A Relational Workforce Capacity Approach to Trauma-Informed Care Implementation: Staff Rejection Sensitivity As Potential Barrier to Organizational Attachment

Background: Research establishing the importance of trauma-informed care (TIC) in human service organizations has been accumulating over the last decade. There is little understanding, however, of the impact of the transition to TIC on the workforce, as the provision of TIC requires a shift from behavior-based to relational services. This study examines the relationship between staff rejection sensitivity (a psychological concept grounded in histories of loss and trauma) and organizational attachment among several mental health agencies transitioning to TIC. Organizational attachment refers to the workforce's affective commitment to the organization, which, in turn, shapes turnover intentions. Specifically, this study examines: 1) whether rejection sensitivity predicts organizational attachment? And 2) whether the association between rejection sensitivity and organizational attachment could be accounted for by staff turnover intentions? We hypothesized that staff with higher rejection sensitivities would be less likely to express an attachment to their agency, which in turn, would increase their intent to turnover. The goal of this work is to connect relational and organizational theory to inform implementation science.

Methods: Data was collected between 2016 – 2019 from 180 frontline staff, supervisors, and administrators working for three Northeastern U.S. mental health agencies. These agencies have begun to implement the Attachment, Regulation, and Competency (ARC) Model into their outpatient and residential programs. Data was analyzed using a stepwise OLS regression model. Organizational attachment was measured using affective, normative, and continuance Commitment measures (Meyer & Allen, 1997). Rejection sensitivity was measured using the Rejection Sensitivity Questionnaire, Adult version (A-RSQ) (Downey & Feldman, 1996), turnover intent was measured using the Turnover Intentions Scale (Irving et al., 1997), and staff were also asked about their previous TIC training experience.

Findings: Rejection sensitivity was significantly associated with organizational attachment (β = -.39, p <.001), accounting for 6% of the variance in organizational attachment. In our second model that layered in both rejection sensitivity and intent to turnover, we accounted for 17% of the variance in org attachment and both rejection sensitivity (β = -.31, p <.01) and intent to turnover (β = -.29, p <.001) significantly predicted organizational attachment. The third model layered in staff demographic variables, and both rejection sensitivity (β = -.26, p <.05) and intent to turnover (β = -.29, p <.001) retained significance, and staff education also significantly predicted organizational attachment, with higher education predicting lower levels of organizational commitment (β = -.15, p <.05), in a model accounting for 22% of the variance in organizational attachment.

Implications: This study builds theory related to the inter-relationship between staff characteristics and relationship expectancies around rejection, and organizational relationships, which is currently outside the focus of most research. Findings demonstrate that staff relational characteristics may influence organizational processes and be one important overlooked variable in efforts to understand staff turnover. Supportive organizational strategies are one intervention to mitigate these effects.