Abstract
Strategies are urgently needed to address the mental health workforce crisis in the United States that threatens essential care for people living with psychiatric disabilities. Assertive Community Treatment (ACT) is a cornerstone of community mental health care and workforce turnover negatively impacts patient experiences and outcomes. The present study aims to examine malleable supervisory strategies for reducing the intention to leave among the ACT workforce in order to reduce voluntary turnover. A cross-sectional observational survey of the largest sample yet of ACT team members (N = 334) from 80 ACT teams working in four States assessed team-level and team members' supervision characteristics theorized to predict supervisory working relationships and team members' intention to leave their positions. Unadjusted and adjusted hierarchical linear regression models examined factors at multiple levels (i.e., team member, team) in relation to team members' intention to leave and accounted for the clustering of team members within teams. Adjusted models indicated that team member and team factors were negatively associated with team members' intention to leave. Specifically, higher levels of transformational leadership and strong supervisory working alliances had a significant association with reduced intention to leave. Additionally, empirically supported supervision strategies and transformational leadership were significantly associated with stronger supervisory working alliances. Strategic workforce investment in the development of ACT team leaders and their use of transformational leadership and empirically supported supervision strategies may represent a promising pathway to promote strong supervisory working alliances and retention of essential ACT team members.