Organizational Influences On the Fidelity to Implementation of An Evidence-Based Practice

Background and Purpose: Community-based mental health (CBMH) organizations epitomize the diverse settings in which efforts are underway to understand the implementation of evidence-based practices (EBPs). Organizational complexities associated with the implementation process make it challenging for agencies to adhere to fidelity protocols and requirements. Recent studies indicate there are organizations that implement with fidelity while others do not achieve success, in spite of significant resource investment. Important dimensions of the organizational context are organizational culture, absorptive capacity, and the change process. In light of the urgency to move empirically based psychosocial mental health interventions into usual-care settings, it is necessary to understand the context in which such organizational dimensions influence fidelity to implementation. The study hypothesized that CBMH organizations with an organizational culture characterized by a developmental/open systems model typology and high levels of absorptive capacity will experience higher fidelity outcomes in the implementation of the Integrated Dual Disorder Treatment (IDDT) model. The assumptions that organizational culture influences the level of fidelity to IDDT implementation, and the change process influences fidelity outcomes, formed the basis of the overall study.

Method: This exploratory study utilized a mixed-methods research design to conduct a secondary analysis using data from the National Implementing Evidence-Based Practices Project (NIEBPP) on the implementation of evidence-based practices. A “QUAL-quant” design defined the study. Eleven CBMH organizations across three states were purposively selected, and involved in implementing the IDDT model. NIEBPP's extensive body of qualitative data allowed for the study to employ a collective case study research analysis to explore differences in three sites that experienced high model fidelity scores and three with low model fidelity scores. Descriptive statistics and a correlational analysis determined if a relationship existed between the measures of organizational culture, absorptive capacity, and fidelity outcomes.

Results: Five qualitative findings emerged from this study: one major finding relevant to organizational culture and four findings pertinent to the change process. Sites that emphasized a strong recovery vision central to consumer-based mental health treatment implemented IDDT with success (high fidelity). Sites with less success (low fidelity) embraced a more traditional service delivery structure that emphasized a more paternalistic treatment vision. Relevant to the change process, findings indicated four significant drivers of change: (a) leadership, (b) agency adaptability, (c) processes that facilitate education and training regarding use of the IDDT model language, and (d) supervision as an agency priority. There was no relationship between organizational culture typology and fidelity to implementation. Other dimensions of organizational culture- leadership collaboration and a values-innovation fit with the IDDT model indicated a strong relationship to fidelity. Absorptive capacity indicated a moderate to strong relationship with fidelity.

Implications: This study sheds light on how organizational context is relevant to evidence-based practice implementation. The findings suggest understanding the contextual aspects of organizational culture and the change process are important to fidelity. This knowledge will benefit CBMH agencies that seek to enhance service delivery through empirically based psychosocial mental health interventions. Ultimately, knowledge from this study can promote client outcomes based in recovery and rehabilitation.