Supervision best practices to train and retain the early career behavioral health workforce: a scoping review and expert interviews

Abstract

The U.S. behavioral health system is experiencing critical workforce shortages. Early career behavioral health clinicians (ECBHCs)—professionals with master’s or doctoral degrees and one to three years post-graduate experience—face unique challenges in obtaining required supervision for independent licensure. While supervision is mandated for professional development, empirical consensus is limited on what constitutes high-quality supervision and its role as a workforce retention mechanism. This study aimed to address this gap by examining models, practices, and systemic factors that influence the quality and function of supervision for ECBHCs. This study employed a two-phase design. Phase one was a PRISMA-ScR-guided scoping review (protocol registered on Open Science Foundation) of peer-reviewed, U.S.-based studies (2014–2024) on supervision practices or outcomes for ECBHCs — master’s- or doctoral-level clinicians in social work, counseling, marriage and family therapy, or psychology with ≤ 5 years of postgraduate experience. Four databases were searched; two reviewers screened records and charted data using a standardized extraction guide. Phase two comprised 12 expert interviews analyzed using reflexive thematic analysis. Findings from both phases were integrated to recommend future workforce practice and policy. Seven studies met inclusion criteria; none evaluated supervision as a workforce intervention. Supervision outcomes were reported at the individual level and barriers included inconsistent requirements, poor supervisory fit, harmful or inadequate practices, and financial burden. Expert interviews reinforced findings and identified four themes: (1) benefits of supervision for skill development and burnout mitigation, (2) challenges (i.e., administrative complexity, training gaps), (3) adaptive strategies (i.e., telesupervision, contracts) and (4) policy priorities, including licensure standardization and financial support for supervision access. Supervision is a requisite for ECBHCs’ independent licensure and clinical training. Despite its importance, findings underscored that its quality and potential function as a strategic workforce intervention remain nascent. While data suggests that high-quality supervision can improve clinician confidence and competence, systemic barriers persist that undermine supervision affordability and accessibility. Coordinated efforts among policymakers, professional associations, and organizations are needed to standardize requirements, fund training and access, and integrate evaluation tools. Without such action, supervision remains underutilized in addressing the broader behavioral health workforce crisis.