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Brabson LA, Harris JL, Lindhiem O, Herschell AD. Workforce Turnover in Community Behavioral Health Agencies in the USA: A Systematic Review with Recommendations. Clin Child Fam Psychol Rev 2020; 23:297-315. [DOI: 10.1007/s10567-020-00313-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johnson-Kwochka A, Wu W, Luther L, Fischer MW, Salyers MP, Rollins AL. The Relationship Between Clinician Turnover and Client Outcomes in Community Behavioral Health Settings. Psychiatr Serv 2020; 71:28-34. [PMID: 31522631 DOI: 10.1176/appi.ps.201900169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE High clinician turnover in community behavioral health settings can lead to increased costs and can have a negative impact on care quality. Few studies have examined the implications of clinician turnover for client outcomes. This study investigated changes in client outcomes associated with clinician turnover. METHODS The study used prospective observational data collected as part of a larger randomized controlled trial. Clients (N=328) from two community behavioral health centers identified the clinician (N=121) whom they saw most often. Clients completed measures of depression, anxiety, mental and physical health functioning, and patient activation at baseline, 6 months, and 12 months. Clinician turnover during the 12-month study was obtained from agency records. Latent growth curve modeling was used to analyze the data. RESULTS Of the 328 clients, 24% experienced clinician turnover. For all outcomes except depression, the association with turnover was moderated by baseline status on the outcome measure. Turnover tended to be associated with clinical decline for clients who at baseline had low to moderate anxiety, high patient activation, or high physical health functioning. Surprisingly, turnover was associated with increased mental health functioning for clients who at baseline had very low mental health functioning. For physical health functioning, the association with turnover was also moderated by age. Turnover was associated with a sharper decline in functioning for older clients. CONCLUSIONS Results suggest that clinician turnover was associated most strongly with decline for higher functioning or older clients, but it was not uniformly associated with worsening clinical outcomes.
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Affiliation(s)
- Annalee Johnson-Kwochka
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Wei Wu
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Lauren Luther
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Melanie W Fischer
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Michelle P Salyers
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
| | - Angela L Rollins
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis (Johnson-Kwochka, Wu, Luther, Fischer, Salyers); ACT (Assertive Community Treatment) Center of Indiana, Indianapolis (Wu, Salyers, Rollins); Center for Health Information and Communication, Richard L. Roudebush Veterans Affairs Medical Center (Rollins); Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston (Luther)
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van de Ven K, Ritter A, Roche A. Alcohol and other drug (AOD) staffing and their workplace: examining the relationship between clinician and organisational workforce characteristics and treatment outcomes in the AOD field. DRUGS-EDUCATION PREVENTION AND POLICY 2019. [DOI: 10.1080/09687637.2019.1622649] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Katinka van de Ven
- Drug Policy Modelling Program (DPMP), Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Alison Ritter
- Drug Policy Modelling Program (DPMP), Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Ann Roche
- National Centre for Education and Training on Addiction (NCETA), Flinders University, Adelaide, Australia
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Buckheit KA, Moskal D, Spinola S, Maisto SA. Clinical Course and Relapse among Adolescents Presenting for Treatment of Substance Use Disorders: Recent Findings. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0209-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Garner BR, Gotham HJ, Tueller SJ, Ball EL, Kaiser D, Stilen P, Speck K, Vandersloot D, Rieckmann TR, Chaple M, Martin EG, Martino S. Testing the effectiveness of a motivational interviewing-based brief intervention for substance use as an adjunct to usual care in community-based AIDS service organizations: study protocol for a multisite randomized controlled trial. Addict Sci Clin Pract 2017; 12:31. [PMID: 29149914 PMCID: PMC5693500 DOI: 10.1186/s13722-017-0095-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 09/11/2017] [Indexed: 12/13/2022] Open
Abstract
