Organizational Readiness for Change in Rape Crisis Centers

Background: Rape crisis centers (RCCs) are primary service providers to survivors of sexual violence who present with significant mental health consequences, including PTSD. There is strong evidence of the effectiveness of several interventions for treating PTSD in survivors, but there is low utilization of them in RCCs. The Consolidated Framework for Implementation Research (CFIR) identifies the inner setting--organizational characteristics and readiness for change--as a key influential factor driving the effective implementation and uptake of evidence based treatments (EBTs). In order to assess the organizational capacity of RCCs to adopt EBTs for PTSD, the current study addressed the following research questions: 1) Are the organizational characteristics of RCCs conducive to the uptake of EBTs? 2) To what extent are RCCs exhibiting organizational readiness for change? 3) To what extent are clinician and director perspectives aligned in their organizational readiness for change?

Methods: CFIR constructs were used in the construction of a web-based survey sent to all RCCs in Texas (N=83). The agency response rate was 72% (n=60), which included questionnaires for directors (n=67) and clinicians (n=76). Director Sample:  97% female; 52 years old; predominately white (81%), 11% Latino, 5% African American.  Clinician Sample: 95% female; 40 years old; predominately white (66%), 22% Latino, 5% African American. Measures: Subscales from Organizational Readiness for Change (ORC).  Data Analysis: Descriptive statistics & t-tests.

Results: The RCCs surveyed are mature (28.15 years), moderately sized (26 staff) organizations, with most budgets between $500,000-1,000,000+ (71%). Three-quarters of directors and clinicians have a bachelors or graduate degree, with significant experience in this field (directors=15 years; clinicians=8 years). The average tenure for staff is 6 years. For each subscale of ORC that was employed, both director and clinician means fell between the 25^th-75^th percentiles, which are desirable. There were no significant differences between RCC directors and a normed national sample of agency directors on training resources, staff influence, staff adaptability, or director openness to change. There were significant differences in: pressure for change (28.98 vs 31.53, p=.019), staff growth (34.56 vs 37.07, p=.014), cohesion (39.24 vs 35.35, p=.000), communication (36.98 vs 34.25, p=.004), and stress (28.20 vs 33.43, p=.000). RCC clinicians and directors had similar perceptions of the pressures for change within the agency, the adequacy of staff training, and the influence and adaptability of agency staff.  Significant differences were observed in director and clinician perspectives of internal agency communication (36.98 vs. 30.98, p=0.000) and agency efficacy for change (36.53 vs. 33.10, p=0.005). 

Implications:  RCCs appear to have the organizational characteristics and readiness for change needed to undertake the implementation of EBTs. Although they are experiencing less pressure for change and less opportunity for growth, staff training is valued, staff is perceived as being adaptable and having influence. Furthermore, the organizational climate is less stressed than the normed national sample. Efforts to increase uptake of EBTs in RCCs should include implementation strategies to enhance management receptivity to staff suggestions for change and the promotion of more effective intra-agency communication.