Program Summary - Who Gets to Practice? Examining Barriers to Behavioral Health Licensure in Massachusetts

Over the last ten years, diagnosis rates and reported symptoms of mental and behavioral health (BH) conditions have continued to rise. Yet Massachusetts’ capacity to meet this growing need is under threat. Licensed BH providers play a critical role in delivering mental and behavioral health services to individuals and families. Professionals who provide services such as psychotherapy and clinical assessments have completed extensive preparation for licensed practice. They have earned a master’s or doctoral degree from an accredited graduate program, gained field experience under the supervision of independently licensed clinicians, and completed the standardized, rigorous licensing processes established by state licensing boards.

Reaching this professional milestone, however, can involve a lengthy, complex, and challenging journey. While progress is being made to streamline licensure processes, opportunities remain to reduce barriers while preserving professional standards and a commitment to high-quality care.

This webinar brings together findings from two recent Massachusetts studies on BH licensure and workforce development. The first, conducted by the Massachusetts Health Policy Commission’s Behavioral Health Workforce Center, examines BH licensure and certification across the Commonwealth. The second, conducted by the Center for Workforce Development at William James College and funded by the Blue Cross Blue Shield of Massachusetts Foundation, explores barriers to licensure across five BH professions.

The webinar will examine licensed BH professions in the Commonwealth and the education, supervised practice, examination, and application requirements associated with each licensure pathway. It will also explore the composition of the licensed BH workforce, including workforce demographics and employment trends. Presenters will highlight key challenges associated with obtaining licensure, including financial costs, access to supervision and mentorship, examination-related barriers, and the complexity of navigating professional licensing systems.

Special attention will be given to the experiences of professionals from historically underrepresented communities, including BIPOC, LGBTQIA+, and multilingual providers. Presenters will describe how licensure barriers may influence entry into and advancement within BH professions, with broader implications for workforce development and access to care. The webinar will conclude with research-informed recommendations and promising approaches at the policy, systems, and practice levels to improve licensure processes and support a strong, skilled, and responsive BH workforce in Massachusetts.

Dr. Alexandra Alden is the Associate Director of Research in the Center for Workforce Development at William James College (WJC). With a PhD in sociology from Northeastern University, she developed a passion for solving real-world problems through social science and even helped launch her former employer’s first public evaluation lab. Throughout her career, Dr. Alden ran evaluation projects for health care facilities, community organizations, and government health entities while also managing the research of others. At WJC, she utilizes her research and evaluation expertise as well as her mission-driven background in the fields of behavioral health services and racial equity.

Dr. Gemima St. Louis is Vice President for Workforce Initiatives in the Center for Workforce Development and Professor in the Clinical Psychology Department at William James College (WJC). She currently serves as Program Director for the Child & Adolescent Mental Health Initiative—a behavioral health workforce program funded by Franciscan Children’s Community Health Initiative—and the Behavioral Health Workforce Education & Training Program for Paraprofessionals, funded by the Health Resources & Services Administration. Her primary clinical and research interests focus on children and adolescents with histories of trauma and behavioral health workforce development.

Dr. St. Louis received her doctoral degree in Clinical Psychology from the University of Massachusetts Boston. She completed her pre-doctoral internship and post-doctoral clinical training at Boston Children’s Hospital where she was appointed as a Research and Clinical Fellow at the Harvard School of Medicine. Dr. St. Louis has received several community service awards, including the Massachusetts Service Recognition Award, the City of Boston’s Award for Leadership and Dedicated Services to the Haitian Community, and the Get Konnected’s 2023 “50 Most Influential Business Leaders of Color” in the MetroWest Region. She is an alum of the Leadership Institute for Women in Psychology, a Distinguished Psychology Fellow in the National Academies of Practice, and a Certified Health Service Provider in Massachusetts.

