COUNTY WORKFORCE, EDUCATION, AND
TRAINING PLANS:
Preliminary Findings
Gwen Foster, MSW
Meghan Brenna Morris, M.A. MSW
California Social Work Education Center Mental Health Program
University of California at Berkeley
5/6/2011
COUNTY WORKFORCE, EDUCATION, AND TRAINING PLANS:
PRELIMINARY FINDINGS
Introduction
The Mental Health Services Act (MHSA) provides funding for workforce, education, and
training (WET) to support the transformation of the public mental health system.
California’s public mental health workforce has been historically underfunded and
suffered from a lack of cultural and linguistic diversity, a geographic misdistribution of
mental health workers at all levels of services, and the lack of educational and training
programs to develop and sustain a workforce that is required to meet the service demands
of growing and aging un-served and underserved communities. In addition, the public
mental system has struggled to include individuals with lived experience and family
members by creating authentic career opportunities throughout the workforce.
Approximately $450 million was made available statewide over 10 years to develop and
deploy a qualified workforce; the Department of Mental Health (DMH) allocated $210
million to local counties, $210 million for statewide WET programs, such as CalSWEC,
and $30 million for regional partnerships. Each eligible jurisdiction (58 counties, the
City of Berkeley and Tri-City Mental Health) must develop a plan and submit it to DMH
for approval to draw down its allocation of WET funds. The allocations range from
$450,000 for each of the 23 smallest counties to $60 million for Los Angeles County.
The California Social Work Education Center (CalSWEC) offers training and stipends to
increase the availability of prepared social workers for the mental health and child
welfare fields. CalSWEC also provides in-service training for child welfare workers, and
supports curriculum development and capacity-building opportunities for faculty
involved with CalSWEC programs. CalSWEC is a collaboration, founded in 1990,
among the state's 20 accredited social work graduate schools, county departments of
social service and mental health/behavioral health, the California Departments of Social
Services (CDSS) and Mental Health (DMH), the California Chapter of the National
Association of Social Workers, professional associations, and foundations. In 2003, the
CalSWEC Mental Health Initiative Committee began to create and implement a set of
core competencies for graduate schools of social work to build curricula designed to train
new mental health social workers from diverse ethnic, linguistic, and geographic
backgrounds. In 2005, DMH and CalSWEC negotiated an interagency agreement to
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provide stipends and some operational support to schools of social work throughout
California. The stipend program is one of the statewide WET programs.
In 2010, as part of its planning process, the Mental Health Program undertook a scan of
the “landscape” in which the program functions, including county and regional WET
programs. CalSWEC staff reviewed documents to identify (1) how counties originally
planned to use WET funds in the funding categories of internships and financial incentive
programs, and (2) what programmatic “themes” in these categories are emerging
regarding strategies for mental health workforce development, including social work.
Documents included:

Approved plans for 48 counties and the City of Berkeley. (Eleven counties
did not yet have approved plans as of October 31, 2010.)

California Department of Mental Health (2010). Mental Health Services Act
Expenditure Report. Fiscal Year 2009-10 Addendum. A Report to the
Legislature In Response to AB 131, Omnibus Health Budget Trailer Bill,
Chapter 80, Statutes of 2005

California Department of Mental Health (2007). Planning Estimates

California Department of Mental Health (2006) Proposed Guidelines:
Workforce Education and Training Component of the Three-Year Program
and Expenditure Plan.

Shilton, Adrienne (2010). County Program Snapshot Regarding MHSA
Workforce, Education, and Training (WET)
Annual updates reflect changes in the plans as obstacles are overcome and mid-course
corrections are made. This “point-in-time” report summarizes what jurisdictions
submitted in their original WET plans.
The Context of County WET Plans
DMH distributed a set of guidelines in July, 2007 that shaped the development and
terminology of the county plans. Counties may fund programs in any or all of five
categories in developing plans:





