Supervisor Atittudes Toward Evidence-Based Practices in Substance Abuse Treatment: The Importance of Organizational Context
Despite demonstrated efficacy, Evidence-Based Practices (EBP) are rarely implemented in community substance abuse treatment settings. Treatment professionals’ attitudes towards EBP are a salient factor in predicting the success of implementation effort; however, the correlates of these attitudes are not well understood. The goal of the current study was to test a model of supervisor attitudes towards EBP using organizational factors (organizational readiness for change; leadership), supervisor characteristics (educational attainment; job tenure) and client characteristics (complexity of clients served) as predictors.
The sample included 77 supervisors of substance abuse treatment agencies in Los Angeles County and 14,511 clients treated by these agencies. The client-level data was collected as part of the Los Angeles County Participant Reporting System and the program-level data was collected by Dr. Erick Guerrero of University of Southern California. Supervisor attitudes toward EBP were measured using Aarons’ Evidence-Based Practice Attitudes Scale (EBPAS). Organizational and supervisor characteristics were estimated using measures of Leadership Capacity, Organizational Readiness for Change (ORC), supervisor educational attainment, and supervisor job tenure. Client complexity was calculated using client-level data to produce an aggregate program-level score of the percentages of clients in each program reporting homelessness, mental illness, criminal justice involvement, and/or ‘harder’ drug-of-choice. OLS regressions were run to determine the fit of the overall model and test for moderating relationships.
The mean score on the EBPAS was 37.1 (SD = 5.35). Overall, the model explained 15% of the variance in supervisor attitudes towards Evidence-Based Practices (F = 1.81, p = .11). Client complexity emerged as a significant predictor of supervisor scores on the EBPAS (p < .04). A significant interaction between client complexity and ORC was found (p < .01). A positive relationship between ORC and EBPAS was observed for agencies with lower levels of client complexity, while a negative relationship between ORC and EBPAS was observed for agencies serving higher proportions of clients with complex issues.
One interpretation for the results may be linked to the fact that ORC has been demonstrated to measure organizational functioning as well as organizational readiness for change. Perhaps supervisors in agencies with highly complex clients but highly functional internal organizational contexts may perceive less of a need for use of innovative EBPs as compared with supervisors in agencies with highly complex clients and low levels of organizational functioning, who might be more open to EBPs in a search for methods to treat a very challenging population without overtaxing the limited capacity of the organization. This study suggests that client variables, rarely used as predictors in implementation research, may have a meaningful impact on implementation of EBPs. Special attention should be given to ensure that providers serving clients with highly complex issues have access to evidence-based interventions, not only because these client populations have the most to gain from effective services, but because the agencies may be particularly receptive towards implementing EBPs.