Ms. Amy Doyle, MSW, MPH, is the Director of the Behavioral Health Workforce Center (BHWC) at the Massachusetts Health Policy Commission (HPC), which was established in partnership with the Executive Office of Health and Human Services (EOHHS) in 2024. Ms. Doyle is responsible for leading comprehensive research activities, convening subject matter experts, engaging community stakeholders, and synthesizing information to generate actionable policy recommendations that drive the development and sustainability of a robust behavioral health workforce in Massachusetts. Ms. Doyle is also an Adjunct Lecturer in social welfare policy and public health social work at the Boston University School of Social Work.

Prior to joining the HPC, Ms. Doyle served as the Deputy Director of Policy for MassHealth’s Office of Accountable Care and Behavioral Health. In this role, she directed the policy development and implementation of MassHealth’s Accountable Care Organization (ACO) and Managed Care Organization (MCO) programs and contracts, with a focus on primary care payment reform, behavioral health services, and health-related social needs. She also collaborated with EOHHS to lead the development and launch of an extensive portfolio of statewide workforce investments, including student loan repayment and clinical fellowship programs. She was previously the Associate Director of Implementation and Quality Improvement at the Baker Center for Children and Families. Ms. Doyle and her team directed workforce training and organizational capacity-building initiatives to improve the quality and accessibility of behavioral health care in community mental health centers and systems of care, regionally and nationally. Ms. Doyle holds master’s degrees in both social work and public health from Boston University.

Mr. Matt Pecoraro, MSW, is the Associate Director of the HPC’s Behavioral Health Workforce Center (BHWC). Mr. Pecoraro oversees the BHWC’s policy-focused workstreams and events, external affairs, and translational research activities to synthesize and disseminate BHWC findings and actionable policy strategies to leaders across the policy, systems, and practice levels.

Prior to joining the HPC, Mr. Pecoraro was the founding Director of the Evidence-Based Policy Institute (EBPI) at The Baker Center for Children and Families where he oversaw the program’s design, implementation, and growth. During his time at The Baker Center, Mr. Pecoraro led the EBPI’s numerous policy and translational research activities, including developing evidence-based policy reports and recommendations, offering legislative testimony, hosting policy forums to convene stakeholders from across the policy, systems, practice, and community levels, and collaborating with state and national partners on an array of initiatives.

He holds a BA in Philosophy from Fairfield University and a master’s degree in social work from Boston College, where he is currently an adjunct lecturer.

Ms. Nadia Hill, MPH, is an Associate at the Massachusetts Health Policy Commission’s Behavioral Health Workforce Center (BHWC) where her research focus has been behavioral health licensure and certification processes in Massachusetts. Prior to joining the BHWC, she participated in research exploring the effects of prenatal supplementation and early childhood development. Her interests include mental health, rural health, and maternal and child health. Ms. Hill received her Bachelor of Science in Neuroscience from Colorado College and her Master of Public Health from Boston University School of Public Health.

Describe the licensed master’s- and doctoral-level behavioral health professions in Massachusetts and the education, supervised practice, examination, and application requirements associated with their licensure pathways;
Discuss the composition of the licensed behavioral health workforce in Massachusetts, including key workforce demographics and employment trends;
Identify key barriers to behavioral health professional licensure in Massachusetts, including financial, administrative, supervisory, mentorship, and examination-related challenges;
Analyze how licensure requirements and processes may affect professionals from historically underrepresented communities, including BIPOC, LGBTQIA+, and multilingual providers; and
Explain how research-informed policy, systems, and practice-level approaches may improve licensure processes and support workforce development, professional advancement, and access to behavioral health services in the Commonwealth.

The HPC Behavioral Health Workforce Center (BHWC) was formed in partnership with the Executive Office of Health and Human Services (EOHHS) to conduct research and make data-informed policy recommendations to strengthen the behavioral health workforce in Massachusetts, including efforts to improve education and training pipelines, increase diversity and cultural competency, enhance opportunities for professional growth, and retain behavioral health providers in the workforce.

The BHWC serves as the Commonwealth’s primary hub for research on the behavioral health workforce. The BHWC aims to (1) identify gaps and challenges across communities and provider types; (2) monitor trends, particularly related to disparities in workforce representation and demand for services; and (3) support development of responsive, high-impact policy recommendations.