Organizational Readiness for Change and opinions toward treatment innovations

Abstract

Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) completed surveys to characterize participating programs and practitioners. A two-level random effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC Scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission and more organizational stress. Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC's utility in assessing agency strengths and needs during the implementation of evidence-based practices. IntroductionThe Institute of Medicine's Crossing the Quality Chasm series recommended increased use of treatments with empirical evidence of efficacy and effectiveness for health care (Institute of Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Corresponding NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptMedicine, 2000;Institute of Medicine, 2001) and for the treatment of alcohol, drug, and mental health disorders (Institute of Medicine, 2006). There is, however, a significant lag between science-based treatment innovations and the widespread adoption of those strategies in health care (Balas & Boren, 2000;Institute of Medicine, 2001). A comprehensive review of implementation research identified six core components that must be present to initiate and sustain the use of proven programs in new locations and environments: 1) select staff who can implement the program, 2) train staff, 3) require ongoing coaching, 4) use supervision and fidelity assessments to provide performance feedback to staff, 5) evaluate overall program functioning, and 6) facilitate implementation and sustainability with administrative supports (Fixsen et al., 2005). Many programs neglect one or more core implementation components and struggle to develop the skills required to effectively ...

Barriers to implementation of evidence-based addiction treatment: A national study

“…Findings on whether supervisor or staff attitudes about EBP implementation vary by the type of treatment unit within which the respondent works are mixed. McCarty et al (2007) and Fuller et al (2007) did not find treatment unit to be associated with differences in staff attitudes regarding EBPs. However, in a study of 376 counselors and 1,083 clients involved in methadone, residential and outpatient substance abuse programs in Oregon and Massachusetts, Rieckmann et al (2007) reported that the most consistent support for pharmacological therapies was from staff in outpatient settings.…”

“…The Simpson and Flynn (2007) Organizational Readiness for Change model and the Texas Christian University Organizational Readiness for Change scales (TCU ORCstaff, TCU ORC-director; Lehman, Greener, & Simpson, 2002) have been used in prior addictions treatment research efforts to understand staff attitudes toward EBPs (see, for example, Fuller et al, 2007;Lundgren et al, 2011;Lundgren, Krull, Zerden, & McCarty, 2011). These articles indicate that specific aspects of organizational capacity are associated with more positive staff attitudes toward EBPs.…”

“…These articles indicate that specific aspects of organizational capacity are associated with more positive staff attitudes toward EBPs. For example, both the Fuller et al (2007) and Lundgren, Amodeo, et al (2011) studies identified that staff in organizations with better technology (e.g., Internet access) have more positive attitudes toward EBPs.…”

Perceptions of Organizational Functioning in Substance Abuse Treatment Facilities in South Africa

“…The combination of these skewed percentages and the lack of client documentation prevented us from linking the level of organizational functioning with rates of client retention. Fuller et al (2007) consider that the long-term survival of a substance abuse treatment facility requires the understanding and comprehension of its organizational capacities to respond to external and internal pressures for change. In South Africa it is evident that the realm of substance abuse treatment is faced with a plethora of external and internal pressures for change and that the successful transfer of evidence-based innovations to real-world applications to meet these pressures for change will require careful planning, implementation, and on-going evaluation.…”

“…Differences in the ORC responses between program directors and counselors appear to be consistent with their respective roles and responsibilities, and can be an important factor in assessing the overall functioning of a program (Fuller et al 2007;Lehman et al 2002).…”