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Abstract: The health services field is increasingly concerned about burnout and turnover among service providers. Substance abuse professionals are particularly susceptible to burnout since factors such as large caseloads, limited resources, low pay, and bureaucratic work environments contribute to burnout. In addition, substance abuse professionals work with a challenging client population of addicts and referrals from the criminal justice system which can leave them feeling frustrated, depressed, and helpless in assisting clients. Examining work environment factors that are amenable to change may make a difference in curbing burnout (and ultimately deterring turnover) among substance abuse counselors. Clinical supervision is one such factor, as it is the primary mechanism for on-the-job training and counselor development. Further, negative experiences in clinical supervision can contribute to burnout and ultimately turnover. As such, the authors propose that positive experiences with one’s clinical supervisor may reduce counselor burnout whereas negative experiences may actually exacerbate burnout. And consistent with previous research, burnout should predict counselor turnover intentions. This poster describes the outcomes of a CTN platform study that surveyed 462 counselors employed at fifteen CTPs (community treatment programs) in the Clinical Trials Network. Two dimensions of burnout were examined: depersonalization and emotional exhaustion. The variables of role overload, job satisfaction, and pay satisfaction were used as control variables in all of the multiple regression analyses. The results indicate that both positive and negative clinical supervisory experiences are associated with turnover intentions. Likewise, counselor burnout was associated with turnover intentions. Further, both depersonalization and emotional exhaustion were partial mediators of the relationship between positive and negative clinical supervisory experiences and turnover intentions. This study indicates that high quality clinical supervision may be important in reducing burnout and subsequent counselor intentions to turnover. The practical suggestions include in-house and education-based training on effective clinical supervision and performance management systems that hold clinical supervisors accountable for their behavior toward counselors.

Abstract:

Clinical research is increasingly being conducted in community-based addiction treatment settings. Although the primary focus of such research is on the development of effective clinical interventions, less attention has been paid to the potential impact of these projects on counseling staff who are involved in their implementation. Such involvement may be perceived as stressful or rewarding, and these perceptions may be associated with counselors’ intention to remain in their jobs (“turnover intention”). Using data from 207 counselors involved in research projects conducted within the National Drug Abuse Treatment Clinical Trials Network (CTN), this study examines the associations between counselors’ reactions to research experiences and turnover intention. Counselors’ turnover intentions were found to be associated with their perceptions about the research activities their organizations were involved in. Turnover intention was significantly greater whenever counselors perceived that their job demands had increased due to the research. However, turnover intention was significantly lower if counselors perceived that the research was resulting in improvements for their clients and organization.

These findings suggest that the impact of clinical trials on treatment organizations and staff members warrants continued study.

Abstract:

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 Drug Abuse Treatment 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 as the larger treatment field, but longitudinal research is needed to establish these causal relationships.

Abstract:

The main goals of the current study were to investigate whether there are linear or curvilinear relationships between substance use disorder counselors’ job performance and actual turnover after 1 year utilizing four indicators of job performance and three turnover statuses (voluntary, involuntary, and no turnover as the reference group). Analyzing longitudinal data collected in 2007 and 2008 as part of the Managing Effective Relationships in Treatment Services (MERITS I) project, a CTN platform study, results indicated that overall, counselors with lower job performance are more likely to turn over voluntarily and involuntarily than not to turn over. Further, one of the job performance measures shows a significant curvilinear effect.

Conclusions: The negative consequences often assumed to be “caused” by counselor turnover may be overstated because those who leave both voluntarily and involuntarily demonstrate generally lower performance than those who remain employed at their treatment program. These findings underscore the importance in investing in recruitment, selection, and training in SUD treatment in an effort to reduce the costs of turnover and increase the likelihood of successful hires that will perform well and remain employed at the treatment organization.

