Top

Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-09-2016 | Original Article

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

Authors: Rinad S. Beidas, Steven Marcus, Courtney Benjamin Wolk, Byron Powell, Gregory A. Aarons, Arthur C. Evans, Matthew O. Hurford, Trevor Hadley, Danielle R. Adams, Lucia M. Walsh, Shaili Babbar, Frances Barg, David S. Mandell

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 5/2016

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.

Available only for authorised users

Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research, 6(2), 61–74.CrossRefPubMedPubMedCentral

Aarons, G. A., Hoagwood, K., Landsverk, J., Glisson, C., Kelleher, K., & Cafri, G. (2010). Psychometric properties and US National norms of the Evidence-Based Practice Attitude Scale (EBPAS). Psychological Assessment, 22(2), 356–365. doi:10.1037/A0019188.CrossRefPubMed

Aarons, G. A., & Sawitzky, A. C. (2006). Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 33(3), 289–301. doi:10.1007/s10488-006-0039-1.CrossRefPubMedPubMedCentral

Aarons, G. A., Sommerfeld, D. H., Hecht, D. B., Silovsky, J. F., & Chaffin, M. J. (2009). The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect. Journal of Consulting and Clinical Psychology, 77(2), 270–280.CrossRefPubMedPubMedCentral

Alexander, J. A., Lichtenstein, R., Joo Oh, H., & Ullman, E. (1998). A causal model of voluntary turnover among nursing personnel in long-term psychiatric settings. Research in Nursing & Health, 21, 415–427.CrossRef

Beidas, R. S., Aarons, G., Frances, B., Evans, A., Hadley, T., Hoagwood, K., & Mandell, D. (2013). Policy to implementation: Evidence-based practice in community mental health-Study protocol. Implementation Science, 8(38), 1–9.

Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology, 17(1), 1–30. doi:10.1111/j.1468-2850.2009.01187.x.PubMedPubMedCentral

Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K., Schoenwald, S., Evans, A., & Mandell, D. S. (2015). Individual and organizational factors related to community clinicians’ use of therapy techniques in a large public mental health system. JAMA Pediatrics, 169(4), 374–382. doi:10.1001/jamapediatrics.2014.3736.CrossRefPubMedPubMedCentral

Ben-Dror, R. (1994). Employee turnover in community mental health organization: A developmental stages study. Community Mental Health Journal, 30(3), 243–257.CrossRefPubMed

Bliese, P. D. (2000). Within-group agreement, non-independence, and reliability: Implications for data aggregation and analysis. In K. Klein & S. Kozlowski (Eds.), Multilevel theory, research, and methods in organizations (pp. 349–380). San Francisco, CA: Joseey-Bass.

Brown, R. D., & Hauenstein, N. M. A. (2005). Interrater agreement reconsidered: An alternative to the r(wg) indices. Organizational Research Methods, 8(2), 165–184. doi:10.1177/1094428105275376.CrossRef

Campbell, N. S., Perry, S. J., Maertz, C. P., Allen, D. G., & Griffeth, R. W. (2013). All you need is… resources: The effects of justice and support on burnout and turnover. Human Relations, 66(6), 759–782. doi:10.1177/0018726712462614.CrossRef

Choi, S., Cheong, K., & Feinberg, R. A. (2012). Moderating effects of supervisor support, monetary rewards, and career paths on the relationship between job burnout and turnover intentions in the context of call centers. Managing Service Quality, 22(5), 492–516. doi:10.1108/09604521211281396.CrossRef

Costa, P. T., & Mccrae, R. R. (1992). The 5-factor model of personality and its relevance to personality-disorders. Journal of Personality Disorders, 6(4), 343–359.CrossRef

Creed, T. A., Stirman, S. W., Evans, A. C., & Beck, A. T. (2014). A model for implementation of cognitive therapy in community mental health: The beck initiative. The Behavior Therapist, 37(3), 56–65.

DePanfilis, D., & Zlotnik, J. L. (2008). Retention of front-line staff in child welfare: A systematic review of research. Children and Youth Services Review, 30(9), 995–1008.CrossRef

Droege, S. B., & Hoobler, J. M. (2003). Employee turnover and tacit knowledge diffusion: A network perspective. Journal of Managerial Issues, 15(1), 50–64.

