Professional wellbeing and turnover intention among child therapists: a comparison between therapists trained and untrained in Trauma-Focused Cognitive Behavioral Therapy

Abstract

Background Poor professional wellbeing and job turnover is challenging for child mental health clinics and despite an increasing interest in implementing evidence-based practices (EBPs) in mental health services, little is known about if and how using EBPs may influence therapists’ professional wellbeing and turnover intention. To investigate this, we compare the average level of compassion satisfaction, burnout, secondary traumatic stress, and turnover intention between therapists trained in an EBP (Trauma-Focused Cognitive Behavioral Therapy – TF-CBT) and untrained therapists. We also explore the prevalence of and the associations between these personal and organizational outcomes. Method In this cross-sectional study, the data is collected from a national sample of 373 therapists 5 years after an implementation program began (i.e., in the sustainment phase). The variables were measured by the Professional Quality of Life and the Turnover Intention Scales. The Evidence-Based Practice Attitude Scale was also used to measure therapists’ attitudes toward EBPs. Results Over 70% of the respondents reported medium to high levels of burnout, secondary traumatic stress symptoms, and compassion satisfaction, whereas one-third of the respondents reported a high level of intention to leave their job in the current or near future. Higher ratings on burnout and secondary traumatic stress were significantly associated with lower compassion satisfaction and higher turnover intention. Finally, we found significantly lower degree of burnout and turnover intention along with higher compassion satisfaction among TF-CBT therapists (n = 96), compared to other therapists who were not trained in TF-CBT (n = 231). These differences could not be explained by between-group differences in age, job tenure, educational background, or therapists’ attitudes towards EBPs. However, mean differences in ratings on secondary traumatic stress symptoms were not statistically significant. Conclusion Although the prevalence findings are in general alarming, the present study provides the first empirical evidence for a potential positive effect of being trained in TF-CBT on therapists’ wellbeing and turnover intention. We discuss these findings in the light of self-efficacy theory and the job demands-resources model.

PRACTICE makes progress, a self-care course for mental health professionals in the child trauma field: A preliminary investigation.

“…These results are important because there are thousands of previously trained TF-CBT clinicians (Heck et al, 2015; Sigel et al, 2013) who might benefit from the use of the PRACTICE self-care skills taught in this course. In fact, recent research has indicated that over 70% of TF-CBT-trained clinicians surveyed reported medium to high levels of STS and burnout (Aminihajibashi et al, 2022).…”

“…The shorter duration of the standalone PMP self-care course (i.e., 2 months) examined here as compared to a learning collaborative (i.e., 9 months) as well as the less intensive PMP format (i.e., course sessions for 1 hr once per week vs. multiple training days and 16 1-hr consultation calls) may be more attractive to stressed and overwhelmed clinicians given the reduced time commitment. Although recent research indicates that being trained in TF-CBT alone may serve as a protective factor against burnout (Aminihajibashi et al, 2022), it may not offer protective benefits against STS over time given the stress of the field. The more succinct and accessible format of the six-session virtual self-care course may also lead to a greater number of clinicians being able to participate in and benefit from the course, which may help with directly addressing STS symptoms and feelings of burnout among professionals working with trauma-exposed clients.…”

“…Similarly, levels of turnover intention were assessed and found to be nonsignificant. Having been trained in TF-CBT may serve as a protective factor against turnover intention (Aminihajibashi et al, 2022), which may have made it difficult to observe significant changes with this sample of highly trained TF-CBT clinicians. In addition, it may be difficult to capture significant changes in turnover intention in such a short follow-up period given that employee turnover is a complex process that can be affected by many variables (e.g., Lee et al, 1999) and changes in turnover are typically measured in follow-up periods of one year between pre- and postassessments (Rubenstein et al, 2018).…”

“…The examination of the participants’ response to the self-care strategies introduced (i.e., PWYP) within the context of TF-CBT learning collaborative training programs, however, did not allow for the disentanglement of the effects of the TF-CBT training itself from the PWYP self-care elements in terms of the positive changes observed in participants’ coping and STS levels. In fact, research suggests that training in evidence-based practices alone may increase professionals’ feelings of well-being (e.g., Aminihajibashi et al, 2022; Craig & Sprang, 2010).…”

Exploring key job demands and resources in Norwegian child mental health services: a cross-sectional study of associations with and relationship between compassion satisfaction, burnout, secondary traumatic stress and turnover intention

“…Compared to professionals from other healthcare sectors, mental health professionals report poorer well-being ( 1 ), and high rates of both burnout ( 2 , 3 ) and secondary traumatic stress ( 4 , 5 ). At the same time, they also express a high level of compassion satisfaction [( 6 , 7 ); see section 2.2 for definition of these concepts]. Particularly working with traumatized and mentally distressed children has been reported to be emotionally more demanding than working with adults ( 8 – 10 ).…”