Behavioral health was Nicole Tierney’s second career. Her first, as a lawyer, was derailed by an opioid addiction. Once she recovered, she decided to dedicate the rest of her career to supporting others facing similar challenges. But the road to get there wouldn’t be easy.
The cost to earn a peer support certification in New Jersey, where Tierney lives, can be hundreds of dollars. And aspiring peer workers must complete dozens of hours of training without any guarantee they’ll get hired.
Tierney, who didn’t drive after racking up thousands of dollars in motor vehicle fines that she couldn’t afford to pay off, was told she needed a valid driver’s license for some jobs, even though driving wasn’t part of the role. When she decided to pursue a master’s degree in counseling, she was told she wouldn’t be able to get her license because of felonies on her record. Thus, the life experience that made her unusually qualified for drug and alcohol counseling was also disqualifying.
“Peers, who are people with lived experience with substance use or mental health issues, are one of the most effective, efficient, and evidence-based ways to support people in treatment,” Tierney says. “Yet they’re paid the lowest and have basically no advancement opportunities.”
Tierney used her background as a lawyer to advocate for a change in New Jersey’s expungement laws. But even as other states have advanced “clean slate laws” that automatically expunge certain drug and alcohol offenses, the path from peer support to licensed counselor is a steep climb.
The Big Idea: For anyone, the traditional path to a well-paid job in behavioral health is often costly and inflexible. Workers in the field need at least a bachelor’s degree, and more often a master’s degree or even a Ph.D., to land higher-paying jobs in therapy and social work. Internships, which are required in many programs, are usually unpaid. All those steps create big barriers to career advancement.
Some higher education institutions, in partnership with employers and training funds, are attempting to break down those barriers with new programs that allow students to work—and earn money—in the field while studying. Not all jobs in behavioral health require degrees, and work experience and certification along the way can create career ladders rather than leaps.
Anthony Carter, the director of practice improvement and consulting at the National Council for Mental Wellbeing, says he believes this is the future of behavioral health training.
“We have to move beyond the undergrad to master’s degree pool of people,” Carter says. “There are people making career shifts and people who never pursued higher education who want to work in this space.”
The solution is timely. Shortages across the spectrum of behavioral health roles—from addiction counselors to psychologists and psychiatrists—are projected to continue for at least a decade. Forty percent of Americans live in an area without enough mental health workers. Getting more people into the field is critical.
“When we talk about the behavioral health workforce shortage, it’s driven less by lack of interest and more by how we structure entry into the field,” says Antoinette “Toni” Gingerelli, who co-authored a 2022 report for Harvard’s Project on Workforce about peer support workers. “We’ve really relied on narrow degree-centric pathways that are slow, costly, and misaligned with demand.
“Those pathways exclude many capable workers.”
‘Unbundling’ Degrees
A few years ago, students at the Community College of Aurora who wanted to work in behavioral health had one main option: Earn an associate of arts degree in psychology. The idea is that students could start there and then transfer to a four-year university to earn a bachelor’s, and eventually go to graduate school.
Jennifer Dale, dean of academic success in online and blended learning at the college, and a former psychology professor, says that traditional track is still valuable to some students. But it isn’t a good fit for those who need to start working right away and earn money while they finish their degrees. That includes the college’s many students who are working adults going to school part-time.
In 2022, the college received a grant from the ECMC Foundation, Workcred, the League for Innovation in the Community College, and the Higher Learning Commission to build a new “certification + degree pathway” in behavioral health. Today, students can earn up to five credit-bearing microcredentials that stack up to two associate degrees—one focused on mental health and social work and the other on addiction recovery.
Dale calls this approach “unbundling” the associate degree into specific job skillsets that align with workforce and industry certifications, but also count toward a degree. The college worked with employers to design the curriculum and credentials based on their biggest hiring needs.
“The framework allowed us to be more intentional in our workforce efforts in an area where, historically, folks say, ‘That’s a gen ed track. That’s not workforce,’” Dale says. “Something that was really important to us was making this a CTE pathway instead of a general education pathway and ensuring work-based learning opportunities and experiential hours.”
Almost 400 students have completed microcredentials since the fall of 2023, with many still enrolled to stack their credits into degrees.
The microcredentials allow students to start working in roles like peer support specialists or behavioral health technicians, and the stackability gives them an incentive to continue their education and move into higher-paying roles down the line. Another advantage of the unbundling approach is that students are getting work experience much earlier than they do in a typical bachelor’s to master’s degree track, showing them what it’s really like to work in the field before they invest significant time and money in their education.
