(PS5-C70) Clinician versus Agency Perceptions of Organizational Readiness for Change

Despite increased support for evidence-based practices (EBP), the implementation of these practices within community mental health settings poses many challenges at system, organization, and individual levels (Moullin et al., 2019). While an understanding of organizational factors is vital for ensuring and cultivating an environment conductive of implementation and sustainment success, few studies have explored whether clinician reports of organizational factors characterize organizations (i.e., clinicians in the same organization would provide similar ratings) or whether they are better conceptualized as a clinician-level measure of their views of their organization (Weiner et al., 2008; Stadnick et al., 2018). Examining variability in organizational measures at clinician and agency levels can help inform our understanding of how organizational barriers to community EBP implementation can be effectively measured.

The current study used clinician baseline measures from a randomized controlled effectiveness trial comparing two EBPs to treatment as usual in community-based youth mental health clinics. Participants included 174 clinicians from 22 clinics with an average of 8 clinicians per clinic; 85.8% identified as cisgender female, 32.4% as Hispanic, and 71.6% white. Analyses examined the degree to which variability in responses on the Organizational Readiness for Change (ORC) measure was at the agency versus clinician level.  

We addressed this question by calculating intraclass correlation coefficients for each ORC subscale score. The intraclass correlation coefficients (ICC) calculated for organizational resources subscales (ICC = 0.06-0.40), staff attributes subscales (ICC = 0.00-0.03), and organizational climate subscales (ICC = 0.00-0.21), indicating that variability was largely at the clinician level rather than at the agency level on all organizational readiness for change subscales. ICCs demonstrated slightly more agency-level clustering for more concrete organizational measures (organizational resources), than for attitudinal measures (staff attributes and organizational climate). These findings indicate that variability in these organizational measures suggest a lack of agreement between clinicians within agencies regarding organizational factors captured by these subscales. This raises questions about whether this measure is accurately capturing organizational characteristics. Implications for the use of the ORC and organizational measures more broadly will be discussed.