Organizational Strategy for Substance Abuse Care Improvement

(LOCI-SL Trial)

Overseen By Gregory Aarons, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Diego

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

470 Participants Needed

Trial Summary

What is the purpose of this trial?

This project will test an implementation strategy that seeks to align system, organization, and clinic leadership strategies to implement and sustain the Lyssn artificial intelligence (AI) quality assurance platform to support implementation of Motivational Interviewing (MI) and evidence-based practice (EBP) for substance use disorders. The Leadership and Organizational Change for Implementation - System Level (LOCI-SL) strategy seeks to engage policymakers and funders at the system level to improve implementation leadership, climate, provider attitudes and behaviors at the provider organization level to enhance implementation climate for EBP. LOCI-SL will be tested in a statewide addiction service system through clinics in community based behavioral health organizations.

Do I need to stop my current medications for this trial?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment Leadership and Organizational Change for Implementation (LOCI) for substance abuse care improvement?

Research shows that the LOCI intervention, which focuses on improving leadership and organizational strategies, has been effective in implementing evidence-based practices in various settings, including mental health clinics and correctional facilities. These studies suggest that improving leadership and organizational processes can enhance the implementation of treatments, potentially benefiting substance abuse care. ^{1 2 3 4 5}

How is the LOCI-SL treatment different from other treatments for substance abuse?

The LOCI-SL treatment is unique because it focuses on improving leadership and organizational strategies to implement evidence-based practices effectively, rather than directly targeting the substance abuse itself. This approach aims to enhance the overall functioning and capacity of treatment organizations, making it different from traditional treatments that focus solely on the individual receiving care. ^{1 2 5 6 7}

Eligibility Criteria

This trial is for staff at provider or payer advocacy organizations, executives and managers at substance use disorder/mental health treatment agencies, clinic supervisors, counselors providing such treatments in Oregon and Indiana. It includes stakeholders from relevant state authorities and managed care organizations.

Inclusion Criteria

Stakeholders from Oregon Alcohol and Drug Policy Commission (ADPC)

Indiana Department of Mental Health and Addiction (DMHA)

Indiana Department of Child Services (DCS)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Preparation

Engagement with state policy and funding stakeholders to align strategies for EBP implementation

4 weeks

Implementation

Implementation of the Lyssn AI platform and Motivational Interviewing using the LOCI-SL strategy

9 months

Sustainment

Ongoing support and evaluation of EBP implementation and sustainment

Ongoing

Follow-up

Participants are monitored for changes in implementation leadership and climate

4 weeks

Treatment Details

Interventions

• Leadership and Organizational Change for Implementation

Trial Overview The trial tests a strategy called LOCI-SL that aligns leadership across systems to implement the Lyssn AI platform for Motivational Interviewing (MI) and evidence-based practices in treating substance use disorders.

Participant Groups

Group I: LOCI Experimental Treatment 1 Intervention

Leadership and Organizational Change for Implementation strategy

Group II: Control Active Control 1 Intervention

assessment only through online survey

Who Is Running the Clinical Trial?

University of California, San Diego

Lead Sponsor

Trials

1,215

Recruited

1,593,000+

Pacific Institute for Research and Evaluation

Collaborator

Trials

28

Recruited

34,200+

Oregon Social Learning Center

Collaborator

Trials

36

Recruited

8,900+

Indiana University

Collaborator

Trials

1,063

Recruited

1,182,000+

Chestnut Health Systems

Collaborator

Trials

27

Recruited

24,500+

University of Central Florida

Collaborator

Trials

101

Recruited

1,191,000+

Findings from Research

The Leadership and Organizational Change for Implementation (LOCI) intervention was found to be feasible and acceptable among 12 mental health service team leaders and their staff, indicating its potential for improving leadership in evidence-based practice (EBP) implementation.

