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Egeland KM, Borge RH, Peters N, Bækkelund H, Braathu N, Sklar M, Aarons GA, Skar AMS. Individual-level associations between implementation leadership, climate, and anticipated outcomes: a time-lagged mediation analysis. Implement Sci Commun 2023; 4:75. [PMID: 37434244 DOI: 10.1186/s43058-023-00459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 06/17/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Leaders can improve implementation outcomes by developing an organizational climate conducive to the implementation of evidence-based practices (EBP). This study tested the lagged associations between individual-level perceptions of implementation leadership, implementation climate, and three anticipated implementation outcomes, that is EBP acceptability, appropriateness, and feasibility. METHODS Screening tools and treatment methods for posttraumatic stress disorder were implemented in 43 Norwegian mental health services. A sample of 494 child and adult mental health care professionals (M = 43 years, 78% female) completed surveys addressing perceptions of first-level leaders' (n = 47) implementation leadership and their clinics' implementation climate. Single-level structural equation models estimating both direct, indirect, and total effects were used to investigate whether perceived implementation climate mediated the association between perceived implementation leadership and perceived acceptability, appropriateness, and feasibility of screening tools and treatment methods. RESULTS Regarding the treatment methods, implementation leadership was associated with therapists' perceptions of acceptability, appropriateness, and feasibility. Implementation climate also mediated between implementation leadership and the outcomes. Regarding the screening tools, implementation leadership was not associated with the outcomes. However, implementation climate mediated between implementation leadership and therapists' perceptions of acceptability and feasibility, but not appropriateness. Analyses with the implementation climate subscales showed stronger associations for therapists' perceptions of the treatment methods than of screening tools. CONCLUSIONS Leaders may promote positive implementation outcomes, both directly and through implementation climate. With regard to the effect sizes and explained variance, results indicated that both implementation leadership and implementation climate were more strongly associated with the therapists' perceptions of the treatment methods, implemented by one group of therapists, than the screening tools, implemented by all therapists. This may imply that implementation leadership and climate may have stronger effects for smaller implementation teams within a larger system than for system-wide implementations or when the clinical interventions being implemented are more complex rather than simple ones. TRIAL REGISTRATION ClinicalTrials NCT03719651, 25 October 2018.
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Affiliation(s)
- Karina Myhren Egeland
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway.
| | - Randi Hovden Borge
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
- National Institute of Occupational Health, Gydas vei 8, 0363, Oslo, Norway
| | - Nadina Peters
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
| | - Harald Bækkelund
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
| | - Nora Braathu
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
| | - Marisa Sklar
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- Diego ACTRI Dissemination and Implementation Science Center, UC San, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- Diego ACTRI Dissemination and Implementation Science Center, UC San, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Ane-Marthe Solheim Skar
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
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Heiervang KS, Egeland KM, Landers M, Ruud T, Joa I, Drake RE, Bond GR. Psychometric Properties of the General Organizational Index (GOI): A Measure of Individualization and Quality Improvement to Complement Program Fidelity. Adm Policy Ment Health 2020; 47:920-926. [PMID: 32107674 PMCID: PMC7547970 DOI: 10.1007/s10488-020-01025-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To assess the implementation of effective practices, mental health programs need standardized measures. The General Organizational Index (GOI), although widely used for this purpose, has received minimal psychometric research. For this study, we assessed psychometric properties of the GOI scale administered four times over 18 months during the implementation of a new program in 11 sites. The GOI scale demonstrated high levels of interrater reliability (.97), agreement between assessors on item ratings (86% overall), internal consistency (.77–.80 at three time points), sensitivity to change, and feasibility. We conclude that the GOI scale has acceptable psychometric properties, and its use may enhance implementation and research on evidence-based mental health practices. Trial registration: REK2015/2169. ClinicalTrials.gov Identifier: NCT03271242
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Affiliation(s)
- Kristin Sverdvik Heiervang
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
- Centre for Medical Ethics, Institute of Health and Society, Medical Faculty, University of Oslo, Oslo, Norway.
| | - Karina Myhren Egeland
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
| | | | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Inge Joa
- TIPS - Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
- Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway
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Abstract
This study examined the psychometric properties and feasibility of the Illness Management and Recovery (IMR) Fidelity scale. Despite widespread use of the scale, the psychometric properties have received limited attention. Trained fidelity assessors conducted assessments four times over 18 months at 11 sites implementing IMR. The IMR Fidelity scale showed excellent interrater reliability (.99), interrater item agreement (94%), internal consistency (.91–.95 at three time points), and sensitivity to change. Frequency distributions generally showed that item ratings included the entire range. The IMR Fidelity scale has excellent psychometric properties and should be used to evaluate and guide the implementation of IMR. Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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Affiliation(s)
- Karina Myhren Egeland
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.
| | - Kristin Sverdvik Heiervang
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway
| | | | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478, Lørenskog, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Egeland KM, Ruud T, Ogden T, Färdig R, Lindstrøm JC, Heiervang KS. How to implement Illness Management and Recovery (IMR) in mental health service settings: evaluation of the implementation strategy. Int J Ment Health Syst 2017; 11:13. [PMID: 28127388 PMCID: PMC5259843 DOI: 10.1186/s13033-017-0120-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/12/2017] [Indexed: 01/17/2023] Open
Abstract
Background The purpose of this study was to evaluate the implementation strategy used in the first-phase of implementation of the Illness Management and Recovery (IMR) programme, an intervention for adults with severe mental illnesses, in nine mental health service settings in Norway. Methods A total of 9 clinical leaders, 31 clinicians, and 44 consumers at 9 service settings participated in the implementation of IMR. Implementation was conducted by an external team of researchers and an experienced trainer. Data were gathered on fidelity to the intervention and implementation strategy, feasibility, and consumer outcomes. Results Although the majority of clinicians scored within the acceptable range of high intervention fidelity, their participation in the implementation strategy appeared to moderate anticipated future use of IMR. No service settings reached high intervention fidelity scores for organizational quality improvement after 12 months of implementation. IMR implementation seemed feasible, albeit with some challenges. Consumer outcomes indicated significant improvements in illness self-management, severity of problems, functioning, and hope. There were nonsignificant positive changes in symptoms and quality of life. Conclusions The implementation strategy appeared adequate to build clinician competence over time, enabling clinicians to provide treatment that increased functioning and hope for consumers. Additional efficient strategies should be incorporated to facilitate organizational change and thus secure the sustainability of the implemented practice. Trial registration ClinicalTrials.gov NCT02077829. Registered 25 February 2014
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Affiliation(s)
- Karina Myhren Egeland
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Terje Ogden
- Norwegian Center for Child Behavioral Development, Essendropsgate 3, 0368 Oslo, Norway.,Institute of Psychology, University of Oslo, Oslo, Norway
| | - Rickard Färdig
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Jonas Christoffer Lindstrøm
- Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway
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