Initially, we planned a randomized trial with a wait-list control group, but staff scheduling conflicts made randomization difficult. We then shifted to a pre-post design, whereby staff selected one of several dates of training. We also added an additional baseline assessment to examine change over time before any intervention (sequenced as an AAB within-subjects design).
Participants were employed at a public agency providing comprehensive mental health and substance abuse services in a large Midwestern city. At the time of the study, the agency had 530 employees, of which 60% were white and 79% were female. All employees, including direct-care staff, administrators, and support staff, were eligible to participate and were recruited through e-mails and flyers advertising a test of a burnout reduction program. Potential participants were directed to a Web site to learn more about the study, provide informed consent, and register for training. Once participants registered, a research assistant contacted them via e-mail to confirm participation and sent reminder e-mails before the training and the follow-up surveys.
Participants were asked to complete a baseline survey at registration and a second baseline survey on the morning of the training session (participants from the first training session completed only one baseline survey at registration). The same measures were readministered six weeks after training. Participants received a $15 gift card for each survey completed. All procedures were approved by the authors' institutional review board. Burnout was assessed with the Maslach Burnout Inventory (8
), a widely used measure of emotional exhaustion, depersonalization, and personal accomplishment. The subscales have shown good internal consistency, stability over time, and convergent validity with related constructs (8
). Job satisfaction was assessed with five items from the Job Diagnostic Survey, which has shown good internal consistency (9
) and evidence of convergent and divergent validity (10
). Intentions to leave their position were assessed by two items: “How often have you seriously considered leaving your job in the past six months?” (rated from 1, never, to 6, several times a week) and “How likely are you to leave your job in the next six months?” (rated from 1, not likely at all, to 4, very likely). Staff views of consumers were measured with the Consumer Optimism scale. Staff were asked to think about consumers with whom they currently work and estimate how many of them they expect will have specific outcomes (for example, housed or employed) on a 5-point scale ranging from 1, almost all, to 5, none, with items recoded such that higher scores indicate more optimism. This 16-item scale has good internal consistency and correlates with related constructs (11
The training was provided as a oneday workshop (six hours long) at a local hotel. Training included a brief introduction, burnout prevention principles, and experiential exercises and skill building in six major areas: contemplative practices (for example, mindfulness and meditation), social (for example, developing support and setting limits), physical (for example, body scan), cognitive-philosophical (for example, cognitive restructuring and values clarification), imagery, and other self-care activities. Information was presented in a lecture format, interspersed with individual, dyadic, and group activities. A conceptual framework for understanding burn-out was presented and consisted of a functional analysis and steps for relapse prevention. Participants were provided with a toolkit with which they were encouraged to identify personal burnout warning signs and triggers and to outline a follow-up personalized burnout prevention plan. Each participant attended only one workshop. Attendance at the five workshops ranged from ten to 28 participants. At the end of the training day, 91% (N=76) of the participants rated the overall training as moderately helpful or very helpful.
The primary purpose of the pilot study was to examine the feasibility and preliminary effectiveness of the training program. First, we identified participants and compared them with those who registered for the training but did not attend. Next, we examined changes over time in scores related to burnout, job satisfaction, intentions to leave the position, and staff views of consumers. For the total sample, we used paired t tests to compare the results of the first baseline survey with those of the six-week follow-up. For the subsample that had two completed baseline measures (N=58), we used repeated-measures analyses of variance to examine changes over time, with post hoc comparisons between time periods.