Staff turnover in statewide implementation of ACT: relationship with ACT fidelity and other team characteristics

Abstract

Staff turnover on assertive community treatment (ACT) teams is a poorly understood phenomenon. This study examined annual turnover and fidelity data collected in a statewide implementation of ACT over a 5-year period. Mean annual staff turnover across all observations was 30.0%. Turnover was negatively correlated with overall fidelity at Year 1 and 3. The team approach fidelity item was negatively correlated with staff turnover at Year 3. For 13 teams with 3 years of follow-up data, turnover rates did not change over time. Most ACT staff turnover rates were comparable or better than other turnover rates reported in the mental health and substance abuse literature.

Figure 1. ACT staff turnover by follow-up year for cohorts 1-4

Cohort is defined by when the baseline assessment was completed. Cohort 1: early 2002; Cohort 2: Fall 2002; Cohort 3: late 2003 and early 2004; Cohort 4: late 2004 and 2005. Note: The arrows show the approximate time that Medicaid per diem began for each cohort. The change in admission criteria happened approximately one year later.

Figure 2. ACT staff turnover rates by calendar year for cohorts 1-4

Cohort is defined by when the baseline assessment was completed. Cohort 1: early 2002; Cohort 2: Fall 2002; Cohort 3: late 2003 and early 2004; Cohort 4: late 2004 and 2005. The first vertical line indicates the start of special Medicaid per diem funding for ACT (October 2004) and the second indicates a policy change of more stringent admission criteria (October, 2005).