The Relationship Between Clinician Turnover and Client Outcomes in Community Behavioral Health Settings

The Behavioral Health Needs of Youth With Preexisting Psychiatric Disorders in the Aftermath of COVID-19

Children and adolescents with psychiatric disorders are a sizable population of children and youth with special health care needs. While the capabilities of behavioral health resources to meet these youth's needs were already strained, the Coronavirus Disease 2019 (COVID-19) pandemic extended resource limitations just as this subgroup of children and youth with special health care needs faced new stressors and potential exacerbations of their underlying psychiatric illnesses. In this article, we provide a brief narrative review of the factors' manifestations with an emphasis upon their disproportionate impact upon children of color and their families and particularly those from disadvantaged communities. We proceed to provide policy proposals for addressing these disparities. These include raising reimbursement for behavioral health services, increasing telehealth care delivery, reducing inter-state licensing requirements, increasing community-based services, and addressing social determinants of health. Conclusions and directions for strengthening behavioral health service delivery capabilities and addressing systemic injustices are made.

The Impact of Organizational Factors and Professional Identity on Turn Over Intent in State Vocational Rehabilitation Agencies

Turnover of staff is an ongoing concern in the state-federal vocational rehabilitation (VR) system. To better understand employee turnover intent, a multiple regression analysis was conducted using professional identity and organizational factors (e.g., pay, work tenure) as predictor variables. An internet-based survey solicited counselor perceptions regarding professional identity, turnover intent, and job satisfaction. Respondents ( n = 351) described their level of satisfaction relevant to several workplace conditions (co-workers, job in general, work assignments, pay, promotion, and supervision), and their current level of professional identity. The outcome variable representing current or future turnover intent was whether participants were actively looking for a new position or planning to look for a new position in the next 5 years. Results indicated that a little over one third of current counselors would look for a new position in the coming year, with half of current counselors seeking a new position within 5 years. Findings suggest that turnover in state-federal VR settings exceeds the national average of 19%. Purposeful pre-hire considerations, goodness of fit, motivation factors (i.e., opportunities for promotion), and hygiene factors (i.e., caseload size, supervision, and pay) identified in this study should be elements of a state-federal VR agency’s plan to mitigate turnover intent.

Perception of Recovery Orientation as a Predictor of Clinician Turnover in Community Mental Health Clinics

Turnover in community mental health clinics threaten the delivery of quality behavioral health services; recovery orientation has been shown to be associated with lower levels of burnout but its relationship with actual turnover has not yet been examined. This study aimed to examine the relationship between provider perceptions of recovery orientation and 12-month turnover status among community mental health providers. Secondary data analyses were conducted with data collected from 224 community mental health providers from ten organizations across 14 clinic sites participating in a larger effectiveness-implementation trial. Chi square analyses were used to examine between-site variation in 1-year turnover rates among the ten organizations. Logistic regression was used to examine effects of perceptions of recovery orientation along with known predictors of turnover among community mental health providers. Results revealed no between-site variation in organizational turnover rates. The logistic regression model was statistically significant, χ²(17) = 47.64, p < .0001 and explaining 30% (Nagelkerke R²) of within-site variance and correctly classifying 79% of cases. Perceptions of recovery orientation emerged as the sole significant predictor of 12-month turnover status, with higher levels of recovery orientation significantly associated with lower odds of turnover at 12 months [B = .90, p = .008, OR 2.47 (95% CI 1.23, 4.82)]. Perceptions of recovery orientation was protective against 12-month turnover status suggesting that a more person-centered and empowering approach to care may improve the provider experience. More research is needed to further understand how recovery orientation can contribute to workforce stability.

Leader–member exchange and organizational climate effects on clinician turnover intentions

Purpose

Clinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader–member exchange (LMX), reflecting the relationship between a supervisor and each supervisee, using mean team LMX, dispersion of individual clinician ratings compared to team members (i.e. relative LMX) and team level variability (i.e. LMX differentiation), in relation to organizational climate and clinician TI.

Design/methodology/approach

Survey data were collected from 363 clinicians, nested in children's mental health agency workgroups, providing county-contracted outpatient services to youth and families. A moderated mediation path analysis examined cross-level associations of leader–member exchange with organizational climate and turnover intentions.

Findings

Lower relative LMX and greater LMX differentiation were associated with higher clinician TI. Higher team-level demoralizing climate also predicted higher TI. These findings indicate that poorer LMX and more variability in LMX at the team level are related to clinician TI.

Originality/value

This study describes both team- and clinician-level factors on clinician TI. Few studies have examined LMX in mental health, and fewer still have examined relative LMX and LMX differentiation associations with organizational climate and TI. These findings highlight the importance of leader–follower relationships and organizational climate and their associations with clinician TIs. Mental health service systems and organizations can address these issues through fostering more positive supervisor–supervisee relationships.