A Prospective Examination of Clinician and Supervisor Turnover Within the Context of Implementation of Evidence-Based Practices in a Publicly-Funded Mental Health System

Abstract

Staff turnover rates in publicly-funded mental health settings are high. We investigated staff and organizational predictors of turnover in a sample of individuals working in an urban public mental health system that has engaged in a system-level effort to implement evidence-based practices. Additionally, we interviewed staff to understand reasons for turnover. Greater staff burnout predicted increased turnover, more openness toward new practices predicted retention, and more professional recognition predicted increased turnover. Staff reported leaving their organizations because of personal, organizational, and financial reasons; just over half of staff that left their organization stayed in the public mental health sector. Implications include an imperative to focus on turnover, with a particular emphasis on ameliorating staff burnout.

Independent Contractors in Public Mental Health Clinics: Implications for Use of Evidence-Based Practices

“…Furthermore, independent contractors demonstrated poorer knowledge of and attitudes towards EBPs, suggesting potentially less access to professional development opportunities. Administrators shared that their organizations would be less likely to include independent contractors in EBP initiatives because independent contractors were more likely to turnover (26) and less able to participate in initiative requirements (10, 27), suggesting that the increase in the number of organizations using independent contractors may pose a threat to implementation of EBPs. Although preliminary, these findings have important implications for the calls to action to better train the behavioral health workforce (1–3, 5, 28, 29).…”

“…Participants discussed the rationale for using independent contractors and their perceptions of the impact of such a model on their organization and staff. Overwhelmingly, participants discussed the dire financial environment in community mental health (26, 35, 36), and the reality that they could not provide salary and benefits to their therapists. There may be alternatives to improve organizational fiscal health such as teaching organizations better business practices (37) or changing federal and state policies to support these organizations.…”

Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

“…There are a number of barriers to implementing EBPs at the organizational-level, including (but certainly not limited to) variable organizational cultures and climates (Beidas et al, 2014; Glisson et al, 2008), implementation climates (Weiner, Belden, Bergmire, & Johnston, 2011), and leadership (Aarons, Ehrhart, & Farahnak, 2014a); lack of access to ongoing training, supervision, and consultation (Ganju, 2003; Manuel, Mullen, Fang, Bellamy, & Bledsoe, 2009; Powell, Hausmann-Stabile, & McMillen, 2013; Shapiro, Prinz, & Sanders, 2012); turnover of staff and leadership (Beidas, Marcus, Benjamin Wolk, et al, 2015), and inadequate financial supports (Hoagwood, 2003; Isett et al, 2007; Stewart et al, 2016). DBHIDS has used a number of strategies to support provider organizations and assist in covering the marginal costs of implementation (Raghavan, 2012; Raghavan et al, 2008), allowing organizations to invest more fully in the adoption, implementation, and sustainment of EBPs.…”

“…First, DBHIDS has attempted to shift from focusing on therapists to organizations. This stems from recognition that therapists need support from all levels of their organization in order to deliver EBPs well, that turnover presents a major threat to EBP adoption and sustainment (Beidas, Marcus, Benjamin Wolk, et al, 2015), and that the system in Philadelphia is organized around provider organizations rather than individual clinicians. In addition to selecting provider organizations carefully using the aforementioned RFP process, DBHIDS has worked hard to engage supervisors, administrators, and executive directors in the implementation process through regular meetings and training opportunities.…”

“…The aforementioned approaches to planning and capturing the complexity of multi-level implementation strategies is one way of addressing this problem. The use of qualitative and mixed methods designs is another, and DBHIDS’ academic partners have taken advantage of the explanatory power of these designs (Beidas et al, 2014; Beidas, Marcus, Benjamin Wolk, et al, 2015; Tebes et al, 2015; Wiltsey Stirman et al, 2015). Further work to specify and measure implementation contexts, processes, and outcomes in large public behavioral health systems is warranted (Lewis, Weiner, Stanick, & Fischer, 2015; Proctor, Powell, & Feely, 2014).…”