Preliminary results suggest that LOCI positively impacts staff-rated leadership outcomes, making it a promising strategy for organizations aiming to enhance their capacity for implementing and sustaining evidence-based practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. Aarons, GA., Ehrhart, MG., Farahnak, LR., et al.[2022]

The study evaluated an Organizational Process Improvement Intervention aimed at enhancing assessment and case planning for drug-involved offenders transitioning from correctional settings to community treatment, indicating that such strategies can effectively improve service coordination.

Qualitative interviews revealed that collaboration between correctional and community agency staff helped identify barriers and facilitators in the implementation process, suggesting that teamwork is crucial for successful treatment outcomes for offenders with substance abuse issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Building Bridges in New Jersey. Abdel-Salam, S., Kilmer, A., Monico, L., et al.[2018]

The LOCI intervention aims to improve the implementation of evidence-based treatments for PTSD in mental health clinics by enhancing leadership at multiple levels and fostering a supportive organizational climate, evaluated through a stepped-wedge cluster randomized trial involving various clinics in Norway.

Surveys will be conducted over 20 months to assess leadership effectiveness and implementation climate, with results used to create tailored plans for improving treatment delivery, ultimately aiming to enhance the quality of care for patients with PTSD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol. Egeland, KM., Skar, AS., Endsjø, M., et al.[2023]

There is a critical need for better dissemination and implementation strategies for evidence-based practices to combat the opioid crisis, as current addiction journals often overlook practical quality improvement projects.

The special issue aims to showcase implementation and quality improvement projects that can provide real-world guidance on translating research into effective practices for treating opioid use disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applying and advancing best practices in opioid use disorder and addiction treatment: Introduction to the special issue on implementation science and quality improvement scholarship. Gordon, AJ., Oliva, EM.[2019]

The demonstration project involved 30 Change Teams from 12 treatment agencies in Los Angeles County, focusing on rapid-cycle changes to improve substance abuse treatment processes, such as reducing wait times and no-shows.

The project highlighted that a clear methodology, peer interaction, and ongoing technical support are crucial for successfully implementing evidence-based improvements in addiction treatment services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving client engagement and retention in treatment: the Los Angeles County experience. Rutkowski, BA., Gallon, S., Rawson, RA., et al.[2010]

Only 19% of the 458 substance use disorder treatment programs studied utilized the NIATx process improvements, indicating a need for better implementation strategies.

Factors such as larger organization size, higher administrative intensity, and membership in provider associations positively influenced the likelihood of adopting NIATx processes, suggesting that supportive policies may enhance the effectiveness of SUD treatment centers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation of Network for the Improvement of Addiction Treatment (NIATx) Processes in Substance Use Disorder Treatment Centers. Fields, D., Knudsen, HK., Roman, PM.[2018]

The study involved 53 community-based substance abuse treatment programs in the Southwest, focusing on how organizational characteristics influence the adoption of new interventions.

Programs facing higher needs and pressures, along with limited resources and poorer staff ratings, were more likely to pursue structured organizational changes, suggesting that these factors drive the need for improvement in treatment practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Using organizational assessment as a tool for program change. Courtney, KO., Joe, GW., Rowan-Szal, GA., et al.[2023]

References

1. England pubmed.ncbi.nlm.nih.gov

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Building Bridges in New Jersey. [2018]

3. England pubmed.ncbi.nlm.nih.gov

Testing the leadership and organizational change for implementation (LOCI) intervention in Norwegian mental health clinics: a stepped-wedge cluster randomized design study protocol. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Applying and advancing best practices in opioid use disorder and addiction treatment: Introduction to the special issue on implementation science and quality improvement scholarship. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

Improving client engagement and retention in treatment: the Los Angeles County experience. [2010]

6. United States pubmed.ncbi.nlm.nih.gov

Implementation of Network for the Improvement of Addiction Treatment (NIATx) Processes in Substance Use Disorder Treatment Centers. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Using organizational assessment as a tool for program change. [2023]