This health services research study focuses on the process of organizational change and technology transfer in the Therapeutic Community (TC), using the implementation of Motivational Interviewing (Ml) with the goal of improving client retention and engagement in substance abuse treatment as the clinical starting point and example. It proposes to implement Ml into the early phase of long-term residential treatment for substance abuse in a large TC, and study the implementation process and its results, applying a heuristic model of technology transfer. Simpson's Model for Program Change (2002) details how programs move through four stages of technology transfer (i.e., exposure, adoption, implementation, and practice); stating that the ease and success of this process is positively correlated with (1) organizational functioning and readiness for change, (2) training activities and their appropriateness, (3) reception and utility of the innovative technology, and (4) institutional supports. The model assumes that successful technology transfer leads to improvement of program and treatment outcomes. Applying this model, the study is aimed at identifying positive and negative conditions for organizational change in the TC, and explores how challenges may be successfully addressed. A quasi-experimental design, i.e., a mix of pre-post implementation measurements of Entry Unit staff and clients, and a comparison group of a matched sample of Daytop staff not exposed to Ml, as well as qualitative exploration will be used to fulfill these specific aims: (A) Document stages of technology transfer in terms of success in gradually integrating Ml into routine clinical practice, defined by increasing Ml adherence to and proficiency; (B) Determine the extent of the major influences (1-4 above) as they occur in the Entry Unit prior, during, and/or following the integration of Ml; (C) Establish relationships between influences (B) and the success in integrating Ml (A); (D) Determine the impact of Ml use on staff variables (job satisfaction, efficacy, beliefs about motivation) and client treatment outcomes in the TC (readiness for treatment, retention). This study contributes to the critical understanding of how to move innovative clinical practices that have been found to enhance the effectiveness of substance abuse treatment into broad application in existing treatment programs. It thus supports on-going quality improvement of public health services, the efficient use of resources, and improved outcomes for individuals struggling with substance abuse and addiction. ? ? ?
