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Retention Over Recruitment: How One Virginia CSB Cut Turnover From 23% to 16% in a Year
A recap of our fireside chat on workforce burnout in the IDD and behavioral health sector
Workforce burnout was the topic no one could stop talking about in the hallways at the Advancing States HCBS conference in Baltimore this year. So we decided to keep that conversation going. Impruvon's Erin Colgan, who leads government and health plan partnerships, sat down with Brandie Williams, Deputy Executive Director of the Rappahannock Area Community Services Board (RACSB) in Virginia, for a candid fireside chat on what burnout actually looks like on the ground — and what a data-driven, three-pronged strategy can do about it.
RACSB is one of Virginia's 40 public behavioral health and developmental services safety-net agencies, serving roughly 21,000 individuals a year across 37 locations and more than 40 programs — everything from 24-hour emergency and crisis stabilization services to DD Waiver Support Coordination, Day Support, and Residential care.
Here are the key takeaways from the conversation.
The Scope of the Problem Is National, Not Local
The discussion opened with three statistics that framed the entire conversation:
37% of Direct Support Professionals (DSPs) turn over every year (NCI State of the Workforce Survey)
88% of IDD providers reported moderate or severe staffing shortages last year (ANCOR)
H.R. 1 is projected to reduce federal Medicaid spending by roughly $911 billion over the next decade
As Erin framed it, burnout isn't a Virginia problem or a single-provider problem — it's a national, system-level risk. And most states don't see it until after an incident or an audit.
What Burnout Looks Like From the Inside
Three years ago, RACSB had 550 employees and 140 open positions — nearly a fifth of its workforce. Brandie described what that did to the staff who stayed: covering the workload of two or three people, on top of running 24-hour services the agency legally could not turn away.
The consequences were concrete, not abstract. RACSB had to temporarily close long-term residential homes and a residential crisis stabilization unit because there wasn't enough staff to serve people safely. Waitlists formed for services that were never supposed to have them.
"We had to temporarily close down a residential crisis stabilization unit... because we didn't have the staff... it just didn't seem like there was any relief in sight." — Brandie Williams, Deputy Executive Director, RACSB
Perhaps the most sobering moment of the conversation: RACSB lost an experienced, high-performing DSP over a medication error — a mistake Brandie attributed directly to the sheer volume of tasks being asked of staff.
"We had just simply asked... the staff to do too much... it was heartbreaking to see." — Brandie Williams, Deputy Executive Director, RACSB
National numbers backed up the personal ones: 64% of DSPs who leave have been with their agency less than a year, and 62% of providers turned away referrals last year due to lack of staff — which, from a state's perspective, shows up as an access problem it usually only hears about from a family or a legislator, not a data feed.
The Three-Pronged Fix
RACSB's turnaround strategy rested on three pillars:
1. Pay competitively. A market study led to what Brandie called "historic" salary adjustments — enough to unsettle the board of directors at the time, but which she now calls the best fiscal investment the agency has made. The goal: let staff hold one job instead of two or three just to make ends meet.
2. Get out of the provider's way. RACSB took a hard look at every data point and documentation requirement it had accumulated over the years — including discovering that a single same-day access assessment required staff to move through over 1,000 data elements before a client even received care. The agency stripped out duplicative and outdated requirements and used technology to make what remained easier to capture from the clinician's point of view, not just easier to report on the back end.
3. Build a career pathway. With support from the Claude Moore Foundation and Germanna Community College, RACSB built a Behavioral Health Technician program, creating an on-ramp between entry-level roles and the licensed positions that otherwise require five to six years of schooling. RACSB then worked with state legislators to make it an official, statewide credential through the Virginia Department of Health Professions — and required Virginia Medicaid (DMAS) to establish a funded rate for the position.
The Strategic Pivot: Retention, Not Recruitment
Two years ago, RACSB rewrote its strategic plan and made a deliberate choice to prioritize retention over recruitment. As Brandie put it, the agency didn't have a hiring problem — it had a keeping problem.
