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（SUDs）和艾滋病毒，仍然是一项重大挑战。领导和组织环境与实施环境和对EBP的态度以及临床结果（如客户满意度和生活质量）有关。虽然有许多领导力发展方法，但它们通常不是基于经验支持的方法和课程，也不是专门为实施EBP开发战略环境而设计的。本项目通过测试领导力和组织变革促进实施（LOCI）干预的效果，解决了这些问题，并推进了实施科学。LOCI干预的目标是提高一般领导力和实施领导力，并利用组织战略为实施EBP创造积极的战略组织氛围。这些应该会导致更积极的SUD治疗提供者的态度和行为，从而支持EBP实施结果的干预保真度和实施过程。与探索、准备、实施、维持（EPIS）概念框架一致，LOCI在提供者组织（例如，主管/中层经理、工作组领导、服务提供者）内的多个级别上创建变更，以培养支持EBP实施和维持的环境。对LOCI干预的可行性、可接受性和实用性的初步支持已在NIH支持的试点研究（R21MH082731, PI: Aarons）中成功证明。本研究将测试LOCI是否能够在SUD治疗机构的一般和实施领导、实施气候、实施过程和EBP保真度方面实现结果的改变。72名工作组负责人及其提供者（即下属）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性访谈（MI）的培训，这是一种领先的EBP

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.