Wraparound Blog

A Study of Turnover Among Wraparound Care Coordinators and Supervisors

June 12, 2017 | Janet Walker

Part 1: Description of the Study and Impacts of Turnover

"Staff turnover in mental health service organizations is an ongoing problem with implications for staff morale, productivity, organizational effectiveness and implementation of innovation, such as the introduction of evidence-based practices." (Aarons & Sawitzky, 2006, p. 289)

Staff from the National Wraparound Initiative and the National Wraparound Implementation Center are in frequent contact with stakeholders from Wraparound programs across the country, and there is no shortage of anecdotal evidence about the negative impacts that staff turnover can have on children and families, as well as on other staff in agencies that provide Wraparound.

The quote from Aarons and Sawitzky sums up the general perception in the field that turnover is an ongoing and serious problem. But surprisingly, there is relatively little research on turnover in human service organizations. The limited research that does exist has found that:

  • Public mental health services typically experience turnover rates of at least 20-30%.
  • The United States Department of Labor estimates the cost of replacing a worker is at least 33% of annual salary.
  • Turnover’s impact on mental health clients has not been well investigated, but is assumed to be problematic.
  • Organizational commitment and job satisfaction help to prevent turnover.
  • Burnout is the most commonly cited cause of turnover in mental health services organizations, and burnout can be significantly influenced by organizational culture, as well as work-based social and professional support.

When we looked for studies and reports about turnover in Wraparound, we were not able to find enough information to address the many questions we had. For example: Are turnover rates in agencies that provide Wraparound similar to rates for other public mental health services? Is there wide variation in turnover rates, such that some agencies experience much higher and others much lower turnover? And if so, what are the factors that might contribute to that variation? Knowing the answers to these sorts of questions could suggest strategies that might be effective for retaining staff, increasing job satisfaction and, ultimately, contributing to a more experienced and more effective Wraparound workforce.

This line of reasoning led us to undertake a study focused on understanding more about turnover in Wraparound. In the early part of this year, we created an online survey about turnover, and recruited broadly for participants. In the early spring, we closed the study and began to analyze what we’d found. We are currently interviewing some of the survey participants to get a more in-depth description of what they think lies behind turnover and retention in their agencies.

This blog post is the first in a series that will discuss the findings from this research. This post will describe who took part in the survey, as well as their perceptions of the impacts that turnover has. In subsequent posts, we’ll go on to discuss the other findings from the survey and from the interviews.

We collected data during the winter of 2016-17, and got 331 complete responses. Respondents were primarily Wraparound care coordinators, supervisors and administrators. Respondents came from a total of 39 states and most reported that their agencies were located in large or medium metropolitan areas, though there were substantial numbers of respondents from small cities and rural areas as well.

One interesting finding was that more than two thirds of respondents reported that the caseloads for care coordinators in their agencies was 12 or fewer (i.e., in line with recommendations from the NWI), though the remainder reported higher caseloads.

We were somewhat startled to find that the average one-year turnover rate reported by respondents was just about 40%. However, turnover varied widely. Seventeen percent of respondents reported no turnover at all among care coordinators in their agencies during the past year, while almost a third of respondents reported more than 50% turnover. Another third of respondents reported turnover of 25-50%. Respondents also estimated that just under half of the turnover was accounted for by care coordinators leaving during their first year.

Percentage of Wraparound Care Coordinators Who Left their Jobs at Respondents’ Agencies During the Past Year

Organizations with Care Coordinator Turnover

About 40% of respondents described turnover among Wraparound care coordinators in their agency as a serious problem. When asked about the negative impacts that turnover had, more than 80% of respondents said that turnover was a significant problem because children and families enrolled in Wraparound suffered when their care coordinators changed. Two-thirds of the respondents noted that turnover among care coordinators was a problem because it increased the workload for the remaining care coordinators, and about half of the respondents noted that turnover was problematic because it increased the workload for supervisors. About half the respondents noted that turnover among care coordinators was problematic because the quality of Wraparound provided was lower, and because turnover caused increased costs to the agency for hiring, training and orientation.

Possible problems caused by CC turnover % of respondents saying this is a "significant" problem in their agencies
Children and families suffer when CCs change 81.2
Increased workload of other CCs 66.7
Increased workload of supervisors 52.1
Lower quality of Wrap provided 51.8
Training and other costs are higher 50.2
New people can’t work as effectively with other systems 30.1
Hard to fit people into the team that provides Wraparound 15.1

Next month, we’ll post more about the findings from the survey, including top reasons for turnover and retention.

What has your experience been regarding turnover among Wraparound care coordinators? Do you think it’s a problem and, if so, do you have ideas about what could be done to decrease turnover? Feel free to leave your comments and thoughts below!

This document was prepared with support from the National Technical Assistance Network for Children’s Behavioral Health operated by and coordinated through the University of Maryland, and under contract with the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Contract #HH280201500007C. The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).

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