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Therapist Financial Strain and Turnover: Interactions with System-Level Implementation of Evidence-Based Practices

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Abstract

Therapist turnover is a major problem in community mental health. Financial strain, which is composed of cognitive, emotional, and behavioral responses to the experience of economic hardship, is an understudied antecedent of therapist turnover given the tumultuous financial environment in community mental health. We prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. We expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. Controlling for covariates, financial strain predicted therapist turnover (OR 1.12, p = .045), but not for therapists who participated in an EBP training initiative. Reducing financial strain and/or promoting EBP implementation may be levers to reduce turnover.

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Acknowledgements

We are especially grateful for the support that the Department of Behavioral Health and Intellectual disAbility Services has provided for this project and for the Evidence Based Practice and Innovation (EPIC) group. We would also like to thank the following experts who provided their consultation on this project: Dr. Steven Marcus and Dr. David Mandell.

Funding

Funding for this research project was supported by NIMH K23 MH099179 (Beidas). Additionally, this paper was supported by the Agency for Healthcare Research and Quality under Grant Award T32 HS000084 (Adams; PI: Kathleen Cagney, PhD). Its contents are solely the responsibility of the author(s) and do not necessarily represent the official views of the AHRQ.

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Author notes

  1. Danielle R. Adams

    Present address: School of Social Service Administration, University of Chicago, Chicago, IL, USA

  2. Laura Skriner

    Present address: Evidence-Based Practitioners of New Jersey, Summit, NJ, USA

  3. Lauren Shaffer

    Present address: University of Texas, Southwestern, TX, Dallas, USA

  4. Kathryn DeWitt

    Present address: Qualtrics, Provo, UT, USA

Authors and Affiliations

  1. Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 3rd Floor, Office 3015, Philadelphia, PA, 19104, USA

    Danielle R. Adams, Emily M. Becker-Haimes, Laura Skriner, Lauren Shaffer, Kathryn DeWitt & Rinad S. Beidas

  2. School of Social Work, Boise State University, Boise, ID, USA

    Nathaniel J. Williams

  3. Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA

    Emily M. Becker-Haimes

  4. Community Behavioral Health, Philadelphia, PA, USA

    Geoffrey Neimark & David T. Jones

  5. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Rinad S. Beidas

  6. Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA

    Rinad S. Beidas

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Correspondence to Rinad S. Beidas.

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Dr. Beidas receives royalties from Oxford University Press. All other authors have no conflicts of interest to report.

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Appendix. InCharge Financial Distress/Financial Well-Being Scale items

Appendix. InCharge Financial Distress/Financial Well-Being Scale items

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Adams, D.R., Williams, N.J., Becker-Haimes, E.M. et al. Therapist Financial Strain and Turnover: Interactions with System-Level Implementation of Evidence-Based Practices. Adm Policy Ment Health 46, 713–723 (2019). https://doi.org/10.1007/s10488-019-00949-8

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