دانلود رایگان مقاله انگلیسی مکانیسم تغییر در استراتژی سازمانی ARC: افزایش پذیرش EBP متخصصان سلامت روانی - اشپرینگر 2017

Abstract

The development of efficient and scalable implementation strategies in mental health is restricted by poor understanding of the change mechanisms that increase clinicians’ evidence-based practice (EBP) adoption. This study tests the cross-level change mechanisms that link an empirically-supported organizational strategy for supporting implementation (labeled ARC for Availability, Responsiveness, and Continuity) to mental health clinicians’ EBP adoption and use. Four hundred seventy-five mental health clinicians in 14 children’s mental health agencies were randomly assigned to the ARC intervention or a control condition. Measures of organizational culture, clinicians’ intentions to adopt EBPs, and job-related EBP barriers were collected before, during, and upon completion of the three-year ARC intervention. EBP adoption and use were assessed at 12-month follow-up. Multilevel mediation analyses tested changes in organizational culture, clinicians’ intentions to adopt EBPs, and job-related EBP barriers as linking mechanisms explaining the effects of ARC on clinicians’ EBP adoption and use. ARC increased clinicians’ EBP adoption (OR = 3.19, p = .003) and use (81 vs. 56 %, d = .79, p = .003) at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced jobrelated EBP barriers. A combined mediation analysis indicated the organizational culture-EBP intentions mechanism was the primary carrier of ARC’s effects on clinicians’ EBP adoption and use. ARC increases clinicians’ EBP adoption and use by creating proficient organizational cultures that increase clinicians’ intentions to adopt EBPs.

Conclusion

Findings from this randomized controlled trial provide evidence that the ARC organizational intervention can increase clinicians’ EBP adoption and use through the transformation of organizational culture and the activation of clinicians’ EBP intentions. These findings highlight directions for future research on the role of organizational social context in shaping a variety of implementation outcomes in mental health services. Results also suggest organizational social context and clinicians’ behavioral intentions represent salient targets for increasing EBP adoption and effectiveness in mental health systems. Additional studies that extend our knowledge of how to efficiently marshal these and other mechanisms are essential to advancing implementation science and practice in the complex arena of mental health services necessarily represent the official views of the National Institute of Mental Health.