Counselor emotional exhaustion and turnover intention in therapeutic communities

Emotional Exhaustion and Emotional Contagion: Navigating Turnover Intention of Healthcare Personnel

Purpose

This study aimed to examine the role of personal emotions and emotional contagion within organizations on the behavior and attitudes of healthcare personnel. This study is expected to provide a theoretical foundation for reducing resignation behaviors and improving healthcare quality.

Materials and Methods

This study adopted a quantitative research method with a cross-sectional survey through an online questionnaire. The bootstrap method with 5000 iterations was used to validate the role of variables within a 95% confidence interval. SPSS 26.0 and Model 5 in Process 3.4 for SPSS were used for the data analysis.

Results

This research involved 459 healthcare personnel, whose levels of role overload (3.821±0.925), emotional exhaustion (3.436±1.189), and turnover emotional contagion (3.110±1.099) were notably high. Role overload was positively related to turnover intention, with emotional exhaustion as a mediator. Notably, turnover emotional contagion exerted a positive moderating effect.

Conclusion

This study emphasizes the adverse effects of emotional exhaustion and turnover emotional contagion in the Chinese context, offering practical recommendations for medical organizational managers to navigate turnover intention among healthcare personnel. This study suggests paying attention to the emotional state of healthcare personnel and providing adequate support resources. Managers should routinely assess and track turnover emotional contagion within the organization, fostering a positive emotional atmosphere.

Behavioral health care provider's beliefs, confidence, and knowledge in treating cigarette smoking in relation to their use of the 5A's intervention

Introduction

Evidence-based smoking cessation interventions are underused settings where behavioral health treatment is provided, contributing to smoking-related health disparities in this patient group. This study assessed the relationship of provider's beliefs about patients' smoking, perceptions of treatment capability, and knowledge of referral options and their use of the 5A's (Ask, Advise, Assess, Assist, and Arrange) intervention for smoking cessation.

Methods

Surveys were collected from providers in healthcare settings in Texas where patients receive behavioral health care (N = 86; 9 federally qualified health centers, 16 Local Mental Health Authorities (LMHAs), 6 substance use treatment programs in LMHAs, and 55 stand-alone substance use treatment centers). Logistic regression analyses were used to assess the association between provider's beliefs about patients' concern and desire to quit smoking; perceptions of their confidence, skills, and effectiveness in treating smoking; their knowledge of referral options; and their use of the 5A's with patients who smoked.

Results

Providers who believed that patients were concerned about smoking and wanted to quit; who perceived themselves as confident in providing cessation care, having the required skills, and being effective in providing advice; and/or who had greater referral knowledge were more likely to use the 5A's with patients who smoked than their (respective) provider counterparts (ps < 0.05).

Conclusion

Provider-level constructs affect their 5A's provision for patients with behavioral health needs. Future work should train providers to correct misconceptions about patients' interest in quitting, bolster their confidence, and provide referral options to support tobacco provision efforts.

Mothering from the Inside Out: Results of a community-based randomized efficacy trial testing a mentalization-based parenting intervention for mothers with addictions

Mothering from the Inside Out (MIO) is a mentalization-based parenting intervention developed to address challenges common among mothers experiencing substance use disorders (SUDs) and previously deemed effective when delivered by research clinicians. This randomized clinical trial was designed to test the efficacy of MIO when delivered by community-based addiction counselors in Connecticut, USA. Ninety-four mothers [M(SD)age = 31.01(4.01) years; 75.53% White] caring for a child 11-60 months of age were randomly assigned to participate in 12 sessions of either MIO or psychoeducation. Caregiving, psychiatric, and substance use outcomes were assessed repeatedly from baseline through 12-week follow-up. Mothers who participated in MIO showed decreased certainty about their child's mental states, and decreased depression; their children demonstrated increased clarity of cues. Participation in MIO was not associated with the same degree of improvement that was observed in prior trials where MIO was delivered by research clinicians. However, when delivered by community-based clinicians, MIO may be protective against a deterioration in caregiving over time often seen in mothers with addictions. The drop in efficacy of MIO in this trial raises questions about intervention-intervenor fit. Research should examine factors influencing MIO effectiveness to close the science-to-service gap common in the dissemination of empirically validated interventions.

Emotional Exhaustion and Turnover Intentions among Counselors in Rural Substance Use Disorder Treatment Programs

Counselor turnover is a serious problem for substance use disorder (SUD) treatment programs, especially in rural areas. This study examined the relationship between workload, workplace environment, and emotional exhaustion on turnover intentions among SUD treatment counselors in rural Pennsylvania. An online, anonymous survey was administered to rural SUD treatment counselors in Pennsylvania between October and December 2020. Completed surveys from 206 counselors were used for analysis. Variables included multi-dimensional measures of emotional exhaustion, intention to quit, workload, and workplace environment. Results showed age, perceptions of distributive justice, and management communication to be inversely related to emotional exhaustion and intention to quit. A subsequent analysis showed that the direct effects of these variables on intention to quit were reduced with the inclusion of emotional exhaustion in modeling, suggesting a potential mediation effect. Findings indicated that higher levels of emotional exhaustion were directly related to a greater intention to quit. A statistically significant indirect relationship was also found for distributive justice on intention to quit through emotional exhaustion, indicating a significant mediating effect. While counseling is a stressful occupation with high potential for burnout, these results show that organizations can adopt practices that help lower emotional exhaustion and turnover intentions for their counselors which could improve retention in the SUD treatment field. This is especially important for rural areas, where there is a high demand for SUD services and not enough treatment workers to meet that demand.

