Therapist turnover in community mental health: Testing the applicability of job embeddedness and shocks

Abstract

Community mental health organizations experience an annual therapist turnover rate of 25-60%, which produces considerable costs to agencies, undermines implementation efforts, and threatens the long-term sustainability of evidence-based practices (EBPs). Despite substantial evidence demonstrating the negative effects of therapist turnover, there exists little empirical guidance on mitigation. To advance understanding of EBP-trained therapist turnover decisions, the current study tested the applicability of two novel concepts from the field of organizational behavior: job embeddedness and shocks. The current study implemented a prospective, longitudinal, repeated measures design to collect periodic survey data from EBP-trained therapists working in community mental health settings. Results from time-varying survival analyses revealed that job embeddedness predicted therapist turnover above and beyond a set of known risk factors of therapist turnover (i.e., job satisfaction and burnout). Although all therapists who left their organizations reported experiencing a shock event, the number of shocks experienced was not a significant predictor of turnover. This study provides insight into factors related to therapist turnover and discusses how findings may help to inform the development of effective retention strategies.