Workforce Staffing Support
Training and Technical Assistance
Mental Health Career Pathway Programs
Residency, Internship Programs
Financial Incentives
For this report, CalSWEC chose to focus on “Residency, Internships,” and “Financial
Incentives” because they are most similar to the current activities of the Mental Health
Program (MHP). Proposed Guidelines: Workforce Education and Training Component
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of the Three-Year Program and Expenditure Plan (pp 35-42) describes these categories
as follows:
Residency, Internship Programs
MHSA funding for psychiatric residency programs, internship programs leading
to licensure and physician assistant programs with a mental health specialty are
designed to address workforce shortages by supplementing existing programs in
order to increase the number of licensed professionals within a program who will
practice in the Public Mental Health System and who
• Specialize in child and geriatric psychiatry
• Work on multidisciplinary teams providing services according to the
fundamental concepts of the Act
• Are recruited from underrepresented racial/ethnic and cultural groups
in the workforce
• Increase mental health awareness and expertise by working with
primary care health care workers
• Can prescribe and/or administer psychotropic medications
• Work in underserved/unserved communities and rural areas.
Counties are encouraged to partner with graduate mental health and psychiatric
residency programs in their communities to establish programs that address one or
more of the above, and use MHSA funding to both address workforce shortages
and influence school curriculum.
Funding may be used to add slots to an existing psychiatric residency program
that enable fourth and/or fifth-year residents to specialize in child or geriatric
psychiatry or work on multidisciplinary teams that include primary care
physicians and health care workers.
Funding may also be used for counties and their community based organizations
to work with masters or doctoral level programs that enable graduates to become
interns in their field and become licensed and authorized by the Department to
sign mental health treatment plans.
Financial Incentives
Stipends, scholarships, and loan assumption programs are financial incentives to
recruit and retain both prospective and current public mental health employees
who can address workforce shortages of critical skills and under-representation of
racial/ethnic, cultural or linguistic groups in the workforce. Financial incentive
programs are also for promoting employment and career advancement
opportunities for individuals with client and family member experience in the
Public Mental Health System.
Stipends:
Stipends can be a used to create a program of educational funding for students
similar to the federal Title IV-E stipend program for graduate level students, such
as social workers or marriage and family therapists, where funds are provided to
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an enrolled student in exchange for a commitment to work in the Public Mental
health System for a specified period of time, usually one year. Counties can
contract with a fiduciary entity, university or accredited educational institution for
the establishment of such a program.
Stipends can also be used to pay individuals with client and family member
experience for participation and completion of an education or training program
that leads to employment in the Public Mental Health System. These are often
budgeted as part of the expenses of such a program.
Scholarships:
Counties and contract community based organizations can establish a scholarship
fund to pay for the costs, such as tuition, registration fees, books and supplies,
associated with employees participating in training and educational endeavors that
are directly linked to:
-Addressing occupational shortages or critical skills needed by the
employer, such as language proficiency or licenses.
-Integrating individuals with client and family member experience into all
levels of the Public Mental Health System workforce, to include positions
that require advanced degrees.
-Addressing the under-representation of racial/ethnic, cultural and
linguistic groups in the workforce.
All education and training in which scholarship funds are provided must adhere to
the fundamental principles embodied in the Act, and cannot supplant existing
funds allocated for staff development activities.
MHSA Loan Assumption Program:
When the guidelines were promulgated, DMH was developing a program
description and requirements for an MHSA Loan Assumption Program, in which
individuals on an annual basis would have payments made on outstanding loan
balances in exchange for a commitment to work in the Public Mental Health
System for a specified time. Amounts paid can vary, depending upon the amount
of educational debt incurred.
Counties were instructed to wait until guidelines for the MHSA Loan Assumption
Program were announced before developing local plans. The Mental Health Loan
Assumption Program, a collaborative endeavor between the Health Professions
Education Foundation (Office of Statewide Health Planning and Development)
and DMH, started in 2009.
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COUNTY WET PLAN SCAN FINDINGS
Residency, Internships:

Twenty-nine (29) counties’ plans included this program component, and the majority
of these describe internship programs.

Some counties planned to offer new paid internships for graduate and/or
undergraduate mental health students. Butte, Contra Costa, Marin, Placer, San
Benito, San Bernardino, San Francisco, San Luis Obispo, Santa Barbara, Solano, and
Stanislaus all designated social work internships in this category.

Cultural and ethnic diversity were mentioned as the most common eligibility priority
for stipend recipients; people with lived experience with the mental health system as
consumers or family members are also frequently mentioned as prioritized
populations, as are transition-age youth.

(Ten) 10 counties prioritized bilingual students: Spanish was identified through
county assessments the most needed language. Also mentioned are: Arabic,
Cambodian, Cantonese, Chaldean, Farsi, Hmong, Laotian, Native American
languages, Somali, Swahili, Tagalog, and Vietnamese.

At least 17 counties have used funds in this category for clinical supervision for
interns and pre-licensure staff, primarily in psychiatry, social work and MFT fields.
The majority of these positions are part-time contracts.

A few counties offer reimbursement for travel or other expenses related to
internships. Most of these encompass hard-to-reach communities without nearby
universities.

Ten (10) counties planned curriculum development and trainings for interns/fellows
on topics such as: resiliency, recovery, license preparation, and supervision.
Several planned to develop new sets of core competencies.

