Approximately 15 million American children suffer from psychiatric disorders at an estimated treatment cost of $8.9 billion annually. During the last 30 years several effective evidence-based treatments (EBTs) have been developed to treat these conditions. However, EBTs are rarely implemented successfully in usual care practice settings. Given the typically poor outcomes of usual care services, the National Institute of Mental Health recently prioritized research that develops and tests implementation strategies to effectively integrate EBTs within community settings. Implementation researchers have tested a range of implementation strategies in mental health settings but two key knowledge gaps limit the field. First, researchers have yet to identify the specific change processes (i.e., the require """"""""active ingredients"""""""" of implementation interventions), or the specific change mechanisms (i.e., the intermediate changes that occur during the course of the intervention and serve as the basis for the effect) that explain how and why implementation strategies generate desired changes. Identification of change processes and mechanisms is critical to developing the most effective and efficient implementation strategies for targeted settings. Second, although most mental health services are provided within complex organizations and decades of research suggest organizational social context is vital to successful innovation implementation, few implementation strategies target social context. The next steps in advancing the development of effective implementation strategies involve understanding how successful implementation strategies generate their effects, and specifically addressing the role of social context in the cross-level organizational change that characterizes successful EBT implementation. The proposed research training plan enables the PI to develop an independent program of research focused on identifying the organizational change processes and mechanisms that contribute to effective integration of EBTs into routine clinical settings. The research training plan includes advanced training activities that develop the PI's competency across three core areas: implementation science, organizational interventions, and organizational change mechanisms. The plan includes specialized didactic learning activities (elective coursework, workshops, and conferences), collaboration with three expert implementation scientists who are each directing NIMH-funded R01 implementation studies, and completion of an independent research project. The research project is the first to directly test organizational change processes and change mechanisms in the context of a randomized controlled trial of an organizational implementation strategy. The training plan prepares the PI for an independent research career focused on improving the implementation of effective mental health treatments in usual care settings. The likely benefits of this research include enhanced quality of life for children with psychiatric disorders and their families and reduced costs of mental health treatment through greater efficiency and effectiveness of service systems.

Public Health Relevance

The proposed research training plan is relevant to public health because it improves our understanding of how to increase the use of effective practices in routine mental health systems, thereby increasing the proportion of children and families who receive effective services and increasing the nation's return on its investment in biomedical and behavioral research. The plan advances the NIMH's strategic goal of closing the gap between the development of new, research-based mental health interventions and their widespread availability to those most in need.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
Project #
Application #
Study Section
Special Emphasis Panel (ZMH1)
Program Officer
Hill, Lauren D
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Tennessee Knoxville
Schools of Social Welfare/Work
United States
Zip Code
Williams, Nathaniel J; Glisson, Charles; Hemmelgarn, Anthony et al. (2017) Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity. Adm Policy Ment Health 44:269-283
Williams, Nathaniel J (2016) Assessing mental health clinicians' intentions to adopt evidence-based treatments: reliability and validity testing of the evidence-based treatment intentions scale. Implement Sci 11:60
Glisson, Charles; Williams, Nathaniel J; Hemmelgarn, Anthony et al. (2016) Aligning organizational priorities with ARC to improve youth mental health service outcomes. J Consult Clin Psychol 84:713-25
Glisson, Charles; Williams, Nathaniel J; Hemmelgarn, Anthony et al. (2016) Increasing clinicians' EBT exploration and preparation behavior in youth mental health services by changing organizational culture with ARC. Behav Res Ther 76:40-6
Williams, Nathaniel J (2016) Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice. Adm Policy Ment Health 43:783-798
Glisson, Charles; Williams, Nathaniel J (2015) Assessing and changing organizational social contexts for effective mental health services. Annu Rev Public Health 36:507-23
Williams, Nathaniel J; Glisson, Charles (2014) Testing a theory of organizational culture, climate and youth outcomes in child welfare systems: a United States national study. Child Abuse Negl 38:757-67
Glisson, Charles; Williams, Nathaniel J; Green, Philip et al. (2014) The organizational social context of mental health medicaid waiver programs with family support services: implications for research and practice. Adm Policy Ment Health 41:32-42
Olin, S Serene; Williams, Nate; Pollock, Michele et al. (2014) Quality indicators for family support services and their relationship to organizational social context. Adm Policy Ment Health 41:43-54
Williams, Nathaniel J; Glisson, Charles (2013) Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare. Child Youth Serv Rev 35:

Showing the most recent 10 out of 11 publications