Growth of Paid Internships for Behavioral Health Trainees: Current Trends and Workforce Implications

Background and Purpose: Master's degree-seeking behavioral health (BH) students must complete a significant number of practicum hours as part of their training, with evidence suggesting this places financial strain on students and potentially undermines recruitment, retention, and degree completion. Although paid placements may reduce economic hardship and promote more equitable access to professional training, little is known about the prevalence, structure, and funding of paid practicum opportunities across social work (MSW), counseling, and marriage and family therapy (MFT) programs. This study assessed the availability of paid practicum placements across these three BH disciplines, examined the structure of financial support, identified funding sources, and explored barriers to paid practicum.

Methods: This study used a sequential mixed-methods design. A cross-sectional survey was developed and disseminated to practicum education leaders from MSW, counseling, and MFT programs. Institutions were randomly selected using publicly available data on U.S.-based accredited programs (N=68: MSW n=29, counseling n=23, MFT n=15). Descriptive statistics summarized prevalence, financial structure, funding sources, and barriers to paid practicum placements. Survey participants were invited to participate in follow-up interviews conducted in October 2025 through February 2026 (N=24). Interviews were audio-recorded, and transcripts were audited for accuracy. Two researchers independently conducted thematic analysis, and discrepancies in emergent themes and sub-codes were reconciled through team consensus.

Results: Most programs (84%) reported at least one paid practicum opportunity for students, with 97% of MSW programs offering paid placements, compared with 80% of MFT and 78% of counseling programs. The most common payment mechanisms supporting students’ practicum experiences were hourly wages (65%), fixed stipends (56%), tuition remission or practicum-linked scholarships (37%), and travel funds (30%). However, amounts varied substantially, with stipends ranging from $500 to $10,000 and hourly wages from $15 to $25. The most frequently cited funding sources were employer-based (51%), federal grants (46%), and health system- or agency-provided stipends (35%). Common barriers to paid placements included insufficient funding (73%), restrictions on student employment (27%), financial aid constraints (26%), and grant continuity (24%). Interviewees corroborated the quantitative results, underscoring the pervasiveness and increasing magnitude of students’ financial precarity. They also cited the impact of recent federal funding cuts, the loss of agency funding that eliminated programming and services, and the administrative complexity of paying students. Interviewees described how some placements, particularly private practices, profited from students by “pull[ing] in really very low or no-cost labor and still get[ting] production out of it.” Innovative efforts to strengthen financial support for practicum students included state legislation to fund internships, state loan-repayment programs, service contracts requiring employment after graduation, and transportation stipends typically funded through philanthropy.

Conclusions and Implications: Paid practicum opportunities exist but are unevenly distributed, with most master’s-level BH students excluded from this type of financial support. Programs relied on a fragmented mix of employer, agency, and grant-based funding rather than stable funding sources. Increased efforts to expand state and federal policies are needed to operationalize equitable paid placement opportunities as an increasingly important way to reduce financial barriers to behavioral health degree completion.