Project Summary

Residential care workers (RCWs) who provide care and support to disabled adults in group homes are at high risk of burnout. The stress for these direct care workers has been amplified by the pandemic that has placed an additional physical, emotional, and mental health toll on RCWs.

The challenge of RCW burnout, turnover, and vacancies in congregate care for adults with behavioral health disabilities has reached crisis proportions across the nation. One in four RCWs leave their job every year and 25 percent of RCW positions go unfilled. This is described by behavioral health leaders, state agency leaders, program managers, advocacy organizations, and family members as the number one challenge and priority in providing quality care to the vulnerable population of disabled adults living in supervised group homes. The best approach to address this RCW workforce crisis is not clear. On one hand, programs aimed at improving stress management and resilience for health care workers are somewhat effective, but their effectiveness may be limited without also addressing work-related causes of burnout. On the other hand, quality improvement aimed at reducing unnecessary tasks are potentially effective, yet may have limited impact without enhancing the capacity of RCWs to manage stress and the impact of the COVID-19 pandemic. In addition, it is not clear where in the system the best approach should be targeted: at the local site level (group home) or at the level of the organization.

To address this gap in knowledge, the research team will conduct a practical research trial comparing two different system-level approaches to improving RCW well-being and resiliency to reduce burnout and staff turnover: (1) a microsystem intervention (group home level) of integrated resiliency training and task sharing (IRTTS) and (2) a mesosystem intervention (organization level) intervention of a virtual workplace improvement learning collaborative (WILC) aimed at reducing administrative burdens and increasing workflow efficiencies. The study will randomize 90 group homes and 450 RCWs to IRTTS and 90 group homes and 450 RCWs to a WILC and compare the following outcomes:

  • RCW resiliency (primary outcome)
  • Stress management and burnout
  • Depression and anxiety
  • Positive health behaviors
  • RCW turnover/retention
  • RCW sick days/absenteeism
  • Group home safety and resident incidents

In addition, the study will evaluate barriers, facilitators, and resources required to successfully implement the IRTTS and WILC interventions and will explore if outcomes differ with respect to RCW race and sex.

The study team has incorporated input from stakeholders identifying unmet needs and key priorities during six stakeholder workgroups and two meetings of the project oversight team. The team also surveyed 1,468 RCWs in group homes for adults with serious mental illness and intellectual and developmental disabilities, with more than 50 percent reporting “very serious” impact of COVID-19 on work or employment and on contact with family and friends. In addition to surveying RCWs, the study team met with behavioral health stakeholder leaders, program managers, advocacy organizations, and family members who identified vacancies, turnover, and burnout in the workforce is the clear priority in providing quality care to the vulnerable disabled adults in residential care. Monthly PCORI Working Groups (including group directors, managers, frontline staff RCWs, residents with serious mental illness and intellectual and developmental disabilities, advocacy organizations, provider leaders, and state agency leaders) shaped the study’s approach in full partnership and will continue to provide full oversight and collaboration in the project.

Results from this study will inform decision makers, managers, and frontline workers on the most effective approach to addressing the crisis of healthcare worker burnout and turnover serving vulnerable disabled adults in congregate care settings. The results of this study will also be important and relevant to very diverse workforces and will identify facilitators to future broad implementation.

Project Information

Stephen Bartels, MD, MS
Massachusetts General Hospital
$6,443,763 *

Key Dates

48 months *
November 2022
2022

*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.

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Last updated: January 20, 2023