Supervision Best Practices to Recruit, Train, and Retain Early Career Behavioral Health Workforce: A Scoping Review and Expert Interviews

Background and Purpose: Clinical supervision is essential for preparing early-career behavioral health clinicians (ECBHCs) for independent practice and to meet licensure requirements. Supervision provides ECBHCs with structured support for developing professional competence, refining clinical judgment, and building confidence to deliver evidence-based care effectively. While supervision is widely acknowledged as a critical training mechanism, there is limited empirical consensus on the core components that constitute high-quality supervision, especially across behavioral health disciplines with differing regulatory and licensure requirements. To address these knowledge gaps, this study aimed to (1) identify key features of quality supervision and describe the effectiveness in training outcomes (i.e., licensure pass rates) and retention (i.e., remaining in the public mental health systems), and (2) describe innovative practices in supervision training through qualitative interviews with expert clinicians regarding supervision practices.

Methods: This study occurred in two phases; Phase 1 involved conducting a comprehensive scoping review of studies that examined ECBHC clinical supervision models, practices, and interventions and how, if examined, were these evaluated to be effective approaches to train and/or retain this workforce. Inclusion criteria were U.S.-based peer-reviewed studies published in the last 10 years that investigated ECBHCs (1-3-years post-graduation) with a master’s degree or higher representing four professions: (1) professional counselors, (2) social workers, (3) psychologists, and (4) marriage and family therapists. Phase 2 included semi-structured interviews with key informants (N=10). Snowball sampling was used to recruit clinical supervisors, educators, and researchers representing the four disciplines across U.S. regions with extensive experience in delivering supervision and/or supervision design and implementation. Interviews were transcribed and thematically coded using an inductive approach.

Findings: Seven articles met inclusion criteria and were extracted for the scoping review; five were qualitative and two based on survey data. Most articles focused on school psychology or educational counseling; only two focused on social work ECBHCs. The sample sizes ranged from 7-700 ECBHCs. Variation in supervision models and structure may be attributed to each of the four professions having degree-specific training and licensure requirements. Differences in how ECBHCs’ supervision was structured and designed (e.g., administrative vs. clinical), frequency (e.g., weekly), and format (e.g., individual or group) were identified. Thematic qualitative analysis revealed while supervisors desire to implement innovate supervision practices but felt stymied by disparate state-specific behavioral health regulatory and regulations. Participants described structural barriers (i.e., inability to provide supervision remotely) to consistency as barriers to high-quality supervision practices.

Conclusions and Implications: The small number of articles identified in this review highlights the lack of literature focused on supervision as a workforce intervention to recruit, train, and sustain ECBHCs. Although supervision, when resourced and structured effectively, can serve as a strategic intervention to strengthen the behavioral health workforce, there is limited research on best practices for supervision of ECBHCs and ongoing structural challenges to delivering high-quality supervision. Findings highlight the need for cross-disciplinary and policy-informed supervision standards that promote licensure readiness, professional development, and retention among ECBHCs. Policy recommendations include streamlining supervision requirements across professions, funding supervision infrastructure, and expanding tele-supervision access.