The Role of Leadership and Readiness for Change in the Implementation of Cultural Competence in Community-Based Substance Abuse Treatment

Background/Purpose: Leaders of community-based substance abuse treatment (SAT) organizations face significant challenges to implementing innovative treatment practices due to their low readiness to respond to rapid changes in health care. These community providers are well positioned to reduce health disparities if they can provide racial and ethnic minority groups with culturally responsive and technically appropriate care. This study evaluated the organizational capacity of publicly-funded community-based SAT organizations in Los Angeles County, California, to implement culturally competent practices.

Methods: Data were collected in 2011. Using a randomly selected sample of 95 managers, we relied on structural equation modeling to validate measures and identify relationships between leadership capacity, organizational readiness for change, and implementation of three culturally competent practices. One factor with nine items represented leadership capacity (Edwards et al., 2010), whereas two factors (organizational resources and climate) with 12 and 16 items each represented readiness for change (Simpson & Flynn, 2007). Three factors with 14, nine, and eight items each represented culturally competent practices (Mason, 2005). These factors measured (1) resources and linkages associated with effectively serving racial/ethnic minority communities; (2) diversity in the racial and ethnic composition of staff; and (3) organizational policies and procedures pertaining to implementing culturally competent practices. A mediational model was conducted accounting for measurement errors and control variables relevant to implementation—namely, funding, regulation, and staff education level.

Results: All measures reported adequate Cronbach’s alphas: leadership capacity (α = .943), readiness for change (α = .932) and culturally competence practices (α = .893). In addition, the hypothesized mediational model fit the data well (χ² = 312.029, p < .000, CFI = .806, TLI = .695). Leadership capacity was positively associated with both factors of organizational readiness, namely resources (ß = .655, p < .001) and climate (ß = .790, p < .001). Leadership capacity was also directly associated with increasing the racial and ethnic diversity of staff (ß = .580, p < .01). Further, through the mediational role of organizational climate, leadership was indirectly related to diversity in the racial and ethnic composition of staff. Finally, consistent with other studies, staff education level were positively associated with organizational resources (ß = .183, p < .01) and climate (ß = .194, p < .05), whereas professional regulation showed a positive relationship with resources and linkages with regard to cultural competence (ß = .236, p < .05) and the implementation of staff diversity in the organization (ß = .253, p < .05).

Conclusions/Implications: Findings underscore the crucial role of leadership in securing resources and promoting a climate that fosters the implementation of innovative practices. Specifically, through organizational climate, leaders may have a greater impact on increasing the racial and ethnic diversity of staff. Findings can inform health care management policies to effectively diversify the workforce, a program design intervention believed to improve client treatment adherence. Implications for future research include identifying managerial strategies to sustain implementation efforts of culturally competent practices and evaluating their impact on treatment outcomes.