Organization Receptivity to Evidence Based Practice
Principal Investigator: Gregory Aarons, PhD, PI
Funder: CMHSR funded pilot (through NIMH - P30 MH068579)
Timeframe: 09/04-07/06
Affiliation: Center for Mental Health Services Research (CMHSR)
Participating Organizations: Children's Division in California
Project Contact: Gregory Aarons, PhD, PI, 858-966-7703 x3550
E-mail: gaarons@ucsd.edu
Project Update as of 05/23/05:
Stage: Completed
Description: A number of factors may impact the likelihood of the adoption of innovation and change in organizations. For example, organizational culture and climate may impact processes that can impede workgroup collaboration and adoption of new technologies. However, there is a scant knowledge base regarding organizational level factors that facilitate or impede adoption of evidence-based practices.
The overall goal of the Organization Receptivity project was to develop a measure that captures an organization’s receptivity to evidence-based practice. The project used sequenced mixed methods, with qualitative procedures and data informing the development of a measure that will be quantitative, and then using qualitative procedures and data to assess the performance of the measure. The proposed pilot study proceeded in 5 phases. In Phase 1 a series of individual interviews were conducted with open‑ended questions in order to identify organizational constraints likely to inhibit or enhance the likelihood of adoption of EBPs. Phase 2 involved a comparison of domains identified in Phase 1 with existing measures of organizational culture and climate. In Phase 3 qualitative data from Phases 1 and 2 were used to develop an item bank for a structured, closed‑ended questionnaire. Phase 4 examined the preliminary quantitative measure for feasibility and face and content validity. Finally, in work subsequent to the pilot, an application to NIMH was prepared in order to field test the quantitative measure of organizational receptivity to EBPs.
The study was housed, through a subcontract, at the Child & Adolescent Services Research Center (CASRC) and conducted in San Diego County, California. Eighteen community agency personnel provided their views on the components of organizational receptivity to EBP through in‑depth qualitative interviews. Because multiple organizational levels are important in understanding organizational change, these 18 participants were drawn from four organizational levels: 1) System/county level, 2) Organizational/program administration, 3) Program supervisor, and 4) Service worker. We selected programs operated by the County and also programs that are contract providers. These two types of programs have different organizational structures and fiscal constraints on services delivered. In addition programs were selected based on the types of services provided (i.e., residential treatment for youth, outpatient, and case management). In depth individual interviews were conducted at each of the proposed settings. This strategy will be used to gather respondents' perceptions of workplace characteristics that facilitate or inhibit the adoption of new practices including evidence based practices.
Significance: Little is known regarding the factors that inhibit or facilitate the adoption of evidence-based treatments (EBTs) for mental health disorders in human service agencies. However, it appears that it is the exception, rather than the rule that interventions with proven efficacy or effectiveness are successfully implemented in community mental health settings. More commonly, ideological models (e.g., child and adolescent service system principles, i.e., CASSP) that lack scientific evidence of efficacy or effectiveness are widely implemented as models of service delivery. Given this situation, it was important to determine what organizational factors may facilitate or inhibit DI of EBTs (with appropriate modifications) into real-world settings
The specific aims of this project were to:
1. Use qualitative methods to identify domains of organizational receptivity to EBPs that serve to facilitate or hinder the adoption of evidence based treatments in public mental health service organizations.
2. Compare domains identified in Step 1 to existing quantitative measures of organizational culture and climate.
3. Based on steps 1 and 2, develop a preliminary quantitative measure of organizational receptivity to evidence based practice.
Progress in ACISR Year 1, 9/22/05-7/31/05: The project moved forward in identifying stakeholder participants from policy, program management, supervisory, and clinical levels. Representatives from each of these groups were identified. The project scheduled interviews and applied for IRB approval. Implementation of this project was expedited by Dr. Aarons' recently funded project, “Concept Mapping of Readiness for Evidence-Based Practice” (R03 MH070703-01A1, 09/04-07/06).
Plans for ACISR Year 2, 8/01/05-7/31/06: In Year 2 the project completed all interviews, completed comparisons of emergent issues with existing measures, and developed the preliminary measure of organizational receptivity.