Testing the Leadership and Organizational Change for Implementation (LOCI) Intervention in Substance Abuse Treatment Programs

描述(由申请人提供)：有效实施循证做法(EBPS)以解决复杂和广泛的公共卫生问题，如物质使用障碍(SUDS)和艾滋病毒，仍然是一个重大挑战。领导力和组织背景与实施氛围和对EBP的态度以及临床结果(如客户满意度和生活质量)相关。虽然有许多领导力发展方法，但它们往往不是基于经验支持的方法和课程，也不是专门为实施EBP而设计的战略环境。该项目解决了这些问题，并通过测试领导层和组织变革对实施(LOCI)干预的影响来促进实施科学。场所干预的目标是提高总体领导力和实施领导力，并利用组织战略为EBP的实施创造积极的战略组织氛围。这些应该导致更积极的SUD治疗提供者的态度和行为，支持EBP实施结果、干预的忠诚度和实施过程。与探索、准备、实施、持续(EPIS)概念框架一致，LOCI在提供商组织内(例如，高管/中层管理人员、工作组负责人、服务提供商)在多个层面上创造变化，以促进支持EBP实施和维持的背景。NIH支持的先导性研究(R21MH082731，PI：Aarons)已经成功地证明了对基因座干预的可行性、可接受性和实用性的初步支持。拟议的研究将测试LOCI是否能够改变SUD治疗机构的一般和实施领导、实施环境、实施过程和EBP忠诚度的结果。72名工作组组长和他们的提供者(即下属)将被随机分配到现场条件或网络研讨会控制条件。所有两种情况下的直接SUD治疗提供者都将接受激励面谈(MI)方面的培训，这是一家领先的EBP 用于性病和艾滋病毒的预防和治疗。基因座检测将在加州多个地点提供SUD治疗和艾滋病毒服务的四家机构内进行。地点干预测试将包括SUD服务提供商(n=432)、工作组负责人(n=72)和机构主管/中层管理人员(n=16)。研究假设将通过比较领导力、实施氛围、心理安全氛围、提供者态度和行为、MI忠诚度和实施过程的地点和控制组结果进行检验。我们还将使用混合方法来探索文化相关性、基因座成分的相对贡献以及面对面培训和视频培训之间的差异。拟议的研究将提供一项切实可行的实施战略，可用于改善工作组的领导能力和实施企业资源规划的战略环境。

DESCRIPTION (provided by applicant): Effective implementation of evidence-based practices (EBPs) to address complex and widespread public health issues, such as substance use disorders (SUDs) and HIV, remains a substantial challenge. Leadership and organizational context are associated with implementation climate and attitudes toward EBP, as well as clinical outcomes such as client satisfaction and quality of life. While there are many leadership development approaches, they are often not based on empirically supported approaches and curricula, nor are they specifically designed to develop strategic climates for EBP implementation. This project addresses these concerns and advances implementation science by testing the effects of the Leadership and Organizational Change for Implementation (LOCI) intervention. The goals of the LOCI intervention are to improve general leadership and implementation leadership and utilize organizational strategies to create a positive strategic organizational climate for EBP implementation. These should lead to more positive SUD treatment provider attitudes and behaviors that support EBP implementation outcomes of intervention fidelity and implementation process. Consistent with the Exploration, Preparation, Implementation, Sustainment (EPIS) conceptual framework, LOCI creates change at multiple levels within a provider organization (e.g., executives/mid- managers, workgroup leader, service provider) to foster a context supportive of EBP implementation and sustainment. Initial support for the feasibility, acceptability, and utility of the LOCI intervention have been successfully demonstrated in an NIH supported pilot study (R21MH082731, PI: Aarons). The proposed study will test whether LOCI can achieve change in outcomes of general and implementation leadership, implementation climate, implementation process, and EBP fidelity in SUD treatment agencies. Seventy-two workgroup leaders and their providers (i.e., subordinates) will be randomized to either the LOCI condition or a webinar control condition. All direct SUD treatment providers in both conditions will receive training in Motivational Interviewing (MI), a leading EBP for SUD and HIV prevention and treatment. The test of LOCI will occur within four agencies that provide SUD treatment and HIV services at multiple sites across California. The test of the LOCI intervention will include SUD service providers (n=432), workgroup leaders (n=72), and agency executives/mid-managers (n=16). Hypotheses will be tested comparing LOCI and control group outcomes of leadership, implementation climate, psychological safety climate, provider attitudes and behaviors, MI fidelity, and implementation process. We will also use mixed methods to explore cultural relevance, relative contribution of LOCI components, and differences between in-person and video training. The proposed study will provide a practical implementation strategy that can be utilized to improve workgroup leadership and strategic climate for EBP implementation.