What Stays Behind When They Leave

By Anthony President

I first met Meg while I was training at Scioto County Children's Services.

She was the kind of professional you notice immediately. She moved through the work with a quiet authority that came from knowing the landscape completely. She knew the name of every school counselor in the county, which ones returned calls and which ones needed a visit in person before they would trust you enough to partner. She knew the coalition chair who had been doing this work for twenty years and needed to feel heard before he could be moved. She knew the family that had lost a son to an opioid overdose two years ago and had quietly become the most committed prevention advocates in the township.

She had been building this for three years in the heart of Appalachian Ohio. And she was about to walk away from all of it.

Her commitment had never been stronger. But nobody had prepared her supervisor for what it actually takes to support someone doing this work in a place like this; rural, chronically under-resourced, carrying a weight of loss that most people outside these communities never fully see. When Meg started looking for a way out, nobody noticed until she was already mostly gone.

When I ran into her at the School Success Conference last week, I was relieved to learn that she stayed. She said a conversation at the right moment with a leader who finally saw what she was carrying made the difference. But that moment almost did not happen. And in the counties surrounding hers, it often does not.

In Appalachian Ohio, in counties like Scioto and Lawrence in the south, Athens and Hocking further north, and the stretches of Adams, Meigs, and Gallia in between, the behavioral health workforce has been doing some of the hardest prevention work in the state for decades. These communities carry historical overdose burdens that rank among Ohio's most severe. Scioto County once led the nation in opioid prescriptions per capita. The Ohio Substance Abuse Monitoring Network has tracked Lawrence, Adams, Meigs, and Gallia counties among the state's most consistently impacted year after year.

Ohio's overdose death rates have been declining, due in no small part to people like Meg. Prevention professionals who drove into school parking lots before the building opened and stayed in community rooms long after everyone else went home. Coalitions that kept meeting through winters and budget cuts and a pandemic. The work worked.

Which is exactly why this is the worst possible moment to let the workforce weaken.

Nationally, behavioral health and prevention professionals leave their positions at striking rates in their early years. Research consistently puts voluntary turnover among professionals in their first three years at somewhere between thirty and fifty percent. In rural Appalachian communities, where counties routinely qualify as federally designated Health Professional Shortage Areas and where the pipeline of trained professionals is already thin, every departure lands differently than it would somewhere else.

When someone like Meg leaves a rural Appalachian county, the loss does not show up on a dashboard right away.

It shows up in the school that loses its prevention contact mid-year. In the coalition that took eighteen months to build and will take another eighteen to rebuild under someone new. In the institutional memory of which families are holding on and which ones are one hard month away from a breaking point. In the signal, quiet but real, that this place is hard to stay in. That the work sometimes takes more than it gives back.

The program that comes to fill the gap, if one comes at all, starts from zero.

Here is what the research shows, and what anyone who has spent real time in Appalachian prevention already knows. The single strongest predictor of whether a professional like Meg stays isn’t pay, workload, or even the emotional weight of working in communities shaped by decades of compounding loss. Those things matter. The research points most consistently to something else: whether they feel genuinely supported by their supervisor.

This finding holds across behavioral health settings, replicated consistently. Supervisors who develop their people, who go beyond managing tasks to actually investing in the people doing the work, are directly associated with higher retention, stronger program outcomes, and the kind of workforce stability that lets communities build on progress rather than constantly restart.

Most prevention supervisors in Appalachian Ohio never received training for the role they are now expected to fill. They came up through the work, became skilled at it, and were promoted because of that skill. The job of leading others doing that work is something different entirely, and the system that asked them to do it rarely gave them what they needed to do it well. Meg's supervisor wanted to support his team. He simply had not been equipped to recognize what that support needed to look like. That is a solvable problem. It just has to be treated as one.

The workforce instability in Appalachian prevention is a retention problem. And it lives downstream of a leadership development gap that has been under-addressed for a long time.

The connection between supervision and community health runs in a straight line.

A supervisor who notices that someone like Meg is struggling, and creates space for that conversation, keeps a worker in the field. That worker keeps showing up to the school, the coalition, the family trying to find their footing. The school partnership holds. The coalition keeps meeting. A teenager gets connected to resources before a problem becomes a crisis. The numbers, over time, move.

Every link in that chain is a person. And the first link is always a leader who chose to see someone.

This is a public health story. The organizations that understand it as such are building prevention infrastructure that actually holds. The ones that treat it as a workforce management problem are managing a cycle of departure that Appalachian communities have already paid too high a price to keep absorbing.

Meg still works in Scioto County. She will tell you the work is hard, the resources are never enough, and there are still days she wonders how long she can keep going. What keeps her is a leader who finally learned to see what his people were carrying and decided to do something about it.

That capacity, built intentionally across Appalachian organizations, is what workforce stabilization actually looks like.

We will be exploring what it takes to build it in an upcoming piece on LinkedIn. Follow Anthony there to catch Part 2 when it drops.

Click here to catch Part 2.

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Master Trainer, International Speaker and author of the book “Invincible Social Worker”, Anthony President has empowered and inspired more than 100,000 professionals to perform, produce and partner better at their places of work.  Thousands of companies and organizations have been transformed as a result of Anthony’s work.  

As Founder and CEO of Presidential Consultants, LLC, Anthony leads a team of more than two dozen experienced learning development and coaching professionals who together serve more than 16,000 helping professionals each year in the areas of leadership, inclusion, and workplace wellness. As a thought leader in the field, Anthony continues to research, innovate, and drive positive change in the realm of professional development and organizational transformation.

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