Ethical Dilemmas Facing Substance Use Counselors During the COVID-19 Pandemic

Introduction

During the COVID-19 pandemic, substance use disorder (SUD) treatment settings experienced several abrupt changes, including decreased admissions, reduction in services, and modified requirements for medication for substance use disorder. While these changes were implemented to facilitate the maintenance of important treatment options, the ethical consequences of such changes remained unknown. The current study aimed to explore ethical issues related to COVID-19-related changes reported by counselors in SUD treatment facilities.

Method

From May to August 2020, we conducted 60 to 90 minutes in-depth interviews with 18 front-line staff in 1 residential and 1 outpatient treatment program, exploring issues drawn from the ethical principles of the national organization representing SUD counselors. Counselors volunteered to participate via phone or email, and participation was confidential. Interviews were conducted via videoconferencing. Topics included day-to-day experiences of ethical dilemmas in the workplace, particularly during the COVID-19 era. Interviews were recorded, transcribed, and checked for accuracy and a trained team of analysts then coded transcripts using thematic analysis.

Results

As a result of the COVID-19 pandemic, SUD treatment programs quickly modified procedures to adhere to public health mandates while also continuing to offer care to clients. SUD counselors reported several ways their programs adapted new and creative procedures to reduce the risk of COVID-19 transmission. SUD counselors also identified several novel ethical dilemmas that occurred during the COVID-19 pandemic, often resulting from the counselor balancing the needs for responding to public health mandates with providing services to clients. There were several ways that COVID-19 related changes resulted in therapeutic challenges for some clients, and the SUD counselors highlighted ways that changes resulted in more flexible services for other clients.

Conclusions

This study highlights the quick response to COVID-19 that occurred within SUD treatment. While these changes resulted in novel ethical dilemmas, they also offered more flexible and client-centered approaches to treatment.

Organizational Justice and Health: Reviewing Two Decades of Studies

Organizational justice refers to employees’ perceptions of the fairness of decision-making rules and policies in the workplace. Lack of justice is suggested to be a significant psychosocial risk factor that affects employees’ attitudes and health. The aim of this narrative review was to compile the evidence available about the effects of organizational justice on health. To this end, a literature search was carried out using the Web of Science, PubMed, and PsycINFO databases. The final sample consisted of 103 articles that studied the effects of justice on mental health (40 results), job stress (26), sickness absence (15), physical health (14), absenteeism/presenteeism (3), safety at work (3), and health of third parties (2). The results show that perceptions of workplace justice predict employees’ mental health, stress-related health problems, and lower levels of sickness absence were relatively compelling. Future studies should focus on less-researched outcomes and on how these associations are modified by other variables for a better understanding of how justice affects health, with a view to being able to carry out preventive measures more efficiently.

Improving the Recruitment and Retention of Counselors in Rural Substance Use Disorder Treatment Programs

While access to drug treatment has increased in recent years, there is still a shortage of substance use disorder (SUD) treatment counselors in the United States, especially in rural areas. This study examined recruitment and retention issues for counselors in rural substance use disorder treatment programs. Qualitative interviews were conducted with 26 program, clinical, and/or human resource directors of SUD treatment programs. Almost all interviewees had problems recruiting high-quality counselors although only a small number saw retention as a significant issue. Improving educational opportunities and training related to addictions counseling could result in more people entering the SUD treatment field. Strategies for improving retention of counselors include more supportive and inclusive management practices. The stigma of SUD also contributed to recruitment and retention problems.

"It's more than Just a Job to Them": A Qualitative Examination of Patient and Provider Perspectives on Medication-Assisted Treatment for Opioid Use Disorder

The expansion of access to medication-assisted treatment by states and the federal government serves as one important tool for tackling the opioid crisis. Achieving this goal requires increasing the number of medical professionals who hold DATA Waiver 2000 waived status, which allows providers to prescribe the medication utilized by treatment programs. Waived providers are scarce throughout rural America, placing a potentially large burden on those who do hold a waiver. This paper uses data gathered through qualitative interviews with healthcare workers and patients at MAT clinics in Montana to understand how the relationship between rural healthcare workers and MAT patients contributes to burnout and potential staff turnover in a rural setting. Patients defined quality care via the patient-staff relationship, including expectations of personal support and viewing staff availability as a requirement for their recovery. Healthcare workers, in contrast, refer to their availability to patients as overwhelming and necessary both during and after business hours. These findings illuminate the need to continue expanding MAT access in rural communities, especially in non-specialty care settings including primary care offices and Federally Qualified Health Centers.

