مکانیسم تغییر در استراتژی سازمانی ARC: افزایش پذیرش EBP متخصصان سلامت روانی از طریق بهبود ظرفیت و فرهنگ سازمانی Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians’ EBP Adoption Through Improved Organizational Culture and Capacity

Introduction Significant deficits remain in the development of implementation strategies that increase the use of evidence-based practices (EBPs) in routine mental health care (Collins et al. 2011; Insel 2009; NIMH 2008). Nearly half of all implementation strategies tested in mental health services fail to influence the targeted implementation, services, or clinical outcomes (Powell et al. 2014) and the most promising strategies are the least economically feasible (Novins et al. 2013). We argue that developing more effective and effi- cient implementation strategies requires a better understanding of the mechanisms that explain how these strategies influence implementation outcomes (Williams and Glisson 2014b). However, almost no studies test the mechanisms that link implementation strategies to outcomes and no studies have supported a hypothesized linking mechanism in mental health settings (Williams 2015). The present study tests the 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 in a 4-year randomized controlled trial. ARC is an organizational intervention that facilitates the adoption and integration of empirically-supported clinical interventions (i.e., EBPs) and other innovations into routine practice by changing organizational cultures and reducing job-related service barriers (Glisson et al. 2010; Powell et al. 2012). ARC has demonstrated positive main effects on clinician turnover, organizational culture, clinicians’ work attitudes, and clinical outcomes for youth (Glisson et al. 2006, 2013, 2010). However, no studies have tested ARC’s effects on clinicians’ EBP adoption or the cross-level change mechanisms that explain how ARC influences clinicians’ practice behaviors. In the present RCT, we examine the cross-level contextual, motivational, and barrier-related mechanisms that explain ARC’s effects on clinicians’ EBP adoption and use. Our outcome criteria distinguish between clinicians including specific EBPs in their treatment repertoires (i.e., adoption) and the extent to which they incorporate EBPs in their work with clients (i.e., use).