If you build it, they will stay! Sustaining evidence-based practices for the treatment of substance use disorders through investment in workforce retention

Much attention has been paid to the persistent gap between the development of effective, evidence-based practices (EBPs) for substance use disorders (SUDs) and their routine delivery in real-world clinical and community settings. The struggle to routinely implement and sustain EBPs with fidelity has been attributed to a combination of systemic, organizational and provider-level barriers. These barriers are compounded by high rates of staff turnover, as behavioral health systems must continuously reinvest in professional development despite their limited resources. Intermediary Purveyor Organizations (IPOs) such as the Addiction Technology Transfer Centers (ATTCs) have been engaged to support capacity building within agencies or systems to implement and sustain EBPs but must also contend with these challenges. As we expand implementation science efforts to explore the contextual factors that influence EBP implementation, including the impact of IPOs, it is important to consider that failure to improve staff turnover rates will only undermine these scientific investments. From the perspective of purveyors of technical assistance, the authors first reflect on the landscape of staff turnover, then offer system- and organization-level strategies for improving staff retention rates.