Improving therapist adoption of evidence-based practices with the LOCI strategy: a randomized controlled trial

Background : This study tested the effect of the Leadership and Organizational Change for Implementation (LOCI) strategy, aimed at helping leaders support and promote organizational change for implementation of evidence-based practice (EBP). The study aimed to evaluate the effects of LOCI on adoption, measured as (1) mental health therapists’ intentions to use assessment tools and EBPs for trauma, and (2) actual use of the EBPs, as indicated by patient recruitment for the EBP service. Methods : A stepped wedge cluster randomized design with three cohorts was conducted in Norwegian child and adult specialized mental health clinics implementing trauma assessment tools and one of three EBPs for trauma treatment. Therapists (n=790) received training in assessment tools, and a subgroup (n=301) received training in one of three EBPs. At the same time, a first cohort of leaders (n=16) began the one-year LOCI strategy, with cohorts 2 (n=14) and 3 (n=17) starting four and eight months later, respectively. Surveys included measures of intentions to implement trauma assessment tools and the EBP for trauma treatment, and were conducted at baseline, 4, 8, 12, 16, and 20 months. Actual use was measured by therapists’ recruitment of patients for treatment. To examine LOCI’s effect on therapists’ intentions, linear mixed-effects models were performed. To examine differences in recruitment status across the three cohorts, a logistic regression and a negative binominal regression were performed. Results : Across the three cohorts, therapists’ intentions to use trauma assessment tools increased significantly when the LOCI strategy was introduced. Intentions to use the trauma treatment methods were high from the start, and did not increase significantly when LOCI was introduced. Patient recruitment differed among cohorts. Therapists in cohort 3 recruited significantly fewer patients than those in cohort 1. Additionally, significantly fewer therapists in cohort 3 had recruited at least one patient than those in cohort 1 and 2. Conclusions : LOCI effectively increased therapists' EBP adoption, emphasizing the importance of early leadership engagement in enhancing uptake of new EBPs. Findings suggest that delayed leadership engagement after EBP training may hinder implementation. Timely support from leaders is crucial for therapists to implement new practices. Trial registration: ClinicalTrials NCT03719651, 5th of July 2018. The trial protocol can be accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417075/