Recent policy changes expanding access to mental health and addiction services for millions of Americans are increasing demand for behavioral health services and reshaping the behavioral health workforce. According to SAMHSA, the demand for behavioral health services exceeds the supply of the workforce, with 55 percent of counties reporting that they do not have behavioral health workers in their counties, and 77 percent of counties reporting unmet behavioral health needs within their communities. Paraprofessionals play a key role in mitigating provider shortages, which has created increased attention to the value of peers and paraprofessionals in behavioral health care delivery. While states may develop SOPs for particular types of paraprofessionals, alignment between SOPs and job responsibilities could result in paraprofessionals working beneath or beyond their professional capacity. In addition, further review of alignment between SOPs and job responsibilities could reveal areas where there are authorities that should be granted to paraprofessionals not currently covered by SOPs that could further alleviate workforce shortage issues and expand access to behavioral health care.

This project will identify five types of paraprofessionals that are ubiquitous in behavioral health care, and assess whether states have developed SOPs for each paraprofessional type. In addition, this project will identify two states that have SOPs for each type of paraprofessional (10 states total), and deploy a survey among a sample of paraprofessionals in those states assessing alignment between SOPs and job responsibilities.


This study included a survey of 108 NAADAC Level I Addiction Counselors, Community Health Workers, Peer Recovery Specialists, Case Managers, and Health Navigators in 10 states to investigate the alignment of job responsibilities with SOPs. Study findings indicate that many of the paraprofessional occupations lack clearly defined SOPs, with many SOPs coming from provider organizations rather than state regulating bodies. Survey results showed substantial overlap of daily job tasks among the occupations.

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Entry level providers are an integral part of the behavioral health workforce, however their job responsibilities are ill-defined. Further role standardization may help fully leverage the skills and competencies of paraprofessionals and Addiction Counselors to improve access to behavioral health services. Future research should investigate the billing and reimbursement structure of these providers in order to holistically understand polices that may limit the delivery of behavioral health services.