Cost-Saving Workforce Trend vs. Evidence-Based Practice Implementation
Economically driven changes in workforce logistics at community mental health clinics may be impeding the spread of evidence-based treatment methods according to a new study led by University of Pennsylvania Perelman School of Medicine Assistant Professor Rinad Beidas.
Published in the journal, Psychiatric Services, the study details how, in an effort to reduce costs, community mental health clinics have increasingly switched to using outside contractors to provide their clinical services. At the same time many of those facilities are attempting to implement the evidence-based therapy practices favored by the Affordable Care Act.
Beidas, PhD and an LDI Senior Fellow, is Director of Implementation Research at the Perelman School's Center for Mental Health Policy and Services Research. She specializes in the study of the dissemination and implementation of evidence-based practices for children and adolescents in community settings.
"Our quantitative results," she and her team members wrote "suggest that independent contractors reported less positive attitudes toward evidence-based practices and less knowledge compared with salaried clinicians."
Outside contract therapists are significantly cheaper because they are only reimbursed for patient visits and don't receive the benefits that employee therapists do.
The study points out that "The organizational management literature suggests that utilizing independent contractors destabilizes the workforce because it may result in conflict between salaried employees and independent contractors."
'Less professional development'
"Given that independent contractors are not employees per se," the study authors write, "organizations may be less likely to invest in their professional development, resulting in potentially poorer knowledge of and attitudes toward evidence-based practices."
In an interview with Penn Medicine News, Beidas said as part of the ongoing NIH-funded study, her team plans to gather further data on this issue. One goal is to develop potential interventions that might increase outside contractors' professional development opportunities; another is to finds ways to alter clinic culture in a manner that more thoroughly integrates outside contractors into the organization.
LDI Senior Fellows David Mandell, ScD, Associate Professor of both Psychiatry and Pediatrics at the Perelman School of Medicine; and Trevor Hadley, PhD, Professor of Psychiatry at Perelman, are members of the study research team.