Implementation Climate and Collaborative Learning: Implementing Trauma Focused Cognitive Behavioral Therapy (TF-CBT) in Mental Health Organizations
The Institute for Healthcare Improvement’s Learning Collaborative (LC) model is a promising strategy for implementing evidence-based practices (EBPs) within mental health agencies. The degree to which LCs facilitate EBPs implementation may depend on an organization’s implementation climate, or the degree to which clinicians perceive that a new practice is rewarded, supported and expected within their organization (Weiner, 2011; Klein &Sorra, 1996)). However, the relationship between implementation climate and the perceived usefulness of LC learning activities remains unexplored. The study bridges this gap by addressing the question, “Are learning activities (LAs) more helpful for implementation when there is a supportive organizational implementation climate?” We expect there to be a positive relationship between implementation climate and the perceived helpfulness of three types of learning activities: Inter-OLAs (inter-organizational), Intra-OLAs (intra-organizational), and ExpertLAs (Expert-Led). We tested the effect of organization implementation climate on three types of LC learning activities, controlling for job role, field experience and organization size.
This study draws on survey data collected from 134 staff members from 27 children's mental health organizational implementation teams participating in a LC to implement trauma-focused cognitive behavioral therapy (TF-CBT). Surveys were administered in person at the end of the LC. Implementation climate at the individual level was measured using 12 survey items(Weiner, 2011). Perceived helpfulness of the three types of LC learning activities was measured using 11 survey items (Nembhard, 2009, 2012). Participants' job role (clinicians, supervisors or senior leaders) and years of field experience were measured. In addition, organization size is measured by the number of employees. Multi-level mixed effects models were used to address the research aim. Variables in Level 1 included individuals' perceived helpfulness scores of LAs, job role and field experience, while organizational implementation climate and size were included in level 2 of the model.
The Intraclass Correlation Coefficient (ICC>0.3) indicated that over 30% of the variance in perceived helpfulness of all three types of learning activities was a result of the level 2 of the model. Cross-level interactions indicated that the positive association between implementation climate and participants' perceived helpfulness of Expert-led LAs (0.407, SE=0.088, P<0.000) is the strongest, followed by InterOLAs (0.394, SE=0.091, p<0.000) and IntraOLAs(0.288, SE=0.104, p<0.006). In addition, organizations' size is positively associated with the perceived helpfulness of Expert-led LAs (0.198, SE=0.089, P<0.027). At the individual level, participants' job role and experience are not associated with perceived helpfulness of the three LAs.
Findings show that organizational contextual factors may account for variance in organizational learning. The more supportive an agency’s climate for implementing TF-CBT, the more helpful practitioners perceive LC learning activities, especially Expert-led and inter-organizational LAs. This suggests that a positive within-organization implementation climate not only enhances participants' learning experience with other staff within the same organization, but also promotes shared learning between organizations and with EBPs experts. Thus, by creating a supportive climate for EBPs implementation within the organization, agency leaders may stimulate practitioners to participate more fully in LCs, learn EBPs, and facilitate successful implementation of EBPs.