Turning Dead Ends into Developmental Jobs
In healthcare, including behavioral health, apprenticeships are slowly gaining ground as another workforce solution to chronic shortages. In April, Reach University and the Healthcare Training Fund launched the nation’s first Apprenticeship College of Health, starting with behavioral health. Students will earn an associate degree in liberal studies with a focus on social science. In combination with an apprenticeship, the degree will qualify them for jobs as substance use disorder professionals.
Joe Ross, president of Reach, says the apprenticeship degree will follow the same model as the university’s well-known teaching degrees: it will be affordable, costing no more than $75 a month per student; the homework will be largely based in the workplace; and students will earn credit for learning they get on the job.
The eventual goal is for the associate degree to stack into bachelor’s and master’s degree programs, subject to accreditor and state approval.
“There is a similar shortage crisis in behavioral health as we’ve seen in teaching,” Ross says. “You have these frontline workers who otherwise would be in dead-end jobs, and there’s an opportunity to turn those jobs into developmental jobs.”
On the Ground: While Reach aims to be the first national effort in scaling behavioral health apprenticeships, local efforts are thriving in some parts of the country. In 2021, the labor-management training trust United We Heal formed in Oregon to help build earn-and-learn pathways in behavioral health. The organization has since created five apprenticeship tracks, ranging from qualified mental health associate to certified alcohol and drug counselor.
United We Heal partnered with several colleges and employers to create the apprenticeships and provide the education for free. Last year, they registered almost 90 apprentices, including many peer support workers who have battled addiction, homelessness, and other challenges in the past. Certification to become a peer in Oregon requires between 40 and 80 hours of training—a much quicker and cheaper option than getting a degree.
One tactic United We Heal uses to help entry-level workers like peers advance in their careers is to determine what parts of their work experience can count toward a credential to help them earn degrees faster. The qualified mental health associate certificate, for example, can be earned through paid work experience instead of education, which many people don’t know. This is especially useful in substance use services, which is a high-demand field in the state with a critical shortage of workers.
“People are leaving the field because it’s really hard work and the pay is not good enough, especially if you are looking at the traditional pathways of getting these credentials—going through a college program, taking away time from work, doing unpaid internships, and taking on student debt,” says Haley Coupe, the behavioral health career pathways supervisor at United We Heal. “Apprenticeship gets people into the field faster and for free, and gets them working on day one.”
Getting to a Master’s Degree: Reach University and United We Heal are working toward establishing apprenticeship pathways in bachelor’s and master’s degrees, but they don’t exist yet. One blueprint for how they might do this is the College of New Jersey’s master’s-level registered apprenticeship program for clinical mental health counseling, which launched last fall.
Sandy Gibson, a professor of online counseling education at the college, says a funder approached the institution about three years ago hoping to create a counseling program that was more accessible and affordable for people already working in the field.
After hitting roadblocks in her previous department, an in-person clinical mental health counseling program, Gibson helped launch an entirely new online department with accelerated classes structured around students’ work schedules. The cost to students is also half the price of the traditional program. The program is especially beneficial to adult learners. About 70% of the students already work in behavioral health.
“We have very few students coming out of undergraduate into our program,” Gibson says. “We mostly have people upskilling from bachelor’s-level jobs in the behavioral health workforce or career changers, and a couple of people who are about to retire and want to do something different in their retirement.”
Gibson didn’t consider apprenticeships at first, but she eventually got in touch with the National Center for the Apprenticeship Degree, an affiliate of Reach University. Together, they created an apprenticeship pathway, which knocked down a significant barrier the online program alone couldn’t overcome: how to pay students to learn. Today, The College of New Jersey has partnered with 29 employers and has 52 active apprentices.
Due to the online nature of the program, the college has also received a lot of interest from students in other states, and Gibson is now working to get it on eligible training provider lists across the country. Next fall, five students in Oregon will be joining.
Gibson says the new master’s degree model removes many of the barriers past students have faced.
“I would often see students working full-time, and they would have to go part-time and the degree could take six years or more,” she says. “Sometimes people would drop out after three years because they’ve got kids, they work all day, and come to class at night—and it’s too much. Now they have all this debt and no degree, and it was just heartbreaking. Our program is very different.”