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

描述（由申请人提供）：有效实施循证实践（EBP）以解决复杂和广泛的公共卫生问题，如物质使用障碍（SUD）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环境和对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EBP实施而设计的战略气候。该项目解决了这些问题，并通过测试的领导和组织变革的实施（LOCI）干预的影响，推进实施科学。LOCI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实施干预保真度和实施过程的结果。与探索、准备、实施、维持（EPIS）概念框架一致，LOCI在供应商组织内的多个层面上创建了变化（例如，管理人员/中层管理人员、企业领导、服务提供商），以培养支持EBP实施和维持的环境。在NIH支持的一项试点研究（R21 MH 082731，PI：Aarons）中成功证明了LOCI干预的可行性、可接受性和效用的初步支持。拟议的研究将测试LOCI是否可以实现一般和实施领导，实施气候，实施过程中的结果的变化，并在SUD治疗机构的EBP保真度。72.第72章和他们的家人，下属）将被随机分配到LOCI条件或网络研讨会控制条件。在这两种情况下，所有直接SUD治疗提供者都将接受动机访谈（MI）培训，这是一种领先的EBP 用于SUD和艾滋病毒预防和治疗。LOCI的测试将在加州的多个地点提供SUD治疗和HIV服务的四个机构内进行。LOCI干预的测试将包括SUD服务提供者（n=432），企业领导者（n=72）和机构高管/中层管理人员（n=16）。假设将进行测试比较LOCI和控制组的领导，实施气候，心理安全气候，供应商的态度和行为，MI的忠诚度，和实施过程的结果。我们还将使用混合方法来探索文化相关性，LOCI组件的相对贡献，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个切实可行的实施战略，可用于提高企业的领导和战略环境的EBP实施。

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.