Organizational readiness for implementation (ORI) is a critical barrier to successfully implementing evidence-based practices (EBPs) that support the recovery of people with severe mental illnesses (SMI). Despite the importance of ORI, to date, no approach for enhancing readiness across an organization has been developed. The two studies conducted as part of this dissertation aimed to identify, organize, and confirm potential strategies to support ORI enhancement in community mental health (CMH) services. Study findings may inform the development of practices to increase ORI, and thus optimize implementation of evidence-based practices in the CMH services.
The first study aimed to develop a typology of pre-implementation strategies focused on ORI enhancement. A panel of implementation experts participated in a modified Delphi process to classify pre-implementation strategies into stages of organizational readiness. The experts selected strategies from a well-accepted compilation of 73 implementation strategies, developed as part of the Expert Recommendations for Implementing Change (ERIC) project. The Transtheoretical Model of behavioral change guided the experts in choosing strategies relevant during pre-implementation and classifying them into three readiness stages: Pre-contemplation, Contemplation, and Preparation. The experts identified 48 of the ERIC strategies as relevant to pre-implementation readiness enhancement and agreed on their classification into the three ORI stages. Several strategies were identified as relevant to more than one stage.
The purpose of the second study was to confirm and expand the expert-based typology based on empirical data relevant to the implementation of mental health evidence-based practices. The study employed qualitative methods to learn about the experiences of various CMH stakeholders who participated in a recent implementation project. Participants’ feedback about the use of different ORI strategies was compared with the expert-based typology to identify consistencies and discrepancies. Two-thirds of the strategies and their ORI stage designation suggested by the experts were congruent with the second study participants' experiences. Participants also assigned several strategies to different stages than those indicated by the experts and mentioned additional strategies not included in the expert-based typology. The second study highlighted the applicability of the expert-based typology to the CMH field and offered suggestions for potential expansions.
Together, these two studies provide an essential step towards conceptualizing and operationalizing the construct of ORI and the strategies for enhancing it in the CMH context. The high congruence between experts and implementers suggests the applicability of the Transtheoretical model for organizing the strategies associated with each stage. This dissertation provides a promising foundation for the future development of a systematic approach to ORI enhancement at various levels of readiness for a practice change. Direct targeting of ORI enhancement could increase the uptake of EBPs and ensure that more people with SMI benefit from state-of-the-art interventions supporting their recovery. / 2023-05-14T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/42576 |
| Date | 14 May 2021 |
| Creators | Vax, Sigal |
| Contributors | Farkas, Marianne, Mueser, Kim T. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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