http://orcid.org/0000-0002-6857-8410
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Abstract
Background: Counselor workforce turnover is a critical area of concern for substance use disorder (SUD) treatment providers and researchers. To facilitate the adoption and implementation of innovative treatments, attention must be paid to how SUD treatment workforce issues affect the implementation of clinical effectiveness research. Multiple variables have been shown to relate to turnover, yet reasons that are specific to conducting research have not been systematically assessed. Methods: In a randomized clinical trial testing a sexual risk reduction counselor training intervention, 69 counselors at 4 outpatient SUD treatment sites (2 opioid treatment programs [OTPs], 2 psychosocial) were enrolled and randomized to 1 of 2 training conditions (Standard vs. Enhanced). Study counselor and agency turnover rates were calculated. Agency context and policies that impacted research participation were examined. Results: Study turnover rates for enrolled counselors were substantial, ranging from 33% to 74% over approximately a 2-year active study period. Study counselor turnover was significantly greater at outpatient psychosocial programs versus OTPs. Counselor turnover did not differ due to demographic or training condition assignment. Leaving agency employment was the most typical reason for study counselor turnover. Conclusions: This secondary analysis used data from a multisite study with frontline counselors to provide a qualitative description of challenges faced when conducting effectiveness research in SUD treatment settings. That counselors may be both subjects and deliverers of the interventions studied in clinical trials, with implications for differential impact on study implementation, is highlighted. We offer suggestions for researchers seeking to implement effectiveness research in SUD clinical service settings.
Acknowledgments
The authors wish to thank Esther Ricardo-Bulis, Research Coordinator, and Carrie Shriver, Research Assistant, for their assistance in gathering site-specific data.
Additional information
Funding
Notes on contributors
Mary A. Hatch-Maillette
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Robin Harwick
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
John S. Baer
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Tatiana Masters
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Kasie Cloud
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Michelle Peavy
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Katharina Wiest
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Lynette Wright
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Blair Beadnell
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.
Elizabeth A. Wells
M.H-M, R.H., J.B., T.M. and E.W. drafted the manuscript. K.C., M.P., and L.W. participated in drafting the manuscript. T.M. and B.B. conducted the data analyses. All co-authors were involved in data collection, study design, provision of scientific critiques, and manuscript review prior to submission. The authors declare they have no conflicts of interest.