LOCI: Leadership and Organizational Change for Implementation

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Below are a collection of articles, books, and websites with more information on implementation and leadership research.

Journal Articles

Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors (2011)
Aarons, G. A., Hurlburt, M., Horwitz, S. M.

Lessons learned about implementation science from business and medical settings are being applied but it is unclear how well they translate to settings with different historical origins and customs (e.g., public mental health, social service, alcohol/drug sectors). The purpose of this paper is to propose a multi-level, four phase model of the implementation process (i.e., Exploration, Adoption/Preparation, Implementation, Sustainment), derived from extant literature, and apply it to public sector services. We highlight features of the model likely to be particularly important in each phase, while considering the outer and inner contexts (i.e., levels) of public sector service systems.

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Evidence-Based Practice Implementation: The Impact of Public versus Private Sector Organization Type on Organizational Support, Provider Attitudes, and Adoption of Evidence-Based Practice (2009)
Aarons, G. A., Sommerfeld, D. H., Walrath-Greene, C. M.

The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice.

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The Impact of Evidence-Based Practice Implementation and Fidelity Monitoring on Staff Turnover: Evidence for a Protective Effect (2009)
Aarons, G. A., Sommerfeld, D. H., Hecht, D. B., Silovsky, J. F., Chaffin, M. J.

Staff retention is an ongoing challenge in mental health and community-based service organizations.
Little is known about the impact of evidence-based practice implementation on turnover in the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children’s services system. Analyses revealed greater staff retention where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values–innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families.

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Implementing Evidence-Based Practice in Community Mental Health Agencies: A Multiple Stakeholder Analysis (2009)
Aarons, G. A., Wells, R. S., Zagursky, K., Fettes, D. L., Palinkas, L. A.

In this article, we sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable).  Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients’ needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.

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Evidence-Based Practice Implementation and Staff Emotional Exhaustion in Children's Services (2009) Aarons, G. A., Fettes, D. L., Flores, L. E. Jr., Sommerfeld, D. H.

Understanding the implementation of evidence-based practice (EBP) in community service settings is critical for the successful translation of research to practice. However, we have limited research evidence about the impact of EBP implementation on the mental health and social service workforce. The present study investigates the association of EBP implementation and fidelity monitoring with staff emotional exhaustion in a statewide EBP implementation study. The 21 case-management teams in this study were randomized in a 2 (EBP vs. services as usual [SAU]) by 2 (monitoring vs. no monitoring) design. The EBP in this study was SafeCare, a home-based intervention that aims to reduce child neglect in at-risk families. We found lower emotional exhaustion for staff implementing the EBP but higher emotional exhaustion for staff receiving only fidelity monitoring and providing SAU. Together, these results suggest a potential staff and organizational benefit to EBP implementation and we discuss implications of the findings relative to EBPs and to fidelity monitoring.

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Implementation of Evidence-Based Practice in Child Welfare: Service Provider Perspectives (2007) Aarons, G. A., Palinkas, L. A.

Implementation of evidence-based practices (EBP) in child welfare is a complex process that is often fraught with unanticipated events, conflicts, and resolutions. In order to better understand the implementation process in the child-welfare system, we interviewed comprehensive home-based services (CHBS) case managers who were actively engaged in implementing an EBP to reduce child neglect in a state youth services system. Six primary factors were identified as critical determinants of EBP implementation: (1) Acceptability of the EBP to the caseworker and to the family, (2) Suitability of the EBP to the needs of the family, (3) Caseworker motivations for using the EBP, (4) Experiences with being trained in the EBP, (5) Extent of organizational support for EBP implementation, and (6) Impact of EBP on process and outcome of services. These factors reflect two broader themes of attitudes toward or assessments of the EBP itself and experiences with learning and delivering the EBP. Eventual implementation is viewed as the consequence of perseverance, experience, and flexibility.

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Organizational Culture and Climate and Mental Health Provider Attitudes toward Evidence-Based Practice (2006)
Aarons, G. A., Sawitzky, A. C.

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Analyses showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP.

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Transformational and Transactional Leadership: Association with Attitudes toward Evidence-Based Practice (2006)
Aarons, G. A.

