scholarly journals A Stepped-Wedge Randomized trial Investigating the Effect of the Leadership and Organizational Change for Implementation (LOCI) Intervention on Implementation and Transformational Leadership, and Implementation Climate

2021 ◽  
Author(s):  
Ane-Marthe Solheim Skar ◽  
Nora Braathu ◽  
Nadina Peters ◽  
Harald Bækkelund ◽  
Mathilde Endsjø ◽  
...  
Keyword(s):  
Transformational Leadership ◽  
Organizational Change ◽  
Randomized Trial ◽  
Posttraumatic Stress ◽  
Organizational Context ◽  
Evidence Based ◽  
Stepped Wedge ◽  
Implementation Climate ◽  
Leadership And Organizational Change ◽  
Implementation Leadership

Abstract Background: This study evaluates the Leadership and Organizational Change for Implementation (LOCI) strategy and its effect on implementation leadership, transformational leadership, and implementation climate. Methods: A stepped wedge cluster randomized trial enrolled 47 first-level leaders from child- and adult-specialized mental health clinics within Norwegian health trusts across three cohorts. All therapists (n = 804) received training in screening of trauma exposure and posttraumatic stress, and a subgroup (n = 249) of therapists received training in evidence-based treatment methods for posttraumatic stress disorder (PTSD). First-level leaders and therapists were asked to complete surveys at baseline, 4, 8, 12, 16, and 20 months assessing leadership and implementation climate. General linear mixed effects models were used to investigate whether engagement in the LOCI strategy would lead to greater therapist-rated scores on implementation leadership, transformational leadership, and implementation climate.Results: There was a significant increase in therapist-rated implementation and transformational leadership as well as implementation climate after the leaders were introduced to the LOCI strategy. This increase was sustained at all measurement time point compared to non-LOCI conditions which demonstrated a steady decrease in scores before LOCI was introduced. Conclusions: The LOCI strategy can develop better transformational and implementation leadership skills as well as contribute to a more positive implementation climate to enhance successful evidence-based practice implementation. Thus, LOCI can help leaders create an organizational context conducive for effective EBP implementation. Trial registration: NSD 60036/3/LH, NSD 60059/3/OOS The full trial protocol can be accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417075/

scholarly journals Organizational Context in General and Special Education: An Exploratory Investigation to Describe the Perspective of School Leaders

2021 ◽  
Author(s):  
Stephanie A. Moore ◽  
Rebecca Landa ◽  
Gazi Azad
Keyword(s):  
Special Education ◽  
General Education ◽  
Organizational Context ◽  
School Leaders ◽  
The United States ◽  
Autism Spectrum ◽  
School Enrollment ◽  
School Type ◽  
Implementation Climate ◽  
Implementation Leadership

AbstractOrganizational context (e.g., climate, culture, resources) can impede or enhance implementation of evidence-based practices in general education settings or special education settings serving students with autism spectrum disorder. We examined the relations between organizational context and individual (i.e., implementation leadership, administrator- or service provider-role) or school (i.e., enrollment size, public/nonpublic school type) characteristics. Participants were administrative or service providing leaders (n = 34) from 11 schools in one state on the East Coast of the United States. School leaders’ average ratings of the organizational context were generally more positive for special education than general education; however, greater culture stress was reported for special education. Correlation analyses indicated being an administrator and implementation leadership were positively associated with implementation climate in both education settings. Being an administrator was also positively associated with cultural effort (i.e., how hard people work towards achieving goals) in special education, but negatively associated with culture stress in general education. In special education, nonpublic schools had better climates (both learning and implementation), but more culture stress. Additionally, school enrollment size was negatively related to available resources and implementation climate in special education. Investigating the similarities and differences in organizational context across educational settings is needed in future research.

scholarly journals Leadership profiles associated with the implementation of behavioral health evidence-based practices for autism spectrum disorder in schools

