Therapist Financial Strain and Turnover: Interactions with System-Level Implementation of Evidence-Based Practices

  • Danielle R. Adams
  • Nathaniel J. Williams
  • Emily M. Becker-Haimes
  • Laura Skriner
  • Lauren Shaffer
  • Kathryn DeWitt
  • Geoffrey Neimark
  • David T. Jones
  • Rinad S. BeidasEmail author
Original Article


Therapist turnover is a major problem in community mental health. Financial strain, which is composed of cognitive, emotional, and behavioral responses to the experience of economic hardship, is an understudied antecedent of therapist turnover given the tumultuous financial environment in community mental health. We prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. We expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. Controlling for covariates, financial strain predicted therapist turnover (OR 1.12, p = .045), but not for therapists who participated in an EBP training initiative. Reducing financial strain and/or promoting EBP implementation may be levers to reduce turnover.


Financial strain Turnover Implementation Behavioral health services Evidence-based practice System transformation 



We are especially grateful for the support that the Department of Behavioral Health and Intellectual disAbility Services has provided for this project and for the Evidence Based Practice and Innovation (EPIC) group. We would also like to thank the following experts who provided their consultation on this project: Dr. Steven Marcus and Dr. David Mandell.


Funding for this research project was supported by NIMH K23 MH099179 (Beidas). Additionally, this paper was supported by the Agency for Healthcare Research and Quality under Grant Award T32 HS000084 (Adams; PI: Kathleen Cagney, PhD). Its contents are solely the responsibility of the author(s) and do not necessarily represent the official views of the AHRQ.

Compliance with Ethical Standards

Conflict of interest

Dr. Beidas receives royalties from Oxford University Press. All other authors have no conflicts of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Danielle R. Adams
    • 1
    • 2
  • Nathaniel J. Williams
    • 3
  • Emily M. Becker-Haimes
    • 2
    • 4
  • Laura Skriner
    • 2
    • 5
  • Lauren Shaffer
    • 2
    • 6
  • Kathryn DeWitt
    • 2
    • 7
  • Geoffrey Neimark
    • 8
  • David T. Jones
    • 8
  • Rinad S. Beidas
    • 2
    • 9
    • 10
    Email author
  1. 1.School of Social Service AdministrationUniversity of ChicagoChicagoUSA
  2. 2.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.School of Social WorkBoise State UniversityBoiseUSA
  4. 4.Hall-Mercer Community Mental Health CenterPhiladelphiaUSA
  5. 5.Evidence-Based Practitioners of New JerseySummitUSA
  6. 6.University of Texas, SouthwesternDallasUSA
  7. 7.QualtricsProvoUSA
  8. 8.Community Behavioral HealthPhiladelphiaUSA
  9. 9.Department of Medical Ethics and Health Policy, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  10. 10.Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI)University of PennsylvaniaPhiladelphiaUSA

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