In August, the Substance Abuse and Mental Health Services Administration (SAMHSA) awarded the National Board for Certified Counselors (NBCC) a Minority Fellowship Program grant. The grant provides NBCC as much as $1.6 million over the next two years to “expand the behavioral health workforce in order to reduce health disparities and improve health care outcomes for traditionally underserved populations.”

Thanks to a move by Congress, eligibility for the program was expanded to include professional counselors for the first time this year. Thomas Clawson, president and CEO of NBCC, calls this inclusion hugely significant. “Over the past 40 years, SAMHSA has awarded funds to other mental health professions to help bring more minority professionals into positions of practice and education,” he says. “NBCC has sought federal legislative requirements for many years so that counseling would benefit from new dollars set aside specifically for minority doctoral counseling students. It’s a big deal because it immediately brings $600,000 a year to support minority students in Council for Accreditation of Counseling and Related Educational Programs (CACREP) doctoral programs. And we have to assume that this funding will continue for decades, thus helping prepare hundreds of quality doctorate-holding counselors by the decade.”

SAMHSA Administrator Pamela S. Hyde says the Minority Fellowship Program, created in 1973, operates with the mission of addressing and rectifying long-standing disparities in access, availability, quality and outcomes of mental health and substance abuse treatment for minority populations.

As outlined by Hyde, that mission includes three aspects. First, she says, it aims to increase the focus on minority behavioral health issues in professional development through curricula and training opportunities in institutions of higher education. These institutions must focus on the needs and conditions of minority populations; the evidence for culturally adapted engagement, services and interventions; and the compilation of knowledge to strengthen the workforce serving minority communities.

The second aim, Hyde says, is to increase the number of minority behavioral health providers so those in need of professional care will have a diverse range of practitioners to choose from. And third, it aims to increase the number of researchers who focus on the behavioral health issues of minority communities and generate evidence-supported approaches to improve services to those populations.

“The MFP (Minority Fellowship Program) is a signature workforce development program that has created a significant cadre of behavioral health professionals in each of these disciplines focusing on services and research for minority communities,” Hyde says. “Graduates who have received MFP fellowships have gone on to become leading researchers, policymakers and practitioners committed to reducing the disparities and the excessive burden of mental health and substance abuse care for diverse racial and ethnic populations.”

An ‘ecosystem’ to serve diverse clients

NBCC plans to award as many as 24 doctoral fellowships per year in professional counseling, with a focus on culturally competent mental health and substance abuse counseling, Clawson says. Through the Minority Fellowship Program grant, he says, NBCC will be able to help strengthen the infrastructure that engages diverse individuals in the counseling profession and increase the number of professional counselors skilled in providing effective services to underserved populations.

“The NBCC Minority Fellowship Program will strategically promote and provide fellowships to doctoral students in the counseling profession,” Clawson says. “The fellows will obtain training in mental health and substance abuse, with specialty training in culturally competent service delivery. Fellows will provide leadership to the profession through education, research and practice benefiting vulnerable underserved consumers. The fellowship program will increase system capacity by increasing the number of culturally competent professional counselors available to underserved populations through engaging 24 doctoral fellows per year, by promoting national standards in culturally competent care and by providing online and conference-based training to practicing professional counselors. We like to project this yearly number over a decade to imagine more than 200 doctoral-level counselors and counselor educators being added to our ranks.”

NBCC is well-positioned to implement the Minority Fellowship Program, Clawson says, because it has already established the infrastructure needed to award NBCC Foundation scholarships to counseling master’s students who make commitments to serve underrepresented populations.

Individuals chosen for the Minority Fellowship Program will receive training in multicultural issues and will have access to experts in the counseling profession for consultation and development, Clawson says. Fellows will increase access to mental health and substance abuse services for ethnic minorities by taking on leadership roles in counseling practice education and research, he adds.

“NBCC will also reach out to counselor educators, counseling programs, minority organizations and consumer groups to find qualified counselors, obtain guidance and feedback to develop the program, and achieve the program objectives,” Clawson says. “The MFP will share new and innovative research and evidence-based treatments relating to ethnic minorities in an effort to improve the behavioral health delivery system. Fellows will serve as emissaries and leaders at conferences and public events where information and resources identified by the MFP can be shared. The MFP community will serve as an ecosystem where information is jointly shared and developed to facilitate better behavioral health care for ethnically diverse populations.”