Revisiting the relationship between contact and physician attitudes toward patients with opioid use disorder

INTRODUCTION

Prior research suggests that some physicians hold negative attitudes toward patients who misuse opioids and that this serves as a barrier which limits the availability and effectiveness of health care services. Interventions which improve physicians' attitudes have thus garnered attention, many of which have focused on increasing contact between physicians and patients who misuse opioids. However, drawing on recent literature on intergroup contact, the current paper argues that contact may not have uniformly positive effects on prejudice.

METHODS

We surveyed 408 board-certified physicians in the state of Ohio where many opioid overdose deaths have been concentrated. We used regression to test for interactions between contact and three focal variables, bias, burnout, and stress, on physician willingness to work with patients who misuse opioids.

RESULTS

The negative relationships between bias, physician burnout, and stress induced by working with patients who misuse opioids and physicians' willingness to work with this patient population are each exacerbated when contact with patients who misuse opioids is high.

CONCLUSIONS

Although intervention studies have shown promise for the role that increased contact may have in reducing stigma toward patients who misuse opioids, these interventions may not be appropriate for physicians who are experiencing strain or who hold preexisting negative attitudes toward this patient population. Future interventions may need to target bias, burnout, and stress, in addition to facilitating contact, to increase physician willingness to work with these patients.

Is public healthcare healthy? The role of emotional exhaustion

Purpose

This study analyzes the mediating effect of emotional exhaustion between certain job demands (workload, role conflict, and influence at work) and employees' work attitudes (affective commitment and turnover intention) in public healthcare. Furthermore, it analyzes the moderating effect of possibilities for development and the degree of freedom at work between the above-mentioned job demands and emotional exhaustion.

Design/methodology/approach

A total of 512 healthcare professionals participated in the study. The data were analyzed using structural equation modeling and a hierarchical multiple regression analysis.

Findings

The results show that emotional exhaustion fully mediates the relationship between job demands (workload and role conflict) and work attitudes (affective commitment and turnover intention). Moreover, the possibilities for development and degree of freedom at work moderate the relationship between role conflict and emotional exhaustion.

Practical implications

Strategies should be designed to prevent employees from becoming emotionally exhausted and lead them to feel more motivated, which results in a more effective public healthcare service.

Originality/value

This study stresses the importance of analyzing the role of emotional exhaustion in the public healthcare context. It demonstrates the mediating role of this variable between several antecedents and consequences, and it analyzes whether other relevant variables can moderate the negative effects of emotional exhaustion.

The Influence of Mistreatment by Patients on Job Satisfaction and Turnover Intention among Chinese Nurses: A Three-Wave Survey

The affective event of mistreatment in the workplace has been recognized as an important factor influencing employee affect and behavior. However, few studies have logically explained and empirically clarified the link between mistreatment by patients and nurses' job satisfaction and turnover intention. The current study aimed to explore the effects of mistreatment by patients on nurses' job satisfaction and turnover intention through work meaningfulness and emotional dissonance, as well as the moderating role of hostile attribution bias. Using three-wave survey data collect from 657 nurses who worked in three hospitals in China, we found that mistreatment by patients had a negative effect on nurses' job satisfaction through work meaningfulness, mistreatment by patients had a positive effect on nurses' turnover intention through emotional dissonance. Furthermore, nurses' hostile attribution bias acted as an effective moderator on the relationship. These findings help uncover the mechanisms and conditions in which mistreatment by patients influences nurses' job satisfaction and turnover intention.

Experiences of burnout among drug counselors in a large opioid treatment program: A qualitative investigation

BACKGROUND

Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap.

METHODS

Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory.

RESULTS

Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision).

CONCLUSIONS

Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.

Effectiveness of Peer-Delivered Trauma Treatment in a Rural Community: A Randomized Non-inferiority Trial

This randomized controlled non-inferiority trial explored the effectiveness of Seeking Safety (SS) delivered by peer providers compared to its delivery by licensed behavioral health clinicians. The study enrolled 291 adults with PTSD and/or substance use disorders. Data were collected at 3 and 6-months post start of treatment. With respect to long-term outcomes, at 6 months PTSD symptoms decreased by 5.1 points [95% CI (- 9.0, - 1.1)] and by 4.9 points [95% CI (- 8.6, - 1.1)] and coping skills increased by 5.5 points [95% CI (0.4, 10.6)] and by 5.6 points [95% CI (0.8, 10.4)], in the peer- and clinician-led groups, respectively. This study demonstrated non-inferiority of peer-delivered SS compared to clinician-delivered SS for reducing PTSD symptoms and similar outcomes for both groups with respect to coping skills. A confirmatory study on the effectiveness of peer-delivered trauma-specific services is warranted, especially given the potential for increasing access to such treatment in underserved rural communities.

