One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.

SummaryThis two-level study of child welfare and juvenile justice case management teams addresses construct, measurement, and composition issues that plague multilevel research on organizational culture and climate. Very few empirical studies have examined both culture and climate simultaneously, and none have provided evidence that culture and climate are distinct or similar constructs. Confirmatory factor analysis (CFA), within-group consistency analysis (r wg ), between-group differences (ICC and eta-squared), and hierarchical linear models (HLM) analysis provide evidence that climate and culture are separate constructs that vary by organizational unit, and are related to work attitudes, perceptions, and behavior. Findings link teamlevel culture and climate to individual-level job satisfaction and commitment, perceptions of service quality, and turnover.

The organizational social context in which mental health services are provided is believed to affect the adoption and implementation of evidence-based practices (EBPs) as well as the quality and outcomes of the services. A fully developed science of implementation effectiveness requires conceptual models that include organizational social context and tools for assessing social context that have been tested in a broad cross-section of mental health systems. This paper describes the role of organizational social context in services and implementation research and evaluates a comprehensive contextual measure, labeled Organizational Social Context (OSC), designed to assess the key latent constructs of culture, climate and work attitudes. The psychometric properties of the OSC measure were assessed in a nationwide study of 1,154 clinicians in 100 mental health clinics with a second-order confirmatory factor analysis of clinician responses, estimates of scale reliabilities, and indices of within-clinic agreement and between-clinic differences among clinicians. Finally, the paper illustrates the use of nationwide norms in describing the OSC profiles of individual mental health clinics and examines the cross-level association of organizational-level culture and climate with clinician-level work attitudes.

The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health and social service provider attitudes toward adopting evidence-based practices. Comprised of four subscales (i.e., Appeal, Requirements, Openness, and Divergence) and a total scale score, preliminary studies have linked EBPAS scores to clinic structure and policies, organizational culture and climate, and first-level leadership. EBPAS scores are also related to service provider characteristics including age, education level, and level of professional development. The present study examined the factor structure, reliability, and norms of EBPAS scores in a sample of 1089 mental health service providers from a nationwide sample drawn from 100 service institutions in 26 states in the United States. The study also examines associations of provider demographic characteristics with EBPAS subscale and total scores. Confirmatory factor analysis supported a second-order factor model, and reliability coefficients for the subscales ranged from .91-.67 (total scale = .74). The study establishes national norms for the EBPAS so that comparisons can be drawn for United States local and international studies of attitudes toward evidence-based practices. The results suggest that the factor structure and reliability are likely generalizable to a variety of service provider contexts and different service settings and that EBPAS scales are associated with provider characteristics. Directions for future research are discussed.

No abstract

No abstract

This article describes a new approach for assessing cognitive precursors to aggression. Referred to as the Conditional Reasoning Measurement System, this procedure focuses on how people solve what on the surface appear to be traditional inductive reasoning problems. The true intent of the problems is to determine if solutions based on implicit biases (i.e., biases that operate below the surface of consciousness) are logically attractive to a respondent. The authors focus on the types of implicit biases that underlie aggressive individuals’attempts to justify aggressive behavior. People who consistently select solutions based on these types of biases are scored as being potentially aggressive because they are cognitively prepared to rationalize aggression. Empirical tests of the conditional reasoning system are interpreted in terms of Ozer’s criteria for ideal personality instruments. Noteworthy findings are that the system has acceptable psychometric properties and an average, uncorrected empirical validity of 0.44 against behavioral indicators of aggression (based on 11 studies).

A two-level strategy for implementing evidence-based mental health treatment was assessed in a 2 × 2 randomized trial with 615 delinquent youth in 14 rural Appalachian counties. The implementation strategy included (1) the introduction of a Multisystemic Therapy (MST) program for delinquent youth in each county, and (2) the ARC (for Availability, Responsiveness and Continuity) organizational intervention for implementing effective community-based mental health services in randomly assigned counties. Within each county, youth were randomly assigned to the MST program or to usual services programs, yielding 4 treatment conditions (MST plus ARC, MST only, ARC only, control). Results of multilevel mixed-effects regression analyses found both main and interaction effects of MST and ARC on youth outcomes. Total problem behaviors as measured by the Child Behavior Checklist (CBCL) decreased significantly to non-clinical levels in the MST plus ARC condition by the six-month post-test, but were at clinical levels for youth in the MST only, ARC only, and control conditions. In addition, youth in the MST plus ARC condition entered out-of-home placements at less than half the rate (16%) of youth in the control condition (34%).