Although the dissemination and implementation of evidence-based practices (EBPs) is considered a national priority, EBPs remain underutilized in mental health care settings. Quality therapist training programs are necessary to successfully bridge this science-practice gap, however, research has not yet discovered optimal methods to ensure sustainable EBP implementation. Evidence has demonstrated the presence of significant obstacles for the successful administration of implementation efforts, such as high clinician turnover rates (30-60%). These high turnover rates produce considerable costs to agencies and consumers, and threaten the long-term sustainability of EBPs. The prevalence and potency of staff turnover emphasize the need to understand and prevent workforce instability. A mixed method design will be utilized to gain a comprehensive understanding of the factors that influence clinicians to leave their agency or stay long-term. This study will provide strong foundation for intervention research targeting workforce stabilization as a way to support the implementation of evidence-based interventions with the goal of improving client services and outcomes. Advancement of this knowledge will cost a small fraction of what we are paying to maintain a status quo that is costing significant loss in money, time, resources, and patient improvement. The current study is unique in a number of ways: (1) to our knowledge, this study is the first to separate and examine factors related to turnover and factors related to long-term retention; (2) unlike the majority of research on this topic that use turnover intention as a proxy for turnover, our study will assess the factors associated with actual turnover; and (3) the proposed study is innovative in that it incorporates transdisciplinary collaboration and utilizes theories, empirical findings, and methods from the field of organizational behavior (OB). The unfolding model, from OB, offers a unique advantage to turnover research, because it focuses on the reasons people leave, which offers more direct links to turnover management strategies than traditional turnover models. Ultimately, this research aims to inform staff-retention strategies that can be consistently and systematically employed in community mental health settings to enhance workforce stability, support the implementation and delivery of EBPs, and improve services and outcomes for consumers. If strategies studied in this proposal are effective and feasible, these strategies can be included in other EBP implementation efforts and will have a substantial public health impact in the area of child and adolescent mental health.

Public Health Relevance

Although high clinician turnover rates produce substantial costs for public mental health agencies, consumers, and implementation efforts, there exists little empirical guidance on mitigation. To guide the development of employee turnover interventions, the current study examined factors associated with clinician turnover and long-term retention. This study will provide a strong foundation for intervention research targeting workforce stabilization as a way to support the implementation of evidence-based mental health interventions, with the ultimate goal of improving services and outcomes for consumers.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
Project #
Application #
Study Section
Special Emphasis Panel (ZMH1)
Program Officer
Hill, Lauren D
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Washington
Schools of Arts and Sciences
United States
Zip Code