title: Testing the leadership and organizational change for implementation (LOCI) intervention in substance abuse treatment: a cluster randomized trial study protocol.
abstract: Evidence-based practice (EBP) implementation represents a strategic change in organizations that requires effective leadership and alignment of leadership and organizational support across organizational levels. As such, there is a need for combining leadership development with organizational strategies to support organizational climate conducive to EBP implementation. The leadership and organizational change for implementation (LOCI) intervention includes leadership training for workgroup leaders, ongoing implementation leadership coaching, 360° assessment, and strategic planning with top and middle management regarding how they can support workgroup leaders in developing a positive EBP implementation climate.
  
  
  
  This test of the LOCI intervention will take place in conjunction with the implementation of motivational interviewing (MI) in 60 substance use disorder treatment programs in California, USA. Participants will include agency executives, 60 program leaders, and approximately 360 treatment staff. LOCI will be tested using a multiple cohort, cluster randomized trial that randomizes workgroups (i.e., programs) within agency to either LOCI or a webinar leadership training control condition in three consecutive cohorts. The LOCI intervention is 12 months, and the webinar control intervention takes place in months 1, 5, and 8, for each cohort. Web-based surveys of staff and supervisors will be used to collect data on leadership, implementation climate, provider attitudes, and citizenship. Audio recordings of counseling sessions will be coded for MI fidelity. The unit of analysis will be the workgroup, randomized by site within agency and with care taken that co-located workgroups are assigned to the same condition to avoid contamination. Hierarchical linear modeling (HLM) will be used to analyze the data to account for the nested data structure.
  
  
  
  LOCI has been developed to be a feasible and effective approach for organizations to create a positive climate and fertile context for EBP implementation. The approach seeks to cultivate and sustain both effective general and implementation leadership as well as organizational strategies and support that will remain after the study has ended. Development of a positive implementation climate for MI should result in more positive service provider attitudes and behaviors related to the use of MI and, ultimately, higher fidelity in the use of MI.
  
  
  
  This study is registered with Clinicaltrials.gov ( NCT03042832 ), 2 February 2017, retrospectively registered.
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA. gaarons@ucsd.edu.|Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA. gaarons@ucsd.edu.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Aarons
authors.affiliation: Department of Psychology, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182-4611, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Ehrhart
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.|Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
authors.forename: Joanna C
authors.initials: JC
authors.lastname: Moullin
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.|Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
authors.forename: Elisa M
authors.initials: EM
authors.lastname: Torres
authors.affiliation: Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA, 92093-0812, USA.|Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Green
mesh_terms: D001291:Attitude of Health Personnel; D004059:Diffusion of Innovation; D055317:Evidence-Based Practice; D005260:Female; D006282:Health Personnel / Q000193:education / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training; D007857:Leadership; D008297:Male; D009042:Motivation; D009936:Organizational Innovation; D019966:Substance-Related Disorders / Q000534:rehabilitation*
keywords: Attitudes; Fidelity; Implementation; Implementation strategy; Leadership; Motivational interviewing; Organizational climate