Workforce Development and Mental Health Transformation: A State Perspective


The existence of a workforce crisis in behavioral health has been recognized for decades. However, workforce problems often have been viewed as too large, too complex, and too daunting for individual states to tackle. This article reviews the progress of one state in systematically strengthening its workforce as part of a federally supported effort to transform mental health services. The workforce priorities in Connecticut are identified and the specific workforce transformation projects and their impact are described. The success in sustaining these initiatives after cessation of federal support is reviewed. The authors conclude by offering five recommendations to guide comprehensive state workforce development. This work has particular salience for the many states across the nation that have identified behavioral health service and workforce needs as obstacles to comprehensive health care reform.

This is a preview of subscription content, access via your institution.


  1. 1.

    SAMHSA (2014) recently added workforce development as one of six goals in its strategic plan, Leading Change 2.0: Advancing the Behavioral Health of the Nation 20152018.


  1. Cannata, E., & Hoge, M. A. (2012). Higher education reform on evidence-based practices: The Connecticut transformation initiative. Report on Emotional & Behavioral Disorders in Youth, 12(1), 18–23.

    Google Scholar 

  2. Department of Health and Human Services (DHHS). (2003). New Freedom Commission on mental health: Achieving the promise: Transforming mental health care in America. Final Report. DHHS pub no SMA-03—3832. Rockville MD, Department of Health and Human Services.

  3. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M. & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

  4. Focus On Recovery-United, Inc. (FOR-U). (2010). Connecticut Recovery Employment Consultation Service (C-RECS) Final Report 2008–2010.

  5. Hoge, M. A., Migdole, S., Cannata, E., & Powell, D. J. (2014). Strengthening supervision in systems of care: Exemplary practices in empirically supported treatments. Clinical Social Work Journal, 42(2), 171–181.

    Article  Google Scholar 

  6. Hoge, M. A., Migdole, S. J., Farkas, M. S., Ponce, A., & Hunnicutt, C. (2011). Supervision in public sector behavioral health: A review. The Clinical Supervisor: An Interdisciplinary Journal of Theory, Research, and Practice, 30(2), 183–203.

    Article  Google Scholar 

  7. Hoge, M. A., Morris, J. A., Stuart, G. W., Huey, L. Y., Bergeson, S., Flaherty, M., & Madenwald, K. (2009). A national action plan on workforce development in behavioral health. Psychiatric Services, 60(7), 883–887.

    Article  PubMed  Google Scholar 

  8. Hoge, M. A., Stuart, G. W., Morris, J., Flaherty, M. T., Paris, M., & Goplerud, E. (2013). Mental health and addiction workforce development: Federal leadership is needed to address the growing crisis. Health Affairs, 32(11), 2005–2012.

    Article  PubMed  Google Scholar 

  9. Institute of Medicine (IOM). (2010). Redesigning continuing education in the health professions. Washington, DC: The National Academies Press.

    Google Scholar 

  10. Leff, S., Cichocki, B., Chow, C. M., & Lupton, C. (2014). Infrastructure change is not enough: An evaluation of SAMHSA’s mental health transformation state incentive grants. Psychiatric Services, 65(7), 947–950.

    Article  PubMed  Google Scholar 

  11. MANILA Consulting Group, Inc., & Human Services Research Institute (HSRI). (2011). Final report. Evaluation of the Mental Health Transformation State Incentive Grant Program. McLean, VA.

  12. Nelson, G., Kloos, B., & Ornelas, J. (Eds.). (2014). Community psychology and community mental health: Towards transformative change. New York: Oxford University Press.

    Google Scholar 

  13. Rehmer, P. (2006). A comprehensive mental health plan for the State of Connecticut. Submitted to the Substance Abuse and Mental Health Administration, Center for Mental Health Services.

  14. SAMHSA. (2005a). SAMHSA advisory. SAMHSA News. $92.5 Million Awarded for Mental Health Transformation State Incentive Grants.

  15. SAMHSA. (2005b). Transforming mental health care in America—The federal action agenda: First steps. Rockville, MD: Author.

    Google Scholar 

  16. SAMHSA. (2009). Workforce development: Transformation in action. Rockville, MD: CMHS Transformation Center.

    Google Scholar 

  17. SAMHSA. (2012). SAMHSA’s working definition of recovery updated March 23 2012. Rockville, MD: Author.

    Google Scholar 

  18. SAMHSA. (2014). Leading change 2.0: Advancing the behavioral health of the nation 2015–2018.

  19. Silveira, P. R., Bugella, B., Paris, M., & Hoge, M. (2007). Connecticut moves to transform its workforce. Mental Health News, 9(2), 37–42.

    Google Scholar 

  20. Tebes, J. K., Matlin, S. L., Migdole, S. J., Farkas, M. S., Money, R. W., Shulman, L., et al. (2011). Providing competency training to clinical supervisors through an interactional supervision approach. Research on Social Work Practice, 21(2), 190–199. doi: 10.1177/1049731510386827.

  21. Wolf, J., Lawrence, L. H., Ryan, P. M., & Hoge, M. A. (2010). Emerging practices in employment of persons in recovery in the mental health workforce. American Journal of Psychiatric Rehabilitation, 13(189–207), 2010.

    Google Scholar 

Download references


This work was supported in part by the State of Connecticut through the SAMHSA Mental Health Transformation State Incentive Grant (MHT-SIG) No. SM57456. The authors acknowledge Thomas Kirk, Patricia Rehmer, and Barbara Bugella for their leadership in making this work possible.

Author information



Corresponding author

Correspondence to Michael A. Hoge.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hoge, M.A., Wolf, J., Migdole, S. et al. Workforce Development and Mental Health Transformation: A State Perspective. Community Ment Health J 52, 323–331 (2016).

Download citation


  • Workforce development
  • Mental health
  • Transformation
  • States
  • Health care reform