Provider Turnover Following Randomization to Implement an Evidence Based Practice

Introduction: Child welfare and mental health service systems are adopting evidence-based practices (EBP) in an effort to improve consumer outcomes. Adoption of EBP can be stressful and burdensome for providers, so it is critical to consider the impact of EBP implementation on the workforce, especially in high-turnover fields like child welfare. If implementation of evidence-based practices increases job demands, stress, and burnout, it may exacerbate turnover, especially among providers with poor attitudes toward EBP or high degrees of stress and burnout. This research examined provider turnover following random assignment of provider teams at nine child-welfare serving agencies to either implement an EBP (SafeCare) or continue services as usual.

Methods: Teams at nine child welfare agencies were randomized to either implement a new EBP or to continue usual service. One hundred two providers who were randomized (52%) completed a survey at baseline that included questions on demographics, Aarons evidence-based practice attitude scale (EBPAS), and the TCU Survey of Organizational Functioning. Depending on the time of enrollment of their site, providers were followed for a varying amount of time (3-17 months; median = 14). We conducted simple and multivariable regression analyses to examine the relationship between EBP assignment and turnover, and whether attitudes or organizational variables interacted with EBP assignment to predict turnover.

Results: The sample of providers was primarily female (88%) and white (73%), Bachelor’s degreed (71%), and had a median age of 31. Simple rates of turnover did not differ between providers assigned to EBP (39%) or control (29%), OR = 1.3, p = .60. In multivariable analyses, only three variables predicted turnover: age (OR = .92), attitude that adopting the EBP was burdensome (OR = .59), and motivation for change (OR = .89). We examined interactions between EBPAS scores and EBP assignment, and between organizational variables and EBP assignment, but none were significant (all p > .10).

Discussion: EBP assignment was not related to turnover, and did not interact with EBPAS or organizational functioning to predict turnover. Both substantive predictors of turnover were in the opposite direction of what one might expect, suggesting that turnover in this study may have been differently motivated than in prior studies. Limitations of this work include (1) variable duration of follow up, (2) not identifying reasons for turnover, and (3) relatively poor response rate to the survey.