title: Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services.
abstract: BACKGROUND
  Despite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices.
  
  
  METHODS
  We relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs.
  
  
  RESULTS
  Findings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members during the uptake of new practices, knowledgeable to properly guide the implementation process, and perseverant to address ongoing barriers that are likely to stall implementation efforts.
  
  
  CONCLUSIONS
  These findings emphasize how leadership approaches are leveraged to facilitate the implementation and delivery of EBPs in publicly funded addiction treatment programs. Findings have implications for the content and structure of leadership interventions needed in community-based addiction treatment programs and the development of leadership interventions in these and other service settings.
authors.affiliation: School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA. erickgue@usc.edu.
authors.forename: Erick G
authors.initials: EG
authors.lastname: Guerrero
authors.affiliation: University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Boulevard, Suite 200, Los Angeles, CA, 90025, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Padwa
authors.affiliation: School of Social Work, University of Southern California, 655 West 34th Street, Los Angeles, CA 90089, USA.
authors.forename: Karissa
authors.initials: K
authors.lastname: Fenwick
authors.affiliation: Kent School of Social Work, University of Louisville, Louisville, KY 40292, USA.
authors.forename: Lesley M
authors.initials: LM
authors.lastname: Harris
authors.affiliation: Department of Psychiatry, University of California, 9500 Gilman Dr. (0812), San Diego, La Jolla, CA 92093-0812, USA.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
mesh_terms: D000368:Aged; D055317:Evidence-Based Practice / Q000379:methods*; D005260:Female; D006284:Health Plan Implementation / Q000379:methods*; D006296:Health Services; D006801:Humans; D007857:Leadership; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D019966:Substance-Related Disorders / Q000628:therapy*
keywords: Addiction; Evidence-based practice; Implementation; Leadership strategies; Management; Managers; Organization; Substance use disorder