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Simpson, D. D., & Flynn, P. M.  (Guest Eds.).  (2007).  Organizational Readiness for Change (Special Issue).  Journal of Substance Abuse Treatment, 33(2).

1)  Simpson, D. D., & Flynn, P. M.  (2007).  Moving innovations into treatment:  A stage-based approach to program change.  Journal of Substance Abuse Treatment, 33(2), 111-120.

Abstract:  The process of innovation adoption and implementation is the focus of studies included in this special journal volume.  Collectively, they examine staff perceptions of program needs, organizational readiness for change (i.e., motivational pressures, resources, staff attributes, and organizational climate), quality of workshop training, subsequent utilization of training materials, and client self-report of treatment engagement in approximately 800 treatment programs nationwide.  A standardized assessment of organizational functioning captured attributes that describe environments, settings, and staffs, and the findings are interpreted in the context of a stage-based approach to making program changes.  This paper presents conceptual refinements to the Simpson (2002) “program change model” used to help organize and summarize longitudinal results within the organizational context of treatment programs and according to implementation influences related to qualities of the innovations.
  

2)  Rowan-Szal, G. A., Greener, J. M., Joe, G. W., & Simpson, D. D.  (2007).  Assessing program needs and planning change.  Journal of Substance Abuse Treatment, 33(2), 121-129.

Abstract:  Assessments of treatment staff training needs, preferences, and barriers can help guide and improve training activities and transfer of evidence-based technologies into clinical practice.  The TCU Program Training Needs (PTN) assessment consists of 54 items organized into seven domains:  Program Facilities and Climate, Program Computer Resources, Staff Training Needs, Preferences for Training Content, Preferences for Training Strategy, Training Barriers, and Satisfaction with Training.  Data collected from 589 counselors representing 194 treatment programs showed the PTN was psychometrically sound and predictably associated with results from a more comprehensive assessment of organizational functioning.  Importantly, fewer barriers to training and greater staff satisfaction with training were reported in programs with higher levels of organizational functioning.  In addition to representing an efficient source of staff perceptions about organizational operations and needs, the PTN empowers staff with a “voice” they can contribute to strategic planning and priority setting for organizational actions.
  

3)  Courtney, K. O., Joe, G. W., Rowan-Szal, G. A., & Simpson, D. D.  (2007).  Using organizational assessment as a tool for program change.  Journal of Substance Abuse Treatment, 33(2), 131-137.

Abstract:  Organizational functioning within substance abuse treatment organizations is important to the transfer of research innovations into practice.  Programs should be performing well for new interventions to be implemented successfully.  The present study examined characteristics of treatment programs that participated in an assessment and training workshop designed to improve organizational functioning.  The workshop was attended by directors and clinical supervisors from 53 community-based treatment units in a single state in the Southwest.  Logistic regression analysis was used to examine attributes related to program-level decisions to engage in a structured process for making organizational changes.  Findings showed that programs with higher needs and pressures, and those with more limited institutional resources, and poorer ratings of staff attributes and organizational climate were most likely to engage in a change strategy.  Furthermore, organizations with greater staff consensus (i.e., smaller standard deviations) on ratings of organizational climate also were more likely to engage in change.
  

4)  Greener, J. M., Joe, G. W., Simpson, D. D., Rowan-Szal, G. A., & Lehman, W. E. K.  (2007).  Influence of organizational functioning on client engagement in treatment.  Journal of Substance Abuse Treatment, 33(2), 139-147.

Abstract:  The present study focused on the relationship between organizational functioning factors measured in a staff survey using the TCU Organizational Readiness for Change (ORC) assessment and client-level engagement measured by the TCU Client Evaluation of Self and Treatment (CEST) in drug treatment programs.  The sample consisted of 531 clinical and counseling staff and 3475 clients from 163 substance abuse treatment programs located in 9 states from three regional Addiction Technology Transfer Centers (ATTC).  Measures of client engagement in treatment (rapport, satisfaction, and participation) were shown to be higher in programs with more positive staff ratings of organizational functioning.  In particular, these programs had fewer agency needs and more favorable ratings for their resources, staff attributes, and climate.  These findings help establish the importance of addressing organizational factors as part of an overall strategy for improving treatment effectiveness.
  

5)  Broome, K. M., Flynn, P. M., Knight, D. K., & Simpson, D. D.  (2007).  Program structure, staff perceptions, and client engagement in treatment.  Journal of Substance Abuse Treatment, 33(2), 149-158.

Abstract:  A key goal for drug abuse treatment providers is to get their clients engaged and participating in therapeutic activities, as a first step toward deriving longer-term benefits.  Much research has focused on personal characteristics that relate to client engagement, but characteristics of the program have received less attention.  This study explores client and program differences in engagement ratings, using data from a nationwide set of 94 outpatient drug free (ODF) treatment programs in a hierarchical linear model (HLM) analysis.  Results show that elements of program context, including both structural features (e.g., smaller size and JCAHO/CARF accreditation) and staff perceptions of personal efficacy, organizational climate, and communal workplace practices, relate to better overall client engagement.  These findings add further evidence that treatment providers should also address the workplace environment for staff as part of quality-improvement efforts.
  

