Methods: The study data come from a cross-sectional survey of counselors who provide outpatient substance abuse treatment. Counselors were selected via a nested probability sample. Fifty-seven (81%) organizations and 293 (68%) counselors participated. Treatment approaches were measured with a scale adapted from the Practitioner Technique Inventory (Ball, et al., 2002). Organizational contexts were measured with scales designed to assess specific dimensions of organizational climate and culture (UT-CMHSRC, 2002; TCU-SOF, 2005). Organizations were first classified according to the dimensions of organizational cohesiveness and orientation to change. ANOVA and random effects multi-level (HLM) models were conducted to appropriately address the nested sample and assess associations between organizational contexts and frontline practice.
Results: ANOVA models indicate that levels of evidence-based treatment practices are highest in change-oriented organizational contexts. The use of evidence-based treatment practices is lowest in diffuse and traditional organizational contexts. By contrast, directive/12-step treatment techniques are used most extensively in cohesive organizational contexts, whether change-oriented or not. Cross-level HLM results indicate that change-oriented organizational contexts may promote the use of evidence-based techniques as they enhance practitioners' capacity to use training. Also, a cross-level HLM interaction model indicates that practitioners feel more positively about their organizations when they are freer to use traditional treatment techniques.
Conclusions and Implications: Findings from this study are consistent with the observation that the implementation of evidence-supported practices is associated with both social and technical processes in organizations (Glisson, et al., 2008). The influences of technical processes associated with change-oriented contexts and leadership have become clearer, and are again supported in this study's findings. The influences of social processes, such as co-worker cohesion, however, clearly warrant further attention. When cohesive staff bond together in their use of traditional practices, as seems the case in many substance abuse treatment settings, successful efforts at innovation implementation are likely to be those that can address and creatively capitalize on the social aspects of work in challenging organizational contexts.