Organizational Readiness for Change in Community-Based Substance Abuse Treatment Organizations and Fidelity in Implementing Evidence-Based Practices: A National Study

Background/Purpose: Prior studies by the authors have found that the level of organizational capacity in a substance abuse treatment (SAT) organization is associated with clinical staff perceptions of the level of difficulty of implementing an evidence-based practice (EBP). This study is the next step in our ongoing research effort examining whether higher levels of organizational capacity (or readiness for change measured through the TCU-ORC) are also associated with staff fidelity in EBP implementation. Research indicates that the quality of EBP implementation strongly influences outcomes, and that higher fidelity to the EBP produces superior clinical results (Drake, Goldman, Leff, & Lehman, 2001; Torrey et al., 2001). If key elements are omitted during replication, the outcomes tend to be less positive or even contradictory (Mowbray, Holter, Teague, & Bybee, 2003). Further, without fidelity criteria for the specific EBP, it is not possible to determine whether unsuccessful outcomes are due to a failure of the intervention or a failure to implement the intervention as intended.

Methods: The analytic sample included 349 clinical staff from community-based SAT organizations. Fidelity was explored through a continuous variable measuring the extent to which staff modified EBP standards and manuals when implementing a new EBP. Bivariate analysis (one-way ANOVA and correlation analysis for categorical and continuous variables, respectively) examined the statistical relationship between all independent variables (age, gender, number of years of education, years of experience in drug abuse counseling, organizational affiliation with a research institution, type of treatment unit, primary service area, program duration, type of EBP implemented, rating of barriers to implementation, and the 18 TCU-ORC subscales) and the dependent variable. A multilevel linear regression model was developed using all variables significant at the bivariate level (p< 0.05).

Results: Accounting for other organizational factors, multivariate regression methods identified several program and staff characteristics associated with more modifications to the EBP. Findings indicated that clinical staff who worked in an organization that less frequently adopted new counseling interventions and techniques, who reported a higher level of barriers in implementing the EBP, who reported implementing Motivational Interviewing (MI) rather than other EBPs, and who had more years of addiction counseling experience also reported making more modifications to the EBP.

Conclusions/Implications: Findings suggest that organizations as a whole, not just individual staff, need training on EBPs. Organizations new to using EBPs need to receive agency-wide training to understand fidelity requirements. This is a complex process; without it, EBPs could be modified in such a way that they lose the specific “active ingredients” that have therapeutic effect. Organizations need to help staff anticipate possible implementation barriers and problem-solve to reduce them. Concerning specific EBPs, staff who implemented MI, in contrast to other EBPs, made higher levels of modifications. Such modifications may be more likely when an EBP is more flexible (i.e., less dictation of components, format, and timing by the EBP designers). With such EBPs, staff may need more guidance about what elements should and should not be modified.