Agreement and Discrepancy Between Supervisor and Clinician Alliance: Associations with Clinicians' Perceptions of Psychological Climate and Emotional Exhaustion

Despite increasing interest in supervision as a leverage point for bolstering public mental health services, the potential influence of supervisory alliance on organizations and direct service providers remains understudied, particularly in the context of supporting evidence-based treatment (EBT) use. This study examined agreement and discrepancy between supervisor and clinician ratings of alliance associated with clinicians' perceptions of psychological climate and emotional exhaustion. Results indicated that discrepancies in alliance ratings were common and associated with clinicians' perceptions of psychological climate. These findings have important implications for collaboration among supervisors and clinicians within a community mental health organizational context and the provision of EBTs.

Counselor turnover in substance use disorder treatment research: Observations from one multisite trial

Background: Counselor workforce turnover is a critical area of concern for substance use disorder (SUD) treatment providers and researchers. To facilitate the adoption and implementation of innovative treatments, attention must be paid to how SUD treatment workforce issues affect the implementation of clinical effectiveness research. Multiple variables have been shown to relate to turnover, yet reasons that are specific to conducting research have not been systematically assessed. Methods: In a randomized clinical trial testing a sexual risk reduction counselor training intervention, 69 counselors at 4 outpatient SUD treatment sites (2 opioid treatment programs [OTPs], 2 psychosocial) were enrolled and randomized to 1 of 2 training conditions (Standard vs. Enhanced). Study counselor and agency turnover rates were calculated. Agency context and policies that impacted research participation were examined. Results: Study turnover rates for enrolled counselors were substantial, ranging from 33% to 74% over approximately a 2-year active study period. Study counselor turnover was significantly greater at outpatient psychosocial programs versus OTPs. Counselor turnover did not differ due to demographic or training condition assignment. Leaving agency employment was the most typical reason for study counselor turnover. Conclusions: This secondary analysis used data from a multisite study with frontline counselors to provide a qualitative description of challenges faced when conducting effectiveness research in SUD treatment settings. That counselors may be both subjects and deliverers of the interventions studied in clinical trials, with implications for differential impact on study implementation, is highlighted. We offer suggestions for researchers seeking to implement effectiveness research in SUD clinical service settings.

Boon or Burden: The Effect of Implementing Evidence-Based Practices on Teachers' Emotional Exhaustion

This study examined the association between (1) beginning-of-the-year emotional exhaustion and use of three evidence-based practices (EBP) for children with autism spectrum disorder; and (2) use of these EBP and end-of-year emotional exhaustion among 46 kindergarden to 2nd grade autism support teachers participating in a randomized trial. Emotional exhaustion was measured at the end and beginning of the school year using a subscale of the Maslach Burnout Inventory. Fidelity was measured using monthly observations, coded by research assistants trained to reliability. Correlations were used to examine unadjusted associations and ordinary least squares regression was used to examine associations adjusted for beginning-of-year burnout, years teaching, and average change in student cognitive functioning. Emotional exhaustion at the beginning of the year was not associated with EBP use. Greater fidelity to each EBP was associated with lower end-of-year emotional exhaustion (coefficients ranging from - .34 to - 1.13, all p's < .05). Results indicate that helping teachers implement EBP with greater fidelity may help reduce burnout, a substantial challenge in the field.

Terrorism vulnerability: organizations' ambiguous expectations and employees' conflicting priorities

This study demonstrates how field employees' perceived threat of terrorism (PTT) is magnified by the incompatibility between role demand (travel and work outdoors) and resources (terrorism-endangered environment). With a foundation in the conservation of resources perspective and transactional theory of stress, a theoretical framework was proposed to test the mediating effect of role ambiguity (RA) and role conflict (RC) in the relationship between PTT and emotional exhaustion (EE). An approach involving confirmatory factor analysis and the structural equation was used for analysis. Data from 432 pharmaceutical sales representatives indicate a significant positive relationship between PTT and EE, while RA and RC significantly mediated the relationship. The findings are potentially useful for employers in charge of field employees in high-risk regions by explaining how such groups can be provided with support to reduce their role stress and exhaustion, leading ultimately to increased satisfaction.

Occupational therapists' experience of workplace fatigue: Issues and action

BACKGROUND

Occupational therapists (OTs) work in all areas of health and wellbeing. The work is physically and psychologically demanding, but OTs are often not diligent about recognizing and attending to the workplace health and safety issue of fatigue in their own work settings.

OBJECTIVE

The purpose of this paper is to determine current issues and the evidence-base as presented in the literature so as to develop awareness and best practice interventions for fatigue reduction and management in occupational therapists' workplace.

METHODS

A comprehensive search strategy was carried out by the medical librarian on the study team and themes were extracted from the relevant literature by the study team.

RESULTS

The literature revealed little research directly addressing occupational therapy workplace fatigue and we expanded our review of the evidence-base across all healthcare workers to identify publications of particular relevance to occupational therapists.

CONCLUSION

This background paper is an important first step to raising awareness among OTs, guide key stakeholders regarding contributing factors to, and consequences of, OTs' workplace fatigue, and set research direction. Knowing which factors influencing workplace fatigue are shared across healthcare professionals and which are unique to OTs can also help organizations develop more tailored workplace fatigue risk reduction programs. This review concludes with a list of existing guidelines and tools for developing workplace fatigue risk assessment and management programs relevant to occupational therapists.

