Aligning organizational priorities with ARC to improve youth mental health service outcomes.

Abstract

Objective The ARC organizational intervention was designed to improve community-based youth mental health services by aligning organizational priorities with five principles of effective service organizations (i.e., mission-driven, results-oriented, improvement-directed, relationship-centered, participation-based). This study assessed the effect of the ARC intervention on youth outcomes and the mediating role of organizational priorities as a mechanism linking the ARC intervention to outcomes. Methodology Fourteen community-based mental health agencies in a Midwestern metropolis along with 475 clinicians and 605 youth (aged 5–18) served by those agencies were randomly assigned to the three-year ARC intervention or control condition. The agencies’ priorities were measured with the ARC Principles Questionnaire (APQ) completed by clinicians at the end of the intervention. Youth outcomes were measured as total problems in psychosocial functioning described by their caregivers using the Shortform Assessment for Children (SAC) at six monthly intervals. Results The rate of improvement in youths’ psychosocial functioning in agencies assigned to the ARC condition was 1.6 times the rate of improvement in agencies assigned to the control condition, creating a standardized difference in functioning of d = .23 between the two groups at the six month follow-up. The effect on youth outcomes was fully mediated by the alignment of organizational priorities described in the five ARC principles (d = .21). Conclusions The ARC organizational intervention improves youth outcomes by aligning organizational priorities with the five ARC principles. The findings suggest that organizational priorities explain why some community mental health agencies are more effective than others.

Navigating the storm: How proficient organizational culture promotes clinician retention in the shift to evidence-based practice

“…Prior studies have shown that higher levels of proficient culture in child mental health clinics is linked to improved clinical outcomes for youth [43], more positive clinician work attitudes of job satisfaction and organizational commitment [26], better clinician attitudes towards EBP [44], and higher likelihood of clinicians’ adopting EBP [45] and achieving fidelity to EBP [46]. Experimental studies show that improvement in proficient culture contributes to increased clinician attendance at EBP workshops [24] and increased use of EBP with clients [27].…”

Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth?

“…Recent research has suggested that clinicians may be constrained in adopting best practices by the ecology of their organizations, and that our field has relied too heavily on assigning responsibilities to clinicians alone (Raghavan et al 2008). Researchers conducting empirical studies of organizational-level interventions to increase the uptake of EBP approaches and improve client outcomes may help provide clinicians with needed agency support (Glisson et al 2016;Proctor et al 2011). Other researchers have found that organizational factors can influence the delivery of medication treatment, beyond clinical need factors of patients (Warner et al 2005).…”

Integrated Care Models and Child Health: A Meta-analysis

“…Most (n = 13) studies were conducted in North America. [31][32][33][34][35][36][37][38][39][40][41][42][43][44] Comparison groups were treatment as usual (n = 14), waitlist control (n = 2), or enhanced usual care (n = 2); however, a description of usual care was typically not provided.…”

“…Most interventions were complex, incorporating multiple elements to achieve integration, summarized in Table 1. Ten interventions included aspects of vertical integration, 31,38,40,41,[43][44][45][46][47][48][49][50] 10 included horizontal integration, [32][33][34][35][36][37]39,40,42,44,51 and no interventions described longitudinal integration.…”

“…The hypothesized outcome associated with integrated care interventions varied across articles, with some aiming to increase CYP contact with the health care service and others to reduce contact. Overall, 31 Chernoff et al 32 Cicutto et al 33 Ellis et al [34][35][36] Glisson et al 37 Gorelick et al 38 Gorelick Six studies reported indicators for health care quality; 5 of these were related to service satisfaction. The quality of evidence among included studies was moderate.…”