Evidence map›Paper›PMID 38549122›Full record

Trial reportImplementation science : IS2024

Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial.

Nathaniel J Williams, Mark G Ehrhart, Gregory A Aarons, Susan Esp, Marisa Sklar, Kristine Carandang, Nallely R Vega, Lauren Brookman-Frazee, Steven C Marcus

Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Implementation science : IS, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04096274 (Randomized Trial of a Leadership and Organizational Change Strategy to Improve the Implementation and Sustainment of Digital Measurement-based Care in Youth Mental Health Services), which is not on this map. Cited by 20 papers.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04096274 nacompletednot on this map

Randomized Trial of a Leadership and Organizational Change Strategy to Improve the Implementation and Sustainment of Digital Measurement-based Care in Youth Mental Health Services

TypeinterventionalSponsorBoise State UniversityRan2019 to 2022Enrolled686ConditionsImplementation, Behavioral SymptomsArmsLeadership for Organization Change and Implementation (LOCI), Training and Technical Assistance Only
3 · Its place in the literature

Who cites it

20 citing papers in PubMed.

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  16. Measurement-Based Care as a Tool to Detect and Prevent Harm in Youth Psychotherapy.Research on child and adolescent psychopathology · 2025
    Review
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  19. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Nathaniel J WilliamsInstitute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA. natewilliams@boisestate.edu.ORCID 0000-0002-3948-7480
Mark G EhrhartDepartment of Psychology, University of Central Florida, Orlando, FL, USA.
Gregory A AaronsDepartment of Psychiatry, University of California, San Diego, CA, USA.
Susan EspInstitute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA.
Marisa SklarDepartment of Psychiatry, University of California, San Diego, CA, USA.
Kristine CarandangUniversity of Wisconsin-River Falls, River Falls, WI, USA.
Nallely R VegaSchool of Social Work, Boise State University, Boise, ID, 83725, USA.
Lauren Brookman-FrazeeDepartment of Psychiatry, University of California, San Diego, CA, USA.
Steven C MarcusSchool of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA.

Funding

Randomized trial of a leadership and organizational change strategy to improve the implementation and sustainment of digital measurement-based care in youth mental health servicesR01MH119127 · NIMH · BOISE STATE UNIVERSITY · PI WILLIAMS, NATHANIEL J. · 2019 to 2022
$2.8M
NIMH NIH HHS R01 MH119127NIMH NIH HHS R01MH119127
6 · The paper itself

Abstract

backgroundTheory and correlational research indicate organizational leadership and climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement and Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes from WISDOM indicated the Leadership and Organizational Change for Implementation (LOCI) strategy improved fidelity to measurement-based care (MBC) in youth mental health services. In this study, we tested LOCI's hypothesized mechanisms of change, namely: (1) LOCI will improve implementation and transformational leadership, which in turn will (2) mediate LOCI's effect on implementation climate, which in turn will (3) mediate LOCI's effect on MBC fidelity.

methodsTwenty-one outpatient mental health clinics serving youth were randomly assigned to LOCI plus MBC training and technical assistance or MBC training and technical assistance only. Clinicians rated their leaders' implementation leadership, transformational leadership, and clinic implementation climate for MBC at five time points (baseline, 4-, 8-, 12-, and 18-months post-baseline). MBC fidelity was assessed using electronic metadata for youth outpatients who initiated treatment in the 12 months following MBC training. Hypotheses were tested using longitudinal mixed-effects models and multilevel mediation analyses.

resultsLOCI significantly improved implementation leadership and implementation climate from baseline to follow-up at 4-, 8-, 12-, and 18-month post-baseline (all ps < .01), producing large effects (range of ds = 0.76 to 1.34). LOCI's effects on transformational leadership were small at 4 months (d = 0.31, p = .019) and nonsignificant thereafter (ps > .05). LOCI's improvement of clinic implementation climate from baseline to 12 months was mediated by improvement in implementation leadership from baseline to 4 months (proportion mediated [p

conclusionsLOCI improved MBC fidelity in youth mental health services by improving clinic implementation climate, which was itself improved by increased implementation leadership. Fidelity to EBPs in healthcare settings can be improved by developing organizational leaders and strong implementation climates.

trial registrationClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.

Indexed as

Mental HealthMental Health ServicesDelivery of Health CareEvidence-Based PracticeHumansLeadershipImplementation climateImplementation leadershipLOCIMeasurement-based careMechanismMediatorWISDOMYouth

Identifiers

PMID38549122
PMCPMC10976812

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.