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Penn Study Finds Drawbacks to Cost-Saving Measures in Public Mental Health Clinics

We would like to call your attention to recent research on the impact of staffing models on the delivery of behavioral health services. The study, conducted by partners at the University of Pennsylvania, Center for Mental Health Policy and Services Research, is one of the first to investigate the relation between independent contractor employment status and service quality, specifically attitudes and knowledge of Evidence-based Practices (EBPs). They found that independent contractors had less knowledge and more negative attitudes about the use of EBPs. In qualitative interviews, agency leadership indicated that there is less investment in training and professional development for contract employees due to concerns about turnover and contract employees’ reluctance to engage in non-billable activities.

While the research stops short of finding that the use of independent contractors results in lower quality of care, this is an area of significant concern for our system. We understand that providers are turning to this staffing model to address financial challenges; however, there are important clinical implications of this staffing model. Independent contractors, including non-licensed clinicians, are not afforded professional development, training, supervision and support to ensure the delivery of quality services.

This staffing model also impacts workforce turnover, stability and continuity of care for service recipients. As a system, our priority is effective and efficient service delivery, which includes incorporating evidence-based practices.

As you know, we have been discussing staffing models for quite some time and this study serves to reinforce this important point. We need to identify strategies to support the development of a highly skilled workforce and address this staffing trend. To that end, we will be taking a number of steps to address this issue, such as:

  • Looking to address financial challenges and concerns related to staffing
  • Engaging you, and other provider agencies, to solicit additional input and recommendations
  • Including expectations that all staff receive supervision and professional development throughout all of our policies

To learn more about the study, please take a look at a recent media article in the Philly Voice. Additionally, we encourage you to learn more about DBHIDS’ Evidence-based Practice and Innovation Center to better understand how we aim to work with you to further promote the delivery of behavioral health evidence-based practices throughout Philadelphia.