6)  Saldana, L., Chapman, J., Henggeler, S., & Rowland, M. (2007).  The Organizational Readiness for Change scale in adolescent programs: Criterion validity.  Journal of Substance Abuse Treatment, 33(2), 159-169.

Abstract:  This study examined the convergent and concurrent validity of the Organizational Readiness for Change (ORC; Lehman, Greener, & Simpson, 2002) scale among practitioners who treat adolescents. Within the context of a larger study, the ORC and measures of practitioner attitudes toward evidence-based practices (EBPs) and treatment manuals were administered to a heterogeneous sample of 543 community-based therapists in the state mental health and substance abuse treatment sectors. Using a contextual random-effects regression model, the associations between ORC domains and measures of practitioner characteristics and attitudes were examined at both therapist and agency levels. Results supported the convergent and concurrent validity of several domains. Namely, the motivational readiness and training needs domains were associated with higher appeal and openness to innovations. Program resources and climate, however, were less related. Discussion focuses on the utility of the ORC in helping to evaluate the needs of programs considering the adoption of an EBP.
  

7)  Joe, G. W., Broome, K. M., Simpson, D. D., & Rowan-Szal, G. A.  (2007).  Counselor perceptions of organizational factors and innovations training experiences.  Journal of Substance Abuse Treatment, 33(2), 171-182.

Abstract:  Because work environment is central to understanding job performance, drug counselor perceptions of their programs and their skills were examined in relation to their attitudes about innovations training and its utilization.  Latent profile analysis of measures on organizational climate and staff attributes for 1047 counselors from 345 programs defined three categories of counselors – labeled as Isolated, Integrated, and Exceptional.  All had generally positive views of their professional skills, although the Isolated group scored lower on scales representing professional growth and influence on peers.  They were less positive about the “climate” of programs in which they worked and were higher on stress.  Program resources predicted the counselor groups, with the Isolated having more limited resources.  Counselor categorizations also differed in terms of workshop training experiences, with the Isolated group of counselors reporting significantly less exposure, satisfaction, and program-wide use of workshop training.
  

8)  Fuller, B., Rieckmann, T., Nunes, E., Miller, M., Arfken, C., Edmundson, E., & McCarty, D. (2007).  Organizational Readiness for Change and opinions toward treatment innovation.  Journal of Substance Abuse Treatment, 33(2), 183-192.

Abstract:  Program administrators and staff in treatment programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN) completed surveys to characterize participating programs and practitioners. A two-level random effects regression model assessed the influence of Organizational Readiness for Change (ORC) and organizational attributes on opinions toward the use of four evidence-based practices (manualized treatments, medication, integrated mental health services, and motivational incentives) and practices with less empirical support (confrontation and noncompliance discharge). The ORC scales suggested greater support for evidence-based practices in programs where staff perceived more program need for improvement, better Internet access, higher levels of peer influence, more opportunities for professional growth, a stronger sense of organizational mission and more organizational stress. Support for confrontation and noncompliance discharge, in contrast, was strong when staff saw less opportunity for professional growth, weaker peer influence, less Internet access, and perceived less organizational stress. The analysis provides evidence of the ORC’s utility in assessing agency strengths and needs during the implementation of evidence-based practices.
  

9)  Bartholomew, N. G, Joe, G. W., Rowan-Szal, G. A., & Simpson, D. D. (2007).  Counselor assessments of training and adoption barriers.  Journal of Substance Abuse Treatment, 33(2), 193-199.

Abstract:  The prevailing emphasis on adoption of evidence-based practices suggests more focused training evaluations are needed that capture factors in clinician decisions to use new techniques.  This includes relationships of post-conference evaluations with subsequent adoption of training materials.  Training assessments were therefore collected at two time points from substance abuse treatment counselors that attended training on dual diagnosis and on therapeutic alliance as part of a state-sponsored conference.  Customized evaluations were collected to assess counselor perceptions of training quality and relevance, and follow-up surveys were obtained to gauge its utilization during the 6 months following the conference.  Higher ratings for relevance to service needs of clients, desire to have additional training, and level of program support were each related to greater trial usage of training concepts and materials during the follow-up period.  Primary barriers cited by counselors included lack of time and redundancy with current practices.
  

10)  Simpson, D. D., Joe, G. W., & Rowan-Szal, G. A. (2007).  Linking the elements of change:  Program and client responses to innovation.  Journal of Substance Abuse Treatment, 33(2), 201-209.

Abstract:  Program-level measures of the innovation adoption process were defined by averaged counselor ratings of program training needs and readiness, organizational functioning, quality of a workshop training conference, and client-level indicators of adoption progress at follow-up.  Longitudinal records were collected from a statewide network of almost 60 treatment programs over a 2-year period.  Findings show that staff attitudes about training needs and past experiences predicted subsequent staff ratings of training quality and the progress they made in adopting innovations.  Organizational climate (especially clarity of mission, staff cohesion, openness to change) also was related to innovation adoption.  In programs that lacked an open atmosphere for adopting new ideas, it was found that trial usage of training by the counselors was attenuated.  Most important was the evidence that innovation adoption based on training for improving treatment engagement was significantly related to better client participation and rapport in treatment, measured at the end of the 2-year evaluation period.

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