Five (5) counties (Nevada, Placer, Riverside, Solano, and Ventura) planned to
strengthen their internship programs through closer coordination with partner
universities, increased trainings on MHSA-related topics, structured field placement
experiences, etc.
Financial Incentives

Thirty-two (32) counties included this component in their WET Plan.
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
At least 15 counties included stipends and scholarships. Seven (7) counties identified
scholarships/stipends for MSW students: Alameda, Calaveras, Contra Costa, LA,
Santa Clara, Santa Cruz, Shasta, and Orange counties. Financial incentives for MSW
students may also exist in other county plans, but many counties did not provide a
breakdown by discipline.

19 counties gave stipend priority to ethnic and/or linguistic diversity; 11 counties
gave stipend priority to current employees; 12 counties gave stipend priority to
consumers and/or family members of consumers. There was some overlap, with
counties giving priority to several of the above categories, such as “bilingual
employees,” etc.

The number of scholarships planned by counties to be given to students for graduate
education in mental health (which could include MSWs) varies from three in Colusa
(a small county with a $450,000 allocation) to 200 in LA County (the largest county
in the State with $60 million). Most cluster around 10-20.

The amount per scholarship/stipend per year varied from $1000-$18,500. There were
9 counties offering scholarships/stipends of approximately $5000 each.

Several counties, including Contra Costa, El Dorado, Fresno, Monterey, Placer,
Stanislaus, and Ventura covered operational costs, including staffing and supervision
for their stipend/scholarship program through Financial Incentive funds. There does
not seem to be a particular pattern to how counties are paying for operational costs,
but the WET Workforce Staffing component provides funding for new staff positions
for oversight and coordination across the planned program components

At least seven (7) counties - Alameda, Colusa, El Dorado, Siskiyou, Solano, Sonoma,
and Yolo – have implemented or were planning to develop loan assumption
programs. DMH now has started the Mental Health Loan Assumption Program for
licensed mental health professionals who are employed in county or contract mental
health agencies. All counties have the option of participating in this program, and in
2010, $2.28 million was awarded to 309 individuals.
Discussion
Since the passage of MHSA, California’s public mental health workforce has taken an
historic step toward overturning years of struggle to build and sustain a system capable of
comprehensively addressing the mental health needs of the population from prevention to
recovery. This step includes significant dedicated resources to resolve long-standing
problems of workforce shortages and capacity limitations for working with highly
diverse, vulnerable populations across the lifespan.
There is clearly a great deal of positive energy and innovation in the development and
implementation of plans for programs supported by the MHSA WET funding component.
Fundamentally, the plans share the goals of building and rapidly expanding a new,
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inclusive, multidisciplinary workforce and re-tooling the existing workforce to actualize
recovery-oriented systems of care.
Some counties are collaborating to address these goals in unique ways. For example,
MSW graduate programs have been launched in several California State Universities
(CSUs) in response to workforce development needs. Santa Cruz, San Benito, and
Monterey Counties along with the Greater Bay Area Mental Health and Workforce
Collaborative each provided funding to CSU Monterey Bay to launch an MSW program,
which opened its doors in Fall 2010. The new MSW program is a three-year program,
with a focus on working adults. Calaveras, Amador, Tuolumne, and El Dorado counties,
along with the Central Regional Partnership, pooled WET funds to launch a part-time,
weekend MSW program with a rural mental health focus through CSU Sacramento
Division of Social Work. The program is open to employees and non-employees.
This scan did not closely examine the Career Pathways component of each plan, but that
would be informative. Many counties are using MHSA resources to build ladders of
learning from high school through graduate programs, and many have prioritized
consumers and family members as primary candidates for such programs. The CalSWEC
Mental Health Program does not currently focus on secondary education or
undergraduate preparation for mental health careers, but recognizes that collaboration
with and among counties, regional partnerships, and schools is a critical component of
workforce development.
Recommendations
1. Use the scan results to inform the development of goals and strategies for social
work workforce development in the Mental Health Program plan for 2011-14.
2. Strengthen collaboration among CalSWEC MHP schools, other statewide WET
programs, county WET programs, and Regional Partnerships to leverage the rich
diversity of training and career development that is now underway.
3. Ensure that program evaluation is expected of WET-funded programs, is tailored
to the needs and size of each program, and routinely collects statewide data for
maximum learning about progress toward workforce development goals for the
behavioral health field and solutions to policy and programmatic barriers.
4. Develop and implement ways to disseminate information to stakeholders about
the achievements and challenges of local, regional, and statewide WET programs.
Conclusion
The infusion of new resources for workforce development creates many short- and longterm opportunities for innovation. It also creates the potential for duplication of effort,
gaps in infrastructure to support programs, and limited attention to learning from start-up
and expansion processes. These risks are part of the “life cycle” of large-scale system
change, and there are opportunities to develop new or strengthen existing collaborations
that will accelerate workforce development to meet the need for multidisciplinary staff
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for the public mental health system, as well as for the next large-scale system changes
called for in health care reform.
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