Mechanisms of Change in the ARC Organizational Str

Authors: Nathaniel J Williams Charles Glisson Anthony Hemmelgarn Philip Green

Publish Date: 2016/05/28

Volume: 44, Issue: 2, Pages: 269-283

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Abstract

The development of efficient and scalable implementation strategies in mental health is restricted by poor understanding of the change mechanisms that increase clinicians’ evidencebased practice EBP adoption This study tests the crosslevel change mechanisms that link an empiricallysupported organizational strategy for supporting implementation labeled ARC for Availability Responsiveness and Continuity to mental health clinicians’ EBP adoption and use Four hundred seventyfive mental health clinicians in 14 children’s mental health agencies were randomly assigned to the ARC intervention or a control condition Measures of organizational culture clinicians’ intentions to adopt EBPs and jobrelated EBP barriers were collected before during and upon completion of the threeyear ARC intervention EBP adoption and use were assessed at 12month followup Multilevel mediation analyses tested changes in organizational culture clinicians’ intentions to adopt EBPs and jobrelated EBP barriers as linking mechanisms explaining the effects of ARC on clinicians’ EBP adoption and use ARC increased clinicians’ EBP adoption OR = 319 p = 003 and use 81 vs 56  d = 79 p = 003 at 12month followup These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced jobrelated EBP barriers A combined mediation analysis indicated the organizational cultureEBP intentions mechanism was the primary carrier of ARC’s effects on clinicians’ EBP adoption and use ARC increases clinicians’ EBP adoption and use by creating proficient organizational cultures that increase clinicians’ intentions to adopt EBPsThis study was funded by grants from the National Institute of Mental Health to NJW F31MH099846 and CG R01MH084855 The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health

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