Growing demand for mental and behavioral health care continues to outpace the supply of clinicians available to meet it. At the same time, states, payers, and health systems are pursuing new strategies to strengthen the behavioral health workforce, expand access, and improve service quality. Evidence to guide these policy and practice decisions is urgently needed.
Our research partners at the UNC Behavioral Health Workforce Research Center (UNC-BHWRC) are launching nine new studies that explore critical dimensions of the behavioral health workforce. From licensure supervision requirements and crisis service use to the economics of private practice and the dynamics of clinician satisfaction, the UNC-BHWRC is tackling these critically important aspects of behavioral health services research in four studies now underway. AcademyHealth will support the dissemination of these findings to help policymakers, payers, and providers better understand barriers to care and identify opportunities for improvement.
Below are some of the new projects now underway as the UNC-BHWRC enters its fourth year of research supported by Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA):
Understanding State-Level Variability in Virtual Supervision Regulations for Behavioral Health Professionals
Clinical supervision has been shown to increase provider competence and is seen as integral to supporting continued learning, support, and quality of clinical practice for behavioral health professionals. Furthermore, remote supervision can expand training opportunities for behavioral health clinicians, particularly those in rural areas or in states with limited supervisor availability. Yet regulations governing virtual supervision vary widely across states and disciplines.
This study will conduct a policy analysis of licensure board regulations across 30 states and four behavioral health professions to determine whether remote supervision is allowed for clinicians pursuing licensure. The research team will also interview licensure board representatives to understand how existing policies are implemented and explore potential future changes to states’ supervision requirements. Findings will help clarify the current landscape and identify opportunities to modernize supervision policies.
Characterizing Crisis Service Use among the Commercially Insured Population
Most research on behavioral health crisis care focuses on Medicaid or uninsured populations, leaving little known about crisis service utilization among commercially insured adults. The majority of US residents in 2023 were insured through employer or non-group options, revealing the importance of understanding this population. This gap limits states’ and regulators’ ability to engage commercial payers in strengthening crisis response systems.
Using commercial claims data from 2017–2023, this study will describe the demographic and clinical characteristics of commercially insured individuals who use behavioral health crisis services. The findings will provide states and payers with a clearer picture of who is accessing crisis services—and where additional community-based supports may be needed.
Cost of Doing Business for Outpatient Private Practice Behavioral Health
Low reimbursement rates and high administrative burdens are frequently cited reasons why many outpatient behavioral health clinicians do not participate in insurance networks and instead rely solely on self-pay models. The lack of in-network providers, also known as network inadequacy, can create significant financial barriers for people seeking care and ultimately lead them to forgo care altogether.
This project will quantify the true costs of operating an outpatient behavioral health private practice to inform efforts to realign reimbursement rates with the actual cost of delivering care. Insights from the study may help reduce clinicians’ need to rely exclusively on cash payments and ultimately expand access to treatment across payer types.
Differences in Work and Practice Satisfaction and Anticipated Retention of Behavioral Health Clinicians Working in Integrated versus Non-Integrated Safety Net Settings
Integrated behavioral health and primary care models are reshaping how services are delivered, particularly in safety net settings. However, little is known about how these evolving practice environments affect clinician satisfaction and retention—two factors that are deeply connected to workforce stability.
This study will compare work satisfaction, practice satisfaction, and anticipated retention among behavioral health clinicians working in integrated versus non-integrated safety net settings. The findings will offer policymakers and health system leaders insights into how practice models influence workforce well-being and long-term clinician engagement.
Together with SAMHSA and HRSA, AcademyHealth will support the researchers at UNC-BHWRC as they conduct their studies and share findings as soon as they are available. Information about the UNC-BHWRC and previous studies is available here.