Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol

Abstract

BackgroundEvidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate.MethodsThis test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure.DiscussionLOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI.Trial registrationThis study is registered with Clinicaltrials.gov (NCT03042832), 2 February 2017, retrospectively registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-017-0562-3) contains supplementary material, which is available to authorized users.

EBP Implementation Leadership of Frontline Nurse Managers: Validation of the Implementation Leadership Scale in Acute Care

“…The four ILS domains (proactivity, knowledge, support, and perseverance) can guide intervention work by highlighting areas for improvement in frontline leaders’ EBP implementation leadership behaviors and testing interventions targeted to these areas. For example, the Leadership and Organizational Change for Implementation program uses the ILS to help improve general and EBP implementation‐focused leadership of frontline managers and EBP implementation climates in substance use treatment facilities (Aarons, Ehrhart, Moullin, Torres, & Green, ).…”

An Observational Study of the Impact of COVID-19 and the Transition to Telehealth on Community Mental Health Center Providers

“…Data were collected as part of an ongoing service contract between the UC San Diego team and the Indiana Division of Mental Health and Addictions (DMHA) to engage in the Leadership and Organizational Change for Implementation (LOCI) strategy to facilitate an implementation climate for evidence-based practice (EBP) in Indiana CMHCs [7][8][9]. Participants were providers (n = 93) from 6…”

Translation and linguistic validation of the implementation leadership scale in Chinese nursing context

“…Specifically, what leaders do to facilitate and support EBP has not been considered in Chinese nursing research (Cheng, Broome, Feng, & Hu, 2017a, 2017bCheng et al, 2017) (Aarons & Aarons, 2006;Aarons, Ehrhart, Moullin, Torres, & Green, 2017;Brimhall et al, 2015;Marchionni & Ritchie, 2008;Masood & Afsar, 2017;Paparone, 2015;Powell et al, 2017). Leadership in general refers to a process of influencing others to accomplish shared objectives (Yukl, 2006); however, instruments measuring leadership in general do not capture the particular leadership strategies and behaviours that are critical to implementing EBP (Aarons, Ehrhart, & Farahnak, 2014).…”