(PS5-C73) Therapist Burnout: Associations with Contraindicated Behaviors in Sessions for Youth in School-based Mental Health Services

Background: Therapist burnout is a widespread concern, with as many as 25-35% of therapists experiencing burnout and depression to the extent that it interferes with their work capabilities (Rupert & Morgan, 2005). Existing literature has explored the effects of burnout on therapists, but little research has examined how therapist burnout impacts the quality of services provided to clients (Rupert & Morgan, 2005). Long-term chronic stress, particularly in the context of COVID-19, has resulted in both greater demand for mental health services and increased burnout in therapists (Surgeon General Advisory, 2021). Given the significant strain on the mental health care system posed by the pandemic, this study seeks to address a gap in the literature by examining the association between therapist burnout and therapist use of non-evidence-based behaviors considered to be harmful to youth or families seeking school-based mental health services (SMHs).

Methods: As part of a multi-site cluster-randomized trial to enhance youth and family engagement in SMHs, 280 treatment sessions from 167 school-based providers and their 175 youth clients identified as high-risk for treatment disengagement were audio-recorded, transcribed, and qualitatively coded for frequency of provider-initiated contraindicated behaviors as well as the type of contraindicated behavior that occurred. Contraindicated behaviors were categorized into six primary types: (1) Conflict (e.g., arguing, criticizing, or threatening); (2) Other Non-Evidence Use (e.g., contraindicated behaviors not otherwise captured in other categories; (3) Negative Emotions (e.g., appealing to fear, eliciting shame or guilt, or manipulating the client’s feelings); (4) Telling (e.g., engaging in inappropriate self-disclosure); (5) Respect (e.g., communicating insensitivity or invalidating client’s experiences or identities); and (6) Advice (e.g., giving advice or using direct persuasion without teaching, reinforcing, or consolidating generalizable skill). Therapists (n=167) also self-reported their level of professional burnout, captured by the Organizational Readiness for Change (TCU ORC-D) and Therapist Background Questionnaire (TBQ). Given that child treatment sessions (level-1) were nested under therapists (level-2), multilevel modeling analyses will be conducted to look at associations between therapist burnout and the frequency and type of contraindicated behaviors occurring in sessions.



Results:   Across 280 sessions, 61.1% of sessions (n = 171) included at least one instance of provider-initiated contraindicated behavior. 707 unique instances of provider-initiated contraindicated behaviors were identified across sessions, and inter-rater reliability for identifying the six types of contraindicated behaviors ranged from fair to excellent (κ = 0.41 - 0.92). Further examination of the relationship between self-reported levels of provider burnout and the frequency and type of contraindicated behaviors present across treatment sessions has the capacity to yield rich data that can inform community-based service organizations on how to best support therapists in providing high-quality evidence-based care.