In order to examine this question, Dr Beidas and colleagues surveyed 130 therapists from 23 different Philadelphia public mental health clinics. Nearly 60% of these therapists were independent contractors and the rest were salaried employees.

The researchers found that compared with salaried employees, independent contractors reported they would be less willing to adopt EBPs even if they found them appealing; specifically, they scored .28 points lower on a 4-point scale measuring this attitude. Contractors also showed significantly less knowledge of EBPs for children with psychiatric disorders, scoring about 5 points lower on a 160-point scale measuring this knowledge.

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Dr Beidas hypothesized that it was likely that these contractors did not have access to the professional development opportunities provided to salaried staff. Interviews with executive administrators at nine of the agencies confirmed that this was the case: the agencies had not sent contractors to the EBP training programs attended by their salaried staff.

“The agencies seemed less willing to invest in the professional development of their independent contractor therapists, because they perceived them as more likely to leave once they found a more permanent position,” Dr Beidas said.

The interviews also confirmed that the agencies tend to hire contractors in order to stay within increasingly tight budgets.

“Because of its modest sample size, this study is preliminary, but we hope it opens up a new research agenda nationally to understand the implications of this shift in the workforce model in public mental health clinics — particularly in regard to EBPs — where we think there may be a collision between this new contractor-based workforce model and efforts to improve services,” Dr Beidas said.

As part of an ongoing National Institutes of Health-funded study, Dr Beidas and her colleagues plan to gather further data on this issue. In the future, they may suggest ways to increase independent contractors’ knowledge of EBPs, such as by increasing professional development opportunities for contractors, or by creating a culture where contractors are more integrated into the fabric of the organization.


Beidas RS, Stewart RE, Wolk CB, et al. Independent Contractors in Public Mental Health Clinics: Implications for Use of Evidence-Based Practices. Psychiatr Serv. 2016; doi:10.1176/