Cracking the Nut: Sustaining a Trained Workforce of ACT Providers

Background

Evidence indicates challenges in maintaining trained staff within community mental health settings, including ACT. Over time, ACT providers are encountering significant change as the treatment they provide and the systems they work within continually transform. This requires ACT providers to acquire new clinical skills and ways to provide rapid responses to environmental and treatment changes, as recently illustrated by the COVID-19 pandemic. Moreover, the substantial turnover rate of behavioral health providers holds true for ACT and poses challenges for sustaining a trained workforce. This study evaluates one state’s strategy to use a Purveyor and Intermediary Organization (PIO) based on an implementation science framework to promote and sustain training for ACT providers. So-called intermediary and purveyor organizations (IPO) can provide the infrastructure to support the spread of EBPs while addressing challenges and opportunities as they emerge.

Methods

In this state, ACT was first introduced in early 1990 with 28 teams and approximately 336 providers. By 2014 the state had grown to 88 teams with 880 providers and in in 2022 ACT has 108 teams with 1103 providers. All staff were required to complete a CORE training using a blended learning approach (7 online modules and 2 live trainings) in CORE principles of ACT, Community safety, Person Centered Treatment Planning, Transition, Introduction to Specialists Role for all providers, and Role Specific Training for each specialist within 6 months of hire. A learning management system (LMS) is used to register ACT providers and track training status. Data is collected on date of hire, role on ACT, training uptake, pre and post knowledge tests and satisfaction. Incentives are provided for individual providers (CEUs) and teams (fully trained team certificates). Descriptive statistics and t-tests were employed to evaluate the knowledge and satisfaction among the trainees.

Results

Data will be presented from 2015 - 2022 covering a period where ACT grew from 88 teams to 108 teams. The selection of this timeframe was chosen to illustrate the role of the PIO in tracking training across staff turnover, training revisions and a pandemic that required different training platforms. With the additional new providers and the monthly turnover rate of 12%, overall training completion was maintained at a high rate of 77. 13% (N = 880 Providers in 2015; N= 1103 Providers in 2023). Satisfaction with the training remained high with overall satisfaction rated 4.7 on a Likert scale (1-5). In 2022, pre and post knowledge test was conducted with a subsample of 77 ACT providers indicating that knowledge significantly increased (t(77)=5.2, p <.001).

Conclusion and implications

Implementing and sustaining ACT over time is critical to successful outcomes for individuals with SMI served by ACT. Despite a fluid health care environment with frequent turnover, findings suggest that fully trained ACT workforce can be sustained, with increased knowledge and high satisfaction. With a rigorous training structure and data collection, a PIO can monitor training uptake and nimbly respond to new needs and address barriers to successful implementation of ACT.