Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol

Egeland, Karina M.; Skår, Å.; Endsjø, Mathilde; Laukvik, Erlend Høen; Bækkelund, Harald; Babaii, Aida; Granly, Lene; Husebø, Gry Kristina; Borge, Randi Hovden; Ehrhart, Mark G.; Sklar, Marisa; Brown, C. Hendricks; Aarons, Gregory A.

doi:10.1186/s13012-019-0873-7

Cited by 32 publications

(29 citation statements)

References 52 publications

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“…The next step in this line of research includes confirmative comparative effectiveness trials to test implementation strategies-such as the Leadership and Organizational Change for Implementation strategy (LOCI) [98] or the Training in Implementation Practice Leadership (TRIPLE) [100] strategy-that target the implementation leadership-EBP implementation climate mechanism identified in this study. The LOCI intervention [30,98], which targets implementation leadership and EBP implementation climate through training and coaching for first-level leaders along with consultation with executives, has shown promise in pilot research and is currently under study in a number of settings [30,101,102]. The TRIPLE intervention aims to build leader skill in assessing quality of current service delivery; identifying appropriate and feasible EBPs; developing support for EBP use; assessing and increasing stakeholder engagement in improving practice; and identifying and using data to monitor quality and lead practice change.…”

Section: Discussionmentioning

confidence: 99%

Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis

et al. 2020

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Background Implementation theory suggests that first-level leaders, sometimes referred to as middle managers, can increase clinicians’ use of evidence-based practice (EBP) in healthcare settings by enacting specific leadership behaviors (i.e., proactive, knowledgeable, supportive, perseverant with regard to implementation) that develop an EBP implementation climate within the organization; however, longitudinal and quasi-experimental studies are needed to test this hypothesis. Methods Using data collected at three waves over a 5-year period from a panel of 30 outpatient children’s mental health clinics employing 496 clinicians, we conducted a quasi-experimental difference-in-differences study to test whether within-organization change in implementation leadership predicted within-organization change in EBP implementation climate, and whether change in EBP implementation climate predicted within-organization change in clinicians’ use of EBP. At each wave, clinicians reported on their first-level leaders’ implementation leadership, their organization’s EBP implementation climate, and their use of both EBP and non-EBP psychotherapy techniques for childhood psychiatric disorders. Hypotheses were tested using econometric two-way fixed effects regression models at the organization level which controlled for all stable organizational characteristics, population trends in the outcomes over time, and time-varying covariates. Results Organizations that improved from low to high levels of implementation leadership experienced significantly greater increases in their level of EBP implementation climate (d = .92, p = .017) and within-organization increases in implementation leadership accounted for 11% of the variance in improvement in EBP implementation climate beyond all other covariates. In turn, organizations that improved from low to high levels of EBP implementation climate experienced significantly greater increases in their clinicians’ average EBP use (d = .55, p = .007) and within-organization improvement in EBP implementation climate accounted for 14% of the variance in increased clinician EBP use. Mediation analyses indicated that improvement in implementation leadership had a significant indirect effect on clinicians’ EBP use via improvement in EBP implementation climate (d = .26, 95% CI [.02 to .59]). Conclusions When first-level leaders increase their frequency of implementation leadership behaviors, organizational EBP implementation climate improves, which in turn contributes to increased EBP use by clinicians. Trials are needed to test strategies that target this implementation leadership–EBP implementation climate mechanism.

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Section: Discussionmentioning

confidence: 99%

Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis

et al. 2020

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“…The evaluation of providers’ attitudes toward EBP with help of both instruments might inform about successful strategies in implementation efforts in research in German-speaking countries as well as potential targets for improvement in clinical training and practice. For example, The Leadership and Organizational Change for Implementation (LOCI) strategy can be used to improve workplace climate for EBP, which should then influence provider attitudes toward, and use of, EBP with fidelity [ 77 , 78 ]. Thus, attitudes could be considered a mechanism by which an implementation strategy has its effects on clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Cross-cultural adaption and psychometric investigation of the German version of the Evidence Based Practice Attitude Scale (EBPAS-36D)

