Session: Leadership and Implementation of Evidence-Based Practices in Behavioral Health Organizations (Society for Social Work and Research 21st Annual Conference - Ensure Healthy Development for all Youth)

Leaders of behavioral health systems are challenged to make organizations helpful to effectively address society’s health care service needs. Among the most critical changes are increased implementation of cost-effective evidence-based practices (EBPs). EBP implementation involves complex processes that require significant changes to organizational policy, design, and staffing. Strong leadership can facilitate these changes by fostering an organizational context that is supportive of change, encouraging buy-in from staff, increasing implementation fidelity, and reducing perceived burden associated with delivery of EBPs.

However, more research is needed to identify mechanisms through which leadership influences implementation of EBPs and other service innovations. In addition, more studies are needed that go beyond examining the individual characteristics of leaders (for example, leadership style) to consider the relationship between leaders and staff in hectic work environments, as well as how the relative priorities of leaders impact implementation.  Each of the three papers in this symposium addresses one or more of these issues related to the embedded factors of implementation and together help to further knowledge about the role of leadership in making service improvements in behavioral health settings.

The first paper examines the mechanisms of how aspects of leadership such as transformational leadership (the leader’s ability to inspire a staff to follow a particular course of action) and leader–member exchange (LMX, or the quality of the relationship between the supervisor and staff member) create an organizational context that is conducive to EBP implementation.  In particular, it examines whether transformational leadership and LMX are positively associated with mental health providers’ attitudes about feedback and whether LMX mediates the relationship between transformational leadership and provider attitudes toward feedback.

The second paper examines the mechanisms of how leadership influences the implementation of EBPs in addiction health services by testing two main models. In the first model, we examine the indirect relationship between transformational leadership and implementation of (a) contingency management and (b) medication-assisted treatment via leader’s prioritization of implementation of EBPs. In the second model, we examine the indirect relationship between transformational leadership and implementation of three culturally competent practices—(a) knowledge, (b) service, and (c) personnel practices—via leader prioritization of implementation of cultural competence. Social exchange theory informs these findings by highlighting the importance of role modeling of implementation as an influence promoting leadership behavior.

Finally, the third paper presents findings from an intervention development study in which program leaders identified and ranked implicit leadership strategies for implementing EBPs in addiction health services. Using a grounded theory approach and a diverse set of methods to elicit information about implicit approaches to influencing a staff in the implementation process, the authors provide examples of how leadership is transmitted in real-world settings.

Together, these papers rely on different, large and unique datasets in behavioral health organizations and comprehensive mixed methods to conduct rigorous organizational research. Findings provide nuanced understanding of transformational leadership and the contextual mechanisms through which it operates to influence the implementation process in real-world health care settings in the United States.