Meeting a longtime need

Historically, Hyde says, the mental health and substance abuse treatment needs of racial and ethnic minority communities in the United States have been underserved, in part due to a lack of practitioners properly trained to work with these communities. “This has led to a disproportionate burden of care for these communities,” Hyde says. “In 2003, the president’s New Freedom Commission on Mental Health released its report, ‘Achieving the Promise: Transforming Mental Health Care in America.’ In its recommendations, the report highlighted the need for eliminating disparities in mental health services, including the provision of culturally competent, recovery-based care and the need to address workforce shortages. In particular, the commission noted that ‘… many providers are inadequately prepared to serve culturally diverse populations, and investigators are not trained in research on minority populations.’ In 2011, the secretary of the Department of Health and Human Services released the ‘Strategic Action Plan to Reduce Racial and Ethnic Health Disparities,’ which similarly called for an increased focus on workforce development to better serve minority communities. And in the coming months, it is anticipated that the department will propose a plan for improved language access in health care delivery. The MFP addresses each of these key national plans.”

Clawson echoes the need for the Minority Fellowship Program. “In spite of the significant role of counselors in providing care to U.S. populations, only 12 percent of national certified counselors (NCC) identify as members of an ethnic minority,” he says. “There is a significant discrepancy between minority representation in the overall U.S. population and among NCCs.” Too few minority students are being drawn to counseling, Clawson says, so he believes targeted outreach needs to occur and that fellowships and scholarships need to be offered. He is hopeful that the Minority Fellowship Program grant is a big step in the right direction.

Attracting more minority counselors to the profession is one piece of the puzzle. Another, Clawson says, is training all mental health providers, regardless of race or ethnicity, to better serve minority populations. “The surgeon general’s 2001 report on culture, race and ethnicity found that cultural misunderstandings and communication problems may prevent ethnic and racial minorities from using mental health services,” he says. “Training professional counselors to provide culturally appropriate care will decrease misunderstandings and increase demand, accelerating the need for more culturally competent providers.”

The Minority Fellowship Program implements objectives from SAMHSA’s eight strategic initiatives and the Affordable Care Act, Clawson says. “The need for more culturally competent mental health counselors is consistent with SAMHSA’s strategic initiative to address workforce shortages and provide recovery-based services,” he says. “As the Affordable Care Act expands health care insurance to ethnic minorities and lesbian/gay/bisexual/transgender/queer [clients], and as counseling services become more affordable, it becomes increasingly important that available counselors are culturally competent and trained in the best evidence-based, culturally sensitive practices. Further, addressing this need for increased numbers of culturally competent providers of mental health care directly corresponds to SAMHSA’s mission to reduce the impact of substance abuse and mental illness on communities.”

Finding the right candidates

The primary barrier to successful implementation of the program, Clawson says, is an insufficient pool of qualified doctoral candidates. “Underserved minority populations targeted for this project are underrepresented in master’s degree counseling programs and in current national counseling organizations,” he says. “This is a systems issue that the Minority Fellowship Program is designed to address.” Clawson says NBCC is planning a vigorous outreach program to ensure that all qualified candidates are aware of this fellowship opportunity.

Making sure that counselors funded through the grant go on to serve ethnically diverse populations after graduation will be a top priority, Clawson says. “The eligibility criteria will require a demonstrated history or commitment to serving the identified populations. [We] will prioritize candidates who come from underserved categories and demonstrate a desire to give back to their communities,” he says. “Moreover, the program will be designed to foster cultural competency and delivery of services to these populations. Fellows will be required to prepare a dissertation with a focus on the mental health and substance abuse needs of ethnic minorities. Internships and clinical practicum will require service to underserved populations in the public sector. The program will highlight the opportunities and benefits of providing services in the public sector and in federally recognized underserved areas, including, but not limited to, loan forgiveness programs.”

Although minority counselors will be given preference for the fellowships, individuals do not necessarily have to be minority counselors to be eligible. All individuals receiving a fellowship must be committed to serving a minority population, however.

Only six types of mental health and substance abuse organizations are eligible to receive the Minority Fellowship Program grant. When the program began four decades ago, the first set of eligible organizations included the American Nurses Association, the American Psychiatric Association, the American Psychological Association and the Council on Social Work Education. “In 2007, Congress expanded eligibility to the American Association of Marriage and Family Therapy, and in Fiscal Year 2012, to professional counselors,” Hyde says. “These organizations recruit and support doctoral-level students who are trained to teach, administer, conduct services research and provide direct mental health/substance abuse services for underserved minority populations in the public sector, consistent with congressional intent.”

For more information on the Minority Fellowship Program, visit nbcc.org or samhsa.gov. Fellowship availability is scheduled to be posted by the end of November.

NBCC would like to thank the following organizations for the support they provided as NBCC pursued the Minority Fellowship Program grant:

• Council for Accreditation of Counseling and Related Educational Programs
• American Counseling Association
• Association for Counselor Education and Supervision
• Chi Sigma Iota
• American Mental Health Counselors Association
•  National Association of Alcoholism and Drug Abuse Counselors u