Prevalence of somatisation as a determinant of burnout amongst staff working in drug and alcohol services

Purpose

The purpose of this paper is to explore the prevalence of somatisation as a determinant of burnout amongst drug and alcohol staff in the UK.

Design/methodology/approach

The study employed a cross-sectional design utilising a self-completion online questionnaire. Data were collected from substance misuse workers across England and Wales. In total, 165 responses were eligible for analysis, yielding a response rate of 5 per cent. Burnout and somatization were measured with Maslach’s Burnout Inventory and the Physical Symptoms Inventory.

Findings

The prevalence of somatic symptoms was relatively low in the sample studied. The reported levels of burnout were moderate. Personal accomplishment remained high in the sample. There was a strong association between burnout and incidence of stress-related somatic symptoms, with higher levels of burnout correlating with multiple symptoms.

Research limitations/implications

It was not possible to determine the extent of non-response bias, as at the time of the study there was no information available relating to the characteristics of drug and alcohol staff in the selected services. Therefore, as the response rate was very low (5 per cent) it was recognised that non-response bias might have affected the findings, in such way that non-respondents may have differed in their experiences of work stress, satisfaction, burnout and health outcomes.

Practical implications

Despite the limitations, the study provided practical information relating to burnout vulnerability and associated physical symptoms in this specific occupational group. These findings can support employers to address staff wellbeing with a view to prevent burnout and reduce existing levels of burnout and related somatic symptoms, and improve job performance, job satisfaction and staff retention through making appropriate adjustments, such as developing staff-wellbeing programmes. These adjustments could potentially contribute to improvement in substance misuse practice, through maintenance of healthy and satisfied workforce.

Originality/value

There are very few studies looking at burnout in drug and alcohol staff. This study is also novel in a way that it reveals correlations between a variety of specific stress-related physical symptoms and the three components of burnout.

Examining the roles of shared vision and career growth opportunity in developing new employees

Purpose

The purpose of this paper is to explore the relationship between career growth opportunity (CGO), well-being and turnover intention of new employees, and also probe into the moderating role of shared vision (SV) in organizations.

Design/methodology/approach

In total, 253 new employees participated in this study, and the partial least squares analysis was adopted to analyze the data.

Findings

The study findings have indicated that CGO will play a key role in determining emotional exhaustion (EE) and job satisfaction. Additionally, a positive connection between EE and turnover intention, a negative relationship between EE and job satisfaction, as well as a negative link between job satisfaction and turnover intention have been found in this study. Finally, it has been demonstrated that SV will moderate the connection between CGO and EE, the relationship between CGO and job satisfaction, the link between EE and turnover intention as well as the correlation between job satisfaction and turnover intention.

Originality/value

Although there are numerous studies related to CGO, well-being and turnover intention, relatively little attention has been paid to the connection between CGO, well-being and turnover intention of new employees. With particular respect to the impact of SV on organizational outcomes, there is still a dearth of research examining the moderating role of SV in organizations.

Overcoming professionals' challenging experiences to promote a trustful therapeutic alliance in addiction treatment: A qualitative study

BACKGROUND AND AIMS

A good therapeutic alliance plays a major role in the healing process. Professionals working in addiction treatment report high levels of psychological distress related to work and this may challenge the establishment of a trustful therapeutic alliance, and lead to a loss of care quality provided to service users. The purpose of this study was to investigate the experience of specialized professionals, its effects on trust and the therapeutic alliance, and the means to restore them.

DESIGN

We conducted a qualitative study using a semi-structured questionnaire and a narrative tool. Discourse was extracted from focus groups and individual interviews and analyzed following the Interpretative Phenomenological Analysis method.

PARTICIPANTS

Twenty-six professionals from three addiction treatment centers in the Paris area were interviewed.

FINDINGS

The difficulties weighing on the care alliance were described by the participants in terms of their nature, their effects and means to overcome them. Emotional drain leads to a climate of relational distrust and the temptation to desert or over-control patients. Teambuilding, specific training and self-care are viewed as means to restore a therapeutic alliance based on an appropriate type of trust.

CONCLUSIONS

Distrust deriving from professionals' challenging experiences may lead to worrying consequences. Promoting democratic organization of care structures, specific training, and also responsible self-care on the part of professionals could help to restore a type of trust that helps to establish a therapeutic alliance suited to service user individualities. This could ultimately be beneficial for user care, professional wellbeing and team functioning.

Counselors' Perspectives of Positive Psychology for the Treatment of Addiction: A Mixed Methods Pilot Study

Little is known about the use of positive psychology interventions (PPI) in addictions treatment. Questionnaires and interviews with alcohol and substance use disorder counselors explored theories of how PPIs might work, the degree to which they are used, and downsides. Results suggested that positive and pathology-based themes were attended in equal proportion, that substance abuse treatment should help clients develop a good life in recovery; that counselors already use PPI; and that PPI might counter negative cognitions and affect. Reservations for using PPI included relying on PPI exclusively and employing PPI indiscriminately without regard to client characteristics.