Abstract:

Based on mentoring theory, social exchange theory, and theories of stress and coping, this study of data from the 2008 Managing Effective Relationships in Treatment Services project (MERITS I, a National Drug Abuse Treatment Clinical Trials Network (CTN) platform study) examined antecedents and consequences of the provision of mentoring support by clinical supervisors. Of particular interest is how the provision of mentoring support is further linked to counselor’s experience of work-to-nonwork conflict. Survey data were collected in person in 2008 from 418 matched clinical supervisor-counselor dyads who worked in substance use disorder treatment programs across the U.S. Path analysis showed that clinical supervisors’ evaluation of relational costs, relational benefits, and overall relationship quality with a particular counselor was related to the counselor’s perception of the amount of mentoring support provided. In turn, perceived mentoring support was negatively related to both strain-based and time-based work-to-nonwork conflict among counselors.

Conclusions: These findings suggest that counselors and clinical supervisors should be made aware of and encouraged to create positive social exchanges, foster quality relationships, and promote mentoring support to help address and reduce counselors’ work-to-nonwork conflict, likely increase well-being, and possibly promote positive outcomes for organizations, such as reduced turnover and improved performance.

Abstract:

The nationwide CTN platform project, “Managing Effective Relationships in Treatment Services” (MERITS), has been following a cohort of substance use disorder counselors from a variety of CTN community treatment programs over several years. MERITS I, the first round of the study, was developed to (a) examine predictors of voluntary turnover among counselors and clinical supervisors and (b) determine the relationship between clinical supervision (CS), counselor strain, and turnover. MERITS I found a cumulative turnover of 47% over 3 years, most of which was voluntary. Longitudinal predictors of turnover included procedural and distributive justice, job satisfaction, and perceived organizational support. MERITS II is focusing on implementation of OASAS tobacco-free regulation in New York State, looking at the description of implementation over time, effect of local change management practices on clinician outcomes, and the effect of implementation extensiveness on clinician reactions to the regulation and subsequent strain. MERITS III will be looking at the adoption, implementation, and sustainability of smoking cessation services, including organizational and policy factors related to evidence-based treatments for smoking.

This presentation ends with a brief introduction to a new CTN platform study at the University of Georgia (Katie Kinkade and Lillian Eby) examining “Effects of Client Trauma on Substance Abuse Counselors and Their Families.” This research will examine how counselors’ experiences with client trauma affects them and their families, as well as outcomes of counselor “secondary traumatic syndrome” (STS) caused by exposure to clients’ vivid accounts of trauma experiences.

Abstract:

Using data from the nationwide CTN platform project “Managing Effective Relationships in Treatment Services” (MERITS I), researchers have been annually tracking a cohort of 598 substance use disorder counselors from a variety of CTN community treatment programs over a four-wave period to (a) document the cumulative rates of voluntary turnover and (b) examine how counselor perceptions of the organizational environment (procedural justice, distributive justice, perceived organizational support, and job satisfaction) and clinical supervisor leadership effectiveness (relationship quality, in-role performance, extra-role performance) predict voluntary turnover over time. Survey data were collected from counselors in Year 1, and actual turnover data were collected from organizational records in Years 2, 3, and 4. Findings reveal that 25% of the original counselors turned over by Year 2, 39% by Year 3, and 47% by Year 4. Counselors with more favorable perceptions of the organizational environment are between 13.8% and 22.8% less likely to turn over than those with less favorable perceptions. None of the leadership effectiveness variables are significant.

Conclusions: This is the first study to systematically examine substance use disorder counselors’ actual turnover rates over a 3 year time frame and investigate predictors of turnover over time. These findings highlight the importance of examining voluntary turnover and suggest that efforts to reduce turnover and stabilize the substance use disorder workforce should focus on efforts to improve job satisfaction, perceptions of distributing and procedural justice, as well as organizational support.

Abstract:

Voluntary nurse turnover, which is costly and disrupts patient care, has not been studied as an organizational phenomenon within substance abuse treatment organizations. In this exploratory study, we examined the frequency and correlates of nurse turnover within treatment programs affiliated with the National Drug Abuse Treatment Clinical Trials Network. During face-to-face interviews conducted in 2005–2006, 215 program administrators reported the number of nurses currently employed. Leaders of programs with nursing staff then described the number of nurses who had voluntarily quit in the past year, the degree to which filling vacant nursing positions was difficult, and the average number of days to fill a vacant position. About two thirds of these programs had at least one nurse on staff. In programs with nurses, the average rate of voluntary turnover was 15.0%. Turnover was significantly lower in hospital-based programs and programs offering adolescent treatment but higher in facilities offering residential treatment. Most of the administrators indicated that filling vacant nurse positions was difficult and took more than 2 months to complete. These findings suggest that nurse turnover is a significant issue facing many substance abuse treatment facilities. Efforts to improve retention of the addiction treatment workforce should be expanded to include nursing professionals.