Background In 2010, the first comprehensive National HIV/AIDS Strategy for the United States was released and included three goals: (1) reducing the number of people who become infected with HIV, (2) increasing access to care and improving health outcomes for people living with HIV, and (3) reducing HIV-related health disparities and health inequities. In 2013, as part of its effort to help address the National HIV/AIDS Strategy, the National Institute on Drug Abuse (NIDA) funded a type 2 effectiveness-implementation hybrid trial titled the Substance Abuse Treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS Service Organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. Methods As part of a multisite randomized controlled trial, individuals with comorbid HIV/AIDS and problematic substance use are randomized to receive either the ASOs’ usual care (control condition) or usual care plus a MIBI for substance use (experimental condition) delivered by trained ASO case-management staff. Primary outcome measures are reductions in days of primary substance use, number of substance-related problems, times engaging in risky behaviors, days of non-adherence to HIV medications, and increases in substance use treatment. As part of this paper, we describe the trial protocol in accordance with the Standard Protocol Items: Recommendations for Interventional Trials guidelines. Discussion If successfully able to implement MIBI as an effective adjunct to usual care, the current trial may have a significant impact on increasing the capacity of ASOs to address problematic substance use among individuals living with HIV/AIDS. Reducing the prevalence of problematic substance use among individuals living with HIV/AIDS within the United States may lead to significant improvements on key performance measures (i.e., the HIV Care Continuum and the 90-90-90 target). Trial registration ClinicalTrials.gov: NCT02495402 Electronic supplementary material The online version of this article (10.1186/s13722-017-0095-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bryan R Garner
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA.
| | - Heather J Gotham
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, USA
| | - Stephen J Tueller
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Elizabeth L Ball
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - David Kaiser
- RTI International, P. O. Box 12194, 3040 E. Cornwallis Rd., Research Triangle Park, NC, 27709-2194, USA
| | - Patricia Stilen
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, USA
| | - Kathryn Speck
- University of Nebraska Public Policy Center, 215 Centennial Mall South, Suite 401, Lincoln, NE, 68588, USA
| | - Denna Vandersloot
- Vandersloot Training and Consulting, 11845 NW Stone Mt. Lane, #108, Portland, OR, 97229, USA
| | - Traci R Rieckmann
- Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd. CB669, Portland, OR, 97239, USA
| | - Michael Chaple
- National Development and Research Institutes, Inc, 71 West 23rd Street, New York, NY, 10010, USA
| | - Erika G Martin
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, 1400 Washington Avenue, Milne 300E, Albany, NY, 12222, USA.,Rockefeller Institute of Government, State University of New York, 1400 Washington Avenue, Milne 300E, Albany, NY, 12222, USA
| | - Steve Martino
- Department of Psychiatry, VA Connecticut Healthcare System, Yale University, 950 Campbell Avenue (116B), West Haven, CT, 06516, USA
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Jack HE, Oller D, Kelly J, Magidson JF, Wakeman SE. Addressing substance use disorder in primary care: The role, integration, and impact of recovery coaches. Subst Abus 2017; 39:307-314. [PMID: 28991516 DOI: 10.1080/08897077.2017.1389802] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Only 10% of people with substance use disorder (SUD) receive treatment, partially due to inadequate access to specialty SUD care and limited management within primary care. "Recovery coaches" (RCs), peers sharing the lived experience of addiction and recovery, are increasingly being integrated into primary care to help reach and treat people experiencing SUD, yet little is known about how their role should be defined or about their clinical integration and impact. METHODS Semistructured interviews with RCs (n = 5) and their patients (n = 16) were used to explore patient and RC perspectives on the RC role. Maximum variation sampling was employed to select patients who displayed diversity across gender, RC, housing status, and number of contacts with an RC. Patients were sampled until no new concepts emerged from additional interviews, and a semistructured interview guide was used for data collection. To analyze interview transcripts, the constant comparative method was used to develop and assign inductively developed codes. Two coders separately coded all transcripts and reconciled code assignments. RESULTS Four core RC activities were identified: system navigation, supporting behavior change, harm reduction, and relationship building. Across these activities, benefits of the RC role emerged, including accessibility, shared experiences, motivation of behavior change, and links to social services. Challenges of the RC model were also evident: patient discomfort with asking for help, lack of clarity in RC role, and tension within the care team. CONCLUSIONS These findings shed light on RCs in primary care. Many patients and coaches perceived that RCs play a valuable role within primary care, providing both tangible system navigation and intangible, social support that promote recovery and might not otherwise be available. Enhanced communication between RCs and health center leadership in defining the RC role may help resolve ambiguity and related tensions between RCs and care team members.
