title: Multilevel predictors of clinic adoption of state-supported trainings in children's services.
abstract: OBJECTIVE
  Characteristics associated with participation in training in evidence-informed business and clinical practices by 346 outpatient mental health clinics licensed to treat youths in New York State were examined.
  
  
  METHODS
  Clinic characteristics extracted from state administrative data were used as proxies for variables that have been linked with adoption of innovation (extraorganizational factors, agency factors, clinic provider-level profiles, and clinic client-level profiles). Multiple logistic regression models were used to assess the independent effects of theoretical variables on the clinics' participation in state-supported business and clinical trainings between September 2011 and August 2013 and on the intensity of participation (low or high). Interaction effects between clinic characteristics and outcomes were explored.
  
  
  RESULTS
  Clinic characteristics were predictive of any participation in trainings but were less useful in predicting intensity of participation. Clinics affiliated with larger (adjusted odds ratio [AOR]=.65, p<.01), more efficient agencies (AOR=.62, p<.05) and clinics that outsourced more clinical services (AOR=.60, p<.001) had lower odds of participating in any business-practice trainings. Participation in business trainings was associated with interaction effects between agency affiliation (hospital or community) and clinical staff capacity. Clinics with more full-time-equivalent clinical staff (AOR=1.52, p<.01) and a higher proportion of clients under age 18 (AOR=1.90, p<.001) had higher odds of participating in any clinical trainings. Participating clinics with larger proportions of youth clients had greater odds of being high adopters of clinical trainings (odds ratio=1.54, p<.01).
  
  
  CONCLUSIONS
  Clinic characteristics associated with uptake of business and clinical training could be used to target state technical assistance efforts.
authors: Dr. Olin, Mr. Weaver, Dr. Kerker, Dr. Hoagwood, and Dr. Horwitz are with the Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York (e-mail: serene.olin@nyumc.org ). Dr. Kerker is also with the Nathan S. Kline Institute for Psychiatric Research, Orangeburg, New York. Dr. Chor is with the Health and Social Development Program, American Institutes of Research, Chicago. Dr. Duan is with the Division of Biostatistics, Department of Psychiatry, Columbia University, New York. Ms. Clark is with the New York State Office of Mental Health, Albany. Dr. Cleek is with the Silver School of Social Work, New York University, New York.
authors: Su-Chin Serene
authors: SC
authors: Olin
authors: Ka Ho Brian
authors: KH
authors: Chor
authors: James
authors: J
authors: Weaver
authors: Naihua
authors: N
authors: Duan
authors: Bonnie D
authors: BD
authors: Kerker
authors: Lisa J
authors: LJ
authors: Clark
authors: Andrew F
authors: AF
authors: Cleek
authors: Kimberly Eaton
authors: KE
authors: Hoagwood
authors: Sarah McCue
authors: SM
authors: Horwitz
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D006282:Health Personnel / Q000193:education*; D006297:Health Services Accessibility; D006801:Humans; D007318:Inservice Training / Q000379:methods / Q000706:statistics & numerical data*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009518:New York; D010045:Outpatients