Rinad S Beidas1, Rebecca E Stewart1, Courtney Benjamin Wolk1, Danielle R Adams1, Steven C Marcus1, Arthur C Evans1, Kamilah Jackson1, Geoffrey Neimark1, Matthew O Hurford1, Joan Erney1, Ronnie Rubin1, Trevor R Hadley1, Frances K Barg1, David S Mandell1. 1. Dr. Beidas, Dr. Stewart, Dr. Benjamin, Ms. Adams, Dr. Hadley, and Dr. Mandell are with the Department of Psychiatry and Dr. Barg is with the Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia (e-mail: rbeidas@upenn.edu ). Dr. Marcus is with the School of Social Policy and Practice, University of Pennsylvania, Philadelphia. Dr. Evans and Dr. Hurford are with the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Philadelphia. Dr. Jackson, Dr. Neimark, Ms. Erney, and Dr. Rubin are with Community Behavioral Health, Philadelphia.
Abstract
OBJECTIVES: Community mental health clinics are increasingly utilizing independent contractors to provide clinical services. At the same time, many organizations are participating in initiatives intended to increase implementation of evidence-based practices (EBPs). The primary aim of this study was to understand the associations of utilizing independent contractors with clinician knowledge and attitudes toward EBPs and organizational culture and climate. The study also sought to understand the potential impact of using independent contractors on mental health services delivery from the perspective of organizational leadership. METHODS: Quantitative data were collected from 130 therapists in 23 organizations; qualitative data were collected from executive administrators in nine of the 16 organizations participating in EBP initiatives sponsored by the City of Philadelphia. Regression with random effects was used to estimate the associations between worker status (contractor or employee) and clinician attitudes toward EBPs, knowledge of EBPs, and organizational culture and climate. Qualitative inquiry was used to understand the impact of reliance on independent contractors on organizational participation in EBP initiatives. RESULTS: Independent contractors endorsed less positive attitudes toward EBPs and scored lower on knowledge of EBPs. Interviews revealed four main themes: reasons for using independent contractors, general consequences of using independent contractors, specific impact of independent contractors on participation in EBP initiatives, and suggestions for alternatives. CONCLUSIONS: A growing number of community mental health clinics rely on independent contractors. There may be consequences of this shift that deserve exploration.
OBJECTIVES: Community mental health clinics are increasingly utilizing independent contractors to provide clinical services. At the same time, many organizations are participating in initiatives intended to increase implementation of evidence-based practices (EBPs). The primary aim of this study was to understand the associations of utilizing independent contractors with clinician knowledge and attitudes toward EBPs and organizational culture and climate. The study also sought to understand the potential impact of using independent contractors on mental health services delivery from the perspective of organizational leadership. METHODS: Quantitative data were collected from 130 therapists in 23 organizations; qualitative data were collected from executive administrators in nine of the 16 organizations participating in EBP initiatives sponsored by the City of Philadelphia. Regression with random effects was used to estimate the associations between worker status (contractor or employee) and clinician attitudes toward EBPs, knowledge of EBPs, and organizational culture and climate. Qualitative inquiry was used to understand the impact of reliance on independent contractors on organizational participation in EBP initiatives. RESULTS: Independent contractors endorsed less positive attitudes toward EBPs and scored lower on knowledge of EBPs. Interviews revealed four main themes: reasons for using independent contractors, general consequences of using independent contractors, specific impact of independent contractors on participation in EBP initiatives, and suggestions for alternatives. CONCLUSIONS: A growing number of community mental health clinics rely on independent contractors. There may be consequences of this shift that deserve exploration.
Authors: Michael A Hoge; Manuel Paris; Hoover Adger; Frank L Collins; Cherry V Finn; Larry Fricks; Kenneth J Gill; Judith Haber; Marsali Hansen; D J Ida; Linda Kaplan; William F Northey; Maria J O'Connell; Anita L Rosen; Zebulon Taintor; Janis Tondora; Alexander S Young Journal: Adm Policy Ment Health Date: 2005 May-Jul
Authors: Michael A Hoge; Gail W Stuart; John Morris; Michael T Flaherty; Manuel Paris; Eric Goplerud Journal: Health Aff (Millwood) Date: 2013-11 Impact factor: 6.301
Authors: Michael A Hoge; John A Morris; Gail W Stuart; Leighton Y Huey; Sue Bergeson; Michael T Flaherty; Oscar Morgan; Janice Peterson; Allen S Daniels; Manuel Paris; Kappy Madenwald Journal: Psychiatr Serv Date: 2009-07 Impact factor: 3.084
Authors: Rinad S Beidas; Steven Marcus; Courtney Benjamin Wolk; Byron Powell; Gregory A Aarons; Arthur C Evans; Matthew O Hurford; Trevor Hadley; Danielle R Adams; Lucia M Walsh; Shaili Babbar; Frances Barg; David S Mandell Journal: Adm Policy Ment Health Date: 2016-09
Authors: Rinad S Beidas; Steven Marcus; Gregory A Aarons; Kimberly E Hoagwood; Sonja Schoenwald; Arthur C Evans; Matthew O Hurford; Trevor Hadley; Frances K Barg; Lucia M Walsh; Danielle R Adams; David S Mandell Journal: JAMA Pediatr Date: 2015-04 Impact factor: 16.193
Authors: Rinad S Beidas; Rebecca E Stewart; Danielle R Adams; Tara Fernandez; Susanna Lustbader; Byron J Powell; Gregory A Aarons; Kimberly E Hoagwood; Arthur C Evans; Matthew O Hurford; Ronnie Rubin; Trevor Hadley; David S Mandell; Frances K Barg Journal: Adm Policy Ment Health Date: 2016-11
Authors: Rinad Beidas; Laura Skriner; Danielle Adams; Courtney Benjamin Wolk; Rebecca E Stewart; Emily Becker-Haimes; Nathaniel Williams; Brenna Maddox; Ronnie Rubin; Shawna Weaver; Arthur Evans; David Mandell; Steven C Marcus Journal: Behav Res Ther Date: 2017-08-25
Authors: Laura C Skriner; Courtney Benjamin Wolk; Rebecca E Stewart; Danielle R Adams; Ronnie M Rubin; Arthur C Evans; Rinad S Beidas Journal: J Behav Health Serv Res Date: 2018-04 Impact factor: 1.505
Authors: Byron J Powell; David S Mandell; Trevor R Hadley; Ronnie M Rubin; Arthur C Evans; Matthew O Hurford; Rinad S Beidas Journal: Implement Sci Date: 2017-05-12 Impact factor: 7.327