Szota

Thielemann

Christiansen

et al. 2021

Health Res Policy Sys

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Background The implementation of evidence-based practice (EBP) in mental health care confers many benefits to patients, and research into factors facilitating the implementation of EBP is needed. As an important factor affecting the implementation of EBP, service providers’ attitudes toward EBP emerged. The Evidence-Based Practice Attitude Scale (EBPAS-36) is an instrument with good psychometric characteristics that measures positive and ambivalent attitudes toward EBP. However, a German version is missing. The present study therefore aims to provide a validated German translation of the EBPAS-36. Methods The scale was translated and back-translated as recommended by standard procedures. German psychotherapists were recruited to participate in an online survey. They provided demographic and professional information, completed the EBPAS-36, the Implementation Climate Scale (ICS) and the Intention Scale for Providers (ISP). Standard item and reliability analyses were conducted. Construct validity was evaluated with exploratory (EFA) and confirmatory factor analyses (CFA) in two subsamples (random split). Convergent validity was tested by predicting a high positive correlation of the EBPAS-36D with two scores of attitudes of the ISP and an interest in EBP score. It was tested whether the EBPAS-36D predicts the intention to use EBP. Results N = 599 psychotherapists participated in the study. The item analyses showed a mean item difficulty of pi = 0.64, a mean inter-item correlation of r = 0.18, and a mean item-total correlation of ritc = 0.40. The internal consistency was very good for the total scale (α = 0.89) and ranged from adequate to very good for the subscales (0.65–0.89), indicating high reliability. The original factor structure showed an acceptable model fit (RMSEA = 0.064 (90% CI = 0.059–0.068); SRMR = 0.0922; AIC = 1400.77), confirming the 12-factor structure of the EBPAS-36. However, a second-order factor structure derived by the EFA had an even better model fit (RMSEA = 0.057 (90% CI = 0.052–0.062); SRMR = 0.0822; AIC = 1274.56). When the EBPAS-36D was entered in a hierarchical regression model with the criterion Intention to use EBP, the EBPAS-36D contributed significantly to the prediction (Change in R2 = 0.28, p < 0.001) over and above gender, age and participants’ report of ever having worked in a university context. Conclusions The present study confirms good psychometric properties and validity of a German version of the EBPAS-36 in a sample of psychotherapists.

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“…These questions are previously used in a large Norwegian study, investigating important factors related to cooperation and quality in services for children and their families [ 47 ] Total workload Questionnaire , (TWQ) The TWQ [ 48 ] includes 15 questions regarding autonomy and workload that will be used to assess these important parts of the group leader’s work situation The Implementation Climate Scale (ICS) The ICS [ 49 ] will be used to assess the implementation context in the participating agencies. The original psychometric properties are good, and the instrument is currently being investigated in a Norwegian context [ 50 ] The Implementation Leadership Scale (ILS) The ILS [ 51 ] will be used to assess to what extent the leaders in the services support and promote implementation of evidence-based interventions. The psychometric properties have shown excellent internal consistency and convergent and divergent validity for the original version Post-intervention questionnaire (PIE) The PIE, a self-developed questionnaire (see Additional file 1 ) regarding experiences and satisfaction with running EMOTION groups.…”

Section: Method/designmentioning

confidence: 99%

Study protocol of a factorial trial ECHO: optimizing a group-based school intervention for children with emotional problems

et al. 2021

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Background Youth mental health problems are a major public health concern. Anxiety and depression are among the most common psychological difficulties. The aim of this study is to evaluate an optimized version of a promising indicated group intervention for emotional problems. The program (EMOTION Coping Kids Managing Anxiety and Depression) targets school children 8–12 years with anxious and depressive symptoms and examines three factors. Factor 1 compares the standard EMOTION intervention delivered in 16 group-based sessions (Group), versus a partially-digital EMOTION intervention (DIGGI) delivered as eight group sessions and eight digital sessions. Both versions use virtual reality technology (VR) to improve behavioral experiments. Factor 2 compares parent participation in a 5-session parent group (high involvement) versus sharing information with parents via a brochure (low involvement). Factor 3 compares the use of a measurement and feedback system (MFS) designed to help group leaders tailor the intervention using feedback from children with no MFS. Methods Using a cluster-randomized factorial design, 40 schools across Norway will be randomized to eight different experimental conditions based on three, two-level factors. To assess internalizing symptoms in children, children and their parents will be given self-report questionnaires pre-, post-, and one year after intervention. Parents also report on demographics, user satisfaction, personal symptoms and perception of family related factors. Teachers report on child symptoms and school functioning. Group leaders and the head of the municipal services report on implementation issues. The primary outcomes are changes in depressive and anxious symptoms. Some secondary outcomes are changes in self-esteem, quality of life, and user satisfaction. Questions regarding the consequences of the COVID-19 pandemic are included. Treatment fidelity is based on checklists from group leaders, and on user data from the participating children. Discussion This study is a collaboration between three regional centers for child and adolescent mental health in Norway. It will provide knowledge about: (1) the effect of school-based preventive interventions on anxiety and depression in children; (2) the effect of feedback informed health systems, (3) the effect and cost of digital health interventions for children, and (4) the effect of parental involvement.

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Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol

Cited by 32 publications

References 52 publications

Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis

Testing a theory of strategic implementation leadership, implementation climate, and clinicians’ use of evidence-based practice: a 5-year panel analysis

Cross-cultural adaption and psychometric investigation of the German version of the Evidence Based Practice Attitude Scale (EBPAS-36D)

Study protocol of a factorial trial ECHO: optimizing a group-based school intervention for children with emotional problems

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