Autism ◽  
2019 ◽  
Vol 23 (8) ◽  
pp. 1957-1968
Author(s):  
Nicole A Stadnick ◽  
Rosemary D Meza ◽  
Jessica Suhrheinrich ◽  
Gregory A Aarons ◽  
Lauren Brookman-Frazee ◽  
...  
Keyword(s):  
Autism Spectrum Disorder ◽  
Latent Profile Analysis ◽  
Organizational Context ◽  
Leadership Behaviors ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Implementation Climate ◽  
Strategic Implementation ◽  
Ebp Implementation

Implementation of evidence-based practice (EBP) for autism spectrum disorder (ASD) in the education system is a public health priority. Leadership is a critical driver of EBP implementation but little is known about the types of leadership behaviors exhibited by school leaders and how this influences the context of EBP implementation, particularly for students with ASD. The objectives of this study were to determine (1) the leadership profiles of principals involved in EBP implementation for students with ASD and (2) how these leadership profiles related to school characteristics and implementation climate. The Exploration, Preparation, Implementation, Sustainment (EPIS) framework was used to guide the design and analysis of this study. Participants (n = 296) included principals, teachers, and classroom support staff. They provided demographic information and completed the Multifactor Leadership Questionnaire and Implementation Climate Scale. Using latent profile analysis, a three-pattern solution was identified: Disengaged (6% of sample), Undifferentiated (23% of sample), and Optimal (71% of sample). Principals in schools with higher proportions of students with an individualized education program were more likely to be classified as Undifferentiated than Optimal. The Optimal group was associated with more positive implementation climate than the Undifferentiated or Disengaged groups. Findings suggest that leadership behaviors rated by principals and their staff involved in implementation of common autism EBPs can be meaningfully clustered into three discernible profiles that are shaped by organizational context and linked to strategic implementation climate. Our study findings have implications for leadership training and service delivery in schools by underscoring the critical nature of school leadership during implementation of EBPs for children with autism and the interplay between specific leadership behaviors and strategic implementation climate.

scholarly journals Implementation of Evidence Based Practice For Benign Paroxysmal Positional Vertigo in the Emergency Department: A Stepped Wedge Randomized Trial

2019 ◽  
Author(s):  
Kevin Kerber ◽  
Laura Joy Damschroder ◽  
Thomas McLaughlin ◽  
Devin Brown ◽  
jim burke ◽  
...  
Keyword(s):  
Emergency Department ◽  
Randomized Trial ◽  
Fixed Effects ◽  
Benign Paroxysmal Positional Vertigo ◽  
Random Effect ◽  
Evidence Based ◽  
Stepped Wedge ◽  
Head Ct ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Objective: To evaluate a strategy to increase use of the test (Dix-Hallpike test [DHT]) and treatment (canalith repositioning maneuver [CRM]) for Benign Paroxysmal Positional Vertigo (BPPV) in emergency department (ED) dizziness visits. Methods: We conducted a stepped-wedge randomized trial in six EDs. The population was visits with dizziness as a principal reason for the visit. The intervention included educational sessions and decision aid materials. Outcomes were DHT or CRM documentation (primary), head CT use, length-of-stay, admission, and 90-day stroke events. The analysis was multi-level logistic regression with intervention, month, and hospital as fixed effects, and provider as a random effect. We assessed fidelity with monitoring intervention use and semi-structured interviews. Results: We identified 7,635 dizziness visits over 18 months. The DHT or CRM was documented in 1.5% of control visits (45/3077; 95% CI, 1%-1.9%) and 3.5% of intervention visits (159/4558; 95% CI, 3%-4%; difference 2% 95% CI, 1.3%, 2.7%). Head CT use was lower in intervention visits compared with controls (44.0% [1352/3077] vs 36.9% [1682/4558]). No differences were observed in admission or 90-day subsequent stroke risk. In fidelity evaluations, providers who used the materials typically reported positive clinical experiences but provider engagement was low at facilities without an emergency medicine residency program. Conclusions: These findings provide evidence that an implementation strategy of a BPPV-focused approach to ED dizziness visits can be successful and safe in promoting evidence-based care. Absolute rates of DHT and CRM use, however, were still low which relates in part to our broad inclusion criteria for dizziness visits.

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