Relationship between Provider Stigma and Predictors of Staff Turnover among Addiction Treatment Providers

To further our knowledge about feasible targets for improving quality of addiction treatment services, the current study provides preliminary assessment of the relationship between provider stigma and indicators of staff turnover. As predicted, results suggest that higher provider stigma was significantly related to lower ratings of job satisfaction and workplace climate. However, provider stigma was not significantly related to burnout. Our preliminary findings, if replicated, suggest the importance of considering provider stigma as a risk factor for future staff turnover and job dissatisfaction. Promising provider stigma interventions do exist and offer viable opportunity for improving quality of addiction treatment.

Recovered eating disorder therapists using their experiential knowledge in therapy: A qualitative examination of the therapists' and the patients' view

In the eating disorder (ED) field there is a lack of guidelines regarding the utilization of recovered therapists and the experiential knowledge they can bring to therapy. In this study, a qualitative design was used to examine recovered eating disorder therapists using their experiential knowledge and how this influences therapy and the patients they treat. Respectively, 205 patients (response rate 57%), and 26 recovered therapists (response rate 75%) completed a questionnaire about advantages and disadvantages of the utilization of experiential knowledge in therapy. Results showed that using experiential knowledge can have several advantages and disadvantages in therapy. Therapists can use this knowledge as a therapeutic intervention with specific goals, such as providing the patient with insight into the recovery process, establishing a working relationship, and enhancing hope for recovery. To be effective, self-disclosure and experiential knowledge need to be shared thoughtfully, and should not include specific details about ED symptoms. Other factors noted that enhanced the benefits of experiential knowledge included therapist self-insight and self-care, adequate training and guidance, and a safe work environment. Patients stated that being treated by a recovered therapist had a positive effect on their recovery process. It is advised to establish guidelines in the ED field about working with recovered therapists and the experiential knowledge they might use in therapy. Further research is needed on the process of when, how, and which experiential knowledge is shared by recovered therapists in therapy, and the effects of these interventions on patients and their treatment outcomes.

The impact of bundled high performance human resource practices on intention to leave

Purpose

– The purpose of this paper is to examine the mediating effect of emotional exhaustion (EE) in between bundled high-performance human resource practices (HPHRPs) and intention to leave (ITL) in the education sector.

Design/methodology/approach

– A survey questionnaire method was used to collect data from a sample of 514 teachers working in different professional colleges in Jammu and Kashmir (North India). Data were validated with CFA and SEM was used to test hypothesised relations.

Findings

– The results show that bundled HPHRPs have greater impact on EE and ITL as compared to individual HPHRPs. Further, the study also confirmed that EE partially mediates the bundled HPHRPs and ITL relationship.

Research limitations/implications

– Future research need to explore same relationships in different sectors with longitudinal data at the multi-level approach.

Practical implications

– Educational administration should focus on the bundled HPHRPs, which will benefit not only the teachers, but the students too. It should adopt relaxation techniques like mindfulness training approach, yoga and meditation. Further, to reduce their career-related confusions management should organise career awareness programmes.

Originality/value

– The results from this study explored new and untested mechanism, i.e. EE as mediator between bundled HPHRPs and ITL relationship in the professional degree colleges in India, has not been previously researched.

Predictors of Staff Turnover and Turnover Intentions within Addiction Treatment Settings: Change Over Time Matters

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.

Substance abuse-specific knowledge transfer or loss? Treatment program turnover versus professional turnover among substance abuse clinicians

This longitudinal study investigated the extent to which substance abuse (SA) clinician turnover is associated with SA-specific knowledge loss due to change in professions (professional turnover) versus SA-specific knowledge transfer due to movement from one SA clinical setting to another (treatment program turnover). For this study, clinicians had to have voluntarily left their current treatment program. Eligible clinicians completed a quantitative survey while employed and a qualitative post-employment exit interview 1 year later. Compared to those that exited the SA profession (n = 99), clinicians who changed treatment programs (n = 120) had greater SA-specific formal knowledge and were more likely to be personally in recovery. No differences were found between the two groups in terms of SA-specific practical knowledge.

Professional confidence and job satisfaction: an examination of counselors' perceptions in faith-based and non-faith-based drug treatment programs

Understanding substance abuse counselors' professional confidence and job satisfaction is important since such confidence and satisfaction can affect the way counselors go about their jobs. Analyzing data derived from a random sample of 110 counselors from faith-based and non-faith-based treatment programs, this study examines counselors' professional confidence and job satisfaction in both faith-based and non-faith-based programs. The multivariate analyses indicate years of experience and being a certified counselor were the only significant predictors of professional confidence. There was no significant difference in perceived job satisfaction and confidence between counselors in faith-based and non-faith-based programs. A majority of counselors in both groups expressed a high level of satisfaction with their job. Job experience in drug counseling and prior experience as an abuser were perceived by counselors as important components to facilitate counseling skills. Policy implications are discussed.

