About the Project 

This national initiative is funded by the Foundation for Opiod Response Efforts and stems from a recommendation made in The Playbook for Enhancing Indiana’s Mental and Behavioral Health Workforce. It aims to strengthen the behavioral health and substance use (BH/SU) paraprofessional workforce. There is extreme variation in how state’s use this workforce. Some states have no pathway for paraprofessionals. Other states have roles, but a lack of consistency across states in education and regulation standards limits the effectiveness of these roles. Through research, collaboration, and strategic planning, the project will develop a framework to guide states in formalizing roles for paraprofessionals. 

Who Are Paraprofessionals? 

Paraprofessionals in behavioral health are trained individuals who assist clinicians by providing services such as care coordination, psychosocial skills training, screenings, and prevention services. Unlike peers with lived experience or individuals with graduate degrees, paraprofessionals may enter the field with more accessible education levels. Formalizing these roles can relieve clinicians of non-clinical tasks and expand career pathways for individuals who may be interested in behavioral health care. 

50-State Policy Review 

The project began with a review of policies across all 50 states to understand how BH/SU paraprofessional roles are currently defined and regulated. This includes examining state statutes, administrative codes, and Medicaid guidance to identify standards related to: 

• • Occupational regulation 

• • Education and experience requirements 

• • Scope of practice 

• • Reimbursement policies 

States with formalized roles will undergo deeper analysis to inform the framework. 

Key Informant Interviews 

To gain deeper insights, interviews will be conducted with state and national experts. These conversations will explore the successes, challenges, and lessons learned from existing paraprofessional programs. Participants will include representatives from education, regulation, insurance, industry, and national organizations. 

Wage Economic Analysis 

A wage economic analysis will use federal employment data to assess wages for comparable entry-level healthcare occupations. The goal is to ensure BH/SU paraprofessional roles offer competitive compensation and viable career pathways. By understanding the wage environment of comparable occupations, the framework will include considerations for setting wage and the intersection of wage and reimbursement. This analysis also informs how paraprofessional roles can fit into broader workforce pipelines and helps states design roles that are economically sustainable from the perspective of the individual, the employer, and the state. 

Roundtable Engagement 

Stakeholders from across the country—including from government agencies, professional organizations, philanthropic groups, insurance, and employers—will be invited to a roundtable. This event will present research findings and facilitate strategic planning to shape the framework. Participants will also be invited to join a coalition to support ongoing implementation of the framework.  

Framework Development and Dissemination 

Using information gathered from research and stakeholder engagement, the project will develop a national framework outlining actionable steps for states interested in formalizing paraprofessional roles in a way to support individual portability and patient protection. The framework will address four key domains: 

• • Regulation 

• • Education and experience 

• • Practice 

• • Wage 

Dissemination of the framework will occur through publications, presentations, webinars, and media outreach to ensure broad awareness and adoption. 

Final Goal 

The ultimate goal is to create a standardized, sustainable model for BH/SU paraprofessionals that enhances service access, supports clinicians, and opens new career pathways. Whether adopted nationally or by individual states, the framework will help build a more responsive and inclusive behavioral health workforce that is better equipped to meet the needs of individuals and communities affected by opioid use disorder.