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Recruitment Intervention Strategies

Recruitment and Retention Toolkit   Recruitment Intervention Strategies   Introduction to the Realistic Job Preview [2.2.1a]   Case Studies: How Realistic Job Previews Have Been Applied in Behavioral Health [2.2.1.i]

Case Studies: How Realistic Job Previews Have Been Applied in Behavioral Health


The following case studies are excerpted from a Center for Medicare and Medicaid Services (CMS) report. Only those sections that describe Realistic Job Previews are included.

Name of Report:  Centers for Medicare and Medicaid Services Direct Service Workforce Demonstration Promising Practices in Marketing, Recruitment, and Selection Interventions
Funded by: Centers for Medicare and Medicaid Services
Prepared by:  University of Minnesota, Research and Training Center on Community Living, in partnership with The Lewin Group
Date:  December 2006


The Centers for Medicare and Medicaid Services (CMS) initiated the Demonstration to Improve the Direct Service Community Workforce to test the effectiveness of different workforce interventions on the retention and recruitment of Direct Service Workers (DSWs). Part of the President’s New Freedom Initiative, this demonstration is one of several CMS grant programs designed to help States strengthen and improve the quality of their home and community based long-term care service systems, which support individuals with disabilities to live and work in the community…The CMS demonstration program presents an opportunity for researchers and policymakers to better understand the issues of recruitment and retention in the direct service workforce and to develop effective interventions and strategies designed to effectively address the challenges… The term DSW is used to refer to the professionals who provide direct support to individuals with long term support.” 
The report highlights some prior studies on Realistic Job Previews:
“Several studies have reported that providing realistic job previews can be effective in reducing turnover. Among newly hired residential DSWs, those who had fewer unmet expectations about their jobs and organization were significantly less likely to quit in the first 12 months (Larson, Lakin & Bruininks, 1998) [1]. In one meta-analysis, RJPs improved retention rates by 9 to 17 percent (McEvoy & Cascio, 1985); another found that RJPs increased retention of employees by 12 percent for organizations with annual retention rates of 50 percent, and 24 percent for organizations with annual retention rates of 20 percent (Premack & Wanous, 1985) [2]. A meta-analysis conducted by Phillips (1998) reported that RJPs delivered after a job offer has been made, but before an applicant decides whether to accept a position, are more effective in reducing turnover than those conducted before a job offer or after hire. RJPs that include an opportunity for the applicant to ask questions during the process are the most effective in reducing turnover; while not quite as effective, written and videotaped RJPs also aid in reducing turnover. Selection is the process of deciding from amongst the applicants the one who is best qualified for an opening. In one study, 15 percent of all new DSW employees were fired in the first 12 months of employment (Larson, Lakin & Bruininks, 1998). Improving selection practices can reduce turnover due to selection errors.”
Out of the 2003 and 2004 grantees involved in the project, Delaware, Kentucky and Washington used the Realistic Job Preview as a marketing, recruitment, and selection intervention to be studied.”

Similarities to the Behavioral Health Workforce

As the report states, “the DSW turnover results in people experiencing difficulty: 
  1. Developing and maintaining relationships with their staff that are based on respect, trust, and knowledge of one’s needs;
  2. Maintaining continuity in their support and care; and
  3. Developing new treatments and interventions that are based on a comprehensive and long-term understanding of the person’s unique needs and preferences.”
The report highlights another similarity to the current behavioral health workforce, stating that, “the ability to market positions and recruit qualified potential new workers that are committed to the profession and will stay in their positions is directly related to the ability of organizations to provide high quality care and support...High vacancies are caused in part by low unemployment, increased demand for DSWs, and a shrinking supply of people from which to choose…Low wages contribute to high vacancy rates in community health and human services because the wages are not high enough to attract new workers to the fields.”
A Realistic Job Preview is defined in the report as, “providing applicants with specific, realistic, and consistent information about the job of direct support (from the perspective of people who do the work) before a decision to accept employment is made… In one study, 15 percent of all new DSW employees were fired in the first 12 months of employment (Larson, Lakin & Bruininks, 1998) [3]"...Improving selection practices can reduce turnover due to selection errors.

Case Studies: Planning and Implementation of Realistic Job Previews

The Delaware Project [2.2.1.i.1]

Case Studies: Preliminary Outcomes and Findings

The report states, “Each DSW grantee conducted an evaluation of their activities, measuring the impact of their demonstrations on key outcome variables such as turnover and retention. These evaluations are ongoing at the time of this report’s completion, but two of the grantees discussed in this report were able to document some changes over time. Aggregating data across all participating agencies, Kentucky documented a drop in turnover rates from 43 percent to 29 percent over a 2-year period. Over the same period, average retention per employee increased from 31 months to 36 months. The realistic job preview intervention certainly contributed to these changes.

Case Studies: Challenges and Barriers to Implementation

According to the report, “while each of the grantees experienced success with many of their marketing, recruitment and selection strategies, each also reported challenges and barriers to implementation. One significant challenge was developing and maintaining partnerships. When partners withdrew from project activities this often resulted in the process and timelines for completing activities to slow down. Many of the grantees involved in marketing, recruitment, and selection interventions had not planned for the length of time it would take to evolve strong partnerships and solidify and evolve unique roles and responsibilities of partnering organizations. Obtaining the cooperation of participating agencies regarding developing interventions and using and implementing project products was also difficult for many grantees. This resulted in many demonstration projects having longer planning periods than anticipated and also in varied implementation and use of the interventions across project partners. Another challenge was finding DSWs to participate in the activities of the projects. In some situations this was related to problems getting information out to provider organizations, the importance of using effective and easy to-understand recruitment materials, and in some situations there were financial barriers to worker participation.”

Case Studies: Conclusion

The CMS-funded Direct Service Workforce demonstrations have yielded many promising practices in the areas of marketing, recruitment, and selection of employees. Many of these interventions were based on well-researched and established practices, and they could be replicated and used by long-term care organizations across the United States. For these interventions to be sustained and replicated, it will be important for grantees and CMS to focus considerable effort on disseminating information regarding these specific practices and their related tools and products. Future research would help stakeholders understand the costs and benefits associated with these interventions within organizations and for people who direct their own services. It will also be important to take additional steps to better understand how the use of these interventions makes a difference in the lives of the individuals who are supported by Direct Service Workers.
The Final Report on the Case Studies [2.2.1.i.4] provides information from the evaluation and follow up completed in 2008.

[1] Larson, S.A., Lakin, K.C., & Bruininks, R.H. (1998). Staff recruitment and retention:
study results and intervention strategies. Washington, DC: American Association on Mental Retardation.
[2] Permack, S., & Wanous, J. P. (1985). When does it hurt to tell the truth? The effect of realistic job previews on employee recruiting. Public Personnel Management. Fall, 413-422.
[3] Larson, S.A., Lakin, K.C., & Bruininks, R.H. (1998). Staff recruitment and retention:
study results and intervention strategies. Washington, DC: American Association on Mental Retardation.

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