Leadership in organizations is important in shaping workers’ perceptions, responses to organizational change, and acceptance of innovations, such as evidence-based practices.  Transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges.  Studies have shown that in youth and family service organizations, mental health providers’ attitudes toward adoption an evidence-based practice are associated with organizational context and individual provider differences.  The purpose of this study was to expand on these findings by examining the association between leadership and mental health providers’ attitudes toward adopting evidence-based practice.  Participants were 303 public-sector mental health service clinicians and case managers from 49 programs who were providing mental health services to children, adolescents, and their families. Data were gathered on providers’ characteristics, attitudes toward evidence-based practices, and perceptions of their supervisors’ leadership behaviors.  Analyses showed that both transformational and transactional leadership were positively associated with providers’ having more positive attitudes toward adoption of evidence-based practice, and transformational leadership was negatively associated with providers’ perception of difference between the providers’ current practice and evidence-based practice. Mental health service organizations may benefit from improving transformational and transactional supervisory leadership skills in preparation for implementing evidence-based practices.

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Mental Health Provider Attitudes toward Adoption of Evidence-Based Practice: The Evidence-Based Practice Attitude Scale (EBPAS) (2004)
Aarons, G. A.

Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined in relation to a set of provider individual difference and organizational characteristics.  Participants were 322 public sector clinical service workers from 51 programs providing mental health services to children and adolescents and their families. Four dimensions of attitudes toward adoption of EBPs were identified: (1) intuitive Appeal of EBP, (2) likelihood of adopting EBP given Requirements to do so, (3) Openness to new practices, and (4) perceived Divergence of usual practice with research-based/academically developed interventions. Provider attitudes varied by education level, level of experience, and organizational context. Attitudes toward adoption of EBPs can be reliably measured and vary in relation to individual differences and service context. EBP implementation plans should include consideration of mental health service provider attitudes as a potential aid to improve the process and effectiveness of dissemination efforts.

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Leadership and Procedural Justice Climate as Antecedents of Unit-Level Organizational Citizenship Behavior (2004)
Ehrhart, M.G.

Despite an abundance of research conducted on organizational citizenship behavior (OCB), relatively little is known about unit-level OCB. To investigate the antecedents of unit-level OCB, data were collected from employees of 249 grocery store departments. Structural equation modeling techniques were used to test a model in which procedural justice climate was hypothesized to partially mediate the relationship between leadership behavior (servant-leadership) and unit-level OCB. Models were tested using both employee ratings and manager ratings of unit-level OCB. The results gave general support for the hypotheses, although there were some differences depending on the source of the OCB ratings (supervisor or subordinate), whether the type of department was controlled for, and whether a common method variance factor was included. Overall, the evidence generally supported the association of both servant-leadership and procedural justice climate with unit-level OCB. Building on the current study, a multilevel framework for the study of OCB is presented in conjunction with a discussion of future research directions in four specific areas.

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An Organizational Climate regarding Ethics: The Outcome of Leader Values and the Practices that Reflect Them (2001)
Dickson, M. W., Smith, D. B., Grojean, M. W., & Ehrhart, M. E.

In this article, we argue that the organizational climate regarding ethics — the shared perception of what is ethically correct behavior and how ethical issues should be handled within an organization — is an outgrowth of the personal values and motives of organizational founders and other early organizational leaders. We begin by arguing that one common label for the climate regarding ethics construct — “ethical climate” — is inappropriate. We also argue that climate regarding ethics has an impact on organizational outcomes, including organizational outcomes that do not have explicit ethical components. We propose that this impact largely occurs through the mediating mechanisms of organizational cohesion and morale. We conclude by discussing the variety of antecedents and outcomes related to climate regarding ethics.

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Predicting Followers’ Preferences for Charismatic Leadership: The Influence of Follower Values and Personality (2001)
Ehrhart, M. G. & Klein, K. J.

Existing research on charismatic leadership focuses primarily on the traits and behaviors of charismatic leaders and the effects of charismatic leaders on their followers. One issue that has been neglected is the disposition of the followers who form charismatic relationships with their leaders. To investigate this topic, we conducted a laboratory study in which participants' values and personality dimensions were used to predict participants' preferences for charismatic leadership vs. two other leadership styles: relationship-oriented and task-oriented leadership. The results showed that values and personality were useful in predicting leadership preferences. More research is needed to gain further insights into the active role of followers in the formation of charismatic relationships.

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EBPAS: The Evidence-Based Practice Attitude Scale

An empirically validated measure assessing mental health provider attitudes toward adoption of evidence-based practice.

If you are interested in the EBPAS please contact us for further information.