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

This study tested the effect of the Leadership and Organizational Change for Implementation (LOCI) strategy, aimed at helping leaders support organizational change for implementation of evidence-based practices (EBPs). The study aimed to evaluate the effects of LOCI on adoption, measured as (1) therapists’ intentions to use assessment tools and EBPs for trauma, and (2) actual use of EBPs, indicated by patient recruitment. 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 EBPs for trauma treatment. Therapists ( n = 790) received training in assessment tools, and a subgroup ( n = 301) received training in one of three EBPs. Concurrently, the 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 assessing intentions to implement trauma assessment tools and EBPs were conducted at baseline, and 4, 8, 12, 16, and 20 months. Actual use was measured by patient recruitment. Linear mixed-effects models examined LOCI’s effect on intentions. Logistic and negative binominal regressions assessed cohort differences in recruitment. 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. Significantly fewer therapists in cohort 3 had recruited at least one patient than those in cohort 1 and 2. Additional pre-specified hypotheses (e.g. job demands, implementation citizenship behavior, reach, fidelity, and patient outcomes) yielded null or non-testable results due to design and timing constraints. LOCI effectively increased therapists’ intentions to use trauma assessment tools and with indicators of 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. Clinical Trials NCT03719651, 5th of July 2018. The trial protocol can be accessed from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6417075/