Ehrhart, M. G., Aarons, G. A., & Farahnak, L. R. (2014). Assessing the organizational context for EBP implementation: The development and validity testing of the Implementation Climate Scale (ICS). Implementation Science, 9(1), 157. doi:10.1186/s13012-014-0157-1.CrossRefPubMedPubMedCentral

Evans, S., Huxley, P., Gately, C., Webber, M., Mears, A., Pajak, S., & Katona, C. (2006). Mental health, burnout and job satisfaction among mental health social workers in England and Wales. The British Journal of Psychiatry, 188, 75–80.CrossRefPubMed

Firth, H., & Britton, P. (1989). Burnout, absence and turnover amongst British nursing staff. Journal of Occupational Psychology, 62(1), 55–59.CrossRef

Ganju, V. (2003). Implementation of evidence-based practices in state mental health systems: Implications for research and effectiveness studies. Schizophrenia Bulletin, 29(1), 125–131.CrossRefPubMed

Glisson, C., & Green, P. (2011). Organizational climate, services, and outcomes in child welfare systems. Child Abuse and Neglect, 35(8), 582–591.CrossRefPubMed

Glisson, C., Green, P., & Williams, N. J. (2012). Assessing the organizational social context (OSC) of child welfare systems: Implications for research and practice. Child Abuse and Neglect, 36(9), 621–632. doi:10.1016/j.chiabu.2012.06.002.CrossRefPubMed

Glisson, C., & James, L. R. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23(6), 767–794.CrossRef

Glisson, C., Schoenwald, S. K., Kelleher, K., Landsverk, J., Hoagwood, K. E., & ResearchNetwork on Youth Mental Health. (2008). Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 124–133.CrossRefPubMed

Heavey, A. L., Holwerda, J. A., & Hausknecht, J. P. (2013). Causes and consequences of collective turnover: A meta-analytic review. Journal of Applied Psychology, 98(3), 412–453. doi:10.1037/a0032380.CrossRefPubMed

Isett, K. R., Burnam, M. A., Coleman-Beattie, B., Hyde, P. S., Morrissey, J. P., Magnabosco, J., & Goldman, H. (2007). The state policy context of implementation issues for evidence-based practices in mental health. Psychiatric Services, 58(7), 914–921.CrossRefPubMed

James, L. R., Demaree, R. G., & Wolf, G. (1984). Estimating within-group interrater reliability with and without response bias. Journal of Applied Psychology, 69(1), 85–98. doi:10.1037//0021-9010.69.1.85.CrossRef

Jayaratne, S., & Chess, W. A. (1984). Job-satisfaction, burnout, and turnover—A national study. Social Work, 29(5), 448–453.PubMed

Jenkins, R., & Elliott, P. (2004). Stressors, burnout and social support: nurses in acute mental health settings. Journal of Advanced Nursing, 48(6), 622–631.CrossRefPubMed

Knudsen, H. K., Johnson, J. A., & Roman, P. M. (2003). Retaining counseling staff at substance abuse treatment centers: Effects of management practices. Journal of Substance Abuse Treatment, 24(2), 129–135.CrossRefPubMed

Leiter, M. P., & Maslach, C. (2009). Nurse turnover: The mediating role of burnout. Journal of Nursing Management, 17(3), 331–339. doi:10.1111/j.1365-2834.2009.01004.x.CrossRefPubMed

Maslach, C., Jackson, S. E., & Leiter, M. P. (1996). The Maslach Burnout inventory manual (3rd ed.). Palo Alto: Consulting Psychologists Press.

