title: Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity.
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 job-related 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.
authors.affiliation: School of Social Work, Boise State University, 1910 University Dr., Boise, ID, 83725-1940, USA. natewilliams@boisestate.edu.
authors.forename: Nathaniel J
authors.initials: NJ
authors.lastname: Williams
authors.affiliation: Children's Mental Health Services Research Center, University of Tennessee, Knoxville, TN, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Glisson
authors.affiliation: Children's Mental Health Services Research Center, University of Tennessee, Knoxville, TN, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Hemmelgarn
authors.affiliation: Children's Mental Health Services Research Center, University of Tennessee, Knoxville, TN, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Green
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003156:Community Mental Health Services / Q000458:organization & administration*; D055317:Evidence-Based Practice / Q000458:organization & administration*; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065886:Neurodevelopmental Disorders / Q000628:therapy*; D015279:Organizational Culture; D009936:Organizational Innovation
keywords: ARC; Evidence-based practice; Intervention; Mechanism; Mediation; Mental health; Organizational implementation strategy; Organizational culture