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Turning Around Turnover in Behavioral Health

Do you remember when you first started working in the behavioral health field? I do. I was still attending college and was home for a break. I had applied to a local mental health center for an ‘emergency relief’ direct care worker position at one of their group homes. I would work weekends and holidays and cover the shifts that were more likely to be open.

Hiring and onboarding were a blur. During my first shift, one of the clients experienced a crisis. I didn’t know what to do. I had not attended my crisis prevention training yet. A more senior staff member came in from the kitchen and directed me on what to do. A severe crisis was averted, but I was left a bit shaken. I am wholly unprepared for this, I thought. I only worked a few more shifts before finding other part-time employment.

My onboarding experiences did not significantly improve as I gained experience and education. It was almost like I was expected to know what to do and how to do it. Don’t get me wrong; I was provided HIPAA training, reviews of organizational policies and procedures, and reminders of mandated reporting and confidentiality. But job shadowing was limited, clinical training was something that I attended on my days off and supervision was limited as well, because many of my managers had caseloads themselves.

Turnover in behavioral health

It’s no surprise that healthcare, in general, suffers from workforce shortages and poor job retention rates. But it is shocking to see how much greater that challenge is for the behavioral health workforce.

According to recent studies, the industry average for turnover in behavioral health is 31% and, for some states and jobs, as high as 37%. That is correct – 37%. Most organizations panic if their turnover rates get close to double digits.

Amid an opioid crisis, substance use treatment facilities across the nation are struggling to retain staff. Many treatment facilities are in a constant state of recruitment with average turnover rates upward of 18-20%.

These turnover rates are compounded by the aging workforce in behavioral health. For example, in 2012, the Vital Signs report found more than half of individuals working in the substance use field were over the age of 45 with more than 60% of the clinical directors over the age of 50.

What can we do?

How do we find the right fit with the right competencies for the right job and prepare them appropriately? What can we do differently in our onboarding programs? What if managers could identify areas ripe for development and focus specifically on those areas during supervision?

Several actions can be taken to improve onboarding. Organizations can:

  • Define the competencies necessary for each role
  • Evaluate staff competency
  • Identify knowledge gaps
  • Provide training to close knowledge gaps
  • Provide tailored onboarding and orientation
  • Provide more supervision and mentoring, which is difficult in fast-paced behavioral health organizations but crucial to retain and grow their workforce

How can revealing someone’s strengths and possibly uncovering their weaknesses encourage them to stay on staff? Behavioral health providers are like anyone else – they respond to opportunities for personal and professional growth. They react favorably to individuals in upper management who are interested in their future.

Throughout my career, when people have been interested in my growth, I’ve become more attached to the organization. And the opposite has been true as well. When there’s not a focus on my development and advancement — no expectations to advance in an organization — I’ve lost interest and taken my ambition elsewhere.

Behavioral health providers are under tremendous stress. Burnout is common, even expected. When an organization takes the time to assess skills, provide guidance and supervision, and deliver targeted training, they can turn someone who’s just going through the motions into a committed, valuable team member.

Without that interest, it’s easy to see why a direct care worker or counselor could switch jobs for just a small salary increase or perceived career advancement.

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