Barriers to substance abuse treatment in rural and urban communities: counselor perspectives

The purpose of this study is to compare rural and urban substance abuse counselors' perceptions of barriers to providing effective treatment services. Data were collected from 28 substance abuse counselors in Kentucky during four focus group sessions in 2008. Line-by-line coding and memoing were used by two raters on the transcribed data to isolate findings. The results of this study suggest that, though rural and urban counselors encounter similar constraints that hamper successful treatment outcomes, rural counselors are subject to special circumstances within their communities that present unique challenges to treatment efficacy. Novel contributions, implications, and limitations are also discussed.

Job frustration in substance abuse counselors working with offenders in prisons versus community settings

Substance abuse counselors who work with offenders are facing increasing caseloads, which puts them at higher risk of job frustration. The purpose of this study was to explore differences between substance abuse counselors employed in prison versus community settings in terms of level of organizational support and job frustration. This study also investigated whether organizational support was associated with job frustration after controlling for counselor characteristics and workplace setting. This was accomplished utilizing data that were collected from 267 counselors as part of the Criminal Justice Drug Abuse Treatment Studies research cooperative. Results indicated that counselors employed in community settings, as compared with those employed in prisons, are more likely to report higher levels of perceived organizational support. In addition, ordinal logistic regression results reveal that counselors who are non-White and have greater levels of organizational support have less job frustration, after controlling for counselor characteristics and workplace setting. The researches to practice implications are discussed.

Dialectical behavior therapy training to reduce clinical burnout in a public behavioral health system

There is a risk of experiencing clinical burnout among therapists providing treatment to clients with borderline personality disorder (BPD), a complex, costly and difficult-to-treat psychiatric disorder. Dialectical behavior therapy (DBT) is an evidence-based treatment of BPD that has been widely disseminated. There is only one published study that has examined pre and post scores of burnout among clinicians who receive training in DBT, and none that have taken place within a public behavioral health system in the United States where resources for community-based agencies are limited and demands are high. The current study examined the rates of burnout among therapists treating clients with BPD within a large, urban public behavioral health system. The study included a sample of nine clinicians and showed significantly decreased scores of burnout after participants attended a series of DBT trainings over a period of 13 months. There were several key limitations to internal validity including the lack of a control group. Similar evaluations of training outcomes are needed to address the widespread occurrence of burnout among community-based clinicians providing treatment to clients with BPD in order to enhance the quality of patient care.

Transformational leadership moderates the relationship between emotional exhaustion and turnover intention among community mental health providers

Public sector mental health care providers are at high risk for burnout and emotional exhaustion which negatively affect job performance and client satisfaction with services. Few studies have examined ways to reduce these associations, but transformational leadership may have a positive effect. We examine the relationships between transformational leadership, emotional exhaustion, and turnover intention in a sample of 388 community mental health providers. Emotional exhaustion was positively related to turnover intention, and transformational leadership was negatively related to both emotional exhaustion and turnover intention. Transformational leadership moderated the relationship between emotional exhaustion and turnover intention, indicating that having a transformational leader may buffer the effects of providers' emotional exhaustion on turnover intention. Investing in transformational leadership development for supervisors could reduce emotional exhaustion and turnover among public sector mental health providers.

Sharing stories: indigenous alcohol and other drug workers' well-being, stress and burnout

BACKGROUND

Indigenous alcohol and other drug (AOD) workers' roles are often exhausting, poorly paid and under-recognised. There has been relatively little examination of work-related stressors on their health and well-being. This national study identified Indigenous AOD workers' experiences and perspectives on well-being, stress and burnout along with strategies to improve worker well-being.

METHODS

Focus groups were conducted with 121 participants (70 Indigenous, 20 non-Indigenous, 31 unspecified) from metropolitan, rural and remote locations around Australia, selected via a purposive sampling strategy. Audio files and interview notes were analysed to identify key themes.

RESULTS

Main themes identified included excessive workloads, extensive demands and expectations, workers' proximity to communities, loss and grief issues, lack of recognition, inadequate rewards, stigma and racism, and Indigenous ways of working. Stressors were compounded by workers' complex personal circumstances, profound levels of loss and grief, and lack of culturally safe working environments.

DISCUSSION AND CONCLUSION

Indigenous workers' stress was exacerbated by close links and responsibilities to their communities and a 'dual accountability', being constantly on call, playing multiple roles, complex personal and professional lives, and needing to interact with multiple agencies. Many Indigenous AOD workers had developed mechanisms to deal with work-related pressures and received valued support from their communities. The study identified the importance of workforce strategies to improve Indigenous workers' well-being and reduce stress, including: mutual support networks, training in assertiveness and boundary setting, workloads that take account of Indigenous ways of working, adequate remuneration, supervision and mentorship, and cultural sensitivity training for non-Indigenous workers.

Training workshops positively impact beliefs about contingency management in a nationwide dissemination effort

In 2011, the Veterans Administration called for nationwide implementation of contingency management (CM) in its intensive outpatient substance use disorders treatment programs, and this study evaluated the impact of the initial 1 and ½ day training workshops on knowledge and perceptions about CM among 159 clinical leaders from 113 clinics. Workshop attendance significantly increased CM-related knowledge (d=1.88) and changed attendees' perceptions of CM (ds=0.26-0.74). Endorsement of barriers to CM adoption decreased and positive impressions of CM increased. These perceptions about CM emerged as key correlates of post-training preparedness to implement CM. Results suggest that training workshops can be an effective avenue for increasing CM-related knowledge, as well as addressing persistent misperceptions about CM that may impede adoption efforts. Continued efforts to introduce educational materials and offer training and consultation opportunities may increase understanding about this evidence-based intervention among clinicians, thereby leading to improved patient outcomes.