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Affiliation(s)
- Helen E Jack
- a Harvard Medical School , Boston , Massachusetts , USA
| | - Devin Oller
- b Department of Medicine , Massachusetts General Hospital , Boston , Massachusetts , USA
| | - John Kelly
- c Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA
| | | | - Sarah E Wakeman
- a Harvard Medical School , Boston , Massachusetts , USA.,b Department of Medicine , Massachusetts General Hospital , Boston , Massachusetts , USA
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Sulek R, Trembath D, Paynter J, Keen D, Simpson K. Inconsistent staffing and its impact on service delivery in ASD early-intervention. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 63:18-27. [PMID: 28254668 DOI: 10.1016/j.ridd.2017.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/23/2016] [Accepted: 02/16/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Inconsistent staffing (high turnover, casual workforce) is problematic in organisations, with the potential to impact both staff and services provided. Research has primarily focused on the impacts of inconsistent staffing in child welfare and community services with little evidence surrounding their ability to impact the outcomes for children with Autism Spectrum Disorders attending early-intervention services. AIM The aim of this study was to explore staff views regarding the impact of staff turnover on the delivery of group based early intervention for children with ASD. METHODS AND PROCEDURES We conducted five focus groups involving 29 professional (e.g. teachers, behaviour therapists), para-professional (e.g. child care workers), and managerial staff to explore their views. Audio recordings were transcribed verbatim for use in thematic analysis. OUTCOMES AND RESULTS Two central themes, comprising five categories emerged to encompass participants' views. "Impacts on Staff" accounted for the challenges existing staff felt when working with new and untrained staff in the centre. Participants also expressed concerns for the "Impacts on Service Delivery" that resulted from dynamic staffing, affecting fidelity of interventions and the program itself. CONCLUSIONS AND IMPLICATIONS The findings suggest that lacking a consistent staffing structure is problematic when attempting to provide high quality early intervention services to children with ASD and suggest that future research should investigate the extent of inconsistent staffing, impacts of inconsistent staffing on providing intervention, and develop a range of tools to help measure these effects.
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Affiliation(s)
- Rhylee Sulek
- Menzies Health Institute Queensland, Griffith University, Australia.
| | - David Trembath
- Menzies Health Institute Queensland, Griffith University, Australia
| | - Jessica Paynter
- Menzies Health Institute Queensland, Griffith University, Australia
| | - Deb Keen
- Autism Centre of Excellence, School of Education and Professional Studies, Griffith University, Australia
| | - Kate Simpson
- Autism Centre of Excellence, School of Education and Professional Studies, Griffith University, Australia
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Garner BR, Hunter BD. Predictors of Staff Turnover and Turnover Intentions within Addiction Treatment Settings: Change Over Time Matters. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2014; 8:63-71. [PMID: 25336960 PMCID: PMC4196888 DOI: 10.4137/sart.s17133] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 08/01/2014] [Accepted: 08/05/2014] [Indexed: 11/07/2022]
Abstract
This study examined the extent to which changes over time in clinicians’ responses to measures of work attitude (eg, job satisfaction) and psychological climate (eg, supervisor support) could predict actual turnover and turnover intentions above and beyond absolute levels of these respective measures. Longitudinal data for this study were collected from a sample of clinicians (N = 96) being trained to implement an evidence-based treatment for adolescent substance use disorders. Supporting findings from a recent staff turnover study, we found job satisfaction change was able to predict actual turnover above and beyond average levels of job satisfaction. Representing new contributions to the staff turnover literature, we also found that change over time in several other key measures (eg, job satisfaction, role manageability, role clarity) explained a significant amount of variance in turnover intentions above and beyond the absolute level of each respective measure. A key implication of the current study is that organizations seeking to improve their ability to assess risk for staff turnover may want to consider assessing staff at multiple points in time in order to identify systematic changes in key employee attitudes like turnover intentions and job satisfaction.
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