Mor Barak, M. E., Nissly, J. A., & Levin, A. (2001). Antecedents to retention and turnover among child welfare, social work, and other human service employees: What can we learn from past research? A review and metanalysis. Social Service Review, 75, 625–661.CrossRef

Morse, G., Salyers, M. P., Rollins, A. L., Monroe-DeVita, M., & Pfahler, C. (2012). Burnout in mental health services: A review of the problem and its remediation. Administration and Policy in Mental Health and Mental Health Services Research, 39(5), 341–352. doi:10.1007/s10488-011-0352-1.CrossRefPubMedPubMedCentral

Paris, M., & Hoge, M. A. (2010). Burnout in the mental health workforce: A review. Journal of Behavioral Health Services & Research, 37(4), 519–528. doi:10.1007/s11414-009-9202-2.CrossRef

Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science, 8, 139. doi:10.1186/1748-5908-8-139.CrossRefPubMedPubMedCentral

Rollins, A. L., Salyers, M. P., Tsai, J., & Lydick, J. M. (2010). Staff turnover in statewide implementation of ACT: Relationship with ACT fidelity and other team characteristics. Administration and Policy in Mental Health and Mental Health Services Research, 37(5), 417–426. doi:10.1007/s10488-009-0257-4.CrossRefPubMedPubMedCentral

Salgado, J. (2002). The big five personality dimensions and counterproductive behaviors. International Journal of Selection and Assessment, 10, 117–125.CrossRef

Salyers, M. P., Hood, B. J., Schwartz, K., Alexander, A. O., & Aalsma, M. C. (2015). The experience, impact, and management of professional burnout among probation officers in juvenile justice settings. Journal of Offender Rehabilitation, 54(3), 175–193. doi:10.1080/10509674.2015.1009967.CrossRef

Stirman, S. W., Spokas, M., Creed, T. A., Farabaugh, D. T., Bhar, S. S., Brown, G. K., & Beck, A. T. (2010). Training and consultation in evidence-based psychosocial treatments in public mental health settings: The ACCESS model. Professional Psychology, Research and Practice, 41(1), 48–56. doi:10.1037/a0018099.CrossRefPubMedPubMedCentral

US General Accounting Office. (2003). Child welfare: HHS could play a greater role in helping child welfare agencies recruit and retain staff. Washington, DC: U.S. General Accounting Office.

Weisz, J. R. (1997). Therapist background questionnaire. Los Angeles, CA: University of California.

Wieder, B. L., & Kruszynski, R. (2007). The salience of staffing in IDDT implementation: One agency’s experience. American Journal of Psychiatric Rehabilitation, 10, 103–112.CrossRef

Williams, N. J., & Glisson, C. (2014). The role of organizational culture and climate in the dissemination and implementation of empirically supported treatments for youth. In R. S. Beidas & P. C. Kendall (Eds.), Dissemination and implementation of evidence-based practices in child and adolescent mental health (1st ed., pp. 61–81). New York: Oxford University Press.

Woltmann, E. M., & Whitley, R. (2007). The role of staffing stability in the implementation of integrated dual disorders treatment: An exploratory study. Journal of Mental Health Administration, 16, 757–769.CrossRef

Woltmann, E. M., Whitley, R., McHugo, G. J., Brunette, M., Torrey, W. C., Coots, L., & Drake, R. E. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59(7), 732–737. doi:10.1176/appi.ps.59.7.732.CrossRefPubMed

Title: A Prospective Examination of Clinician and Supervisor Turnover Within the Context of Implementation of Evidence-Based Practices in a Publicly-Funded Mental Health System
Authors: Rinad S. Beidas
Steven Marcus
Courtney Benjamin Wolk
Byron Powell
Gregory A. Aarons
Arthur C. Evans
Matthew O. Hurford
Trevor Hadley
Danielle R. Adams
Lucia M. Walsh
Shaili Babbar
Frances Barg
David S. Mandell
Publication date: 01-09-2016
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 5/2016
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-015-0673-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2016

The Parent Participation Engagement Measure (PPEM): Reliability and Validity in Child and Adolescent Community Mental Health Services

Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice

Leadership, Organizational Climate, and Perceived Burden of Evidence-Based Practice in Mental Health Services

Constraints and Benefits of Child Welfare Contracts with Behavioral Health Providers: Conditions that Shape Service Access

The Health Service Use of Frequent Users of Telephone Helplines in a Cohort of General Practice Attendees with Depressive Symptoms

Well-Being and Safety Among Inpatient Psychiatric Staff: The Impact of Conflict, Assault, and Stress Reactivity