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Randomized Trial of the Availability, Responsiveness, and Continuity (ARC) Organizational Intervention With Community-based Mental Health Programs and Clinicians Serving Youth

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Objective

Evidence-based Practice (EBP) implementation is likely to be most efficient and effective in organizations with positive social contexts (i.e., organizational culture, climate, and work attitudes of clinicians). The study objective was to test whether an organizational intervention labeled Availability, Responsiveness and Continuity (ARC) could improve the organizational social contexts of community-based mental health programs for youth.

Method

The study randomly assigned 26 community-based mental health programs for youth to ARC or control conditions. The organizational cultures, climates, and work attitudes of clinicians (n = 197) in the programs were assessed with the Organizational Social Context (OSC) measure for mental health services at baseline and following the 18-month ARC intervention.

Results

Hierarchical linear models (HLM) analyses indicated that organizational culture, climate, and work attitudes were significantly improved in the ARC condition after 18 months. Clinicians in programs assigned to ARC reported less rigid, less centralized and less apathetic organizational cultures, more engaged and functional organizational climates with less role conflict, and work attitudes with improved morale, job satisfaction, and organizational commitment.

Conclusions

ARC improved the organizational social contexts of clinicians in community-based mental health programs for youth. Results suggest that organizational intervention strategies can be used to create the types of organizational social contexts that are believed to be necessary for EBP implementation and other service innovations in mental health programs.

Section snippets

Method

Community mental health programs for youth were purposefully selected from a multi-site mental health service system for economically disadvantaged adults, families, and youth encompassing a range of settings (e.g., schools, outpatient clinics, residential facilities, homes) across 17 counties. The system serves more than 10,000 youth and adults annually and employs a range of full-time professionals including social workers, psychologists, and both child and adult psychiatrists.

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Results

The results of the analyses are shown in Table 1 for each dimension of organizational social context. The coefficient from the HLM analysis and the standardized effect size of ARC are reported for each criterion. The effect size (d) reported in Table 1 is the adjusted difference between the ARC and control groups represented by the HLM coefficient, divided by the pooled standard deviation of the two groups.38 Because higher scores on some dimensions represent positive change (e.g., morale) and

Discussion

The 18-month ARC intervention changed the organizational social contexts of participating community-based mental health programs for youth by improving multiple dimensions of organizational culture, organizational climate, and work attitudes of clinicians. This study is the first randomized controlled trial of ARC to document improvements in all three domains of social context. A difference between the present study and a previous study of ARC that documented improvements in climate but not

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    This research was funded by the William T. Grant Foundation (PI: C.G.).

    Disclosure: Drs. Glisson, Hemmelgarn, and Green, Mr. Dukes, Ms. Atkinson, and Mr. Williams report no biomedical financial interests or potential conflicts of interest.

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