An important challenge for the next generation of substance abuse intervention research is to explore strategies that increase the implementation of evidence-practices within community-based treatment programs. This application proposes to address this issue by employing a continuous quality improvement (CQI) management intervention to improve concordance with guidelines for treating mental health problems. The application will develop the intervention, assess implementation feasibility, and test preliminary efficacy of the intervention to improve organizational and client constructs hypothesized to be key to the successful adoption of innovation. In addition, a wealth of information will be gathered on CQI implementation issues that can yield important lessons about improving organizational capacity for future innovation adoption efforts. The study will be implemented within two Palladia outpatient treatment programs with similar staff and client bases. During Year 1, an existing electronic chart system will be customized to collect study data at both sites as well as provide near-real time feedback to staff. In this same period, senior organizational leaders along with research consultants will develop a guideline for CQI implementation. Using both the electronic data monitoring system and questionnaire methods, an initial snapshot of client mental health problems and services received (n = 60 per program) along with an assessment of the staff attitudes on relevant organizational variables (n = 20 per program) will be gathered. Once this baseline pre-assessment is completed at the beginning of Year 2, sites will be randomized to receive either the standard or CQI implementation intervention. The experimental condition will involve the implementation of the 4 steps of CQI. The control condition will consist of the provision of state mandated input on brief screening for mental heath disorders and a one-time training. Following the implementation and successful utilization of the CQI intervention, during Year 3 a post-intervention assessment phase will commence. The client assessment will be sampled from a new group (n=60 per program) of clients. This data will be analyzed to determine the impact of CQI on guideline concordant behaviors (e.g., number mental health sessions attended by client). In addition, a repeated measurement (n=20) of program staff attitudes will be evaluated to determine the impact of CQI on organizational constructs hypothesized to be predictive of guideline adoption. Finally, qualitative data will be collected on the process of CQI implementation on relevant organizational variables. ? ? ?
