Examining vertical alignment in perceived implementation climate within a trial of motivational interviewing in substance use disorder treatment clinics

项目摘要/摘要 动机访谈(MI)是治疗物质使用障碍(SUD)的领先循证实践(EBP)。 具有改善人口健康的潜力。尽管广泛传播，MI的保真度和持续使用仍然 在社区提供商中较低。需要制定战略，以改善通常情况下EBPS的覆盖范围和影响 关心。与改善SUD治疗方案的组织环境有关的实施战略 可能导致改进MI实施。改善组织的EBP实施环境，共享 认识到EBP在组织内实施的重要性，可以促进供应商 实施成果。EBP实施氛围是由表现出行为的项目负责人营造的 支持执行；因此，干预措施，如领导和组织变革， 实施(Loci)干预，正在评估其对提供商MI实施的影响 结果。一个假定的位置机制是组织的垂直排列，这是在多大程度上 领导和员工都对EBP的实施环境有共同的看法。引线之间的垂直对齐 关于实施气候的供应商可以发出信号，表明对EBP重要性的共同看法，以及 共同的观点是，领导人建立的结构和程序有助于在前线实施 台词。然而，分析还没有定量地检验这种机制，研究通常是指数化的 对一线提供商的平均水平认知，不考虑变化或提供商调整的影响 对领导者的看法。此外，垂直对齐是否对转换敏感还不得而知。 时间和接触领导干预的机会。这些数据对于建立垂直对齐至关重要 将执行气候感知作为执行战略的潜在行动机制。 这个NRSA应用程序的目标是促进我作为一名实施科学家的发展， 关于组织行为、领导力和成瘾健康服务。该建议利用了来自 NIDA资助的集群随机试验，考察了地点对实施领导力和 气候和管理措施的实施成果。拟议的项目将检查组织的垂直一致性 将感知到的执行气氛作为组织执行的潜在行动机制 战略。具体地说，目标1将在以下方面衡量可感知的实施环境中的垂直一致性 实施心肌梗死的SUD治疗诊所的提供者和领导者。目标2将确定以下临床特征 与基线上的垂直对齐相关。最后，目标#3将检查垂直的纵向轨迹 对执行环境及其与管理措施执行结果的关联的看法的一致性。 本研究是进一步了解执行机制的重要一步 战略，以及在我的指导团队的支持下，我向独立职业生涯的发展 实施科学家介入，以改善成瘾健康服务环境中EBP的实施。

PROJECT SUMMARY /ABSTRACT Motivational interviewing (MI) is a leading evidence-based practice (EBP) for substance use disorder (SUD) with potential to improve population health. Although disseminated widely, MI fidelity and sustained use remain low among community providers. Strategies are needed to improve the reach and impact of EBPs in usual care. Implementation strategies related to improving the organizational context of SUD treatment programs may lead to improved MI implementation. Improving an organization’s EBP implementation climate, the shared perception of the importance of EBP implementation within an organization, can promote provider implementation outcomes. EBP implementation climate is cultivated by program leaders who exhibit behaviors that support implementation; thus, interventions, such as the Leadership and Organizational Change for Implementation (LOCI) intervention, are being evaluated for their impact on provider MI implementation outcomes. A presumed mechanism of LOCI is organizational vertical alignment, which is the extent to which leaders and staff share perceptions about EBP implementation climate. Vertical alignment between leaders and providers regarding implementation climate can signal shared views about the importance of the EBP, and shared views that the structures and processes set in place by leaders facilitate implementation on the front lines. However, analyses have yet to quantitatively examine this mechanism, with research typically indexing mean level perceptions of front-line providers, without considering the impact of variation or provider alignment with leader perceptions. Additionally, it is yet unknown whether vertical alignment is sensitive to change over time and with exposure to leadership intervention. These data are critical to establishing vertical alignment of implementation climate perceptions as a potential mechanism of action of implementation strategies. The objective of this NRSA application is to foster my development as an implementation scientist with a focus on organizational behavior, leadership, and addiction health services. This proposal leverages data from a NIDA funded cluster randomized trial that examined the effect of LOCI on implementation leadership and climate and MI implementation outcomes. The proposed project will examine organizational vertical alignment of perceived implementation climate as a potential mechanism of action of organizational implementation strategies. Specifically, Aim #1 will measure vertical alignment in perceived implementation climate among providers and leaders in SUD treatment clinics implementing MI. Aim #2 will identify clinic characteristics that are correlated with vertical alignment at baseline. Lastly, Aim #3 will examine longitudinal trajectories of vertical alignment in perceptions of implementation climate and their associations with MI implementation outcomes. The present study represents an important step in further understanding mechanisms of implementation strategies and, with the support of my mentoring team, my development toward a career as an independent implementation scientist intervening to improve EBP implementation in addiction health service settings.