trauma-informed services, and tackling health-related social needs and social determinants of health, such as affordable housing and healthy built and natural environments.
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. Healing City Baltimore, an initiative described in Box 3-2, along with examples from Rhode Island's Equity Zones, illustrate in broad terms how the different types of prevention workers with varied backgrounds may function in one setting.
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. Building that workforce would benefit from a convening of stakeholders to discuss assets and gaps, involving the public health agency, behavioral or mental health agency, community mental health centers or behavioral health centers, first responders, hospitals, community health centers, nonprofit organizations, school districts, and other relevant entities to, for example, (1)
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. Many prevention providers are employed by state and tribal4 agencies to deliver MH and SUD prevention services, and those agencies or units 4 The Indian Health Service's four branches that focus on mental health, alcohol and sub stance abuse, behavioral health initiatives, and tele-behavioral health center of excellence, respectively, refer to I/T/U providers, denoting ("I")
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Improving the mental health/ resilience of existing behavioral health professionals can likely be facilitated by creating a more efficient system of early detection and support that is less dependent on higher levels of education/degrees. Building a stronger prevention workforce could include approaches to stepped care, with different levels of workers delivering different types of interventions or overseeing frontline workers, and the building of a larger workforce that ensures better worker-to-community ratios.
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. Research comparing multisector community coalition models to individual program technical assistance in the delivery of MH interventions found that the coalition approach was more effective in "reducing the probability of having poor mental health-related quality of life, behavioral health hospitalization, and homelessness risk factors" (Arevian et al., 2019, p.
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health promotion and prevention of MEB disorders. SAMHSA should add
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Identifying and operationalizing the competencies needed for this broad category in the prevention workforce for MEB disorders will be necessary for effective implementation that will benefit individuals and communities (Metz et al., 2021)
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. The National Community Health Worker Core Consensus Project identified 10 core roles and competen cies for the role -- all of which apply to the MEB health context and most of which may apply to BH support specialists and other non-licensed or non-postsecondary-degree-trained occupations: 1.
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. Other sources of training and resources for educators, community coalitions, and a variety of prevention workers include the National Associations of State Mental Health Program Directors, National 6 As noted, the MHTTC Network was ended in September 2024, but its resources remain available on the webpage.
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. Other opportunities exist to train staff of community-serving organi zations in mental, emotional, and behavioral health promotion.
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. Community health worker training varies greatly nationwide, and varied delivery models have been catalogued by the National Association of Community Health Workers.
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to work in communities to improve public health, and also connect with pathways to community health worker certification (AmeriCorps, n.d.) .8 Technical Assistance Providing technical assistance for prevention workers is generally not a function appropriate for local-level government agencies or entities for reasons of capacity, efficiency, and effectiveness.
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. Other academic centers, such as the EPIS Center at Pennsylvania State University, can provide technical assistance to community-based coalitions and other groups working in prevention of MEB disorders (J.
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For community health workers, or community health representatives in tribal communities, certification is linked with payment because Medicaid reimbursement also requires certification, and not all states certify them (APHA, 2014; ASTHO, 2024b; NASHP, 2019)
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Building an effective workforce will require review of competencies, training and certification needs, strategies for developing a pipeline and pathways to professional development, opportunities to expand and support the prevention workforce to implement EBPs in a variety of settings, and fair pay and labor protections. To begin, several changes are needed to better characterize and enumerate the prevention workforce, and a SAMHSA office devoted to the prevention workforce could provide a point of coordination and support for all workforce matters, including better integration of prevention related to mental health and to substance use (NASEM, 2024)
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to ensure that academic institutions and training programs equip prevention workers with the knowl edge, skills, and competencies needed to implement evidence-based preventive interventions in a variety of settings and age groups. • Strengthen academic–community partnerships that provide techni cal assistance to communities and community-based prevention workers to support implementation of preventive interventions for MEB disorders (i.e., MH and SUD together)
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Options for training include collaboration with colleges and universities to build or expand prevention programming in their curriculum. The recommended Coordinating Office on the MEB Prevention Workforce could build on existing competencies, such as SAMHSA's own prevention competencies, to • Define and adopt a common set of national competencies for prevention-focused community coordinators, with aligned national training and supportive infrastructure; • Develop a tracking system to understand the achievement of com petencies for community coordinators who have the responsibility for facilitating community decision making to carry out steps in the implementation process; and • Work with relevant entities, such as the Association of State and Territorial Health Officials, to provide guidelines for certification of non-licensed workers.
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Clergy and congregation members can deliver evidence-based prevention interventions, as has long been demonstrated around the country. In one region of Pennsylvania, INTERSECT trainers provide evidence-based MH and prevention training to clergy, social services providers, and community members, including MH first aid, Applied Suicide Intervention Skills Training, and QPR, while in San Antonio, a multisector (faith community, public health, health care, and nonprofit organization)
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. Direct service practitioners such as community health workers may work in a variety of community settings but will also require supervision -- such as from prevention coordinators.
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2024. Infrastructure supporting prevention among older adults, presented to the Committee on Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders, Meeting 3.
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: Clinical & economic benefits, presented to the Committee on Blueprint for a National Prevention Infrastruc ture for Behavioral Health Disorders, Meeting 2. https://www.nationalacademies.org/ event/41980_02-2024_blueprint-for-a-national-prevention-infrastructure-for-behavioral health-disorders-meeting-2 (accessed December 16, 2024)
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2024. Policy recommendations for coordinated and sustainable growth of the behavioral health workforce.
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2024. State-level infrastructure to support prevention, presented to the Committee on Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders, Meeting 3.
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2021b. Behavioral health workforce report.
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2023. A look at strategies to address behavioral health workforce shortages: Findings from a survey of state Medicaid programs.
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https://engage.youth.gov/opportunities (accessed October 13, 2024)
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