Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial

• Published in: Implementation science : IS 2024-03, Vol.19 (1), p.29-29, Article 29
• Main Authors: Williams, Nathaniel J, Ehrhart, Mark G, Aarons, Gregory A, Esp, Susan, Sklar, Marisa, Carandang, Kristine, Vega, Nallely R, Brookman-Frazee, Lauren, Marcus, Steven C
• Format: Article
• Language: English
• Subjects: Adolescent; Analysis; Clinics; Delivery of Health Care; Evaluation; Evidence-based medicine; Evidence-Based Practice; Feedback; Health care reform; Humans; Hypotheses; Implementation climate; Implementation leadership; Intervention; Leadership; LOCI; Measurement; Measurement-based care; Mechanism; Mediation; Mediator; Mental Health; Mental Health Services; Organizational change; Patients; Psychiatric services; Psychological aspects; Psychotherapy; Quality management; Testing; Transformational leadership; Youth services
• ISSN: 1748-5908; 1748-5908
• DOI: 10.1186/s13012-024-01356-w

Theory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI's hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI's effect on implementation climate, which in turn will (3) mediate LOCI's effect on MBC fidelity. Twenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders' implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses. LOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps