Organizational Processess in Treatment Programs

人们认识到需要弥合研究创新和治疗之间的差距。NIDA临床试验网络（CTN）是通过在社区治疗项目（ctp）中测试有效治疗来缩小差距的一种尝试。该网络的目标之一是将临床知识带入研究领域。另一个目标是为这些项目带来新的治疗方法。然而，目前尚不清楚以ctn为基础的治疗何时或是否会扩散并保留。创新的治疗方法也可能对组织的结构和过程产生影响。这一建议使用了一个经过验证的创新扩散模型（Rogers, 1995），试图确定创新扩散、保留并对五大湖节点的ctp产生影响的过程。该项目的具体目标是：a)描述社会关系和社区治疗项目及其工作人员的临床服务的基本结构和过程；b)描述社区治疗项目采用和遵守ctn批准的研究方案所使用的组织流程和策略；C)分析参与和非参与社区治疗项目的从业者层面治疗创新的传播和保留；d)检查基线组织文化和/或组织文化的变化是否与组织有效性随时间的变化有关，以及CTN参与是否与向更有效的组织文化发展有关。该研究将使用包括16个不同设施在内的7个ctp的多方法设计。每年对所有员工进行定量和定性访谈，并每半年对主要人员进行访谈。对每个设施的组织调查将记录组织的结构和文化。补充数据将在具体临床试验方案实施前、6个月时和招募结束时收集。这项深入研究的结果将有助于更有效地管理CTN临床试验，并将产生可转移到其他药物滥用治疗机构的组织信息，以促进向非参与机构传播研究结果和治疗创新。基于这些知识，我们可以就如何在持续的基础上引入创新的治疗方法和管理实践，以及如何在一段时间内保持这些创新，对广泛的治疗方案提出相关建议。

There is a recognized need to bridge the gap between research innovations and treatment. The NIDA Clinical Trials Network (CTN) is one attempt to narrow the gap by testing efficacious treatment in community treatment programs (CTPs). One goal of this network is to bring clinical knowledge to the research field. Another goal is bring new treatments to the programs. It is not clear, however, when or if the CTN-based treatments will diffuse and be retained. The innovative treatments also may have impact on the structure and processes of the organization. This proposal, using a validated diffusion of innovation model (Rogers, 1995), seeks to determine the processes by which innovations are diffused, retained, and have an impact on the CTPs of the Great Lakes Node. The specific aims of this project are to: a) describe baseline structure and processes of social relations and clinical services of community treatment programs and their staff; b) describe organizational processes and strategies that are utilized by community treatment programs to adopt and adhere to CTN-approved research protocols; c) analyze diffusion and retention of treatment innovations at the practitioner level in both participating and non-participating community treatment programs; and d) examine whether organizational culture at baseline and/or changes in organizational culture are related to changes in organizational effectiveness over time, and whether CTN participation is related to movement toward more effective organizational cultures. The study will use a multi-method design of seven CTPs including sixteen different facilities. Annual quantitative and qualitative interviews of all staff will be conducted along with semi-annual interviews with key personnel. Organizational surveys of each facility will document the structure and culture of the organization. Supplemental data will be collected prior to specific clinical trial protocol implementation, at six months, and at conclusion of recruitment. The results of this in-depth research will enable more effective administration of CTN clinical trials and will yield organizational information that can be transferred to other substance abuse treatment settings to facilitate dissemination of research results and treatment innovations to non-participating agencies. Based upon this knowledge, relevant suggestions can be made to a wide range of treatment programs on how to introduce innovative treatments and management practices on an ongoing basis, and furthermore, how to retain these innovations over time.