Quality of clinical supervision and counselor emotional exhaustion: the potential mediating roles of organizational and occupational commitment

Counselor emotional exhaustion has negative implications for treatment organizations as well as the health of counselors. Quality clinical supervision is protective against emotional exhaustion, but research on the mediating mechanisms between supervision and exhaustion is limited. Drawing upon data from 934 counselors affiliated with treatment programs in the National Institute on Drug Abuse's Clinical Trials Network (CTN), this study examined commitment to the treatment organization and commitment to the counseling occupation as potential mediators of the relationship between quality clinical supervision and emotional exhaustion. The final ordinary least squares (OLS) regression model, which accounted for the nesting of counselors within treatment organizations, indicated that these two types of commitment were plausible mediators of the association between clinical supervision and exhaustion. Higher quality clinical supervision was strongly correlated with commitment to the treatment organization as well as commitment to the occupation of SUD counseling. These findings suggest that quality clinical supervision has the potential to yield important benefits for counselor well-being by strengthening ties to both their employing organization as well the larger treatment field, but longitudinal research is needed to establish these causal relationships.

Treatment providers with a personal history of eating pathology: a qualitative examination of common experiences

Using qualitative methodology, this study examined the experiences of treatment providers with a personal history of eating pathology. A total of 139 eating disorder treatment providers completed a questionnaire designed by the authors that (a) asked whether and how their personal history influences treatment of patients with eating disorders and (b) elicited feedback for other therapists. Results indicated that the large majority of participants (94%) believed that their eating disorder history positively influenced their treatment of patients (e.g., increased empathy, greater understanding of the disorder, more positive personal outlook). Conversely, only 8% identified ways in which it can negatively influence treatment (e.g., feeling personally triggered, over-identifying with patients). Feedback for other professionals included the importance of personally recovering before treating this population and monitoring one's experiences in session (e.g., notice countertransference). Continued discourse regarding the benefits and challenges of a personal history of eating pathology in treatment providers is warranted.

Organizational environment of outpatient drug treatment services in Hungary: a pilot study

OBJECTIVES

Organizations engaged in drug addiction treatment started their activities only recently in Hungary. This paper examines the organisational environment in drug outpatient treatment using the example of Blue Point Foundation (BPF), a non-governmental organization (NGO). The authors describe BPF's organizational structure and functioning related to its effectiveness.

METHODS

BPF staff members anonymously completed a 59-item questionnaire about its organizational characteristics and functioning. The questionnaire covered demographic data, 50 items of the Quality Control questionnaire and a SWOT (Strengths, Weakness, Opportunities, Threats) analysis.

RESULTS

Policy and strategy were considered BPF's best feature, while the management of funds received the lowest rating. The assessment of the staff and that of the organization as a whole was closer to the midpoint of the scale.

DISCUSSION

High risk of staff burnout and unstable organizational environment are the most important threats on the NGOs working in addictology in Hungary.

Examining the temporal relationship between psychological climate, work attitude, and staff turnover

Relative to the broader industrial-organizational (I-O) psychology field, research on the turnover of substance use disorder (SUD) treatment staff is in its infancy. Despite its long and rich history, recent reviews of the turnover literature within I-O psychology have noted that there remains considerable room for improvement. In particular, recommendations have been made for research that considers time in the turnover process and explores more distal causes of staff turnover. Addressing these gaps, this article examined the temporal relationship between latent measures of psychological climate, work attitude, and staff turnover. Using data from 95 SUD treatment staff clustered within 29 treatment organizations, multilevel discrete-time survival analyses revealed that a latent measure of work attitude (e.g., job satisfaction, pay satisfaction, turnover intentions) fully mediated the temporal relationship between latent measures of psychological climate (e.g., supervisor support, coworker support, role conflict) and subsequent staff turnover.

The implementation of smoking cessation counseling in substance abuse treatment

Research on the implementation of smoking cessation counseling within substance abuse treatment organizations is limited. This study examines associations among counselors' implementation of therapy sessions dedicated to smoking cessation, organizational factors, and counselor-level variables. A two-level hierarchical linear model including organization- and counselor-level variables was estimated using survey data collected from 1,794 counselors working in 359 treatment organizations. Overall implementation of smoking cessation counseling was low. In the final model, implementation was positively associated with counselors' knowledge of the Public Health Service's clinical practice guideline, perceived managerial support, and belief that smoking cessation had a positive impact on recovery. Private versus public funding and presence of a formal smoking cessation program were organization-level variables which interacted with these counselor-level effects. These results highlight the importance of organizational contexts as well as counselors' knowledge and attitudes for effective implementation of smoking cessation counseling in substance abuse treatment organizations.