How Graduate Programs Develop and Sustain Practicum Sites for Behavioral Health Trainees: A Mixed Methods Study.

Abstract

Practicum education is a foundational component of master's-level training across social work, counseling, and marriage and family therapy programs. However, expanding and sustaining practicum placements with community partners remains difficult due to rising service demands, high caseloads, and systemic workforce challenges. This explanatory sequential mixed methods study examined practicum site development and supervision supports among a cross-disciplinary sample of accredited U.S. master's-level behavioral health training programs. A cross-sectional survey collected data from 68 practicum education leaders across 31 states and Puerto Rico to describe recruitment strategies and their perceived effectiveness, material incentives, and structural barriers. Semi-structured interviews with 24 practicum education leaders contextualized the quantitative findings and explored the dynamics of academic-community partnerships. The results indicated that programs expand placement capacity primarily through informal, relational strategies, such as alumni outreach, student-initiated proposals, and extending existing partnerships, rather than formalized recruitment infrastructure. Quantitatively, 72% of participating programs reported providing no direct financial or material incentives to either host sites or site supervisors. Qualitative themes showed that placement capacity is fundamentally relational and relies heavily on uncompensated, time-intensive labor from both academic staff and community partners. The most salient barriers to expanding capacity included a lack of available agency-based supervisors, supervisor time constraints, and bureaucratic hurdles such as legal and insurance compliance. This study suggests that continued reliance on professional goodwill and uncompensated supervisory labor may be difficult to sustain, underscoring the need for greater structural investment in practicum infrastructure.