"We weren't keeping them... we had that turn and burn... if we wanted to build our staff, we wanted one of those priorities to be around retention." — Brandie Williams, Deputy Executive Director, RACSB
That meant running its first employee engagement survey since 2012, actually sharing the results back with staff, and tying feedback to visible changes. The results speak for themselves:
Open positions dropped from 140 to roughly 35
Annual turnover fell from 23% to 16% in a single year
What a State Can See — and When
RACSB's experience raised a bigger question for the audience: state-level leaders can't see burnout on a person's face the way a supervisor can. So what can they track?
Brandie pointed to turnover data — but not just an aggregate number. RACSB pushed Virginia to break turnover down by position (support coordinators and nursing roles stood out) and by geography, so the state could tell whether a problem was systemic or localized. Virginia has only been collecting this data for about two years.
Bracing for Impact: HR1 and Medicaid
The conversation turned candid on federal policy. RACSB's budget is roughly 25% state-funded, 4% federal, 10% local — with the majority coming through Medicaid. That makes the agency acutely exposed to H.R. 1's projected $911 billion reduction in federal Medicaid spending over a decade, on top of a landscape where 44 of 50 states already cap HCBS waiver enrollment or spending, and the share of IDD providers considering further program cuts jumped from 34% to 52% in a single year.
"We're boarding up the windows and making sure we're on the most solid foundation that we can have, so that we can help weather the storm." — Brandie Williams, Deputy Executive Director, RACSB
Locally, the stakes are personal: Brandie noted that in Virginia, over a dozen individuals on long-term disability waivers stand to lose waiver eligibility tied to upcoming citizenship-status verification requirements — people Virginia has served for decades. What’s happening in your state, and what do you need to do to prepare?
Technology: Streamline First, Then Let It Carry the Load
The chat closed on where technology fits in. Brandie's guidance for any state or agency about to fund a new system: use it to reduce steps, not to add them.
Three tests emerged for evaluating whether a technology implementation is actually working:
Does it mean fewer steps? Does the worker's shift get shorter, or does it require another login and more data entry?
Is documentation a byproduct of doing the work, rather than a separate task? Capturing information once, not five or six times.
Is the data used to fix processes before it's used to discipline people? Late documentation and near-misses should be early warning signs a state or agency can act on — not evidence gathered for write-ups.
"If you try to measure everything, you don't measure anything well." — Brandie Williams, Deputy Executive Director, RACSB
Brandie also flagged a practical, often-overlooked barrier: rural internet access. RACSB has had to choose technology that works across Wi-Fi and cellular connections and has a reliable offline fallback — a consideration state-level technology decisions don't always build in.
An audience poll during the session echoed this point, identifying integrations with other systems as one of the biggest barriers to technology adoption, alongside budget, staff capacity, change fatigue, and leadership buy-in.
The Bottom Line
Three ideas to carry forward from this conversation:
Retention, not just recruitment, is the lever that actually moves the needle on chronic staffing shortages.
What a state can see is different from what a provider can see — closing that gap requires disaggregated, position- and geography-level turnover data.
Streamline before you add. Technology should reduce steps for frontline staff before it's asked to do anything else.
Want the full conversation?
This recap only scratches the surface of RACSB's turnaround story, the technology evaluation framework, and the live audience discussion on burnout and Medicaid policy.
Sources: National Core Indicators (NCI) State of the Workforce Survey; ANCOR State of America's Direct Support Workforce Crisis; Kaiser Family Foundation (KFF) Medicaid HCBS analysis. Statistics and quotes referenced above were shared live by Brandie Williams, Deputy Executive Director of RACSB, during Impruvon's fireside chat, "Combating Workforce Shortage and Staff Burnout to Eliminate Risk: Technology Solutions that Support HCBS" (September 2026).
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