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Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial
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 an...
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| Published in: | Implementation science : IS 2024-03, Vol.19 (1), p.29-29, Article 29 |
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| creator | Williams, Nathaniel J Ehrhart, Mark G Aarons, Gregory A Esp, Susan Sklar, Marisa Carandang, Kristine Vega, Nallely R Brookman-Frazee, Lauren Marcus, Steven C |
| description | 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 |
| doi_str_mv | 10.1186/s13012-024-01356-w |
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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 < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI's effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI's improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [p
] = 0.82, p = .004). Transformational leadership did not mediate LOCI's effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI's effect on MBC fidelity during the same period (p
= 0.71, p = .045).
LOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates.
ClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.</description><identifier>ISSN: 1748-5908</identifier><identifier>EISSN: 1748-5908</identifier><identifier>DOI: 10.1186/s13012-024-01356-w</identifier><identifier>PMID: 38549122</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Analysis ; Clinics ; Evaluation ; Evidence-based medicine ; Evidence-based practice ; Feedback ; Health care reform ; Hypotheses ; Implementation climate ; Implementation leadership ; Intervention ; Leadership ; LOCI ; Measurement ; Measurement-based care ; Mechanism ; Mediation ; Mediator ; Mental health ; Organizational change ; Patients ; Psychiatric services ; Psychological aspects ; Psychotherapy ; Quality management ; Testing ; Transformational leadership ; Youth services</subject><ispartof>Implementation science : IS, 2024-03, Vol.19 (1), p.29-29, Article 29</ispartof><rights>2024. The Author(s).</rights><rights>COPYRIGHT 2024 BioMed Central Ltd.</rights><rights>2024. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c564t-c68d22c059d05b18a6574104b6567048166e8c5b51975af23a236ac0964537e93</citedby><cites>FETCH-LOGICAL-c564t-c68d22c059d05b18a6574104b6567048166e8c5b51975af23a236ac0964537e93</cites><orcidid>0000-0002-3948-7480</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC10976812/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3037873744?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,25732,27903,27904,36991,36992,44569,53770,53772</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38549122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Williams, Nathaniel J</creatorcontrib><creatorcontrib>Ehrhart, Mark G</creatorcontrib><creatorcontrib>Aarons, Gregory A</creatorcontrib><creatorcontrib>Esp, Susan</creatorcontrib><creatorcontrib>Sklar, Marisa</creatorcontrib><creatorcontrib>Carandang, Kristine</creatorcontrib><creatorcontrib>Vega, Nallely R</creatorcontrib><creatorcontrib>Brookman-Frazee, Lauren</creatorcontrib><creatorcontrib>Marcus, Steven C</creatorcontrib><title>Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial</title><title>Implementation science : IS</title><addtitle>Implement Sci</addtitle><description>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 < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI's effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI's improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [p
] = 0.82, p = .004). Transformational leadership did not mediate LOCI's effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI's effect on MBC fidelity during the same period (p
= 0.71, p = .045).
LOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates.
ClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.</description><subject>Analysis</subject><subject>Clinics</subject><subject>Evaluation</subject><subject>Evidence-based medicine</subject><subject>Evidence-based practice</subject><subject>Feedback</subject><subject>Health care reform</subject><subject>Hypotheses</subject><subject>Implementation climate</subject><subject>Implementation leadership</subject><subject>Intervention</subject><subject>Leadership</subject><subject>LOCI</subject><subject>Measurement</subject><subject>Measurement-based care</subject><subject>Mechanism</subject><subject>Mediation</subject><subject>Mediator</subject><subject>Mental health</subject><subject>Organizational change</subject><subject>Patients</subject><subject>Psychiatric services</subject><subject>Psychological aspects</subject><subject>Psychotherapy</subject><subject>Quality management</subject><subject>Testing</subject><subject>Transformational leadership</subject><subject>Youth services</subject><issn>1748-5908</issn><issn>1748-5908</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptkstu00AUhi0EoqXwAizQSGzYuMzdYzaoqrhEqsQG1qOT8TieyPaEGbtR-kA8JydJKQ1CXtg-5_-_c9EpiteMXjJm9PvMBGW8pFyWlAmly-2T4pxV0pSqpubpo--z4kXOa0qlklo8L86EUbJmnJ8XvxbDJsXbMK7I4CHPyQ9-nMolZN8QB8mTMGz6QxCmEEcSRrKL89SRQ6gnnYce_6YuxXnVkZhWMIa7gxazvYfGp9yFDYERgX0YYPIfCKDddajMU3CYgn6XQybbMHVYAEhCdRzCHTYxpQD9y-JZC332r-7fF8WPz5--X38tb759WVxf3ZROaTmVTpuGc0dV3VC1ZAa0qiSjcqmVrqg0TGtvnFoqVlcKWi6ACw2O1loqUflaXBSLI7eJsLabhO2mnY0Q7CGA01lI2HLvLeW8ariXohVaai6hbnyrG-ZByAaJyPp4ZG3m5eAbh_tK0J9ATzNj6Owq3lpG60obxpHw7p6Q4s_Z58kOITvf9zD6OGcrsAccTDCB0rf_SNdxTrjXvUpUphKVlH9VK8AJwthGLOz2UHtVGUMrw_W-7OV_VPg0fggujr4NGD8x8KPBpZhz8u3DkIza_ana46nizqQ9nKrdounN4_U8WP7cpvgNCQrmZg</recordid><startdate>20240328</startdate><enddate>20240328</enddate><creator>Williams, Nathaniel J</creator><creator>Ehrhart, Mark G</creator><creator>Aarons, Gregory A</creator><creator>Esp, Susan</creator><creator>Sklar, Marisa</creator><creator>Carandang, Kristine</creator><creator>Vega, Nallely R</creator><creator>Brookman-Frazee, Lauren</creator><creator>Marcus, Steven C</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-3948-7480</orcidid></search><sort><creationdate>20240328</creationdate><title>Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial</title><author>Williams, Nathaniel J ; 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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 < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI's effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI's improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [p
] = 0.82, p = .004). Transformational leadership did not mediate LOCI's effect on implementation climate (p = 0.136). Improvement in clinic implementation climate from baseline to 12 months mediated LOCI's effect on MBC fidelity during the same period (p
= 0.71, p = .045).
LOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates.
ClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>38549122</pmid><doi>10.1186/s13012-024-01356-w</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-3948-7480</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1748-5908 |
| ispartof | Implementation science : IS, 2024-03, Vol.19 (1), p.29-29, Article 29 |
| issn | 1748-5908 1748-5908 |
| language | eng |
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| source | Publicly Available Content Database (Proquest) (PQ_SDU_P3); PubMed Central(OpenAccess) |
| subjects | Analysis Clinics Evaluation Evidence-based medicine Evidence-based practice Feedback Health care reform Hypotheses Implementation climate Implementation leadership Intervention Leadership LOCI Measurement Measurement-based care Mechanism Mediation Mediator Mental health Organizational change Patients Psychiatric services Psychological aspects Psychotherapy Quality management Testing Transformational leadership Youth services |
| title | Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial |
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