Abstract:

This 2-hour webinar, produced by the National Drug Abuse Treatment Clinical Trials Network (CTN) Clinical Coordinating Center for CTN members and the public, provides methods useful in enhancing community treatment provider workforce stability. Viewers will be introduced to the value of staff continuity; how management, workplace culture, job design, opportunities, rewards and relationship impact staff retention; the importance of the “internal customer;” retention through empowerment and growth; and mentoring recommendations.

The target audience is CTN members and other clinical research staff management.

Presented by Louise F. Haynes, MSW (Medical University of South Carolina, SC Node) and Jack Chally, MBA (EMMES Corporation).

Additional Resources:

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Abstract:

This presentation, a combination of three presentations given at CTN Steering Committee meetings in 2009 and 2010, begins with an overview of the goals of the University of Georgia CTN platform study. This study aims to better understand organization-level processes of adoption, implementation, and potential discontinuation of evidence-based treatment practices (EBPs); and to study the counseling workforce within CTN programs. Methodology for the study used face-to-face interviews with administrators and clinical directors of CTPs, along with mail/internet based surveys of counselors. The study looked at both publicly funded and privately funded programs, with data collection at baseline, 24 months, and 48 months. The first part of the study examined adoption of buprenorphine in opioid treatment programs, and found that CTN affiliation was significantly associated with buprenorphine adoption (CTN programs were three times more likely to adopt bup than non-CTN programs). The second part looked at buprenorphine adoption over time, finding that adoption at baseline was strongly associated with continued adoption at follow-up. The third part of the study examined adoption of alcohol pharmacotherapies in CTN and non-CTN programs, finding this time that CTN participation was not a significant predictor of tablet naltrexone adoption at baseline, but that CTN programs were three times more likely to adopt naltrexone after both 24 months and 48 months. The latest focus of the platform study was on an examination of barriers to buprenorphine or motivational incentive adoption, which found that cost was a significant factor for many programs.

The presentation concludes with a discussion of the use of the CTN as a platform for studying the counseling workforce, focusing on attitudes towards evidence-based practices, implications of research involvement for employee retention, and the role of clinical supervision in reducing emotional exhaustion and turnover.

Abstract:

The complex makeup of the substance abuse treatment workforce poses unique challenges to the field. One interesting dynamic is the high rate of counselors who are personally recovering from addictions. Based on social identity theory, it was expected that counselors working in the field of substance abuse treatment who are in recovery themselves will identify more with their profession and report higher professional and organizational commitment. The data used in this study are part of a larger National Institute on Drug Abuse (NIDA)-funded research project that used the National Drug Abuse Treatment Clinical Trials Network as a research platform. Treatment organizations were recruited through formal presentations at the CTN’s External Affairs Subcommittee Meeting and the Community Treatment Program Caucus in May 2004.

Analysis of the data support the proposed relationship between personal recovery status and professional commitment, but not organizational commitment. Based on these findings, it is clear that clinician recovery status should be considered in future work in the substance abuse treatment field. Counselors who are personally in recovery are more committed to their profession than counselors who are not. Recovering from an addiction is a personal accomplishment that extends down into the core of an individual and can affect all aspects of their life, and its influence should not be overlooked.

Abstract:

In the substance abuse treatment field, the annual turnover rate is cited as being anywhere between 19% and 50%. However, no research to date has evaluated these claims by tracking turnover longitudinally using organizational turnover data from substance abuse treatment centers. This research presents the results of a longitudinal study designed to systematically examine actual turnover among counselors and clinical supervisors. Twenty-seven geographically dispersed treatment organizations, all participants in the National Drug Abuse Treatment Clinical Trials Network (CTN), provided data for the study over a 2-year time span (2008-2009). The annual turnover rate was 33.2% for counselors and 23.4% for clinical supervisors. For both groups, the majority of turnover was voluntary (employee-initiated). Specific reasons for turnover were largely consistent across the two groups, with the most common reason being a new job or new opportunity.

The findings are discussed in terms of the unique employment context of substance abuse treatment. Practical recommendations are also discussed to help stem the tide of turnover in the field of substance abuse treatment, including workplace interventions that enhance quality of worklife and examination of perceptions of pay satisfaction and perceived fairness of pay allocation.

Abstract:

Patient and staff turnover are significant therapeutic and management concerns in substance abuse treatment programs. Some literature suggest a positive correlation between patient satisfaction and successful outcome, while other studies are inconclusive. The treatment environment (location, physical space, and cultural milieu) is also associated with successful outcomes. Although providers often represent that they are satisfied with their jobs this seems to be contradicted by high staff turnover. Initiated in 2006 and based on completed CTN protocol CTN-0016 (“Patient Feedback : A Performance Improvement Study in Outpatient Addiction Treatment Settings”), the Patient Feedback study is a randomized, effectiveness trial, implementing a quality improvement (QI) system at 20 outpatient, substance abuse treatment programs. Patients’ baseline assessments were self-reported on survey instruments capturing ratings of treatment satisfaction. Clinic demographic forms and four self-report surveys assessing job satisfaction captured baseline data from providers along the following domains: 1) quality of director-employee relationships, 2) organizational characteristics, and 3) intrinsic/extrinsic satisfaction. Preliminary analysis from surveys of 679 patients reveals very high treatment satisfaction across patients of various treatment durations, including 227 patients in treatment for 1 month or less. Job satisfaction amongst 76 clinicians will be presented based on scores from the LMX-7 (evaluates interactions between directors and employees), the ORC (18 domains assessing organizational characteristics), and the MSQ (scale rating job satisfaction). Additional findings will be presented on gender, ethnicity, and length-of-treatment on patient and staff satisfaction. In conclusion, these findings have implications for the development and implementation of QI systems to enhance treatment outcomes and the work environment in substance abuse programs.

Related protocols: CTN-0016

Abstract:

An intriguing hypothesis is that clinical supervision may protect against counselor turnover. This idea has been mentioned in recent discussions of the substance abuse treatment workforce. To test this hypothesis, the authors extended their previous research on emotional exhaustion and turnover intention among counselors by estimating the associations between clinical supervision and these variables in a large sample (N = 823) of community treatment providers in the National Drug Abuse Treatment Clinical Trials Network. An exploratory analysis reveals that clinical supervision was negatively associated with emotional exhaustion and turnover intention. Given previous findings that emotional exhaustion and turnover intention were associated with job autonomy, procedural justice, and distributive justice, the authors estimate a structural equation model to examine whether these variables mediated clinical supervision’s associations with emotional exhaustion and turnover intention. These data support the fully mediated model. The authors found that the perceived quality of clinical supervision is strongly associated with counselors’ perceptions of job autonomy, procedural justice, and distributive justice, which are, in turn, associated with emotional exhaustion and turnover intention. These data offer support for the protective role of clinical supervision in substance abuse treatment counselors’ turnover and occupational well-being.

Abstract:

Developed by the Health Services Research Special Interest Group of the National Drug Abuse Treatment Clinical Trials Network, this bibliography is designed to briefly review the literature regarding staff turnover and retention in addiction treatment programs. The focus of this bibliography concerns issues regarding the continuation of professional staff who provide drug and alcohol treatment services, including personnel who provide direct addiction counseling or psychotherapeutic services in free-standing programs, hospital-, prison- or university-based programs, for-profit or not-for-profit programs, outpatient, day treatment, residential programs, therapeutic communities and halfway houses, and private practice. Publications that primarily focus on staff retention and turnover issues in settings other than addiction treatment programs (e.g. psychiatric or mental health facilities) have been excluded from this bibliography. Likewise excluded are publications that focus on non-professional staff, such as clerical workers. The bibliography consists of ten citations found in the database PsycINFO and focuses on peer-reviewed journals, books written for professionals, conference proceedings, reference books, handbooks and manuals, electronic collection items, dissertations, and encyclopedias. Most of the citations involve surveys of substance abuse treatment programs and staff regarding turnover, and most focus on treatment programs in the United States.