What's New? Or Not... in the World of Behavioral Health

ContinuumCloud just released its 2023 Behavioral Health Industry Trends Report. Over 250 respondents from behavioral health and human service organizations answered the survey in December. Those taking the survey included CEO’s, Finance, HR, IT, operations and clinical staff. While just over a quarter were C-suite staff, the same percentage were front line or non-supervision and the organizations represented ranged in size from 100-200 employees to over 2,000.

Recruitment and Retention of staff remained at the top of the priorities list, albeit not as high, with 59% placing it at the top compared to 72% last year. Client and Patient Engagement were next this year with 45.5% of respondents saying it was the top priority, moving ahead of its ranking and percentage last year of 39.7%. It replaced Budgeting and Revenue Cycle Management, which slipped to 29.7% and fourth place this year compared to 48.8% last year. Employee Development and Engagement was the third most cited as top priority this year at 36.5%, whereas last year “Talent Management and Development” was seventh in the ranking and given priority by only 20.2% of respondents in 2022.

What Do These Results Mean?

The persistence of recruiting and retaining staff as a critical issue facing these organizations, and the declining priority on budgeting and revenue cycle management, makes me think that perhaps the financial impact of COVID and the tumult it created has begun to settle. The focus on staff recruitment and retention may also reflect that if high vacancies and turnover rates remain, revenue stability will be affected since service demand has not declined and meeting that demand requires a high-functioning team.

Workers continue to be in short supply with vacancy rates up to 40% in the industry and, even though salaries have risen anywhere from 4% to 25% in different sectors, employees are still leaving, often citing corporate culture as a reason. As a result, a vicious cycle is created. In a 2022 Behavioral Health Business white paper Solving the Staffing Shortage: The power of recovery in rebuilding and retaining staff, the CEO of Holding the Hope, Mary Jadwisiak, describes the cycle this way: increased service demand (more clients or reduced staffing levels) creates burnout among staff, which leads to attrition and staff shortages. This leads to reduced productivity and increased stress. The remaining staff is overworked by trying to make up the gap from the vacancies and from new staff who are less experienced and productive, which continues the cycle by creating more attrition.

How to Break the Cycle

Holding the Hope recommends using the Guiding Principles of Recovery (SAMHSA) and aligning them with business practices to reverse the cycle. In the Behavioral Health Business white paper, she states, “The guiding principles of recovery are not just about wellbeing – they create a company-wide unification… [ensuring the organization is] the place where everyone wants to work and everyone wants to stay.” She outlines a three (3)-step process: assessment, commitment, and engagement.

In the first step, recovery principles are introduced across the organization as operating principles, not limited to clinical processes or outcomes. Each department is assessed separately to determine its members’ knowledge and understanding of the principles. Second, a plan is made to implement the principles in each department incrementally – one change at a time. The final step is engagement. Jawisiak’s organization brings national experts and frequent coaching to support the transition across the organization.

The approach applies to an organization the concept that to help others in crisis you must help yourself first. By making sure the organization’s culture and practices align with its client mission (recovery), staff is more engaged, likely to remain, and be productive. Holding the Hope believes an atmosphere of trust, respect, and stability emerges as a result of this approach to staff engagement.

The table below is adapted from the Behavioral Health Business white paper, quoting the Recovery Principles and placing each one next to a corresponding question they believe can get an organization started in the work of aligning recovery principles to business practices.

Recovery …

Ask yourself …

Emerges from hope

Do you know what gives staff members hope?

Is person-driven

How do you provide staff with autonomy?

Occurs via many pathways

Are your staff members locked into strict protocols?

Is holistic

Does your personnel know that everyone, from maintenance to medication, has a role in recovery?

Is supported by peers and allies

How do your staff members find mutual support?

Is supported through relationships and social networks

Are your staff members caught up in interdepartmental conflict?

Is culturally based and influenced

How is your agency’s culture formed and reinforced? Do you consider recovery to be part of the organization’s culture?

Is supported by addressing trauma

How do you mitigate secondary trauma?

Involves individual, family, and community responsibility

How are your staff member’s strengths and responsibilities infused throughout your agency’s operations?

Is based on respect

Does your staff feel respected? How do you know?

As organizations grapple with staff shortages and the need to train and retain staff, this seems an approach that could improve retention and more closely align organizational mission with business practices.

About the Author

Maggie Labarta

Maggie Labarta is Founder and Consultant at Impact Non-profit Consulting, having previously retired as CEO of Meridian Behavioral Healthcare. Labarta holds a Ph.D. in Clinical and Community Psychology and has extensive experience in both administration and clinical practice. She also has particular expertise in strategic planning, data and analytics as management tools, and organizational development. She provides consultative services for numerous community organizations.

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