Effects of Organizational Characteristics on Change in Capability to Provide Co-Occurring Services

Transcription

1 Effects of Organizational Characteristics on Change in Capability to Provide Co-Occurring Services Heather J. Gotham, PhD 1, Ron Claus, PhD 2, Andrew Homer, PhD 3, Edward Riedel, MSW 3, & Rachel Christiansen, MSW 3 1 Mid-America Addiction Technology Transfer Center, University of Missouri-Kansas City 2 Westat 3 Missouri Institute of Mental Health, University of Missouri-St Louis AHSR 2011

2 Implementation of New Practices Implementing complex, clinical evidence-based practices can take up to 2-4 years (Fixsen et al., 2005) Research examining the multi-year process of implementation is limited McHugo et al. (2007) - National Implementing Evidence-Based Practices Project, 5 EBPs at 53 sites over 2 years Organizational level variables influence implementation Funding source, agency size, organizational climate and culture, and organizational readiness to change

3 Organizational Readiness for Change ORC measure (Lehman et al., 2002) Program and training needs Institutional resources Staff attributes Organizational climate ORC related to attitudes toward EBPs, intention to make program changes, and client outcomes Fuller et al. (2007) - CTN sites with higher organizational stress and organizational cohesiveness showed more support for integrated cooccurring services Courtney et al. (2007) - programs with higher needs and pressures, limited institutional resources, and lower ratings of staff attributes and organizational climate were more likely to commit to making program change

4 Previous Study Co-occurring capability & organizational attributes Missouri Co-occurring State Incentive Grant 14 addiction and mental health treatment programs Change in capability over two years, ORC at baseline Organizational Readiness for Change Programs with more program and training needs and pressures to change at baseline showed more change in COD capability Programs with lower levels of organizational climate (staff cohesion, autonomy, management openness to change, etc.) at baseline showed more change in COD capability Gotham, Claus, Selig & Homer, 2010, JSAT

5 Current Study Goals Examine changes in addiction and mental health treatment programs co-occurring capability over two years Explore the effects of baseline organizational readiness for change on capability over time Replicate earlier study but with more sites, more power

6 Missouri Foundation for Health s Co-Occurring Disorders Priority Area Supported implementation of EBPs for co-occurring disorders TIP 42 for addiction programs IDDT for mental health programs 27 publicly-funded treatment providers in Missouri 9 addiction treatment programs 18 mental health treatment programs

7 Method Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index - McGovern, Matzkin, & Giard, 2007 Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index Gotham, Brown, Comaty, & McGovern, 2009 Two evaluators conducted a half-day visit to each site annually for 3 years Program director, clinical supervisor & clinical staff interviews Agency walk-through Chart review of current & former clients with COD Focus group with 2-4 clients Staff surveys

8 DDCAT/DDCMHT: 7 DIMENSIONS, 35 ITEMS I II III IV V VI VII Dimension Program Structure Program Milieu Clinical Process: Assessment Clinical Process: Treatment Continuity of Care Staffing Training Content of items Program mission, structure and financing, format for delivery of co-occurring disorder services Physical, social and cultural environment for persons with co-occurring disorders Processes for access and entry into services, screening, assessment & diagnosis Processes for treatment including pharmacological and psychosocial evidence-based formats Discharge and continuity for both addiction and mental health services, peer recovery supports Role and integration of staff with addiction and mental health services expertise, supervision process Proportion of staff trained and program s training strategy on co-occurring disorders

9 DDCAT/DDCMHT RATINGS Dual Diagnosis Enhanced (DDE) serve clients with more severe, unstable cooccurring disorders Dual Diagnosis Capable (DDC) serve clients with low severity, stable co-occurring disorders Addiction/Mental Health Only Services (A(MH)OS) serve clients with no or minimal co-occurring disorders

10 Organizational Readiness to Change 115-item self-report measure (Lehman,et al., 2002) 18 subscales combined into four indices Needs & Pressures Institutional Resources Staff Attributes Organizational Climate 26/27 sites with data from at least 2 staff (mean = 8 staff, range 2-31)

11 Change in Capability (N=27) DDE DDC 3.00 AOS/ MHOS Year 1 Year 2 Year 3

12 Range in Change: Year 1 3 (N=27) Agencies Had negative or minimal changes from Year 1 to Agencies Improved more than 1 DDCAT Unit from Year 1 to Minimal to Negative Change Small Improvement (>.5 DDCAT Unit) Better than Avg Improvement Lots of improvement (>1.75 Units)

13 Correlations Between ORC Indices & Capability Change (n=26) ORC Institutional Resources ORC Needs & Pressres -.16 ORC Instit Resour ORC Staff Attributes ** ORC Organizational Climate ORC Staff Attrib **.36 ORC Org Climate Year 1 Total Capability -.52 ** Year 1 Total Capablty Year 3 Total Capability Total score change Y1 to Y3 Year 3 Total Capablty.51 ** **.58 **

14 Correlations Between ORC Indices & Capability Change (n=26) ORC Institutional Resources ORC Needs & Pressres -.16 ORC Instit Resour ORC Staff Attributes ** ORC Organizational Climate ORC Staff Attrib **.36 ORC Org Climate Year 1 Total Capability -.52 ** Year 1 Total Capablty Year 3 Total Capability Total score change Y1 to Y3 Year 3 Total Capablty.51 ** **.58 **

15 Predicting Change Hierarchical multiple regression analysis predicting Year 3 capability Step 1: Year 1 total capability Step 2: ORC indices Neither step nor any variables were significant Same with just the Needs & Pressures Index

16 Conclusions - Capability Co-occurring capability increased over 2 years At Year 1, most sites were between A(MH)OS & DDC By Year 3, most sites were between DDC & DDE Current study versus COSIG Current sites started at higher level of COD capability and showed greater change over time; history effect?

17 Conclusions - ORC Programs with higher needs and pressure to change started at a lower level of capability, but changed more over time Otherwise, little correlation between ORC and capability Different from COSIG study Staff not consistently rating the program, error in aggregated ORC indices Low number of respondents (8 sites <5 respondents) ICC s for subscales across raters at each site varied (.23 to.88) Use std dev to predict (Courtney et al., 2007) no significant results Complexity of implementation, other intervening factors related to change in co-occurring capability

18 Acknowledgements Support for this presentation was provided by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the community it services

19 Contact Heather J. Gotham, PhD Edward Riedel, MSW Ron Claus, PhD Rachael Christiansen, MSW edu Andrew Homer, PhD